As someone who has been living for 25 years with Type 1 diabetes, Tawny Murdock specializes in treating those who have diabetes and suffer from eating disorders.  She says that when someone with diabetes does not receive insulin, rapid weight loss may result when their body starts to eat its own stores of fat and muscle.  This is caused by diabetic ketoacidosis and in addition to weight loss, produces other health complications, like heart disease, nerve damage, kidney failure, blindess, amputations, and possibly even death.

Diabulimia typically strikes adolescent and young adult women that most likely deny they could be affected by these complications.  It is estimated that approximately 450,000 women in the U.S. (or one-third of all females with Type 1 diabetes) have attempted insulin deprivation as a method to lose weight.

Denis Daneman has done research on the subject and published it in Diabetes Spectrum in 2002.  His research shows that 1% of girls aged 12 years manipulate insulin.  This number increases as they get older.  14% of them manipulate at age 15 and 34% at 19.

Individuals develop eating disorders out of the appeal of losing weight and even though such consequences as blindness, amputation, and death may occur, those threats may not be seen as serious enough to overcome the underlying thought patterns and behaviors.

Causes of Diabulimia

Diabulimia may arise due to many different factors.  The nature of Type 1 diabetes requires those affected to watch what they eat and how much they weigh.  This vigilant behavior can be a catalyst for developing an eating disorder.  It may also lead to defiant acts because limiting insulin intake is an easier route than carefully measuring what you eat.

Murdock mentions that restricting the intake of insulin may also provide Type 1 diabetes sufferers with a sense of control, when things around them are out of control.  She says: “Although they may be feeling in control by limiting their insulin consumption, they really are not in control because this causes their health to suffer.”

Warnings to Look For

Diabulimia has existed for awhile now, but medical as well as mental health professionals today have a better understanding of its symptoms.  Here are some warning signs to look for to identify if someone with diabetes may have an eating disorder:

• Their eating habits are different (for instance, they may eat more, but end up losing weight).
• They quickly lose or gain weight.
• Metabolism control is poor even though it appears they are complying
• Self-esteem is low.  Has a preoccupation with how their body looks, how much they weigh, and how much food they eat.
• Going to the bathroom frequently.  They are very thirsty and have high blood sugar levels.
• Their energy level is low and they are often fatigued, shake, are irritable, confused, have anxiety, or sometimes faint.
• They purge, maybe via the use of laxatives.
• They are uncomfortable when they eat or take insulin in front of others.
• They hoard food.
• They are not willing to attend or miss medical appointments.
• They have recurring diabetic ketoacidosis

Diabulimia Treatment

Just personally caring for your own diabetes is tough enough. It is even harder when you have an eating disorder on top of it.  The health consequences may be life-threatening.  It is mandatory that both the medical and the mental health issues are treated at the same time.

Diabulimia treatment requires careful medical monitoring, the steady gain of weight, and instruction on nutrition and personal care.  Intensive physical therapy and eating disorder treatment are very important in order to address the struggles with weight fluctuations and body image obsession.  Patients need help in discovering healthy methods of coping and to grow a support network.

For a majority of patients, the best results are achieved through a team of multi-disciplinarians that involve a registered dietician, an endocrinologist, and a psychotherapist.

“Simply seeking treatment from just a physician is not enough because they would not attack the emotional portion of their eating disorder,” warns Murdock, who was a marriage and family therapist intern at The Victorian, which is a treatment center in Newport Beach, CA that helps women with eating disorders.  She adds: “Just seeing a therapist would not cure the disease because treatment and careful monitoring is required.”

The Victorian is an ideal treatment center for women dealing with the damaging effects of diabulimia.  It provides a perfect combination of medical management, individual, group, and family therapy, and gives diabetic patients the social support to assist them with effectively managing and overcoming their eating disorder.