The diagnosis of Type 1 Diabetes mellites (T1DM) in
adolescents heralds a major transition, not just for the patient but for the
entire family. Due to the stress of living with a chronic disease, these young
patients are more prone to psychiatric disorders.
Adolescence is a period of psychological, physiological, and emotional
transition. It is a phase that is characterized by a struggle for
self-acceptance and peer-acceptance.
If an adolescent is afflicted with a chronic illness such as diabetes, then it
creates a very negative impact on the personality of the child. In addition,
biological factors, such as increased levels of growth hormone, increased
nutrient requirements during puberty and puberty-provoked insulin resistance
makes management of diabetes difficult in the very young.
Other factors of resistance in disease management include embarrassment about
the disease, lack of awareness regarding the disease, rebellion against
authority, family pressure, negative peer relationships, and frustrations about
overall life changes.
Young adults with diabetes are at increased risk for developing psychiatric
comorbidities, including eating disorders. It is estimated that 14% of girls,
and 7% of boys, in the age group of 9 to 14 years show behavioral patterns that
are symptomatic of eating disorders. Among all the psychiatric illnesses,
eating disorders have the highest mortality rate (nearly 20%).
A multitude of factors including, biological genetic, psychological and
sociocultural are involved in the formation of eating disorders. These factors
are more pronounced in young women with type 1 diabetes.
The researchers had observed that subthreshold eating disorders with milder
symptom was more prevalent in T1DM patients (14%) in comparison to controls
(8%). The eating disorders that persisted early during the manifestation of the
disease tend to persist leading to poor glycemic control and other health
complications, particularly microvascular complications, such as retinopathy. The
most common eating disorder among T1DM patients was bulimia, although anorexia
was also present in these patients.
Another eating disorder observed in 80% of young women with T1DM is
binge-eating disorder (BED), which is characterized by recurrent consumption of
large quantities of food, which leads to hyperglycemia. Eating disorders are
commonly characterized by body dissatisfaction, dietary restraint, a
preoccupation with food and body, substance abuse, mood disorders, electrolyte
abnormalities and cardiac conduction changes.
A 10 -year follow-up of patients with T1DM and anorexia revealed a mortality
rate of 34.6 per 1,000 person- compared to 7.3 for controls.
Insulin is the most viable treatment for T1DM but it is also associated with
hypoglycemia and weight gain. Thus by omitting insulin intentionally the
patient creates a hyperglycemic state resulting in polyuria and caloric
reduction, a state that brings about weight loss. Omission of insulin in T1DM
patients leads to dehydration, ketoacidosis, and fatigue (short term
complications), higher rates of nephropathy, foot-related problems and
increased possibilities of death (long-term consequences).
Once diagnosed with T1DM young patients should be adequately advised about the
need to eat healthy and balanced diet to prevent hypoglycemia and associated
complications. Regular screening for eating disorders in T1DM patients is
necessary to prevent complications. A common feature in T1DM patients with
eating disorder who are administered insulin therapy is that their BMI and
weight would be normal. Therefore, identifying the disease in these patients,
although not easy must be a part of the comprehensive management plan in these
patients.
Thus the authors conclude that a supportive family is quintessential in
managing TIDM and in preventing psychiatric illnesses in adolescents with the
disease.
With timely diagnosis and appropriate treatment and support, T1DM can be adequately
managed.
Reference: Disordered Eating in Type 1 Diabetes: Insulin Omission and
Diabulimia; Lalita Prasad et al; US Pharmacist 2012