Diabulimia

Diabulimia (a portmanteau of diabetes and bulimia) is an eating disorder in which people with type 1 diabetes deliberately give themselves less insulin than they need or stop taking it altogether for the purpose of weight loss. Diabulimia is not recognized as a formal diagnosis by the medical or psychiatric communities, but the phrases “disturbed eating behavior” or “disordered eating behavior” (DEB in both cases) and disordered eating (DE) are quite common in medical and psychiatric literature addressing patients who have type 1 diabetes and manipulate insulin doses to control weight along with exhibiting bulimic behavior.

Signs and symptoms

A person with diabulimia, especially if not treated early, can suffer negative effects on the body earlier than one who is managing properly. Of diabetics who have a DEB, some intentionally misuse insulin to control weight.[1][2][3]

Suspension of insulin combined with overeating can result in ketoacidosis. Multiple hospitalizations for ketoacidosis or hyperglycemia are cues to screen for an underlying emotional conflict.[4][5]

Short term

The short-term symptoms of diabulimia are:

Medium term

These are the medium-term symptoms of diabulimia. They are prevalent when diabulimia has not been treated and hence also include the short-term symptoms.

Long term

If a person with type 1 diabetes who has diabulimia suffers from the disease for more than a short time—usually due to alternating phases during which insulin is injected properly and relapses during which they have diabulimia—then the following longer-term symptoms can be expected:

  • Severe kidney damage: high blood sugar can overwork the kidneys, eventually leading to kidney failure and the need for a kidney transplant[6]
  • Severe neuropathy (nerve damage to hands and feet)
  • Extreme fatigue
  • Edema (during blood sugars controlled phases)
  • Heart problems
  • Retinal damage and subsequent vision problems
  • High cholesterol
  • Osteoporosis
  • Death

Often, people with type 1 diabetes who omit insulin injections will have already been diagnosed with an eating disorder such as anorexia nervosa, bulimia nervosa, or EDNOS. These individuals often think diabulimia is less common than it is and do not know how difficult it is to overcome. Unlike anorexia and bulimia, diabulimia sometimes requires the afflicted individual to stop caring for a medical condition. Unlike vomiting or starving, there is sometimes no clear action or willpower involved.

Many articles and studies further conclude that diabetic females have, on average, higher body mass index (BMI) than their nondiabetic counterparts. Girls and young adult women with higher BMIs are also shown to be more likely to have disordered eating behavior (DEB).[7][8] Many authoritative articles show that preteen and teenage girls with type 1 diabetes have significantly higher rates of eating disorders of all types than do girls without diabetes.[4][9][10][11] This condition can be triggered or exacerbated by the need for diabetics to exercise constant vigilance in regard to food, and glycemic control. In adolescent females, increased weight gain that insulin treatment can cause may increase the risk of anorexia and/or bulimia.

Treatment

There are no specific guidelines for the treatment of diabetes and disordered eating, but the standard approach for treatment of two complex conditions as multidisciplinary team of professionals which in this case could include an endocrinologist, psychiatrist, psychologist, dietician, etc.

gollark: Oh, and the way everything is mutable by default can cause badness.
gollark: Plus !!referential transparency!!.
gollark: `is` is terrible and confusing because it's object identity and will *appear* to work sometimes when it's wrong.
gollark: It would be easier and more consistent to just do `not (whatever in whatever)`.
gollark: I mean, consider `is not` and `not in` and stuff. Who thought "hmm yes we will complicate the parsing logic to make this work"?

See also

References
  1. Neumark-Sztainer, Dianne PHD; Patterson, Joan PHD; Mellin, Alison PHD; Ackard, Diann M. PHD; Utter, Jennifer MPH; Story, Mary PHD & Sockalosky, Joseph MD (2002). "Weight Control Practices and Disordered Eating Behaviors Among Adolescent Females and Males With Type 1 Diabetes". DiabetesCare.com. 25 (8): 1289–96. doi:10.2337/diacare.25.8.1289. PMID 12145223.
  2. Alemzadeh, R., MD & Wyatt., MD (2007). Nelson Textbook of Pediatrics (18th ed.). ISBN 978-1-4160-5622-5.CS1 maint: multiple names: authors list (link)
  3. Jones J, Lawson ML, Daneman D, Olmsted MP, Rodin G (2000). "Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study". BMJ (Clinical Research Ed.). 320 (JUN 10): 1563–1566. doi:10.1136/bmj.320.7249.1563. PMC 27398. PMID 10845962.
  4. Alemzadeh, R., MD & Wyatt., MD (2007). Nelson Textbook of Pediatrics (18th ed.). ISBN 978-1-4160-5622-5.CS1 maint: multiple names: authors list (link)
  5. Jancin, Bruce, Best treatment unclear for disordered eating in type 1 diabetes, 2008 (2008). "Best treatment unclear for disordered eating in type 1 diabetes". MDConsult.CS1 maint: multiple names: authors list (link)
  6. "How to Distinguish Depression and Diabulimia". Archived from the original on 2015-06-30.
  7. Domargard A, Sarnblad S, Kroon M, Karlsson I, Skeppner G, Aman J (1999). "Increased prevalence of overweight in adolescent girls with type I diabetes mellitus". Acta Paediatr. 88 (11): 1223–1228. doi:10.1080/080352599750030329. PMID 10591423.
  8. Colton, P. A.; Olmsted, M. P.; Daneman, D.; Rydall, A. C.; Rodin, G. M. (2007). "Five-Year Prevalence and Persistence of Disturbed Eating Behavior and Eating Disorders in Girls With Type 1 Diabetes". Diabetes Care. 30 (11): 2861–2862. doi:10.2337/dc07-1057. PMID 17698613.
  9. Colton, P. A.; Olmsted, M. P.; Daneman, D.; Rydall, A. C.; Rodin, G. M. (2007). "Five-Year Prevalence and Persistence of Disturbed Eating Behavior and Eating Disorders in Girls With Type 1 Diabetes". Diabetes Care. 30 (11): 2861–2862. doi:10.2337/dc07-1057. PMID 17698613.
  10. Nielsen S (2002). "Eating disorders in females with type 1 diabetes: an update of a meta-analysis". European Eating Disorders Review. 10 (4): 241–254. doi:10.1002/erv.474. Archived from the original on 2013-01-06.
  11. Jones J, Lawson ML, Daneman D, Olmsted MP, Rodin G (2000). "Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study". BMJ (Clinical Research Ed.). 320 (JUN 10): 1563–1566. doi:10.1136/bmj.320.7249.1563. PMC 27398. PMID 10845962.
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