Overcoming an eating disorder – diagnosed with high insulin levels – what to do?

A reader writes:

i’m a fat girl who just got diagnosed with high insulin levels. i’m sorta freaking out. i’ve spent the past 2 years working really hard at rebuilding my relationship with food after a bout of bulimia. i’ve been following “the fat nutritionist” & using a lot of her tips about normal eatting & now it’s all fucked. what do i do? are there any other fatties with this medical issue? how did you guys treat it & still be okay with your body? i feel like my dr looked at me & saw fat not a person. hhhhhelp!

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  1. Caprice

     /  June 11, 2012

    There appears to be a correlation with insulin resistance and fat. If you are insulin resistant it will take more insulin to keep your blood sugar at a healthy level. Your pancreas will put out more insulin and therefore your insulin levels will be higher. Some fat people will develop Diabetes Type II. This type of Diabetes is hereditary. If you don’t have the gene(s) for it you won’t get it.

    Why did your doctor do this test? What did the doctor say you should do about this? If s/he says you should go on a diet to lose weight then you know s/he only sees fat and you should get another less ignorant doctor. In the long run most of us will gain weight as a result of dieting and a good doctor should be aware of this.

    I’m not a trained professional so treat my advice with that in mind. I’d say unless the doctor has a specific treatment plan that you agree with then you should keep on doing what you’re doing. I have Type II Diabetes and I use insulin so I don’t have to restrain my eating in a disordered way. I have been diagnosed for 14 years and I’m doing well. I am extremely insulin resistant and I use a lot of insulin. No problems so far. I’ve worn the same size for the last 12 years so no huge weight gain in spite of the amount of insulin I use.

  2. nonegiven

     /  June 11, 2012

    If your doctor hasn’t prescribed metformin you should ask to try it. It reduces insulin resistance. Also, drop as much carb from your diet as is comfortable to get your insulin levels down, don’t try to limit fat. I found reducing carb reduced my appetite and let me go longer between meals without hunger which is also helpful for reducing chronically high insulin levels. I also found wheat to be a bigger problem than just the carbs. It seems to make me crave more wheat. Finding your own intolerances may help your issues, also.
    I thought I had an eating disorder, not bulimia or anorexia, just the “don’t get between me and that DingDong” variety. I felt unable to control my appetite, ravenously wolfing down low fat sandwiches on whole wheat bread or whole grain cereal with fruit and low fat milk every 2 hours, never feeling satisfied. Now I have meat and eggs for breakfast and go for 5-6 hours before I need to eat again. I thought I was emotionally eating but what I found was, it wasn’t emotional, it was insulin driven. I could eat a big steak, big potato and a salad, I would feel stuffed but never satisfied. I would have eaten more if I could have. As soon as I dropped the potato I found I was able to eat the salad and part of the steak, then I felt satisfied but not stuffed. Satisfied. I had forgotten what it felt like.
    Fat cells are supposed to be dynamic, you eat, the calories you aren’t using right now are stored, by the insulin stimulated by eating, some as glycogen and the rest as fat, to be accessed later. Later, when insulin returns to baseline the fatty acids come out of the fat cells to be used for energy. Chronically high insulin levels inhibit your body’s access to the contents of the fat cells so you get hungry, tired and cranky and have to eat again sooner even though theoretically you should have plenty of fuel still available. Your cells are starving because they can’t access what you have stored.
    Just don’t start weighing and freaking out over the numbers or obsessing about counting anything and I bet you’ll find your relationship with food will improve.
    btw If your doctor says being fat causes high insulin levels instead of a high insulin level causes getting fat, then she needs to reread her biochemistry textbook. Most fat people do have high insulin levels because insulin causes fat storage and inhibits the release of stored fat. They have tested young thin relatives of type 2 diabetics and found they already have insulin resistance and higher insulin levels than people without diabetic relatives and I bet they would have found the same thing if they tested the young thin relatives of fat people who aren’t diabetic.

  3. Mich

     /  June 11, 2012

    That is some good info from nonegiven. I thought I had anorexia for a time since I would only eat once a day or once every two days during my university days (still in university, but a different one) due to my parents getting after me all the time due to weight gain (which I found out is caused by PCOS).

    I also feel better/not as hungry when not eating plants.

  4. Not everyone can take metformin, just be warned. I was put on metformin for 10 years and the doctors who only saw the fat refused to take me off it until my liver enzymes were way high, in spite of 10 years of daily diarrhea.

    It was only then that I found out that a high fasting insulin by itself is not the proper test for insulin resistance, there are other things that can cause it.

    At the beginning, they also prescribed me (ex-borderline-anorexic) the Atkins diet, which fed RIGHT into my ED-mindset. What I’ve found helpful is the Fat Nutritionist etc. approach, trying to figure out what foods exactly make me feel lousy (and food combinations, there are some foods I feel fine eating by themselves, but if I eat them together, it does. not. work).

    Keep in mind, diabetes, even if you develop it, is NOT as scary or a death sentence like so many doctors present it. and no matter what the doctors say, it is NOT your fault! If they say things like that, find a new doctor, because otherwise you won’t be getting good care! You deserve better!

  5. I’m in a similar position to you, I’m type two diabetic and trying to repair my relationship with food after 25 years of dieting and disordered eating. At first I did everything the dietician said, I ate no sugar at all, I monitored everything, after 6 months I was suicidal. i couldn’t do it. I have decided that my mental health is just as important as all other aspects of my health, and similarly to the first response, I rely on medication to treat my diabetes. I have made a few manageable changes, I eat predominantly multi grain bread, use low GI potatoes and eat only basmati rice, but really that’s about it. I never really drank sugary drinks so that was easy. My blood sugars are not perfect, I’m not on insulin yet, but they are better than they were.

    I do find it hard sometimes to ignore all the “OMG your’e going to DIE” crap that gets thrown my way, but my weight has been stable for two whole years, which is a first in the last 2 decades, and I know that’s a huge improvement in my health and future health.

  6. FreddieA

     /  June 12, 2012

    I just need to correct Caprice on one fact, which is about type 2 diabetes. ANYBODY can get type 2 diabetes, but you’re far more likely to if it runs in the family.

    Insulin resistance (needing more circulating insulin to control blood sugar) is often called pre-diabetes and can be a step on the way to becoming a fully-fledged diabetic. The worst part is the vicious cycle of it all – more circulating insulin stimulates increased fat deposition and increased fast stores lead to (you guessed it!) increased insulin resistance. And it does make losing weight an uphill battle. And it sucks when you do all the “right” things and you don’t lose weight the way you expected to.

  7. You probably have PCOS, which has chronically high insulin levels, and this often affects various hormone levels.

    More exercise (regular is more important than intensity) is extremely helpful in controlling high insulin levels. So is metformin (a medication).

    Watching the carbs is important with insulin resistance, but you have to find your happy medium. Some people feel best when they really cut the carbs strongly, but for some people this is triggering for eating-disordered behaviors or binge eating because of restrictive experiences in the past.

    So for some it’s more a matter of finding the pattern the works for you. It is important to develop some awareness of carbs, but it’s also important not to obsess over carb counts too strongly. More important is learning to combine foods properly….the body processes carbs better when they are combined with protein and fats. It will produce less insulin in reaction to a carb-intense food if that food is eaten with a good protein source and some fats, than if that same carb-intense food is eaten on its own.

    It’s less about restriction than learning what triggers your particular body’s insulin response, and adapting accordingly.

  8. La

     /  June 12, 2012

    That really is the problem – the doctor’s take on it. I have PCOS, had extreme insulin resistance (which is now Type II Diabetes), lost weight, gained it back – huge amounts…a bit more than 150 pounds, exercised my way into knee replacements at 45, etc., etc.

    I really struggle with trying to eat right for my diabetes. When I was first diagnosed, I dropped all white flour, sugar, bad for you carbs, etc. I have to admit that it did make my numbers drop, however, I was miserable!!! Now, I am trying to find a happy medium. I am rather swinging in the wrong direction at the moment, but am struggling to get to a place where I am eating more of a HAES way.

    Unfortunately, my exercise bike is out of commission and I really do need a new one. But, when I was riding that for 30 minutes a day, my numbers really dropped. So, exercise does make a huge difference. Not anything extreme, like i was doing before I had my knee replacements, just easy-going movement worked for me.

    This is definately not an easy thing to work out. I am on Metformin and Januvia. The doctor has been throwing meds at me. Also, for high blood pressure – which mine is only elevated a very small amount and for high cholesterol. The side effects for those drugs were miserable, so I quit taking them for the time being. I want to have my bloodwork done again and see how things are without those drugs. Some people find Metformin intolerable, but it works well for me. My sugars tend to run about 200 when I wake up and I need to check things out more than once a day. I was conserving my strips because the insurance company only allows me to use 2 per day. I have a bit of a stockpile now, so I will start checking it more often.

    It’s hard…I’ve had the PCOS and insulin resistance, I would say since my very early teens. It’s just that the doctors never looked for it. They all assume that you’re home stuffing your face or trying to blame your thyroid (which I do have hypothyroidism). It’s vicious out there – especially now with all the “obesity crisis” bullshit going on. I even read a story about a creamatorium blaming a “fat corpse” for starting their building on fire – because all the fat caused extreme flames. Damn, you can’t even be respected when you’re dead!

    Keep your chin up and just be diligent – you will eventually find what works for your body – each person is different. Good luck to you and don’t let the doctors put you down. Stand up for yourself, it’s the best way to go. I don’t even let my doctor weigh me anymore. We’re not going there! I always say…I’m fat, write that down!

  9. La

     /  June 12, 2012

    Oh, I forgot to say….my father has Type II diabetes – heriditary in my case!

  10. Caprice

     /  June 12, 2012

    Most fat people are insulin resistant. Most fat people will never develop diabetes of any type. Most fat people who don’t smoke, get a little exercise, and eat some fruits and/or veggies are as healthy as thin people who do the same things. There appears to be a very slight increase in mortality for those people with a BMI oIver 40.

    At this time there seems to be no reliable way to make fat people thin. There also seems to be no health reason to do so. Therefore, I think our fat girl should keep on doing what she has been doing to develop eating competence regardless of her recorded insulin levels.

    If she has PCOS, Diabetes, or a broken ankle then those should be treated in a way that will not impede the quest for eating competence.

    Again, I am self educated on these issues so my conclusions may no be the same ones you would reach.

    • nonegiven

       /  June 12, 2012

      Not everyone will get diabetes no matter how fat they are, you only have the risk of getting it if you have one or more of the genes that affects insulin production. Family history doesn’t tell you that you’re safe from it because in the old days a lot of people never got diagnosed and a lot of the ones that did never mentioned it to anyone. Doctors have only started testing for it aggressively over the last 10 years or so.
      I’m not saying cut carbs to just cut carbs, but it may be at least part of what drives the disordered relationship with food. If you always eat a lot of carbs you might not notice that they are what makes you feel bad because you always feel bad. That really never occurred to me until I tried it and found that cutting back on some of it made me feel so much better. I hardly ever touch bread from the store any more, it isn’t worth it. A restaurant that I know makes good bread, I’ll eat that sometimes because it is worth it, but one roll, not the 6 I used to eat, now that I know how I’ll feel if I do that. No more cold, greasy french fries to clean my plate, either. Pretty much anything that I couldn’t stop eating before is a special thing now, not an every day thing. Being able to eat until I’m satisfied and then stop is a precious thing. All the bread, potatoes, pasta and rice in the world will never make up for that feeling.

      • Caprice

         /  June 12, 2012

        As I said, most fat people never develop diabetes. The question we are dealing with here is what should a person do if she has a history of bulimia and has been told she has high insulin levels. She’s spent two years becoming more comfortable with eating and now is feeling pressured to change that comfort level. While restricting carbs may be working for you now, I don’t think it is the answer for her because of her previous eating disorder,

        If she is using the advice she has found in The Fat Nutritionist Blog and it has been working for her then I think she should continue that path. Nothing I have seen shows that that will harm her. Restriction of any type could send her back to bulimia and that is harmful.

  11. lilacsigil

     /  June 14, 2012

    What kind of test was done? Doctors have a terrible tendency to do a single insulin test and declare “DIABETES!” This is not sufficient! You need a full series of tests to establish consistently high insulin. If your doctor isn’t willing to do this, get a referral to an endocrinologist. Weight loss is a very poor way to deal with diabetes, so don’t be pressured into that.

    I have problems with binge eating, not bulimia, but I’ve found paying attention to my satiety has been really helpful in improving my eating patterns – it means that I had to increase the protein in my diet because I found that carbs weren’t as good at filling me up and were more likely to lead to binge eating. Coincidentally, this is also a lower glycemic index eating pattern and works well for me.

    I am very fat, have PCOS and thyroid issues which predispose me to diabetes, but have normal insulin levels, probably because I have no family history of diabetes. Fat alone isn’t going to cause diabetes, so please keep your mental health in mine

  12. hungryhungrymoose

     /  June 23, 2012

    As a person who also had major food issues, I understand the panic of someone saying you might have to ‘restrict’ your eating. As a diabetic, I know that some foods can cause a faster blood sugar rise than others.

    It takes a while but I’ve learned to juggle foods. If I want a cookie (or two) I can have a cookie (or two), but it means eating them as part of a meal where the cookie(s) are part of the carb count.

    For me, the secret is reminding myself (over and over and over again) how much better I feel when I eat less carbs, without completely denying myself the foods I crave.

    I’d also like to take a moment to shamelessly promote the fa-diab mailing list, a diabetes mailing list for people who do not believe that weight loss is required to control the disease. No diet-for-weight-loss talk is allowed. http://fa-diab.com

  13. Arlene

     /  July 2, 2012

    Metformin helps me with sugar cravings and topamax makes soda taste bad so helps with soda cravings. Metformin is used for diabetes but also specifically treats insulin resistance and is commonly used for PCOS, metabolic syndrome and insulin resistance. Topamax is for seizures but is used off label for migraines and even for weight loss, though it can cause memory problems, but it sure makes soda taste bad, very thick and syrupy!

  14. JennyRose

     /  July 31, 2012

    I know I am late to the party but want to say thanks for all the helpful comments. Looking back, I have had hypoglycemia much of my life. I crave sugar and spikes in blood sugar are followed by deep crashes. This definitely played into my bulimia. I would eat a small, nutrtious breakfast and a few hours later I would be extremely hungry. I would then eat lots of carbs and cheap food, vomit and repeat. It was a terrible cycle. Going on the pill actually stoped the bingeing and purging although I continuted to have a bad body image and dieted and ate compulsively. It is still a struggle. A doctor thought I might have PCOS and put me on metformin. I was amazed that I did not crave sugar a few hours after eating. It worked but I stopped it because I thought it was overmedicating.

    I eat too much sugar on a daily basis but I cannot stop. The person above who mentioned being depressed without carbs and sugar hit the nail on the head for me. I know some of my eating is driven by blood sugar issues but a lot of it is emotional as well. I don’t know what to do at this point and I am still struggling.

    Thanks everyone.

  15. littlem

     /  August 18, 2012

    I want to second nonegiven on the lowcarbing — diabetes runs in my family and I also have hypoglycemia and am in ED recovery — keeping in mind that low carb does not mean, as so many mistake it for, no carb (have your veggies and fruit!).

    Because I’m always suspecting the FDA of not exactly looking out for citizens’ best interests when it comes to what they permit corporations to put in our “food products”, I read several studies hinting of high suspicion WRT whether some of the “additives” put in simple-carb and -sugar foods — white and even wheat breads, rolls, pretzels, chips, as well as sweeter snack foods — were in fact literally addictive. So if you feel like you’re in withdrawal whenever you try to kick sugar cold turkey, maybe that’s in fact exactly what state you’re in, because of the cross-reactions in your body between simple carbs and sugars and those additives, especially for those of us who are insulin-sensitive and/or come from families with those histories.

    Once I’d read enough to be suspicious on my own, I really did then treat it as withdrawal, realize I might probably feel like crap for awhile (a few weeks? a month?) and try to treat myself as well as I could in the meantime — including, as nonegiven also mentions, making sure I never skimped on other foods, ever, and had as much meat and fish and veggies and fruit as I wanted that were available (I’m privileged in that I have a neighborhood grocery and access to NYC greenmarkets). I don’t count calories; I made sure I get moderate exercise, and I paid really really close attention to how I felt as my diet changed. But I don’t want to underemphasize how much it did, actually feel, to me, like kicking an addiction. So it really felt to me like I’d better treat it like that. YMMV, of course.

    Best of luck to you.

  16. Hilary

     /  November 13, 2012

    I don’t know what your food triggers are or if you are able to do any kind of food tracking/adjusting, but I have had really good results in terms of blood sugar and metabolic problems by eating “primal” style: fruits, vegetables, meats, full fat dairy, wheat free and no grains/legumes. I dont count calories or track at all, just eat in season, make full meals, but abide by those food rules. I know a bunch of peolpe who have had really good results in terms of their metabolic and insulin related symptoms from it. Good luck!

  17. singpretty

     /  January 2, 2013

    I was diagnosed diabetic almost right after I left dieting behind forever and had started freeing myself from the restriction-based eating disorder I had developed over a lifetime of dieting. I join the fa-diab mailing list, which is a weight-loss free safety zone of empowerment, knowledge and community for us. I jumped right into testing to learn all I could about how my body reacted to food (each us is different), did not shun meds and learned how to balance my consumption of fats, carbs & proteins. I am now more than 15 years in as a non-dieting diabetic. I do not restrict, if I really want something I adjust my meds to suit. I am complication free (to my knowledge) and routinely keep my hb1ac below 6.5.


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