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Diabetes and disordered eating fact sheet

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Living with diabetes places a lot of focus on food, weight and body image. Sometimes, this can lead to an unhealthy relationship with food, disordered eating or possibly an eating disorder. If you’re experiencing these problems, you are not alone. There are many things you can do to change your relationship with food.

“Sometimes you’ll binge and you’ll feel disgusting and you’re like, ‘Well, I just won’t inject my insulin for it and it’ll kind of even itself out again’… it sounds screwed up.”

Christine, 22, person with diabetes

What is disordered eating?

Disordered eating includes a wide range of eating behaviours that are not considered healthy.

Disordered eating can take many forms. It can involve:

  • severely restricting food intake
  • binge eating
  • using unhealthy weight-loss tactics (e.g., self-induced vomiting or restricting insulin).

These behaviours are very similar to those of an eating disorder, except less severe, less frequent, or both. Nonetheless, disordered eating is a serious medical and mental health issue that requires professional attention.

Negative emotions accompany these behaviours. For example, feeling:

  • alone or worthless
  • unhappy with your body
  • as if your life is ‘out of control’
  • depressed or anxious
  • ashamed or guilty around food.

Over time, disordered eating can lead to eating disorders such as anorexia nervosa, bulimia nervosa or binge eating disorder. These are serious mental health conditions that need immediate professional attention.

In the short term, disordered eating can still be very dangerous for your physical health, including your diabetes.

It is important that you seek help from a qualified health professional.

What has disordered eating got to do with diabetes?

Focusing on food, healthy eating and body weight is an important (and possibly the most challenging) part of managing diabetes. With so much attention on when, what and how much to eat, this can lead to problems over time with how people think and feel about food and themselves.

Research has shown that some people with diabetes struggle with maintaining healthy eating, develop fixations about food and misuse insulin for weight management.

Disordered eating can affect the way a person manages their diabetes and, in turn, their physical health. Some examples include:

  • skipping meals
  • missing or manipulating insulin doses to lose weight.

What you can do

If you have concerns about how you feel and think about your eating, weight or body image, seek help from your general practitioner (GP) or diabetes health professional. They can help you identify if there is a problem and give you the best advice. Disordered eating, or an eating disorder, is unlikely to go away on its own. Without professional intervention, it will only get worse, but with the right support, it can get better.

Whether or not you are stressed about food or your weight, it’s important to look after your emotional well-being.

Some of the following strategies may work for you; others may not, and that’s okay. They may give you ideas about other things you could try.

Open up

Disordered eating can make you feel like you are alone, but people who care about you will want to support you.

  • If there are any particular family members or friends you trust, talk to them about how you feel.
  • If you don’t feel like you have anyone to share your feelings with, call a helpline, talk to your doctor or join a support group or online community.

Starting the conversation can be hard, but it’s a good first step towards recovery. Sometimes, family or friends are not aware that their comments (e.g., about food) might have a negative effect on you. Letting them know how you feel can help them understand your needs.

It can be difficult for people who care about you to hear that you are unhappy or unwell. If the conversation doesn’t go well, don’t let their initial reactions deter you. They may need some time to process what you have told them. Talk to them again when you feel the time is right. Meanwhile, seek support from a health professional who will understand and won’t judge you.

Take one day at a time

Having diabetes and disordered eating is really tough. Don’t be too hard on yourself. Take one day at a time. You will face some setbacks, but that’s okay—keep going and have confidence that you can and will recover.

Write it down

Keeping a food diary can be helpful for understanding some of your eating patterns and emotions associated with food. You might like to try making your own food diary to get a better idea about some of your own patterns (see box for tips).

If you choose to bring your food diary to your next consultation (for instance, with a dietitian or psychologist), they will not judge you for anything you write down. It will help them to understand how you are feeling.

Tips on writing a food diary

  • Record everything you eat and drink—be specific
  • Record the time and place you eat.
  • Record any binge episodes you have.
  • Record any exercise you do.
  • Record all unhealthy weight loss tactics. For example, if you skip taking insulin (including when, where, how many times).
  • Record what you are eating as you eat, rather than before or after. You will be much more accurate if you do this.
  • Write down your thoughts and feelings before and after eating.
  • Write down how you feel physically (e.g., how hungry you feel, if you had an empty stomach, if you are uncomfortably full or sick afterwards).
  • Be honest with yourself—the diary is designed to help you.

Eat mindfully

Whether you overeat or restrict what you eat, mindful eating can help. Mindful eating is about focusing your awareness on how you eat so that you can become more in tune with your level of hunger and fullness. It helps you to respond appropriately to your body’s needs. Try a mindful eating exercise (see box Mindful eating exercise).

Mindful eating exercise

Practise a mindful bite at least once every meal or snack:

  1. Choose one piece of food, such as a raisin, a slice of mandarin, a potato chip or a piece of chocolate.
  2. Start by looking at the food. Examine its shape, colour, and texture.
  3. Bring the food to your nose and take note of what you smell.
  4. Next, place the food on your tongue. Notice how your salivary glands begin to respond.
  5. Take a bite and pay attention to the sounds from your mouth and texture on your tongue.
  6. Chew slowly and notice how the texture of the food changes as you chew.
  7. Now swallow the food. Pay attention as it travels down your throat and into your stomach. Notice the sensations.
  8. Now say the name of the food silently to yourself.

The aim of mindful eating is to help you become more aware of what you eat and to appreciate and enjoy the experience. It might take some practice, but once you’ve tried it a few times, you may be surprised by how helpful it is for improving your relationship with food. If this kind of thing isn’t for you, that’s okay, just skip it.

Talk with a professional

The strategies above may give you some insight into your disordered eating, but they can’t replace professional help. It’s always a good idea to discuss your concerns with your GP or another health professional. They are there to help you, and they will not judge you for the way you are feeling.

Who can help?

Your diabetes health professionals

Your diabetes health care team is there to help you with all aspects of your diabetes, including how you feel about it. Share your feelings with them if you feel comfortable to do so; they will give you non-judgmental support and advice.

You may want to talk with your:

  • general practitioner (GP)
  • endocrinologist
  • diabetes educator
  • nurse practitioner
  • dietitian
  • counsellor or psychologist.

Bring this fact sheet to your appointment to help get the conversation started. You will probably feel relieved after sharing your feelings, and it will help your health professional to understand how you are feeling.

Together, you can make plans to manage your disordered eating.

A psychologist or psychiatrist

You might like to talk to a psychologist or psychiatrist. These professionals are best placed to make an assessment and provide treatment for disordered eating. Treatment may involve the following:

  • One-on-one counselling (e.g., cognitive behavioural therapy)
  • Group therapy and/or family therapy
  • Medication (e.g., antidepressants)
  • A combination of psychological therapy and medication.

Ask your diabetes health professional if they know a psychologist or psychiatrist in your area who is familiar with diabetes, or try the following options:

  • Find a psychologist near you by visiting the Australian Psychological Society website at psychology.org.au.
  • Your GP can tell you if you are eligible for a Mental Health Treatment Plan to reduce the costs of seeing a psychologist or psychiatrist.

You will need a referral from your GP to see a psychiatrist, but not to see a psychologist.

Your GP can tell you if you are eligible for a Mental Health Treatment Plan to reduce the costs involved in seeing a psychologist or psychiatrist.

A dietitian

Nutritional support from a dietitian experienced in treating disordered eating and diabetes can be an important part of recovery.

A dietitian can help you develop a healthy relationship with food in a safe environment. They can also help you to make food-related goals and achieve these goals at a pace that feels right for you.

Ask your diabetes health professional if they know a dietitian who is familiar with diabetes and disordered eating.

 “My family will say things like, ‘You shouldn’t eat that!’. They have no idea how hurtful that is to me. I know they’re just trying to help, but I wish they wouldn’t. It just makes me feel so inferior, so bad about myself.”

Julia, 45, person with diabetes

More information and support

The Butterfly Foundation

thebutterflyfoundation.org.au or ph 1800 334 673

The Butterfly Foundation provides telephone and online counselling by trained professionals who understand eating disorders, as well as information and support services.

Lifeline

lifeline.org.au or ph 13 11 14

Lifeline offers 24-hour confidential telephone and online crisis support. People contact Lifeline for a range of reasons, including feelings of depression, stress, anxiety and suicidal thoughts or attempts.

Peer support

ndss.com.au
(search for ‘Publications & Resources’)

To find out what peer support is and how you can access it in your area, see the National Diabetes Services Scheme (NDSS) leaflet, Peer support for diabetes.

Diabetes Australia and the NDSS

diabetesaustralia.com.au
ndss.com.au
NDSS Helpline 1300 136 588

Through the NDSS, you can access a free national NDSS Helpline to obtain information about diabetes and learn about education programs, peer support groups and other events.

The NDSS and you

A wide range of services and support is available through the NDSS to help you manage your diabetes. This includes information on diabetes management through the NDSS Helpline and website. The products, services and education programs available can help you stay on top of your diabetes.

This fact sheet is intended as a guide only. It should not replace individual medical advice and if you have any concerns about your health or further questions, you should contact your health professional.

Version 2 December 2018. First published June 2016.