Diabulimia: Signs, Symptoms, & Getting Treatment
Eating disorders come in many forms and can look different from person to person. Diabulimia has been around for a few years but has recently gained notoriety and is being more heavily discussed by professionals in the medical community. So what is diabulimia, how do you recognize the symptoms, and what can be done about this dangerous condition?
What Is Diabulimia?
Type 1 diabetics require insulin injections to properly manage their health as their pancreatic systems do not produce sufficient insulin for their dietary needs. In simple terms, insulin processes glucose and regulates blood sugar levels. These insulin injections prevent chronic high blood sugar levels that would otherwise occur in type 1 diabetics. Not taking insulin for a type 1 diabetic is a severe medical problem that can lead to chronic high blood sugar.
Some of the complications associated with chronic high blood sugar include:
- Ulcers
- Infections
- Vision problems and blindness
- Nerve damage
- Keto acidosis
- Skin damage
- Kidney issues
- Cardiovascular disease
Diabulimia is the deliberate rationing or skipping of insulin injections by type 1 diabetics to control weight gain or to promote weight loss. This could look like a diabetic intentionally missing a dose periodically or frequently to control their weight. This insulin skipping is often in conjuncture with other disordered eating behaviors, like binging, purging, or severe calorie restriction.
Diabulimia is not a recognized DSM-5 eating disorder but is gaining more attention as a serious concern. As of now, it is seen as an extension of the traditional eating disorders anorexia nervosa or bulimia nervosa.2 Many people with type 1 diabetes who change their dosing of insulin as a weight-control method may not even recognize that it could be part of a disordered relationship with food and diet, as this eating disorder isn’t often discussed.
Type 1 diabetes is a severe medical condition requiring strict healthcare professional observation and monitoring. Intentionally going against a medically supervised insulin schedule can have devastating, if not life-threatening, effects. One of the most dangerous side effects of diabulimia is diabetic ketoacidosis. This occurs when poorly managed diabetes leads to high acidity levels in the blood’s pH, leading to adverse health effects and even coma or death if untreated.
Signs Someone Has Diabulimia
The signs of diabulimia1 often overlap with the symptoms of other eating disorders. If you’re worried about a loved one who may be manipulating their insulin intake as part of disordered eating (or possibly concerned about it within yourself), here are some signs to look out for:
- Preoccupation with weight loss or gain, food, calorie counting, exercise
- Frequent thirst and urination due to high blood sugar levels
- Confusing or disordered eating patterns
- Irritability, mood fluctuations
- Social withdrawal
- Failing to take insulin as they had in the past
- Secretive or defensive behavior
Based on the limited data that has been found on the disorder, diabulimia disproportionately impacts young people and women. However, men can and have experienced this specific type of disordered eating.
It can often be difficult to tell if someone is experiencing diabulimia, as a diabetic’s insulin habit is often private and difficult to monitor from the outside. There is additionally a fair amount of stigma around not only eating disorders in general but the idea of restricting insulin for weight purposes. Because of this stigma and the general fear, anxiety, and discomfort accompanying eating disorders, seeking help for your loved one may be the best course of action.
Getting Support for Diabulimia
Talking to a loved one about a suspected eating disorder can be challenging. Many people worry about saying the wrong thing or causing a rift between those they seek help. Often, however, having a kind and empathetic conversation about your concerns is the first step many people need to seek help. This type of conversation requires tact and a lack of judgment to be effective.
It is typically best to avoid discussing the individual’s weight or appearance, particularly in a critical or harsh way. Phrases like, “you look too skinny” or, “you just need to eat more/less.” These comments can often create more problems than they solve and build up a wall of resistance between you and them. Being overly critical or making assumptions about their dietary and medical choices is also inadvisable when attempting to build a therapeutic alliance with someone you think may be navigating a difficult time with disordered eating.
Eating disorders are often scary, isolating, and emotionally distressing. They typically accompany a strong sense of self-criticism and feelings of inadequacy. This can cause many to withdraw from social and emotional supports. Sometimes the best thing you can do for someone is just to listen and encourage them.
Additionally, seeking professional support for a loved one experiencing an eating disorder is often the best approach for many. Sooner rather than later is always the best, as unmanaged diabetes can lead to severe medical issues. Professionals are trained not only in getting medical assistance to the individual but also in navigating the often-tricky resistance that comes with recognizing and overcoming a complicated eating disorder. And because diabulimia carries a dangerous risk of chronic high blood sugar and the related adverse effects of this, recovery may require psychological and medical intervention.
A doctor or medical professional should check blood glucose, ketone levels, hydration, and other critical factors regularly to ensure the individual isn’t at risk of severe side effects of diabetes. Some people experiencing diabulimia might require hospitalization and more extensive medical monitoring if diabetes becomes too out of control.
Conclusion
If you suspect a loved one of diabulimia, it may help to read up on the material about it and educate yourself as much as possible. Several studies have been published around the disorder, and understanding what diabulimia is (and isn’t) is a great start. Watching for the warning signs, seeking professional help, and having empathetic conversations are all great starting points on beginning the journey to recovery.
