Diabulimia.

Diabulimia refers to an eating disorder in which people with type 1 diabetes deliberately give themselves less insulin then they need, for the purpose of weight loss.

The symptoms

Short term

These are the short term symptoms of patients with diabulimia.

• Constant urination
• Constant thirst
• Excessive appetite
• High blood glucose levels (often over 600)
• Weakness
• Fatigue
• Large amounts of glucose in the urine
• Inability to concentrate
• Electrolyte disturbance
• Severe ketonuria, and, in DKA, severe ketonemia
• Low sodium levels

Medium term

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

• Muscle atrophy
• GERD
• Indigestion
• Severe weight loss
• Proteinuria
• Moderate to severe dehydration
• Edema with fluid replacement
• High cholesterol
• Death

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
• Blindness
• Severe neuropathy (nerve damage to hands and feet)
• Extreme fatigue
• Edema (during blood sugars controlled phases)
• Heart problems
• High cholesterol
• Osteoporosis
• Death

What is diabulimia?

Diabulimia is not currently recognized as a formal diagnosis by the medical or psychiatric communities. However, the phrases “disturbed eating behavior” or “disordered eating behavior” (DEB in both cases), or disordered eating (DE) are quite common in medical and psychiatric literature which addresses the condition of patients who have type 1 diabetes and who also intentionally manipulate insulin doses to control weight.

Failure to administer insulin places the body in a starvation state, resulting in breakdown of muscle and fat into ketone bodies and subsequently ketoacids, while at the same time making the body unable to process sugars that have been consumed, so the sugars are excreted in the urine rather than being used by the body for energy or stored as fat. This typically results in significant weight loss but also places the patient at risk of a life-threatening condition known as diabetic ketoacidosis. Prolonged failure to administer insulin results in long-term complications such as diabetic neuropathy. Insulin restriction is associated not only with increased rates of diabetes complications but increased mortality risk as well. Diabetics who restrict insulin die at earlier ages on average than those diabetics who use insulin properly.

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 and/or compulsive eating. In cases where a person with type 1 diabetes has another eating disorder, there is a tendency to discuss the other eating disorder more openly than they discuss diabulimia, as many people with diabetes are embarrassed or don't want to deal with the reality that they have lost control of their diabetes. These individuals are often not aware that diabulimia is more common than they think and is also very difficult 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. Diabulimia may be more appealing to individuals who want to lose weight and do not want to feel hungry, or do not want to engage in purging via vomiting. Often there is an obsessive compulsive urge to engage in this activity for the purpose of emotional disassociation or a need to satisfy feelings of control.

Diabetic ketoacidosis (DKA) is very common in persons with type 1 diabetes who have diabulimia. This is due to the body's need for a constant supply of energy, which lack of insulin prevents. DKA is a very serious condition that occurs when one doesn't have enough insulin; without treatment it results in death within a very short span of time.

Diabulimia tends to start in adolescence and is more likely to occur in women than men. One can identify a patient as having diabulimia if there are many unexplainable spikes in their Hemoglobin A1c, weight loss, lack of marks from fingerpricks, lack of prescription refills for diabetes medications, and records that do not match the HbA1c.