Diabulimia:

When Diabetes and Eating Disorders Connect

Defining Diabulimia

The term “diabulimia” was coined to refer to an eating disorder that occurs in someone who has diabetes, wherein the person intentionally restricts insulin in order to lose weight. Medical professionals term diabulimia as ED-DMT1, which stands for Eating Disorder – Diabetes Mellitus Type 1. This term is used to describe any type of eating disorder that co-occurs with diabetes type 1.

Most often, diabulimia refers to the practice of withholding insulin in order to lose weight, but it may also include unhealthy behaviors surrounding food or exercise, which often mimic the symptoms of anorexia nervosa or bulimia nervosa.

Diabetes

According to the American Diabetes Association, more than 30 million Americans (9.4 percent of the population) had diabetes in 2015.1 Around 1.5 million people are diagnosed with diabetes in the U.S. each year, and more than 325,000 people lose their lives each year due to complications related to diabetes.

Diabetes is characterized by high blood glucose or blood sugar levels. After you eat food, most of it is turned into glucose, which is the main source of energy for the body. In people who don’t have diabetes, blood glucose levels stay within a normal range, because insulin is released at the right time and in the proper amounts to help glucose enter the body’s cells. But in people with diabetes, blood glucose builds up in the body for a number of possible reasons:

  • Not enough insulin is made in the body
  • The liver releases too much glucose
  • Cells are unable to utilize insulin properly

Type 1 Diabetes

Type 1 diabetes is characterized by the inability of the body to make insulin, and insulin is the cornerstone of treatment. Around five percent of people with diabetes have type 1, and most are under the age of 20 when they’re diagnosed.

Type 2 Diabetes

Type 2 diabetes is characterized by insulin resistance, or the inability of the cells to use insulin optimally. Over time, the ability of the pancreas to make insulin decreases. Most people with diabetes have type 2, and most are over the age of 40 during diagnosis.

Hyperglycemia

Known as hyperglycemia, too much glucose in the blood can cause a range of complications, such as:

  • Kidney disease
  • Nerve damage
  • Blindness
  • Heart attack
  • Stroke

The Most Common Eating Disorders

People with diabulimia may only manipulate their insulin to lose pounds or manage their weight, or they may engage in a number of disordered eating habits as well. These typically involve behaviors associated with anorexia nervosa or bulimia nervosa, two of the most common eating disorders.

Bulimia Nervosa

Bulimia nervosa is typically characterized by periods of excessive overeating or bingeing, followed by purging behaviors such as vomiting or taking laxatives in order to lose weight or manage their current weight. Some people with bulimia are overweight or obese, but many maintain a normal weight. Regardless, most people with bulimia are preoccupied with their weight or body shape and judge themselves harshly for perceived flaws.

Anorexia Nervosa

Anorexia nervosa is characterized by a very low body weight, a distorted body perception, and an intense fear of gaining weight. People with anorexia typically severely restrict their food intake and may use vomiting or laxatives to control calories. Some may exercise excessively to lose weight or keep it off. 

What Causes Diabulimia?

Like most eating disorders, diabulimia begins with low self-esteem, poor body image, and concern about body weight.

Women who have type 1 diabetes are at two and a half times the risk of developing an eating disorder, compared with women who don’t have the disease. Additionally, a review of studies shows that around 30 to 35 percent of women with type 1 diabetes restrict insulin to lose weight at some point in their life.2

Researchers believe that this high prevalence of diabulimia is partly due to the psychological challenges that come with managing a serious chronic disease, partly due to the weight gain that may be caused by insulin, and partly due to the heavy attention paid to food as treatment. Treating type 1 diabetes requires knowing carbohydrate amounts, and sometimes, it’s necessary to eat even if you’re not hungry. This tosses intuitive eating out the window and can make you feel like a slave to food. According to the National Eating Disorders Association, people who have diabetes are at a higher risk for emotional problems associated with eating disorders.3 One analysis found that having diabetes more than doubles the risk of having clinical depression.

In some cases, before being diagnosed with diabetes, individuals experience intense weight loss, followed by weight gain once treatment begins. For some, this weight gain becomes a major negative focus in life.

Video: Diabulimia

TRANSCRIPT
00:02
There’s an eating disorder more dangerous to its sufferers
00:06
than anorexia or bulimia.
00:08
It’s an eating disorder with a chronic illness,
00:11
so you’re trying to fight both on a daily basis,
00:14
and that’s quite difficult to do.
00:17
Most people haven’t heard of it.
00:19
I just never wanted to hurt my family.
00:22
Its name is diabulimia.
00:25
It is like the perfect diet gone wrong.
00:55
I have someone with me all the time because I’m under section and…
01:00
apparently I’m at risk to myself, I think.
01:04
I don’t know, really.
01:06
I think that’s why.
01:11
What way do you want to go – this way?
01:18
Like all Type 1 diabetics,
01:20
Gemma needs to constantly monitor her blood sugar levels and inject
01:23
herself with insulin several times a day in order to live.
01:44
I’ve got my test kit.
01:46
I have test strips and then…
01:49
..put it in.
01:51
Doesn’t actually take long, but it’s just more of a head…mind game.
01:55
And then…
01:58
..get the blood out…
02:01
..like that.
02:07
4.3. But I’m not allowed my insulin cos I’m not allowed
02:11
to inject it myself.
02:13
They’re doing it.
02:25
It’s addictive not to inject your insulin cos, I don’t know,
02:28
you can just eat whatever you want
02:30
and lose weight. It’s like…
02:34
..two birds and one stone, and all that.
02:40
Diabulimia is an umbrella term that consists of three main features.
02:44
The first is that it only occurs in people with Type 1 diabetes.
02:48
Secondly, that people with Type 1 diabetes have a fear
02:52
that insulin causes weight gain. And third,
02:55
that this fear is so strong that it leads them to omit the amount of
03:00
insulin they take in order to have weight loss.
03:05
If the person with Type 1 diabetes
03:08
does not take any insulin, they will die very quickly.
03:15
Diabulimia is extremely dangerous and, in some cases, fatal.
03:20
The lack of awareness in health care services means help for sufferers
03:25
in the UK is very scarce.
03:27
Psychiatrist Khalida Ismail runs
03:28
a diabetes and eating disorders clinic,
03:31
which aims to break new ground for this life-changing condition.
03:36
So would you like to just give me a bit of a summary
03:40
of where you are now?
03:43
You know, I’m quite a rational person.
03:46
I know I should be taking my insulin,
03:48
I know exactly what it does
03:50
and I know what will happen if I don’t take it.
03:53
But then I’ve just got this other voice being like,
03:55
“It’s much more important to be skinny.”
03:58
Do you still want to just give two units per meal?
04:01
I… And try to get into a routine with that?
04:04
I think that would be sensible,
04:05
I don’t really want to try and take any more, but maybe if I could take
04:10
two units with as many meals as possible.
04:14
You can look quite well and have a normal body size,
04:18
and yet, because you’re restricting insulin inside you,
04:22
you’re running very high blood sugars,
04:24
and these high blood sugars are increasing your risk
04:27
of getting diabetes complications,
04:28
such as damaging your eyes and going blind,
04:31
damaging your kidneys and needing a kidney transplant,
04:34
or damaging your nerve endings.
04:49
INDISTINCT CHATTER
04:57
Nabeelah lives at home with her extended family.
05:01
She’s struggled with diabulimia for several years,
05:04
but has difficulty being honest with her parents about it.
05:07
All right, decent smiles, please.
05:10
OK, everybody, one, two… Everybody say…
05:13
HE TRILLS
05:15
Oh, my God!
05:16
Hey, smiley boy.
05:20
Well, today’s Eid and we’ve got my whole family here.
05:23
For the past month, it’s been Ramadan and everyone’s been fasting.
05:26
But I’ve been exempt from it because of the diabetes,
05:28
so I don’t have to fast.
05:30
But everyone else has been keeping…
05:33
They’ve been without food and water for about 20 hours or so every day.
05:49
When I’m injecting, my hand tends to shake, usually,
05:52
especially once I’ve got the EpiPen close to my skin.
06:00
Me being completely recovered would be me being able to inject
06:05
on a daily basis without the big cloud of depression
06:10
or the big cloud of weight gain standing over my head.
06:16
A reason why, in different cultures, it’s not really spoken about is
06:22
because it’s not admirable to have
06:25
a mental illness or an eating disorder.
06:28
And if it’s not spoken about in families,
06:30
then it’s kind of just ignored and blocked away,
06:34
like it’s not there.
06:42
With my diabulimia,
06:44
you’ve got the added complications of what diabetes brings.
06:48
My eyesight has gotten worse,
06:50
I’ve been getting nerve pains in my feet and hands and fingers
06:54
cos that’s where it tends to affect you the most.
06:57
I’ve also noticed, like, kidney pains in my lower back.
07:00
I get dizzy easily, I get migraines.
07:03
It’s an eating disorder with a chronic illness,
07:06
so you’re trying to fight both on a daily basis
07:09
and that’s quite difficult to do.
07:43
So the reason I walk with crutches at the moment is
07:46
because of the damage that I’ve done to my feet,
07:49
but that’s all due to not taking care of my insulin
07:53
and my diabetic control.
07:56
The surgeon at the time was like,
07:57
“Yeah, your bone is actually like honeycomb and mush.”
08:00
It’s kind of dissolving it, it’s, like, disintegrating.
08:04
So that’s kind of…
08:08
..hard to think
08:10
that these things are going to be with me for life.
08:12
Becky’s on her way to the eating disorder unit,
08:16
where she spent 16 months as an in-patient
08:18
receiving treatment for her diabulimia.
08:21
I’m really nervous cos I haven’t been back in quite a few months,
08:26
so it’ll be strange seeing some of the actual staff.
08:33
This is us at the Eden Unit, at the front door.
08:36
It’s nerve-racking, this.
08:48
As far as I’m aware,
08:50
the Eden Unit is one of very few units in the UK
08:54
which has been able to take on and treat people
08:57
who are suffering from an eating disorder with
09:00
Type 1 diabetes.
09:03
This used to be one of the old rooms that I stayed in.
09:15
That was the first or second night I was in, that one.
09:20
I got tubed because I wasn’t able to physically eat.
09:25
I was just scared to. I didn’t want to put on the weight.
09:28
I… I don’t know.
09:30
I guess it’s because I knew if I’d eaten something,
09:33
then I would have to take insulin with it
09:35
and that was the last thing I wanted to do.
09:39
Like I say, it is upsetting seeing them…
09:44
..but it’s a good reminder of where I don’t want to be.
09:54
Hello. Oh, come in.
09:56
Hello!
09:58
Haven’t seen you for ages and ages.
10:00
Take a seat.
10:03
It’s been a year and a half now.
10:06
It’s as long as that?
10:08
At the time you came to us, I think you’d got in touch
10:12
with the danger of your condition and you were properly frightened.
10:16
And fortunately, it wasn’t too late and you wanted help.
10:20
Becky’s had three in-patient admissions with us.
10:23
The third and final admission that she had was very nearly fatal.
10:29
She only really got to us just about in time to put her through
10:33
the very delicate re-feeding process.
10:41
OK, so we’re just about to head into the kitchen…
10:46
..where they’re sort of preparing for afternoon snack.
10:56
I ended up on a compulsory treatment order.
10:59
I wasn’t allowed to prick my finger on my own,
11:01
I wasn’t allowed to take my insulin on my own,
11:04
no form of medication on my own.
11:06
It always had to be with a member of staff.
11:09
But then when the time comes for you to actually be handed it,
11:13
to take your insulin, that’s the scary part.
11:16
You’re like, “No, I don’t want to.”
11:36
Gemma has been in a diabetes ward in King’s College Hospital for weeks,
11:40
waiting to hear if any eating disorder units can give her a bed.
11:44
I’m shaking.
11:49
I’m trying to get a place in an eating disorder unit in-patient.
11:57
It’s just finding a bed
11:58
cos at the moment there aren’t any beds in England,
12:02
and especially ones that know about diabetes and eating disorders.
12:09
Back in August last year, I was diagnosed with anorexia,
12:14
binge purge subtype.
12:17
So…it’s like you either eat everything and make yourself sick,
12:24
or stop injecting your insulin,
12:28
or just get rid of the calories in some way.
12:33
My observation is that these patients are falling
12:37
between the nets
12:39
and, as a result, they’re getting worse diabetes control,
12:42
they’re increasing their risk of getting diabetes complications,
12:46
and of early mortality.
12:51
It’s so boring in here that I’ve literally picked the tiniest drawing
12:55
that’s in the book
12:57
so that I can spend as much time just not thinking.
13:01
So I don’t have to just colour that.
13:02
I’m like just literally wasting time.
13:05
This Harry Potter one.
13:08
There’s nothing to do in here.
13:09
And then a comic one, which is awesome.
13:13
Oh, my daughter’s done some, though.
13:18
That’s her artwork.
13:20
At home, I live with my mum, daughter.
13:24
My daughter’s five years old.
13:26
This is to protect… And I’ve got my daughter’s name, Evie.
13:31
So basically the line is protecting her.
13:34
I think she has some sort of idea.
13:37
Yeah, it will affect her soon and she will know.
13:40
But that’s why I am here now, that’s the only reason I am here, like,
13:46
to get better, and prevent her from getting one because…
13:53
..it’d be like the worst thing in the world.
14:04
Currently, access to information and support for diabulimia
14:08
is so hard to come by that, for some, it’s too little, too late.
14:20
This is Lisa’s diary.
14:23
“I feel so fat. Everyone looked at me today.”
14:29
Lisa was 27 years old when she died.
14:36
Do you miss her?
14:40
Yeah, I do.
14:54
Yeah, this dress.
14:55
I think this dress is a size six.
14:58
And even then, it needed taking in, I think.
15:02
But naturally, I would say she was a size…sort of 10 to 12.
15:07
Her cheeks are really, really red in this –
15:10
it’s a sign of not taking your insulin –
15:13
and in this one.
15:15
That one’s quite a recent one, I think.
15:20
It was after Lisa died that I first heard about diabulimia.
15:24
Lisa’s story was posted on social media
15:27
and, reading a lot of the comments, there were a lot of comments saying,
15:30
“Oh, I had this.”
15:31
I don’t even know if Lisa’d heard of that word before.
15:35
It’s nothing that I’d ever had a conversation with her about anyway.
15:41
There’s a series of pictures of her in the gym…
15:44
on here. Sending them to her friends.
15:50
It happened on the 7th of September.
15:52
This was taken on the 6th at 11:45.
15:56
There’s one of her on her birthday here.
15:59
This was…
16:02
This would have been her last birthday that she was alive,
16:05
December 2014.
16:08
She looks a bit drawn in that picture.
16:14
It’s just something that if she’d have help with earlier,
16:18
then…maybe it wouldn’t have happened.
16:27
Mm…
16:31
CROSSING BEEPS
16:40
My parents know slight things with what I’m going through,
16:44
with the diabulimia, with the skipping injections.
16:47
What they know is that I’m skipping injections,
16:50
but they don’t know…
16:52
They don’t understand the mental health part of it.
16:56
But a part of me is too scared to tell them in person, face-to-face,
17:00
because of their reactions.
17:06
So are you meant to inject after every meal?
17:08
Yes. But you don’t?
17:11
Not every meal, no. OK.
17:14
So, have you injected now?
17:17
No, I need to go up and inject, but I end up washing up instead.
17:28
It’s very hard to understand what’s going on in her mind, really.
17:32
Probably she’s wishing she never had diabetes, you know?
17:36
She wishes she was probably normal, like other people without diabetes,
17:40
and at her age you want to eat and drink and do things that other
17:44
youngsters want to do, but she’s limited.
17:53
Nabeelah told me it is an eating disorder
17:55
because I really don’t know about eating disorders.
17:59
She’s got this? Yeah.
18:01
Eating disorder? Eating disorder.
18:03
THEY SPEAK THEIR OWN LANGUAGE
18:18
We never expected to think that at 16 she’d be diagnosed with diabetes.
18:23
All these years, you know, she’s grown up
18:26
and then just before her GCSEs,
18:28
she’s diagnosed with Type 1 diabetes…
18:32
Which has changed everything, hasn’t it, for her?
18:35
Yeah, changed everything. Yeah.
18:58
What are you thinking?
19:00
Do you wish you didn’t have diabetes –
19:02
is that what you’re thinking?
19:03
Then, what you thinking?
19:08
Do you think, by taking insulin, you put on weight?
19:11
Does that matter?
19:13
It’s the main matter. Is that the main matter?
19:19
If insulin didn’t make you gain weight, you would take it?
19:24
What’s the maximum you’ve missed out on?
19:29
The maximum would probably be…
19:33
..not taking it at all.
19:35
For how long? Couple of weeks.
19:37
Not taking any insulin at all for a couple of weeks?
19:40
Wow.
19:43
That’s naughty.
19:46
You didn’t know she missed two weeks on the trot, did you?
19:48
No.
19:51
Never told this. Hmm?
19:53
Never, ever told this. Yes.
19:57
Well, glad you’ve told us now.
20:03
Love you, babes, remember that. Always and forever.
20:07
OK?
20:12
Take more insulin, OK?
20:16
Take sugar in front of me, OK?
20:18
This one, OK?
20:20
OK. OK, smile.
20:47
Honestly, you need to try this.
20:52
Gemma has been a patient of mine for nearly nine months.
20:57
Right, Gemma, how are you?
20:58
Did I see you yesterday?
21:00
I would say that Gemma is one of the most severe cases
21:04
of eating disorders in Type 1 diabetes.
21:08
So I’ll tell you what the situation is at the moment,
21:11
there really are no eating disorders beds. There may be some,
21:14
but they will not at the moment accept you
21:18
because you are perceived as too complex.
21:22
People with Type 1 diabetes and eating disorders who get this ill
21:26
really do fall between the different types of hospitals –
21:31
the medical and the psychiatric.
21:32
Yep.
21:36
There is a lack of care for people who’ve got diabulimia in the UK.
21:42
I have heard of patients that have died whilst waiting
21:47
to get the right care.
21:49
We’re going to keep exploring, trying to persuade these units.
21:52
I’m going to contact the diabetes teams
21:54
that are attached to the eating disorders units
21:57
to see if I can persuade the diabetes teams to provide you
22:00
the diabetes support as an in-patient.
22:03
VOICEOVER: What is difficult is that a lot of diabetes teams
22:06
may not necessarily have the expertise or the skill set
22:11
to carry out the assessments
22:13
and know how to ask patients about this problem
22:16
and, even when they do, that the services do not exist,
22:20
neither does the research evidence exist,
22:23
as to how best to support these people.
22:27
Apparently those clinics don’t handle
22:29
diabetes and eating disorders very well,
22:32
so I’m just going to have to wait a little bit longer and
22:36
hope that a clinic will take, um, a diabetic. So, disappointed.
22:51
Nabeelah has come to a meet-up in London
22:54
for people in recovery from diabulimia.
22:56
The meet-up has been organised by the only UK charity
22:59
for sufferers of the condition.
23:02
I’m nervous.
23:03
I’ve never spoken to anyone else who’s got this, really,
23:08
not in person, anyways.
23:13
I started Diabetics With Eating Disorders as a charity in 2009,
23:19
following the death of a friend of mine who…
23:24
passed away on an eating-disorder ward
23:27
surrounded by doctors who didn’t really understand
23:30
what was going on with her.
23:31
So how is everything going?
23:34
Um… It’s going, kind of…
23:37
JACQUELINE CHUCKLES It sucks.
23:42
Technically, diabulimia doesn’t exist.
23:46
It’s not in any of the big manuals that classify diseases.
23:51
When you’re talking about insulin omission,
23:53
they’re not the common eating-disorder symptoms,
23:55
they’re more like body and shape concerns.
23:58
It is that inherent distress. I remember, when I was about 15,
24:01
having been diabetic for six years by that point,
24:05
all of a sudden there was a week where I was like,
24:07
“I can’t inject myself. I can’t do it.”
24:09
And they sent me to a psychologist, basically like,
24:11
“Stop being so stupid.” And so, from then on, I was like,
24:13
“Well, there’s no point in talking to anyone about this.”
24:16
Yeah. The pros for me were weight loss
24:19
and not having to inject, and eating whatever I want
24:22
and not putting the weight on.
24:24
Yeah. So it wasn’t…
24:26
This is why I don’t know if it’s an eating disorder exactly because
24:30
I can eat whatever I want.
24:32
I’m not looking at what I eat, I’m just not injecting.
24:36
You’re different. The minute you get diabetes, you’re different.
24:39
You feel so isolated. I did.
24:41
I didn’t know anybody that had diabetes.
24:44
Once you feel out of it, once you feel disconnected
24:46
from everyone around you, it’s really easy to go on
24:48
that downward slope and start doing something to yourself.
24:51
The issue with diabulimia and the issue of…
24:57
..eating disorders being looked at in terms of weight…
25:02
..it doesn’t work in this illness.
25:04
The second that you stop taking your insulin, you’re on the clock.
25:07
You’re in the same amount of danger, regardless of what your weight is,
25:11
if you’re not taking your insulin.
25:13
You don’t want that showing up on your dating profile –
25:15
“I’m 90% air up top.”
25:17
“You take my bra off and it disappears!”
25:23
It’s like the diabulimia version of Sex And The City, come on.
25:26
So nice to meet you. It feels great to meet you guys too.
25:29
We’ll be in touch. Please do, reach out.
25:32
That’s fine.
25:35
It wasn’t what I was expecting.
25:38
It was really informal and…I enjoyed it a lot.
25:43
I’m glad I came.
25:45
It makes a big difference when it comes from someone
25:48
who’s been in your place and you can see their recovery
25:52
because they can understand in a way that other people can’t.
26:09
Now that Becky’s in recovery,
26:11
she’s injecting her insulin regularly and working on improving
26:14
the physical disabilities that her diabulimia has left her with.
26:20
Every time I come into the gym,
26:22
I have to just check my blood sugars to make sure I’m in a safe place to
26:27
actually carry on, um, with an exercise routine.
26:31
So what I’m doing is, I’ve just pricked my finger.
26:34
All I need to do is just soak up a little bit of blood.
26:40
I’m at 11.11, which is great for going into the gym.
26:45
So it’s telling me I need to take two units,
26:48
and all my insulin’s just in here.
26:52
And then you count for ten seconds.
26:57
Release, and out, and that’s it done.
27:05
I take every day as they come
27:06
because I don’t how I’m going to wake up in the morning.
27:12
The minute you wake up, you think, “I’ve got to take my blood sugars.”
27:16
You can’t… You don’t get a day off.
27:18
Every day is all about numbers
27:21
and it’s all about numbers with an eating disorder as well, so there’s
27:24
double the amount of numbers flying around in your head.
27:33
I would tell, recommend to anybody,
27:35
“Don’t muck around with your insulin, don’t do it.”
27:39
It’s a dangerous game to start and, once you start it,
27:42
you kind of get obsessed with it.
27:44
There’s no point in risking your own life.
27:50
You really want a shot!
27:52
I think to get a range of movement back in my feet
27:55
so that walking’s actually going to be easier,
27:58
so that I could actually go and do things that I enjoy,
28:02
like going on a bike!
28:05
Or, I don’t know, going dancing like I used to.
28:08
That would be amazing.
28:10
But little steps.

Symptoms of Diabulimia

Some of the symptoms of diabulimia are very similar to the early symptoms of diabetes. That’s because diabulimia essentially turns back the clock on the disease, since it’s not being adequately managed.

Physical warning signs of diabulimia include:

  • Rapid weight loss despite heavy or normal eating
  • A1C of 9.0 or higher on a continuous basis
  • Fatigue and exhaustion
  • Increased appetite
  • Excessive thirst and urination
  • Recurring diabetic ketoacidosis without any apparent cause
  • Frequent bladder or yeast infections
  • Dry hair and skin
  • Irregular or no menstruation

Emotional signs and symptoms of diabulimia include:

  • Fear of low blood sugar
  • Extreme anxiety about body image
  • Changes in mood
  • Discomfort with eating in social situations
  • Discomfort with testing or injecting in front of others
  • Rigidity surrounding food or exercise rules
  • Depression and anxiety

Behavioral signs and symptoms of diabulimia include:

  • Increasing neglect of diabetes management
  • Secrecy surrounding diabetes management
  • Missing doctor’s appointments
  • A belief that insulin makes you gain weight
  • Extreme changes in diet
  • Restricting certain foods to reduce insulin doses
  • Excessive exercise
  • Withdrawal from friends or family

Not everyone with diabulimia will exhibit all its signs and symptoms. Symptoms may range from mild to severe.

Short and Long Term Effects of Diabulimia

Diabulimia poses a serious risk to health. Unmanaged blood sugar levels combined with inadequate nutrition or dangerous purging behaviors can lead to severe consequences down the road.

Diabetic Ketoacidosis

Withholding insulin, the key characteristic of diabulimia, can quickly lead to diabetic ketoacidosis or DKA, a life-threatening problem that occurs when insulin levels in the body are so low that:

  • Glucose can’t enter cells to be used as a source of fuel
  • The liver makes extremely large amounts of glucose
  • Fat in the body is broken down too quickly for the body to process

The liver breaks down fat into a fuel called ketones. When ketones are produced too quickly, they build up in the blood and urine, making the blood acidic. Symptoms of DKA include deep, rapid breathing, dry skin and mouth, frequent urination, extreme thirst, headache, muscle stiffness, and nausea and vomiting.

Treating diabetic ketoacidosis involves administering insulin to correct high blood sugar and replacing lost fluids. Untreated, DKA can lead to severe illness and death. Complications of DKA include kidney failure, cardiac arrest, and fluid buildup in the brain.

Short Term Effects

Other short-term consequences of diabulimia include:

  • Slow wound healing, since elevated blood sugar causes poor circulation and damages small blood vessels
  • Bacterial infections, since high blood sugar reduces the body’s defense against infection
  • Yeast infections, since high blood sugar allows yeast in the body to overgrow
  • Muscle atrophy, which occurs when the body can’t utilize fuel, cells begin to starve and the body begins to use muscle for fuel
  • Severe dehydration due to frequent urination
  • Electrolyte imbalance, which occurs when the kidneys extract sodium and potassium along with the sugar and ketones to expel through urine

Long Term Effects

Long-term complications of diabetes may occur in people with diabulimia due to frequent, high blood sugar levels.
Health complications due to diabetes can include:

  • Retinopathy, which involves damage to the blood vessels of the retina, potentially causing blindness down the road
  • Macular edema, or the swelling of the eyeball due to excessive fluid
  • Nephropathy, a serious kidney complication that can lead to kidney failure
  • Neuropathy, a type of nerve damage that causes pain and numbness in the affected area (usually the legs and feet), or problems with the digestive system, blood vessels, heart, or urinary tract
  • Kidney disease, liver disease and heart disease
  • Stroke
  • Coma
  • Death

Eating disorders also have serious consequences on health and wellbeing, including:

  • Depression and anxiety
  • Suicidal thoughts and behaviors
  • Problems with growth and development
  • Social and relationship problems
  • Substance abuse
  • Problems with the body’s systems, including the cardiovascular, gastrointestinal, endocrine, and neurological systems
  • Organ failure
  • Death

Once diabulimia develops, treatment is frequently needed to address the underlying roots of the disorder.

Treating Diabulimia

Like all eating disorders, diabulimia is treatable, but its treatment differs from that of other eating disorders. Treatment for diabulimia must address both the eating disorder and diabetes. An eating disorder treatment program that focuses on disordered eating that co-occurs with diabetes offers the best chances of successful recovery.

Holistic Team Treatment

A team approach to treatment offers the best outcomes and will involve an endocrinologist, a diabetes educator, a registered dietician who has knowledge of both diabetes and eating disorders, a physician, and a mental health professional who specializes in eating disorders. High quality diabulimia treatment is holistic in nature, addressing issues of the body, mind and spirit for whole-person healing.

Traditional vs. Complimentary

Both traditional and complementary therapies are used in high-quality diabulimia treatment programs. Traditional therapies like cognitive behavioral therapy and family therapy help individuals address a range of issues and develop an arsenal of coping and life skills that will help them maintain good physical and mental health while successfully managing their diabetes. Complementary therapies such as art therapy, equine therapy or restorative yoga help improve self-awareness, self-esteem, and self-confidence.

Inpatient vs. Outpatient

Treatment may take place through an inpatient recovery program or an outpatient program. Care providers will administer a number of assessments to determine the best level of care to start. Inpatient treatment involves living at a residential center, while outpatient treatment involves living at home and attending programs at the center during the day. Outpatient treatment is ideal for people who are able to take insulin consistently, eat enough food, and avoid purging behaviors.

Individual vs. Group

Therapy takes place in individual and group settings. Individual therapy helps patients address unique issues, work through setbacks, celebrate successes, and find answers to their questions and concerns. Group therapy is highly effective for treating eating disorders and offers an additional layer of support. Psychoeducational classes take place in group settings and educate individuals about a range of issues surrounding diabulimia, including:

  • Body image
  • Mindful eating
  • Intuitive eating
  • Coping with co-occurring disorders
  • Family relationships
  • Relapse
  • Long-term recovery

In addition to therapy, treatment may include medication prescribed to address a mental illness or manage a co-occurring physical illness.

Goals of Treatment

The overarching goal of diabulimia treatment is to normalize the use of insulin, restore healthy blood glucose levels, and help the patient achieve a healthy weight. The first phase of treatment is medical and psychiatric stabilization, which may involve hospitalization if the diabulimia is severe.

Once stable, patients participate in a structured curriculum of therapies that help them explore the underlying causes of the eating disorder and build the skills they need to stay in recovery from the eating disorder and manage their diabetes. Treatment plans for diabulimia are highly individualized, designed by care providers to address all of an individual’s complex needs and issues.

Through a variety of therapies, patients:

  • Learn how to manage stress and anxiety
  • Set boundaries
  • Manage healthy relationships
  • Develop the ability to be a mindful, intuitive eater
  • Overcome a diet mentality
  • Develop an understanding of how good nutrition helps fuel good health
  • Develop self-confidence and greater self-awareness
  • Foster motivation to change

Recovery from diabulimia is possible, but it largely depends on you. Here are some tips during treatment to get the most out of it and improve the chances of successful recovery:

Tips for Successful Recovery from Diabulimia

Be Honest

Honesty is essential for recovery, especially when meeting with your therapist or therapy group. Only by being completely honest with yourself and others is it possible to work through the complicated issues that underlie in an eating disorder.

Stay Open-Minded

Through treatment, you’ll work to identify cognitive distortions, which psychologists call “stinking thinking.” You’ll examine your beliefs about yourself, your relationships, and the world around you. Keep an open mind throughout this process, which is an important foundation of successful recovery.

Be Fully Engaged

Engage fully in your treatment plan. Keep your focus on recovery and stay rooted in the present moment where all the action is happening. Participate in group sessions, work hard in individual therapy, and be a good listener.

Once treatment is complete, an aftercare plan will help navigate the early weeks and months of solo recovery from diabulimia. The better the plan is followed, the better the chances of long-term recovery.

Get Support

Even if your aftercare plan doesn’t include participating in a support group, a support network can make a huge difference in your recovery. Support groups provide a place where people understand and can relate to what you’re going through. They offer emotional and practical support and promote personal accountability. According to a study published in the journal Addictive Behaviors Reports, support groups improve chances of successful recovery by increasing a sense of purpose and helping with motivation for change.​​​ 4

Ask Your Family to Get Support

Living with diabulimia can take a toll on family members. It’s helpful for family members to join a support group for family members of people recovery from eating disorders. Support groups help family members better understand the healing process and how to maintain their own good mental health. It offers them a place to go for resources, answers, and support.

Practice Mindfulness Every Day

Mindfulness is another important foundation of recovery, and is frequently taught during treatment. Keep practicing mindfulness by meditating daily and checking in throughout the day to assess how you’re feeling. Keep a journal, even if you write just a few sentences a day.

Continue with Therapy

Therapy helps you sort through a wide range of issues that can contribute to diabulimia and lead to relapse once in recovery. Continuing with therapy gives the opportunity to delve deep and resolve a variety of physical, mental and spiritual issues for greater happiness and self-awareness.

Treatment Works

Although diabulimia is more complex than other eating disorders, high-quality treatment works to help individuals restore health and wellness. A holistic treatment program will address all an individual’s needs and issues to pave the way for long-term success. If you have diabulimia, treatment can help you end disordered eating behaviors. It’s never too early or too late to get help. The sooner you seek help, the better your chances of full recovery.

Resources

  1. http://www.diabetes.org/diabetes-basics/statistics/
  2. https://www.progressnp.com/wp-content/uploads/sites/29/2016/03/Diabulimia-mental-health-condition-or-media-hyperbole.pdf
  3. https://www.nationaleatingdisorders.org/statistics-research-eating-disorders
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836517/