The hidden dangers of eating disorders for people with diabetes

Diabulimia is an eating disorder that affects people with type 1 diabetes (T1D). Those with diabulimia intentionally reduce or stop their insulin use to lose weight. The earliest cases of diabulimia were reported in the 1980s, and, though it’s a relatively recent phenomenon, it can impact individuals aged anywhere from 13 to 60. Research shows that around one-third of women and one-sixth of men with T1D will restrict insulin for weight loss. Approximately 30% of adolescents with T1D also engage in this behavior.

But what makes diabulimia so dangerous? What are the signs and symptoms, and how can it be treated? This gallery explores these questions and others. Click through to learn more.

What is diabulimia?

Diabulimia is a life-threatening eating disorder where a person with T1D withholds insulin in order to lose weight. People who suffer from diabulimia may also have other disordered eating behaviors, such as purging.

Diabulimia and binge eating

Not everyone who has diabulimia binge eats, which is a defining feature of bulimia nervosa. The term diabulimia is used to describe restricting insulin in order to lose weight.

Where is glucose stored?

The body and its cells need energy to survive. Any glucose that hasn't been used for energy is stored in the liver, muscles, and fat tissue.

Dehydration

A persistent lack of insulin can lead to severe dehydration, which also causes weight loss in the form of water loss, which is a dangerous form of weight loss.

Persistently high blood sugar

Having persistently high blood sugar can cause severe dehydration, so once individuals receive treatment for their T1D, they may also gain water weight.

How common is diabulimia?

According to research, up to 40% of people assigned female at birth and 10% of people assigned male at birth with T1D aged 15 to 30 take less insulin needed in order to lose weight.

Signs and symptoms of diabulimia

Other physical symptoms include fatigue, frequent urinary tract infections, deteriorating or blurry vision, and dry hair and skin.

Emotional and psychological signs of diabulimia

Emotional and psychological signs and symptoms include fear that insulin causes weight gain, anxiety about body image, feeling drained by diabetes management, and having an obsessive interest in food and calories.

What causes diabulimia?

All eating disorders, including diabulimia, are complex conditions, with no one cause. Reasons why diabulimia may develop may be a combination of physical, social, and mental health problems.

Other contributing factors

Diabetes burnout causes frustration and exhaustion with diabetes management, leading to behaviors like less frequent blood sugar checks and insulin guesses rather than precise measurements. This can raise blood sugar and lead to weight loss. Burnout may also result in deliberate insulin restriction to lose weight.

Body image issues

A distorted self-image can contribute to the development of eating disorders, including diabulimia. Stigma and the misconception that excess body fat directly causes diabetes may drive some individuals to focus on losing weight.

Bullying, teasing, or peer pressure

For children and adolescents, teasing, bullying, or peer pressure because of appearance or for having diabetes can contribute to the development of diabulimia.

How is diabulimia treated?

Treatment for diabulimia includes using insulin properly, managing blood glucose levels and weight, and treating psychological issues that may have contributed to the development of diabulimia.

Treatment for diabulimia

Treatment for diabulimia often combines psychotherapy, medication, and medical evaluation. Because of the physical and psychological elements of diabulimia, treatment involves care from multiple types of healthcare providers.

Long-term complications of diabulimia

Although the long-term complications of diabulimia are the same as those associated with diabetes, individuals with diabulimia may experience these complications sooner due to continuously elevated blood sugar levels. These complications include kidney disease, liver disease, and diabetes-related retinopathy, which can lead to blindness.

Sources: (Cleveland Clinic) (BBC) (The Recovery Village)