The promise of quick and easy weight loss appeals to many people, but diabulimics take this concept to a dangerous level.
Diabulimia is an eating disorder in which people with Type 1 diabetes deliberately give themselves less insulin than their bodies need in order to lose weight.
Tawny Murdock, who has lived with Type 1 diabetes for 25 years, specializes in treating people with diabetes and eating disorders. She explains that when a person with Type 1 diabetes doesn’t receive insulin, their body begins to eat its own fat and muscle stores caused by diabetic ketoacidosis, which produces rapid weight loss as well as a range of health complications such as kidney failure, heart disease, amputations, nerve damage, blindness and even death.
Diabulimia most commonly affects adolescent and young adult women, many of whom are in denial that these complications will ever affect them. As many as one-third of all female Type 1 individuals with diabetes (or about 450,000 women in the U.S.) have engaged in insulin deprivation for the purposes of weight control.
Research by Denis Daneman, published in Diabetes Spectrum in 2002, suggests that 1 percent of girls at 12 years old are manipulating insulin. By age 15, that number increases to 14 percent, and by age 19, 34 percent admit to manipulating their insulin intake.
Though the appeal of easy weight loss may be the initial draw, once individuals are in the grip of an eating disorder, the threat of amputation, blindness or even death is not strong enough to overcome the disordered thoughts and behavior patterns.
What Causes Diabulimia?
There are a number of factors that may contribute to diabulimia. Being diagnosed with Type 1 diabetes requires the individual to be constantly vigilant about food and weight. This ongoing attention can trigger eating disordered behaviors and thoughts. It can also trigger rebellious behaviors since restricting insulin sometimes seems easier than carefully monitoring food intake.
Limiting insulin intake can also give people with Type 1 diabetes a sense of control over their bodies at a time when everything else is out of control, says Murdock.
“They restrict their insulin intake because they don’t want to feel like their disease is winning,” she says. “What they don’t realize is that they are letting the disease win when they aren’t using insulin because their health inevitably suffers.”
Know the Warning Signs
Although diabulimia is not a new condition, medical and mental health professionals are becoming more aware of the symptoms of diabulimia. The following are a few of the warning signs that an individual with diabetes may also be developing an eating disorder:
• Changes in eating habits (e.g., eating more but still losing weight)
• Rapid weight loss or weight gain
• Poor metabolic control despite the appearance of compliance
• Low self-esteem or preoccupation with body image, weight or food intake
• Frequent urination, excessive thirst or high blood sugar levels
• Low energy, fatigue, shakiness, irritability, confusion, anxiety or fainting
• Purging behaviors (e.g., excessive exercise or the use of laxatives)
• Discomfort with eating or taking insulin in front of other people
• Hoarding food
• Unwillingness to follow through with medical appointments
• Recurrent diabetic ketoacidosis
Proper self-care for diabetes is difficult enough. When you add an eating disorder into the mix, the consequences can be life-threatening. In most cases, concurrent treatment for both the medical and mental health conditions is required.
Treatment of diabulimia entails significant medical monitoring, gradual weight gain, and education about nutrition and appropriate self-care. Because individuals with diabulimia struggle with weight gain and body image issues, intensive therapy and eating disorder treatment are also essential to help patients learn healthy ways to cope and develop a support network.
For most patients, a multi-disciplinary team approach that involves an endocrinologist, registered dietician, and psychotherapist produces the best outcome.
“Seeing a physician alone is not enough because the individual needs to address the emotional components of their eating disorder,” says Murdock, who formerly worked as a marriage and family therapist intern at The Victorian, an eating disorder treatment program for women in Newport Beach, California. “Seeing a therapist alone also is not enough because diabetes is a serious medical condition that requires treatment and monitoring.”
The Victorian offers women suffering from diabulimia the ideal combination of medical management, individual, group and family therapy, and social support to help them effectively manage their diabetes and recover from their eating disorders.
“With treatment, people with diabulimia can learn to accept their disease and manage their symptoms,” says Murdock. “Diabetes doesn’t define you but you do have to take control over your disease and your life.”