What is Diabulimia? When Eating Disorders and Diabetes Collide

Thrive • Nov 18, 2021

By Thrive Reno’s Director of Nursing Liz Lass, RN, CEDRN, CPT

WHAT IS DIABULIMIA?

Although diabulimia isn’t an official medical diagnosis, the clinical term describes when insulin-dependent diabetes (typically type 1) co-occurs with an eating disorder. Individuals with diabulimia often engage in binge eating and compensatory behavior to prevent weight gain, including the restriction of their insulin intake.

Insulin is a necessary hormone in the body that allows carbohydrates to be metabolized into energy that fuels cellular function. Without insulin, the cells essentially starve, which can cause the affected individual to experience significant weight loss as well as develop other life-threatening complications.

WHY DIABULIMIA DEVELOPS

Many associated elements of insulin-dependent diabetes serve as risk factors for the development of an eating disorder.

Some risk factors of diabulimia include:

Being Diagnosed With Diabetes at Young Age

One of the most prominent risk factors for diabulimia is being diagnosed with type 1 diabetes during adolescence or childhood. Adolescents already face challenges as they adjust to their bodies’ natural changes during puberty. If an adolescent is diagnosed with diabetes during this volatile period, they may feel an increased sense of isolation at a time when social acceptance is highly valued. These heightened feelings of social discomfort surrounding body image and food can drive some adolescents with diabetes to control their weight, especially by manipulating their insulin intake.

Associating Weight Gain With Insulin Intake

As diabetes develops, the affected individual may experience increased thirst and hunger in addition to weight loss. When their symptoms become severe enough to seek medical attention and they receive a diabetes diagnosis, the individual may correlate their subsequent weight gain with their insulin intake. Although their body is restoring itself to its natural weight, some people may resist this healthy weight gain by limiting their insulin intake.

Increased Focus on Diet

To administer the correct amount of insulin, individuals with insulin-dependent diabetes are required to monitor their carbohydrate intake which can lead to a hyperfocus and even avoidance of carbohydrates.

Additionally, sometimes parents of a diabetic child obsessively limit their child’s carbohydrate and sugar intake. Though well-intentioned, this parental behavior can cause children to feel ashamed when they eat these types of foods and even drive them to secretly binge eat.

SIGNS AND SYMPTOMS OF DIABULIMIA

Signs and symptoms of diabulimia that are similar to those of other eating disorders include:

Restriction of food
Binging and/or purging
Compulsive exercise
Manipulation/restriction of insulin intake
Not wanting to eat with others
Avoiding eating carbohydrates
Increased irritability
Low energy
Loss of interest in activities one used to enjoy

Diabulimia can cause a person to experience persistently elevated blood sugar. Symptoms of persistently elevated blood sugar include:

Multiple hospital admissions related to high blood sugar leading to diabetic ketoacidosis (when the body lacks the insulin necessary to allow blood sugar into the cells for use as energy)
Tachycardia (having a heart rate that is too fast)
Hyperpnea (taking deeper breaths than usual)
Nausea
Vomiting
Confusion or altered mental status
Acetone breath (when the breath has a fruity scent similar to nail polish remover)

Medical labs can also help indicate if a person is struggling with diabulimia. Signs that can be indicated by medical lab work include:

Elevated blood glucose levels
Elevated hemoglobin A1C (indicates elevated average blood glucose levels over three months)
Elevated fructosamine (indicates elevated average blood glucose levels over the previous weeks)
Urine ketones (byproducts produced when the body is forced to burn fat for energy instead of carbohydrates)

THE DANGERS OF DIABULIMIA

The persistent high blood sugar caused by diabulimia often results in the desired weight loss, however, it comes at a very high price.

The medical consequences of diabulimia include:

Neuropathy (nerves damage that causes numbness, tingling, muscle weakness, and pain)
Blindness
Non-healing wounds
Organ failure
Amputations
Diabetic-ketoacidosis, which can result in coma and death

MEDICAL MISCONCEPTIONS ABOUT DIABULIMIA

Similar to eating disorders in general, there is a lack of training related to diabulimia within the medical field. As a result, it’s common for clinicians to overlook a diabetic client’s eating disorder. Instead of addressing co-occurring conditions, physicians may tell their diabulimia clients that they are not managing their diabetes responsibly, designating them as “non-compliant” with their diabetes management or as “experiencing diabetic burnout.” Often, individuals struggling with diabetes and eating disorders feel ashamed and this erred clinical approach only adds to their sense of shame and isolation.

INTEGRATED TREATMENT AND RECOVERY FOR DIABULIMIA

If you’re struggling with diabulimia, know that embracing life free of an eating disorder while responsibly managing your diabetes and eating intuitively is entirely possible. Thrive Wellness can empower you to do just that. Thrive takes a multidisciplinary approach to treating individuals with diabulimia so you can heal holistically. You can learn more about our eating disorder treatment programs by reaching out to us .

About the Author

Thrive Reno’s Director of Nursing Liz Lass, RN, CEDRN, CPT

Liz Lass, RN, CEDRN, CPT, is Thrive’s Director of Nursing and is truly passionate about working with the eating disorder community. Liz earned her Bachelor’s of Science in Nursing from the University of Nevada, Reno, and Bachelor’s in Science in Exercise and Sport Science from Western Washington University in Bellingham, WA. Liz is a CEDRN (Certified Eating Disorder Registered Nurse) and has 9 years of experience working with the eating disorder population. Liz is also a certified personal trainer and is passionate about integrating her background of exercise science into her practice through mindful movement and helping clients heal their relationship with exercise. Her dynamic role at Thrive Wellness includes performing nursing assessments, providing meal support, leading groups, consultations, and assisting prescribers at Thrive Wellness with coordination of care between agencies, pharmacies, and laboratories. In her free time, Liz enjoys all that the Reno-Tahoe area has to offer, including skiing, hiking, biking, camping, wake-surfing, paddle boarding, and listening to live music. She grew up in Sun Valley, ID, and lives with her husband, two sons, and blue heeler in Verdi, NV.

The post What is Diabulimia? When Eating Disorders and Diabetes Collide first appeared on Thrive Wellness.

< Older Post Newer Post >

Clean House, Healthy Mind: Spring Cleaning Benefits for Mental Health

By Sage Tippie • 23 Apr, 2024

Spring Cleaning Benefits for Mental Health Spring is a time of new beginnings, change, and transitions, including in our homes. With the warmer weather kicking motivation into high gear, Spring can be a prime time to do a deep clean. Not only is a clean space aesthetically pleasing to the eyes, but it can also help to improve your mental health. Learn about how tidying up your space can also tidy up your thoughts below along with tips for cleaning when you’re struggling with your mental health. 4 Reasons Why Cleaning is Beneficial to Mental health 1.Decreased Stress Not only does an uncluttered space provide a sense of calm, but the physical act of cleaning can release feel-good endorphins, reducing feelings of stress and anxiety. As you cross tasks off your checklist, your body also releases Dopamine. Also known as the “happy hormone”, Dopamine provides a sense of accomplishment and pride that can promote motivation in other areas of our lives. 2. Improved Focus Studies have shown that an uncluttered space can also lead to an uncluttered mind. Your focus can be drawn away from important tasks by a chaotic, messy space. Research has also shown a connection between procrastination and clutter, as an unwillingness to tackle larger chores like cleaning can translate over into various areas of our lives. By keeping your space tidy, it can inspire you to stay on top of other major tasks like work and school assignments. 3. Regulated Emotions According to this 2015 study , cleaning can function as a practice in mindfulness, providing an increased sense of calm and inspiration. Slowing down while cleaning gives you room to relax and free your mind of burdens, stressors, and irritants that can affect your mental health. Cleaning can even be considered a practice of self-care as the action helps you to connect with yourself and the outcome allows you to better enjoy your own space. 4. Sense of Order and Control When experiencing mental health struggles, people may feel a lack of control over their lives and emotions. Cleaning even small areas of the home can provide an increased sense of order and control as you cross tasks off your to-do list. Through realizing your own power by simply completing minor tasks like cleaning, it can reaffirm your ability to do more. 10 Tips for Cleaning When Struggling with Mental Health Mental health struggles and disorders commonly create barriers to one’s ability to clean and properly practice personal hygiene. Although these behaviors are normal side effects of mental health disorders, we want to work to aid our clients in cleaning to the best of their ability even in difficult times. Below, Thrive Wellness occupational therapist Meadow Deason shares some helpful tips she gives to clients when they struggle with cleaning due to mental health conditions: 1.Ask For Help Having support to clean can make a huge difference. Do the cleaning with the person helping you and have them hold you accountable. 2. Don't Wait for Motivation Motivation might not come before action, but it can build as you begin to see the results of your efforts. 3. Start Small Start with one area or one task and go from there. For example, concentrate on your bedroom first and then move on to the living room and bathroom. 4. Do Something Daily Even if you do only one small cleaning task a day, doing that one task creates momentum and prevents small tasks from building up and becoming overwhelming. 5. Use Sensory Modulation Change your environment by playing music, adjusting the lighting, or using aromatherapy. This can help to put you in a new headspace for cleaning. 6. Start with "High Impact" Tasks Start with more intensive or all-over cleaning tasks such as picking up clutter or doing the dishes. The visual "noise" of some tasks makes a large impact on the entire space, building motivation to continue cleaning. 7. Make a To-Do List Write a detailed to-do list of tasks and cross them off as you go. Physically marking down what you’ve accomplished can promote increased motivation. 8. Reward Yourself Set up a reward system where you reward yourself with a favorite activity or item when you complete a task as an incentive to clean. 9. Use the Rocket Method Don't think about it, just choose a task, countdown from five or ten and then start. This can help you to avoid potential anxiety and dread that can prevent you from cleaning. 10. Gamify Tasks Make up a game for your tasks or time yourself to promote increased engagement in cleaning. Your ability to complete tasks can be affected by a multitude of different factors and conditions including OCD , anxiety, depression , ADHD , and more. If you are struggling with motivation due to your mental health, help is here at Thrive Wellness.

child getting bandaid from doctor while mother smiles

The Importance of Whole Family Primary Care: A Q&A with Dr. Stephanie Wright

26 Mar, 2024

By serving the whole family, physicians are able to have a better understanding of family dynamics, family health care goals, and history of disease in the family.