Diabulimia

Diabulimia

Dusty Narducci, MD, and Heidi James, MD

“Diabulimia” is a media-coined term for eating disorder in diabetes mellitus type 1 (ED in DMT1). It is characterized by deliberately skipping or decreasing insulin doses with the intent to lose or control weight.

• Epidemiology and risk factors
• More common among female adolescents
• Obese, overweight body mass index (BMI) status
• Body dissatisfaction
• Anxiety, depression
• Lack of family support 
• Screening tools for diabulimia
• Diabetes Eating Problems Survey-Revised (DEPS-R)
•  Begin screening patients with DM1 at 10 to 12 years of age 
• Warning signs of diabulimia
• Typical signs of an eating disorder
• Missed diabetes-related appointments
• Forgetting diabetic equipment
• Decreased blood glucose checks
• Discomfort taking insulin in front of others
• Depression and/or anxiety
• Symptoms of diabulimia
• Excessive thirst
• Urinary frequency
• Recurrent hospitalizations for diabetic ketoacidosis
• Frequent urinary tract infections (UTIs) or yeast infections
• Irregular menstruation
• Deteriorating blurry vision
• Recurrent skin infections
• Slow wound healing
• High hemoglobin A1c (HbA1c) (>9.2%) or mismatched with blood glucose
• Complications of diabulimia
• Irreversible findings similar to those seen in an uncontrolled diabetic (eg, neuropathy, retinopathy) 
• Higher mortality rate 
• Management
• Early diagnosis with intervention correlated with improved outcomes in patients who have eating disorders
• Multidisciplinary team nutritional assessment and planning
• Encourage patients and families to obtain “good” diabetes management, not “perfect” control
• Mental health care if needed

PEARL
Diabulimia is a common manifestation of disordered eating in female adolescents who have type 1 diabetes. Be sure to familiarize yourself with the signs and symptoms and to screen your patients for it.

• Additional Information:

References

Disordered eating and body dissatisfaction in adolescents with type 1 diabetes and a population-based comparison sample: comparative prevalence and clinical implications
Ackard DM, Vik N, Neumark-Sztainer D, et al. Pediatr Diabetes. 2008;9(4 Pt 1):312-319. doi: 10.1111/j.1399-5448.2008.00392.x.

Diabulimia, a type I diabetes mellitus-specific eating disorder
Kınık MF, Gönüllü FV, Vatansever Z, et al. Turk Pediatri Ars. 2017;52:46-49. doi: 10.5152/TurkPediatriArs.2017.2366.

Eating disorders and diabetes: introduction and overview
Colton P, Rodin G, Bergenstal R, et al. Diabetes Spectr. 2009;22:138-142. doi: 10.2337/diaspect.22.3.138

Eating disorders and disordered eating symptoms in adolescents with type 1 diabetes.
Toni G, Berioli MG, Cerquiglini L, et al. Nutrients. 2017;9:906. doi: 10.3390/nu9080906. 

National Eating Disorders Association (NEDA). 2019. Statistics & Research on Eating Disorders. Retrieved from https://www.nationaleatingdisorders.org/statistics-research-eating-disorders 

Sick Enough: A Guide to the Medical Complications of Eating Disorders. Gaudiani JL. (2019). NY: Routledge

Brief screening tool for disordered eating in diabetes
Markowitz JT, Butler DA, Volkening LK, et al. Diabetes Care. 2010; 33:495-500. doi: 10.2337/dc09-1890

Academy for Eating Disorders: A Guide to Medical Care. AED Report 2016. 3rd edition. Retrieved from https://www.massgeneral.org/psychiatry/assets/pdfs/EDCRP/eating-disorders-medical-guide-aed-report2016.pdf

Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study
Jones M, Lawson ML, Daneman D, et al. BMJ. 2000;320:1563-1566.

Disturbed eating behavior and eating disorders in preteen and early teenage girls with type 1 diabetes
Colton P, Olmsted M, Daneman D, et al. Diabetes Care. 2004;27:1654-1659. doi: 10.2337/diacare.27.7.1654.