“I decided to stop my insulin shots in a desperate bid to lose weight. A lot was happening in my life. I just had my second child in 2020, and my marriage was ending. It was a tough phase for me. I had gained several pounds,” says 31-year-old Naomi Durham, a UK-based podiatrist and student nurse who was diagnosed with type 1 diabetes at the age of 16 in 2008. She had started restricting her food intake drastically and also stopped her insulin shots. Soon, she was diagnosed with diabulimia, an eating disorder in people with type 1 diabetes, which can often lead to serious complications.
“I didn’t care about diabetes or what my blood sugars were then. I was feeling numb, and I sort of enjoyed it,” she adds. She is presently taking medication and is on the path of slow recovery.
What is diabulimia?
Bulimia is one of the most common eating disorders across the world. It involves the person stuffing themselves with large servings of food and then trying to eject it out of their system by self-induced vomiting or laxatives, only to repeat it with another round of binge eating. But diabulimia is an eating disorder in people with type 1 diabetes, where they reduce or refuse to take insulin shots and resort to extremely unhealthy diets for quick weight loss.
Dr David Chandy, consultant, endocrinology, Sir H.N. Reliance Foundation Hospital, Mumbai, explains that diabulimia is when people with type 1 diabetes try unhealthy ways to lose weight. A common method is to reduce their food intake so that they can reduce their daily insulin dose accordingly. The desire to lose weight coupled with the perception that insulin would lead to weight gain because of its role in glucose metabolism and fat storage is the root cause of this disorder. Some even completely refuse to take insulin, leading to further complications.
“A sudden dip in insulin requirement is one of the initial signs of an eating disorder in people with type 1 diabetes,” Dr Chandy adds.
Diabulimia is often referred to as the world’s most dangerous eating disorder. According to Dr Chandy, most eating disorders trigger serious complications only after a couple of months but diabulimia could lead to major issues within a couple of weeks as the person could end up with a life-threatening condition like diabetic ketoacidosis (DKA).
What causes diabulimia?
It is important to note that diabulimia is not solely caused by deliberate insulin restriction; it is a complex condition influenced by various factors.
According to Dr Chandy, people with type 1 diabetes lose weight through multiple methods, such as exercising too much and eating too little, which makes their insulin doses come down, and eventually use up insulin circulating in their body.
Dr Chandy adds that individuals prone to eating disorders are often highly conscious of their body image, experience peer pressure or have frequent concerns about their health. They may experiment with different dietary approaches and exercise regimens.
People with diabulimia shouldn’t compare their insulin dose to those with diabetes who take insulin regularly, as their requirements may be different”, says Dr Chandy.
Additionally, a strained relationship with healthcare providers or a lack of communication with their medical team can contribute to self-imposed management methods. Dr Chandy also adds that post-pregnancy weight gain is often a major factor leading to the drastic reduction in food intake and over-exercising in women with type 1 diabetes.
Can people with type 2 diabetes have diabulima?
“It is very rare for people with type 2 diabetes to have diabulimia,” says Dr Chandy.
According to Dr Chandy, in the case of type 2 diabetes, insulin resistance prevents individuals from going off insulin completely as they often need it in their treatment due to their dietary and exercise requirements.
Managing diabulimia
According to experts, building a healthy and open relationship with healthcare professionals, including diabetes educators, can help address anxieties and ensure proper guidance and treatment.
Dr Ravindra Agarwal, consultant psychiatrist, Manipal Hospitals, Goa, says that as people with diabulimia deliberately restrict insulin to lose weight while knowing the severe consequences it can bring, it’s become important to provide proper counselling to them. People with diabulimia may suffer from diabetes burnout as they are taking drastic steps to lose weight.
He suggests following a balanced diet with an adequate amount of food along with the required quantity of insulin to manage a healthy body weight. He also highlights the importance of physical activity in weight management.
Takeaways
Diabulimia is an eating disorder caused due to the sudden restriction of insulin shots combined with the drastic reduction in food intake in people with type 1 diabetes. If not treated properly, it could lead to life-threatening conditions like DKA. Better lifestyle and dietary choices that help in diabetes and weight management, along with counselling sessions, are often suggested for those diagnosed with this condition.
