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Dangers of Diabulimia

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Skipping insulin to lose weight creates an eating disorder in diabetics that can be fatal.

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Maggie Baumann, MA: "New" eating disorders are popping up in the population so quickly it's hard to keep up with the diagnosis of all of them. Of course, we know about anorexia and bulimia. But there are more: anorexia athletica, orthorexia, pregorexia, and one of the latest to be discussed is diabulimia.

Like pregorexia, diabulimia is not an official medically diagnosed disorder, but rather a condition the media and some health professionals have chosen to describe as a very dangerous form of eating disorder.

What is Diabulimia?
Diabulimia refers to a type of eating disorder in which people with type 1 diabetes intentionally reduce or eliminate the insulin they need for the sole purpose of losing weight.

According to researchers, such as Ann Goebel-Fabbri, Ph.D., from the Joslin Diabetes Center, type 1 diabetes is an autoimmune condition in which the body is no longer able to produce insulin, a hormone that allows the body to utilize glucose and store calories for energy. Without the insulin, cells can't access the glucose they need and are left to starve. A reduction of insulin in the body causes a high saturation of glucose in the bloodstream, causing symptoms of excessive urination, extreme thirst, extreme fatigue, and weight loss, as well as other potentially life-threatening conditions.

Patients with type 1 diabetes attempt to control body weight by reducing or skipping insulin dosages in an attempt to increase weight loss and reduce weight gain. A side effect of patients who are correctly dosing their insulin intake can result in some weight gain. Diabulimia is most common in young girls and women with type 1 diabetes.

Young girls are already experiencing the pressures to "look thin" to improve self-esteem and confidence. Body image is often a very predominant issue with these young girls and women with type 1 diabetes. When patients are diagnosed with type 1 diabetes, they are groomed to fixate on numbers, weight, and the foods they eat. It's easy to recognize how this fixation can cause someone with type 1 diabetes to have an increased predisposition to developing an eating disorder.

Newport Beach marriage and family therapist intern Tawny Murdock, MA, specializes in treating clients with diabetes, including those with eating disorders. Murdock, who has lived with type 1 diabetes for 25 years, says, "Patients restrict insulin intake because they don't want to feel like their disease is winning. What they don't realize is that they are letting the disease win when they aren't using insulin because their health inevitably suffers."

Fortunately, Murdock has not struggled with an eating disorder, but works diligently every day in managing her diabetes to remain the healthiest she can be and avert the dangerous complications of uncontrollable diabetes management.

Dangers of Diabulimia
Many patients with diabulimia not only manipulate their insulin dosages, but also participate in other traditional eating disorder behaviors, including restricting calories as well as bingeing and purging calories through vomiting or use of excessive exercise or laxative abuse.

A study by the Joslin Diabetes Center in 2008 found that women with type 1 diabetes who reported taking less insulin prescribed had a three-fold increased risk of death and higher rates of disease complications than those who did not skip insulin shots. The average age of death was younger for those involved in insulin restriction: 45 years of age as compared to 58 years for those who did not restrict. The study also indicated that women with diabetes are nearly 2.5 times more likely to develop an eating disorder than women without diabetes.

Medical complications

• Diabetic ketoacidosis (DKA)
A serious life-threatening condition that occurs when there isn't enough insulin in the body. Symptoms include nausea, vomiting, abdominal pain, rapid breathing, and, in severe cases, unconsciousness/coma that can lead to death.
• Long-term damage to eyes, eventually causing blindness
• Kidney damage
• Nerve damage
• Amputations
• Death from complications of diabetes and/or eating disorder

Common Diabulimia warning signs for parents to watch for
• Consistent high hemoglobin (A1c) ... elevated blood glucose levels
• Frequent ER visits for treatment of diabetic ketoacidosis (DKA)
• Body image concerns
• Irregular eating patterns ... skipping meals, bingeing, and purging
• Irregular or lost menstruation ... High A1c levels have been linked to causing irregular menses and even delayed puberty
• Lack of proper insulin documentation
• Manipulation of blood glucose level readings
• Unexpected weight loss

Diabulimia bloggers share:
There are websites dedicated to people struggling with diabulimia. One diabulimia blogger wrote: "I was finding ways that kept me out of the hospital but still allowed me to lose weight. I misused my insulin and cut back on my eating. Every once in a while I would throw up, and I still couldn't walk long distances. But staying skinny was really all I cared about."

Another blogger wrote, "I have known a few diabulimics myself. The one that comes to mind first had to have various toe amputations and was going to lose a leg, if she didn't take better care of herself. The weight control gained from not taking insulin was still more important to her than her health."

Treating Diabulimia

Eating disorders like diabulimia are illnesses, not choices. The logic of knowing that skipping insulin can have grave effects on the body seems to lay dormant in the minds of patients with diabulimia. The ideal for "thinness" overrides the logic of the medical complications these patients put themselves at risk for.

Treatment can include:
• Inpatient care, in which the patient receives treatment for both the diabetes management and eating disorder treatment
• Outpatient care, in which both disorders are treated simultaneously.

The most important factor is to have a multidisciplinary team of professionals providing care, including an endocrinologist, therapist, and registered dietitian who are experienced in working with eating disorders and diabetes management.

Getting Help

If you or your child or teen is struggling with diabulimia, seek immediate treatment. Talk to your endocrinologist and speak to a medical professional with expertise in treating eating disorders. There are eating disorder treatment programs that can address both the eating disorder and diabetes management concurrently, offering you the best outcome for your health. Good resources to start with include the Joslin Diabetes Center and the National Eating Disorders Association, as well as local treatment centers and professionals.

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