Although not a recognized eating disorder, “diabulimia” is a condition in which individuals with Type 1 diabetes reduce insulin levels in order to lose weight. According to the New England Journal of Medicine (1997), up to 30 percent of adolescent women with Type 1 diabetes have an eating disorder.
Why Reduce Insulin Levels?
Type 1 diabetes is an autoimmune condition in which the body’s immune system attacks its own insulin-producing cells in the pancreas. Individuals with this disorder must inject insulin into their bodies. If someone were to reduce insulin levels, her blood glucose levels would rise and her kidneys would have to work very hard to get rid of the excess blood sugar, resulting in frequent urination and weight loss.
What Causes Diabulimia?
According to Psychology Today (2008), individuals with Type 1 diabetes are more than twice as likely to develop an eating disorder as the general population. One possible explanation for this increased risk is that diabetics must maintain a strict diet and exercise regularly to control blood glucose levels. This constant attention to diet can trigger an eating disorder, particularly in adolescent females.
Symptoms of Diabetes and Eating Disorders
The symptoms of diabulimia can be difficult to detect because family and friends are often unaware that such a condition exists. Even doctors may have trouble recognizing the symptoms of diabulimia.
Warning signs of diabulimia include:
- Amenorrhea (missed menstrual periods)
- Changes in eating habits (such as eating more but still losing weight)
- Chronic problems with diabetic ketoacidosis
- Elevations in HbA1C values
- Fixation on weight and weight loss
- Frequent urination
- Inexplicable hyperglycemia (high blood sugar)
- Rapid weight loss.
Binge eating, excessive exercise and self-induced vomiting may also be associated with diabulimia.
Effects of Diabetes and Eating Disorders
Diabulimia is a very serious condition because it involves neglecting diabetes treatment. Reduced blood sugar levels can result in short-term problems with dehydration, fatigue and muscle loss.
An individual who continues to reduce insulin levels over a long period of time may end up suffering from serious diabetic complications, such as:
- Eye damage or blindness
- Foot ulcers (possibly requiring amputation)
- Heart disease
- Kidney failure
- Nerve damage.
These problems tend to begin at a much younger age in people with diabetes and diabulimia than people who only have diabetes. A study published in Diabetes Care (2008) found that women with diabulimia were at increased risk of developing diabetes complications, and that they died at an earlier age than those who didn’t restrict insulin use.
Diabulimia is a persistent disorder. The cycle of poor body image, insulin abuse and anxiety is difficult to break. Effective diabulimia treatment requires guidance from both diabetes and eating disorder specialists, with the goal of stabilizing blood glucose levels and teaching healthy eating habits. Eating disorders produce an irrational fear of weight gain, and the patient must learn to overcome this fear so that she will be able to take insulin as needed.
Flora, C. (2008). The danger of diabulimia. Retrieved September 7, 2010, from http://www.psychologytoday.com/articles/200807/the-danger-diabulimia
Goebel-Fabbri, A. (n.d.) Eating disorders/”diabulimia” in type 1 diabetes. Retrieved September 7, 2010, from http://www.joslin.org/info/Eating_Disorders_Diabulimia_in_Type_1_Diabetes.html
Goebel-Fabbri, A. E., Fikkan, J., Franko, D. L., Pearson, K., Anderson, B., J. & Weinger, K. (2008). “Insulin Restriction and Associated Morbidity and Mortality in Women with Type 1 Diabetes.” Diabetes Care, 31(3), 415-419. DOI: 10.2337/dc07-2026
Juvenile Diabetes Research Foundation of Canada. (2007). “Diabulimia”: Young girls with type 1 diabetes skipping insulin doses to lose weight. Retrieved September 7, 2010, from http://www.jdrf.ca/index.cfm?fuseaction=home.viewpage&page_id=08781B14-C65C-41CC-10E030EFD558A8B0
Rydall, A. C., Rodin, G. M., Olmsted, M. P., Devenyi, R. G. & Daneman, D. (1997). Disordered Eating Behavior and Microvascular Complications in Young Women with Insulin-Dependent Diabetes Mellitus. New England Journal of Medicine (336), 1849-1854.