What We Treat


What Is Diabulimia?

Those who have type 1 diabetes are more than twice as likely than the average person to develop an eating disorder, according to the Journal of Diabetes Science and Technology.

In addition to being susceptible to anorexia, bulimia and binge eating disorder, those with type 1 diabetes often skip or reduce insulin injections out of fear that insulin causes weight gain. In her research, Ann Goebel-Fabbri, PhD, found that 30% of girls and women with type 1 diabetes skip or reduce necessary insulin injections to lose weight.

When insulin restriction becomes routine, ED-DMT1 (Eating Disorder – Diabetes Mellitus Type 1), commonly referred to as “diabulimia,” develops. Although diabulimia is not included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it can result in serious medical problems.

Symptoms of Diabulimia

According to the National Eating Disorders Association, symptoms of diabulimia include:

  • Hemoglobin A1c level of 9.0 or higher on a continuous basis
  • Unexplained weight loss
  • Persistent thirst, frequent urination or both
  • Preoccupation with body image
  • Blood sugar records that do not match hemoglobin A1c results
  • Depression, mood swings or fatigue

Health Risks of Diabulimia

Those who have diabulimia typically experience frequent episodes of diabetic ketoacidosis (DKA), which causes vomiting, dehydration, difficulty breathing and confusion. A person with DKA may also become comatose, according to Diabetes Care.

Those who develop diabulimia triple their risk of death, while increasing their chances of eye disease, kidney disease and nerve damage, according to research at Joslin Diabetes Center.

An 11-year study of 234 women with type 1 diabetes showed that those who restricted their insulin intake died at an average age of just 45 years old, which is 13 years younger than those who did not restrict insulin intake, according to Diabetes Care.

Diabulimia Treatment

Considered separately, type 1 diabetes and eating disorders are serious, life-threatening illnesses that are difficult to treat. Combined together, they pose an especially serious challenge for healthcare practitioners.

In spite of the frequency of diabetes and eating disorders occurring together, individuals impacted by both generally receive separate treatment for each condition, which may be counterproductive. For example, insulin dosage is determined based on an individual’s meal plan. When someone has anorexia and eats little, however, blood sugars and insulin needs are reduced and must be actively addressed.

Another concern is that those who have eating disorders are unlikely to manage their diabetes properly. Standard eating disorder treatment is designed to help individuals relinquish their focus on food, but those with diabetes cannot be encouraged to do this, since diabetes management requires a focus on food to maintain healthy blood glucose levels. Treatment of diabetes may reinforce the eating disorder – and treatment of the eating disorder, without consideration for required glucose monitoring and supervised insulin administration, may pose dangers to the health of someone with diabetes.

Recognizing the need for an individualized, coordinated program to treat those who have both type 1 diabetes and eating disorders, Walden Behavioral Care takes an integrated care approach, with ongoing contact between the individual’s eating disorder and diabetes treatment teams, as well as outside healthcare providers.

By working with the diabetes treatment team, Walden seeks to provide:

  • Treatment that is tailored to each individual’s needs at any time
  • Concurrent treatment of multiple illnesses, including not only diabetes and eating disorders, but other psychiatric disorders
  • A combination of medical, psychological, psychiatric and nutritional care, along with family therapy

By addressing diabetes, eating disorders and any other co-occurring disorders in tandem, rather than separately, Walden can better manage treatment, creating an opportunity for effective diabetes management and eating disorder recovery.

Levels of Treatment for Diabulimia

Walden offers a full range of treatment programming for individuals of all ages and genders. This enables us to meet the needs of all individuals as they progress toward recovery. Options include inpatient, residential, partial hospitalization, intensive outpatient and outpatient care. We also provide family-based treatment for children and adolescents.

Therapy for Diabulimia

At Walden, we provide comprehensive treatment that addresses all facets of diabulimia, while providing superior care across several areas. Treatment includes:

  • Cognitive Behavioral Therapy (CBT) – Helps the individual identify, interrupt and replace distorted thinking and associated compensatory behavior with positive thinking.
  • Dialectical Behavior Therapy (DBT) – Combines CBT techniques with mindful meditation to help individuals discover new ways to manage emotions and develop a more positive self-image.
  • Family-Based Treatment (FBT) – Designed for adolescents and children, family-based treatment includes family as part of the clinical team. We work with families to help their child restore weight and develop a positive identity through a coordinated three-phase approach.
  • Nutritional Counseling – Educates individuals on how to best balance proper diabetes management while fulfilling essential nutritional needs. This includes individual consultations and meal planning designed to normalize eating patterns.
  • Other
    • Individual and Group Counseling
    • Expressive Therapy
    • Relapse Prevention

Regain Your Life. Walden Can Help.

If you are concerned that you – or a loved one – may have an eating disorder, we are here to help. Please call 781-647-6727 to speak with a Walden eating disorders intake specialist, or complete the form on the right, to start the road to recovery.