What is diabulimia?
Although not an official diagnosis, diabulimia (also known as ED-DMT1 or Eating Disorder-Diabetes Mellitus Type 1), refers to an eating disorder in a person with diabetes, typically type I diabetes, where the person purposefully restricts insulin in order to lose weight. Depending on the other eating disorder behavior present and manipulation of insulin, diabulimia can present with features of both anorexia and bulimia.
Emotional and behavioral signs of diabulimia can include:
- Dramatic weight loss
- Dresses in layers to hide weight loss or stay warm
- Increasing neglect of diabetes management
- Secrecy about diabetes management
- Avoiding diabetes related appointments
- Fear of low blood sugars
- Fear that insulin will lead to weight gain
- Extreme increase or decrease in diet
- Extreme anxiety about body image
- Restricting certain food or food groups to lower insulin dosages
- Avoids eating with family or in public
- Discomfort testing/injecting in front of others
- Overly strict food rules
- Preoccupation with food, weight and/or calories
- Excessive and/or rigid exercise
- Increase in sleep pattern
- Withdrawal from friends and/or family activities
- Depression and/or anxiety
- Infrequently filled prescriptions
Physical signs of diabulimia can include:
- Similar symptoms of anorexia and bulimia
- A1c of 9.0 or higher on a continuous basis
- A1c inconsistent with meter readings
- Constant bouts of nausea and/or vomiting
- Persistent thirst and frequent urination
- Multiple DKA or near DKA episodes
- Low sodium and/or potassium
- Frequent bladder and/or yeast infections
- Irregular or lack of menstruation
- Deteriorating or blurry vision
Health consequences of diabulimia
The human body is surprisingly resilient and people with diabulimia often manage to function with much higher blood sugars than should be possible. Thus, the major consequences of diabulimia are usually related to prolonged elevated blood sugar. These complications can be severe and irreversible, so proper treatment and early detection are critical.
Short-term health consequences
- Slow wound healing
- Staph and other bacterial infections
- Yeast infections
- Muscle atrophy
- Menstrual disruption and fertility issues
- Severe dehydration
- Electrolyte imbalance
- Diabetic Ketoacidosis, which can cause cause organ systems to shut down resulting in coma and sometimes death
Long-term health consequences
- Retinopathy (small black spots or “floaters” disrupting a person’s vision; the bleeding may be stopped with treatment, but persistent or recurrent retinopathy can eventually lead to blindness.)
- Macular edema (swelling of the eye ball from excess fluid; if untreated it can eventually cause permanent damage to the eye)Peripheral neuropathy (stabbing/burning/tingling pain, weakness or numbness in the hands, feet, legs and/or arms)
- Gastroparesis (slowed stomach emptying from damaged nerves preventing proper digestion and causing stomach pain, nausea and vomiting)
- Vasovagal syncope (malfunction of the nervous system in response to stress or position change causing a sudden drop in blood pressure and heart rate and sometimes fainting)
- Chronic diarrhea or constipation
- Kidney disease or kidney failure requiring frequent dialysis or kidney transplant.
- Liver issues like non-alcoholic fatter liver, cirrhosis and liver failure
- Heart disease
Many of the above consequences can result in comas, strokes, or even become fatal.
Facts about diabulimia
- Women with type 1 diabetes are 2.5 times more likely to develop an eating disorder
- Some medical professionals use the term Eating Disorder-Diabetes Mellitus Type 1 (ED-DMT1), which is used to refer to any type of eating disorder comorbid with type 1 diabetes
- Patients with weight-related insulin restriction were 3.2 times more likely to die over an 11-year study period, and to die an average of 13 years younger than those who didn’t restrict insulin.
- A person may develop diabulimia at any age and at any point after their diabetes diagnosis
- Sometimes diabulimia begins with body image issues or a desire to lose weight, and sometimes it begins as diabetes burnout
Please reach out for help and support.
If you think you are or someone you care about is struggling with diabulimia or another eating disorder while also living with diabetes, please don’t wait to get help. Contact us here or click below to schedule an appointment online with one of our therapists or dietitians.