Public education has done well in bringing awareness to anorexia nervosa and bulimia nervosa as eating disorders. There has been a rise in information about binge eating disorder. The term “diabulimia” however, is foreign to most.
What is Diabulimia?
Diabulimia is the term used to refer to the link between type 1 diabetes and eating disorders. It is not yet a recognized medical disorder, however the term, and therefore awareness of the condition, is beginning to gain traction in the public and health communities. It is characterized by individuals with type 1 diabetes restricting or completely omitting their insulin injections for the purpose of weight loss. Without sufficient insulin, glucose from the blood can’t be transported into the cells to be used or stored. This effectively prevents weight gain. Instead, glucose levels simply rise in the blood and then is excreted through the urine. While not as easily discernible as traditional bulimia, the cycle of binging and purging remains. An individual binges on whatever foods they want, and then purges those unwanted calories through their urine. This practice is incredibly dangerous.
Who’s at Risk?
While eating disorders in general are more common in preteen girls and young women, boys and men also suffer from them. However, the American Diabetes Association states that women with diabetes are nearly three times more likely to develop an eating disorder than women without diabetes. Individuals with type 1 diabetes, girls especially, tend to have a poorer self-image because of the disease. In addition to this, the habits one must adopt to manage type 1 diabetes are also the habits one develops in response to an eating disorder. These habits include focusing intently on their diet, constantly monitoring blood sugar levels and carbohydrate intake and avoiding “bad” foods. This near obsessive relationship with food increases the chances of individuals with type 1 diabetes triggering an eating disorder.
What are the Health Consequences?
Diabulimia can have devastating and permanent effects on the body. Short-term consequences include dehydration, frequent urination and glucosuria, insatiable thirst, increased appetite, high blood glucose levels, fatigue, decreased concentration, electrolyte imbalance, ketoacidosis episodes and weight loss. The long-term consequences are the same for diabulima as for poorly controlled diabetes, however these effects are seen much sooner in those with diabulimia. These include heart attack, stroke, blurry vision or blindness, kidney disease and damage, muscular and nerve damage, vascular disease, gum diseases, infertility and death. It is not uncommon for these signs, which usually begin to present themselves in middle age and beyond, to appear in an individual in their twenties.
What are things to watch for?
One thing to look for is a consistently high hemoglobin A1c (glycosylated hemoglobin) or eAG (estimated average glucose). These are markers of the average glucose level over a period of approximately three months, and when high can be an indicator of diabulimia. Frequent emergency room visits for diabetic ketoacidosis (DKA) may also be an indicator, however some individuals may be manipulating their insulin levels in such a way as to prevent DKA episodes. Individuals will also present with the traditional eating disorder mentality, namely an increased drive for thinness and increased body dissatisfaction. Body weight is not a good indicator, as any person of any weight can develop an eating disorder. Another indicator of diabulimia would be irregular eating patterns. Individuals may restrict intake, skip meals or eliminate sweets and fats from their diet. This may be followed by a binge and purge cycle. Individuals may also be uncomfortable eating around others. They may avoid eating with others all together or eat very little in the presence of others. Just like with traditional bulimia nervosa, irregular or nonexistent menses may indicate diabulimia. High A1c levels have the potential to cause irregular menses, the complete cessation of periods, and even delayed puberty due to interference with the function of the brain. Individuals may also be unwilling to follow through with appointments in order to avoid their doctor finding out. They may be manipulating their blood glucose test results or “forget” testing all together.
How is Diabulimia treated?
A multi-disciplinary team approach is best. In order to address and successfully treat the multi-faceted symptoms and behaviors of diabulimia, a team including an endocrinologist who is sensitive to the psycho-social component of individuals, a psychotherapist experienced with both chronic illness and eating disorders and a registered dietitian who is passionate about eating disorders and is skillful in mastering the management of blood glucose patterns and insulin regimens should all work together with the patient to bring about holistic healing. Helping the individual to develop healthy eating habits, shift their focus away from weight, teaching them and promoting appropriate exercise, as well as helping the individual find their “why” for healing are all key parts of treatment. In some cases, however, individuals will require hospitalization to achieve metabolic control and get treatment for the complications associated with diabulimia.
What can be done?
Education is key in order for diabulimia to be appropriately recognized, diagnosed and treated. Physicians need to learn about the signs, symptoms and treatments for diabulimia in order to effectively diagnose their patients. It may not yet be an officially recognized disorder, however it is still important for doctors to know how type 1 diabetes and bulimia affect one another in order to address the issue of eating disorders in their diabetic patients effectively. Diabulimia should also be added into the curriculum for eating disorders so that young adults become educated on what it is and it’s short-term and long-term consequences so that they can be ready to help those in their circle of influence.
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August 2012. Dada, J. H. Understanding Diabulimia- Know the Signs and Symptoms to Better Counsel Female Patients. Today’s Dietition Vol. 14. No. 8. P. 14. Retrieved from http://www.todaysdietitian.com/newarchives/080112p14.shtml
March 2, 2009. Shih, G. H. Diabulimia: What it is and how to treat it. Diabetes Health.com Retreived from https://www.diabeteshealth.com/diabulimia-what-it-is-and-how-to-treat-it/
July 2016. Tarkan, L. Diabulimia: The Diabetes Eating Disorder. Endocrinweb.com. Retrieved from https://www.endocrineweb.com/news/diabetes/15989-diabulimia-diabetes-eating-disorder