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Type 1 diabetes with eating disorder — SCE Endocrinology MCQ

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HardDiabetes mellitusType 1 diabetes with eating disorderSCE Endocrinology

A 33-year-old man with type 1 diabetes has HbA1c 88 mmol/mol and recurrent DKA. He frequently omits insulin because of fear of weight gain and has binge-purge behaviours. BMI is 21 kg/m2 and ketones are often positive. What is the most appropriate management?

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Correct answer: E — Integrated diabetes and eating-disorder specialist care with insulin safety planning

Integrated diabetes and eating-disorder specialist care with insulin safety planning is best because insulin omission for weight control is a high-risk eating-disorder behaviour needing integrated psychological and diabetes expertise. The alternatives are less appropriate because disengagement worsens risk; SGLT2 inhibitors increase ketoacidosis risk; punitive approaches impair care; restricting insulin access is unsafe. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG69; NICE NG17