February 28, 2019
Anorexia, bulimia and even binge eating are perhaps the eating disorders that come to mind for most people. But there are other, lesser-known categories, including something called diabulimia.
Diabulimia is a “media-coined” term that refers to an eating disorder involving a person with diabetes — typically Type 1 diabetes — who purposefully restricts insulin in order to lose weight. Medical professionals, however, use the term ED-DMT1, Eating Disorder-Diabetes Mellitus Type 1, which is used to refer to any type of eating disorder involving Type 1 diabetes, according to the National Eating Disorders Association.
Insulin shuttles glucose into your cells, which then burn it for fuel or store it as fat. Without insulin, as is the case with Type 1 diabetes, glucose can’t reach the cells, and it simply floats in the bloodstream unused. Excess glucose, when built up, can quickly damage blood vessels throughout the body and wreak havoc on organs.
Once diagnosed, people with Type 1 diabetes must take insulin in the form of medication to help regulate their blood sugar. Proper doses of insulin spare the kidneys from being overworked and protect the rest of the body from harm. It also prevents the rapid weight loss that is one symptom of the untreated disease, per Everyday Health.
People suffering from ED-DMT1 may exhibit any number of eating disorder behaviors or they may only manipulate their insulin and otherwise have normal eating patterns.
Warning signs of diabulimia include: rapid weight loss with normal or heavy eating, high A1C (blood sugar levels), physical exhaustion, increased appetite (the body’s cells are essentially starving), mood changes, decreased concentration and motivation (this can be seen in changes in academic and professional performance) and recurrent diabetic ketoacidosis, or DKA, without any explainable cause (which can be life-threatening), according to Beyond Type-1.
Those with diabulimia may underdose their insulin or skip it altogether. Then, blood sugar rises and the kidneys dispose of the excess glucose in urine, Dr. Susan Herzlinger, a specialist in eating disorders in people with diabetes, told HEALTH:
“This is a way to purge what’s been eaten because the sugar you ingested isn’t absorbed and instead is eliminated.”
What’s more, limiting insulin forces your body to digest fat (and some muscle) to support the brain’s functioning, she explains.
As many as 35 percent of young adult women with Type 1 diabetes met the criteria for a “sub-threshold” eating disorder, meaning they display symptoms of an eating disorder but do not meet the full diagnostic criteria. Further, as many as 11 percent of young adult women with Type 1 diabetes meet the criteria for a full-syndrome eating disorder and 16 percent of males with the disease have disordered eating behaviors, per the Eating Recovery Center.
Ironically, managing diabetes requires behaviors that are similar to those adopted by people with eating disorders: intensely focusing on everything consumed, closely reading nutrition labels, and monitoring physical activity, Everyday Health explains.
Skipping insulin is listed as a purging behavior in the current American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and more and more health professionals who regularly treat people with diabetes are aware of the condition.
Marilyn Ritholz, Ph.D. told Beyond Type 1, a nonprofit educational resource:
“If you have diabetes and are not taking insulin, your organs will become saturated in glucose. You can put your body into a state of DKA, and you can experience the long-term complications of diabetes such as retinopathy, nephropathy and neuropathy. If left untreated, it can lead to death.”
Treatment for diabulimia is similar to other eating disorder treatments with a similar goal: normalize the use of insulin, blood glucose levels and patient weight, and avoid acute and chronic complications.
Treatment will begin by ensuring the patient is medically stable. In severe cases, treatment for diabulimia will require hospitalization to interrupt insulin manipulation and other eating disorder behaviors, such as excessive exercise or purging. Once patients are medically and mentally stable, a structured curriculum of individual, group therapy and experiential therapy helps patients explore the function of the eating disorder as they work to build recovery skills. Recovery skills for diabulimia may include learning how to manage stress and anxiety and how to maintain their recovery following discharge, according to the Eating Recovery Center.