Diabulimia is the term commonly given to a type of disordered eating behaviour that only affects people living with type 1 diabetes. It’s also known as ‘type 1 disordered eating’.
People living with type 1 diabetes have to carefully manage their blood glucose levels by focussing on what they eat and giving themselves insulin. It’s a relentless task that requires multiple interventions throughout the day and maybe even during the night too.
Disordered eating can affect people of all genders, however, it’s twice as common in people living with type 1 diabetes than those without the condition.
Type 1 disordered eating is starting to be better understood as a form of eating disorder and can impact both mental and physical wellbeing.
In this post, Dr Amy Harrison, Senior Associate with Altum Health, explains the link between type 1 diabetes and disordered eating, why it occurs, and how it can be treated.
Diabulimia can be a difficult subject to discuss. Should the information in this blog post resonate with you, we encourage you to get in touch with our team to learn more about how we can help.
What is diabulimia?
Diabulimia (or type 1 disordered eating as we refer to it) is any form of eating disorder related to diabetes.
We use this alternative term because ‘diabulimia’ doesn’t encompass all forms of disordered eating that people may experience with type 1 disordered eating, so it’s not a broad enough definition of what our clients experience. It’s a bit like saying ‘England’ when you mean ‘The UK’.
For example, not everyone with type 1 disordered eating will purge or binge eat, but they will try to control their weight and shape by not matching the amount of insulin their body requires for good health with the amount that they take.
It has many different symptoms.
- Some people may be terrified of giving themselves insulin and may fear weight changes that can be part of living with type 1 diabetes.
- Some people may restrict or stop taking their insulin because they are concerned about gaining weight, or want to lose weight.
- Others may restrict food or exercise excessively, which indirectly limits the amount of insulin required.
- Some people might over-correct, taking on board too much insulin, to allow themselves the sweet treats they’d like, but prohibit themselves from having, in order to treat hypoglycaemia. Some people then experience binge eating.
- Some people may be terrified of hypoglycaemia or hyperglycaemia and long term complications, and may tightly control their food, exercise and insulin in a very perfectionist way which can be highly stressful and interfere with daily life.
How does it develop?
People with type 1 diabetes might be more vulnerable to disordered eating because of the necessary focus on food and eating when looking after their diabetes. Here’s why:
It can make you more dissatisfied with your body and more focused on food and eating than other people.
- It can make you more dissatisfied with your body and more focused on food and eating than other people.
- It can make you really sensitive to cues around eating and food, giving you a constant awareness of the calories and carbohydrates in snacks and meals.
- It makes you focus on your weight, which can change your relationship with your body. People will often experience weight loss before a type 1 diagnosis and then weight gain as they start taking insulin. It can prove difficult to maintain a healthy weight when living with type 1 diabetes.
- Treating a hypoglycaemic episode – or ‘hypo’ – (when the glucose level in the blood drops below optimal levels) with hypo-treatments like juice and sweets can lead to feelings of guilt. If a person is attempting to restrict their food intake, because they are concerned about weight gain, then breaking a food rule in order to treat a hypo can sometimes lead to over-eating, or a binge.
- You might be trying to manage your diabetes perfectly all the time, but that’s not possible. It’s too hard! If you need help from others to treat a hypo, or struggle with diabetes self-care, it can result in feelings of shame.
There are many different ways that type 1 disordered eating can play out. Unfortunately we know that people with disordered eating alongside their diabetes can be more vulnerable to long-term complications and it can be very dangerous.
Why is type 1 disordered eating so dangerous?
If you have a friend or family member with diabetes that you’re concerned about from this perspective, it’s important to be aware of this type of disordered eating. Having disordered eating and type 1 diabetes is really dangerous because it’s more likely to lead to diabetes complications, such as:
Hyperglycaemia
If a person binges and doesn’t take enough or any insulin, blood glucose levels will become high.
This will result in feeling really unwell, sleepy, nauseous, and possibly confused.
Hyperglycaemia is very dangerous in the long-term. It can cause eye damage and even sight loss. It can damage organs, cause circulation problems, and problems with peripheral nerves. These are some of the long-term complications struggling to care for diabetes.
In the short-term, if the body starts to run out of insulin, harmful substances called ketones build up. This is called diabetic ketoacidosis (DKA), and can be life-threatening if not found and treated quickly. If blood sugars are allowed to run high, there’s greater risk of DKA.
or:
Hypoglycaemia
If a person restricts food, under eats, or exercises excessively, or gives too much insulin, blood glucose levels can go very low (hypoglycaemic).
This can lead to them feeling angry, out of control, and they may be in need of help from others to help with hypo-treatment to raise blood glucose levels with a quick-acting glucose drink or snack. It can cause them to lose consciousness. And it can be fatal.
What’s the best treatment for diabulimia or type 1 disordered eating?
The way diabetes and disordered eating interact make it hard for people to recover.
When someone comes to Altum Health with type 1 disordered eating, we work closely with their diabetes team to join up their diabetes treatment with the necessary mental health support. In order to treat type 1 disordered eating as a whole, we need a shared focus and understanding of both conditions.
This might involve gradually increasing the amount of insulin administered, or challenging someone’s beliefs about how their body should look. If there’s any distress felt around the impact of diabetes self care on a person’s body weight and shape, we can address this too. Treatment is very individualised depending on a person’s symptoms or behaviours.
If you’re living with type 1 disordered eating, please reach out to our licensed and trained professionals for help and advice. You can book a free, 20-minute consultation with us by clicking here.
Take care,
