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Post written by Hina Ashraf dietetic intern, reviewed by Shena Jaramillo, MS, RD
Diabulimia is commonly seen in people with type 1 diabetes. In this eating disorder, a person with type 1 diabetes intentionally reduces or eliminates insulin dosage to lose weight.
Diabulimia relies on the absence of insulin produced by the body to shrink the body. With the inability to process glucose, the body experiences rapid weight loss as well as potentially deadly spikes in blood sugar.
This article digs into some of the risk factors for developing diabulimia, warning signs to watch out for and effective treatment for diabulimia.
What are the symptoms of diabulimia?
Behavioral warning signs of diabulimia
Diabulimia often comes with behavioral signs of the condition before an official diagnosis can be made. Many behavioral signs of diabulimia are similar to other warning signs of eating disorders.
- Neglecting diabetes management
- Not taking insulin for meals or taking inadequate dosage of insulin for meals
- Secretive about diabetes management
- Missing diabetes-related physician’s appointments
- Uncomfortable in testing blood sugar or taking insulin in front of other people
- Not filling the insulin prescriptions regularly
- Extreme rise or reduction in food intake
- Disengagement from friends and/ or family activities
- Avoids having food with family and/ or in public
- Rigid and/or compulsive exercise pattern
- Unusual sleepiness
Emotional warning signs of diabulimia
- Fear of insulin causing weight gain
- Anxiety about body image
- Feeling exhausted by diabetes management
- Anxious about low blood sugars (hypoglycemia)
- Presence of depression or anxiety
- Getting easily annoyed and/or frequent mood swings
- Compulsive about food, weight and/or calories
Physical warning signs of diabulimia
- HgA1c (average blood glucose of 3 months) is 9.0 or higher on a regular basis
- Weight loss
- Frequently experiencing nausea and/ or vomiting
- Constant thirst and frequency in urination
- Several DKA (diabetic ketoacidosis) or near DKA episodes
- Low Sodium or Potassium levels
- Repeated bladder and/ or yeast infections
- Lack of menstruation
- Hair loss
- Dryness of skin and hair
Physical signs of diabulimia occur rapidly, but might not be immediately apparent to others. The extent of the physical symptoms of diabulimia will also depend on if the person is simply reducing their insulin dosages or eliminating them altogether.
Physical signs of diabulimia occur because the body cannot absorb glucose for energy leading to high glucose levels in the blood.
The body will try to get rid of excess glucose through excessive urination. The body starts breaking down its muscle and fat reserves. As a result, the person will lose weight.
What are the causes of diabulimia?
Diabulimia is a complex mental and physical health condition. There is never just one cause.
Diabulimia can be a result of a mixture of physical, social, and mental health concerns.
Here are some triggers for diabulimia:
- Diabetes burnout
- Longing for a sense of control
- Distorted body image
- Weight changes with diabetes diagnosis
- Peer pressure
Keeping track of the foods you are eating, reading food labels, and carbohydrate counting can be exhausting for someone with diabetes. This can create a toxic focus on food and potentially trigger an eating disorder.
A person with diabetes can feel mental exhaustion and annoyance regarding diabetes management. This can make you stop checking your blood sugar regularly and not taking the insulin dosage accordingly.
Lack of appropriate blood sugar testing and insulin dosing results in high blood sugar levels and insufficient insulin in the body, which can cause weight loss. This can also turn into a vicious cycle of intentionally reducing insulin dosage to lose weight.
Distorted Body Image and Diabulimia
A person who has a distorted body image is more likely to develop eating disorders, including diabulimia. People with diabetes can be more concerned about their body image as excess weight is stigmatized and connected with developing diabetes.
Distorted body image can occur as a result of:
- Pressures from diet culture
- Constant body checking
- Social media
- Fear of gaining weight
- Unrealistic BMI expectations
Weight fluctuation after initial diabetes diagnosis and treatment can be a trigger for diabulimia.
People after the diagnosis of diabetes type1 are put on insulin and gain some weight as the body starts to rehydrate and rebuild itself. This can cause often cause an identity crisis in our thin-obsessed society.
People with Diabetes Type1 can experience shame and guilt related to the development and management of their diabetes. They may have lower self-worth and self-esteem issues not just related to diabetes but also other factors in their lives, which can all contribute to the development of diabulimia.
Risks With diabulimia
If you don’t have enough insulin, your blood sugar rises and the body will break down fats into ketones. This will make the blood more acidic, causing diabetic ketoacidosis (DKA)
Diabetic ketoacidosis can lead to:
- Rapid weight loss
- Kidney damage
- Heart irregularities
Eating disorders have the highest mortality rate of all mental illnesses. Females of all ages are twice as likely to develop diabulimia when they have type1 diabetes. Females who restrict insulin to lose weight die an average 10 years earlier than females without an eating disorder.
Diabulimia treatment will include either inpatient or outpatient treatment. The treatment team should include a physician, a therapist, and an eating disorder dietitian.
Treatment for diabulimia will include:
- An eating recovery meal plan
- Strategies to respect and honor your body
- Challenging fear foods
- Reducing Calorie counting
- Decreasing body checking
If you or someone you know is experiencing an eating disorder, check out these recovery books for additional support.
Recovery is possible.