Despite the term diabulimia not being widely known, it is used to classify a subset of people suffering from a dangerous condition. Diabulimia describes people who are living with Type 1 diabetes and an active eating disorder. Though it is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) at this point, the comorbid diagnosis can be life-threatening and can sometimes even lead to substance abuse.
The occurrence of Type 1 diabetes and comorbid eating disorders is not a new topic, but medical professionals have expressed diabulimia as a growing concern in recent years. Clinicians and clinical literature began using the term in the mid-2000s. However, researchers found that the condition has been described in scientific journals since the early 1980s. 
What Is Diabulimia?
The National Eating Disorders Association (NEDA) describes diabulimia as “an eating disorder in a person with Type 1 diabetes wherein the person purposefully restricts insulin in order to lose weight.” In most cases, diabulimia refers to people who manipulate their insulin levels to lose weight. In other situations, people who engage in disordered eating behaviors with Type 1 diabetes may also be diagnosed with diabulimia.
The three variations of diabulimia are:
- Bulimia type: Binge-eating and restricting insulin while purging in other ways
- Anorexia type: Purposefully restricting food intake in addition to restricting insulin
- Purposefully restricting insulin regardless of the amount of food intake
So, what is diabulimia, then? Diabulimia can refer to a host of circumstances. It is mainly centered around insulin restriction but can also describe other bulimic symptoms, specifically in people with Type 1 diabetes.
What Causes It?
Eating disorders, such as diabulimia, are not typically caused by one specific reason. Like many disorders, eating disorders can stem from factors like personality, genetics, temperament, and personal experiences. Personal experiences refer to stress, victimization, and childhood trauma.
In general, women are more likely to develop eating disorders, such as diabulimia. Many suspect women are vulnerable to eating disorders because of cultural messages, including weight and social status.
Before being diagnosed, many individuals with Type 1 diabetes are considered underweight. After beginning treatment, people with diabetes begin to gain weight and, for some, this can lead to being overweight. Weight change can be stressful and, unfortunately, can lead to adolescent bullying. For this reason, women who are bullied for weight changes have a higher chance of developing eating disorders like diabulimia.
Diabulimia Symptoms and Signs
Warning signs and diabulimia symptoms are both psychological and physical. Weight loss is an obvious sign and symptom of an eating disorder. However, other symptoms are likely to be present. If you are worried that a loved one with Type 1 diabetes is developing an eating disorder, there are several common signs and symptoms to look out for.
Psychological symptoms are more evident than physical symptoms since they commonly occur first. You may hear your loved one complain about their weight constantly, or they may even express how they are using insulin to manage their weight.
People with eating disorders are often noticeably fixated on their weight. Whether it’s from low self-esteem or negative self-image, some psychological diabulimia symptoms are:
- Expressing unhappiness with appearance, specifically weight
- Expressing how insulin can help with weight management
- Showing signs of newly developing anxiety or depression
- Secretive insulin usage
- Not eating in front of others
- Avoiding hobbies, activities, or social events
Physical diabulimia symptoms range in severity. Severe symptoms can result in coma or stroke, which can lead to death in the most serious cases. More common physical symptoms include:
- Unexplained weight loss
- Mood shifts
- Avoiding doctor’s appointments
- Persistent thirst
- Frequent urination
- Nausea or vomiting
- Inconsistent A1C readings
- Diabetic ketoacidosis
- Stopping of menstruation
- Blurred vision
Effects of Diabulimia
The consequences of diabulimia can be both short-term and long-term. Most of the issues stem from prolonged, high blood sugar levels. Some examples include slow wound healing, susceptibility to staph infections, and electrolyte imbalances. Long-term consequences may involve organ damage, body numbness, and retinopathy, which could eventually blind someone who has diabetes.
Most of the risk factors of diabulimia involve medical complications. In some circumstances, diabulimia can lead to issues involving substance abuse. Before looking at the risk factors of diabulimia and addiction, some physical short-term or long-term risk factors of the condition include:
- Lessened immune system function
- Loss of muscle
- Eye damage (temporary and permanent)
- Bacterial infections
- Chronic illnesses involving liver, kidney, and heart disease
When the body lacks insulin, it cannot make energy from sugar. If someone who needs to take insulin refuses to take it, their body will begin breaking down fat for energy. This may seem beneficial but this process can result in ketoacidosis, where the individual’s blood becomes too acidic. Multiple ketoacidosis episodes, which is a significant risk factor of diabulimia, can cause life-threatening damage to the liver and kidneys.
Not using the correct dosage of insulin can be fatal for individuals with Type 1 diabetes. If you know someone who is struggling with diabulimia, understand that treatment and medical stabilization must be a priority. Diabulimia treatment requires professional care and specialized eating plans.
Inpatient and outpatient diabulimia treatment centers involve treatment for the disorder and monitored nutrition, as well as offer counseling and therapy. In many cases, people with eating disorders have co-occurring mental issues, as well. Research shows that cognitive behavioral therapy (CBT) can help people examine and change their distorted thinking regarding their appearance and self-image.
Diabulimia and Substance Use
People with diabulimia are under high amounts of emotional and physical stress. Unfortunately, it is not uncommon for people to manage their emotions and stress with substances. Diabulimia is already a dangerous condition, but adding substance abuse makes a bad problem even worse. Substances seem to help minimize issues regarding mental health in the short run but, once dependence takes place, recovery becomes much more complicated.
Substance abuse is common among people with mental illness because it helps mask the person’s emotions for a short time. This can easily be confused with decreasing the symptoms and triggers of the disorder. However, substance use makes diabulimia treatment and recovery much more challenging.
Alcohol and Diabetes
Alcohol use can cause a severe drop in blood glucose levels. For someone who is diabetic, this is dangerous since the liver does not make glucose at normal levels when alcohol is present in the system. Physicians recommend that people who are diabetic should not consume more than two drinks a day for men and one drink for women.
Dangers of Substance Abuse When Diabetic
Diabetes is not a minor condition. It affects every system within the body. People with diabetes often have other health conditions since its effects are so far-reaching. Substance use disorders make it much more challenging to handle the potential health impacts of diabetes. Substance abuse makes the body unhealthy. It also makes it more difficult to keep track of diabetes and its possible variables.
Addiction is a brain disease that causes people to act in ways that are unhealthy, dangerous, and sometimes even unexplainable. Using substances to cope with health difficulties is a major sign of addiction. If you or someone you know is expressing signs of addiction and has health issues like diabetes or diabulimia, it is imperative that they seek treatment immediately.
Co-Occurring Substance Use and Diabulimia Treatment
Diabulimia not only requires complex medical treatment but it also requires mental health treatment. The level of care needed for people with diabulimia is similar to that of substance abuse treatment centers.
People with co-occurring substance use and diabulimia disorders require extremely specialized care. This care will involve dietary and nutrition help alongside in-depth mental health counseling. Treatment centers like Harmony Place ensure that the withdrawal process is done safely and comfortably. After detoxification, the treatment team will help you decide if inpatient or outpatient treatment is more appropriate.
Support groups offer an essential level of care for people struggling with eating disorders, addiction, or both. Self-help options are available to help you continue developing tools for your mental and physical health. Some self-help options include:
- Narcotics Anonymous and Alcoholics Anonymous: NA and AA meetings are country-wide and available in almost every city.
- Self Management and Recovery Training (SMART): SMART is a self-help option that utilizes meetings and education to help people maintain and sustain recovery.
- Diabulimia Helpline: The diabulimia helpline offers online support and other support opportunities.
- The National Eating Disorder Association (NEDA): NEDA offers forums and other forms of help for people in recovery and family members.
Find Help With Harmony Place
Co-occurring disorders are overwhelming and should not be dealt with alone. Treatment for dual diagnosis can be life-changing. It is much easier to treat issues involving addiction early on in the development of dependence. That being said, it is never too late.
If you or a loved one is dealing with substance and mental health issues, we can help. At Harmony Place, we prioritize your recovery, health, and well-being. If you would like more information or have any questions, please give us a call today.