Understanding diabulimia - signs, symptoms and next steps

Diabulimia is a term that's been developed by the media to describe a specific type of eating disorder that can happen to people with type 1 (insulin dependent) diabetes. It involves the person deliberately restricting the amount of insulin they take in order to lose weight.

For diabetics, eating disorders are more dangerous, and sadly also more common. The combination of an eating disorder with diabetes increases diabetic complications and can even result in death. The body can become damaged by insulin restriction, and eating disorder behaviours like bingeing and purging can also disturb glycaemic control.

If you're concerned that someone close to you has diabulimia, we understand how stressful this can be. This blog has been put together to help you get a better understanding of the condition and what can be done to help the person who is struggling.  

We have looked at the common causes of diabulimia, the warning signs and symptoms, and the next steps that should be taken in terms of support and treatment.

What can cause diabulimia?

The causes of eating disorders are dependent on a number of factors. Unfortunately with diabulimia, insulin restriction can become another way to lose weight in someone who's vulnerable to developing an eating disorder. 

Some of the biological, psychological and social risk factors that can combine to cause someone to start struggling with an eating disorder include:

• Genetics - certain genotypes can leave a person more at risk
• Family environment - a person is more likely to develop an eating disorder if a family member has had an eating disorder or issues around food and dieting
• Personality traits - research suggests that eating disorders may be associated with certain personality traits, including obsessive thinking, perfectionistic tendencies, emotional instability and low self-esteem
• Childhood experiences - dealing with traumatic or life-changing events, such as conflicts, abuse and alcoholism in the family, can leave someone more at risk of developing an eating disorder
• Culture and societal pressures – a focus on physical appearance, specific body shapes, weights and skewed beauty standards can contribute. For example, the pressure in certain professions such as ballet dancers, low weight athletes and models adds to risk
• Coping skills – if a person doesn’t have positive coping strategies to deal with difficult emotions, such as stress, sadness or anger, they may develop an eating disorder as a way to cope with their emotional pain
• Diabetes management – someone with diabetes has to focus on controlling their food intake, and this monitoring can result in some people becoming preoccupied with label reading, which can leave them at risk of diabulimia

These risk factors combine in certain people and can lead them to develop an eating disorder.

Dangers of diabulimia

Diabulimia is highly dangerous and can be fatal. As people with type 1 diabetes need insulin to live, reducing or stopping their insulin doses can cause very serious complications, including:

• Loss of eyesight
• Kidney damage
• Nerve damage in feet
• Amputations

For someone with type 1 diabetes, a lack of insulin can also lead to diabetic ketoacidosis, which can cause comas and death.

Recognising the signs and symptoms of diabulimia

Signs and symptoms specific to diabulimia

If you're worried that someone you're close to may be restricting or stopping their insulin intake in order to lose weight, it's important to look out for the following warning signs of diabulimia.

Firstly, it's important to look out for signs of hyperglycaemia (high blood sugar), as taking too little insulin can cause this.

Short-term signs of hyperglycaemia

• Increased urination
• Excessive thirst
• Fatigue and lethargy
• Headaches

Long-term signs of hyperglycaemia

• Nausea and vomiting
• Dehydration
• Shortness of breath
• Abdominal pain
• Bladder and/or yeast infections
• Weakness
• Confusion
• Passing out

If someone is displaying the signs of hyperglycaemia, it should be taken very seriously and treated as quickly as possible, as it can have life-threatening consequences.

Alongside hyperglycaemia, further signs and symptoms of diabulimia to be aware of include:

• Changes in weight, in particular losing weight
• Fear of insulin making them ‘fat’
• Poor diabetic control leading to consistently high HbA1c levels
• Blood sugar records not matching with their HbA1c readings
• Having a negative view of insulin, possibly seeing it as calorie-laden
• Becoming secretive about taking their insulin and testing their blood sugar
• Missing appointments related to their diabetes

Common signs and symptoms of eating disorders

A person with diabulimia is also likely to display warning signs that are common to all eating disorders:

• Preoccupation with the control of body weight, body image and/or eating
• Compulsion to exercise, even if they're tired or feeling ill
• Strict rules and rituals around food and/or exercise
• Changes in appetite or food preferences, for example, not allowing themselves their favourite treats
• Secrecy around food and eating habits
• Withdrawal from family and friends
• Avoiding eating with others
• Irregular, missed or delayed periods
• Changes in mood

We understand that you may not spot all these signs. When someone is dealing with diabulimia, there may be only a few clues. Also, people struggling with an eating disorder often feel ashamed of their behaviours so may try to keep what they're going through a secret.

Helping someone to seek support

If you're worried about someone and think they may be suffering with diabulimia, it's so important to reach out and talk to them.

We understand that the idea of having this conversation may be causing you to worry, but it’s a discussion that needs to happen because of the dangers to their health. Eating disorders are serious conditions that can worsen without the right intervention and support.

Our blog on how to support someone with an eating disorder contains plenty of advice and information to help you prepare for this discussion.

Treatment for diabulimia

Professional support from a skilled multidisciplinary team is essential when someone is suffering from diabulimia. The treatment they receive should be collaborative and include nutritional and medical help, as well as a psychiatric assessment and evidence-based psychological treatment from an eating disorder specialist.

At Priory, our psychological treatment can be provided on an inpatient, day care and outpatient basis. Our inpatient treatment is best suited to people who need support in getting mentally and physically stable, while our day care and outpatient treatment is available for people who need ongoing support that can fit around their responsibilities, which may include school or work.

If you'd like to find out more about the treatment options that are available at Priory, please use the details below to get in contact.