The word diabulimia is a combination of the words diabetes and bulimia.
Diabetes is a disease that affects the way your body uses blood sugar. Bulimia is an eating disorder where you binge on food and then purge it by throwing up or taking a laxative in order to lose weight.
People sometimes use the term "diabulimia" to refer to someone with type 1 diabetes who skips insulin doses to lose weight.
Although diabulimia is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it can result in serious medical problems.
Who Gets It?
It mostly affects women. Females of all ages are twice as likely to get an eating disorder when they have type 1 diabetes. Some 30% of teens hold back on their insulin treatments in order to shed pounds.
Eating disorders don’t have a clear cause, but you could be slightly more likely to have one if they run in your family. Sometimes family stress or trauma can trigger an eating disorder.
What Are the Risks?
Diabulimia happens when you skip the insulin you need to treat your type 1 diabetes on purpose in order to lose weight. When you have type 1 diabetes, your body can’t make insulin. This means you can’t use sugar for energy, so blood sugars rise and are released in excess in your urine.
Without enough insulin, you also create ketones as a source of energy, which can also lead to anorexia and weight loss. This can bring on diabetic ketoacidosis, which can lead to coma or death.
Diabulimia complications are a mix of those that come with diabetes and eating disorders:
- High blood sugar levels
- Sugar in your urine
- Confusion
- Dehydration
- Muscle loss
- Diabetic ketoacidosis
- High cholesterol
- Bacterial skin infections
- Yeast infections
- Skipped or abnormal periods
- Staph infections
- Damage to the blood vessels in your eyes (retinopathy)
- Numbness in your hands and feet from nerve damage
- Peripheral arterial disease
- Thicker arterial walls (atherosclerosis)
- Liver disease
- Low sodium and potassium levels
- Stroke
- Coma
- Death
Eating disorders have the highest death rate of all the mental illnesses. Women who withhold insulin to lose weight die an average of 10 years earlier than women without an eating disorder.
What Are the Signs?
The first and most obvious sign of diabulimia is losing weight without trying. Other signs include:
- Feeling tired all the time
- Feeling thirsty a lot
- Thinking or talking a lot about body image
- Blood sugar records that don’t match up with hemoglobin A1c readings
- Depression or mood swings
- Secrecy about blood sugar, insulin, food, or eating habits
- Canceling doctors' appointments
- Eating more often, especially sugary foods
- Delayed puberty
- Stress within the family
- Hair loss
- Dry skin
- Sweet-smelling breath (a sign of ketoacidosis)
- Exercising a lot
What Can You Do?
Because it’s a mental illness, diabulimia requires professional treatment. If you or someone you care about shows signs of diabulimia, seek nutritional, medical, and psychological help from health professionals like:
- Endocrinologists
- Diabetes counselors
- Nurses
- Nutritionists who specialize in eating disorders or diabetes
- Counselors/psychologists
- Social workers
Treating diabulimia isn’t a quick fix. It can take many different approaches and hard work to change behavior patterns and learn to manage triggers. Counseling is a great source of help. You can try:
Cognitive behavior therapy (CBT), which works on changing the way you think in order to change the way you act.
Group therapy, which provides support from other people going through diabulimia.
Family based therapy (FBT), which includes the whole family. It can be a good tool for parents with a teen dealing with the disorder.
