Diabulimia in Children & Teens

Reviewed by Clinical Director, Jillian Walsh, RD, RP

What is Diabulimia?

Diabulimia is an eating disorder that individuals living with diabetes may experience. Individuals living with diabulimia intentionally restrict their insulin usage in an attempt 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 – which isn’t surprising! Other factors that may increase the risk of your child developing an eating disorder are that your child may have concerns about their weight and shape, and have 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 in an attempt 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 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. Cells taking in sugar from the bloodstream ultimately 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 in order to regulate their blood sugar.

Image of items used by individuals living with diabetes to determine blood sugar and whether ketones are present in the urine

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.

Warning Signs and 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

As we talked about earlier, children living with diabetes can also be affected by eating disorders other than diabulimia. To learn more about how to spot an eating disorder in your child, check out our blog post here.

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. This is 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. Above we mentioned that if your child is living with diabulimia, they may be diagnosed with bulimia nervosa because insulin restriction is considered a purging behaviour. Bulimia nervosa is characterized by both bingeing and purging behaviours. 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 will be “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 Eating Disorders

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.

References

  1. Coleman, S. E., & Caswell, N. (2020). Diabetes and eating disorders: an exploration of “Diabulimia”. BMC Psychology, 8(101). https://doi.org/10.1186/s40359-020-00468-4
  2. Diabulimia. (n.d.). NEDA. Retrieved June 1, 2021, from https://www.nationaleatingdisorders.org/diabulimia-5 
  3. Winston, A. P. (2020). Eating Disorders and Diabetes. Current Diabetes Reports, 20(32). https://doi-org.proxy1.lib.uwo.ca/10.1007/s11892-020-01320-0
  4. Ahmad, A. (2014). Insulin sources and types: a review of insulin in terms of its mode on diabetes mellitus. Journal of Traditional Chinese Medicine, 34(2), 234-237. https://doi.org/10.1016/S0254-6272(14)60084-4
  5. Castillo, M., & Weiselberg, E. (2017). Bulimia Nervosa/Purging Disorder. Current Problems in Pediatric and Adolescent Health Care, 47(4), 85-94. https://doi.org/10.1016/j.cppeds.2017.02.004
  6. Todd, C., L. (2019). What to Know About Diabulimia, the Eating Disorder Specific to Diabetes. SELF. Retrieved June 1, 2021 from https://www.self.com/story/diabulimia-facts
  7. Prahalad, P., Tanenbaum, K., & Maahs, D., M. (2018). Diabetes technology: improving care, improving patient-reported outcomes and preventing complications in young people with Type 1 diabetes. Diabetic Medicine, 35(4), 419-429. https://doi-org.proxy1.lib.uwo.ca/10.1111/dme.13588
  8. Rewers, A. (2012). Current Concepts and Controversies in Prevention and Treatment of Diabetic Ketoacidosis in Children. Current Diabetes Reports, 12, 524-532. https://doi-org.proxy1.lib.uwo.ca/10.1007/s11892-012-0307-2

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