Did you know that women with Type One diabetes are two and a half times more likely to develop an eating disorder? (Ann Goebel-Fabbri Ph.D, 2008). While diabulimia is not yet included in the DSM-5, the term is quite often used to describe someone who is living with a comorbid diagnosis of Type 1 diabetes and an eating disorder.

Here are a few things that you should know about this condition.

What is Diabulimia?

Diabulimia, also known as ED-DMT1 or Eating Disorder-Diabetes Mellitus Type 1, is defined as the withholding of insulin to manipulate one’s weight or shape. In the DSM-5, there is not a separate diagnostic code for diabulimia, though, depending on the eating disorder behavior and manipulation of insulin, diabulimia can present with features of both anorexia and bulimia. It can also be classified in the DSM-5 under Other Specified Eating Disorder(OSFED).

What are the Warning Signs of Diabulimia?

• Unexplained weight loss
• Fatigue/Lethargy
• Persistent Thirst or frequent urination
• Inconsistent readings of A1C (estimated average of sugar in one’s blood)
• Secrecy about Diabetes management
• Fears around “Insulin making me fat”
• Avoiding Diabetes related appointments
• Recurrent Diabetic Ketoacidosis
• Mood shifts and changes
• Discomfort testing/injecting in front of others
• Overly strict food rules

There are both short and long-term consequences of diabulimia. Most of the major consequences of diabulimia are associated with prolonged elevated blood sugars. These complications are severe and permanent, so early detection is critical. Some examples of short-term consequences include slow wound healing, susceptibility to staph and other bacterial infections, and electrolyte imbalances. Examples of long-term consequences may consist of retinopathy or small black spots affecting one’s vision, numbness in arms or legs and organ damage.

Why Do Type 1 Diabetes and Eating Disorders Co-Occur so Frequently?

• A diagnosis of any chronic illness including Type 1 diabetes can be scary and may elicit uncomfortable emotions like sadness, anger, fear and anxiety. Having added stress, anxiety and/or depression puts an individual at higher risk for developing eating disordered behaviors.
• The proper management of Type 1 diabetes typically includes the careful moderation of carbohydrates and sugar. Monitoring of consumption, nutrition facts and weight is indicated in this population which can lead to perfectionistic and controlling behaviors that we also understand to be true in eating disorder development.
• The management of Type 1 diabetes tends to be focused on numbers (i.e. blood glucose levels, labels, portion control) in similar ways that those with eating disorders experience with weight, calories and portion size.
• Finally, a person who is using their insulin as indicated often experiences some kind of weight gain which can impact body image and lead an individual to go to great lengths to lose weight.

How do I Talk to a Loved one with Diabulimia?

Once you have identified a concern and recognized that warning signs are present, it is important to communicate your feelings to your loved one. Addressing your concerns in a calm, compassionate and respectful manner is essential. Here are some other tips to keep in mind:

• Be honest and direct
• Avoid being judgmental
• Focus on your feelings by using “I” statements
• Be patient
• Avoid placing blame on the person
• Reassure them they are not alone
• Expect some denial /negative reactions
• Encourage them to get help

What Kind of Treatment is Indicated for this Population?

Treatment for diabulimia requires a collaborative approach of eating disorder AND diabetes specialists. A multidisciplinary team should include health care providers such as physicians, nurses and a diabetes educator as well as an eating disorder team including a therapist and a registered dietician.

Treatment may include medical stabilization which would include the monitoring of blood glucose levels and management of side effects due to the reintroduction of insulin and potential complications of diabetes. In addition to medical oversight, it will be essential for the individual to focus on the thoughts and emotions related to food and their bodies. Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are treatment approaches that have been successful in the treatment of eating disorders.

If you or someone you love are living with any of the symptoms above, there is help available. Contact us today to speak with one of our friendly admissions counselors.

Stephanie Kadis, MSW, LICSW, currently works in the Milford and Worcester clinics which provide PHP and IOP levels of care to adolescents and adults. Stephanie received her Masters Degree in Social Work from Wheelock College and has worked in various settings offering support for individuals with mental health and substance abuse disorders. She is passionate about helping others and also loves to mentor interns or staff who are new to the field. In her spare time, Stephanie enjoys spending time with her family, traveling, and running.