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What We Treat
Eating Disorders & Diabetes

Eating Disorders & Diabetes (EDDM)

The dangerous intersection of eating disorders and diabetes can devastate your health and relationships, but with comprehensive treatment, full recovery is within reach.

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What are eating disorders in diabetes mellitus (EDDM)?

Informally and mistakenly referred to as “diabulimia”, Eating Disorders in Diabetes Mellitus (EDDM) are dangerous and potentially life-threatening eating disorders that affect individuals with all types of diabetes. EDDM can involve deliberate manipulation of insulin doses or other prescribed treatments, avoidance of carbohydrates, fears surrounding eating to correct hypoglycemia, and all types of traditional eating disorder behaviors in order to lose weight or control body shape.

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Clients with EDDM often face many treatment and management challenges, as many eating disorder providers lack the expertise in diabetes care while diabetes management teams are frequently inexperienced in the management of eating disorders.

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Characteristics of EDDM:
  • Unmanaged glucose levels
  • Misuse or underuse of insulin or other medications
  • Frequent hospitalizations for managing diabetic ketoacidosis
  • Restriction or avoidance of foods to try to control blood sugar
  • Avoidance of necessary intake to correct hypoglycemia
  • Compulsive exercise, often right after meals
  • Any traditional eating disorder behavior

Types of EDDM

Understanding and recognizing how diabetes mellitus intersects with eating disorders is essential for developing and tailoring the most effective treatment plan. There are many types of diabetes that can be involved in EDDM. The 2 most common types are:

Eating Disorders in Type 1 Diabetes Mellitus (EDDMT1)

  • Individuals with Type 1 diabetes mellitus can develop eating disorders. 30-40% of young women with Type 1 diabetes also have an eating disorder (National Institute of Diabetes and Digestive and Kidney Diseases, 2021).
  • Insulin misuse, restriction, and binge/purge behaviors are common in EDDMT1. These individuals are at a significantly higher risk of poor outcomes from both their eating disorder and diabetes compared to those without EDDMT1.

Eating Disorders in Type 2 Diabetes Mellitus (EDDMT2)

  • Individuals with Type 2 diabetes also frequently develop eating disorders.
  • Some people with Type 2 diabetes still use insulin and can misuse it as a part of their eating disorder.
  • Others may engage in restrictive eating, binge eating, and purging behaviors.
  • Weight stigma is also a common component of EDDMT2.
  • EDDMT2 can also be life-threatening and lead to serious complications.

Signs & symptoms of EDDM

EDDM impacts you mentally and physically. Some signs, symptoms, and dangerous side effects of this disorder are:

  • Restricting/omitting insulin doses or other medications for diabetes
  • Persistently elevated blood glucose levels (hyperglycemia)
  • Frequent episodes of diabetic ketoacidosis (DKA)
  • Distorted body image or body dissatisfaction
  • Preoccupation with food and weight
  • Weight fluctuations
  • Diabetes-related complications resulting from poor blood sugar control
  • Restricting foods, often carbohydrate containing foods
  • Avoidance of necessary intake to correct hypoglycemia
  • Bingeing, often on carbohydrate containing foods
  • Compulsive exercise with any eating, particularly carbohydrate containing foods
  • Purging through self induced vomiting

Risk factors for EDDM

EDDM can be influenced by a combination of risk factors. It's important to note that not everyone with diabetes will develop EDDM, and the presence of risk factors does not guarantee that an individual will develop this condition. However, these factors may increase the likelihood of diabulimia: 

Genetics, heredity, history 

  • Gender: EDDM can affect individuals of any gender, but it is more commonly reported among females.
  • Prior eating disorder: A history of other eating disorders, such as anorexia nervosa or bulimia nervosa, can increase the risk. 

Sociocultural factors

  • Body image concerns: People with diabetes are frequently asked to place an extreme focus on food, numbers, and health. Individuals with diabetes face stigma for their disease as well as weight stigma on a daily basis. Weight loss is often encouraged or celebrated by their health care teams.
  • Mental health factors: People with diabetes are often faced with feeling different from their peers and can have a higher rate of depression and anxiety.

Diabetes distress

  • Burden of diabetes: People with diabetes are estimated to make an additional 180 health related decisions per day. They often feel pressure to "perfectly" manage their diabetes.
  • Stress and coping mechanisms: High levels of stress or difficulties in coping with the demands of managing diabetes may lead individuals to engage in harmful behaviors and have a range of emotional responses.

What does EDDM treatment look like?

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Monte Nido can help

At Monte Nido, we understand that having specialized care that can manage both diabetes while getting treatment for an eating disorder is unfortunately not available everywhere. We have multiple pathways for individuals with diabetes and eating disorders (EDDM) to receive outstanding, safe, and informed care on their treatment journey. The best facility within Monte Nido’s network will depend entirely on individual preferences and safety needs.

For those with eating disorders and Type 1 Diabetes (EDDMT1), we are proud to showcase Monte Nido Rosewood Ranch in Wickenburg, Arizona. Rosewood Ranch has been treating higher volumes of clients with EDDMT1 since 2021, and now has improved and sophisticated protocols that are congruent with best practices for diabetes care. Here are a few of the ways that Rosewood can serve clients that exemplify this:

  • Clients can work with Hannah Lochner, a certified diabetes education specialist (CDCES), who can then continue to work with them if they continue with MNA for step down care. CDCES are integral members of the Rosewood treatment team, helping to bridge communication with the home teams, family members, and elevate our sensitivity to the needs of clients with EDDM, both during treatment and planning for discharge and beyond.
  • Rosewood has a multidisciplinary team with significant expertise in all aspects of EDDM and its management.
  • Clients can use continuous glucose monitors on site.
  • If desired and appropriate, clients can work toward returning to a pump or even initiating a pump by the end of their stay, allowing for a more seamless transition to PHP levels of care.
  • Clients are expected to be proficient in and responsible for counting their own carbs and managing their insulin dosing by discharge.
  • Insulin dosing at Rosewood Ranch is done in a more physiologically compatible manner, with pre and post meal dosing to keep blood sugars in a more comfortable range and reduce rapid rises after meals.

Monte Nido Walden is another outstanding facility in the Monte Nido family that can also manage EDDMT1, but does so without a CDCES and use a more traditional pathway at this time, with post-meal insulin dosing, routine fingerstick glucose checks, and without the ability to transition to insulin pumps during the admission. Walden may be appropriate for you or your loved one depending on their needs and certainly has the ability to manage insulin safely.

Finally, all of our residential facilities can manage eating disorders and Type 2 Diabetes Mellitus (EDDMT2), as long as insulin is not a prescribed medication. At our residential centers, clients will work directly with the treatment team to determine needs and do not work with a CDCES although we remain in close contact with their home endocrinology team throughout their stay. As we have 24/7 nursing care at all of our facilites, we can manage any diabetes care needs on site for Type 2 diabetes. We do not stop any medications used for diabetes management, although if something is prescribed solely for weight loss and not for diabetes care we will recommend stopping that medication.

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Frequently asked EDDM questions

How is EDDM diagnosed?

Currently, no specific diagnostic criteria are outlined in the DSM-5 for EDDM. However, healthcare professionals may diagnose and treat EDDM based on a combination of the following factors and observations:

  • Diabetes Diagnosis: The individual must have a confirmed diagnosis of Type 1 or Type 2 diabetes.
  • Disordered Eating Behavior: The person exhibits disordered eating behaviors, such as restricting insulin doses, omitting insulin injections, or manipulating insulin doses to induce hyperglycemia to lose weight or control body shape.
  • Weight Loss or Weight Maintenance: EDDM is often associated with unexplained weight loss or the maintenance of a significantly lower body weight than is healthy for the individual's age and height.
  • Blood Sugar Irregularities: Evidence of poor blood sugar control, including persistently elevated blood glucose levels (hyperglycemia) and frequent episodes of diabetic ketoacidosis (DKA).
  • Psychological Symptoms: The presence of psychological symptoms or comorbid mental health issues commonly associated with eating disorders, such as body dissatisfaction, preoccupation with food and weight, anxiety, depression, or low self-esteem.
  • Medical Complications: The person may also exhibit signs of diabetes-related complications resulting from poor blood sugar control.
  • History and Self-Report: Information gathered from the individual's medical history and self-reporting of their behaviors and thoughts related to diabetes management and eating.
Is recovery from EDDM possible?

Yes! We believe recovery is possible for everybody. Take the first steps by reaching out to us to discuss more.

Learn more

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We can help you get the treatment and care you need to overcome EDDM.
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to speak confidentially with one of our eating disorders specialists to start the road to recovery.
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