Did you know that people with diabetes can suffer from an eating disorder?
It’s called diabulimia and refers to an eating disorder in which a person with diabetes, (usually Type I) restricts insulin in order to lose weight.
The term, Eating Disorder-Diabetes Mellitus Type 1, or ED-DMT1, is the medical term used to refer to any type of eating disorder occurring with Type 1 diabetes.
According to The National Eating Disorders Association (NEDA), the largest nonprofit organization dedicated to supporting individuals and families affected by eating disorders, the intense focus on weight, blood glucose, and A1c make having diabetes a high risk factor for developing an eating disorder.
A review of studies published over the last 25 years on the prevalence of eating disorders and insulin restriction among people with diabetes shows that 30%-35% of women restrict insulin in order to lose weight at some point in their life. This number has remained relatively constant over the decades. — NEDA.
A person may develop diabulimia or ED-DMT1 at any age and at any point after their diabetes diagnosis, according to the non-profit.
“Sometimes it begins with body image issues or a desire to lose weight, and sometimes it begins as diabetes burnout,” they explain on their website. “Regardless of how it begins, treatment can be challenging as individuals with Type 1 diabetes tend to show higher dropout rates and poorer treatment outcomes than other patients,” the organization states.
Treatment for someone with diabulimia has to address both diabetes and eating disorder aspects of the disorder.
Becuase diabulimia does not have a separate diagnostic code for professionals, a person’s specific diagnosis will depend on their eating disorder behaviors. For example:
The diagnostic manual for eating disorders classifies insulin omission as a purging behavior, therefore it may be coded as bulimia nervosa if the person is binging then restricting insulin.
Or, diabulimia may be diagnosed as purging disorder if the person is eating normally and restricting insulin. It may be classified as anorexia nervosa if the person is severely restricting both food and insulin.
Diabulimia can also be diagnosed as Other Specified Feeding and Eating Disorder (OSFED).
Signs and Symptoms of Diabulimia:
The following are signs and symptoms of diabulimia compiled from the NEDA:
Emotional/Behavioral Signs:
- Neglect of diabetes management
- Secrecy about diabetes management
- Avoiding diabetes-related appointments
- Fear of low blood sugars
- Fear that “insulin makes me fat”
- Extreme increase or decrease in diet
- Extreme anxiety about body image
- Restricting certain food or food groups to lower insulin dosages
- Avoids eating with family or in public
- Discomfort testing/injecting in front of others
- Overly strict food rules
- Preoccupation with food, weight and/or calories
- Excessive and/or rigid exercise
- Increase in sleep pattern
- Withdrawal from friends and/or family activities
- Depression and/or anxiety
- Infrequently filled prescriptions
Physical Signs:
- A1c of 9.0 or higher on a continuous basis
- A1c inconsistent with meter readings
- Unexplained weight loss
- Constant bouts of nausea and/or vomiting
- Persistent thirst and frequent urination
- Multiple DKA or near DKA episodes
- Low sodium and/or potassium
- Frequent bladder and/or yeast infections
- Irregular or lack of menstruation
- Deteriorating or blurry vision
- Fatigue or lethargy
- Dry hair and skin
The Consequences of Diabulimia
The major consequences of diabulimia are usually related to prolonged elevated blood sugar. These complications can be severe and permanent so early detection is key.
According to NEDA, patients with weight-related insulin restriction were 3.2 times more likely to die over an 11-year study period, and to die an average of 13 years younger than those who didn’t restrict insulin.
Short-Term Consequences:
- Slow wound healing
- Staph and other bacterial infections
- Yeast infections
- Muscle atrophy
- Menstrual disruption
- Severe dehydration
- Electrolyte imbalance
- Diabetic Ketoacidosis
Long-Term Consequences:
- Retinopathy
- Macular Edema
- Peripheral Neuropathy
- Gastroparesis
- Vasovagal Syncope
- Chronic diarrhea or constipation
- Kidney disease
- Liver disease
- Heart disease
Treatment
The best thing for a patient with diabulimia is to see an endocrinologist and a dietician who has knowledge of both diabetes and eating disorders, and a mental health professional who specializes in eating disorders.
There are some great resources for individuals with eating disorders:
- The National Eating Disorders Association (NEDA): The NEDA has a toll-free, confidential helpline, Monday – Thursday from 9:00 am – 9:00 pm and Friday from 9:00 am – 5:00 pm (EST): 1-800-931-2237.
- Diabulimia Helpline: They also have 24 Hour Hotline: (425) 985 – 3635.
- Learn more about diabulimia with this informative BBC documentary.