What is diabulimia?

It's important to note that "diabulimia" is not an officially recognized medical or psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the standard diagnostic manual used by mental health professionals. Instead, diabulimia is a term that has been informally used to describe a specific pattern of disordered eating behavior and insulin manipulation in individuals with insulin-dependent diabetes. Because it is not an official diagnosis, there are no specific diagnostic criteria outlined in the DSM-5 for diabulimia.

However, healthcare professionals may diagnose and treat diabulimia based on a combination of the following factors and observations:

• Insulin-Dependent Diabetes Diagnosis: The individual must have a confirmed diagnosis of insulin-dependent diabetes, which requires ongoing insulin therapy to manage blood sugar levels.
• Disordered Eating Behavior: The person exhibits disordered eating behaviors, such as restricting insulin doses, omitting insulin injections, or manipulating insulin doses to induce hyperglycemia with the intention of losing weight or controlling body shape.
• Weight Loss or Weight Maintenance: Diabulimia is often associated with unexplained weight loss or the maintenance of a significantly lower body weight than is healthy for the individual's age and height.
• Blood Sugar Irregularities: Evidence of poor blood sugar control, including persistently elevated blood glucose levels (hyperglycemia) and frequent episodes of diabetic ketoacidosis (DKA).
• Psychological Symptoms: The presence of psychological symptoms or comorbid mental health issues commonly associated with eating disorders, such as body dissatisfaction, preoccupation with food and weight, anxiety, depression, or low self-esteem.
• Medical Complications: The person may also exhibit signs of diabetes-related complications resulting from poor blood sugar control.
• History and Self-Report: Information gathered from the individual's medical history and self-reporting of their behaviors and thoughts related to diabetes management and eating.

Because diabulimia involves both diabetes management and disordered eating patterns, it often requires a collaborative approach to diagnosis and treatment involving healthcare professionals with expertise in both diabetes care and eating disorders. If you suspect that you or someone you know may be struggling with diabulimia, it is essential to seek help from a healthcare provider or mental health specialist who can assess the individual's specific situation and provide appropriate treatment and support. Early intervention is crucial to addressing diabulimia and preventing potential health complications.

Diabulimia can affect anyone with insulin-dependent diabetes. Based on recent studies, it is estimated that around 30-50% of females and 9% of males with type 1 diabetes have diabulimia (Peducci et al., 2019).

Diabulimia can be influenced by a combination of risk factors. It's important to note that not everyone with diabetes will develop diabulimia, and the presence of risk factors does not guarantee that an individual will develop this condition. However, these factors may increase the likelihood of diabulimia:

• Gender: Diabulimia can affect individuals of any gender, but it is more commonly reported among females (Hall et al., 2021).
• Age: Adolescents and young adults with type 1 diabetes may be more susceptible to diabulimia. This may be because they are at a stage of life where body image and peer influence are particularly salient.
• Body Image Concerns: Individuals who are dissatisfied with their body image or have a strong desire to achieve a certain body weight or shape may be at a higher risk of diabulimia (Hall et al., 2023). Additionally, the fear of weight gain due to insulin use can drive disordered eating behaviors.
• Prior Eating Disorder: A history of other eating disorders, such as anorexia nervosa or bulimia nervosa, can increase the risk of developing diabulimia.
• Mental Health Factors: Individuals with a history of mental health issues, such as depression, anxiety, or low self-esteem, may be more susceptible to diabulimia. These conditions can contribute to disordered eating patterns (Hall et al., 2021).
• Lack of Diabetes Education: Limited knowledge about diabetes management, including the importance of insulin therapy and the risks of insulin omission, can be a risk factor. Lack of access to comprehensive diabetes education and support may contribute to diabulimia.
• Stress and Coping Mechanisms: High levels of stress or difficulties in coping with the demands of managing type 1 diabetes may lead individuals to engage in diabulimic behaviors as a way to cope with emotional distress.
• Family and Peer Support: The presence of supportive friends and family members can be protective against diabulimia. Conversely, a lack of understanding or support from loved ones may increase the risk.

Diabulimia can have serious health consequences (Hall et al, 2021; Yahya et al., 2023), including:

• Poor blood sugar control: Elevated blood sugar levels can lead to a range of short-term and long-term complications, such as diabetic ketoacidosis (DKA), neuropathy, kidney disease, and eye problems.
• Weight loss: Diabulimia can lead to rapid and unhealthy weight loss, which can have detrimental effects on overall health.
• Organ damage: Prolonged hyperglycemia can damage organs and systems throughout the body, including the heart, kidneys, eyes, and nerves.
• Increased risk of complications: People with diabulimia are at a higher risk of experiencing diabetes-related complications at a younger age due to poor blood sugar control.
• Psychological effects: Like other eating disorders, diabulimia can have significant psychological effects, including anxiety, depression, guilt, and low self-esteem.
• Increased mortality: Individuals with type 1 diabetes and an eating disorder have a threefold increase in mortality.

Treatment for diabulimia typically involves a multidisciplinary approach, including medical and psychiatric care, nutritional counseling, and therapy to address both the eating disorder and the management of diabetes. It is essential for individuals with diabulimia to receive appropriate support and treatment to improve their overall health and well-being.

With appropriate and comprehensive treatment, individuals with diabulimia can experience significant improvements in both their physical and psychological well-being. Here are some potential treatment outcomes:

• Stabilized Blood Sugar Levels: Effective treatment typically leads to improved blood sugar control, reducing the risk of acute complications such as diabetic ketoacidosis (DKA) and long-term complications related to uncontrolled diabetes.
• Healthier Eating Behaviors: Through therapy and nutritional counseling, individuals can develop healthier relationships with food, reduce disordered eating behaviors, and establish balanced eating patterns that meet their nutritional and diabetes management needs.
• Weight Management: While weight loss is a common goal for those with diabulimia, treatment aims to help individuals achieve a healthy weight or maintain an appropriate weight for their body type and age.
• Improved Mental Health: Many individuals with diabulimia experience co-occurring mental health issues such as depression, anxiety, or low self-esteem. Effective treatment can lead to a reduction in these symptoms and improved overall mental health.
• Enhanced Body Image: Therapy and counseling can address body image concerns, helping individuals develop a more positive and realistic view of their bodies.
• Better Diabetes Management Skills: Education and support in diabetes management can lead to improved insulin use, blood sugar monitoring, and overall diabetes care.
• Decreased Risk of Complications: By addressing diabulimia, individuals can reduce their risk of diabetes-related complications, including cardiovascular issues, neuropathy, kidney disease, and eye problems.
• Improved Quality of Life: With successful treatment, individuals often experience an improved quality of life, as they are better able to manage their diabetes, engage in social activities, and pursue their life goals.
• Reduced Relapse Risk: Ongoing support and relapse prevention strategies can help individuals maintain their progress and reduce the risk of returning to diabulimic behaviors.

Early intervention is crucial in diabulimia, as it can prevent severe health complications and improve the chances of successful treatment outcomes. Seeking help from healthcare professionals who specialize in diabetes care and eating disorder treatment is essential for anyone struggling with diabulimia. At Monte Nido & Affiliates, we offer specialized treatment for people with diabulimia at our Rosewood Ranch program.