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For people with diabetes, weight loss is often a positive goal driven by a desire to improve overall health and well-being. However, a desire to lose weight isn’t always positive. Individuals with diabulimia may take dangerous steps to achieve their goal regardless of negative health consequences, making it important that you understand the condition if you or someone in your family has type 1 diabetes.

What is diabulimia?

Diabulimia is an eating disorder that affects people with type 1 diabetes. Eating disorders are a set of mental health conditions that include preoccupation with food, body weight and body shape. People with diabulimia and other eating disorders engage in extreme behaviors to lose weight, and like those with substance abuse disorders, struggle to stop doing them once they start.

Studies show that people who have type 1 diabetes are more likely to develop eating disorders at some point in their lives than those who don’t. Across the general population, eating disorders are often difficult to diagnose. Diabetes compounds the problem as many of the symptoms of diabulimia can mimic those of hypoglycemia experienced by individuals who don’t suffer from the mental health disorder.

Who is at risk for diabulimia?

Some risk factors for diabulimia include:

  • Age: people between the ages of 7 to 18 are more likely to develop diabulimia, and those who do may need to manage the eating disorder for the rest of their lives. Although more prevalent in children and adolescents, diabulimia can occur at any age.
  • Gender: women are more likely to suffer from all eating disorders, including diabulimia. One study found that 10.3% of teenage girls report behaviors indicative of diabulimia compared to 1.4% of boys.
  • BMI: individuals with a higher than average body mass index (BMI) may be at greater risk for diabulimia, but being overweight or obese is not a requirement for the eating disorder. In addition, if behaviors associated with diabulimia lead to reductions in BMI, those with the condition are unlikely to stop engaging in them. In other words, losing weight won’t cure diabulimia.
  • Unstructured meals: research indicates that people who don’t eat structured meals are more likely to develop diabulimia. The condition is almost twice as common in families that don’t sit down and eat meals together on a regular basis.

What causes diabulimia?

Diabulimia has a number of potential causes, including:

  • Genetics: having a family member with an eating disorder puts you at greater risk for developing one yourself.
  • Brain chemical imbalances: although doctors don’t fully understand how brain chemistry contributes to eating disorders, imbalances of brain chemicals do seem to play a role.
  • Negative body image: low self-esteem can lead to an obsession with weight. Movies, TV shows and social media posts set unrealistic beauty expectations that reinforce a negative body image.
  • Growth and development: adolescents may struggle with physical changes that occur during puberty, worsening body images.
  • Diabetes treatment: closely monitoring diet is important for controlling type 1 diabetes. In people with diabulimia, dietary monitoring becomes an obsession rather than a positive health intervention.
  • Stress: stress often contributes to diabulimia. Individuals trying to cope with a major life change, such as moving, divorce or losing a loved one may become focused on weight to regain a feeling of control.

What do people with diabulimia do to lose weight?

Individuals with diabulimia may try one or more of the following to lose weight:

  • Insulin restriction: by taking less insulin than recommended, people with diabulimia intentionally cause hyperglycemia to trigger fat burning and lose weight.
  • Binge-eating: those suffering from diabulimia may eat large amounts of sugary or carbohydrate-rich foods to induce hyperglycemia with or without insulin restriction. This behavior is similar to the binging and purging common among people with bulimia.
  • Calorie restriction: diabulimia can also manifest as anorexia nervosa, an eating disorder that involves dramatically restricting calories to lose weight. Individuals with diabulimia may also exercise excessively to drive weight loss.

What are the symptoms of diabulimia?

Some symptoms of diabulimia include:

  • Being secretive or unwilling to discuss aspects of diabetes management, such as insulin dose
  • Canceling medical appointments to avoid discussing diabetes management
  • Intense anxiety about or fear of low blood sugar
  • Thoughts or statements about insulin making you fat
  • Thoughts or statements that reveal a poor self-image
  • Avoiding certain foods or types of foods
  • Going through insulin and diabetes supplies more slowly than usual
  • Establishing strict rules about food or exercise
  • Unwillingness to test or administer insulin in front of other people
  • Insisting on eating meals alone
  • Refusing to eat in public
  • Not filling prescriptions for insulin
  • Sleeping for longer periods of time
  • Avoiding friends and family
  • Giving up activities and hobbies that were once enjoyed
  • Throwing away insulin or diabetes supplies to hide behavior
  • Difficulty concentrating
  • Nausea and vomiting
  • Excessive thirst
  • Frequent urination
  • High number of hyperglycemic incidents
  • Urinary tract and yeast infections
  • Irregular menstrual periods or a complete cessation in menstruation
  • Changes in vision
  • Slow wound healing
  • Dryness of hair and skin

Due to insulin restriction, people with diabulimia often have A1C readings of 9.0 or more. Doctors may also observe major differences between meter readings and A1C levels. Bloodwork may reveal low levels of sodium and potassium.

What are the health risks for people with diabulimia?

Diabulimia involves frequent episodes of hyperglycemia similar to what people with uncontrolled type 1 diabetes experience. As a result, the eating disorder puts sufferers at an increased risk  for:

  • Heart attack
  • Stroke
  • Vision disturbances and vision loss
  • Nerve damage that causes pain, numbness and weakness in the extremities
  • Gum disease
  • Infertility
  • Kidney disease
  • Liver disease
  • Coma

Diabulimia also greatly increases the chances of premature death due to type 1 diabetes. One 11-year study found that people who restricted insulin were 3.2 times more likely to die and died an average of 13 years earlier than those who did not.

How do you treat diabulimia?

People with diabulimia often benefit from a multidisciplinary treatment approach that includes:

  • Close monitoring by your medical team to keep blood glucose under control
  • Nutritional counseling and support from a registered dietitian who specializes in eating disorders and diabetes management
  • Therapy from a licensed mental health professional experienced with eating disorders
  • Support from family and friends who may also wish to enter therapy to learn how to help their loved one

Medical care for diabulimia

During treatment for diabulimia, the goal is often to keep blood sugar levels under control without striving for perfect results. Until the person receives the additional nutritional and mental health counseling they need, they may not be able to completely control their blood glucose. In addition to closely monitoring the patient’s diabetes management plan, a doctor may prescribe an antidepressant to address symptoms of anxiety and depression associated with diabulimia.

Nutritional counseling for diabulimia

Nutritional counseling for diabulimia usually starts with a general discussion of the importance of nutrition and education regarding the health consequences of hyperglycemia. Then a personalized plan is constructed for the patient If the patient could benefit from weight loss, the medical team will work with them to develop a sensible nutrition plan and monitor progress to ensure that the patient does not begin severely restricting calories or binging.

Therapy for diabulimia

Individuals with severe diabulimia may require hospitalization at the start of treatment. Others may only require outpatient mental health treatment, which may include one or more of the following:

  • Cognitive behavioral therapy: psychotherapy that explores the thoughts and feelings that contribute to diabulimia and focuses on developing strategies to modify dangerous behaviors.
  • Group therapy: therapy given to a group of people with diabulimia. Talking with others who suffer from the condition can reduce feelings of isolation and allow individuals to learn from the experiences of others.
  • Family therapy: a form of counseling that involves all immediate family members. The person with diabulimia has a chance to express their thoughts and feelings, and their parents, siblings, spouses or other family members can learn how to best support their loved one throughout treatment.

Can people with type 1 diabetes lose weight safely?

Excess body weight is not a risk factor for type 1 diabetes, but if you are overweight, shedding pounds could improve blood sugar control to decrease your risk of health complications. The key is to follow a safe diet and fitness plan that allows you to lose weight gradually and keep it off. Close monitoring by your primary care provider is also important to monitor the effects of weight loss and exercise on your blood glucose. Over time, changes to your treatment plan may be necessary.

How Forward can assist with safe weight loss with diabetes

As your primary care provider, Forward can manage your treatment plan for type 1 diabetes and help you accomplish your weight loss goals. Our 12-week, doctor-led Weight Management Program focuses on making sustainable changes to your diet and increasing your physical activity to make long-term weight loss possible. We develop a custom plan that fits your goals, culture, lifestyle and health needs and provide ongoing support to set you up for success and ensure that you lose weight safely.

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