Introduction: Young people with an eating disorder are likely to have a morbid preoccupation with weight and/or shape associated with a dread of fatness, a determined avoidance of food with dramatic loss of weight (Anorexia nervosa) or binge-eating followed by self-purging through self-induced vomiting, use of laxatives or diuretics (Bulimia Nervosa). Diabetes is uniquely placed to offer opportunities for weight and shape control without overt avoidance of food. It is increasingly recognised that adolescents may manipulate their insulin dose and/or diet because of weight and shape concerns in ways that may not be immediately or easily identified as symptoms of an ED.
Methods: Estimates of the prevalence of ED in young people with diabetes vary however it is well recognised that poor glycaemic control may therefore reflect insulin omission in association with disordered eating which may be driven by weight and shape concerns as well as additional emotional disorders.
Results: Classical approaches to eating disorder diagnosis and management need to be modified to incorporate the specific demands of diabetes regimens. Clinicians need to take into account potential insulin omission, dietary dissatisfaction or manipulation, body dissatisfaction and family functioning as well as high numbers of admission to hospital and/or failure to attend clinic appointments.
Conclusion: Aspects of proven eating disorder treatments may be helpful but must be modified to take into account the demands if the diabetic regimen to include insulin requirement, levels of acceptable metabolic control, body mass, diabetes related dietary restrictions and the relationship between the family as well as the diabetes team. The presentation will describe the evidence base for interventions as well as consider practice based evidence. The personal perspective of a young person who lives with diabetes and has been bullied by an eating disorder will provide a unique insight into this challenging clinical dilemma.
23 - 25 Nov 2016
British Society for Paediatric Endocrinology and Diabetes