Diabulimia: Symptoms, Causes, and Treatment

Overview 

Bulimia is an eating disorder and when it happens along with diabetes it’s known as diabulimia. We are quite familiar with the word diabetes, which affects our body’s blood sugar level, while bulimia is a weird eating disorder when an individual feels overweight and binges on food, either by throwing up or using a laxative for losing weight. 

So, we will know about it in detail and also what strange people do in this condition and how to get rid of it. 

What Exactly Is Diabulimia?

As we know it’s connected to an eating disorder bulimia, people often named it diabulimia when diabetes patients skip their insulin to lose weight. Even so, the diabulimia isn’t included in the DSM-5, the diagnostic and statistical manual of mental disorder. But overall it happened due to a serious medical issue.  

Some medical professionals termed it as ED-DMT1, which is an eating disorder diabetes mellitus type 1 and is used to describe any type of eating disorder combined with diabetes. 

So, along with the extreme focus on food, and labels, weight there are various high-risk factors for getting an eating disorder. Hence, a person may acquire diabulimia at any stage once their diabetes has been diagnosed. People often get such disorders due to body image issues or an urge to lose weight or at times it starts as diabetes burnout. Regardless of its onset, people struggled in treatment as individuals with type 1 diabetes generally show a higher dropout rate and poor results than other patients. The treatment should focus on both diabetes and eating disorders. 

Also read: How to get rid of stress 

Diabulimia does not have any specific place in the DSM-5, so most people’s diagnosis will depend on their abnormal eating behaviors. This is why the diagnostic manual had classified the insulin omission as a purging behavior and hence, it may be referred to as bulimia nervosa if the person is skipping on insulin. It may be diagnosed as a purging disorder when the person is eating normally and skipping insulin or if severely restricting both food and insulin, then it is diagnosed as anorexia nervosa. 

So, it was all about the diabulimia, that it may happen in diabetic patients and can be critical as it exaggerates the diabetes condition. So, how would you know that the person is dealing with such a medical condition? Here are some common emotional and physical signs and symptoms to spot a person with diabulimia. 

Signs And Symptoms Of Diabulimia 

Emotional symptoms:- 

  • A weird fear of gaining weight by insulin
  • Ignorance of diabetes management
  • Fear of low blood sugar
  • Avoiding diabetes appointments 
  • Intense increase or decrease in diet
  • Avoiding eating in public or with family
  • Over Conscious about body image 
  • Avoiding certain kind of foods to lower insulin doses
  • Overly strict food routine
  • A highly vigorous workout 
  • Increased sleep
  • Anxiety and depression
  • Detachment from family and friends

  Physical symptoms:-

  • A1c of 9.0 or higher constantly
  • A1c inconsistent with meter readings
  • Great weight loss
  • Constant urges of nausea/vomiting
  • Non-stop thirst and a frequent urination
  • Low sodium or potassium levels
  • Frequent bladder or yeast infection
  • Irregular menstruation
  • Extreme fatigue
  • Dry hair and skin

So, who is more vulnerable to this weird disorder diabulimia? Well, primarily the patients having diabetes type 1 are more at the risk, but highly affects women. Yes, females of all ages are two times more likely to get an eating disorder when they have diabetes type 1. At Least 30% of teenagers pause on their insulin doses so they can shed some pounds. 

Though eating disorders have an exact cause you get closer to having the symptoms if this runs in your family. And yes, it could result from social stress or trauma. 

What Are The Consequences?

Diabulimia develops when you keep on skipping your insulin doses to lose some weight due to various reasons. Your body won’t make insulin when you have type 1 diabetes. So now your body can’t use sugar for energy and the blood sugar levels hikes up and releases through urine. 

Not having enough insulin, your body creates ketone bodies as a source of energy, which tends to cause you anorexia and shedding of weight. In a severe condition, it can cause ketoacidosis. Which can even cause coma or death. 

Diablumilia consequences are a combination of those that happen in diabetes type 1 and the eating disorder. 

So, the consequences are categorized into two, short-term consequences and long-term consequences.

Short-term consequences 

Delayed wound healing:- the raised blood sugar causes poor circulation and reduces the functions of red and white blood cells, and harms the small blood vessels. And eventually, delays wound healing and can even result in an ulcer in a diabetic person. 

Bacterial infections:- the increased blood sugar level starts producing certain enzymes and hormones which negatively attack your immune system and turn down the body’s defense against infection. Both things, the slowed healing, and risk of infection increase the patient’s chances of developing severe conditions like gangrene, sepsis, and bone infection. 

Yeast infection:- the excess sugar release allows the yeast infection in the vagina. 

Dehydration:- without the insulin your body puts itself in a condition of severe starvation leading it to break down the tissues, to create ketone bodies to be used as fuel. Hence in a try of expanding the ketones in the urine, the body fetches up eliminating too much fluid. 

Irregular periods:- due to lack of proper nutrition, the estrogen levels in females fall off dramatically and cause irregular periods or no periods at all. Moreover, the women’s body automatically stops reproduction to conserve energy. 

Muscle atrophy:- in the insulin-deficient body, the utilization of foods doesn’t happen and the cells starve, the body then starts to break down muscles for energy. 

Diabetic ketoacidosis:- people having diabetes 1, may develop a severe level of ketones faster than others, as the body needs more insulin to transfer ketones from the bloodstream into cells. In absence of insulin, the ketone body hikes in the bloodstream faster than kidneys can extract them causing the blood to become acidic. And the acidic blood not only damages blood vessels, organs and nerves, but a small alternation in the blood’s pH can cause the functions to shut down and may result in coma or even death. 

Long-term consequences:- 

Retinopathy:- the small black spots or “floaters” damaging a person’s vision. However the bleeding may stop, but the persistent retinopathy can result in blindness. 

Macular edema:- the swelling of the eye due to the accumulation of excessive fluid, if untreated can cause permanent damage to the eye. 

Peripheral neuropathy:- burning/ tingling/ stabbing and weakness or numbness in the hands, feet, arms, and legs. 

Vasovagal syncope:- dysfunction of the nervous system as a reaction of stress or position change leading to a sudden fall in blood pressure and heart rate and at times fainting.

Chronic diarrhea or constipation:- if the nerves which control the intestines and colon are dysfunctional, then the person may observe an abnormal fluid absorption or decreased motility. 

Diabulimia Helpline

As there are helplines for numerous services that are provided worldwide, diabulimia is also on the list to deal with this confidently or to recommend some of your loved ones to release him or herself out of this. 

Nonetheless, this was founded in 2009 and was the world’s first non-profit organization. They provide 24*7 hours service on the respective diabulimia helpline number 425-985-3635.

Treatment 

So, we know that diabulimia is a severe mental disorder and always requires help from medical professionals. 

The affected person will need nutritional, psychological, and medical help either from medical health professionals like endocrinologists, nurses, counselors, diabetic counselors, and social workers. 

Also read: Breathing techniques for anxiety 

Honestly dealing with diabulimia isn’t an overnight process, and will require a lot of patience and emotional support as well. A positive approach and hard work will be needed to learn to manage the triggers and overcome the unnecessary thoughts. 

Counseling such as behavioral therapy is very useful in managing the symptoms and treating the illness over time. 

Cognitive-behavioral therapy:- so, it’s all about psychological processing of your mind, the way you think and act. This therapy will help in changing the way you think and act, by routine sessions and healing. 

Group therapy:- you will practically understand the pain of other people dealing with diabulimia by following a group chit-chat. Then you will be able to heal after knowing that you aren’t the only one to feel so. 

Family-based therapy:- as the name suggests, it includes emotional help from the family.

Diabulimia helpline:- as we know about this, we should go after this worldwide helpline and take an initiative towards this disease treatment. 

Conclusion 

Diabulimia is a severe mental disorder that has symptoms combined with diabetes and an eating disorder. The person skips his insulin doses in a deep urge to lose weight due to several reasons. Though it’s not included in the DSM-5, the treatment is possible with certain behavioral therapies like cognitive behavioral therapy. 

Frequently Asked Questions 

 

What are the symptoms of Diabulimia?

One of the medical symptoms of diabulimia is high blood sugar levels and chronic dehydration. 

Other related symptoms are:- 

  1. Irregular periods
  2. nausea/ vomiting
  3. Frequent urination
  4. Persistent thirst
  5. Yeast infection
  6. A quick weight loss
  7. Blurry vision
  8. Disturbed heart rate
  9. Dry skin and hair
  10. Skipping insulin doses

What is the cause of Diabulimia?

There is no clear cause of diabulimia yet, but the primary reason is of course the diabetes type 1 which later results in a comorbid medical condition. It may happen due to several reasons, like genetically if you have this run in your family, or due to the body image issues and the fear of being bullied or judged by someone over your weight. So, basically, the person starves himself by avoiding food and skipping insulin doses, in a fear of becoming fatty.  

The affected individual will either use a purgative to lose weight or throw up after eating immediately. 

Does insulin make you gain weight?

Yes, weight gain is like a side effect of taking insulin doses. Insulin is a hormone that regulates our blood sugar levels. People with type 1 diabetes have to rely upon external insulin to use blood sugar as fuel. Or else, the sugar will release out of urine leaving the person drained. So, overall it’s frustrating and irritating to gain weight. In such conditions, a good plan of diabetes management should be done from the start.  

Is Diabulimia a mental illness?

Well, it’s not a recognized mental illness and not included in the diagnostic manual as well. But most people use the word diabulimia to describe a diabetes comorbid eating disorder. So, people with type 1 diabetes are vulnerable to getting these dual disorders. In which the person starts omitting the insulin doses to shed weight. 

What does Pregorexia mean?

Pregorexia is the term used to refer to the desire to control pregnancy weight by excessive dieting and exercise. 

How do you diagnose Diabulimia?

Diagnosis of diabulimia is not a very complex thing, if the person with diabetes type 1 is overly conscious about his weight even when the weight isn’t as much, and secretly skips insulin doses, chances are there of having diabulimia. And the other symptoms are a constant urge of nausea/vomiting, and frequent urination, persistent thirst, and dehydration. 

However, the correct diagnosis should be carried out by a medical health professional. 

How common is Diabulimia? 

It’s a very tricky question, because not every diabetic person deals with this. But yes, statistically women are more likely to develop the condition between 15-30. So, on average every 4 out of 10 women skips over insulin doses to lose weight. But apart from the studies, anyone can develop this illness, at any stage of their diabetes. 

Can you lose weight while on insulin?

You can observe weight loss before taking insulin therapy. This is because the loss of sugar in urine carries water with it, so the weight loss happens due to the excessive fluid loss. Moreover, unmanaged diabetes can make you hungry madly, and you will eat more food even when you start insulin therapy. 

How can I help someone with Diabulimia?

So, first of all, you need to convince them that he/she is not alone and you are there to help him, by listening to their issues in detail. And you can recommend a good doctor where he/she can go for therapies or treatment. You can accompany them on the visit. You don’t have to feel like he has some serious condition, rather try to make him feel normal and always try to keep in touch until he completely gets out of the condition. 

What are the consequences of Diabulimia?

The consequences can be short-term or long-term. Unmanaged diabetes can be horrific. The affected individual dealing with the condition often suffers from retinopathy, metabolic imbalance, depression and mood swings, kidney and heart diseases. The person will suffer physically as well as emotionally in diabulimia.

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