Diabulimia is an unofficial eating disorder diagnosis characterized by intentionally withholding insulin with the goal of weight loss. “Dia”, meaning diabetes, and “bulimia”, meaning the mode of “purging”, which in this case means withholding insulin use. To reiterate: Diabulimia is used to describe individuals with Type 1 Diabetes (T1DM) who intentionally withhold or misuse the use of insulin to lose weight.
First, what is type 1 diabetes? (Bear with me, as it might get confusing!) Type 1 diabetes is an auto-immune disorder characterized by the bodies inability to produce insulin due to the destruction of its pancreatic beta cells. The direct cause of this remains unknown; however, T1DM is often diagnosed at an early age, often before the age of 30. Insulin is the hormone required to allow glucose (sugar) in the blood to enter cells to utilize as energy and maintain a normal blood glucose level. Individuals with type 1 diabetes do not produce insulin endogenously (in the body), thus are required exogenous (from an outside source) insulin. This is why individuals with T1DM require insulin as it allows glucose to enter cells for energy.
So what does this have to do with eating disorders? Individuals with Diabulimia misuse or withhold insulin as a mode to lose weight. The absence of insulin causes the body to breakdown fat stores for the body to use as energy. (Remember, the body cannot use glucose without insulin). This causes rapid weight loss. However, the body requires glucose and insulin to survive.
Misusing and intentionally withholding insulin has serious short-term and long-term medical consequences. Short-term misuse can cause diabetic ketoacidosis caused by your body breaking down fat to form ketone bodies to use for energy. Ketone bodies are acidic, raising the acidity in your blood which can cause dehydration, nausea, vomiting, confusion, abdominal pain, weakness, fatigue, shortness of breath, coma, and even death. Long-term misuse can cause hypertension, hyperlipidemia (high concentration of fat in the blood), retinopathy causing vision impairment and even blindness, and neuropathy causing loss of sensation in your hands and feet. Neuropathy can cause injuries, such as infections or ulcers, to go unnoticed and without treatment result in tissue deterioration and possible amputation of limbs.
Diabulimia signs and symptoms are critical in recognizing the need for treatment and support for those with chronic signs of hypoglycemia and eating disorder behaviors. However, recovery and diabetes management is possible with the support of a multidisciplinary treatment team.
Emily Baum, M.S., RDN, LD
