Diabulimia is a term used to describe an unofficial eating disorder that sometimes appears in people with type 1 diabetes. It involves the purposeful skipping of scheduled injections of the hormone insulin, which diabetics need to take in order to properly regulate their blood glucose levels. When diabetics skip their insulin doses, they can control their body weight and appearance by indirectly encouraging weight loss. As a consequence of this dangerous method of weight loss, people with diabulimia can develop a number of serious and potentially fatal complications associated with the advance of uncontrolled diabetes. Recovery from the condition typically involves support and assistance from several different medical and mental health professionals.
In addition to helping diabetics properly control their blood glucose levels, insulin tends to promote the storage of body fat. By skipping some of their scheduled insulin doses, people with diabulimia circumvent some of this fat accumulation; weight loss in people with the disorder also occurs as a result of heightened glucose elimination during urination. While all cases of diabulimia involve insulin dose manipulation, some diabulimics take this practice to an extreme and only take enough insulin to avoid the onset of a potentially fatal short-term condition called diabetic ketoacidosis. Potential long-term consequences of mild, moderate or extreme diabulimic behaviors include muscle tissue breakdown, kidney failure, blurry vision or blindness, systemic nerve damage, extremity (foot or hand) amputation, heart disease or heart attack, coma, and stroke.
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While the term diabulimia first appeared only around the year 2007, medical professionals involved in the treatment of diabetes have known for a long time that some patients manipulate their insulin doses in order to lose weight. Although anyone with type 1 diabetes can fall into this pattern of insulin dose manipulation, it most commonly occurs in pre-teen girls, teenage girls, and women, three population groups that also account for the vast majority of people affected by the officially recognized eating disorders anorexia nervosa and bulimia nervosa.
In severe cases, people with diabulimia may initially require treatment in a hospital setting in order to resolve immediate health threats stemming from the onset of diabetic ketoacidosis. In addition, some diabulimics need hospital care in order to get better control over some of the major complications associated with uncontrolled blood glucose. After any immediate or short-term issues are under control, long-term recovery efforts can begin. Medical professionals who typically support a patient recovering from diabulimia include a general physician with experience in managing type 1 diabetes and second doctor, called an endocrinologist, who specializes in problems related to the body’s hormone-producing endocrine system. Additional members of a multi-disciplinary treatment team include a psychotherapist experienced in dealing with eating disorders and a nutritionist experienced in dealing with both eating disorders and the effective management of diabetes. Generally speaking, recovery is easiest for people in the earliest stages of diabulimia.
Specific Recovery Approaches
Like people with anorexia and bulimia, diabulimics commonly have a distorted body image and an extreme fear of gaining weight. In addition, they sometimes develop an extreme fear of insulin and the procedures involved in insulin injection. According to experts at Lucile Packard Children’s Hospital at Stanford, management of these issues during recovery requires finesse and the establishment of small, achievable goals. For instance, young diabulimics—who often don’t have the perspective to comprehend the long-term seriousness of their condition—tend to do best when they pursue short-term symptom-related achievements such as a reduction in incidences of blurry vision, reduction of their levels of tiredness or fatigue, or reduction of the pain associated with advancing nerve damage. Correction of insulin levels in diabulimics also frequently requires gradual, non-threatening dosage increases rather than a rapid return to proper insulin intake.
Psychotherapy for diabulimics largely mirrors the techniques used in treating anorexia and bulimia, which fall under the heading of an approach called cognitive behavioral therapy, or CBT. During this therapy, which is typically customized to meet the needs of the individual, patients learn new ways of thinking about body issues and weight gain, as well as new ways to cope with the social and psychological stresses that lead to active diabulimic behavior. Nutritionists can help recovering diabulimics increase their understanding of healthy eating habits while shifting attention away from eating patterns centered on obsessions with body weight. As with ongoing symptom management, educational approaches usually work best when diabulimics receive small bits of information that get reinforced over time. In addition to medical, psychotherapeutic and nutrition-related support, most people in diabulimia recovery benefit from a gradual introduction to a regular exercise program.