Diabulimia: Eating Disorders and Type 1 Diabetes
What is diabulimia?
Diabulimia describes how some people with type 1 diabetes intentionally misuse insulin to lose weight. They may:
Take less insulin than prescribed
Omit insulin doses
Delay insulin doses
Manipulate the insulin to render it inactive
People with diabetes face an increased risk for eating disorders [Hanlan, 2013]. Caregivers and providers must know the warning signs for this dangerous condition.
Diabulimia definition
“Diabulimia” is a non-medical term describing a specific type of eating disorder in people with type 1 diabetes. The medical term is dual diagnosis of eating disorder with diabetes mellitus type 1 (ED-DMT1).
What causes diabulimia?
All eating disorders stem from a combination of genetic, biological, psychological and sociocultural factors.
Is it an eating disorder?
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1 in 5
people with diabetes have an eating disorder
[NIDDK, 2024]
30-40%
of young females with type 1 diabetes have an eating disorder
[NIDDK, 2024]
SYMPTOMS
Diabulimia symptoms
Due to the increased risk of eating disorders in people with diabetes, the American Diabetes Association recommends that all individuals with type 1 diabetes be screened regularly for eating disorders.
Unexpected weight loss
Growth failure in adolescents
Poor blood-glucose control (especially if the individual had good control previously)
Hyperglycemia
Ketonuria
Recurrent episodes of diabetic ketoacidosis (DKA); marked by polydipsia (excessive thirst), polyuria (frequent urination) and/or polyphagia (increased hunger)
Severe recurrent episodes of hypoglycemia
Higher than usual hemoglobin A1c levels (despite good blood sugar records, which may be falsified by the individual)
Microvascular disease affecting the eyes, kidneys and heart
Peripheral neuropathy (weakness, numbness and/or pain in hands and feet)
Secrecy, abnormal behaviors or rituals around insulin administration
Disordered eating behaviors, including restriction, binge eating, refusal to eat in the presence of others, obsession with weight, body image, exercise and/or food
Depressed mood, social withdrawal and/or deterioration of school or work performance.
Insulin misuse in people with eating disorders often shows up in dangerously high blood sugar levels, with many potential consequences. Individuals may also avoid eating carbohydrates or reduce carb intake, reducing the need for medications (including insulin).
Adee Levinstein, MS, RD, LD, CEDS-C
National Manager of Strategic Partnerships & Virtual Growth
Diabulimia health risks
Hyperglycemia (elevated levels of glucose in the bloodstream) resulting from insulin deficiency; damage of small vessels (microvascular damage) and nerve cells, specifically peripheral nerves.
Manipulating insulin as a way of “purging” calories can be life-threatening for people with type 1 diabetes. When insulin is misused, sugar is eliminated from the body in the urine, instead of being stored as fat or used as fuel. This can lead to weight loss and other health complications, including:
Damage to the retina of the eye, kidneys and heart (related to microvascular disease)
Small nerve damage (peripheral neuropathy, pain, tingling, and even numbness of hands and feet
Ketonuria
Diabetic ketoacidosis
Other diabetes complications (e.g., onset and severity of microvascular disease and peripheral nerve damage)
Nutrition education and support
In eating disorder treatment, registered dietitians provide structured meal planning that focuses on balance, variety and flexibility. At ERC:
Individuals plan their meals with registered dietitians each week. Adults select their own menus and caregivers select menus for kids and teens.
The team works closely with caregivers to provide the education and tools they need to support their loved one’s long-term recovery.
Over time, as the brain and body heal, patients become less preoccupied with food and weight.
There is Hope
There is hope. I have seen many young people regain focus, resume appropriate management of their diabetes and recover their health, happiness and engagement with a meaningful life. However, for those where this is left unaddressed, the consequences can be devastating.
Dr. Ovidio Bermudez, MD, FAAP, FSAHM, FAED, F.iaedp, CEDS
Senior Medical Advisor for ERC
Diabulimia recovery
Diabulimia FAQs
Have a question we didn't answer? Contact us
The warning signs of eating disorders in people with type 1 diabetes include:
Obsession with weight loss, dieting or counting calories
Secret/odd behaviors around insulin administration
Poor blood-glucose control
Hyperglycemia or hypoglycemia
Ketonuria
Higher than normal hemoglobin A1c levels
Diabetic ketoacidosis (DKA) with frequent urination and or increased thirst and hunger
You can recover from diabulimia with help from an experienced eating disorder treatment team that includes:
Medical and psychiatric care
Individual therapy
Group therapy
Family therapy, education and support
Diabetes and nutrition education and support
Experiential therapies (yoga, arts)
The most extreme consequence of diabulimia is risk of death. Other consequences include:
Hyperglycemia (high blood sugar)
Damage to eyes, kidneys or heart (microvascular disease)
Damage to nerves in hands or feet (pain, tingling, and numbness)
Ketones in urine
Diabetic ketoacidosis (DKA)
Depression, anxiety and other mental health concerns
Researchers have found that diabulimia increases many health complications including an increased risk of early death. One study found that the restriction of insulin with diabulimia is associated with a “threefold increased risk of mortality.” [Goebel-Fabbri, 2008] Type 1 diabetes can increase one’s risk of death; diabulimia further increases that risk.
References
1. Hanlan, ME, Griffith, J, Patel, N, Jaser, SS. (2013). Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options. Current Diabetes Reports.
2. Patricia A. Colton, Marion P. Olmsted, Denis Daneman, Jamie C. Farquhar, Harmonie Wong, Stephanie Muskat, Gary M. Rodin; Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence. Diabetes Care 1 July 2015; 38 (7): 1212–1217.
3. Robert C Peveler, Christopher G Fairburn, Irene Boller, David Dunger; Eating disorders in adolescents with IDDM: A controlled study. Diabetes Care 1 October 1992; 15 (10): 1356–1360.
4. Nielsen S, Emborg C, Mølbak AG. Mortality in concurrent type 1 diabetes and anorexia nervosa. Diabetes Care. 2002 Feb;25(2):309-12.
5. Goebel-Fabbri, A., Fikkan, J., Franko, D., Pearson, K., Anderson, B. & Weinger, K. (2008). Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care 31(3): 415-419.
6. National Institute of Diabetes and Digestive and Kidney Diseases. Eating disorders and the patient with diabetes. Published May 5, 2021. Accessed March 20, 2024.