What is Diabulimia?

Diabulimia is a term which has come into recent usage to describe people who are suffering from Type 1 diabetes and a related eating disorder. Specifically, it means people with Type 1 diabetes who omit or reduce their intake of insulin in order to lose weight.

This makes diabulimia extremely dangerous: if people with Type 1 diabetes fail to take the correct amount of insulin, they place themselves at risk of many serious complications which can include eye problems (including risk of blindness), kidney problems, nerve damage and even amputations.

Diabulimia treatment is challenging because of the way it requires multi-disciplinary expertise across medical services which do not ordinarily need to come together. Diabetes professionals may not recognise that a patient’s persistently poor diabetes control reflects hidden diabulimia symptoms. Equally, even if they suspect this could be the case, professionals may feel they lack the expertise and confidence to speak to a patient about their concerns or to raise mental health issues.

Warning signs and symptoms

Identifying diabulimia warning signs as soon as possible is very important, although this can be difficult because poor diabetes management may be caused by a number of different factors, especially in adolescents and young people.

Some reports suggest up to 40 per cent of young women with Type 1 diabetes restrict their insulin with the intent of weight loss. It is also recognised that diabetes control among adolescents and young adults can be poor for other reasons (moving away from parental control to managing themselves; moving away from home and leading less structured lifestyles).

The following symptoms, both physical and psychological, could be considered as potential diabulimia warning signs:

  • Severe fluctuations in weight
  • Repeated incidences of hyperglycemia (high blood sugar level) leading to hospitalisation
  • Elevated HbA1c (a blood test which reflects diabetic control)
  • Missing meals or avoiding eating with others
  • Secrecy about diabetes management/avoidance of diabetes appointments
  • A fear insulin ‘makes you fat’
  • Frequent yeast or urinary infections
  • Drinking abnormally high amount of fluids
  • Irregular periods or no periods at all
  • Deteriorating or blurry vision
  • Dry hair, skin and dehydration
  • Loss of appetite
  • Preoccupation and anxiety around body image
  • Avoidance of carbohydrate in order to lower insulin doses

Health consequences

Diabulimia health consequences are serious and multiple, affecting both physical and mental health. The consequences listed below can be caused by diabulimia, although they may also be a result of poor diabetes control due to other factors.

Short term consequences

The short-term consequences of diabulimia can include:

  • Fatigue
  • Dehydration
  • Poor immunity, leading to repeated infections
  • Ketoacidosis, a dangerous medical condition in which there are high levels of glucose and the blood. Diabetic ketoacidosis (DKA) often requires admission to the hospital and can be life-threatening.

Long term consequences

The long-term consequences of diabulimia can include:

  • Irreversible damage to eyesight (retinopathy)
  • Nerve damage leading to pain, tingling or numbness of the limbs (neuropathy)
  • Damage to the kidneys (nephropathy)

Treatment and support

Once identified, diabulimia treatment requires a multi-disciplinary approach, addressing the emotional and psychological difficulties the individual is experiencing. Diabulimia cannot be effectively treated within the scope of diabetes management alone. Diabulimia treatment is dependent upon the underlying emotional issues being identified and addressed at the same time as measures to improve diabetes control.

Treatment and support must incorporate acknowledgement that diabetes necessitates a greater focus on specific food intake than is ordinarily necessary and this can quickly become tangled with weight and body image issues. Skilled diabetes management and eating disorders expertise are required for effective treatment and full diabulimia recovery, avoiding harmful and potentially dangerous short and long term health effects.

It is important to recognise that people with Type 2 diabetes also experience eating disorders which are serious and debilitating, but with a different presentation to diabulimia. Typically, people with Type 2 diabetes are affected by binge eating disorder (with the resulting problem of poor diabetes control and obesity).