Diabulimia: The Dangers of Trading Health for Thinness

By Meghan Vivo

Imagine turning 13 years old and learning that you have a chronic, life-threatening disease that will require you to take shots every day for the rest of your life. Not only does Type 1 diabetes impact the way you view food, your body, and life in general, but those daily shots may cause weight gain at a time when most teens are obsessed with appearance and thinness, and are already at high risk for developing eating disorders.

Although many young people can effectively manage their diabetes and control their weight by reducing their calorie intake, adopting a healthier diet, and increasing their levels of physical activity, many have noticed that skipping or restricting doses of insulin can produce rapid weight loss. They develop a love-hate relationship with insulin - the drug that keeps them alive, but also tends to cause weight gain. Their solution? Take just enough to stay alive but not enough to feel well. The term for this condition is "diabulimia."

About Diabulimia

Individuals with diabulimia face two life-threatening diseases at once: diabetes and an eating disorder. When confronted with double the abuse, their bodies begin to break down much more rapidly and in more significant ways than individuals who have either condition alone.

Though diabulimia is a new term and one that is not officially recognized as a medical condition, experts believe the behavior is widespread, particularly among young women. As many as one-third of all female Type 1 individuals with diabetes (or about 450,000 women in the U.S.) have engaged in insulin deprivation for the purposes of weight control.
By its nature, diabetes is a disease that requires an immense focus on food - counting carbs and sugars, taking insulin to maintain adequate blood sugar levels. It's all about the food, which makes individuals with diabetes likely candidates for an eating disorder. For teenagers and young adults who are already struggling to adapt to the demands of adolescence and adulthood, a diabetes diagnosis can be crushing.

The Appeal of 'Easy' Weight Loss

Because it is relatively easy to manipulate one's weight by restricting insulin intake, the temptation can be too much for a body-conscious teen to resist. The appeal of quick and easy weight loss results in more and more young women developing an eating disorder on top of their diabetes. In fact, Type 1 diabetics are two and a half times more likely to develop an eating disorder than other women.

Insulin restriction is like a "magical diet" in the minds of some individuals struggling with diabulimia. If they don't discover this "diet" by themselves, they are likely to learn of the unhealthy weight management practices from friends or on the Internet.
"When insulin intake is restricted, an individual with diabetes may lose as much as 3-5 pounds a day with little or no effort. But once their bodies start getting the necessary insulin, they may gain as much as 2-3 pounds a day," explains Steve Graybar, Ph.D., a licensed psychologist. "This can be unbearable for someone struggling with body image, weight, or other emotional issues - and for some, naturally leads to the life-threatening conclusion to restrict their insulin intake for weight management purposes."
 
Though the thrill of an easy weight-loss plan may be the initial draw, once individuals are in the grips of an eating disorder, the threat of amputation, blindness, or even death is not strong enough to overcome the disordered thoughts and behavior patterns. They have developed a serious mental illness that requires intensive treatment.
The Price of Thinness

Eating disorder behavior is the opposite of ideal diabetes management behavior. By omitting insulin, individuals with diabetes artificially raise their blood sugar to dangerous levels, which results in more frequent emergency room visits, hospitalization, and diabetic ketoacidosis (DKA) - a life-threatening complication caused by acidic buildup in the blood.

Individuals with diabulimia pay a hefty price for these weight control measures. Consistently high blood sugar levels cause individuals with diabetes to feel dehydrated, fatigued, and experience a breakdown in muscle tissue, and can drastically increase the likelihood of long-term complications like heart disease, nerve damage, kidney failure, and blindness.

A study published in Diabetes Care found that women with Type 1 diabetes who intentionally forgo their insulin medication have a threefold increased risk of premature death and higher rates of complications, such as kidney dysfunction and foot problems, than those who don't. These complications, plus those that come from having an eating disorder, are not that far off for women who allow their blood sugar to remain high over many months or years.

"For many individuals with diabulimia, these complications appear as early as their 20s because of the interaction of their diabetes and the eating disorder, whereas these risks materialize for most individuals with diabetes in their 40s or 50s," says Kathryn Eckert, M.D., a board certified pediatric endocrinologist.

Finding Treatment for Diabulimia

Treatment of diabulimia requires finding a balance between appropriate insulin intake and slow, gradual weight gain, and then closely monitoring the individual's progress. It also requires educating patients about their bodies and their diseases so that they learn to regulate the amount of sugar and carbohydrates they're consuming. This way, patients find a balanced, healthy weight they can be happy with, without feeling compelled to abuse insulin.

Although intensive diabulimia treatment programs are difficult to find, they do exist. The Center for Hope of the Sierras, known for its success in treating women with anorexia, bulimia, and related disorders, is one of only a handful of residential eating disorder treatment facilities in the nation that offers specialized care for women with diabulimia.

Patients with diabetes at the Center for Hope work with a collaborative team of doctors, nurses, dieticians, and therapists who intimately understand both issues, and who offer the ideal combination of medical management, therapy, and social support to help patients effectively manage their diabetes and recover from their eating disorders.

Shunning insulin to shed pounds is not a tradeoff worth making. If you or someone you know is struggling to manage their diabetes without resorting to insulin restriction, call the Center for Hope today at (866) 690-7242 or visit www.centerforhopeofthesierras.com.