Diabulimia: Eating disorder affecting type 1 diabetes

Diabulimia: Serious eating disorder in type 1 diabetes

It is essential to maintain blood glucose levels in people with type 1 diabetes. Compliance with Insulin is vital to achieving good glycemic control. Combination of eating disorders and lack of compliance with insulin can lead to serious health problems in people with type 1 diabetes. Diabulimia is becoming a common disorder in people with type 1 diabetes. Without proper care and treatment, it can progress and lead to many health-related problems. In addition to adverse health outcomes, people with type 1 diabetes also face many psychological issues. It can be controlled with proper care and treatment.  Let’s discuss in this article that what Diabulimia is, its causes, symptoms, and treatment.


What is Diabulimia?

Diabulimia or ED-DMT1 is referred to weight variations and eating disorder because of not taking insulin at the right time and right dose by a person with type 1 diabetes.

A person suffering from Diabulimia may also suffer from conditions like bulimia nervosa, eating disorders, and anorexia nervosa.

If dealt earlier, severe complications can be prevented. However, the incidence of diabulimia is increasing as it is not easily recognized by the person with type 1 diabetes or health care professional.  


What can happen if Diabulimia is not treated?

As mentioned above, the main problem in diabulimia is not using Insulin at all or at the right time or right dose. Due to the lack of Insulin, the body is unable to utilize glucose. This will lead to building up of glucose in the blood. Furthermore, in order to produce energy, the body produces acid and ketones. This can lead to the development of serious complication like diabetic ketoacidosis. A person suffering from diabetic ketoacidosis needs treatment in a hospital. And if it is not treated early, then it can lead to coma and death.

Other significant problems in the short term include:

  • Increased urination
  • Dehydration
  • Muscle loss
  • High level of fat in the blood
  • Weight loss

In the longterm, high blood glucose will result in blood vessel damage. This can result in:

  • Development of retinopathy and vision loss
  • Damage to the kidney, which in severe cases requiring dialysis.
  • Damage to the nerves resulting in pain and numbness in hands and feet (neuropathy).
  • Damage to the nerve of the bowels (stomach and intestines). This can cause problems with bowel movement or motility. This can lead to feeling bloated, sick, and on occasions vomiting. A person suffering from this can have constipation or diarrhea or alternate between constipation and diarrhea.
  • Damage to the nerve of the blood vessels and heart. This can result in feeling faint due to changes in blood pressure and pulse rate.
  • Blood supply to limbs (especially to legs) are affected. This can lead to gangrene and amputation.
  • Risk of heart complication like heart attack
  • Risk of development of stroke.

In addition to the above, a person with diabulimia also suffers from psychological and mental problems.


What are the causes and warning signs of Diabulimia?

There is no one reason which can explain why Diabulimia occurs in a person. We know that a person with Diabulimia does not take insulin to lose weight. There are many factors which play a central role in the development of Diabulimia. It is thought that diabulimia is caused by a complex mix of mental, social, emotional, behavioral, and physical problems. The following factors play a crucial role in Diabulimia:

  • Unable to get along with the healthcare professional.
  • Feeling pressure to keep diabetes under control
  • Poor self-body image.
  • Feeling pressure to keep weight under control.
  • Feeling that Insulin will lead to increased weight.
  • Constant worry about developing hypoglycemia. A person is worried that if they eat carbohydrate to treat hypoglycemia, it will lead to putting on weight.
  • Focus too much on blood glucose control leading to burning out
  • Worried about giving insulin in public (feeling embarrassed).
  • A bad relationship with food. Feeling constant pressure to watch what to eat and read food labels.
  • Suffering from mental health problems like depression and anxiety.
  • Previous problems with misuse of medicines and drugs


These above factors should be identified early to avoid developing Diabulimia. Other warning signs include:

  • Missing appointments with healthcare professional
  • Not checking blood glucose
  • Inconsistent blood glucose testing
  • Making up blood glucose numbers which are not matched by HbA1c
  • Poor HbA1c
  • Not picking up Insulin prescription regularly
  • Social isolation (avoiding family and friend)
  • Recurrent hospital admissions with DKA
  • Repeated yeast infection
  • Excessive exercise


What are the signs and symptoms of Diabulimia?

Most of the signs and symptoms are related to high blood glucose. These include:

  • Lack of energy and feeling tired.
  • Losing weight.
  • Going to the toilet to pass urine frequently.
  • Always feeling thirsty.
  • Blurred vision
  • Recurrent yeast infection


What are the treatment Options of Diabulimia?

There is no easy or quick solution for diabulimia. However, with the right approach, a person can recover from diabulimia. Treatment of diabulimia requires specialized and multidisciplinary treatment. The team should include, Diabetologist, Diabetes specialist nurse, Dietician, Psychologist, and Psychiatrist with interest in eating disorder.

The above team works with the person suffering from diabulimia to improve compliance with insulin and blood glucose testing. It should be reinforced that diabetes care is a journey rather than a race. We are aiming for stable control rather than perfect sugar control. This should be reinforced repeatedly in each review by a healthcare professional. Additional tools like counseling, cognitive, Group, and family behavior therapy can also be used.

Diabetics for Eating Disorder (http://dwed.org.uk/) are a charity which provides and support to the people with diabulimia.


How common is Diabulimia?

It is not very clear how many people suffer from diabulimia. However, it is estimated that 4 out of 10 females and 1 in 10 males aged between 15 to 30 year old suffer from diabulimia. If left untreated, risk of death is approximately 17 times higher than a person with type 1 diabetes without diabulimia.


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