Diabulimia: The intersection of eating disorders and diabetes

What is diabulimia?

Diabulimia is a type of eating disorder that afflicts individuals with type 1 diabetes. Someone with diabulimia will manipulate their insulin doses to facilitate weight loss. It is estimated that up to 30% of the 1.3 million Americans with type 1 diabetes intentionally mismanage their insulin to attempt to lose weight. Taking less insulin than you need to manage your type 1 diabetes will lead to dangerous, if not deadly, health complications. 

The role of insulin in type 1 diabetes

Type 1 diabetes is an autoimmune disease that causes your body to attack its own insulin producing cells in the pancreas. The body uses insulin to manage blood sugar levels and to assist your cells in converting food into fuel. Individuals with type 1 diabetes must inject synthetic insulin with meals on a daily basis to stay alive.

Without the correct amount of insulin, the body is unable to manage healthy blood sugar levels or convert food into fuel. In the short term this can cause diabetic ketoacidosis (DKA), a deadly condition where your body is forced to metabolize fat for fuel, which creates ketones and raises the acidity of your blood to dangerous levels. In the long term, poorly managed blood sugar can lead to vision loss, nerve damage, gastroparesis, heart disease, kidney disease, and non-alcoholic fatty liver disease (NAFLD).

What causes diabulimia

Like other eating disorders, diabulimia has no single clear-cut cause. Individuals with type 1 diabetes are at risk of developing disordered eating as a result of increased focus on food and carbs to manage their disease, as well as weight fluctuations that can accompany managing their insulin and blood sugar levels. “Diabetes burnout” is also common, where individuals feel tired and frustrated with having to manage their blood sugar and insulin, and find themselves skipping or guessing at their insulin dosage. 

Other risk factors can include:

• Family history of eating disorders
• Family history of dieting
• Poor body image or low self esteem
• Societal pressure to be thin
• Bullying and peer pressure
• Anxiety, depression, OCD

What are the symptoms of diabulimia?

There are several physical symptoms of diabulimia, including:

• Unexplained weight loss
• An A1C of 9.0% or higher
• Extreme thirst
• Frequent urination
• Fatigue
• Frequent UTI’s
• Blurred vision
• Dry hair, skin, or nails
• DKA events

It’s important to also be able to recognize the behavioral and emotional symptoms of diabulimia as well:

• Skipping insulin after meals
• Avoiding discussing insulin doses or testing blood sugar
• Missing doctor’s appointments
• Obsessively counting calories or carbs
• Fear of blood sugar lows and having to eat to avoid them
• Guilt surrounding eating certain foods
• Fear of weight gain
• Anxiety about weight and appearance
• Irritability and mood swings

Refer a loved one to an eating disorder professional if you have noticed these behaviors and believe they may be struggling with an eating disorder.

How is diabulimia treated?

The first step to being treated for diabulimia is getting a full assessment and blood work from your doctor to rule out immediate physical complications, like DKA, and discuss appropriate insulin dosing.

Working with a dietitian who has expertise in both eating disorders and diabetes management will be key to treatment success as well. A dietitian can help you determine how much you need to be eating to maintain a healthy weight and how many carbs are appropriate for your meals and snacks. A dietitian can also help you challenge disordered eating thoughts and behaviors and overcome fear of weight gain.

Having a therapist on your support team can also help if you struggle with anxiety, depression, or other co-occurring mental health conditions. Your therapist can provide you with healthy emotional coping tools to help you navigate the stress of managing your condition.

The goals of diabulimia treatment are:

• Dosing insulin correctly and on time
• Keeping blood sugar in a healthy range
• Avoiding short and long term diabetes complications
• Decrease dysfunctional eating behaviors
• Establish a healthy relationship with food
• Maintain a healthy body weight

If you are worried about a loved one, be sure you know what to say to support them and how to get them assessed for their eating disorder by a qualified professional.

What to eat in recovery from diabulimia

Someone with type 1 diabetes can eat whatever they want. Yes! You read that right! Someone with type 1 diabetes can eat whatever they want. That said, you will want to correctly dose your insulin to match the carbohydrate content of your meal so your blood sugar stays in a healthy range.

In recovery from an eating disorder, it is important to focus on eating consistent, adequate, balanced meals. Let’s break down what that means:

Consistency

Consume regular meals and snacks throughout the day so you are never going longer than 3-4 hours without eating. The goal of consistent eating is to provide regular fuel to your body and to regulate hunger and fullness cues.

Adequacy

Eating enough food is also extremely important. Your dietitian can help you determine how much food is required to support your recovery and restore your weight. Early in recovery you may need to eat more than you think is necessary if your body has been deprived of essential nutrients for an extended period of time. Eating to hunger and fullness may not be enough– hunger and fullness cues are not always reliable in eating disorder recovery and can be something you work on honoring as you heal.

Balance

A balanced diet includes food from all food groups, including protein, fats, and carbohydrates. It is important to eat a variety of balanced foods in recovery to support your energy levels, balance hormones, and restore body weight. No foods are off limits. If you are feeling anxious or fearful of including certain foods, your dietitian can guide you through food challenges so you can once again enjoy the foods you used to love most.

Having a meal plan can help as you navigate eating in recovery. Work with your dietitian to establish a meal plan that incorporates consistency, adequacy, and balance.

Where to find support for diabulimia

Ready to start your recovery journey? Consult with one of our registered dietitians specializing in eating disorders and begin healing today. You may also find it helpful to explore recovery resources like books, podcasts, social media accounts, and more.

Blog thoughtfully reviewed and updated July 1, 2024