Diabulimia: Skipping Insulin to Lose Weight

A new type of “eating” disorder has surfaced recently, one that only strikes people with type 1 diabetes, many of whom are young women. Sometimes referred to as “diabulimia,” this condition occurs when type 1 individuals skip or restrict their required insulin doses in order to lose weight. Called “ED-DMT1 by medical professionals, diabulimia and its associated behaviors can have both devastating and permanent effects on the body.

In people with type 1 diabetes, the body’s immune system attacks the beta cells in the pancreas and prevents them from producing insulin. Individuals must therefore take doses of insulin multiple times a day, usually by injection or through an insulin pump, in order to survive. Failing to take one’s insulin causes blood sugar levels to rise and results in frequent urination, as the kidneys must work overtime to rid the body of the excess sugar in the bloodstream. This “purging” of the sugar from the body results in rapid weight loss, and has been compared to the kind of purging done by bulimics, who vomit or use laxatives to rid their bodies of the food they consume, hence the term “diabulimia.”

A dangerous trend

For many people with type 1 diabetes, particularly teenage girls, skipping insulin doses to lose weight seems like an easy way to drop a few pounds, yet it puts an individual at risk for a variety of health problems. Continuous high blood sugar levels can cause short-term effects such as dehydration, fatigue, and breakdown of muscle tissue. Over longer periods of time, individuals are at risk for developing many serious diabetic complications — including blindness, kidney disease, and heart disease — at a much earlier age.

Although the risks associated with restricting or omitting insulin are severe, the most alarming aspect of this behavior is how widespread it seems to be among type 1 individuals. One study found that as many as 30 percent of adolescent type 1 females have skipped or restricted insulin doses in order to lose weight.*

A possible explanation for the occurrence of this behavior among those with type 1 diabetes lies in the fact that the nature of the disease requires one to maintain a strict care regimen in order to stay healthy. Individuals must pay close attention to their diet and exercise, constantly monitoring their blood sugar levels and carbohydrate intake to ensure that their disease remains under control. This near-obsessive relationship with food can trigger a full-blown eating disorder in some type 1 individuals, particularly young girls, who studies suggest are more than twice as likely to develop an eating disorder as those without diabetes.

Recognizing the symptoms

While skipping or restricting insulin doses to lose weight is a practice well-known among many within the diabetes community, few outside it are familiar with it, making it difficult for both parents and doctors to recognize the symptoms of this risky behavior.

Warning signs can include:

  • changes in eating habits (eating more but still losing weight)
  • unexplained weight loss
  • unexplained hyperglycemia (high blood sugar)
  • low energy levels
  • frequent urination

Getting help

According to Dr. Ann Goebel-Fabbri, a clinical psychologist at the Joslin Diabetes Center whose research focuses on the link between eating disorders and diabetes, treatment for an individual who severely restricts or skips insulin doses requires both an eating disorder specialist and a diabetes management team in order to be effective.

“[The eating disorder specialist] should be willing to collaborate openly and directly with the diabetes specialist,” Goebel-Fabbri says. This two-way relationship will allow healthcare professionals to understand and treat the eating disorder as well as teach patients how to safely manage their diabetes, both of which are essential for recovery.

Stopping it before it starts

Teaching people with type 1 diabetes to develop a healthy relationship with food and insulin at an early age can help prevent them from practicing harmful behaviors such as insulin omission and restriction later on. It is important for people to “strive for a more balanced, flexible approach to eating,” Goebel-Fabbri explains. “Kids and families need to lean that food isn’t toxic, […] it is possible to eat a tremendous variety at different times and still cover insulin appropriately”.

* New England Journal of Medicine, Vol. 336, June 26, 1997

Helpful links:
Eating Disorders and Diabetes
Information from the Joslin Diabetes Center

The Renfrew Center Foundation
Advancing the Education, Prevention, Research, & Treatment of Eating Disorders

Web site on eating disorders