Eating disorders affect approximately 10 percent of American adolescents and young adults. These disorders can range from full-blown anorexia and/or bulimia to patterns of disordered eating such as binging, excessive exercise, or other methods of controlling calorie intake.

Results of a study conducted at the University of Toronto and the Hospital for Sick Children showed that eating disorders are twice as likely to occur in teenage girls with type 1 diabetes than in girls who do not have diabetes.

Teens with Type 1 sometimes exhibit another symptom of disordered eating that is unique to diabetes: deliberately changing their insulin dose to achieve weight control or weight loss. Manipulating doses of insulin has been shown to be a popular approach to weight loss among some teens with Type 1 diabetes.

During the time of diagnosis of Type 1, or before good metabolic control is achieved, kids usually experience weight loss. Sometimes teens think this a good thing, especially girls who live with constant peer pressure to be thin. When insulin therapy is begun there is most likely some weight gain, especially as metabolic control is gained. Some teens don't like the additional weight gain, especially if it is noticed and commented on by their peers. Shortchanging or skipping their insulin dose seems like an easy fix, because not taking enough insulin brings on hyperglycemia which causes excessive urination and weight loss.

This is very dangerous in many ways. Teens who use insulin dose manipulation to achieve weight loss suffer serious consequences to their health:

• Higher A1c levels due to poor metabolic control.
• Early onset of diabetes complications, especially retinopathy. In fact, the highest percentage of teens with detectable damage were the ones with the most severe eating disorders, 86 percent had evidence of retina damage, compared with 24 percent for teens who did not have eating disorders.
• Hypoglycemia due to not eating or not eating enough.
• Diabetic ketoacidosis (DKA), brought on by deliberately short-changing the insulin dose or skipping doses altogether.

Warning Signs of Possible Eating Disorder

• Poor metabolic control despite the appearance of compliance.
• Look for signs of hyperglycemia -- excessive urination, excessive thirst, unusually high blood sugars, and/or fatigue.
• Signs of hypoglycemia, such as shakiness, irritability, confusion, sweatiness, anxiety, and fainting.
• Preoccupation with self-image, weight, or food intake.
• Moodiness, irritability, anxiety or depression, being overly critical of appearance, self-hatred.

What Can Parents Do?

• Be aware that your teen may be defensive or deny that there's a problem.
• Call your teen's healthcare provider if you suspect an eating disorder of any kind.
• Seek referrals for therapists and/or treatment centers who are experienced with eating disorders and diabetes. An endocrinologist may be a good source of information.