Diabulimia: The intersection of Diabetes and Eating Disorders
Written by: Megan Bogue, M.Ed., LPC
What exactly is Diabulimia?
Diabulimia is a term not commonly know in circles outside of the world of eating disorder treatment. This term is coined to represent a person with type one diabetes whom intentionally restricts insulin in an effort to lose weight. Unfortunately, this is a common issues for teens and adolescents however, it can occur at any age or station in life.
Once a person is properly treated for type one diabetes and begin insulin their bodies change rapidly often leading to weight restoration and changes to a person’s appearance. Fluid retention is typical during this stage which can lead the individual to feel a preserved sense of loss of control. Diabulimia can develop out of a desire to lose weight, difficulties with body image or especially diabetic burnout. The health consequences of co-occurring eating disorders and diabetes are serious and can be life-threatening. The risk of death for diabulimia is 17 times more likely than type-1 diabetes alone, and seven times more likely than anorexia alone according to the National Eating Disorder Association.
What is Type 1 diabetes and how does it affect the body?
A person who is diagnosed with Type 1 diabetes isn’t able to produce insulin on their own thus they must inject insulin into their body every day with every meal. Furthermore, glucose (a sugar) — is a main source of energy for the cells that make up muscles and other tissues. Glucose comes from two major sources: food and the liver. When glucose levels are low, such as when you haven't eaten in a while, the liver breaks down the stored glycogen into glucose. This keeps glucose levels within a typical range. In type 1 diabetes, there's no insulin to let glucose into the cells. Because of this, sugar builds up in the bloodstream. This can cause life-threatening complications. - National Eating Disorder Association
What causes Diabulimia?
When you have Type 1 diabetes, the things you need to do to manage it can play a part in triggering diabulimia and other eating disorders, including:
Constant and intense focus on food, especially counting carbohydrates.
Having to carefully read nutrition labels.
Needing to track several numbers, such as blood glucose levels, A1c results and weight.
Needing to consume food in order to treat low blood sugar (hypoglycemia), which can lead to weight gain.
Feeling shame about how you manage your diabetes and/or for having a chronic illness.
Difficulty maintaining a healthy weight.
Warning Signs & Symptoms of Diabulimia
Increasing neglect of diabetes management
Secrecy about diabetes management
Avoiding diabetes related appointments
Fear of low blood sugars
Fear that “insulin makes me fat”
Extreme increase or decrease in diet
Extreme anxiety about body image
Restricting certain food or food groups to
Lower insulin dosages
Unexplained weight loss
Constant bouts of nausea and/or vomiting
Persistent thirst and frequent urination
Low sodium and/or potassium
Frequent bladder and/or yeast infections
Irregular or lack of menstruation
Deteriorating or blurry vision
Fatigue or lethargy
Dry hair and skin
Challenges to Treatment
While recovery from eating disorders is possible with treatment, diabetes is a lifelong illness, the management of which requires a different, more complicated relationship with food. People with diabetes can't base food choices on hunger cues, wants, or intuition and often develop rigid eating behaviors, making them even more susceptible to disordered eating.
Weight stigma causes some individuals to feel pressure to lose weight in an effort to avoid judgment or the perception that their lifestyle choices "caused" their diabetes. Diabulimia clients typically require more medical touchpoints than their peers and have unique nutritional needs such as being required to read food labels. Making peace with individual recovery needs can be a challenging but worthwhile part of the process. This can lead the individual to feel “different” even from other individuals in recovery for an eating disorder.
Lastly, because diabulimia clients must keep track of their carb intake, they – unlike their peers – are required to read food labels. When “life happens” in the form of last-minute menu changes, diabulimia clients may struggle more than others in their program to adapt. Most if not all eating disorder clients need help learning to embrace flexibility in recovery, but diabulimia clients may need extra
Treatment
No matter where someone is at in their eating disorder or recovery, a multidisciplinary team is necessary to address the many entangled issues present with diabulimia. The best scenario for a patient is to see an endocrinologist, a dietician who has knowledge of both diabetes and eating disorders, and a mental health professional who specializes in eating disorders.
Both healthcare professionals and patients need to remember that “good enough” diabetes management is the goal, not “perfect” control. The quest for perfection can lead to an increase in diabetes burnout and enhance all-or-nothing thinking which in turn can boost the eating disorder.
Remaining in an outpatient setting should be contingent upon taking a minimum amount of insulin consistently, being able to eat enough food to maintain weight, and not engaging in degrees of purging that causes dangerous electrolyte imbalance.
Remember that diabulimia is a serious mental health disorder, thus it cannot be treated by simply reinforcing diabetes education or stressing the dangers of diabetes complications.
We can help you have a positive relationship with food and your body.
Your therapist will work closely with your dietician, medical doctor, and/or psychiatrist to ensure that you have all the pieces you need for sustainable recovery.
References
Ali Beckman, M. (2022, November 4). What is diabulimia?: Signs, symptoms, risk factors, treatment. Alsana®.https://www.alsana.com/blog/what-is-diabulimia-signs
Diabulimia. National Eating Disorders Association. (2018, February 21). https://www.nationaleatingdisorders.org/diabulimia-5 professional, C. C. medical. (n.d.-a). Diabulimia: What it is, symptoms, risk factors & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22658-diabulimia