Diabulimia Eating Disorder

Diabulimia is intentional insulin restriction. People with diabulimia skip or shrink their insulin doses to lose weight.

Most people with diabulimia have type 1 diabetes. Some doctors call the condition type 1 diabetes with disordered eating (T1DE) or eating disorder diabetes mellitus type 1 instead. There is no official diagnostic term, as this condition is relatively new and poorly understood.

No matter what you call it, know that diabulimia is very dangerous. People with it may feel like they’re making smart decisions, attempting to accomplish a short-term goal of weight loss, but they could be risking their long-term health. 

Understanding Diabetes & Insulin 

Diabetes is a chronic condition that affects how the body processes food into energy. Ultimately, diabetes results in too much sugar in the blood. 

Insulin is what helps blood sugar enter cells, where it can be used as an energy source. If you don’t have enough insulin, your blood sugar will be too high. Of the more than 30 million adults in America with diabetes, about 7.4 million need insulin to stay healthy. (1)

People with type 1 diabetes (juvenile diabetes) can’t make insulin at all. They need injections to survive. (2)

21% of people with type 2 diabetes also need insulin.

People with type 2 diabetes are resistant to insulin or can’t use it efficiently. About 21% of people with type 2 diabetes also need insulin to stay healthy. (2) Their injections augment the insulin their bodies already make.

Whether your insulin is delivered by a meal or a needle, it’s critical each time you eat. As you take a bite, the following happens:

  1. Your digestive tract breaks down food into elements, including sugar. 
  2. Your cells release insulin in response to your meal.
  3. Sugars from your food move into the bloodstream.
  4. Insulin moves the sugars out of the blood and into your cells. 
  5. Your body either burns the sugars within the cells, or it’s stored away as fat for future use. (3)

Insulin-dependent diabetics know that they must take their medications. They’re experts at testing their blood, preparing insulin doses, and injecting them. They also know how to clean their insulin pumps, watch out for complications, and adjust doses as needed. 

For these people, medications are a daily part of life. Some stay on insulin for the majority of their lives, and it’s vital to their long-term health.

Why Does Diabulimia Begin?

Up to 30% of people with type 1 diabetes have an eating disorder. Some say adjusted eating is a reasonable response to the trials of life with diabetes. (4)

People who have type 1 must adjust so many aspects of how they manage their diets. These are just some examples of things diabetics must change:

  • How they shop for food: They must read every food label, check for carbohydrates, and opt for low-sugar varieties. They can’t just throw something in their shopping cart without much thought.
  • How they monitor their weight: Even a small change on the scale could indicate an insulin problem. People with type 1 diabetes must pay very close attention to the number on the scale.
  • How they prepare and consume food: High-sugar treats and carb-loaded meals are dangerous for people with type 1. They have strict rules about what they can and can’t eat. If they veer from these guidelines, they feel the results, and they can be dangerous. (4)

What happens when you’re always focused on what you eat, what you weigh, and how you look? For many people, control becomes an obsession. And this can easily trigger an eating disorder. 

Diabetics have a different tool at their disposal too, and easy access to it can worsen disordered eating. They can use their diabetes medications to change their appearance. 

Insulin is a growth hormone, and using it can encourage weight gain. By skipping or limiting doses, people reason, they can lose weight instead. (5)

What Happens When People With Diabetes Stop Taking Insulin?

Insulin is a lifesaving medication for people with diabetes. Skipping doses can be catastrophic, but even limiting the amount of insulin you take can have consequences that doctors can’t always reverse.

For people with type 1, a lack of insulin means that glucose can’t move from the blood into the cells. It spills into the urine instead, pulling in water and causing excessive urination. Dehydration sets in. This can be dangerous. (6)

Additionally, cells can’t take in glucose, so they burn fat and muscle instead. Both dehydration and fat burning lead to weight loss. 

People with diabulimia can function with very high blood sugar levels. But if they continue this practice, they can develop serious issues tied to long-term blood sugar elevation. (7)

Short-Term Effects of Diabulimia

Short-term consequences can include the following:

  • Confusion 
  • Exhaustion 
  • Dehydration
  • High cholesterol levels 
  • Muscle loss (8)

Long-Term Effects of Diabulimia

Other known consequences of diabulimia include the following:

  • Blinding eye conditions, such as retinopathy and macular edema 
  • Heart disease and vascular disease due to high cholesterol and arterial narrowing 
  • Kidney disease
  • Liver disease
  • Nerve pain 
  • Wounds that won’t heal (7)

Diabetic Ketoacidosis

People with type 1 diabetes can also face diabetic ketoacidosis, which is a life-threatening complication. The body breaks down fat at a quick rate, and the liver transforms that fat into a fuel called ketones. Blood becomes acidic and toxic when flooded with ketones, and people need hospitalization to survive an episode. (9)
These are warning signs of diabetic ketoacidosis:

  • Dehydration
  • Headache
  • Nausea
  • Rapid breathing
  • Sore muscles
  • Sunken eyes
  • Unconsciousness 

People with insulin who restrict insulin die about 13 years younger than those who use the medication properly. (7)

If you have diabetes, you shouldn’t mess around with your insulin doses. It’s just not worth the risk.

Patient speaking with a doctor

How Is Diabulimia Treated?

People with diabulimia have an eating disorder, and eating disorders can be effectively treated. Treatment generally moves on two fronts. 

First, the person’s diabetes must be stabilized. Doctors determine a proper insulin dose for their weight, height, and health, and choose a way to deliver the medication. 

For some people, that means a tamper-proof insulin pump. For others, it means living in a controlled setting (like a clinic) and agreeing to let professionals provide their medications. 

Inpatient care is often needed in the early stages of eating disorder treatment. Continual medical supervision and support ensure individuals stay on track with their treatment plan. And patients benefit from an encouraging environment, often learning from others who are in recovery from eating disorders.

When the person feels healthy, stronger, and focused, therapists can help them address body image and disordered eating. 

Therapy must be tailored for people with diabulimia, as their eating disorders are different than those of people who don’t have diabetes. They may never be able to eat freely, for example. 

The goal is to find a balance between controlling their diabetes and creating healthy eating habits. Patients will learn how to control their insulin use, healthfully manage their weight, and manage complications from diabetes.

Mental health issues, such as anxiety and depression, are also addressed in treatment. Some people may benefit from medications that alter chemical imbalances within the brain and make disordered insulin use less likely. 

Therapy is part of virtually everyone’s treatment plan for diabulimia. Counseling techniques that focus on body acceptance, anxiety reductions, and family support can be incredibly helpful for people with diabulimia. 

Isolation is a common sign of eating disorders, including diabulimia. Support groups can help people to see that they are not alone in their struggles. 

In these peer meetings, participants can learn from the experiences of others with diabulimia or other forms of eating disorders. And they can help others by sharing their own struggles.

A Path to Wellness

Diabulimia is a serious condition since it can cause long-term harm to the body, shortening life expectancy. 

The earlier diabulimia is identified, the better. With early intervention, any effects on life expectancy can be mitigated. 

With the right care, the condition can be managed, leading to a healthier and happier life.

Resources


  1. Fewer Diabetes Patients Are Picking Up Their Insulin Prescriptions — Another Way the Pandemic Has Delayed Health Care for Many. (November 2021). University of South Carolina.
  2. Understanding the Insulin Market. (March 2020). American Action Forum.
  3. Blood Sugar and Insulin at Work. American Diabetes Association.
  4. Diabulimia and Diabetes. Diabetes UK.
  5. Insulin and Diabetes. Diabetes UK.
  6. Insulin. (March 2018). Society for Endocrinology.
  7. Diabulimia. National Eating Disorders Association.
  8. The Dangerous Reason Why Diabetics Are Skipping Their Insulin. (November 2017). Health24.
  9. Insulin Insecurity and Death by DKA. (June 2019). Diabetes Voice.

Last Update | 11 - 14 - 2022

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