November is Diabetes Awareness Month. Diabetes is a disease that causes blood glucose (also known as blood sugar) to be too high. Diabetes affects 37 million people in the United States. If not treated properly, it can damage the eyes, kidneys, heart, nerves, and even cause cancer.

By: Dawn Lundin

Diabulimia is a life-threatening eating disorder that can develop in those with type 1 diabetes. The combination of diabetes and eating disorder symptoms can make it a difficult condition to diagnose and treat. Treating diabulimia requires an interdisciplinary team approach to prevent short-term and long-term consequences related to both diabetes and an eating disorder.

What Is Diabulimia?

Diabulimia is an eating disorder that can affect those with type 1 diabetes (T1D). T1D is an auto-immune disease that impacts the cells in the pancreas that make insulin. Because of this, people with T1D have to inject synthetic insulin to manage blood glucose levels. If someone with T1D were to take a smaller than recommended dose of insulin or no insulin at all, it could cause life-threatening complications, including diabetes-related ketoacidosis (DKA). In DKA, the absence of insulin causes the body to break down fat to use as energy, which causes ketones to be released into the bloodstream. When ketones are released into the bloodstream, the blood becomes acidic, which creates a medical emergency that requires treatment.

Those with diabulimia restrict insulin as a way to lose weight. While this is its hallmark eating disorder behavior, it can also include purging. A lack of insulin and consistently high blood glucose can lead to serious health outcomes. A consistent lack of insulin can also lead to severe dehydration.

Who Develops Diabulimia?

Diabulimia only occurs in individuals with T1D. It is more common in adolescents and young adults and more common in females than males. There are a variety of physical, behavioral, and emotional signs and symptoms of diabulimia. The physical signs and symptoms include unexplained weight loss, high blood sugar, increased thirst & urination, nausea and/or vomiting, recurrent episodes of DKA, unexplained fatigue, blurry vision, dry hair, and skin, and more.

Behavioral signs and symptoms include not giving insulin or under-dosing insulin for meals, neglect and secrecy around diabetes management, avoiding diabetes-related appointments, not wanting to test blood sugar or administer insulin in front of others, and sleeping more than usual. Emotional signs and symptoms include fear that taking insulin will cause weight gain, body image concerns, diabetes-related treatment burnout, fear of having low blood sugars because they’ll need to eat to correct it, depression, anxiety, irritability, and constantly thinking about food, calories, and dieting.

Because diabulimia affects those with T1D, the signs and symptoms are unique. It is thought that the heightened awareness around food that is required to manage T1D may predispose an individual to developing an eating disorder. The management of T1D involves constant awareness of food, carbohydrate counting, reading nutrition labels, tracking numbers like blood glucose and weight, needing to rely on food to treat low blood sugars, feelings of shame around diabetes management, and difficulty maintaining weight.

Treatment Burnout

If we think about the food-related tasks that are necessary to manage T1D, several factors affect both those who have T1D and an eating disorder. Treatment burnout is a real thing. This occurs when someone feels frustrated and emotionally exhausted from managing their condition. Treatment burnout is more common in chronic diseases that extend one’s lifetime and can cause individuals to miss appointments and not follow treatment recommendations. This may involve guessing portion sizes, carbohydrate content, or insulin doses and canceling or not attending appointments with their treatment team.

Treating Diabulimia

Diabulumia can be treated through medical management, therapy, nutrition counseling & education, and medication. The goals of treatment include managing both the eating disorder and T1D. Treatment goals for T1D include taking insulin as prescribed, managing blood glucose levels, avoiding diabetes-related complications, and gaining or maintaining weight. The complex nature of diabulimia makes it essential that individuals have an interdisciplinary team to support them. This interdisciplinary team should include an endocrinologist, therapist, registered dietitian, and/or certified diabetes educator (CDE).

At BALANCE eating disorder treatment center™, our compassionate, highly skilled team of clinicians is trained in diagnosing and treating the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating behaviors and body image issues. If you or a loved one are struggling with diabetes and eating disorder behaviors, RSVP for our next free Virtual Eating Disorder Support group here.

Our admissions team would happily answer any questions about you or a loved one receiving eating disorder treatment for anorexia or another eating disorder. Book a free consultation call with our admissions team below, or read more about our philosophy here.

This post was written by BALANCE Blog Contributor, Dawn Lundin (she/her).

Dawn Lundin, MS, RD is a registered dietitian and owner of Restore Ease Dietetics which is a virtual nutrition private practice that focuses on mental health + sports nutrition. She primarily with adolescents and young adults with eating disorders. She believes in meeting clients where they are at which provides a unique client-focused approach to recovery. She lives in Marquette, Michigan with her husband and three sons. As a family, they love to travel and spend time outdoors. She also enjoys mountain biking, running, cross-country skiing, being on or in the water, and knitting.

References

Diabulimia. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22658-diabulimia. Accessed November 3, 2023.

Diabetes-related Ketoacidiosis.

https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka. Accessed November 3, 2023.

National Diabetes Month 2023. National Institute of Diabetes and Digestive and Kidney Diseases.https://www.niddk.nih.gov/health-information/community-health-outreach/national-diab etes-month. Accessed November 2, 2023.

Stand with Us in the Fight. American Diabetes Association. https://diabetes.org/adm. Accessed November 2, 2023.

Diabulimia - The Intersection of Diabetes and Eating Disorders