The Uncontrollable Urge to Eat and Eat Despite Knowing the Consequences
Hypoglycemic reactions cause many problems for diabetics, the least of which are
diabetic comas. That is why it is so important to eat or drink something as soon as
possible when a blood sugar reaction occurs. What happens next is quite problematic for
the diabetic. The unconscious bingeing behavior that occurs can create more challenges
for even the most astute diabetic.
The diabetic binge begins after the appropriate amount of glucose has been ingested to
handle the hypoglycemic reaction. Emotional and physical reasons fuel this behavior and
make it difficult to stop. There are two approaches to managing the diabetic binge and
this seemingly uncontrollable reaction to the reaction. First, let's identify the reasons why
people binge.
To fully understand why this is such an important issue for diabetics on insulin
management, you’ll need to throw out all of your knowledge about bingeing and go back
to the basics. I say this because the majority of diabetics don’t binge due to poor selfcontrol,
as seen with drunken college students or as a result of certain drug addictions.
They don’t binge because they have reached a high tolerance level and need to drink a lot
to get a buzz, as seen with alcoholics. This has nothing to do with compensating for a
poor body image as typically seen in the bingeing and purging behaviors of bulimics.
Bingeing is an act of excessive or compulsive consumption, especially of food or
alcoholic beverages. It is the uncontrollable need to continue putting food or alcohol into
the body. With bulimics and anorexics, food is used as a coping mechanism to reduce
stress and negative emotions in much the same way that alcoholics use alcohol. In both of
these cases, the end result is more stress and negative feelings than they were feeling
prior to drinking a case of beer or drowning in a bag of Oreos. Some diabetics do use
food as a coping mechanism, but unlike most disorders or addictions it is not the sole
reason for the bingeing.
So let’s go back to basics and answer the question of why do human beings eat? If you
were to refer to the “The Five Levels of Maslow's Hierarchy of Needs,” you would find
that food is the top priority because it is needed for survival. Without it, our bodies won’t
function and we will die, just as we need air to breathe. Next would be shelter. To
understand why a diabetic binges, we don’t need to go any further than the most
important necessity of feeding the body. It’s a great theory that reveals the answers we
are looking for.
Maslow talks about needs and addictions, including process addictions like bulimia and
anorexia which fall under the category of wants. Our wants create cravings and desires
which cause someone who binges to feels hungry when one is not. This is usually
triggered when the person is angry, sad, depressed or thinks about the foods one loves.
The feeling produces tension in the chest, which often gets mistaken for hunger.
The way to tell whether it is emotional or physical is to determine if the tension is coming
from the chest or the stomach. Does your stomach make noise when you are hungry?
Mine does!
The Biological Reason For Eating
If Maslow is right about eating being our biggest need, how does the body know when it
needs to refuel?
When the stomach runs out of food, our blood sugar levels drop which triggers a
hormone called ghrelin. This gets released by the stomach to communicate the message
to the brain that it is time to eat. At that point the hypothalamus section of the brain
releases neuropeptides which trigger hunger.
When we have eaten enough, our fat tissues release a hormone called leptin telling the
brain that it is time to stop eating. The brain reduces the production of neuropeptides and
simultaneously releases proopiomelanocortin, which suppresses appetite. Unfortunately
for bingers, this part of the process is not instantaneous which allows us to overeat. If we
eat too fast, more food than necessary enters the digestive system prior to the suppression
of our appetite which results in overeating.
It’s not a simple process, but then again neither is diabetes. For a diabetic, there is a big
tendency to binge during a hypoglycemic reaction. Many diabetics feel bad about eating
so much without knowing that bingeing during a reaction is normal and very difficult to
prevent. Many times diabetics go around thinking that they have a bingeing disorder and
may even become depressed over many failed attempts to stop.
Low blood sugars will trigger the release of ghrelin from the stomach in a diabetic, just as
it will in every human being, and send the message to the brain that it is time to eat. At
that point the hypothalamus section of the brain releases neuropeptides triggering hunger.
For the diabetic who has taken in the appropriate amount of carbohydrates to handle their
hypoglycemia, this is often not enough to release the hormone called leptin so their brain
doesn’t get a message that it is time to stop eating. As long as a diabetic’s blood sugar
remains low, they will be physically hungry as neuropeptides will continue to be released
and trigger hunger.
After a diabetic takes in the appropriate amount of carbohydrates to handle their
hypoglycemia, the blood sugars can remain low for a period of as little as 15 minutes and
as long as several hours. Ghrelin keeps sending the message that it’s time to eat and the
neuropeptides continue to be produced, sustaining the feeling of hunger. The lower the
blood glucose goes and the longer the blood glucose stays low, the stronger the feeling of
hunger grows. During this process, the majority of diabetics feel like they are starving
and fear that they will go into a hypoglycemic coma. In many ways, that is exactly what
the body is telling the brain.
Since leptin doesn’t get released until the blood sugars return to normal, the brain
continues its production of neuropeptides. This creates a situation where the brain is
tricked into thinking it needs to eat more to respond to how low the blood sugar goes and
the length of time it takes to recovery.
A diabetic may rationalize the experience and think, “Well, I would rather be higher than
end up in a coma.” Most likely they are not thinking at all because their synapses are
firing all over the place. This is due to a lack of sugar and an increase in oxygen to the
brain, making it impossible to think clearly. As continual ghrelin signals hijack the brain,
our survival instincts kick in and we start to binge.
Trying to stop a binge for a diabetic is like trying to keep your hand on a hot stove. Our
body’s natural instinct is to withdraw the hand when we feel the heat. When people
binge, our instinct is to gravitate towards eating when we feel hungry, even though
logically one knows that you don’t need to eat or drink anymore because you have drunk
enough orange juice or taken whatever you use to recover from the hypoglycemic
reaction you’re having. Your body and hypothalamus remain on high alert in an effort to
raise those blood sugars, pushing you to eat in the same way that the brain tells our hand
to pull away from the hot stove.
Instead of using food to cover up feelings, the diabetic ends up eating to medicate a
problem that has already been fixed because the body is tricked into thinking that the
problem is still happening. It can take up to an hour or more for the diabetic’s body to
catch up.
Binge Prevention
The first way to reduce bingeing for a diabetic and the quantity of hypoglycemic
reactions is to maintain well-controlled blood sugar levels. The more your blood sugars
fluctuate, the greater the impact reactions will have on the body’s natural process to keep
the body fueled and the higher the risk of hypoglycemia. The more one can keep these
blood sugar levels stable, the more this leads to the opportunity to catch reactions sooner,
so you spend less time with low blood sugars.
It’s important to acknowledge that every diabetic has hypoglycemic reactions. With that
said, to prevent binge eating during a hypoglycemic reaction, the diabetic needs to realize
what a difficult task this is and that willpower will be part of the equation. In Alcoholic
Anonymous, it’s called “white-knuckling,” but not everyone can stop the binge. Even for
those who can, there will be times when it will get the better of them. So, regardless of
which category you fit into, you need to have a plan for when it occurs.
Start by testing your blood sugar levels often. The levels shown below indicate the risk of
bingeing based on Glucose Levels:
-
70 mg/dl, (Low risk of bingeing)
-
60 mg/dl, (Medium risk of bingeing)
-
50 mg/dl, (High risk of bingeing)
-
40 mg/dl or Below, (Very High risk of bingeing)
For the Low risk of bingeing category, just eat a small snack of your choosing or take
some glucose tablets and retest 15 - 30 minutes later.
For the Medium risk of bingeing, you should be aware and take care of your reaction as
you normally would. I suggest orange juice, drinking the quantity your body normally
needs to get back to a normal blood sugar. Don’t worry about being perfect. Aim for 120-
160 mg/dl so you know it is taken care of. If you feel yourself wanting to eat more, then
have a low carbohydrate snack that you can follow up with and eat slowly. Don’t forget
to retest 15 - 30 minutes later.
For the High -Very High risk, follow the same plan as the Medium level with the
following change: test every 10 - 15 minutes and adjust accordingly. Use orange juice
when available. You will need to drink a little bit more than the amount for a Medium
risk binge because you are at a higher risk of going into a diabetic hypoglycemic coma
when you go below 40 mg/dl. Drink the quantity your body normally needs to get back to
a normal blood sugar. Stay calm! Next, get a second small glass of orange juice or, for
variety, have a small glass of lemonade (or another sugary drink) that you can sip while
waiting out the hunger. Distract yourself by calling a friend or watching a TV program
you like or anything you can do to take your mind off the reaction. Do NOT go to sleep.
Vegetables are a good snack to curb the hunger. Make sure what you pick is something
that you will really enjoy (if your cholesterol is normal, some dressing to dip them in
would be good to satisfy the cravings). Be creative. A low carbohydrate protein would be
another good choice. I tend to favor an 1/8th pound of tuna fish salad that I eat with a
small fork. Eat your snack slowly. Have it ready. I get pre-made tuna fish salad at the
grocery store. If I don’t have a reaction that week, I have it for lunch before it goes bad.
Harm Reduction
The biggest problem with bingeing is the destabilization of your blood sugars. Let’s work
on preventing this.
When you end up bingeing, now what? Now you have one important task to do during
this period of time. Keep paper and a pen on the refrigerator door. When you take out the
big tub of ice cream or whatever you are choosing to eat, scoop out or take out one
serving at a time and write out the carbohydrates you’re eating as you go along. Do not
eat out of the tub or package. Total them when your binge ends. Next, take fast-acting
insulin to match what you just put in your body. You may feel sick from eating too much
but when everything is said and done, you will hopefully end up with a glucose level
between 120-160 mg/dl instead of 400 mg/dl.
Conclusion
Diabetic bingeing is a physical response to the brain receiving conflicting information
about the status of the stomach and the need to eat. Messages of hunger hijack the human
brain as long as the diabetic’s blood sugars remain low.
There are two ways to handle this hijacking and the binge that follows: one way is to
prevent the binge and the other is to reduce the harm when a binge occurs and the
resulting imbalance it creates in the blood sugar levels of diabetics. After the reaction is
treated, Binge Prevention techniques can be used to suppress the false messages of
hunger that are caused by low blood sugars. This can be done by slowly eating foods that
are low in carbohydrates like vegetables and diverting the attention away from the
remaining thoughts of hunger through activities like talking to friends or watching a
movie. Harm reduction allows the binge to occur but utilizes carbohydrate counting to
maintain normal blood sugars after the binge and reaction subside.
Overall, bingeing is not good for anyone but it is quite normal for diabetics when blood
sugars drop and cause hypoglycemic reactions. All Type 1 diabetics will go through
many reactions in a lifetime, but they can reduce the number of binges and find comfort
in the fact that it is a physical issue and not fully in their control.
Eliot LeBow LCSW – As a psychotherapist, my primary focus is on treating those who
have diabetes, a chronic illness or an addiction. I also have a thriving general practice
where I see clients with a variety of different backgrounds and issues including:
depression, anxiety, trauma and others. I treat pre-teen and adolescents to adults of all
ages as well as couples and families. For more information on my services please visit
www.therapyhelp.pro.
