Diabulimia is an eating disorder that can affect people who suffer from type 1 diabetes. In this condition, the patient may also reduce the levels of insulin injections they require in an attempt to lose weight. This, however, puts them at danger of other complications because it results in a rise of glucose in the blood.
Insulin is a hormone that controls the level of glucose in the blood. Patients with type 1 diabetes do not produce enough insulin in the pancreas to regulate glucose properly and, in the long term, this can lead to organ damage. Patients with the condition therefore have to take regular insulin injections to maintain the right levels of glucose to support their health.
Insulin can lead to weight gain because it contributes to fat storage in the body and hence some patients manipulate insulin levels to lose weight. Type 1 diabetes is usually identified in patients before they reach 40 years of age. Diabulimia is believed to mainly affect young women but some young men also suffer from the condition. About one third of young women with type 1 diabetes are estimated to have the disorder. Patients may also have other eating disorders such as anorexia - over reduction of calorie intake and / or excessive exercise designed to keep their body thin - or bulimia - an eating disorder where the patient binge eats and purges food on a regular basis.
Signs of Diabulimia
Diabulimia can lead to a type 1 diabetes patient having very high glucose levels in the blood. This can result in hyperglycemia and the patient feels very thirsty, needs to urinate more often than usual, has blurred vision, and is fatigued.
Patients who manipulate their insulin levels can have changes in weight, avoid health checks, and feel awkward talking to their physician about their condition. Another sign can be high glycosylated hemoglobin (HbA1c) levels of 9 or above. The patient’s behavior at home can also change with them avoiding eating in front of others and starting to hoard food rather than eat it.
Risks of Diabulimia
In the short-term, a patient can experience symptoms such as weakness, tiredness, constant thirst, increased urination, lack of concentration, and ketonuria, which is a rise in ketones in the blood.
As diabulimia advances further, the patient’s cholesterol levels may go up, eye problems may develop, their weight reduces, swelling may happen in the limbs due to accumulation of fluid, GERD develops and muscle wasting starts. Diabulimia patients are also at a high risk of bacterial and yeast infections, atherosclerosis, liver disease, and stroke.
With further progression, there can be more severe complications such as kidney damage, heart problems, neuropathy, osteoporosis, and possibly death, if left untreated.
Treatment for Diabulimia
Some patients may need to be hospitalized to regain normal health. Outpatients will need advice and mental health therapy to help them understand the impact of diabulimia and guidance on how to manage their weight through healthy practices. The medical team should include a dietician, an endocrinologist, and a psychotherapist so as to provide holistic approach to treatment of diabulimia.
Reviewed by Susha Cheriyedath, MSc