Diabulimia and Diabetes
There are a number of different eating disorders that are fairly common in the general public, however they are not generally spoken about openly. This can contribute to a low level of awareness and understanding of the impact of these conditions.
Eating disorders that you may recognise, like anorexia and bulimia, are quite common among people with diabetes, but did you know there are also diabetes-specific eating disorders that many people struggle with? The most common of these is diabulimia. Here we have taken a closer look at this condition, and answered some questions you may have.
What is diabulimia?
Diabulimia is an eating disorder that occurs when a person with type 1 diabetes deliberately and regularly reduces or misses their insulin doses in order to control their body weight. Not taking your insulin can be extremely dangerous and even critical to life.
Although not yet officially recognised as a medical or mental health condition, diabulimia is a serious problem that can speed up the development of diabetes complications and have a significant negative effect on health.2,3 Healthcare professionals are becoming more aware of the risk of diabulimia in people with diabetes and know that the right psychological support is required to address the problem.1
How common is diabulimia?
Studies show that eating disorders are a common and serious concern among girls and young women with type 1 diabetes.3 It is estimated that up to one-third of young women with type 1 diabetes may be struggling with diabulimia.2 Ongoing identification of vulnerable people, treatment of and ways to prevent eating disorders and the potential risk of diabulimia are essential.3 However, this may not happen because teenagers and young adults with diabetes, who are those most at risk of diabulimia, are particularly likely to experience disrupted medical care as they make the move from paediatric to adult care. Effective transition and continuity of care for young people with type 1 diabetes is therefore vital.3
While diabulimia is more common in girls and young women, it is seen in significant numbers of young men as well. Young people with diabetes, who already face numerous issues, may link not taking insulin with losing weight, often without a full understanding of how much damage this can cause to their bodies.2
How does diabulimia develop?
Diabulimia may develop for lots of reasons. It’s usually not just a single thing, but may be a combination of social, mental health, and physical issues. Some of the things you do regularly to manage your diabetes may even play a part, such as:
- Focusing on your weight when you visit a doctor
- Constantly counting calories or carbohydrates in your meals
- Difficulty keeping your weight at a healthy level
- Needing to read food labels carefully
- Eating during hypos, which may lead to guilt or weight gain
- Feeling shame over the way you’re managing diabetes
Sometimes diabulimia may start with the constant focus on managing diabetes. Body image issues, the desire to lose weight, or diabetes burnout may also contribute to developing diabulimia.
If you’ve recently been diagnosed with type 1 diabetes, you may have lost weight before your diagnosis. When you start on insulin, you may gain that weight back. This can be difficult to deal with but is very common, and can lead some people to start skipping insulin doses.
No matter how it begins, it’s often hard to recognise the symptoms and then find a successful treatment.
Common diabulimia warning signs
- Regular attacks of nausea or vomiting
- Dry skin and hair
- Weight loss
- Low potassium or sodium levels
- Blurry vision
- HBA1c that’s 9.0 or higher
- Frequent urination
- Excessive thirst
- Irregular or lack of menstrual periods
- Episodes of diabetic ketoacidosis
- Frequent yeast or bladder infections
Behavioral and emotional warning signs
- Neglecting diabetes management such as checking blood glucose levels
- Strict food rules
- Anxiety or depression
- Being secretive about diabetes management
- Avoiding eating in public or with others
- Worrying that insulin will “make me fat”
- Restricting foods to reduce insulin doses
- Withdrawing from loved ones
- Preoccupation with exercise, weight, food, or calories
- Excessive exercising
- Avoiding doctor’s appointments
- Anxiety about how your body looks
What are the risks?
Diabulimia is a dangerous condition, which can shorten life expectancy,1 as well as increase the risk of several diabetes complications. This is due to consistently high blood sugar levels as a result of lack of insulin.
In the short term, diabulimia may cause a number of health issues such as Bacterial infections, muscle wasting, disruption in your menstrual cycle and diabetic ketoacidosis. By themselves each of these can be very dangerous, but they can also lead onto much longer term problems.
A long period of high levels of glucose in the blood, for example over several months/years, can result in damage to your blood vessels, leading to eye problems. Nerve damage may also occur and cause chronic constipation or diarrhea, slowed stomach emptying, or even burning, tingling, or weakness in your arms, legs, feet, or hands, known as peripheral neuropathy. Eventually, constant levels of high blood sugar can cause damage to your kidneys, liver, or heart, and ultimately even lead to organ failure.
It can be tough to break the cycle of not taking insulin in order to lose weight. However, recovery is possible with support and help, this is why it is key to know the warning signs.
Eating disorder specialists and diabetes teams have become more aware of this eating disorder. Treatment with a full team of specialists is the key to helping you in your recovery. This may include an endocrinologist, mental health professional specialising in eating disorders, and a dietician. Of course, the first step to treatment is asking for help.
Where can I get help?
Managing diabetes isn’t always easy. Dealing with diabulimia makes it tougher. You may be struggling with the way you view your body while feeling bad about hiding this eating disorder from those your love and your healthcare team.
Diabulimia is a serious problem, but with the right support it can be beaten. Remember you can’t do this on your own. Asking for help doesn’t mean you’re weak or that you’ve failed. Everyone working to manage their diabetes deals with their own ups and downs.
It might feel difficult to ask for help, but this is the first step to recovery. Once you share with someone the problems you’re experiencing, you’ll be ready to move forward to getting treatment from healthcare professionals. You can talk to someone you trust, such as a friend or family member, or you can reach out to:
- Your healthcare team
- Diabetics with Eating Disorders (dwed.org.uk) - a charity set up to address eating disorders for people with type 1 diabetes
- Diabetes UK
1. Diabetes UK. https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/diabulimia (last accessed February 2018).
2. Diabetes.co.uk. http://www.diabetes.co.uk/Diabetes-and-Diabulimia.html (last accessed February 2018).
3. Colton PA, Olmsted MP, Daneman D. et al. Eating disorders in girls and women with type 1 diabetes: a longitudinal study of prevalence, onset, remission, and recurrence. Diabetes Care 2015;38(7):1212‒1217.
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