Diabulimia

Diabulimia (a portmanteau of diabetes and bulimia) is an eating disorder in which people with type 1 diabetes deliberately give themselves less insulin than they need or stop taking it altogether for the purpose of weight loss. Diabulimia is not recognized as a formal diagnosis by the medical or psychiatric communities, but the phrases “disturbed eating behavior” or “disordered eating behavior” (DEB in both cases) and disordered eating (DE) are quite common in medical and psychiatric literature addressing patients who have type 1 diabetes and manipulate insulin doses to control weight along with exhibiting bulimic behavior.

Signs and symptoms

A person with diabulimia, especially if not treated early, can suffer negative effects on the body earlier than one who is managing properly. Of diabetics who have a DEB, some intentionally misuse insulin to control weight.

Suspension of insulin combined with overeating can result in ketoacidosis. Multiple hospitalizations for ketoacidosis or hyperglycemia are cues to screen for an underlying emotional conflict.

Short term

The short-term symptoms of diabulimia are:

• Frequent and excessive urination
• Frequent and excessive thirst
• Frequent and excessive hunger
• High blood glucose levels (often over 600 mg/dL or 33 mmol/L)
• Weakness
• Fatigue
• Large amounts of glucose in the urine
• Inability to concentrate
• Electrolyte disturbance
• Severe ketonuria, and, in DKA, severe ketonemia
• Low sodium levels

Medium term

These are the medium-term symptoms of diabulimia. They are prevalent when diabulimia has not been treated and hence also include the short-term symptoms.

• Muscle atrophy
• GERD
• Indigestion
• Severe weight loss
• Proteinuria
• Moderate to severe dehydration
• Edema with fluid replacement
• High cholesterol

Long term

If a person with type 1 diabetes who has diabulimia suffers from the disease for more than a short time—usually due to alternating phases during which insulin is injected properly and relapses during which they have diabulimia—then the following longer-term symptoms can be expected:

• Severe kidney damage: high blood sugar can overwork the kidneys, eventually leading to kidney failure and the need for a kidney transplant
• Severe neuropathy (nerve damage to hands and feet)
• Extreme fatigue
• Edema (during blood sugars controlled phases)
• Heart problems
• Retinal damage and subsequent vision problems
• High cholesterol
• Osteoporosis
• Death

Often, people with type 1 diabetes who omit insulin injections will have already been diagnosed with an eating disorder such as anorexia nervosa, bulimia nervosa, or EDNOS. These individuals often think diabulimia is less common than it is and do not know how difficult it is to overcome. Unlike anorexia and bulimia, diabulimia sometimes requires the afflicted individual to stop caring for a medical condition. Unlike vomiting or starving, there is sometimes no clear action or willpower involved.

Many articles and studies further conclude that diabetic females have, on average, higher body mass index (BMI) than their nondiabetic counterparts. Girls and young adult women with higher BMIs are also shown to be more likely to have disordered eating behavior (DEB). Many authoritative articles show that preteen and teenage girls with type 1 diabetes have significantly higher rates of eating disorders of all types than do girls without diabetes. This condition can be triggered or exacerbated by the need for diabetics to exercise constant vigilance in regard to food, and glycemic control. In adolescent females, increased weight gain that insulin treatment can cause may increase the risk of anorexia and/or bulimia.

Treatment

There are no specific guidelines for the treatment of diabetes and disordered eating, but the standard approach for treatment of two complex conditions as multidisciplinary team of professionals which in this case could include an endocrinologist, psychiatrist, psychologist, dietician, etc.

See also

• Diabetes mellitus
• Bulimia nervosa
• Eating disorder