Diabulimia
Encyclopedia
Diabulimia refers to an eating disorder
in which people with Type 1 diabetes
deliberately give themselves less insulin
than they need, for the purpose of weight loss
. Diabulimia is not currently recognized as a formal diagnosis by the medical or psychiatric communities. However, the phrases “disturbed eating behavior” or “disordered eating behavior” (DEB in both cases), or disordered eating
(DE) are quite common in medical and psychiatric literature which addresses the condition of patients who have Type 1 diabetes and who also intentionally manipulate insulin doses to control weight.
Failure to administer insulin places the body in a starvation state, resulting in breakdown of muscle and fat into ketone bodies
and subsequently ketoacids, while at the same time making the body unable to process sugars that have been consumed, so the sugars are excreted in the urine rather than being used by the body for energy or stored as fat. This typically results in significant weight loss but also places the patient at risk of a life-threatening condition known as diabetic ketoacidosis
. Prolonged failure to administer insulin results in long-term complications such as diabetic neuropathy
. Insulin restriction is associated not only with increased rates of diabetes complications but increased mortality risk as well. Diabetics who restrict insulin die at earlier ages on average than those diabetics who use insulin properly.
Following a diagnosis of Type 1 diabetes, a patient is prescribed insulin injections, given a controlled diet
, and must check blood sugar
several times a day. This lifestyle may result in weight gain, which some (particularly teen girls) may be unhappy about. This may lead them to neglect their insulin treatment for the purpose of losing weight.
Often, people with Type 1 diabetes who omit insulin injections will have already been diagnosed with an eating disorder such as anorexia nervosa
, bulimia nervosa
and/or compulsive eating. In cases where a person with Type 1 diabetes has another eating disorder, there is a tendency to discuss the other eating disorder more openly than they discuss diabulimia, as many people with diabetes are embarrassed or don't want to deal with the reality that they have lost control of their diabetes. These individuals are often not aware that diabulimia is more common than they think and is also very difficult to overcome. Unlike anorexia and bulimia, diabulimia sometimes requires the afflicted individual to stop caring for a medical condition. Unlike vomiting
or starving, there is sometimes no clear action or willpower
involved. Diabulimia may be more appealing to individuals who want to lose weight and do not want to feel hungry, or do not want to engage in purging via vomiting. Often there is an obsessive compulsive urge to engage in this activity for the purpose of emotional disassociation or a need to satisfy feelings of control.
This condition can be triggered or exacerbated by the need for diabetics to exercise constant vigilance in regard to food, weight and glycemic control. In adolescents the need for parental control over the young diabetic's life, and the increased weight gain that insulin treatment can cause, may play roles in the increased risk for onset of anorexia and/or bulimia. The frustration of managing blood sugars and their subsequent effects on weight and self perception (altered by dealing with a chronic illness) can also be damaging to self esteem and body image.
A person with diabulimia, especially if not caught and treated early, is likely to suffer the negative effects on the body of diabetes earlier than a person with diabetes who is managing their diabetes in a faithful manner. Long-term potential repercussions of diabetes include renal failure
, blindness
and diabetic neuropathy
. With diabulimia there is an increased chance of death. Diabetic ketoacidosis
(DKA) is very common in persons with Type 1 diabetes who have diabulimia. This is due to the body's need for a constant supply of energy, which lack of insulin prevents. DKA is a very serious condition that occurs when one doesn't have enough insulin; without treatment it results in death within a very short span of time.
Diabulimia tends to start in adolescence and is more likely to occur in women than men. One can identify a patient as having diabulimia if there are many unexplainable spikes in their Hemoglobin A1c
, weight loss, lack of marks from fingerprick
s, lack of prescription refills for diabetes medications, and records that do not match the HbA1c.
Many articles and studies further conclude that diabetic females have, on average, higher body mass index
(BMI) than do their nondiabetic counterparts. Girls and young adult woman with higher BMIs are also shown to be more likely to have disordered eating behavior (DEB).
Of diabetics who have DEB, a significant number intentionally misuse insulin as a means to control weight.
Suspension of insulin, combined with overeating and resulting in ketoacidosis, may be a call for psychological help or attempts to escape unpleasant or undesirable environments. Less frequently, they may be manifestations of suicidal intent. Multiple hospitalizations for ketoacidosis or hypoglycemia are cues to screen for an underlying emotional conflict. Dealing with the feelings brought on by the restrictive regime of diabetes 1 treatment can be overwhelming. In addition, patients may experience anxiety over the possibility of complications developing from diabetes and possible decreased life span.
Diabetics with Eating Disorders [U.K.] http://www.dwed.org.uk Charity dedicated to recognition and support, based in the UK.
Support Group http://www.new.facebook.com/group.php?gid=20504517571 A support group for those suffering with diabulimia
DiabetesCare.org (Published by the American Diabetes Association) http://care.diabetesjournals.org/search?fulltext=eating+disorders&submit=yes&x=0&y=0
Eating disorder
Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...
in which people with Type 1 diabetes
Diabetes mellitus type 1
Diabetes mellitus type 1 is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose...
deliberately give themselves less insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
than they need, for the purpose of weight loss
Weight loss
Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
. Diabulimia is not currently recognized as a formal diagnosis by the medical or psychiatric communities. However, the phrases “disturbed eating behavior” or “disordered eating behavior” (DEB in both cases), or disordered eating
Disordered eating
Disordered eating is a classification to describe a wide range of irregular eating behaviors that do not warrant a diagnosis of a specific eating disorder such as anorexia nervosa or bulimia nervosa. Affected people may be diagnosed with an eating disorder not otherwise specified...
(DE) are quite common in medical and psychiatric literature which addresses the condition of patients who have Type 1 diabetes and who also intentionally manipulate insulin doses to control weight.
Failure to administer insulin places the body in a starvation state, resulting in breakdown of muscle and fat into ketone bodies
Ketone bodies
Ketone bodies are three water-soluble compounds that are produced as by-products when fatty acids are broken down for energy in the liver and kidney. They are used as a source of energy in the heart and brain. In the brain, they are a vital source of energy during fasting...
and subsequently ketoacids, while at the same time making the body unable to process sugars that have been consumed, so the sugars are excreted in the urine rather than being used by the body for energy or stored as fat. This typically results in significant weight loss but also places the patient at risk of a life-threatening condition known as diabetic ketoacidosis
Diabetic ketoacidosis
Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances...
. Prolonged failure to administer insulin results in long-term complications such as diabetic neuropathy
Diabetic neuropathy
Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves in addition to macrovascular conditions that can culminate in diabetic neuropathy...
. Insulin restriction is associated not only with increased rates of diabetes complications but increased mortality risk as well. Diabetics who restrict insulin die at earlier ages on average than those diabetics who use insulin properly.
Following a diagnosis of Type 1 diabetes, a patient is prescribed insulin injections, given a controlled diet
Diet (nutrition)
In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...
, and must check blood sugar
Blood sugar
The blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally in mammals, the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM , or 64.8 and 104.4 mg/dL...
several times a day. This lifestyle may result in weight gain, which some (particularly teen girls) may be unhappy about. This may lead them to neglect their insulin treatment for the purpose of losing weight.
Often, people with Type 1 diabetes who omit insulin injections will have already been diagnosed with an eating disorder such as anorexia nervosa
Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...
, bulimia nervosa
Bulimia nervosa
Bulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, usually by purging and/or by laxative, diuretics or excessive exercise. Bulimia nervosa is...
and/or compulsive eating. In cases where a person with Type 1 diabetes has another eating disorder, there is a tendency to discuss the other eating disorder more openly than they discuss diabulimia, as many people with diabetes are embarrassed or don't want to deal with the reality that they have lost control of their diabetes. These individuals are often not aware that diabulimia is more common than they think and is also very difficult to overcome. Unlike anorexia and bulimia, diabulimia sometimes requires the afflicted individual to stop caring for a medical condition. Unlike vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
or starving, there is sometimes no clear action or willpower
Will (philosophy)
Will, in philosophical discussions, consonant with a common English usage, refers to a property of the mind, and an attribute of acts intentionally performed. Actions made according to a person's will are called "willing" or "voluntary" and sometimes pejoratively "willful"...
involved. Diabulimia may be more appealing to individuals who want to lose weight and do not want to feel hungry, or do not want to engage in purging via vomiting. Often there is an obsessive compulsive urge to engage in this activity for the purpose of emotional disassociation or a need to satisfy feelings of control.
This condition can be triggered or exacerbated by the need for diabetics to exercise constant vigilance in regard to food, weight and glycemic control. In adolescents the need for parental control over the young diabetic's life, and the increased weight gain that insulin treatment can cause, may play roles in the increased risk for onset of anorexia and/or bulimia. The frustration of managing blood sugars and their subsequent effects on weight and self perception (altered by dealing with a chronic illness) can also be damaging to self esteem and body image.
A person with diabulimia, especially if not caught and treated early, is likely to suffer the negative effects on the body of diabetes earlier than a person with diabetes who is managing their diabetes in a faithful manner. Long-term potential repercussions of diabetes include renal failure
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
, blindness
Blindness
Blindness is the condition of lacking visual perception due to physiological or neurological factors.Various scales have been developed to describe the extent of vision loss and define blindness...
and diabetic neuropathy
Diabetic neuropathy
Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves in addition to macrovascular conditions that can culminate in diabetic neuropathy...
. With diabulimia there is an increased chance of death. Diabetic ketoacidosis
Diabetic ketoacidosis
Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances...
(DKA) is very common in persons with Type 1 diabetes who have diabulimia. This is due to the body's need for a constant supply of energy, which lack of insulin prevents. DKA is a very serious condition that occurs when one doesn't have enough insulin; without treatment it results in death within a very short span of time.
Diabulimia tends to start in adolescence and is more likely to occur in women than men. One can identify a patient as having diabulimia if there are many unexplainable spikes in their Hemoglobin A1c
Glycosylated hemoglobin
Glycated hemoglobin is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose...
, weight loss, lack of marks from fingerprick
Fingerprick
Fingersticks and heelpricks are small superficial wounds that provide venous blood for some blood tests. Various methods are used to open the wound, which produces no more than a few drops of blood...
s, lack of prescription refills for diabetes medications, and records that do not match the HbA1c.
Short term
These are the short term symptoms of patients with diabulimia- Constant urinationUrinationUrination, also known as micturition, voiding, peeing, weeing, pissing, and more rarely, emiction, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control...
- Constant thirst
- Excessive appetiteAppetiteThe appetite is the desire to eat food, felt as hunger. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Decreased desire to eat is...
- High blood glucose levels (often over 600)
- Weakness
- Fatigue
- Large amounts of glucose in the urine
- Inability to concentrateAttentionAttention is the cognitive process of paying attention to one aspect of the environment while ignoring others. Attention is one of the most intensely studied topics within psychology and cognitive neuroscience....
- Electrolyte disturbanceElectrolyte disturbanceElectrolytes play a vital role in maintaining homeostasis within the body. They help to regulate myocardial and neurological function, fluid balance, oxygen delivery, acid-base balance and much more. Electrolyte imbalances can develop by the following mechanisms: excessive ingestion; diminished...
- Severe ketonuriaKetonuriaKetonuria is a medical condition in which ketone bodies are present in the urine.It is seen in conditions in which the body produces excess ketones as an alternative source of energy. It is seen during starvation or more commonly in type I diabetes mellitus...
, and, in DKA, severe ketonemia - Low sodiumSodiumSodium is a chemical element with the symbol Na and atomic number 11. It is a soft, silvery-white, highly reactive metal and is a member of the alkali metals; its only stable isotope is 23Na. It is an abundant element that exists in numerous minerals, most commonly as sodium chloride...
levels
Medium term
These are the medium term symptoms of patients with diabulimia. They are prevalent when diabulimia has not been treated and hence also includes the short term symptoms- Muscle atrophyMuscle atrophyMuscle atrophy, or disuse atrophy, is defined as a decrease in the mass of the muscle; it can be a partial or complete wasting away of muscle. When a muscle atrophies, this leads to muscle weakness, since the ability to exert force is related to mass...
- GERDGastroesophageal reflux diseaseGastroesophageal reflux disease , gastro-oesophageal reflux disease , gastric reflux disease, or acid reflux disease is chronic symptoms or mucosal damage caused by stomach acid coming up from the stomach into the esophagus...
- Indigestion
- Severe weight loss
- ProteinuriaProteinuriaProteinuria means the presence of anexcess of serum proteins in the urine. The protein in the urine often causes the urine to become foamy, although foamy urine may also be caused by bilirubin in the urine , retrograde ejaculation, pneumaturia due to a fistula, or drugs such as pyridium.- Causes...
- Moderate to severe dehydrationDehydrationIn physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
- EdemaEdemaEdema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
with fluid replacement - High cholesterolCholesterolCholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...
- DeathDeathDeath is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
Long term
If a person with Type 1 diabetes who has diabulimia suffers from the disease for more than a short time—usually due to alternating phases during which insulin is injected properly, and relapses, during which they have diabulimia—then the following longer-term symptoms can be expected:- Severe kidney damage
- Blindness
- Severe neuropathy (nerve damage to hands and feet)
- Extreme fatigue
- Edema (during blood sugars controlled phases)
- Heart problems
- High cholesterol
- Osteoporosis
- Death
Causes
Many authoritative articles have been published which show that preteen and teenage girls with Type 1 diabetes have significantly higher rates of eating disorders of all types than do girls without diabetes.Many articles and studies further conclude that diabetic females have, on average, higher body mass index
Body mass index
The body mass index , or Quetelet index, is a heuristic proxy for human body fat based on an individual's weight and height. BMI does not actually measure the percentage of body fat. It was invented between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing...
(BMI) than do their nondiabetic counterparts. Girls and young adult woman with higher BMIs are also shown to be more likely to have disordered eating behavior (DEB).
Of diabetics who have DEB, a significant number intentionally misuse insulin as a means to control weight.
Suspension of insulin, combined with overeating and resulting in ketoacidosis, may be a call for psychological help or attempts to escape unpleasant or undesirable environments. Less frequently, they may be manifestations of suicidal intent. Multiple hospitalizations for ketoacidosis or hypoglycemia are cues to screen for an underlying emotional conflict. Dealing with the feelings brought on by the restrictive regime of diabetes 1 treatment can be overwhelming. In addition, patients may experience anxiety over the possibility of complications developing from diabetes and possible decreased life span.
External links
Diabulimia Helpline: http://www.diabulimiahelpline.org The U.S.'s only nonprofit organization dedicated to the recognition and prevention of diabulimia.Diabetics with Eating Disorders [U.K.] http://www.dwed.org.uk Charity dedicated to recognition and support, based in the UK.
Support Group http://www.new.facebook.com/group.php?gid=20504517571 A support group for those suffering with diabulimia
DiabetesCare.org (Published by the American Diabetes Association) http://care.diabetesjournals.org/search?fulltext=eating+disorders&submit=yes&x=0&y=0
- http://www.timesonline.co.uk/tol/life_and_style/health/features/article2649279.ece a young diabetic woman who has overcome diabulimia.
- In-depth article on diabulimia from Self.com
- Diabulimia... The Eating Disorder that Strikes Diabetic Teens from About.com
- Diabulimia Discussion Group
- http://www.mercksource.net/pp/us/cns/cns_krames_template.jspzQzpgzEzzSzppdocszSzuszSzcnszSzcontentzSzkrameszSz11309_12zPzhtm
- http://www.anred.com/diab.html
- http://www.savvyhealth.com/disp.asp?doc_id=25
- http://www.something-fishy.org/isf/diabetes.php
- A Teenage Girl's Account of Her Diabulimia