Diabulimia: a dangerous eating disorder for type 1 diabetics

Key Points

• Diabulimia is an eating disorder where people with type 1 diabetes skip their insulin to lose weight.
• It can be hard to detect but has dangerous consequences for health.
• Recovery from diabulimia involves therapy as well as nutritional guidance.
• A personalized nutrition plan developed by a Registered Dietitian can help you along your recovery journey.

Eat all you want and never gain weight — when something sounds this good, it’s usually too good to be true. And in the case of diabulimia, it can be extremely dangerous.

Diabulimia is an eating disorder where people with type 1 diabetes restrict or stop taking insulin to lose weight. Unfortunately, even with no immediate symptoms, severe health consequences are in store.

Learning more is the first step to get better or help a loved one. So, here’s a closer look.

What is diabulimia?

Diabulimia is an eating disorder in which a person with type 1 diabetes skips their insulin to lose weight.

It is not officially recognized as an eating disorder, but medical professionals may refer to it as ED-DMT1.

While the term 'diabulimia' suggests that bulimia (binging and purging) is involved, it is a bit inaccurate—not everyone with diabulimia binges. However, omitting to take insulin is similar to purging, where this type of disordered eating gets its name.

Who is at risk of developing diabulimia?

According to the National Eating Disorder Association (NEDA), women with type 1 diabetes are 2.5 times more likely to have an eating disorder.

Additionally, people with type 1 diabetes are more vulnerable (than those with type 2) because they experience more drastic weight changes based on insulin levels.

Diabulimia affects mainly teens and young adults. The disease is often reported in females, but there is insufficient data on diabulimia in males.

What is the impact of skipping insulin for weight loss?

People with type 1 diabetes do not produce enough insulin to process their food and regulate blood sugar levels. As a result, they have to inject insulin before meals.

With diabulimia, people with type 1 diabetes stop taking their insulin, and their health has dangerous effects.

There are many short-term and long-term consequences from diabulimia, which can lead to death. A study shows that people with weight-related insulin restriction were 3.2 times more likely to die over an 11-year period.

Why is insulin important?

Insulin is extremely important for getting the nutrition we need and managing biological functions. Insulin is the hormone that breaks down the sugars and carbohydrates we eat into glucose. It also ushers this glucose into different cells to be used for energy.

Think of insulin like an air traffic controller who directs planes to the correct runway at the right time and assigns them to their respective gates (a simplified explanation).

Apart from breaking down sugars and carbohydrates and facilitating fat storage, insulin also promotes the production of proteins and much more.

What happens to our bodies without insulin?

Imagine many planes trying to land at an airport with no air traffic controller. The planes have no one to guide and manage them and notify the right gates to be open.

Similarly, there is chaos when insulin is not around to process sugars and carbs into glucose. Food is flushed out of the body without any nutrients being absorbed.

While this results in weight loss (since food is not being broken down into nutrients), it is detrimental to health.

You do not have to fight diabulimia alone. A Registered Dietitian can guide you along your eating disorder recovery journey. Fay can help you find a Registered Dietitian near you, covered by your insurance.

What are the dangers of diabulimia?

When our cells do not get the glucose they need, several problems occur, including:

• Elevated blood sugar levels: Since glucose cannot enter different cells, it accumulates in the blood, leading to high blood sugar or hyperglycemia.
• Lower immunity: High blood sugar impairs the production of white blood cells, a key component of our immune response. As a result, the body is more susceptible to bacterial infections.
• Poor healing: High blood sugar levels slow down blood circulation, which can damage blood vessels and impair the function of immune-boosting red and white blood cells. Also, with poor circulation, the body cannot deliver enough oxygen or nutrients to the site of infection, which further delays healing.
• More susceptible to yeast infections: When blood sugar levels are consistently high, the environment promotes yeast and bacterial growth, which can lead to urinary tract and skin infections.
• Diabetic ketoacidosis (DKA): Without glucose, cells are depleted of energy. The body then switches to alternate sources of fuel, like fat. The liver begins to break down fat and produce ketones for energy. The issue is that ketones are highly acidic, and high ketone levels of ketones in the blood can lead to a very dangerous condition called diabetic ketoacidosis (DKA). DKA can weaken the immune system and make people susceptible to other infections.

What causes diabulimia?

Eating disorders are complex, and there is never one particular cause. However, people with diabetes are already at a high risk of developing eating disorders. This is because they often have to calculate portion sizes, monitor A1C levels, and may have to restrict certain food groups.

Some people may resort to diabulimia primarily to lose weight and achieve their body image goals. In particular, if they experience diabetes-related weight gain, they may be dissatisfied with their bodies and develop a negative self-image. Like other eating disorders, many are driven by extreme fear of gaining weight, making it difficult for them to take their insulin.

However, others may feel like their diabulimia gives them a sense of control when other aspects of their lives (including managing diabetes) make them feel a loss of control.

Is recovery from diabulimia possible?

If you have diabulimia, you may already know the risks to your health but may feel helpless against the eating disorder bully in your head.

You may have already tried various ways to stop but veered into other eating disorder territories like orthorexia (an obsession with eating "clean") or anorexia nervosa.

But it's important to know that diabulimia recovery is possible with the proper support.

Because diabulimia is closely tied to a chronic condition like type 1 diabetes, a combination of therapy and personalized nutrition plans can help you along your recovery journey.

If you would like to talk to someone about your diabulimia, Fay can help you find a Registered Dietitian near you, covered by your insurance.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.