What is Diabulimia?
Diabulimia is an an eating disorder in which patients with Type 1 Diabetes deliberately skip and/or restrict their insulin in order to cause extreme weight loss and often supplement this with bulimic behaviors. Diabulimia is not currently recognized as a formal medical diagnosis but is well known to endocrinologists and is considered disordered eating behavior.
Who is Susceptible?
The people who are most susceptible to disordered eating are young females (yet eating disorders are not exclusive to females), especially those with a history of dieting and restrictive eating, weight loss/gain cycles, low self-esteem, and familial struggles. Those with Type 1 Diabetes are at a higher risk of disordered eating habits such as diabulimia because the foundation of Diabetes treatment revolves around a focus on food. After cycles of restraining food intake followed by overeating, a diabetic person may develop diabulimia to compensate for the food that they compulsively consumed. Over 30% of females with Type 1 Diabetes reported insulin restrictive behaviors.1
Warning Signs & Causes
Personal causes of developing an eating disorder include an individual with self-critical thoughts, a preoccupation with food, and obsessive counting of calories and carbohydrate intake. These causes create the obsessive habits revolving around food and are warning signs of developing disordered eating. Behavioral factors such as consistent use of the bathroom right after eating, avoiding social eating, avoiding relationships, and obsessing over diet magazines and food-related media can be signs an of an eating disorder.2
Symptoms & Health Risks
When a Type 1 Diabetic restricts insulin, it causes diabetic ketoacidosis, which means that the glucose from carbohydrate intake spill into the urine and cause quick and extreme weight loss. When the body is lacking appropriate insulin, it breaks down fat to produce ketones, which are a chemical produced when there is a shortage of insulin in the blood and the body breaks down body fat for energy, that are poisonous to the body.3 Rapid weight loss and ketoacidosis can have serious long-term complications. The combination of weight loss and ketoacidosis increases the risk of kidney disease, nerve damage, heart disease, and retinopathy (retina damage) that can lead to blindness.1 Symptoms of diabulimia include a pale appearance, chills, dull and thin hair, sunken facial appearance, dry skin, abdominal pain, constipation, dizziness and fainting, anxiety, depression, and lack of focus.
Treatment and Prevention
Early treatment for any eating disorder is crucial because the longer it continues, the more difficult it is to treat.2 Because the treatment for diabetes involves careful intake of calories, carbohydrates, fats, and sodium, the treatment for diabulimia can contradict the mindset necessary for a diabetic lifestyle4. Disordered eating habits are broken by relabeling foods as neither “good: nor “bad in order to eliminate guilt.1 Due to this complication, treating diabulimia requires the effort of a psychiatrist and endocrinologist simultaneously and should include family involvement especially if the patient struggling is a child. In the short term, the surrounding family members should aim to gain a shared understanding of the difficulties of the individual struggling with diabulimia in a non-judgmental way. Re-establishing regular insulin maintenance and reducing episodes of diet restriction should be done in short term incremental goals. For the long term, it is key to help the individual accept Diabetes as a lifelong condition in order to find healthy ways of coping. Initiating a dialogue with empathy and without blame will aid in the psychological treatment of the eating disorder.
Sex & Diabulimia
A low body weight due to forceful reduction of insulin and poor nutrition has a direct impact on sex hormones. Less fat decreases estrogen, an important sex hormone and also decreases ovarian activity and therefore decreases the testosterone production that is vital to female libido.5 Diabulimia directly affects sexual functioning, and can cause not only physical but emotional distress as well. For a healthy sex life, acceptancy of diabetes as a medical condition, a positive body image, and a comfortable relationship with a partner will be an important part of sexual and relational recovery.
Are you or someone you know struggling with Diabulimia?
Call 1-800-931-2237, the National Eating Disorder Association for more information on how to help yourself or a loved one.
1. Rabin, Roni. "An Eating Disorder in People With Diabetes." The New York Times. 1 Feb. 2016. Web.
2. Philpot, Ursula. "Eating Disorders in Young People with Diabetes: Development, Diagnosis and Management." Journal of Diabetes Nursing 17 (2013).
3. Callum, Audrey, and Lori Lewis. "Diabulimia among Adolescents and Young Adults with Type 1 Diabetes." Clinical Nursing Studies 2.4 (2014).
4. Shaban, Clare. "Diabulimia: Mental Health Condition or Media Hyperbole?" Practical Diabetes 30.3 (2013).
5. Scheel, Judy. "Sexual Satisfaction and Eating Disorders." Psychology Today. Sussex Pubishers, n.d. Web. 29 Feb. 2016.