Understanding Diabulimia

By Michel Harris, MS, RD, LDN, CDE
Imagine a mother watching her five-year-old daughter (we'll call her Lisa) wasting away, despite eating larger than usual amounts of food, and experiencing frequent urination. Unfortunately, those were symptoms of undiagnosed Type I diabetes. While this was not desirable, after receiving education, Lisa was able to return to a healthy state because of daily, multiple insulin injections, a well-balanced meal plan, and participation in sports activities.

Ten years later, Mom noticed that once again, Lisa was consuming larger than usual amounts of food, but she assumed it was just a growth spurt. However, when Mom was changing the sheets on Lisa's bed one morning, she found several vials of unused insulin under the mattress. At this point in time, Lisa had been fully responsible for administering her daily insulin injections and monitoring blood glucose levels. When Mom approached Lisa, she got very defensive but then broke down in tears and admitted that she was only taking one-fourth her usual amount of insulin, and sometimes skipping it altogether.

People with diabetes experience burnout in performing daily self-care to manage their condition. But after much discussion, Lisa admitted that she was not taking her insulin to help control her weight. As a teenager, not only was Lisa having to deal with a chronic condition that required a significant amount of attention each day, but she was also faced with the discomfort of normal weight increases during puberty and the pressure to be thin.

You may have heard of bulimia, a condition in which one eats large quantities of food, then purges the calories via self-induced vomiting, laxative use, excessive exercise, and/or diuretics. Lisa is suffering from a form of bulimia called Diabulimia, and her chosen method of purging is controlling her insulin doses. Without going into too much detail, insulin is a hormone produced by the pancreas that is vital in shuttling glucose (sugar) from the blood into body cells after nutrients are digested and absorbed into the bloodstream. Those with Type I diabetes must inject insulin at meals, snacks, and on occasions when their blood glucose levels may be too high. Failure to do so results in weight loss because the cells cannot use glucose for energy and other vital body functions; that excess of glucose is eliminated in the urine and also builds up to potentially life-threatening levels in the blood.

Diabulimia is a serious condition that requires a treatment team including a psychotherapist, psychiatrist, registered dietitian, medical doctor, and endocrinologist. Symptoms to be aware of are

• Frequent urination
• Weight loss despite eating large quantities of food
• Abnormally high blood glucose levels
• Excessive thirst
• Weakness
• Fatigue
• Inability to concentrate
• Hiding insulin/purposely not taking insulin

In severe cases, the person may develop diabetic ketoacidosis, a potentially fatal condition in which blood glucose levels become dangerously high. People with Type I diabetes are already at risk for several long-term complications that include neuropathy (numbness and tingling of the extremities), cardiovascular disease, retinopathy, kidney disease, and gastroparesis. Since Diabulimia elevates blood glucose levels, this further increases the risk of developing these complications if treatment is not immediately sought.

While most therapists who specialize in eating disorder treatment are equipped to deal with the behaviors associated with Diabulimia, a registered dietitian with eating disorder experience, and who is also a Certified Diabetes Educator (CDE), should be sought after as part of the treatment team.

Michel Harris is the nutritionist at The Awakening Center and believes in the mindful approach to develop a peaceful relationship with food and exercise in the recovery process of eating disorders.