Diabulimia: Symptoms and treatments

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Diabulimia is when a person with type 1 diabetes restricts their insulin intake to cause weight loss.

Insulin is a hormone that helps the body absorb energy from food. People with type 1 diabetes do not make any or enough insulin on their own, which is why they need to take this medication.

When a person does not take enough insulin, they can lose weight. Sometimes, this is accidental. Diabulimia is the practice of doing it on purpose.

Doctors do not consider diabulimia to be a distinct medical condition. Instead, it is a subtype of other eating disorders — usually bulimia, but sometimes anorexia. People with diabulimia may also restrict calorie intake, vomit after meals, or misuse laxatives.

Doctors and some diagnostic manuals refer to diabulimia as eating disorder–diabetes mellitus type 1, or ED-DMT1.

The main sign of diabulimia is a person deliberately limiting their insulin dose or taking less than they know they need. On the outside, this may cause visible symptoms, such as:

• sudden or unexplained weight loss
• weakness and fatigue
• persistent thirst
• frequent urination
• nausea or vomiting
• fainting
• dizziness
• dry skin or hair

The emotional and behavioral changes a person with diabulimia may exhibit include:

• not managing their diabetes
• being secretive about their blood sugar levels or insulin dose
• a fear of insulin or having low blood sugar
• a belief that insulin makes them gain weight
• anxiety and preoccupation with body image
• body dysmorphia, which is when a person sees a distorted reflection of themselves
• having overly strict rules about eating, nutrition, exercise, or calories
• avoiding eating around others
• withdrawing from family and friends
• avoiding diabetes-related medical appointments

The person may also experience medical complications, such as:

• diabetic ketoacidosis
• low sodium or potassium levels
• frequent bladder or yeast infections due to high blood sugar
• irregular periods or no periods
• deteriorating vision

Only people with insulin-dependent diabetes can develop diabulimia, or ED-DMT1. However, similar to other manifestations of eating disorders, the reasons why some people develop it and not others are complex. Researchers believe the following factors play a role:

• Diet culture: Diet culture is a term that describes cultures that associate thinness with health, beauty, and morality. It has played a significant role in fuelling eating disorders worldwide.
• Gender ideals: Most eating disorders are more common in women than men. This is likely due to an increased pressure on women to be desirable. In cultures that value being slimmer, this involves staying a certain weight.
• Psychology: People with anxiety, perfectionism, or obsessive-compulsive behavior are more vulnerable to developing eating disorders. People with childhood trauma, such as experiencing abuse, are also significantly more likely to develop eating disorders.
• Biological factors: Genetics may raise or lower a person’s risk for eating disorders. Changes in chemicals and hormones, such as serotonin, could also influence appetite and mood.

Diabulimia is a serious condition. Without treatment, it can cause a range of health issues. This is because, without the correct dose of insulin over time, diabetes can lead to:

• a weakened immune system
• hearing loss
• vision loss
• nerve damage
• organ damage
• pancreatitis
• stroke
• coma
• death

In addition, the other symptoms of eating disorders, such as restricting food intake or purging, can lead to other complications. These include:

• nutritional deficiencies
• electrolyte imbalances
• hormone imbalances
• low blood pressure
• slow or irregular heartbeat
• damage due to vomiting, such as tooth erosion or oral bleeding
• reduced bone density and risk of fractures

These complications can compound the consequences of unmanaged diabetes, increasing their risk and making them occur more rapidly than they otherwise would.

Doctors diagnose eating disorders based on the symptoms. A doctor may ask a person directly about their behavio or draw on other sources, such as the reports of their parents or caregivers.

For diabulimia, a doctor may also test a person’s A1c or blood sugar level to look for signs of unmanaged blood sugar. This can show if a person is not getting enough insulin.

As diabulimia is relatively uncommon, greater awareness among healthcare providers may make it easier to detect.

Treatment for diabulimia has two goals: stabilizing diabetes by increasing insulin intake and addressing the underlying eating disorder.

Encouraging a person to eat or use their insulin is not enough to treat this condition. It might help them remain stable for longer, but their belief system, distorted body image, and emotional distress will still be present. Therefore, a person needs support from a mental health professional.

Depending on the severity, treatment for eating disorders can include outpatient or inpatient treatment. This may include:

• Psychotherapy: This can help a person identify unhelpful beliefs about their body and diabetes, learn where these beliefs come from, and how to cope when they feel the urge to limit insulin or food. Over time, therapy can also replace these beliefs with more balanced ones.
• Nutrition therapy: This involves gradually eating more food or limiting insulin less so that a person gets the nutrients they need. People may also benefit from speaking with a dietitian to learn what the body needs to be healthy and how to look after it.
• Family and social support: This can help a person feel supported and accepted as they are and prevent relapsing. This is especially important for younger people with eating disorders.
• Medication: People with other conditions, such as anxiety or depression, may benefit from antidepressants.

In some cases, a person may also need treatment for diabetes complications.

With help and support, diabulimia is treatable. People concerned about themselves or someone else should speak with a doctor or mental health professional as soon as possible.

Diabulimia, or ED-DMT1, is a subtype of other eating disorders. It is when a person with type 1 diabetes does not take enough insulin so that they will lose weight. This can lead to high blood sugar which, over time, can lead to a range of complications.

As with other eating disorder symptoms, diabulimia is serious and can be fatal. Treatment is essential to help a person recover and ease the underlying distress that causes the behavior.