Diabulimia: A double disaster

I mentioned yesterday that I attended an education session on diabulimia last week. If you haven’t heard of diabulimia, it’s a type of eating disorder in which people with type 1 diabetes deliberately skip or reduce their insulin doses so that their bodies can’t use all of the glucose from the food they eat. The result? Weight loss or prevention of weight gain after overeating.

The term diabulimia is a bit of a misnomer, as it implies a combination of diabetes + bulimia. In fact, the restriction of insulin to promote weight loss can be a part of any type of eating disorder, including anorexia, bulimia and binge eating disorder.

No matter which shape the eating disorder takes, diabulimia is a dangerous game. Type 1 diabetes, which is usually diagnosed in childhood, requires the use of supplemental insulin, because the pancreas has stopped producing it. Without sufficient insulin, blood sugar becomes dangerously high. Over time, this can lead to diabetic ketoacidosis, kidney damage, heart damage, retinopathy (eye damage which can result in blindness) and neuropathy (damage to the nerves of the feet and legs, which can require amputation).

Even people with type 1 diabetes without an eating disorder face the possibility of developing one or more of these complications (the degree of risk would of course depend in part about how well the person was managing their diabetes). When you combine diabetes plus an eating disorder you often see early onset of serious diabetes complications.

While eating disorders carry their own serious health risks, if someone with, say, anorexia gets effective treatment, they can make a full recovery (one exception is bone density, depending on how long the person had their eating disorder). If someone with diabulimia experiences retinopathy or neuropathy, that damage is permanent. A 20-year-old with diabulimia may have health problems generally seen in diabetics who are decades older.

Diabulimia unfortunately is not a formal eating disorder diagnosis. It’s also often missed by doctors, who may describe a patient as being “non-compliant” with their insulin but not realize that the non-compliance is intentional, and potentially deadly. I was quite glad that some young endocrinologists attended the session. The sooner awareness of this condition grows among healthcare providers, the better.

The session speakers were Erin Akers, a former sufferer of diabulimia and founder and CEO of Diabulima Helpline, and Lorraine Platka-Bird, Ph.D., RD, dietitian and nutrition therapist with Center for Hope of the Sierras. Center for Hope is one of the few residential treatment facilities that helps people with diabulimia.

This talk was significant for me because once I’m an RD I want to help women (and men) with eating disorders. I could say a lot more about the subject of diabulimia, but I won’t, because there is a very good article on that very subject in the current issue of Diabetes Forecast, “Hope in the World of Eating Disorders and Diabetes.” Akers and Platka-Bird were both interviewed for the article, and they touch on some of the aspects of diabulima that they also addressed in their talk.

Here are some other resources: