Diabulimia and Diabetes: The Eating Disorder No Ones Talks About

Diabulimia is when someone with type 1 diabetes stops or restricts insulin use to lose weight.[i] If you have type 1 diabetes, you need insulin to live. Not taking your insulin can be dangerous.

You may be aware that if you stop taking insulin, you may start losing weight. But you probably don’t realize that this is actually an eating disorder. Most people don’t know about diabulimia. Yet it’s serious and pretty common.

Diabulimia may develop for lots of reasons. It’s usually not just a single thing, but can be a combination of social, mental health, and physical issues. Some of the challenges that come with managing diabetes may even play a part — such as:[ii]

• Focusing on your weight when you visit a doctor
• Constantly counting calories or carbohydrates in your meals
• Difficulty keeping your weight at a healthy level
• Needing to read food labels carefully
• Poor relationships with a healthcare professional or team
• Eating to try hypoglycemia, which may lead to guilt or weight gain
• Feeling shame over the way you’re managing diabetes

Diabulimia may start with the constant focus on managing diabetes. Body image issues, the desire to lose weight or diabetes burnout may also contribute.

If you’ve recently been diagnosed with type 1 diabetes, you’d probably lost weight before your diagnosis. When you go on insulin, you may gain that weight back. This can be difficult to deal with, leading some people to start skipping insulin doses.

No matter how it begins, it’s often hard to recognize the symptoms and then find a successful treatment.

Physical Warning Signs[iii]

• Regular attacks of nausea or vomiting
• Dry skin and hair
• Weight loss
• Low potassium or sodium levels
• Blurry vision
• A1C that’s 9.0 or higher
• Frequent urination
• Excessive thirst
• Irregular or lack of menstrual periods
• Fatigue
• Episodes of diabetic ketoacidosis
• Frequent yeast or bladder infections

Behavioral and Emotional Warning Signs

• Prescriptions that don’t get filled
• Neglecting diabetes management
• Fearing low blood sugars
• Strict food rules
• Anxiety or depression
• Being secretive about diabetes management
• Avoiding eating in public or with others
• Worrying that insulin will “make me fat”
• Restricting foods to reduce insulin doses
• Withdrawing from loved ones
• Preoccupation with exercise, weight, food, or calories
• Excessive exercising
• Avoiding doctor’s appointments
• Anxiety about how their body looks

If your body isn’t getting enough insulin, it allows your blood sugar levels to stay too high. When blood sugar levels stay too high over time, this may lead to serious consequences.[iv]

Short term, diabulimia may cause:

• Bacterial infections
• Muscle wasting
• Disruption in your menstrual cycle
• Slow healing for wounds
• Dehydration
• Diabetic ketoacidosis

Long term, high levels of glucose in the blood can result in damage to your blood vessels, leading to eye problems. Nerve damage may occur and cause chronic constipation or diarrhea, slowed stomach emptying, or even burning, tingling, or weakness in your arms, legs, feet, or hands (known as peripheral neuropathy). Eventually, constant levels of high blood sugar may damage your kidneys, liver or heart.

It can be tough to break the cycle of not taking insulin in order to lose weight. However, recovery is possible with support and help.

Eating disorder specialists and diabetes teams have become more aware of this eating disorder. Treatment requires a full team of specialists to help you to recovery. This may include an endocrinologist, a mental health professional specializing in eating disorders and a dietician. Of course, the first step to treatment is asking for help.

Managing diabetes isn’t always easy. Dealing with diabulimia makes it tougher. You may be struggling with the way you view your body — while feeling bad about hiding this eating disorder from those your love and your healthcare team.

When you’re batting a serious problem, remember: You can’t do this on your own. This doesn’t mean you’re weak or that you’ve failed. Everyone working to manage their diabetes faces ups and downs.

It might feel difficult, but asking for help is the first step to recovery. Once you share with someone the problems you’re experience, you’ll be ready to move forward to getting treatment from healthcare and mental health professionals.

Talk to someone you trust, bring it up to your physician, or reach out to the Diabulimia Helpline: diabulimiahelpline.org or call 1-425-985-3635.