Diabulimia
While diabulimia is a frightfully common form of disordered eating, is it not currently recognized as a formal diagnosis by the medical or psychiatric communities. Diabulimia is the deliberate restriction of necessary insulin by people with type 1 diabetes for the purpose of weight loss. Many sources show that preteen and teenage girls with type 1 diabetes have significantly higher rates of eating disorders of all kinds than girls without type 1 diabetes (1,2,3,4). Furthermore, diabetic females tend to have higher body mass (BMI) than those without diabetes. Females with higher BMI are more likely to show eating disordered behaviors. Of diabetics with eating disordered behaviors, a significant amount intentionally manipulate their insulin intake in order to control weight.
Diabulimia is incredibly dangerous because failure to administer insulin places the body in a starvation state. When in a starvation state, the body breaks down muscle and fat into ketone bodies while simultaneously disabling the body’s ability to process sugars. Sugars are subsequently excreted through the urine rather than being used as energy or stored as fat. This results in significant weight loss, which is what the patient is aiming for. However, this also places the patient in a life-threatening condition called diabetic ketoacidosis. Prolonged failure to administer insulin results in diabetic complications as well as increased risk of premature death.
Those with type 1 diabetes are often diagnosed in early adolescents, a time of life when young girls are often highly concerned about their weight and appearance. Treatment for type 1 diabetes includes insulin injections, a controlled diet, and regular blook sugar checks several times a day. This pattern can lead to weight gain, which can cause weight-conscious individuals to intentionally restrict their insulin intake in attempts to lose weight.
I have come across several patients who were already diagnosed with an eating disorder prior to learning about their diabetes. Unfortunately, those with diabulimia often feel more comfortable discussing their eating disorder openly than they do discussing their diabetes because there is much shame and embarrassment around mismanaging their diabetes. Plus, many patients are not aware of how common diabulimia actually is. Diabulimia is incredibly difficult to overcome because there is no overt action or willpower involved, such as starving or purging. This behavior also satisfies an emotional need for control and/or avoidance of difficult feelings. In addition, the affects of dealing with a diagnosis of a chronic condition plus the physical effects of managing blood sugar levels, such as weight gain, can be highly damaging to one’s self-esteem and self-image.
In some instances, suspension of insulin administration may be a suicidal attempt. Like any form of eating disorder, it is necessary to address the underlying feelings driving the insulin manipulation. Any time a young person is diagnosed with type 1 diabetes, it is highly advisable that they receive therapeutic aid to help process the repercussions of this lifestyle change.
1. Colton, P. A., Olmsted, M. P., Daneman, D., Rydall, A. C., Rodin, G. M. (2007). “Five-Year Prevalence and Persistence of Disturbed Eating Behavior and Eating Disorders in Girls With Type 1 Diabetes.”. Diabetes are 30 (11): 2861–2862. doi:10.2337/dc07-1057. PMID 17698613. http://care.diabetesjournals.org/content/27/7/1654.full.
2. Alemzadeh, R., MD and Wyatt., MD (2007). Nelson Textbook of Pediatrics, 18th ed. ISBN 9781416056225 141605622X.
3. Nielsen S (2002). “Eating disorders in females with type 1 diabetes: an update of a meta-analysis. European Eating Disorders Review”. European Eating Disorders Review 10: 241. doi:10.1002/erv.474. http://www3.interscience.wiley.com/journal/94517347/abstract?CRETRY=1&SRETRY=0.
4. Jones J, Lawson ML, Daneman D, Olmsted MP, Rodin G (2000). “Eating disorders in adolescent females with and without type I diabetes mellitus: cross-sectional study. journal=BMJ”. BMJ (Clinical research ed.) 320 (JUN 10): 1563–1566. doi:10.1136/bmj.320.7249.1563. PMC 27398. PMID 10845962. http://www.bmj.com/cgi/content/abstract/320/7249/1563?ijkey=b1e16f46a47a882d693585f3739c6a47f65e92d5&keytype2=tf_ipsecsha.
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