Diabetic Hyperphagia: Why You’re Always Hungry

Diabetic hyperphagia, sometimes called polyphagia, is a condition common in people with diabetes who are always hungry despite eating plenty of food. This happens because insulin problems interfere with the transfer of glucose (sugar) into energy.

This type of hunger can affect a person with hyperglycemia (high blood sugar) as well as hypoglycemia (low blood sugar). Diabetic hyperphagia may also be an early warning sign of diabetic ketoacidosis, a potentially life-threatening complication as the body produces excess blood acids.

This article looks at the symptoms and causes of diabetic hyperphagia, including how the condition is treated. It presents other conditions that may be possible causes and explains why it's important to see a healthcare provider for an accurate diagnosis.

What Is Hyperphagia?

Hyperphagia is not a disorder but rather a symptom of a medical condition. It is characterized by an abnormally strong, persistent sensation of hunger that is not satisfied with eating. This can lead to overeating and weight gain.

Hyperphagia is one of the most common symptoms of diabetes, but it is also associated with other disorders, including:

• Graves’ disease (autoimmune hyperthyroidism)
• Prader-Willi syndrome
• Bulimia nervosa
• Premenstrual syndrome (PMS)
• Insulinoma (a tumor of the pancreas)
• Kleine-Levin syndrome
• Pick’s disease
• Frontotemporal dementia

How Is It Linked to Diabetes?

Hyperphagia is common with all types of diabetes, including type 1 diabetes, type 2 diabetes, and gestational diabetes. It is so common, in fact, that it is regarded as one of the three “P’s” of uncontrolled diabetes:

• Polyphagia (excessive hunger)
• Polyuria (excessive urination)
• Polydipsia (excessive thirst)

In people with diabetes, hyperphagia is either the result of a lack of glucose (the body’s main source of energy) or the inability of the body to use glucose for energy.

What Are the Symptoms of Diabetic Hyperphagia?

While everyone has cravings from time to time, the experience of hyperphagia is separate from normal hunger.

People with diabetic hyperphagia will typically experience:

• Feelings of hunger despite eating regularly
• Intense food cravings
• Overeating
• Weight gain
• Fatigue
• Excessive thirst
• Frequent urination

Digestive problems such as diarrhea, nausea, and heartburn (mainly related to overeating) also may occur.

Causes of Hyperphagia Related to Diabetes

In people with diabetes, hyperphagia is related to problems with insulin and blood glucose levels.

Hyperglycemia (High Blood Sugar)

The link between hyperglycemia and hyperphagia is a direct one, and insulin is the trigger.

Insulin is a hormone that acts like a key, allowing blood glucose into cells for use as energy. With diabetes, your body either doesn't make enough insulin or can't use it as well as it should (known as insulin resistance).

As a result, no matter how much glucose is obtained from food, it doesn’t get into cells as it should. And, because no energy is produced, a person is left feeling hungry as the body’s cells become “starved."

This creates a vicious cycle in which overeating leads to high blood sugar and high blood sugar leads to problems with insulin.

Hypoglycemia (Low Blood Sugar)

Hypoglycemia can occur in people with diabetes and without. In both cases, it can happen if you don’t eat enough food and your blood glucose drops.

In people with diabetes, it can also occur when there is too much insulin in the bloodstream. When this happens, the liver stops secreting glucose, causing blood sugar levels to drop.

This typically happens when a person takes too much insulin or diabetes medication. Without enough glucose to deliver to cells, energy levels drop and hunger sensations increase even with the ample intake of food.

Episodes of hypoglycemia can also occur at night, leading to nighttime food cravings.

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious complication of diabetes when the body can't produce enough insulin. When this happens, the body begins to break down fat as fuel, causing the build-up of damaging acids known as ketones.

Symptoms of DKA include:

• Excessive thirst
• Excessive urination
• Nausea or vomiting
• Stomach pain
• Weakness or fatigue
• Shortness of breath
• Fruity-scented breath
• Confusion

Another one of the early symptoms of DKA is hyperphagia. As insulin starts to drop, the corresponding rise in blood glucose can manifest in hyperglycemic food cravings.

However, as DKA becomes increasingly severe, high ketone levels suppress a hormone known as ghrelin that is responsible for stimulating hunger. As a result, a person will lose all their appetite and have no interest in eating.

Hypothalamic Lesions

The hypothalamus, a part of your brain, plays a regulatory role in key body functions including appetite. Among other things, it directly affects the pituitary gland.

Lesions that can lead to dysfunction have several causes, including congenital conditions you're born with or infection.A hypothalamic lesion can lead to diabetes and related appetite changes.

Hyperthyroidism

Hyperthyroidism occurs when the thyroid gland, located at the base of your neck, becomes overactive and produces too much of the hormone thyroxine. This can cause an increased appetite along with a host of symptoms related to changes in your metabolism. Though people eat more, they often lose weight due to these changes.

An autoimmune condition called Graves' disease is the most common cause of hyperthyroidism in the United States.Yet because of the thyroid's influence on metabolic systems, diabetes and high blood sugar levels often are related conditions. Other risk factors include:

• A history (family or your own) of rheumatoid arthritis, lupus, or another autoimmune disease
• A thyroid disease history
• Smoking
• High dietary intake of iodine or medications that contain it

How Is Hyperphagia Diagnosed?

It may be difficult to distinguish hyperphagia from simple food cravings. Ultimately, the hallmark of hyperphagia is persistent food cravings that are not relieved with food.

Diabetic hyperphagia may be suspected if a person has other symptoms of diabetes, such as:

• Excessive thirst
• Excessive urination
• Blurred vision
• Chronic fatigue
• Wounds that are slow to heal
• Unintentional weight loss
• Abnormally dry skin
• Tingling or burning sensations in the hands the feet

Based on these findings and a review of your medical history, your healthcare provider may order tests to see if you have diabetes, including:

• A1C test
• Fasting blood glucose test
• Glucose tolerance test
• Random blood sugar test (central to the diagnosis of type 1 diabetes)

If diabetes is diagnosed, the appropriate treatment is started to bring blood glucose levels under control.

If diabetes is not found, other tests and exams will be performed to narrow the possible causes of hyperphagia.

How is Hyperphagia Treated?

The most effective treatment for hyperphagia is to treat its underlying cause. In the case of diabetic hyperphagia, managing diabetes will also manage hyperphagia.

Controlling Diabetes

The treatment approach for diabetes depends largely on the type of diabetes.

While type 1 diabetes is a lifelong autoimmune disorder, resulting in the inability to produce insulin, type 2 diabetes is much more common, can often be managed through lifestyle changes, and for some people goes away with treatment.

Type 1 diabetes almost always requires careful blood sugar monitoring and the administration of insulin. Monitoring can be done using at-home devices.

Insulin is either injected or delivered through a pump that is affixed to the skin. This is usually performed by the person with diabetes, or a caregiver if the person is a child or otherwise needs assistance.

Type 2 diabetes may or may not require medication such as insulin or oral diabetes medication.

Both type 1 and type 2 diabetes require lifestyle habits such as:

• Healthy eating
• Exercise
• Good sleep habits
• Stress management
• Blood sugar monitoring
• Monitoring for signs of complications, which may include seeing specialists such as an eye doctor or foot doctor

Managing Hunger

While it is most important to control diabetes, there are some things to try that may help manage hunger with diabetic hyperphagia:

• Check your blood sugar. If it is low, eat quick sugar carbohydrates to bring it up.
• Eat high-fiber, low-carbohydrate foods.
• Drink plenty of water.
• Eat a high-protein breakfast.
• Eat without distractions such as the TV.
• Keep food interesting with a variety of tastes, herbs, and spices.
• Exercise through a craving.
• Distract yourself while having a craving—go on a walk, take a shower, or do an activity you enjoy.
• Manage your stress levels and watch for signs of mental health struggles such as depression or anxiety, which can lead to emotional eating.
• Allow small tastes of the foods you are craving.
• Keep healthy snacks easily accessible.

Other Treatment Options

Medications such as liraglutide are being investigated as possible treatments for hypothalamic hyperphagia, but more research is needed.

When to See a Healthcare Provider

Symptoms of hyperphagia warrant a visit to a healthcare provider when hunger that is not relieved by eating is concerning in and of itself.

Moreover, if diabetes is involved, it is almost invariably due to advancing disease and the increasing loss of blood sugar control. This is especially true if there are other signs of advancing diabetes, such as blurred vision or non-healing foot sores.

If a person is known to have diabetes, hyperphagia can be a sign that the disease is being overtreated and that the treatment needs adjustment.

Or, more concerningly, it could be an early sign of diabetic ketoacidosis, a potentially life-threatening complication that can lead to coma and death if not treated appropriately.