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DIABULIMIA

Diabulimia is a media-coined term referring to an eating disorder affecting people with Type 1 Diabetes, in which the sufferer purposefully restricts insulin to lose weight. Currently, Diabulimia is not formally recognized as an eating disorder and does not have its own diagnostic criteria. Instead a person’s diagnosis will depend on their eating disorder behaviours. 

 

Only people with Type 1 Diabetes can have Diabulimia, as Type 2 Diabetes is often treated with drugs that do not contain insulin, and even if the drugs do contain insulin, the consequences of restricting insulin are not the same. Nevertheless, people with all types of Diabetes are at an increased risk of developing eating disorders due to a variety of reasons, including:

  • A diagnosis of any chronic illness is likely to trigger feelings of stress, anxiety, and/or depression, putting an individual at a higher risk of developing disordered eating behaviours.

  • Furthermore, the elevated focus, specifically on control, of food and numbers such as weight and blood glucose, can lead to controlling and perfectionist behaviours that are understood to be true in eating disorder development. 

  • Finally, the weight gain commonly associated with proper insulin usage can impact body image, putting people with Diabetes at an even greater risk of developing eating disorders

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Symptoms of Diabulimia

 

The symptoms of Diabulimia vary from person to person, however certain physical and psychological symptoms are commonly observed.

 

Some psychological symptoms are similar to those of other eating disorders, while others are more specific to Diabulimia:

  • Extreme focus on food, weight and/or calories

  • Expressing concerns about their appearance and/or weight

  • Isolating themselves and avoiding social activities

  • Refusing to eat in front of others

  • Exhibiting signs of depression or anxiety

  • Talking about insulin’s effect on weight

  • Secrecy or discomfort surrounding Diabetes management

  • Avoiding medical appointments, particularly those that are Diabetes-related


The physical symptoms of Diabulimia can be severe, including:

  • Nausea or vomiting

  • Frequent urination

  • Bladder infections

  • Blurred vision

  • Inconsistent readings of A1C (estimated average of sugar in one’s blood)

 

Some physical symptoms may also resemble those of other eating disorders, including:

  • Secondary amenorrhea: The absence of a menstrual cycle in previously menstruating individuals

  • Irregular heart rate

  • Rapid, unexplained weight loss

  • Dry skin or hair

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Risks of Diabulimia

 

People with Diabulimia frequently skip insulin shots. Subsequently the body cannot use sugar for energy, and the excess sugar is flushed out of the body in urine. Therefore the body is forced to break down fat for energy, causing weight loss and producing ketones. This process is not necessarily dangerous in itself, however excess ketones can cause a dangerous medical condition known as ketoacidosis, in which the blood becomes too acidic. Diabetic ketoacidosis (DKA) can cause severe damage to the liver and kidneys and possibly even result in death. Symptoms of DKA include confusion, fruity breath, nausea, severe dehydration and breathing issues. Many of the most severe complications of Diabulimia occur due to recurrent episodes of DKA.

 

Unlike other eating disorders, Diabulimia involves the frequent restriction of insulin, which can cause severe medical complications, including various short-term and long-term effects:

  • Loss of muscle tissue

  • Reduced immune system function

  • Frequent bacterial or yeast infections

  • Temporary or permanent eye damage

  • Pain, numbness, or tingling of limbs

  • Chronic illnesses such as kidney, heart and liver disease

 

Diabulimia is an incredibly serious mental illness with a multitude of dangerous consequences, prompting some to refer to it as “the world’s most dangerous eating disorder”. Diabulimia can lead to stroke, coma or even death, therefore early treatment is vital to prevent serious consequences.

Diabulimia Treatment

 

Treatment of Diabulimia can be difficult and complex, as eating disorder treatment and Diabetes treatment often conflicts with one another. Diabetes treatment involves reading labels and counting carbohydrates and calories, however eating disorder treatment generally involves counselling to do the opposite. Therefore, people with diabulimia must receive supervised, specialized treatment. If you or someone you care about is showing signs of Diabulimia, please seek nutritional, medical and psychological help from mental health professionals. 

  • A diagnosis of any chronic illness is likely to trigger feelings of stress, anxiety, and/or depression, putting an individual at a higher risk of developing disordered eating behaviours.

  • Furthermore, the elevated focus, specifically on control, of food and numbers such as weight and blood glucose, can lead to controlling and perfectionist behaviours that are understood to be true in eating disorder development. 

  • Finally, the weight gain commonly associated with proper insulin usage can impact body image, putting people with Diabetes at an even greater risk of developing eating disorders

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If you are in need of help, reach out to the Thailand Samaritans English helpline: 02-713-6791

By Carolyn Suradejvibul, Year 13 Student at Bangkok Patana School

 

Sources and Further Reading: 

​The Recovery Village, 2020, Diabulimia [Online] [Accessed August 2020] Available from: https://www.therecoveryvillage.com/mental-health/diabulimia/ 

Diabetes UK, 2020, Diabulimia and Diabetes [Online] [Accessed August 2020] Available from: https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/diabulimia 

National Eating Disorders Association, 2020, Diabulimia [Online] [Accessed August 2020] Available from: https://www.nationaleatingdisorders.org/diabulimia-5 

The Recovery Village, 2020, 5 Common Myths About Diabulimia [Online] [Accessed August 2020] Available from: https://www.therecoveryvillage.com/mental-health/diabulimia/related/diabulimia-myths/ The Gabbert-Montag A, 2020, Diabulimia/ED-DTM1 Terminology [Online] [Accessed August 2020] Available from: https://www.waldeneatingdisorders.com/blog/diabulimiaed-dtm1-terminology/

Williams E, 2020, Complications From Diabulimia [Online] [Accessed August 2020] Available from: https://www.waldeneatingdisorders.com/blog/complications-from-diabulimia/ 

Kadis S, 2020, 5 Things You Need To Know About Diabulimia [Online] [Accessed August 2020] Available from: https://www.waldeneatingdisorders.com/blog/5-things-you-need-to-know-about-diabulimia/  Ellis R, 2020, 5 Things You Need To Know About Diabulimia [Online] [Accessed August 2020] Available from: https://www.webmd.com/diabetes/what-is-diabulimia