What Diabulimia Looks Like

Eating disorders can be caused by a variety of reasons. In most cases, they stem from an obsession with body weight, food, or body shape. In these cases, the person with the eating disorder has some sort of altered reality about their situation or tries to overcompensate for that perceived shortcoming. Though most of us are familiar with anorexia and bulimia as the most common eating disorders, there is also a lesser-known disorder called diabulimia.

Diabulimia (ED-DMT1 ) is not yet documented as an official medical condition. However, the term is used now by medical experts as a way to describe the behavior that has become popular among certain diabetics, with teens being at the greatest risk.

What is diabulimia?

Diabulimia is an eating disorder that occurs when a person with diabetes intentionally restricts their insulin intake to lose weight. Diabetes is a disease that occurs when your blood sugar is too high. Insulin, which is produced by the pancreas, aids glucose in getting into your cells so that it can be used for energy. Occasionally, however, the body doesn’t make enough, or doesn’t make any, insulin. In this case, the glucose stays in your blood and doesn’t make its way to your cells. Having too much sugar in your blood can lead to a myriad of health issues.

For those with type 1 diabetes, their body is unable to produce its own insulin. For those with type 2 diabetes, their body does not create or process insulin well. And unfortunately, those with diabetes are at high risk of developing an eating disorder because controlling diabetes requires an intense focus on food and the type of food that is consumed.

Those with diabulimia often have body image issues or wish to lose weight, but have become frustrated with their dietary restrictions caused by diabetes.

The challenges with body image

The challenges of body image aren’t anything new, though they have certainly escalated in the last 20 to 30 years. Though models aren’t as paper-thin as they used to be, the tall, lithe bodies are something that many teenagers, girls in particular, constantly compare themselves to. Today’s teens have many concerns regarding diet, weight, and how attractive they are. These concerns can then lead to further issues such as preoccupation with body weight and food consumption, challenges maintaining a healthy self-esteem level, not to mention overall well-being and vitality. And when these preoccupations become serious and all-consuming, it is inevitable that they will lead to more serious health concerns.

Eating disorders fall into a broad range of illnesses, including anorexia, bulimia, and binge-eating. Anorexia and bulimia alone after four percent or more of college students, though the prevalence is higher in young women. Binge-eating disorder is also a common issue. With binge-eating, a person consumes high quantities of food and is often unable to stop eating despite feelings of fullness.

The struggle with perceptions concerning body image and the resulting eating disorders is quite alarming, not to mention frightening. To overcome an eating disorder, the teenager must first acknowledge that they have a problem. And, then they need to be willing to try to fix the problem and to correct their poor eating behaviors. But this is often easier said than done.

Signs of diabulimia

The signs of diabulimia will present themselves both with physical symptoms as well as a change in one’s emotional and behavioral state.

Physical symptoms of diabulimia

• A1c (a measure of blood glucose levels) of 9.0 or higher on a continuous basis and/or inconsistent readings on a glucose monitor
• Otherwise unexplained weight loss
• Frequent occurrences of nausea and/or vomiting
• Persistent thirst and frequent urination
• Multiple diabetic ketoacidosis (DKA) episodes or near-episodes
• Low sodium and/or potassium
• Frequent bladder and/or yeast infections
• Irregular or lack of menstruation
• Blurry vision or deteriorating vision
• Extreme exhaustion or lethargy
• Dry hair and skin

Emotional and behavioral symptoms of diabulimia

In the case of diabulimia, especially when it presents itself in a teen, it is critical that parents and other caregivers seek treatment right away. Though teens have likely been properly trained and educated on the proper care necessary for someone with diabetes, they not fully understand the long-term consequences of mismanagement.

• Increasing neglect of or nonchalance regarding diabetes management
• Secrecy about diabetes management
• Hiding their diabetes from others
• Avoiding doctor appointments with diabetes medical providers
• Fear of low blood sugar levels
• Fear that insulin will make them fat
• Sizeable and noticeable increase or decrease in diet
• Extreme vocal anxiety about body image
• Restricting and avoiding certain foods or food groups in an attempt to lower the dosage of insulin
• Avoids eating in public or with family or friends
• Discomfort with testing/injecting in front of others and, instead of going somewhere private for the injection, foregoes the injection altogether
• Overly strict food rules
• Preoccupation with food, weight and/or calories
• Excessive and/or rigid exercise
• Increase in sleep pattern
• Withdrawal from friends and/or family activities
• Shows symptoms of depression and/or anxiety
• Doesn’t fill prescriptions as directed

Overcoming diabulimia

If your teen has grown up with diabetes, the smell of insulin and the ongoing focus and discussion around proper food consumption and insulin levels can be very overwhelming. In many cases, it is easy for doctors and parents to assume that once the teen has been diagnosed and educated on how to manage their disease, that they will simply do what needs to be done and everyone can move on. But unfortunately, the emotional and mental impact of childhood and teenage diabetes is often overlooked.

Those who live with Type 1 diabetes have to do far more than just manage their daily maintenance and injections or medications. There are additional doctor requirements and likely additional check-ins. This can really take a toll on teenagers who simply want to enjoy life and get to do the things that their friends are doing. The emotional commitment to diabetes and the diabetes lifestyle is far more than most people could ever imagine.

Teens develop tension, resentment, and even shame. They don’t want to be different than their friends. They don’t want to be treated differently. And, they certainly don’t want to have to do things differently, or worse, not be able to do or eat certain things at all because of their illness. With teenagers, emotional support often comes from others experiencing the same thing. But with teenage diabetes, that can be difficult to come by when others in the school or in the same grade do not have the disease. Even though diabetes affects 1.25 million American children and adults, finding another with the illness in the same grade, friendship circle, let alone school, could be impossible.

Unfortunately, the result of this feeling of alienation on top of body image concerns can create poor behaviors and judgments in teens. And with diabulimia in particular, there is a lack of education, awareness, and support for those experiencing the struggle. In fact, many doctors classify those who are presenting with the symptoms of diabulimia is non-compliant.

Treatment for diabulimia

As with anorexia and bulimia, diabulimia requires treatment that includes both therapy and nutrition education. Diabulimics, in particular, need to be convinced that insulin is necessary for their health and wellbeing. The intention of treatment for diabulimia is to create normalcy and acceptance towards the use of insulin, blood glucose levels and the resulting weight of the patient. This will then help to reduce the chance, if not avoid altogether, acute and chronic diabulimia complications.

If your diabetic teen is showing signs and symptoms of diabulimia, it is important to seek medical care as soon as possible. In some cases, your teen may require hospitalization. In the least, however, the medical care team will look to make sure that your teen is medically stable. As part of this phase, treatment will include interrupting the manipulation of insulin and addressing the symptoms of the eating disorder, such as excessive exercise or purging.

Once patients are stable both medically and psychiatrically, they will begin a structured curriculum of one on one, group therapy, and experiential therapy to help them explore the function of the eating disorder. At the same time, they will build recovery skills which may include learning how to work through feelings of stress and anxiety as well as how to maintain their recovery and not regress following their discharge from treatment.

Therefore, in order to help teens overcome diabulimia, parents need to partner with medical providers like Hillcrest’s staff who understand the plight and will take it seriously for what it is. Organizations such as We Are Diabetes can be exceptionally helpful for parents and teens. If your teen has demonstrated several of the previously mentioned symptoms, it might be time to seek help from We Are Diabetes, as well as a local treatment center for those with mental health issues. We Are Diabetes, in particular, offers quality referrals to credible providers and treatment centers across the United States, one-on-one mentorship and guidance through the diabulimia recovery process, support for both the individual who is struggling as well as their family and loved ones, unique resources designed specifically for the ED-DMT1 population, and education for healthcare professionals.

Further, and as mentioned, teens can benefit from counseling related to the eating disorder itself, as an augmentation to the education on how to take care of their diabetes. Treatment centers such as Hillcrest provide a variety of educational opportunities include nutritional education that can help teens not only work through their body image issues, but learn how foods affect the body.

A healthy diet for diabetics and those with diabulimia

Figuring out the best foods to eat as a diabetic can be a challenge. And in some cases, trial and error while under medical supervision is the best course of action. In our efforts to help provide support to overcoming and conquering diabulimia, we have put together a list of foods that can easily be added to any home shopping list, that are great for diabetics, and tasty too. In fact, many of these foods are already on your shopping list, and they are low-calorie as well.

These foods can even help prevent diabetic complications such as heart diseases. This list is just an example of great foods that are good for the body and for diabetes.

• Fatty fish – Fish such as salmon, sardines, herring, mackerel, and anchovies are great sources of omega-3 fatty acids DHA and EPA. Not only can these fish be prepared and cooked in a variety of delicious ways, they also can provide major benefits for heart health. For diabetics in particular, consuming enough of these fats on a daily basis can be critical due to the increased risk of stroke.
• Leafy greens – We all know that it is important to take in our fair share of fresh vegetables, and leafy greens are no exception. Leafy greens are low in calories as well as in digestible carbohydrates. Too many carbohydrates can lead to elevated blood sugar levels.
• Broccoli – In addition to those leafy greens, consumption of broccoli is a very good thing. Broccoli is believed to help lower insulin levels and protect cells from damaging free radicals.
• Eggs – Regular consumption of eggs is good for your heart. Not only that, but eating eggs can help to lower inflammation, improve sensitivity to insulin, and improve good HDL cholesterol levels.
• Greek yogurt – Greek yogurt has been found to improve control of blood sugar and reduce the risk of heart disease, largely because of the probiotics that it contains.
• Strawberries – Who doesn’t love fresh strawberries, especially in the summertime? Strawberries are very high in antioxidants that are known as anthocyanins. In fact, it is the anthocyanins that give strawberries their red color. Research has shown that anthocyanins can reduce cholesterol and insulin levels after a meal. And, they improve blood sugar and heart disease risk factors in type 2 diabetes.

By combining these healthy foods with the proper medical attention and emotional treatment, diabulimia is a disease that can be overcome. And, in most cases, patients simply need to make some basic tweaks to their overall nutrition in order to improve their caloric intake but also take great care of their body to stay looking and feeling healthy.

If your teenager is struggling to manage their diabetes because of diabulimia, you have options. Hillcrest is here. Reach out to find out how our facility can help your teenager move forward on the road to recovery.