Diabulimia is a term that refers to a dangerous and often under-recognized eating disorder that can affect those with type 1 diabetes.
This condition sits at the intersection of diabetes management and disordered eating, requiring specialized understanding and care to help address co-occurring mental health complications and any negative physical effects.
What is diabulimia?
According to the Cleveland Clinic, “Diabulimia is an eating disorder in which someone with Type 1 diabetes withholds insulin to lose weight. It can be life-threatening.
“People with diabulimia may have other disordered eating behaviors, like purging. Or they may only limit insulin dosages and otherwise have healthy eating patterns.The name “diabulimia” is misleading. Not all people who have it binge eat or purge — the defining features of bulimia nervosa. Despite this, people widely use the term “diabulimia” to describe limiting insulin to lose weight. Diabulimia is also known as an “eating disorder in diabetes mellitus Type 1 (ED-DMT1).”
Who does diabulimia affect?
Diabulimia primarily affects individuals with type 1 diabetes, particularly adolescents and young adults. It is more commonly observed in females, although males are not immune — disordered eating behaviors can affect anyone.
The onset of type 1 diabetes often occurs during adolescence, a period of time where body image concerns and peer pressure already run rampant, making this age group particularly vulnerable to developing diabulimia. However, it is essential to note that diabulimia can affect anyone with type 1 diabetes, regardless of age or gender.
What are signs of diabulimia?
Identifying diabulimia can be challenging as it involves both psychological and physical signs.
Some of the behavioral signs include:
- Skipping or manipulating insulin doses — Intentionally omitting or reducing insulin doses to lose weight;
- Obsession with body image — An intense focus on weight, body shape and appearance;
- Frequent episodes of hyperglycemia — High blood sugar levels due to insufficient insulin;
- Avoiding medical appointments — Skipping endocrinologist visits or being secretive/dishonest about diabetes management;
- Changes in eating patterns — Restrictive eating, binge eating or other disordered eating behaviors.
Physically, individuals may experience unexplained weight loss, frequent urination, excessive thirst and fatigue. Over time, the lack of proper insulin management can lead to severe complications, including diabetic ketoacidosis, nerve damage and increased risk of infections.
What causes diabulimia?
As with all mental health illnesses, the causes of diabulimia are individual to each person, and depend on psychological and physical factors.
1. Psychological factors
Those with type 1 diabetes may experience anxiety, depression or low self-esteem, which can contribute to disordered eating behaviors. The constant focus on food, weight and blood glucose levels can worsen these feelings and tempt them to cope with unhealthy strategies.
2. Social pressure
Standards of the culture which equate thinness with beauty and success can pressure individuals to achieve an unrealistic body image, leading them to manipulate their insulin as a means of weight control. Additionally, individuals with type 1 diabetes may feel isolated or different from their peers due to their condition, further contributing to the desire to conform to societal norms and “fit in.”
3. Physiological factors
The natural fluctuations in weight associated with insulin use can be distressing for some individuals. Insulin can lead to weight gain, which may prompt individuals to adjust their insulin dosages to prevent these effects. The urge to maintain or lose weight can become overwhelming, leading to dangerous behaviors like insulin manipulation.
However, insulin restriction is not the right way to manage weight gain in this situation. Best practices should be openly discussed with your doctor if you do feel yourself struggling with the stress of weight gain.
4. Diabetes management challenges
Managing type 1 diabetes is a lifelong commitment that requires constant attention to blood glucose levels, diet and insulin dosing. The stress and burden of this management may cause some to seek shortcuts, such as skipping insulin doses, to avoid perceived weight gain and feel a sense of control over their bodies.
Addressing diabulimia
In order to understand and address the unhealthy behaviors and coping mechanisms that may present in situations of diabulimia, recovering individuals need a variety of supportive treatments.
Professional support
A multidisciplinary team, including endocrinologists, dietitians, mental health professionals and diabetes educators can provide the necessary support and guidance for those struggling with diabulimia. Therapy and counseling can help address underlying psychological issues and develop healthier coping mechanisms.
Education
Increasing awareness about diabulimia can help reduce the stigma associated with this condition, encouraging individuals to seek help. Educating healthcare providers, patients and families about the signs and risks of diabulimia is crucial for early detection and intervention.
Peer support
Support groups and peer networks can offer individuals a sense of community and understanding, reducing feelings of isolation. Sharing experiences and strategies with others who face similar challenges can be empowering and motivating, and promote long term recovery.
Positive body image talk
Encouraging a healthy and positive body image, alongside realistic and individualized diabetes management goals, can help individuals feel more comfortable in their bodies and reduce the urge to manipulate insulin for weight control.
Need help addressing diabulimia?
Diabulimia can be a stressful and scary mental health condition with real physical consequences, but that does not mean intervention isn’t helpful. With the right team, treatment plan and individualized goals, recovery from diabulimia is possible.
To learn more, contact Seeds of Hope by calling (610) 268-9245 or fill out an online contact form to get in touch with a counselor.
