What you need to know about diabulimia

Maybe you’ve never heard of the term ‘diabulimia’ before, but this eating disorder affecting people living with type 1 diabetes is more common than you might think.

It’s important to know some eating disorders are unique in populations with type 1 diabetes (T1D). But what are the warning signs of the type 1 eating disorder known as ‘diabulimia’? And what are the best forms of treatment? Here’s everything you need to know.


What is diabulimia?

Eating disorders are relatively common in people with T1D. In fact, nearly 1 in 5 children with T1D, and 1 in 4 females, show signs of disturbed eating behaviour.

Diabulimia is an eating disorder that primarily affects young women with T1D. According to Dr. Michael Vallis at the Behavior Change Institute, Nova Scotia Health Authority and Dalhousie University in Halifax, it is characterized by deliberately withholding, or restricting, insulin in order to lose weight, explains


What are the warning signs of diabulimia?

According to the US National Eating Disorders Association, possible signs of diabulimia include: 

  • Hemoglobin A1C level of 9.0 or higher on a continuous basis.
  • Unexplained weight loss.
  • Persistent thirst/frequent urination.
  • Preoccupation with body image.
  • Blood sugar records that do not match Hemoglobin A1C results.
  • Depression, mood swings and/or fatigue.
  • Secrecy about blood sugars, shots and or eating.
  • Repeated bladder and yeast infections.
  • Low sodium/potassium.
  • Increased appetite especially in sugary foods.
  • Cancelled doctors’ appointments.

A lot of these symptoms are the same ones found in early diabetes diagnosis. Some health professionals say it’s as if they were essentially turning back the clock in disease state.


Why is it so dangerous?

Even though restricting insulin does cause weight loss, it also causes blood sugar levels to skyrocket. Over time, this takes a toll on health that can have life-threatening consequences.

Diabulimia can accelerate T1D-related complications in young people, including blindness, kidney failure and limb amputation – conditions that are typically seen in much older patients. 

One of the most serious complications is diabetic ketoacidosis (DKA), when a lack of insulin causes the body to burn fat in order to fuel itself, creating toxicity in the body, and potentially resulting in coma or even death.  


Why is recovery harder than other conventional eating disorders?

Conventional eating disorder treatment programs, including intensive inpatient programs, often don’t lead to lasting recovery, as they are not geared towards the unique needs of diabulimia patients, so treatment failure rates are high.


How do you effectively treat diabulimia?

Diabulimia, like most eating disorders, begins with low self-esteem. There is a concern about weight, body image and an aim for perfectionism. There’s also a heightened risk of depression in eating disorders for people living with type 1.

Working with a psychiatrist is highly recommended in order to assess the best combination of strategies from various treatment programs.

Recovery is about developing an improved sense of self. To some, this might be practicing yoga and mindfulness; to others it might be exploring different forms of artistic expression. The focus should be on working with professionals that help you assess how to better manage your diabetes and how to build back your sense of worth by reconnecting with what interests and challenges you.


How can I get help?

If you suspect you or someone you know is suffering from diabulimia, you should contact your diabetes healthcare team and/or family physician to discuss referral options and receive support.

Many people still don’t know about diabulimia, that’s why raising awareness about it is so important to prevention and better management. In the future, we hope to see more targeted treatment programs focusing on optimal diabetes management and treating the underlying eating disorder.

Learn more at jdrf.ca