All About

Diabulimia

Diabulimia is an eating disorder that people with Type 1 diabetes exhibit by lowering their medically prescribed insulin. Those who struggle with diabulimia may do so in secret due to fear of being judged or misunderstood.

People with diabulimia may struggle to manage behaviors driven by their eating disorder symptoms, such as habits around eating and exercise. For anyone struggling with diabulimia know that you are not alone. These feelings and urges may be very intense and powerful, but through connection, support and guidance, there is a healing pathway to recovery.

Diabulimia

What is

Diabulimia

Diabulimia refers to an eating disorder in which people with Type 1 diabetes intentionally restrict their insulin. Medical professionals use the term ED-DMT1, meaning Eating Disorder and Diabetes Mellitus Type 1, for any class of eating disorder that occurs alongside this disease. (1)

Diagnosing

Diabulimia

The DSM-5 does not have a classification for this disorder yet. Instead, it is categorized as bulimia nervosa if the person is bingeing when restricting insulin, as the restriction of insulin is considered the “compensatory behavior” as described in DSM 5.

Diagnosis of diabulimia may also be classified as a purging disorder, if the patient eats a regular diet yet restricts insulin, or as anorexia nervosa, when the patient is restricting their food intake. (1,2) Therefore, there are no specific diagnostic criteria for diabulimia as it highly varies patient to patient.

If a medical professional thinks you are struggling with this eating disorder, or any others, treatment will likely be recommended. The sooner the process of treatment may begin, the better, as diabulimia is a serious eating disorder that has enormous medical risks, not to mention tremendous psychological pain and suffering. Your care providers may also want to talk to your endocrinologist to collaborate with their care team and refer you for psychotherapy.

Signs & Symptoms of

Diabulimia

Diabulimia is a serious eating disorder that can lead to extremely dangerous medical consequences if left untreated. It can be hard to recognize the signs that someone is struggling with this eating disorder. 

It is common for people with diabetes to feel sick or not want to eat because maintaining their insulin can be difficult. For that reason symptoms associated with diabulimia may go unnoticed by family and friends, making diagnosis slightly more challenging. 

One of the most significant concerns with diabulimia is that severe complications can arise from incorrectly taking insulin, not to mention the mental suffering that is associated with an untreated eating disorder. This makes the need for proper care and treatment of the utmost importance. 

Effects of Diabulimia

The human body is resilient, and people with diabulimia can often function in ways that allow them to mask their elevated blood sugar levels. 

High blood sugar levels usually cause most people to feel sick and unable to perform regular activities. However, those with diabetes may learn to carry out routine tasks even when their blood sugar is abnormally high.

There are significant consequences of prolonged high blood sugar levels that are usually related to the complications of diabetes, and they're often severe or irreversible. For that reason, early detection is essential for proper treatment. 

Here are the acute and chronic side effects of diabulimia: (4)

Short-Term Effects

  • Weight loss
  • Increased urination
  • Excessive hunger
  • Excessive thirst
  • Blurred vision
  • Confusion
  • Fatigue or lethargy
  • Dry skin
  • Slow wound healing
  • Staph and other bacterial infections
  • Yeast infections
  • Muscle atrophy
  • Menstrual disruption 
  • Severe dehydration
  • Electrolyte imbalance
  • Diabetic Ketoacidosis

Long-Term Effects

  • Retinopathy (can lead to blindness)
  • Macular Edema
  • Peripheral Neuropathy 
  • Gastroparesis
  • Vasovagal Syncope (nervous system dysfunction)
  • Chronic diarrhea or constipation
  • Coma
  • Stroke
  • Death

Related Disorders

Healthcare professionals agree that more research needs to be done about diabulimia and the related medical and psychological disorders associated with this eating disorder. (2)

In a survey published by the National Institute of Health, they identified three main factors in why patients restrict their insulin for weight loss: (2)

  • Body image dissatisfaction
  • Hate of diabetes diagnosis
  • Self-harm

Mental health professionals associate these factors with mental illnesses that lead to these disordered eating behaviors. These intrusive and painful,  obsessive behaviors must be addressed when a patient seeks help for diabulimia so that the patient can begin to heal. 

We recommend patients and their loved ones looking for help try to be honest about their feelings associated with diabulimia. Withholding physical or psychological side effects, or disordered eating behaviors may put the patient at risk of complications that can lead to equally serious medical conditions, such as: (2)

  • Neuropathy
  • Kidney disease
  • Liver disease
  • Heart disease
  • Vascular diseases
  • Diabetic ketoacidosis and death

Treatment of

Diabulimia

Diabulimia is a life-threatening eating disorder that requires professional treatment. People with diabetes who show signs of diabulimia must seek nutritional, psychological  and medical help from an experienced treatment team.

Treatment for diabulimia requires several approaches that may involve using a multidisciplinary treatment team to not only learn about set triggers of the illness, but to understand underlying dynamics that may drive the illness to progress. An integrated mental health team that coordinates care with a physician and nutritionist is essential in such a complicated condition. 

When a person with diabulimia enters into treatment they should be met with an abundance of support and understanding. Many feel as though, for the first time, they are not alone. There are even support groups for the loved ones of those who struggle with this eating disorder. 

Therapies for Diabulimia

  • Cognitive behavior therapy (CBT): CBT is a psycho-social intervention that helps individuals solve problems with their thinking, emotions, and behavior. It focuses on challenging cognitive distortions to improve emotional regulation and developing personal coping strategies.
  • Group support and therapy: These therapies are effective forms of treatment that provide people with diabetes who suffer from diabulimia with the help they need to recover. These groups give fellow suffers a place to feel safe as they discuss their disorder. (2)
  • Family based therapy (FBT): FBT treatment is a good tool for parents with teens dealing with the disorder or others with loved ones with diabulimia. This treatment involves the whole family in therapy. It can help aid in recovery and may have better outcomes than individual-based therapy alone. (2)

Medications for Diabulimia

At this time, there is no one medication for diabulimia, but there are many types of treatment available to help aid in recovery.

When receiving treatment for diabulimia it is crucial that your healthcare provider also treat any other co-occurring mental health conditions. This may include treatment for conditions like major depression, obsessive-compulsive disorder (OCD), anxiety disorders, post-traumatic stress disorder, mood disorders, attention deficit hyperactivity disorder (ADHD), and others. 


Understanding

Diabulimia

When trying to understand people with diabulimia it is important to come from a place of compassion and kindness. Someone who is restricting their insulin may not be doing so willingly, as there are underlying triggers, causes, and disorders often associated with diabulimia. They may even want the behavior to end themselves but are unsure where to turn, and/or overwhelmed with anxiety that makes good, health oriented decisions possible. 

Living With Diabulimia

Due to the disruption diabetes has on the patient's metabolic system, people with diabetes are at a higher risk of developing an eating disorder. (2) 

Social support can be beneficial for coping with diabulimia. To find social groups that work, look to ones centered around health-enhancing behaviors rather than focusing on body shape or dieting. 

It can be helpful  to seek out groups with various levels of recovery represented in the group at once. That way, a patient won't feel like an outsider if a person's treatment progresses faster (or slower) than others. (3)

People with diabetes might be at risk of developing ulcers or even death if they do not take proper care of themselves through injections or blood sugar testing multiple times throughout the day. Yet, many choose to neglect treatment rather than face the intense fear of gaining weight. (4) 

History of Diabulimia

Medical professionals have been documenting this disorder for the last 50 years, but the name “diabulimia” was only applied as recently as 2000.6 Although it is not currently classified in the DSM-5, the medical community is slowly becoming more aware of this disorder, and its particular treatment protocols.

How to Help Someone with

Diabulimia

Detection of diabulimia is challenging to manage because of its variable glycemic control and weight changes. It requires the collaborative response of mental health professionals and diabetes specialists. (6)

Being willing to seek help is a crucial first step to cope with this condition. Those struggling with diabulimia benefit from working with a team that understands the many feelings and thoughts associated with omitting insulin, including a preoccupation with weight and shape. For those with a loved one who deals with diabulimia, it's essential to understand their behavior. The best way to do this is by learning about Type 1 diabetes and the eating disorder treatment process. (2)

Remember, diabulimia is a mental health disorder. It cannot be treated by only reinforcing diabetes education or emphasizing the risks of complications from diabetes.

Within Health has established a personal care team designed to support you through your eating disorder treatment. If you or someone you love is looking to heal from diabulimia, the Within clinical care team is here to help. Call us today to get started with your care partner.

Frequently asked questions

Why is diabulimia so dangerous?

If a person has diabetes and is not taking insulin, this will result in large amounts of glucose building up and eventually damaging the organs. Patients with diabulimia will experience long-term complications such as retinopathy, nephropathy, and neuropathy. Their bodies are at risk for going into a state of DKA, (Diabetic Ketoacidosis) an extremely dangerous condition that can lead to death if left untreated. (1)

What are the most severe signs and symptoms of diabulimia?

Diabulimia can cause comas, strokes, and even death. It can also lead to blindness, high blood sugar levels, nausea, vomiting, or chronic diarrhea, if left untreated. And these medical consequences are only one aspect of the condition. The psychological turmoil, pain, and suffering is difficult to quantify, but can cause profound emotional pain and suffering, and low quality of life.

Resources

  1. National Eating Disorders Association. (2018, February 21). Diabulimia. https://www.nationaleatingdisorders.org/diabulimia-5
  2. Coleman, S. E., & Caswell, N. (2020). Diabetes and eating disorders: an exploration of ‘Diabulimia.’ BMC Psychology, 8(1). https://doi.org/10.1186/s40359-020-00468-4
  3. Pereira, R. F., & Alvarenga, M. (2007). Disordered Eating: Identifying, Treating, Preventing, and Differentiating It From Eating Disorders. Diabetes Spectrum, 20(3), 141–148. https://doi.org/10.2337/diaspect.20.3.141
  4. Types of Eating Disorders | ADA. (n.d.). American Diabetes Association. https://www.diabetes.org/healthy-living/mental-health/eating-disorders
  5. Shaw, A., & Favazza, A. (2010). Deliberate Insulin Underdosing and Omission Should Be Included in DSM-V Criteria for Bulimia Nervosa. The Journal of Neuropsychiatry and Clinical Neurosciences, 22(3), 352.e13. https://doi.org/10.1176/jnp.2010.22.3.352.e13
  6. Coleman, S. E., & Caswell, N. (2020b). Diabetes and eating disorders: an exploration of ‘Diabulimia.’ BMC Psychology, 8(1). https://doi.org/10.1186/s40359-020-00468-4
  7. Chelvanayagam, S., & James, J. (2018). What is diabulimia and what are the implications for practice? British Journal of Nursing, 27(17), 980–986. https://doi.org/10.12968/bjon.2018.27.17.980
  8. Mafi, R., Naqvi, A., Jeschke, J., & Kucharska, K. (2016). Therapeutic traps in management of diabulimia in acute setting: A case report. Postępy Psychiatrii i Neurologii, 25(2), 124–128. https://doi.org/10.1016/j.pin.2016.04.003
  9. Peveler, R. C., Fairburn, C. G., Boller, I., & Dunger, D. (1992). Eating disorders in adolescents with IDDM: A controlled study. Diabetes Care, 15(10), 1356–1360. https://doi.org/10.2337/diacare.15.10.1356
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