KEYSTONE, COLO. — Red flags for disturbed eating behavior in adolescent girls with type 1 diabetes include a persistently high glycosylated hemoglobin level, frequent episodes of diabetic ketoacidosis, and behaviors such as skipping insulin doses or underdosing in order to control weight, according to one expert.
Another warning sign is a pattern of skipping breakfast and/ or lunch, followed by binge eating throughout the evening, Rita Temple-Trujillo said at a conference on the management of diabetes in youth. Distress regarding body weight and shape is also common among affected individuals, but it's a nonspecific indicator.
“It's rare that I see girls who don't have concern about body image. We're a weight-obsessed culture,” said Ms. Temple-Trujillo, a clinical social worker at the Barbara Davis Center for Childhood Diabetes, which cosponsored the conference with the University of Colorado and the Children's Diabetes Foundation at Denver.
Pressed by a primary care physician in the audience for a few quick screening questions to help zero in on disturbed eating behavior in adolescent girls with diabetes, Ms. Temple-Trujillo's fellow panelist, Dr. Denis Daneman, suggested the following:
▸ Are you manipulating your insulin by omission or by changing the dose in order to control your weight?
▸ Are you dieting at the moment to control your weight?
▸ Are you exercising specifically to control your weight?
▸ Are you doing any other things specifically to control your weight?
“Those four questions, if you get honest answers, will probably give you most of the information you need,” said Dr. Daneman, professor and chair of the department of pediatrics at the University of Toronto and pediatrician-in-chief at the Hospital for Sick Children there.
But getting honest answers to questions about eating and insulin-use patterns is a challenge because diabetic youths with disturbed eating behaviors feel great shame and a reluctance to disclose the details, according to Ms. Temple-Trujillo. “They feel like they've failed their families, their providers, and themselves. So I really feel that it's important to be nonjudgmental and supportive.”