Diabulimia

DisclaimerThis page is not here to be used as a self-diagnosis, self-identification, or promotion - it's simply here to be informational. Whether or not one self-diagnoses, self-identifies, and/or seeks a professional diagnosis is up to them.Body ImageThe following page includes discussions of body image, including starving oneself, binging and purging, exaggerated self-analysis, and body dysphoria. If you are uncomfortable or get triggered by this topic, it is recommended to not read this page.

**Diabulimia**, also known as **Type 1 Diabetes with Disordered Eating (T1DE)**, is an eating disorder that individuals with type 1 diabetes can develop. It's when someone reduces or stops taking their insulin to lose weight. 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.

If one has type 2 diabetes and they take insulin to treat it, the consequences of not taking insulin are often not the same, that is why discussion of diabulimia center around type 1 diabetes.

## Signs & Symptoms

### Behavioral

* Increasing neglect of diabetes management.
* Secrecy about diabetes management.
* Avoiding diabetes related appointments.
* Fear of low blood sugars.
* Fear that "insulin makes me fat".
* 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

* A1c of 9.0 or higher on a continuous basis.
* A1c inconsistent with meter readings.
* Unexplained weight loss.
* 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.
* Fatigue or lethargy.
* Dry hair and skin.

### Consequences of Diabulimia

The major consequences of diabulimia or ED-DMT1 are usually related to prolonged elevated blood sugar.

#### Short Term

* Slow wound healing.
* Staph and other bacterial infections.
* Yeast infections.
* Muscle atrophy.
* Menstrual disruption.
* Severe dehydration.
* Electrolyte imbalance.
* Diabetic Ketoacidosis.

#### Long Term

High blood glucose causes blood to become like sandpaper scraping and damaging blood vessel walls. Blood that is acidic from ketones can cause vessel damage. The consequences of this damage are often seen in the eyes where tiny vessels begin to leak into the eyeball.

* Retinopathy, small black spots disrupting an individual's vision.
* Macular Edma, swelling of the eyeball from excess fluids.

Nerve fibers are particularly vulnerable to prolonged periods of high blood sugar. Many factors can damage the small nerves in the body.

* Peripheral Neuropathy, stabbing/burning/tingling pain, weakness or numbness in the hands, feet, legs and/or arms.
* Gastroparesis, slowed stomach emptying from damage 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 and causing a sudden drop in blood pressure and heart rate and sometimes fainting.
* Chronic diarrhea or constipation.

Other organ damage.

* Kidney disease.
* Liver disease.
* Heart disease.

Many of the above consequences can become fatal and can result in:

* Coma.
* Stroke.
* Death.

Without insulin, the body cannot utilize anything eaten, putting the body into a state of malnutrition and starvation.

## Causes

There are lots of reasons diabulimia may develop. It might be a combination of physical, social and mental health problems. When one has type 1, the things they need to do to manage it can play a part in developing diabulimia, such as:

* Having to carefully read food labels.
* Being constantly aware of calories or carbohydrates in food.
* The focus on weight when at the clinic.
* Losing a lot of weight before type 1 diagnosis and regaining weight when starting medications.
* Having to eat to treat hypos, which can cause weight gain and guilt.
* Feeling shame over how one manages their diabetes.
* A bad relationship with ones healthcare team.
* Difficulty keeping to a healthy weight.

## Treatment

The goal of treatment for diabulimia includes:

* Using insulin appropriately.
* Healthily managing blood glucose levels and weight.
* Avoiding short-term and long-term diabetes complications.
* Treating psychological issues that may have contributed to the development of diabulimia.
* Developing long-term behavioral changes for diabetes management.

Because of the physical and psychological components of diabulimia, treatment involves care from multiple types of healthcare providers, including:

* Endocrinologists.
* Psychologists or therapists.
* Registered dieticians and nutritionists.
* Certified Diabetes Educations (CDEs).

## References

https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/diabulimia

https://www.nationaleatingdisorders.org/diabulimia-5

https://my.clevelandclinic.org/health/diseases/22658-diabulimia