Diabulimia

Diabulimia is an unofficial term created from the fusion of the words diabetes and bulimia. This term denotes a hazardous eating behavior exhibited by some individuals with Type 1 diabetes. Afflicted individuals intentionally underdose on insulin, a crucial hormone for glucose regulation, with the motive of losing weight.

Though "diabulimia" is not formally acknowledged in the medical or psychiatric sectors, terms such as “disturbed eating behavior” (DEB), “disordered eating behavior”, or simply “disordered eating” (DE) commonly emerge in literature that discusses this phenomenon.

Origin and Background

Diabulimia generally commences during adolescence and exhibits a higher prevalence in women than in men. The onset of this behavior can be correlated with the challenges associated with managing Type 1 diabetes and the anxiety over potential diabetic complications.

Symptoms

The ramifications of diabulimia can be both immediate and long-term, severely impacting the individual's overall health.

Short-Term Symptoms

• Constant thirst and urination
• Elevated appetite
• High blood glucose levels, often exceeding 600 mg/dL
• Weakness and fatigue
• Glucose presence in urine
• Diminished concentration abilities
• Electrolyte imbalance
• Severe ketonuria, and in cases of diabetic ketoacidosis (DKA), pronounced ketonemia
• Depressed sodium levels

Medium-Term Symptoms

When diabulimia persists untreated, medium-term symptoms, in addition to short-term symptoms, manifest:

• Muscle degeneration
• GERD (Gastroesophageal Reflux Disease)
• Indigestion
• Significant weight loss
• Protein in urine
• Moderate to severe dehydration
• Fluid replacement-induced edema
• Elevated cholesterol levels

Long-Term Symptoms

For individuals with Type 1 diabetes oscillating between compliant insulin use and phases of diabulimia, these grave symptoms may emerge:

• Profound kidney damage, potentially resulting in kidney failure and necessitating transplantation
• Blindness due to retinal diseases induced by prolonged high blood sugar
• Acute neuropathy, primarily impacting hands and feet
• Overwhelming fatigue
• Edema, especially when blood sugar levels stabilize
• Heart-related issues
• High cholesterol levels
• Osteoporosis
• Death

Identifying Diabulimia

Clinicians can suspect diabulimia in patients presenting the following:

• Unpredictable spikes in Hemoglobin A1c
• Weight loss without a clear cause
• Absence of fingerprick marks
• Non-adherence to diabetes medication prescriptions
• Clinical records inconsistent with the HbA1c values

Risk and Complications

Diabetic ketoacidosis (DKA), a life-threatening complication resulting from insufficient insulin, is frequently observed in individuals with diabulimia. The body, starved of energy due to the insulin deficiency, rapidly deteriorates, and without prompt intervention, this condition can be fatal.

The misuse of insulin combined with excessive food consumption leading to ketoacidosis may indicate the need for psychological support. Sometimes, these actions may express a desire to escape challenging environments, or more rarely, manifest suicidal inclinations.

Treatment

There are no specific guidelines for the treatment of diabetes and disordered eating, but the standard approach for treatment of two complex conditions as multidisciplinary team of professionals which in this case could include an endocrinologist, dietician, psychologist, etc.

See Also

• Diabetes mellitus
• Bulimia nervosa
• Eating disorder

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