Diabulimia: A Dangerous Way to Lose Weight
By Heidi J. Dalzell, PsyD
Examiner.com
January 15, 2011
It’s a disturbing trend: diabetics, generally young women, who manipulate insulin in an effort to lose weight. The practice is so prevalent in fact — with about one-third of diabetics between the ages of 15 and 30 engaging in this — that the disorder has been dubbed diabulimia. Although not an “official” eating disorder, the practice has gained attention from experts, due to the significant medical complications and risks associated with it.
Jane, a college student at Temple University in Philadelphia, Pa., understands both the mindset and the dangerousness of diabulimia. This insight, however, comes after years of treatment for the disorder. Jane was diagnosed with Type I diabetes when she was 13. Her symptoms were classic: increased thirst and urination, increased hunger, and weight loss. It was the later symptom that Jane found to be so attractive: the “baby fat” dropped away, and the reactions were positive at first. When her parents became concerned and took for an evaluation, doctors at Children’s Hospital of Philadelphia diagnosed the diabetes and Jane was started on insulin.
She quickly began to regain the weight, plus. “I hated it,” she says, “I looked fat again, even though I was on a strict diet for the diabetes. It just wasn’t fair.”
The factors that Jane mentions are reasons that many young men and women with diabetes develop eating disorders. Worried about body image, anxiety over managing the illness, the need to focus on food and weight, and cravings for “forbidden” foods, are fertile ground for the development of eating issues. Many with diabetes describe feeling as if they have limited control, and express that they feel deprived.
The result: misuse of food and often of insulin, generally by lowering their insulin dosage. Some young people become expert at knowing just how far they can go without inducing an immediate reaction. According to the Rader Programs, the prevalence of eating disorders among insulin dependent diabetics is estimated to be two to six times higher than in the general population. Up to 25% of females with insulin dependent diabetes may have a diagnosable eating disorder.
A common eating disorder pattern, also seen in those without diabetes, is that of restricting and then binging. Like Jane, many discover that as a way to counteract weight gain from the binging, they can underdose their insulin. This forces sugar to leave the body through the urine, resulting in weight loss. “I became an expert at just how much to limit my insulin. And it worked. I don’t think I would have even gotten help if my parents hadn’t caught on and been so scared,” Jane says.
Manipulating insulin is dangerous. It increases the possibility that the person will experience some of the medical complications of diabetes, such as vision loss, kidney failure depression and heart damage The combination of diabetes and an eating disorder also increases the mortality rate to 35%.
Treatment for diabulimia includes a team approach, with nutritional counseling, psychotherapy to help with body image and increase control and self-efficacy, and medical intervention from an endocrinologist.
“It wasn’t easy,” Jane says. “But I’m at a weight now and feel better about myself and my body. I hope that other people who have diabetes and eating disorders can get help.”
Resources
Living WIth Diabetes: Eating Disorders
Diabetes Self-Management: Binge Eating
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