Diabulimia-Dia What?

Peggy Fossen, DNP, RN

Dia what?

This may be the question asked when you bring up the topic of diabulimia. The term diabulimia is a combination of the words diabetes¹and bulimia². Separately, these are two significant health conditions, combine them, and a serious, potentially life-threatening disorder emerges. While diabulimia is an eating disorder, it is not a formal diagnosis and is not specifically addressed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V)³. However, some healthcare professionals are now referring to diabulimia as type 1 diabetes with disordered eating (T1DE) or eating disorder-diabetes Mellitus type 1 (ED-DMT1).

What Exactly is Diabulimia?

Diabulimia is an eating disorder that occurs when a person with type I diabetes deliberately restricts their insulin with the intention of losing weight⁴. Insulin restriction can be achieved by reducing the amount of insulin taken or by stopping the insulin completely. The shortage of insulin results in glycosuria⁵and chronic hyperglycemia⁶, which along with weight loss, brings on serious physiological and psychological health consequences. For the individual with diabulimia, the goal is weight loss, but the lack of insulin puts the body into a state of malnutrition and starvation, resulting in diabetes complications⁷.

Signs

The signs of diabulimia are a combination of diabetes and bulimia and could include:

Losing weight without trying
Diabetic ketoacidosis
High levels of A1c
High blood sugars
Persistent thirst
Frequent urination
Fatigue
Dry skin and hair
Confusion
Muscle loss
Infections
Frequent bladder or yeast infections
Vision problems
Diarrhea or constipation

If not addressed, the long-term consequences can be severe or fatal. Damage to the kidneys, liver, and heart may occur, resulting in coma, stroke, or death. While physical signs may be the first indication of a problem, it is imperative to be alert for the emotional and behavioral signs associated with diabulimia. Some of these signs and behaviors include:

Missing or avoiding appointments related to diabetes management
Expressing fear that insulin makes them fat
Anxiety related to body image
Stress
Depression or mood swings
Avoiding or restricting certain foods
Refuses or avoids eating in public
Strict food rules
Sleep pattern disturbances
Withdrawal or isolation
Excessive exercise
Refusing to test blood sugars or inject insulin in front of others

Risk Factors

Who exactly experiences this disorder, and more importantly, why would they deliberately participate in something that could potentially harm or possibly even kill them? Recent research indicates that approximately 60% of individuals with type 1 diabetes admitted to manipulating their insulin to achieve weight loss. Gender appears as a significant risk factor, with females being affected more than men, specifically young women and adolescents who have been determined to be a high risk for the development of eating disorders. Additional risk factors⁸ that could contribute to the development of diabulimia include:

Anxiety
Depression
Body dissatisfaction
Family conflict
Media influence
Socioeconomic status

Treatment

Certainly, treating physical complications will be of utmost importance, but addressing the emotional aspect is just as important. Diabulimia is considered an eating disorder and mental health disorder. This makes it a very complex and complicated disorder to diagnose and treat.

Because diabulimia is a mental health disorder, professional help is required, with multidisciplinary teamwork being the preferred approach for treatment. This approach includes expertise from medical, nutritional, and psychosocial professionals. Treating diabulimia is a long-term commitment and may involve different approaches and modalities, including:

Cognitive behavior therapy (CBT)⁹
Group therapy
Family therapy
Dialectical behavior therapy (DBT)¹⁰
Nutrition counseling

Awareness

While there is still much to learn about this disorder, it seems progress is being made with increased awareness related to the subject. Resources are becoming readily available, such as the diabulimia helpline¹¹. More studies¹² are being conducted with the aim of increasing the awareness and understanding of diabulimia. Eating disorder programs, such as The Emily Program¹³, provide information specific to the treatment of diabulimia. While it is important for those who care for individuals with eating disorders to be knowledgeable about diabulimia, it is equally important for other healthcare providers to possess this knowledge related to diabulimia. Being in possession of such knowledge will increase awareness of this condition, allowing for timely and accurate diagnoses and treatment. This could make a significant difference in the life of someone suffering from diabulimia.

References/Resources

¹What is Diabetes?: CDC

²Bulimia: MentalHealth.gov

³An Overview of the DSM-5: Verywell Health

⁴What Is Diabulimia?: WebMD LLC

⁵What Is Glycosuria?: WebMD LLC

⁶High Blood Sugar and Diabetes: WebMD LLC

⁷Diabetes Complications: WebMD LLC

⁸A review of risk factors associated with insulin omission for weight loss in type 1 diabetes: National Center for Biotechnology Information: National Library of Medicine

⁹Why CBT Is Usually Suggested for Eating Disorders: Verywell Mind

¹⁰Dialectical Behavior Therapy for Eating Disorders: Verywell Mind

¹¹DBH 24 Hour Hotline: Diabulimia Helpline