For health professionals
Living with diabetes can be challenging, but when combined with an eating disorder like anorexia, bulimia, binge eating, or insulin omission (diabulimia), it can get more complex.
Let’s take a closer look at these eating disorders to learn more about them and find ways to deal with their impact on quality of life and diabetes management.
When someone shows irregular eating habits, such as rigid rituals, anxiety over food, binge eating, vomiting, or an obsession with food and weight, it’s considered disordered eating.1 When these eating habits interfere with the ability to focus or go about one's day, and negatively impact their physical and psychological well-being, disordered eating becomes an eating disorder.
People with diabetes are more likely to struggle with food anxiety, chronic weight changes, or preoccupation with weight and body image — especially women. Focusing too much on diabetes medicine, exercise, and diet can make it harder to manage diabetes, which may increase the risk of developing an eating disorder.1
Recent studies suggest that both type 1 and type 2 diabetes may increase the risk of developing restrictive eating disorders.1 Factors such as irregular meal timing, depressive symptoms, and unhealthy eating habits can contribute to risk. It's important to know the symptoms of eating disorders to help people with diabetes and their healthcare team spot any potential problems early on.
Bulimia Nervosa (bulimia) is a serious eating disorder that involves binge eating large amounts of food with a loss of control over the eating and then purging, trying to get rid of the extra calories in an unhealthy way.1 This can include vomiting, the use of laxatives, excessive exercise, and other methods.
Anorexia Nervosa (anorexia) is an eating disorder characterized by an abnormally low body weight, extreme food restriction, an intense fear of gaining weight, and a distorted perception of weight.1 People with anorexia place a high value on controlling their weight and shape, using extreme weight loss efforts such as self-induced vomiting and laxative abuse that tend to significantly interfere with their lives.2
Binge-eating Disorder is a serious eating disorder in which people frequently consume unusually large amounts of food and feel unable to stop eating.1
Other Specified Feeding or Eating Disorder (OSFED) refers to the signs and symptoms of eating disorders that are clinically significant but do not meet the full diagnostic criteria for anorexia, bulimia, or binge-eating disorder.3 OSFED cases include those who have fewer symptoms (e.g., subthreshold BN/BED) or are missing certain symptoms. OSFED makes up the majority of eating disorder diagnoses.
Now that you know the different types of the more common eating disorders, it’s important to understand the various symptoms and warning signs.
There are certain mental and behavioral symptoms of eating disorders, including a noticeable change in how people view and approach food, weight, and self-image.1 A strong fear of gaining weight, the need to feel in charge of life, and the habit of looking in the mirror all the time to find flaws can all be signs of an eating disorder.2
When it comes to body image and food, it's common to experience mood swings, which can show up as irritability, depression, or apathy.
Some other common eating disorder symptoms are:1
In addition to the psychological and behavioral signs of eating disorders, some people may also exhibit physical symptoms.4
Another eating disorder that affects individuals with diabetes is insulin omission, also known as diabulimia.
Diabulimia, also known as insulin omission, is one of the most commonly reported eating disorders among people with diabetes– it is a serious condition where people with diabetes skip or lower their insulin doses to not gain any additional weight.1,5 Beyond weight loss, some use this harmful practice for self-harm, to avoid the discomfort of injections, out of fear of low blood sugar, or due to feeling overwhelmed by their diabetes therapy. It's especially common in people with type 1 diabetes, but also affects those with type 2 diabetes on insulin therapy.
Not taking insulin or reducing the dosage causes blood glucose levels to increase.1 Then, the body breaks down fat more quickly and discharges excess glucose from the body through the urine leading to a rapid loss in calories.
Insulin is necessary for people with type 1 diabetes to survive, and skipping doses can cause diabetic ketoacidosis (DKA), a potentially life-threatening condition.6,7 Hyperglycemia will also increase the risk of long-term complications, including retinopathy, nephropathy, and vascular disorders.
Diabulimia may develop from a mix of social, mental health, family, media, and physical factors.8 Some of the challenges that come with diabetes management may play a part, such as: 8–11
Diabulimia may start with a constant focus on managing diabetes and problems with body image, a sense of loss of control, a desire to lose weight or diabetes burnout.8
It is common for people who have recently been diagnosed with type 1 diabetes to lose weight before the diagnosis. Starting insulin therapy may result in regaining the lost weight. This can be difficult to deal with, leading some people to skip insulin doses.
No matter how it begins, it’s often hard to recognize the symptoms of and find successful treatments for diabulimia.
There could be emotional, behavioral, and physical signs and symptoms of diabulimia. Many people with diabulimia often keep their condition a secret and may not seek treatment,10 but may show signs of hyperglycemia such as: 8,10
The physical symptoms of diabulimia are often accompanied by emotional and behavioral warning signs such as: 12
It's important to seek professional help if you suspect that you or someone you know may be experiencing diabulimia or any other eating disorder.
Diabulimia, or insulin omission, is an extremely dangerous disorder.1 Having both type 1 diabetes and an eating disorder like diabulimia can cause high HbA1c levels and a higher risk of both short-term and long-term complications, which can lead to more hospital visits and longer stays.10,13,14
Short-term insulin omission will increase blood glucose levels, causing:8
Long-term high levels of blood glucose can cause: 8
Diabulimia may increase the risk of long-term complications from diabetes and can be deadly. 1
Diabetic ketoacidosis can lead to coma or death.13 Look out for DKA symptoms, such as:
DKA symptoms might require emergency medical attention.7 If you recognize any of these symptoms, consult with a healthcare professional as soon as possible.
The chance of recovery from an eating disorder and diabulimia increases the earlier it is detected.1 If you find yourself or a loved one fixating on food or diabetes therapy, obsessing over body image, or developing unhealthy habits, seek help from friends and family, medical professionals, and therapists.
Since diabulimia is not a recognized mental disorder, it often gets overlooked or misunderstood.14,15 Treatment requires a full team of specialists to help the patient recover. This may include an endocrinologist, a mental health professional specializing in eating disorders, and a dietician.
Managing diabetes isn’t easy, but having to deal with an eating disorder or diabulimia makes things harder. You may be having a difficult time with how you feel about your body and are experiencing shame or guilt for keeping your potential eating disorder from the people you care about and your medical team.
It’s important to remember that when you’re fighting a serious problem, you’re never alone. While it might be difficult, asking for help is the first step to recovery. Talk to someone you trust and bring it up with your physician. Breaking the cycle of an eating disorder or diabulimia can be challenging, but recovery is possible with help and support.
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