Diabulimia

Diabulimia

Adolescent girls diagnosed with Type 1 diabetes appear to experience a significantly increased rick of eating disorders compared to those without diabetes. Common risk factors for developing an eating disorder include weight gain and a history of dieting and dietary restraint. Type 1 diabetes intensifies these risks due to the tendency to gain weight following the initiation of insulin therapy and the necessity of focusing on food to successfully manage the condition.

In addition to their general susceptibility to eating disorders, patients diagnosed with diabetes are uniquely vulnerable to developing diabulimia. Diabulimia, a combination a diabetes and bulimia, is the term used in academic literature and the media to describe the deliberate avoidance or limitation of insulin to control weight. The omission or restriction of insulin results in the purging of calories through glycosuria, which causes weight loss. Efforts are currently being made to include diabulimia as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Warning Signs:

  • Obsession with body size & shape
  • Rapid weight loss
  • Preoccupation with food intake
  • Frequent micturition
  • Hyperglycemia
  • Recurrent ketoacidosis
  • Ketone smell on breath & in urine
  • Poor metabolic control despite appearance of compliance
  • Refusal to let others observe insulin injections

Prevention

Although not currently recognized as a medical or psychiatric diagnosis, the acknowledgement of diabulimia by healthcare and medical providers is integral. If left undetected, it can cause early on-set kidney failure and retinopathy and ultimately be fatal. Early identification is important as prevention, therefore regular screening for diabulimia should be a fundamental part of diabetes care. A possible tool physicians can use is the Revised 16-item Diabetes Eating Problem Survey, a diabetes-specific measure of disordered eating that includes questions about purging through maladaptive insulin use.

 

Sources Consulted:
Callum, A. & Lewis, L. (2014). Diabulimia among Adolescents and Young Adults with Type 1 Diabetes. Clinical Nursing Studies 2.4, 12-16.
Darbar, N. & Mokha, M. (2008). Diabulimia: A Body-Image Disorder in Patients with Type 1 Diabetes Mellitus. Athletic Therapy Today, 31-33.
Shaban, C. (2013). Diabulimia: Mental health condition or media hyperbole? Practical Diabetes, 30(3), 104-105.