- It’s estimated that about 20% of people with diabetes have an eating disorder.
- Maintaining a healthy relationship while living with diabetes is about incorporating variety, flexibility, and self-compassion.
- “Good” and “bad” foods don’t exist. Food is food. Society often attaches labels to certain foods which can impact our choices.
It’s often said that to maintain a healthy relationship with food, incorporating variety and flexibility into your diet is key. But what if diabetes—and its required measured approach to eating—is thrown into the equation?
If you ask Rob Howe, founder of Diabetics Doing Things, he’ll tell you that disordered eating is practically inherent to the condition itself.
“No human without diabetes counts all their carbs so consciously or pays attention to their protein and timing so closely,” says the entrepreneur, content creator, and athlete. “Living with diabetes means living with disordered eating in many ways because you’re always thinking about food. That’s one of the invisible disabilities of diabetes. People call it the disease with too many inputs, and food is chief among those.”
Howe has type 1 diabetes and has counted every carb since 2005. It took time to find a way of eating that incorporates more variety and flexibility.
“Early in my diagnosis, I found myself strictly eating at consistent times and amounts so I wasn't chasing blood sugars one way or the other,” says Howe. "Over time I learned how to be more flexible."
A New Lens on Food
With such a heavy focus on food all the time, it’s estimated that up to 20% of people with diabetes have an eating disorder such as anorexia nervosa, bulimia nervosa, and/or binge eating disorder. While there has not been any research on the prevalence of eating disorders in men with diabetes specifically, there’s no doubt that an individual’s relationship with food changes upon diagnosis.
Brendan Snyder, a pediatric registered nurse and Crossfit coach and athlete, was diagnosed with type 1 diabetes at the age of 11. His relationship with food has “gone in waves,” beginning when his medical team and parents found precisely what worked for him.
“We found what fit my allotted carbs for each meal. It was 50 carbs for breakfast, 50 carbs for lunch, 75 carbs for dinner, and a snack before I went to bed,” says Snyder. “We sat down and we figured out exactly what foods worked, and I ate the same meals for eight months. My breakfast, lunch, dinner, and snack were exactly the same. I went from a normal 11-year-old who ate whatever I wanted to having no flexibility.”
Feeling burnt out from eating the same foods, he went through a phase of ignoring his condition altogether as a young teen.
“I see it a lot in kids now that I work in healthcare. It’s this phase of ‘if I don’t take care of it, maybe it doesn’t exist’ kind of thing. You can get very sick, and that’s what I experienced when I was younger.”
Similarly, Ben Tzeel, a registered dietitian (RD), certified strength and conditioning specialist, and founder of Your Diabetes Insider, was diagnosed with type 1 diabetes at the age of seven.
“My relationship with food became more complicated when I was diagnosed. I was only seven. At that age, you’re not thinking about carbs. You’re thinking, I want to go play with my friends, eat pizza at birthday parties, and enjoy life,” explains Tzeel. “By the time I was eight, I had to think what eating something might do not just in the moment but hours later. And, it hasn’t stopped just because I’m an adult now. The only thing that’s changed is I’ve learned what certain foods do to my blood sugar.”
Diabetes and Body Image
While Howe, Snyder, and Tzeel have never been diagnosed with an eating disorder, they have seen firsthand how disordered eating and body image challenges can severely affect those with diabetes.
In fact, sometimes people with diabetes will lean on a diabetes management tool to lose weight quickly.
Often referred to as “diabulimia”—a non-clinical term—some people will intentionally restrict or omit insulin in order to lose weight.
Snyder saw this eating disorder while volunteering at a diabetes camp for teens.
“It was common to see them run the line of being in DKA [diabetic ketoacidosis], not quite to the point of needing to be hospitalized, but close,” says Snyder. “The higher your number is, your body starts to break down fat and you lose weight really quick. Counselors were the ones who found out because we had to log every camper’s numbers for safety reasons. We noticed some were intentionally trying to keep their numbers high. We would try to give them a correction, but they would get awkward and downplay needing a correction.”
In a society that values appearance and strong healthy physiques, people with diabetes can feel the pressure to look a certain way on top of feeling the non-stop pressure to manage their condition, leading to an eating disorder.
“I look at my body now that I’m in my 30s, and I have some scar tissue and scars,” says Howe. “I have parts of my body that take a little more energy and effort for me to love. With food, sometimes I’m eating a pile of gummy worms at 3:00 a.m. after a really nice meal and I just hate it. I only do it to survive. That helps give me a little grace when I look at my body in the mirror and have trouble appreciating what I’m seeing.”
Words from the Wise
With more than 40 years of diabetes management experience between them and additional years of clinical experience working in the healthcare field, Snyder, Tzeel, and Howe can offer sound advice and support for those struggling with disordered eating, body image, diabetes management, or any combination of the three.
“Don’t be afraid to get help. Men, especially, tend to put this ‘I can do this myself’ label on things. Talk to family, friends, or find a registered dietician, therapist, or health coach.”
“I started working with a nutrition coach recently. For a long time, I didn’t eat fruit because it would cause my numbers to go up faster than I could get insulin in so I just avoided fruit. There was an association in my brain that ‘I drink juice when I’m low so why would I eat fruit when my number is normal?’ It was an irrational thought, but it made sense in my brain. Working with a coach helped me incorporate two servings of fruit a day. It’s all about figuring out how your body reacts to certain foods.”
“Instead of latching onto being perfect all the time, realize it’s okay not to be perfect. You can say, ‘I’m going to take a little time off and not be super strict with counting every ounce and gram of everything I eat all the time.’ The key is doing it the majority of the time, doing the best you can with your blood sugars, but not obsessing about it.”
”There’s no such thing as ‘good’ or ‘bad’ food. Food is just food. The key is some foods have more carbs, some have more fats, and some have more protein. You’re the one who gets to decide the meaning behind the food.”
“How long have you lived with the disease? Don’t compare your Day One to someone else’s Day 1,000. That’s the thing about diabetes. You get better at managing it the more you learn about your body.”
“If you woke up today and you didn’t have an ambulance come to your house, you’re doing okay. People forget to celebrate that. Give yourself credit for managing a disability that you never get a day off from and that’s mostly invisible to other people. It takes a lot of thought, effort, and energy. You’re doing a great job.”
This article has been clinically reviewed by Lisa Graham, RN, CDCES, clinical health coach and director of clinical operations at One Drop.