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Diabulimia: What Is It and How Is It Treated?

What is it?

You’re likely familiar with the eating disorders anorexia, bulimia, and binge eating disorder. The term “diabulimia” refers to an eating disorder in which people with type 1 diabetes skip taking insulin in an effort to lose weight. This condition isn’t recognized by the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Still, diabulimia may have serious health consequences if left untreated.

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Symptoms

What are the symptoms?

Insulin is a hormone in the body that helps cells use glucose as fuel. People with type 1 diabetes no longer produce insulin on their own. Without insulin, glucose accumulates in the blood. It’s flushed out of the body through frequent urination, resulting in rapid weight loss. This symptom is often the intended goal with this eating disorder.

Early symptoms of diabulimia are similar to those of poor insulin control, including hemoglobin A1C levels of 9.0 or higher.

You may also experience:

Secrecy around blood sugar numbers, shots, or eating is another sign of diabulimia, as is cancelling scheduled doctor’s appointments.

Causes and risk factors

What causes this and who’s at risk?

Diabulimia can affect anyone with type 1 diabetes. Constantly monitoring blood sugars and diet may lead to a preoccupation or obsession with your body, weight, and food. Others find it hard to break the cycle of skipping insulin because it allows them to binge on sugary, carbohydrate-heavy foods while still losing weight.

Women with type 1 diabetes, especially preteen and teen girls, may be two and a half times more likely to develop an eating disorder than women without type 1 diabetes. Researchers estimate that between 30 and 40 percent of women with type 1 diabetes have developed or will develop some type of eating disorder. Other studies have suggested that some 30 percent of adolescents with type 1 diabetes skip taking insulin as a means to lose weight.

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Diagnosis

How is it diagnosed?

You may see both your primary care doctor and a mental health professional for your diagnosis.

While diabulimia isn’t included as its own disorder in the DSM-5, insulin omission falls under the criteria for anorexia nervosa. Doctors use this manual to help diagnose eating disorders, but there are many other ways to be diagnosed with this condition.

In general, if you or your doctor thinks you may have an eating disorder, they’ll look at a range of symptoms, from physical to psychological. You’ll likely have a physical exam, a psychological exam, and other tests related to the disease. For example, you may have your blood taken to evaluate your A1C or ketone levels. Learn more about how your doctor may diagnose an eating disorder.

Treatment

How is it treated?

Eating disorder treatment is individual to the person and the disorder. It’s often approached by a group of doctors working together on the physical and psychological aspects. For people with diabulimia, it’s also important to have an endocrinologist and registered dietitian involved. These professionals can give specific advice related to diabetes, such as how to properly match insulin intake with carbohydrate counts.

Your treatment may include anything from nutrition education to psychotherapy to medication.

Cognitive behavioral therapy (CBT) is often used in eating disorder treatment. In sessions, you’ll learn anything from how to cope with stress to how to monitor mood-related eating. Family-based therapy (FT) may also be effective, especially for children and teens.

Those individuals with severe diabulimia may first need hospitalization to address serious health complications. There is currently no specific treatment protocol for people with diabulimia. It may be dangerous to go from high glucose numbers to target numbers too quickly. Therefore, this process is often approached gradually to avoid what are called “treatment-induced” complications.

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Complications

Are there complications?

There are many complications associated with diabulimia. Again, the signs and symptoms may initially look a lot like poorly managed insulin levels. If left untreated, this eating disorder can lead to high glucose levels, glucose in the urine, and dehydration. It may even lead to a condition called diabetic ketoacidosis, or unsafe levels of ketones in a person’s blood. The longer the disease progresses, the more serious the health issues become.

Early complications include:

Later-stage complications include:

In severe cases, diabulimia may even lead to stroke, coma, or death.

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Outlook

What’s the outlook?

The health consequences you experience with diabulimia can be life-threatening. With treatment, though, you can overcome diabulimia and avoid long-term consequences. The first step is making an appointment with your doctor to discuss your concerns and get the medical support you need. Check out this uplifting story about how one woman was able to overcome her eating disorder through travel.

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Support

Where to find support

If you or someone you love may be dealing with diabulimia, there are a variety of other resources that may help as well.

  • The National Eating Disorder Association offers a helpline you can call during much of the workweek at 800-931-2237.
  • The Diabulimia Helpline is another resource where you can find stories, a newsletter, and other support. You can call the helpline 24 hours a day, seven days a week, at 425-985-3635. This group also maintains a support group on Facebook where you can connect with other people dealing with diabulimia.
  • Overeaters Anonymous is an organization you can reach out to for help with a variety of eating disorders. There are support group meetings in many areas throughout the United States and worldwide. There are also online and telephone meetings available.

The earlier you start treatment, the better your outcome. Call your doctor or reach out for support today.

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