“Diabulimia” is an unofficial name for a mental health condition where a person with type-1 diabetes purposefully uses less insulin or none at all in an effort to control their weight. This combination of mental health and physical disorders is among the most dangerous types of disordered eating behaviors and can lead to myriad health concerns, including coma and death. Here’s we’ll explore the signs and symptoms of diabulimia, what the health concerns are, and what kinds of treatment can help spur recovery.

Type 1 Diabetes

As opposed to type 2 diabetes, which is caused by poor nutrition and lack of exercise later in life, type 1 diabetes begins in infancy. Diabetes is a condition where the pancreas does not produce enough insulin. Insulin is important in helping the body’s cells to create energy and process foods into fuel. People with type 1 diabetes usually have to take insulin regularly to regulate their body’s energy and nutritional needs.

Diabetes can cause a wide array of negative health effects, including:

Unexplained or sudden weight loss
Persistent thirst and frequent urination
Diabetic ketoacidosis – a crisis in which the blood sugar imbalance caused by low insulin causes the blood to become acidic in nature. This can cause a coma or death.
Low sodium and/or potassium
Yeast infections and bladder problems
Irregular or lack of menstruation
Worsening vision
Fatigue
Dry hair and skin

Bulimia Nervosa

Bulimia nervosa is a well-known and common eating disorder in which the individual engages in binge eating episodes followed by efforts to purge the calories taken in during those episodes. In some cases, the individual will purge following every meal, and not just after a binge eating episode. The most common form of purging is self-induced vomiting, but other methods include laxative abuse, abuse of “diet pills,” and excessive exercise.

Bulimia nervosa is a dangerous mental health disorder that encompasses several mental health issues; these can make it difficult (but not impossible!) to treat. These can include co-occurring disorders like depression and anxiety, as well as body dysmorphia (a distorted self-perception that manifests as feeling “fat” or “overweight” despite extreme weight loss), low self-esteem, and a compulsive need to be “perfect.”

How Bulimia Nervosa Intersects With Type 1 Diabetes

Both bulimia nervosa and type 1 diabetes can cause sudden and unexplained fluctuations in weight. People with bulimia nervosa often feel a strong need or compulsion to control their weight, and in combination with a distorted body image, will push themselves to keep losing weight even when they have become emaciated. For most people with bulimia nervosa, this means purging by vomiting or another method like exercising.

However, for people that have both type-1 diabetes and bulimia nervosa, they may begin to lessen the amount of insulin they take or stop taking it altogether. Although “diabulimia” is not officially listed by the DSM-V as a diagnosable condition in its own right, insulin omission is considered a purging behavior by the diagnostic manual. Since sudden weight loss is a symptom of low insulin, forgoing their regular insulin intake causes people with diabulimia to purge weight without resorting to vomiting or another method.

Behavioral Symptoms of Diabulimia

Some emotional and behavioral signs that a person had diabulimia are similar to those of bulimia nervosa; others are specific to the former condition. In both cases, the individual is liable to have a negative or skewed body image, low self-esteem, and a troubled relationship with food and eating. They may feel anxious or awkward when eating, especially at shared meals and in public. People with bulimia nervosa may also:

Have discolored teeth
Develop calluses on the knuckles
Carry mints and water at all time (to cover the odor of vomiting)
Engage in fad diets or a variety of diet programs
Social withdrawal
Increased signs of depression
Suicidal ideation

The behavioral signs of a person with diabulimia might include any or all of the above, but there are some indicators that are unique to insulin restriction:

Less focus placed on insulin management
Being secretive about their insulin intake
Increased fatigue and lethargy
Avoiding sugary food groups to avoid insulin intake
Developing strict food rules and food rituals
Unfilled insulin prescriptions

Health Consequences of Diabulimia

Many of the health consequences of diabulimia are similar to those of untreated diabetes type 1, but the omission of insulin in addition to the food intake restrictions of many people with bulimia nervosa can accelerate and exacerbate them.

Some short and long-term consequences of diabulimia include:

Slow healing for cuts and bruises–blood sugar imbalances can cause slow healing and sometimes ulcers developing
Severe dehydration – because of the replacement of insulin with ketones to provide fuel for the cells, the body has to urinate more frequently to get rid of the ketones. This leads to dehydration
Yeast infections – sugar in the blood makes yeast infections more common
Staph infections – similar to the slow healing caused by blood sugar imbalances, cuts and bruises get infected more easily and can allow dangerous staph infections
Muscle atrophy – without insulin to provide glucose, the body begins to break down muscle for fuel.
Menstrual disruption – this is also common in other eating disorders where the body does not have enough fuel to maintain regular processes.
Electrolyte imbalance – can cause fainting, nausea, and seizures
Kidney disease –the production of ketones and frequent urination can eventually cause kidney failure
Liver disease – insulin deficiency can cause fatty liver, which reduces its effectiveness
Heart disease – diabetes can cause higher cholesterol which affects the heart negatively.

Treatment for Diabulimia

Most residential or outpatient eating disorder treatment centers are experienced in treating diabulimia to some extent, but special considerations are usually required. While specific mentions of body weight are usually avoided in cases of bulimia nervosa, this is medically unwise for people with type 1 diabetes. So, while cognitive retraining exercises like CBT or DBT, or group therapy sessions, or mindful movement classes might be included in a diabulimia treatment program as they are with a bulimia nervosa program, there needs to be a specialized medical component.

Since diabulimia is medically very dangerous, residential recovery programs are often the better choice until insulin intake is re-established and regulated. With 24/7 medical and psychological oversight, people with diabulimia can count on support if their physical symptoms worsen. Even more so than people with other eating disorders, people with diabulimia need medical as well as psychiatric team members, including therapists, medical doctors, nutritionists, and dieticians.

Diabulimia is among the most dangerous of eating disorders, making it among the most dangerous psychiatric disorders, period. Thankfully, help is available from an eating disorder treatment center near you. If you or a loved one is using insulin omission to control their weight, don’t hesitate – reach out today and get the help you need.