Is Diabetes an Eating Disorder - Take Two

An alert reader commented that she had expected the previous post to be on a very different topic than the one it turned out to discuss. That's because we people with diabetes who care about our health are forced to develop what may look very much like obsessive behaviors to keep ourselves healthy.

So many people--including some doctors--believe that those of us who commit to getting normal blood sugars do it by developing an eating disorder.

The arguments for that interpretation are these: Like people with eating disorders we obsess over our food. We count the grams of carbohydrate in every serving. Some of us weigh our food on high tech scales. We measure our blood sugar after eating and if it isn't within range, we stop what we are doing and devote our entire attention to raising or lowering our blood sugar until it is. If our blood sugar is too high after a bout of careless eating, we may feel strong emotion--anger, fear, or self-condemnation for eating whatever it was that raised our blood sugar too high.

Superficially these behaviors do sound a lot like those of a person with an eating disorder. Except for one huge difference: An eating disorder is a behavior that makes our health worse. It is a dangerous behavior that, if it is not stopped, will lead to serious disability or even death. These outcomes are what first brought the major eating disorders, anorexia and bulimia, into the public consciousness thirty years ago.

But with diabetes, it is eating "normally" that leads to disability and death.

People with diabetes who embrace the idea that they have a "right" to eat like everyone else and who don't obsess about their food are likely to be running blood sugars many hundreds of mg/dls higher than normal for hours after each "normal" meal they eat. Over time those high blood sugars destroy their nerves, their retinas, their kidneys and their cardiac health.

People with diabetes who engage in the so-called "obsessive" behaviors described above, in contrast, maintain the normal blood sugars that provide them with normal health. Their A1cs are closer to 5% than to the 10% that is the typical A1c of most people with diabetes in America.

So you have to realize that what gets defined as "obsessional" has a lot to do with context. Is a person who washes their hands twenty-five times a day suffering from Obsessive Compulsive Disorder? Not if they are a physician whose work involves examining patients in a surgical unit. In that case, it would be a sign of significant mental illness not to wash hands before examining each new patient, because it has been proven through rigorous research that handwashing in the hospital is the single most powerful way of keeping patients from acquiring hospital borne infections.

I hope for a high level of "obsession" in the people who fly the jets I board and the people who work at my bank. If these people do not pay obsessive attention to details the rest of us might ignore, people will be harmed.

By the same token, the nutrient-counting behavior and restricted eating that might make us rightfully concerned when it is practiced by a thin 13 year old girl with no diagnosed health problems is cause for celebration in a 50 year old woman whose blood sugar rises to 300 mg/dl if she eats a single piece of cake.

If you are recently diagnosed with diabetes or if you have only recently started eating in a way that will normalize your blood sugars, be prepared to run into this issue with your family and friends, because when you begin to adopt the behaviors that are necessary to control blood sugar some of them may respond to these new behaviors with concern.

They may think it excessive for you to test your blood sugar once or even twice after a meals or before you start driving your car. They may feel uncomfortable if you interrogate a waitress about exactly what ingredients are going to be in a dish you are ordering, of if you have a fit when the diet soda you ordered turns out to be a sugary regular.

Instead of supporting you they may respond by telling you to ease up. Chances are they do this because to them these behaviors may look obsessive. Your friends and family care enough about you to want to protect you from developing a true mental disorder.

But in this case, their concern is misplaced. The people they should be worrying about are the people with diabetes who are eating "normally," who are not testing, who have no idea how much carbohydrate is in the portions of food they eat--people who are not doing anything but taking the inadequate drugs their doctors prescribe for them and who have no idea what their blood sugars are most of the time--people who have no idea what will happen to them if they don't keep their blood sugars beneath the level that causes complications.

So if someone close to you suggests, "Why not just forget all of that and just enjoy your dinner?" take it as an expression of love or concern. But then explain that you want to enjoy a lot more dinners--and that you enjoy your food best when you can see it and when you are able to walk away from the table on both feet. Let them know that the key to avoiding the most common diabetic complications is to keep blood sugar under 140 mg/dl at all times and even lower if possible.

Yes, it sucks that we people with diabetes have to pay so much attention to what we eat. All of us would love to be able to eat normally. But we can't. We got dealt this body and we have to live with it. We get no choice about that. The choice that is left to us is whether we want to just stay people with diabetes or if we want to become people with diabetic complications.

And if you choose to stay a person without diabetic complications, you need to put your eating into "order" and doing that requires giving unflagging attention to everything that you eat. To keep yourself healthy, in short, you must adopt intensive behaviors which have the opposite effect of harmful eating disorders.