Learning About Diabulimia

Learning About Diabulimia

Most people are familiar with eating disorders such as anorexia, bulimia and binge eating disorder, but few are familiar with an eating disorder that is unique to patients with type 1 diabetes (T1DM). ED-DMT1, or what the media has dubbed “diabulimia,” is an eating disorder where patients with T1DM will purposely stop taking or significantly reduce their insulin doses to lose weight. Without enough insulin,patients with T1DM will lose calories through the loss of glucose in the urine.Insulin is a hormone produced in the pancreas that allows cells in the body to absorb and use glucose for energy. Patients with T1DM are not able to produce their own insulin and have to inject insulin every day to survive.

Inappropriately omitting or reducing insulin doses to lose weight is a behavior recognized as a sign of bulimia. This unique eating disorder has only recently been gaining mainstream attention in the past decade. It was first recognized in public and healthcare communities in the early 2000s.1It is unclear how common this disorder is, but it is estimated that 11% to 39% of women with T1DMwill purposely take less insulin or skip doses to lose weight.1Women with T1DM are twice as likely to develop an eating disorder compared to women without diabetes.2

This unhealthy practice can be dangerous. Patients with diabulimia will take just enough insulin to function and may have signs and symptoms of high blood sugar, such as increased thirst, fatigue (weak, tired feeling) and foggy thinking. The long-term complications of poorly controlled blood sugar include blindness, nerve damage and kidney failure.2However, these long-term problems may develop much earlier in a poorly controlled patient compared to a patient whose blood sugar is relatively well-controlled. In fact, the death rate among patients with T1DMand diabulimia is three times higher compared to patients with T1DMwho take their insulin appropriately.1

There are many factors that can increase the risk of diabulimia including: depression/anxiety, poor body image, and a perfectionist mind-set. Additionally, the necessary emphasis on food and dietary restrictions associated with the management of diabetes can create an unhealthy focus on food, numbers and control.2

Possible signs and symptoms of diabulimia can include1,3:

  • A1C level of 9.0% or higher on a regular basis
  • Unexplained weight loss
  • Lasting thirst/frequent urination
  • Obsession with body image
  • Self-reported blood sugars that do not match A1C results
  • Depression, mood swings and/or fatigue
  • Secrecy about blood sugars, shots and/or eating
  • Repeated bladder and yeast infections
  • Low sodium/potassium levels
  • Increased hunger, especially for sugary foods
  • Cancelled doctors’ appointments
  • Recurrent diabetic ketoacidosis (DKA)

If you or someone you know may be suffering from diabulimia, contact the Diabulimia Helpline 1-800-931-2237 or http://www.diabulimiahelpline.org/for resources, support and finding treatment.

This Article is Brought to you By Our Guest Staff Writers:
Karen (Kacie) Bergin Pharm.D. Candidate 2017, MCPHS University
David Sze, Pharm.D. Fellow, MCPHS University
Jennifer Goldman, RPh, Pharm.D., CDE, BC-ADM Professor of Pharmacy Practice, MCPHS University, Boston, MA
Clinical Pharmacist, Well Life, Peabody, MA

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