Part 1 of a series of 3 articles.
"I'm not taking as much insulin as I should, and I'm running my sugars high. I'm not completely happy with my body... I want to lose weight. Am I alone in this?"
The answer is a definitive, "No, you are not."
People with type 1 diabetes are more likely to develop an eating disorder than those without diabetes, particularly when it comes to women. If you're a woman with type 1, you are at least twice as likely (that's 10% of all women with type 1) to develop an eating disorder compared to women in the general population (3.8% of women)1. This group are most vulnerable to developing disordered eating in their early 20s, however we know from research that disordered eating can touch women with type 1 at any age and stage of life2.
'Diabumilia' is the term used in popular media to describe having both type 1 diabetes and an eating disorder. When people use the word 'diabulimia' they're referring to reducing, skipping or delaying insulin use as a strategy to avoid gaining weight. The reduction in insulin leads to a calorie 'purge' by inducing hyperglycemia (high blood glucose levels), and thereby glucose loss through urine. 'Purging' calories in this way is akin to the purging behaviours seen in bulimia, such as self-induced vomiting or over-exercising. It is a risky choice for weight management because it can greatly accelerate chronic diabetes complications, and can be life threatening due to the risk of diabetic ketoacidosis (DKA).
Patterns of disordered eating related to 'diabulimia' can look quite different. For instance, some people find themselves binge-eating, then feeling guilty and worried about weight gain, and so they purge through insulin manipulation to overcome these negative feelings. They might do this often, or only on the odd occasion. Others may eat within healthy guidelines (that is they don't binge-eat or restrict food), and only manipulate their insulin every now and again, for example in the lead up to an event which they want to lose weight for. Others still might eat healthily, but regularly reduce or skip insulin to maintain a low weight. Although the patterns vary widely, they all carry health risks.
To meet DSM 5 diagnostic criteria for bulimia (the gold standard for diagnosis of mental health disorders in Australia), binge eating and purging behaviours would both have to occur, on average, at least once a week for three months. When people only have some symptoms of an eating disorder, but not enough to meet diagnostic criteria, their problems are described as 'disordered eating'. Research suggests many women with type 1 fall into this sub-threshold diagnostic group at any given time2. Recognising disordered eating in type 1 diabetes is just as important as picking up on an eating disorder, as both carry considerable risk for people with diabetes.
What does this all mean for me?
If you are living with type 1, and recognise that you have some symptoms of bulimia, know that you are not alone in this, but you are putting your wellbeing in jeopardy and it's ok to ask for help. There are many professionals that you can approach for support, including your Diabetes Educator, Endocrinologist, Dietitian, GP or a Psychologist.
For a variety of reasons, insulin omission can seem like a solution to body issues and weight management, and this 'idea' can overshadow knowledge about how unhelpful, and downright dangerous, it really is. The next article in this 3 part series will cover the reasons why disordered eating patterns can develop in people with diabetes. It will also focus on why 'diabulimia' can seem alluring in the face of what we know about keeping healthy. For readers who are thinking about changing some of the approaches to eating that have been discussed, please go on to read my next article. The insights it will have can be powerful tools for motivating change towards a healthier and more sustainable approach to body image and weight management.
If you recognise that you are experiencing problems with eating, and you want to seek help, please get in touch with us at Diabetes Clinical Psychology. We are not a crisis service; for 24/7 counselling you can contact Lifeline Australia on 13 11 14, or for crisis calls please contact your nearest hospital emergency department.
Hanlan ME, Griffith J, Patel N, Jaser SS. Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options. Current diabetes reports. September 2013:10.1007/s11892-013-0418-4.
Colton PA, Olmsted MP, Daneman D, Farquhar JC, Wong H, Muskat S, Rodin GM: Eating disorders in girls and women with type 1 diabetes: A longitudinal study of prevalence, onset, remission, and recurrence. Diabetes Care 2015.
This article can be used on your website or in publications, however you must include the following: Lisa Robins is the Principal Psychologist at Diabetes Clinical Psychology. She helps people to face the challenges of diabetes by creating positive change. Visit www.diabetespsychology.com.au to learn more.