What is diabulimia? An eating disorder unique to people with diabetes

Almost every day, I hear a client say, "I don't want to take more insulin — insulin makes me gain weight."

As a Certified Diabetes Care and Education Specialist, those words raise a red flag for me. It's important that people living with diabetes get the right amount of insulin specifically suggested for them. When I hear comments like that, I start to wonder, could this person have diabulimia?

If the condition is entirely new to you, you may be wondering, what is diabulimia? You're not alone. We've got the answers.

Understanding diabulimia

We're exposed to thousands of messages about our health and weight on a weekly basis. One ad tells us to lose weight, and the next one tries to get us to buy cheeseburgers. It's no wonder so many people have eating disorders and that people with type 1 diabetes (T1D) are at a greater risk of developing an eating disorder, according to a study in Current Diabetes Reports.

Diabulimia is a serious eating disorder that affects up to 39% of people with T1D, a study in the Turkish Archives of Pediatrics reported. Its name is composed of the words "diabetes" and "bulimia." Bulimia is defined as a life-threatening eating disorder where a person eats large quantities of food but feels unable to control themselves while eating, explained Mayo Clinic. Some people with bulimia — but not all — purge themselves of the extra food after eating.

Diabulimia can develop after prolonged periods where the body doesn't get enough insulin. This can be due to people giving themselves lower doses of insulin than needed so they can eat excess calories without gaining weight.

How does diabulimia manifest?

When a person with diabetes uses less insulin than they need, some of the glucose that circulates in their bloodstream can't get into their body's cells, where it will either be used for energy or stored as fat. The body will then do everything it can to get rid of extra blood sugar and keep functioning.

However, if the body can't use insulin to lower blood sugar, the alternative way to get rid of that extra sugar is to send it out through the kidneys and then the urine. This is why many people often experience extreme thirst and need to urinate a lot in the early stages of diabetes before they're diagnosed.

Intentionally taking less insulin than needed to lose extra calories and sugar through the urine "every once in a while" is the way many people with T1D start down the path to diabulimia. Over time, this can quickly become a habit — and diabulimia can develop.

A typical day's diet for someone with T1D

If you've been getting mixed signals about your weight and your food intake, things can get confusing. You may even start to wonder what a "normal" day's food intake really looks like! It's important to realize that every body — including yours — needs food to use for fuel. There's nothing wrong with eating several times a day, and there's nothing wrong with an occasional treat, either.

There's no need to feel guilty when you indulge in some extra calories, but there is a need to "cover" those extra carbs with sufficient insulin. Doing so can help keep your blood sugar in range, and prevent the microvascular damage that can occur in your eyes, kidneys, and extremities when your blood sugar is too high.

Below is an example of a healthy 2,000 calorie diet for a person with diabetes. Of course, people come in all shapes and sizes (and get different levels of activity), so calorie and carbohydrate needs can vary.

Breakfast: Greek yogurt with apples & pecans

1⁄2 teaspoon cinnamon
1 red apple, sliced
1 cup plain low-fat Greek yogurt
2 tablespoons pecans, chopped

Lunch: Open-faced avocado BLT & strawberries

2 slices bacon, cooked
1 slice Ezekiel bread, toasted
1⁄2 avocado, sliced
1⁄2 tomato, sliced
2 leaves romaine lettuce
1 dash pepper
1 1/4 cup whole strawberries

Afternoon snack: Hummus & tomatoes on rice cakes

2 rice cakes
1⁄4 cup hummus
1 tomato, sliced
1 tablespoon parsley, chopped
1 dash pepper

Dinner: Steak dinner

3-ounce sirloin steak
1/2 cup potato, mashed with 1 tablespoon olive oil
1 1/4 cup asparagus, steamed
1 6-inch slice of French bread

Where to get more information about diabulimia

You should now be able to answer the question, "What is diabulimia?" but if you'd like to learn more, the National Eating Disorders Association (NEDA) is a great place to start. NEDA offers a confidential online eating disorder screening test, as well as a hotline for people who need to speak to a trained eating disorder counselor for additional resources and referrals.

If you think you may have diabulimia, don't hesitate to get the facts about eating disorders, as the National Institute of Mental Health outlined. Eating disorders are serious medical issues, and they're difficult to manage without professional help. If you need help, talk with your healthcare provider or a mental health clinician today.

Looking for other meal and recipe ideas that are tasty and T1D-friendly? Check out the library of articles on the Edgepark Health Insights blog.