What is Diabulimia?
Diabulimia is an eating disorder that individuals living with diabetes may experience. Individuals living with diabulimia intentionally restrict their insulin usage to lose weight. Diabulimia is not recognized in the DSM-5, which is the diagnostic manual for eating disorders. However, deliberately restricting insulin is classified in the DSM-5 as a purging behaviour, and therefore if your child is living with diabulimia they may be formally diagnosed with bulimia nervosa. Bulimia nervosa is characterized by both bingeing and purging behaviours. Although diabulimia itself is not a formal diagnosis, it is a unique medical issue that must be taken very seriously.
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Type 1 Diabetes and Eating Disorders
Eating disorders are more prevalent in people living with Type 1 diabetes than the average population. This is particularly true in women and young girls. In fact, 20% of females living with diabetes have an eating disorder, and eating disorders are twice as likely to occur in teens living with diabetes compared to those who do not have diabetes.
20% of females living with diabetes have an eating disorder
There are many factors that may increase the risk of eating disorders in individuals living with Type 1 diabetes. One of the most common reasons is that folks with diabetes have been bombarded with nutrition information since their diabetes diagnosis. Your child may always have had to be mindful of when and what they eat because of their diabetes. They’ve also likely had to focus on meal planning, food portions and monitoring their carbohydrate intake since their diagnosis. This makes your child more susceptible to developing an eating disorder.
Other factors that may increase the risk of your child developing an eating disorder are concerns about their weight and shape, and difficulty coping with their diabetes diagnosis. Diabulimia can develop at any age or any time after the diabetes diagnosis.
Diabulimia
As we mentioned above, diabulimia is an informal diagnosis that is primarily concerned with the intentional restriction of insulin to control weight. Another medical term you may hear is ED-DMT1, or Eating Disorder-Diabetes Mellitus Type 1. This term is used more broadly to describe the presence of any eating disorder alongside Type 1 Diabetes.
How Does Insulin Work?
Insulin is a hormone that is produced by the pancreas and released into the bloodstream in response to blood sugar levels. When we consume food or drinks, the glucose from the food is absorbed by our digestive systems and into our bloodstream. When our blood sugar levels increase, the body releases insulin. Insulin tells our cells to take in the sugar from the bloodstream, which the cells then use for energy. This lowers our blood sugar levels. If your child is living with Type 1 diabetes, their body does not produce insulin which is why your child needs to inject insulin instead to regulate their blood sugar.
Insulin Restriction
Folks living with diabulimia may restrict their insulin in different ways. Your child may take too small a dose of insulin or not take their insulin at all. For example, your child may take their basal insulin, but not their mealtime bolus insulin injections. Some folks living with diabetes and an eating disorder may not omit their insulin at all. Instead, they may restrict food, binge and vomit, use laxatives or excessively exercise. All of these are considered purging behaviours.
Diabulimia Symptoms
Physical Signs and Symptoms
- Consistent A1C higher than 9.0
- Unexplained weight loss
- Frequent nausea and/or vomiting
- Multiple DKA episodes (diabetic ketoacidosis)
- Irregular or absent menstruation in females
- Fatigue
- Dry skin and hair
Mental and Emotional Signs and Symptoms
- Increased neglect of diabetes management
- Secrecy regarding diabetes management
- Extreme diet changes
- Anxiety about body image, weight, and/or shape
- Strict food rules and rituals
- Withdrawal from friends and family
- Preoccupation with food, calories, or weight
Diabulimia Health Consequences
If your child is not taking the amount of insulin they need, then their body cannot use the sugar available in the blood for energy because the sugar is not being taken up by their body’s cells. This would result in their blood sugar always remaining high. Similarly to when your child was diagnosed with diabetes, excess sugar will be excreted in their urine. By not taking their insulin as needed, your child may “binge” on calories because they will not be absorbed into the body. Instead, these calories are “purged” through their urine.
Since sugar cannot be used as energy by the body’s cells without insulin, your child’s body must break down fat and protein for energy instead. The breakdown of fat can lead to diabetic ketoacidosis, which is a very dangerous complication that can be life-threatening. In diabetic ketoacidosis, the pH of the blood becomes too acidic. Other possible health concerns due to diabulimia include vision loss and kidney damage.
Type 2 Diabetes
In Type 2 diabetes, individuals still produce insulin, but their cells do not respond normally to it. This is also known as insulin resistance. Initially, the body responds by producing more insulin to get the cells to let in the sugar from the blood and into the cells. As their diabetes progresses, they slowly develop impaired insulin secretion. In the early stages of Type 2 diabetes, medications other than insulin are typically used to control blood sugar levels. As diabetes progresses, folks may begin using insulin to help control blood sugar levels.
Type 2 Diabetes and Binge Eating Disorder
Binge eating disorder is the most common eating disorder that folks living with Type 2 diabetes are diagnosed with. The prevalence range of binge eating disorder in people living with Type 2 diabetes is 5-26%. Studies show that living with binge eating disorder and Type 2 diabetes does not have a direct effect on blood sugar control. However, all eating disorders are serious health concerns and should not be taken lightly.
How to Get Help for Your Child
Change Creates Change Eating Disorder Care is here for you if you suspect your child is living with diabulimia. We understand how challenging and complex this issue can be. If you are interested in learning more about how we can support you, click below to book a free, 15-minute consultation call with us.
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