What questions should be asked to a patient suspected of having type 1 diabetes complicated by an eating disorder?

Key Screening Questions for Type 1 Diabetes Eating Disorders

When screening patients with type 1 diabetes for eating disorders, use validated screening tools like DEPS-R (Diabetes Eating Problem Survey-Revised) or mSCOFF, combined with specific questions about insulin manipulation and body image concerns.

Validated Screening Tools

• DEPS-R (Diabetes Eating Problem Survey-Revised): Recommended for patients age 10-12 and older 1
• mSCOFF: Modified version of SCOFF specifically for diabetes patients 1
• Single screening question: "Have you ever been overweight?" (high sensitivity for identifying risk) 1

Essential Screening Questions

Insulin Manipulation

• "Do you ever take less insulin than you should?" 1, 2
• "Have you ever skipped insulin doses to manage your weight?" 1, 3
• "Do you ever calculate less carbohydrates than you've eaten to reduce your insulin dose?" 1
• "Do you use specific techniques to impair insulin absorption (e.g., injecting into areas of lipohypertrophy, exposing insulin to heat/light)?" 1

Eating Behaviors

• "Do you have strict food rules that cause anxiety when broken?" 2
• "Do you ever feel guilty or disgusted with yourself after eating?" 2
• "Do you ever eat large amounts of food in a short period and feel out of control?" 1, 3
• "Do you use exercise to compensate for food eaten or to manipulate blood glucose?" 1
• "Do you use laxatives or make yourself vomit to control weight?" 1

Body Image and Weight Concerns

• "Are you concerned about your weight or body shape?" 1, 4
• "Do you believe yourself to be fat when others say you are thin?" 1
• "How do you feel about potential weight gain associated with improved glucose control?" 1
• "Does food dominate your life?" 1

Diabetes Management Patterns

• "Do you experience anxiety about hypoglycemia?" 1, 2
• "Have you had unexplained episodes of diabetic ketoacidosis (DKA)?" 3
• "How do you feel when your blood glucose is high?" 1
• "Do you have persistent poor glycemic control despite adequate knowledge?" 1, 3

Psychological Assessment

• "Do you feel anxious or depressed about managing your diabetes?" 1, 5
• "How does diabetes affect your self-image and social relationships?" 4, 6
• "Do you feel overwhelmed by diabetes management requirements?" 1
• "Do you avoid social situations because of diabetes management needs?" 1

Red Flags Requiring Immediate Attention

• Unexplained weight loss with poor glycemic control 1, 3
• Recurrent episodes of DKA without clear precipitating illness 3
• Hemoglobin A1c >9% despite adequate diabetes knowledge 1, 3
• Extreme exercise patterns 1
• Preoccupation with food, calories, or carbohydrate counting beyond what's needed for diabetes management 1

Clinical Approach

1. Screen all patients with type 1 diabetes starting at age 10-12 years 1
2. Perform screening at initial visit, periodically, and when changes in treatment or life circumstances occur 1
3. Create a non-judgmental environment when asking these questions
4. If screening is positive, refer to a multidisciplinary team including mental health professionals with experience in both eating disorders and diabetes 1

Remember that early detection is critical as eating disorders in type 1 diabetes significantly increase the risk of diabetes complications and mortality 3, 4.