Did you know that women & adolescent girls with Type I diabetes are two and a half times more likely to develop an eating disorder (Diabulimia)? Adherence to self-management and medication regimens is required to achieve optimal blood glucose control in adolescents & females with type 1 diabetes mellitus. Non-adherence places the group at serious risk of short and long-term health complications.
Adherence difficulties may be exacerbated by concurrent eating disorders. Diabulimia is a term used to describe the deliberate administration of insufficient insulin to maintain glycaemic control for the purpose of causing weight loss.
Signs of Diabulimia
• Unexplained weight loss
• Fatigue/Lethargy
• Persistent Thirst or frequent urination
• Inconsistent readings of A1C (estimated average of sugar in one’s blood)
• Secrecy about Diabetes management
• Fears around “Insulin making me fat”
• Avoiding Diabetes-related appointments
• Recurrent Diabetic Ketoacidosis
• Mood shifts and changes
• Discomfort testing/injecting in front of others
• Overly strict food rules
Consequences of Diabulimia
There are both short and long-term consequences of diabulimia. Most of the major consequences of diabulimia are associated with prolonged elevated blood sugars. These complications are severe and permanent, so early detection is critical.
Examples of short-term consequences include slow wound healing, susceptibility to staph and other bacterial infections, and electrolyte imbalances.
Examples of long-term consequences may consist of retinopathy or small black spots affecting one’s vision, numbness in arms or legs, and organ damage.
Why Do Type 1 Diabetes and Eating Disorders Co-Occur so Frequently?
• A diagnosis of any chronic illness including Type 1 diabetes can be scary and may elicit uncomfortable emotions like sadness, anger, fear, and anxiety. Having added stress, anxiety, and/or depression puts an individual at higher risk for developing eating disordered behaviors.
• The proper management of Type 1 diabetes typically includes the careful moderation of carbohydrates and sugar. Monitoring of consumption, nutrition facts, and weight is indicated in this population which can lead to perfectionistic and controlling behaviors that we also understand to be true in eating disorder development.
• The management of Type 1 diabetes tends to be focused on numbers (i.e. blood glucose levels, labels, portion control) in similar ways that those with eating disorders experience with weight, calories, and portion size.
• Finally, a person who is using their insulin as indicated often experiences some kind of weight gain which can impact body image and lead an individual to go to great lengths to lose weight.
Treatment
Treatment for diabulimia requires a collaborative approach of eating disorders AND diabetes specialists. A multidisciplinary team should include health care providers such as physicians, nurses, and a diabetes educator as well as an eating disorder team including a therapist and a registered dietician.
Treatment may include
- Monitoring of blood glucose levels and management of side effects due to the reintroduction of insulin and potential complications of diabetes.
- The individual to focus on the thoughts and emotions related to food and their bodies.
- Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DB) are treatment approaches that have been successful in the treatment of eating disorders and are a good option.
Therapy will depend on the severity of the eating disturbance. Group psychoeducation, incorporating a no derivational approach to eating, may prove effective, especially in those with milder degrees of eating and weight psychopathology.
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