By ANNIE ALTSCHUL
Published: August 13, 2013
Diabulimia is a lay term that has been used widely to describe the unique convergence of two very different diseases: diabetes and eating disorders. Others may refer to this combination as Eating Disorder – Diabetes Mellitus Type I (ED-DMT1). Although ED-DMT1 is not a formal diagnosis according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), Joslin Diabetes Center in Boston reports that women with type 1 diabetes are twice as likely to develop an eating disorder as women of the same age who do not have type 1 diabetes. According to psychologist Ann Goebel-Fabbri, Ph.D., the term diabulimia actually perpetuates a misrepresentation of the illness, with its assumption that diabetic patients who have a comorbid eating disorder primarily display symptoms of bulimia. In reality, diabetic patients may also exhibit symptoms of binge eating disorder and anorexia nervosa
There are several reasons why individuals with type 1 diabetes may be predisposed to develop an eating disorder. One reason specifically relates to the fact that there is a connection between insulin regulation and metabolism. Before being diagnosed with type 1 diabetes and determining proper insulin needs, some patients may experience weight loss. Weight loss may occur in individuals with type 1 diabetes because they lack sufficient amounts of insulin to store energy from food. Injecting synthetic insulin helps to rebound naturally low levels and keeps metabolism working in a normal fashion. However, this may cause some individuals to gain weight or stop losing weight because energy is now being stored in the body, sometimes in fat cells. Drive for thinness may cause some patients to decrease their suggested insulin dose to achieve weight loss. However, doing so can come with series health, and even life-threatening consequences, such as elevated blood sugar levels, nerve damage (neuropathy), severe dehydration, stroke, high cholesterol, and permanent damage to the eyes. Poor metabolic control and earlier onset of diabetes-specific complications are of particular concern in patients with type 1 diabetes and an eating disorder.
Underdiagnosis of eating disorders in individuals with diabetes by endocrinologists and primary care providers is of concern. Providers, who encounter diabetes on a regular basis, must be on the alert for and able to recognize signs and symptoms of eating disorders. Close collaboration between the eating disorders and diabetes teams can improve management and help avoid long-term complications and medical crises.
We do not yet have data to guide whether universal screening for eating disorders should be conducted in individuals with diabetes by their primary care physicians or endocrinologists. Given the prevalence of eating disorders and disordered eating in the general community, frank discussions about dieting, binge eating, and insulin dose manipulation should be included in diabetes specialists’ routine visits with patients.
The comorbidity of these two conditions requires a specialized and coordinated care. The majority of research on this topic has explored the prevalence of eating disorders in individuals with type 1 diabetes; much less is known about effective interventions. There are several organizations that help ED-DMT1 patients, including the Joslin Diabetes Center, the Diabulimia Helpline, and Diabetics with Eating Disorders.
Daneman, D., Rodin, G., Jones, J., Colton, P., Rydall, A., Maharaj, S., & Olmsted, M. (2002). Eating disorders in adolescent girls and young adult women with type 1 diabetes. Diabetes Spectrum, 15, 83-105.
Goebel-Fabbri, A. (2013). Eating disorders/”Diabulimia” in type 1 diabetes.
National Eating Disorders Association. (2012). Diabulimia. Retrieved July 8, 2013