Diabulimia: type 1 diabetes and eating disorders
Type 1 diabetes is a serious health condition, where a person’s blood glucose (blood sugar) level is too high as a result of their body not being able to produce the hormone insulin. While a lot of people are aware of the physiological risks associated with type 1 diabetes, such as damage to the heart, kidneys and eyes, few are aware that people living with type 1 diabetes are also susceptible to developing an eating disorder.
Please note, type 1 and type 2 diabetes are not the same. Type 1 diabetes is an autoimmune condition where the body attacks the cells of the pancreas that makes insulin, resulting in no insulin being produced at all. Type 2 diabetes on the other hand is where the body isn’t able to make enough insulin or the insulin the body makes doesn’t work properly. Of everyone with diabetes, type 1 affects 8%, whereas type 2 affects approximately 90%.
Diabulimia is an eating disorder that can develop in people with type 1 diabetes. It involves the person with type 1 diabetes lowering or stopping their intake of insulin in order to lose weight. This is incredibly dangerous as people with type 1 diabetes need insulin to live, so lowering or omitting its use can have critical consequences.
Despite what the name suggests, diabulimia is not necessarily about someone with type 1 diabetes using purging behaviours like making themselves sick, as with bulimia. Diabulimia is not a medical term, but is the term used for the improper use of insulin amongst people with type 1 diabetes to lose weight.
Research shows that eating disorders are more prevalent in people with type 1 diabetes, particularly females. Eating disorders affect approximately 1 in 5 females with diabetes and are twice as likely to transpire in teenage girls with type 1 diabetes than those without it. People with type 1 diabetes may feel overwhelmed by the continuous focus on nutrition and medication. The development of disturbed eating behaviours may be a way to regain control over their eating and weight, which can subsequently lead to the development of an eating disorder.
People with diabulimia have a fear of gaining weight if they administer insulin, so will either not have their required intake of insulin or will lower the intake. While the person with diabulimia will be achieving their desired weight loss by keeping their blood sugars high, doing this persistently is seriously dangerous to their health, even if they don’t realise this at first.
Just like with many other eating disorders, the weight loss achieved through diabulimia can give the sufferer a ‘high’ feeling, which they want to maintain. Some people with diabulimia may use other weight loss behaviours to lose even more weight, in addition to not administering the correct amount of insulin they need to live. Exercise may be used, which brings even more risk, as exercise can lower blood glucose levels, which therefore encourages the sufferer to again keep their blood sugar levels high. It can be a real balancing act for the sufferer, as they try to keep their blood sugar levels high enough so as to lose weight, but not so high that they would feel significant effects to their health (even though significant damage would still be occurring).
Although the person with diabulimia may feel in control of their weight loss and health, it quickly becomes the case that they are not in control and they are in serious danger of long-term health consequences and even death. Continuing with the improper use of insulin can lead to diabetic ketoacidosis (DKA), which is when there is a build-up of acid (ketones) in the bloodstream. If left untreated, DKA can lead to loss of consciousness and death. It has been shown that after one hospitalisation with DKA, patients have a 10% greater risk of dying within 5 years.
It can be really difficult for someone with diabulimia to gain control over their illness, as it means the proper use of insulin, which would mean gaining back weight they would have lost as a result of their diabulimia behaviours. Preventing diabulimia is incredibly important, as is early intervention in people suffering with mental health problems who have type 1 diabetes. Psychological support is therefore imperative, as well as appropriate education on insulin misuse.