Rediscovering Resilience: Eating Disorder Recovery Post-Diabetes Diagnosis - The Diabetes Link

My Story

When I was diagnosed with Type 1 as a young adult, I felt incredibly overwhelmed. I had struggled with an eating disorder as a teen, and had found a relatively stable recovery from disordered eating behaviors. With the diabetes diagnosis, I was handed a list of diabetic exchanges (a list of various foods’ nutritional values, grouped by type and for carb-rich foods, the amount that made up 15g carb) including “free foods” such as lettuce, and was told to learn to count carbs, for this would be a part of the rest of my life. 

In my recovery process, I had been taught that all foods fit and I could trust my body’s intuition, without tracking my nutritional intake whatsoever. I now needed to count the carbs in a packet of ketchup and dose insulin accordingly for the sake of my health, which was a disheartening paradigm shift. Feeling hopeless that genuine recovery and adequate diabetes management could coexist, I soon relapsed into the familiar eating disorder behaviors of deliberately restricting my intake and driven exercise. 

Potential Warning Signs of Disordered Eating 

• Taking less insulin than you need
• Eating less than you need
• Fear of carbs/certain carb amounts 
• Counting calories, especially with a self-defined limit
• Fear of low and/or high blood sugars
• Feeling that you “have to” exercise, especially after eating certain foods or amounts
• Preoccupation with food, exercise, weight/shape, and/or blood sugars
• Being secretive around diabetes management habits and/or exercise and eating
• Checking blood sugars excessively, or infrequently
• Weighing yourself regularly
• Perfectionism around diabetes management (“I have to be perfect,” extremely precise carb-counting)
• All-or-nothing thinking with diabetes (“if I can’t have 100% time in range, why bother trying?”)
• Blaming yourself when blood sugars are out of range

Diabetes + ED = Complicated

I strove for perfection in my diabetes management, but of course, it was never enough. I struggled with fears of high blood sugars and would avoid foods and portions that I worried would bring my blood sugar above my target, hating myself and engaging in further eating disorder behaviors as a result, creating a vicious cycle of avoidance and anxiety. 

My blood sugars looked great on paper—my endo applauded me for my low A1c, but I was miserable, and barely living. The praise from healthcare professionals around my relatively rigid diabetes management served as further fuel for my eating disorder. There’s no way I can achieve a high time in range without exact carb-counting! I thought to myself. I can’t stop now—maybe I’ll stop tomorrow. “Tomorrow” turned into days, which turned into weeks, which turned into months. I was terrified of giving up control, even though I was far from happy. 

Treatment: Ups and Downs

In the years since being diagnosed with Type 1, I have done a variety of intensive eating disorder treatment stays across the country to support more sustainable eating and diabetes patterns. Treatment has disrupted my education and work, which has been very difficult and has brought up some shame. That said, it has also allowed me to continue living and to work on practicing self-care, for which I am ultimately grateful. 

Connecting to Community

Throughout this journey, I’ve been able to work with some amazing dietitians and diabetes educators, who have believed in me and my capacity for recovery even when I haven’t been able to hold that hope for myself. Over the years, I’ve also gotten the opportunity to connect with others with diabetes and eating disorders, which has been supportive of my recovery in terms of feeling less alone. It’s been really comforting to be able to text and FaceTime friends who “get it” in ways that many people with diabetes, and many people with eating disorders, don’t fully understand. This process has had some intense highs and lows, literally and figuratively, and though I am not recovered, I am moving closer to that goal more often than not these days. 

What I Wish I’d Known

• It’s important to ask for support. Recovery can’t happen alone, and having at least one person you can talk to and share your experiences with (both challenges and successes) is key
• Being hard on yourself doesn’t fix your relationship with diabetes or with your body as a whole
• There is no such thing as a perfect recovery, especially with diabetes in the mix. Recovery isn’t linear, and often, it involves some trial-and-error—self-compassion is so helpful especially when things aren’t going the way you want them to
• Eating enough (3 meals and 2-3 snacks daily, with appropriate insulin dosing) is key, even though it can feel terrifying when adequate nutrition and/or insulin haven’t been happening for some time. This is not a quick fix, but it is foundational to sustained long-term recovery
• Highs and lows will happen—the best thing you can do is acknowledge them, respond appropriately, and move forward

Diabetes and ED Resources in the US

• Diabulimia Helpline (Phone number: 1 (425) 985 – 3635)
• Lauren Newman Nutrition Services