People with eating disorders who also have diabetes may need to monitor their blood glucose and ketone levels more closely, and even be assessed for insulin misuse. Bulimia nervosa with diabetes may require monitoring for glucose toxicity, insulin resistance, ketoacidosis, and oedema.³

A person with an eating disorder who also has type 1 diabetes may avoid taking insulin or hypoglycaemic drugs to lose weight. Complications resulting from this include diabetic ketoacidosis, as well as neuropathy, a tendency to faint when standing, and retinopathy.¹⁴

People with type 1 diabetes and eating disorders (T1DE) may have an intense fear of weight gain, body image concerns or a fear of insulin promoting weight gain. Besides ketoacidosis, other biochemical red flag symptoms can include erratic blood glucose levels, regular admission to hospital due to uncontrolled diabetes, or recurrent severe hypoglycaemia.

However, reintroducing insulin can cause electrolyte shifts (especially potassium) so insulin administration should be supervised initially by the diabetes team working with psychiatrists before involving the primary care team and relatives/carers as appropriate.