Diabulimia Definition

In this article, I will explain what is the diabulimia definition.

We have all heard about how stress can cause a multitude of psychological and physical disorders and health problems.

What can be more stressful than having to live every day managing type 1 diabetes?

Diabulimia is just what it sounds like. A type 1 diabetic who withholds insulin to lose weight and also shows symptoms of bulimia or other eating disorders.

I had never even thought about the possibility of a diabetic having an eating disorder.

Seriously though, with so much focus on eating the right foods, carb counting for dosage, nutrition labels, maintaining a healthy weight while requiring multiple doses of a medication linked to weight gain, I can see how someone could easily develop an eating disorder.

And if a type 1 diabetic were to accidentally discover that by keeping their blood sugars high, they can lose weight, well that sounds like a recipe for disaster regardless of age.

Isn`t that scary?

I think it is terrifying.

I have 5 grand-daughters and while they are not diabetic, it scares me to think of how easily they could develop an eating disorder.

In this day and age where the media worships super thin, models and it seems fat-shaming is prevalent everywhere is it any wonder these kids are at risk?

So let’s take a closer look at diabulimia and see how we can prevent it – if we can.

Diabulimia definition

Diabulimia is a term referring to an eating disorder in a person with diabetes where they restrict their insulin to lose weight.

Medical professionals tend to refer to it as ED-DMT1 (Eating Disorder-Diabetes Mellitus Type 1) and refers to any type of eating disorder in combination with type 1 diabetes.

Because the treatment of type 1 diabetes involves such a strong focus on food, labels, carb counting, numbers(blood glucose, A1c, weight) as well as the many fluctuations in the person’s metabolic system it is known that diabetes significantly increases the risk of developing an eating disorder.

A person can develop diabulimia at any age after a diabetes diagnosis. Treatment is difficult because both diabetes and eating disorders must be treated simultaneously.

Anorexia Nervosa definition

Anorexia Nervosa is an eating disorder characterized by low weight, food restriction,  intense fear of gaining weight, and an unrealistic perception of their body weight.

This means they see themselves as overweight when in fact they are underweight.

They often seek to control weight by severely restricting calories, vomiting after eating, misusing laxatives, diet aids, diuretics, enemas, or excessive exercising.

Bulimia Nervosa definition

Bulimia Nervosa is characterized by someone binge eating (excessively over-eating) followed by forced vomiting (purging).

Bulimic people have a fear of gaining weight. People with bulimia may be underweight or overweight.

In either case, they are trying to prevent further weight gain by purging.

Who’s at risk

It is well known that preteen and teen girls are quite obsessed with their appearance and for those who also have type 1 diabetes this is even more so.

Add to that the fact that to properly manage their diabetes they must heavily focus on food, labels, count carbs, weight, and exercise, it is enough to push them over the edge into a full-blown eating disorder.

Then add the fact that the very life-saving insulin they require also has a tendency to cause weight gain and we have a recipe for disaster.

According to the American Diabetes Association, women with type 1 diabetes are two and a half times more likely to develop an eating disorder than their non-diabetic peers. If that isn’t enough, type 1 diabetes is a known risk factor for developing an eating disorder.

They estimate that over 30% of women and young girls with T1D either have or will develop an eating disorder.

I don’t know about you but I find these statistics extremely disturbing.

These are not just statistics, these women and girls are our friends, mothers, daughters, and sisters.

Yet they are struggling with such a deadly combination risking their very lives to either lose or maintain low body weight and the majority of us don’t even know this exists.

We need to learn what to look out for so we can get them the help they desperately need before it is too late.

Warning Signs

Anyone who has a diabetic preteen, teen, or young woman in their life should keep an eye out for any of these signs or symptoms.

If you start to notice several symptoms, alarm bells should be going off and you need to discuss this with the diabetes care team.

Emotional and Behavioral

• neglecting diabetes management
• secrecy around diabetes management
• skipping diabetes-related appointments
• fear of low blood sugars
• stating that “insulin makes me fat”
• extreme increase or decrease in diet
• extreme anxiety about body image
• restricting certain food groups to lower insulin doses
• avoids family or public eating
• not wanting to test or inject in front of others
• overly strict food rules
• constantly preoccupied with food, weight, or calories
• excessive exercise
• increased sleep
• withdrawing from activities with family or friends
• depression/anxiety
• not filling prescriptions

Physical

• a continued A1c of 9.0 or higher
• A1c inconsistent with meter readings
• unexplained weight loss
• constant bouts of nausea or vomiting
• persistent thirst and frequent urination
• multiple DKA or near DKA episodes
• low sodium and/or potassium
• frequent bladder/yeast infections
• irregular or absent menstruation
• blurry vision
• fatigue or lethargy
• dry skin and hair

Health Consequences

Although the restriction of insulin does cause type 1 diabetics and their caregivers are fully aware of the fact that this practice also causes the blood glucose levels to skyrocket significantly increasing the risk of many complications of diabetes Mellitus.

Some of those complications can be felt in the short term and others only become apparent over time.

Short term

Short term health effects of withholding insulin for weight loss can include:

• slow healing of wounds – high blood sugar causes slower circulation which affects the function of both the red and white blood cells decreasing the body’s ability to heal
• increased bacterial infections – high blood sugar reduces the body’s ability to fight off infection-causing bacteria. This in turn increases the risk of developing sepsis, gangrene, or bone infection.
• increased yeast infections – increased blood sugar encourages overgrowth of yeast often in the vaginal area.
• muscle atrophy – withholding insulin means the body can’t use the glucose from the food we eat causing starvation which means our cells will begin to break down muscle tissue for energy.
• disruption of the menstrual cycle –  starvation can cause the menstrual cycle to become irregular or possibly even cease.
• severe dehydration – insulin deficiency puts the body in starvation mode which causes the body to break down tissue causing ketones to use as fuel, our body tries to flush the ketones through increased urination causing dehydration.
• electrolyte imbalance – when the kidneys extract ketones to use as the fuel they also extract sodium and potassium which can cause an electrolyte imbalance especially if the person is also vomiting which commonly occurs with high ketone levels.

Long term

High blood sugars and heightened ketone levels cause the blood to be acidic which causes damage to blood vessels.

This damage is often first noticed in the eyeball as tiny vessels begin to leak.

Retinopathy – small black spots disrupting the vision

Macular Edema – swelling of the eyeball due to increased fluid

Prolonged periods of high blood sugar can cause nerve damage. Evidence of nerve damage may present as:

Peripheral Neuropathy – pain, weakness, numbing, or weakness of the hands or feet

Vasovagal Syncope – malfunction of the nervous system causing a sudden drop in blood pressure which can lead to fainting

Chronic Diarrhea or Constipation – when nerves to the colon are damaged

Other organ damage – may include kidney disease, liver disease, heart disease. Many of these can be fatal. Some like kidney or liver disease may develop over time.  While heart disease or DKA can develop quickly causing coma, stroke, or death.

 

Treatment

It concerns me that diabulimia is not recognized or included in the Diagnostic andStatistical Manual of Mental Disorders (DSM-5). It should be as it can result in very serious medical problems as we learned above.

The treatment for Diabulimia isn’t a quick fix.

It will take many different approaches and a lot of hard work to overcome set behavioural patterns and learn to control triggers.

The best course of action would be to work closely with a team that includes:

• endocrinologist
• a dietician
• a mental health professional who specializes in eating disorders (psychiatrist, psychologist)
• your family doctor

Both the patient and health care professionals must understand “good enough” diabetes control is the target here. Too strictly managing diabetes at this point risks burnout and a return to unhealthy habits.

A combination of individual and family therapy may be necessary.

Remaining an outpatient should be contingent upon:

• consistently taking a certain amount of insulin
• being able to eat enough food to maintain weight
• not purging to the point of electrolyte imbalance

If it is deemed necessary for a higher level of care it is important to ensure the treatment center specializes in diabulimia/ ED-DMT1.

It is important to remember that diabulimia is a serious mental health disorder and can not be treated by simply reinforcing diabetes management.

It will be a long uphill battle but its treatment can be successful.

Final Thoughts

This article has taught us the diabulimia definition as well as the signs and symptoms to look out for.

We have discussed the many health risks that can result from diabulimia if it is left untreated.

We have also explained the depth of the long term treatment plan required to successfully overcome this serious mental disorder.

Those of us with a family member with type 1 diabetes need to be on the lookout for symptoms of this serious disorder and ensure they get the help they desperately need.

Judging them, or harping on about diabetes management won’t help. It may worsen their self-image which could, in turn, make their condition even worse further risking their health.

Be supportive throughout the recovery process and remember just like any other mental disorder it is an everyday battle. Help them, encourage them but don’t ever judge them.

I am not in any way a medical practitioner, please do not rely on the information on our website as an alternative to medical advice from your doctor or another healthcare provider. We only share our experiences.

Do you know anyone who has struggled with diabulimia?

Do you have any suggestions for helping not only the patient but the family as well?

Leave your suggestions in the comment section below.