Bulimia is a disorder in which a person eats and then purges, usually by vomiting or abusing laxatives. In diabulimia, the tool used to purge calories is simply to cut back on insulin. It’s extraordinarily successful and quite addictive, but it can harm you terribly in the near-to-long term. It is so scary and hard to treat. I had it while I was in my late teens into my 20s. Unfortunately then it wasn’t too widely recognized as it is now so no one knew exactly what was happening with me. I just keep getting told that I need to get eat another burger, when really in truly I was eating just not taking the insulin dose to cover for what I was eating.

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Diabetes: The Insulin and Weight Loss Connection

People with type 1 diabetes need daily insulin doses to live. In this type of diabetes, the pancreas doesn’t produce insulin, the hormone the body needs to absorb glucose (sugar) and use it as energy or store it as fat.

If insulin is used appropriately, the glucose is absorbed from the blood into the body’s tissues and used (or stored). Without insulin, the glucose builds up in the blood and is excreted in the urine. This can cause dramatic weight loss. So it’s understandable why some diabetic women would be tempted to drop insulin doses to lose a dress size.

That is, until you consider the frightening consequences.

The Health Risks of Diabulimia

The Joslin Diabetes Center lists these medical risks of decreasing or skipping insulin doses:

  • More frequent episodes of diabetic ketoacidosis, a condition in which acids build in the blood and can cause coma or death
  • More frequent hospital and emergency room visits
  • Higher risk of developing infections
  • Higher risk of developing early-onset diabetes complications like nerve damage, eye and kidney disease, and heart disease

To find out whether women who restrict insulin are raising their risk of death and complications, a 2008 study looked at 234 women with type 1 diabetes over an 11-year period. At the beginning of the study, almost one-third of the women reported taking less insulin than prescribed; these women had three times the risk of dying over the course of the study compared with those who had originally reported appropriate insulin use. The women who restricted insulin also died younger (at an average age of 45 versus age 58) and reported more diabetes-related problems with their kidneys and feet.

Additionally, insulin-restricting women who died during the study follow-up period had originally reported more frequent insulin restriction than those who had survived the 11 years. They also reported more eating disorder symptoms, like binge eating or not eating enough.

It’s a myth that eating disorders, including so-called diabulimia, are just a teenage girl’s disease. Sometimes entering a new life stage, like having a baby or entering menopause, can trigger eating disorders, who treats women in their 20s, 30s, and 40s. Many of these women find their way to treatment once they start experiencing complications.

Diabetes: Warning Signs for Parents/Loved Ones

“Unexplained, chronically high blood sugar” is the first clue that the Type 1 Diabetic might be skipping or reducing her insulin. It’s advised to watch the patients A1C number, which represents average blood sugar levels over a three-month time period. If it rises inexplicably, that’s a big red flag.

Joslin and the Juvenile Diabetes Research Fund list these other warning signs:

  • Change in eating habits, such as eating more but still losing weight
  • Low energy levels
  • Frequent urination
  • Extreme concerns about weight and body shape
  • Repeated problems with diabetic ketoacidosis
  • Missed menstrual periods
  • Unusual patterns of intense exercise, which are sometimes associated with frequent hypoglycemia

How Someone Can Help

Most girls/women with type 1 diabetes figure out pretty quickly that if they don’t take insulin, they’ll lose weight. Others learn the behavior from peers.  With the incredible pressure to be thin, it’s hard to turn down. This is because of the media portrayal of girls/women needing to be thin.

If you find out your loved one with type 1 diabetes is cutting down or dropping insulin, it’s important to take care in how you approach them. Loved ones should not take a ‘blaming and shaming’ approach, but should start an open discussion with their loved one and their diabetes care team.

When the problem is just emerging, loved ones might want to re-emphasize the scary realities of insulin restriction. If the behavior progresses, a medical health professional with expertise in both eating disorders and diabetes is needed. That combination can be difficult to find, but is well worth it.