The Complex Interplay of Type 1 Diabetes and Eating Disorders

Type 1 and disordered eating (T1DE) is a complex and high-risk mental and physical health disorder which few clinicians have the confidence to identify and manage. The term T1DE refers to a range of presentations in those with a diagnosis of type 1 diabetes whereby a range of behaviors may be adopted to control weight. In this chapter, we first cover general aspects of T1DE including the different phenotypes of T1DE, namely, (1) omission or restriction of insulin, (2) restriction of food but with appropriate insulin dosing, (3) overexercise, self-induced vomiting, and laxative or diuretic misuse, (4) overuse of additional therapies, and (5) insulin over-injection to cover binge eating. We then focus on the condition in childhood and adolescence covering screening, and medical, psychological, and risk management. We aim to raise awareness of how people living with type 1 diabetes are more vulnerable to developing an eating disorder, how they may present, and recommendations on how to best support and safely manage this cohort of patients.