November is Diabetes Awareness month, and with the holidays around the corner, we want to shed light on the 38.4 million Americans living with diabetes. During the holidays, sugary treats are all around. These festive sweets may be delicious, but they pose a threat to those living with diabetes whose blood sugar is already too high.
People with type 1 diabetes (T1D) are prescribed insulin to regulate their blood glucose levels because their bodies do not naturally make enough. Some individuals have such an intense fear of gaining weight that they strictly limit, skip or avoid taking their insulin dosage altogether. This potentially life-threatening condition is known as diabulimia, and it is something to be very aware of and understand better during the upcoming holiday season.
What is diabulimia?
Diabulimia is an eating disorder in which people with type 1 diabetes take less than the prescribed amount of insulin in an attempt to control their blood sugar levels and body shape. Often, people who begin insulin treatment gain some weight as their bodies are now able to absorb nutrients from food. This may lead people to believe the insulin is the reason for weight gain. As a result, they are resistant to taking the prescribed dosage of insulin. There are times when people with type 2 diabetes may misuse insulin but it is far less common than in people with type 1 diabetes.
When coupled with other psychological, situational, environmental or hereditary factors, receiving a type 1 diabetes diagnosis can lead patients to disordered eating practices. When the T1D diagnosis is coupled with insulin restriction, it is extremely dangerous. If someone is already struggling with an eating disorder like anorexia nervosa, bulimia nervosa, binge eating disorder, and/or other specified feeding and eating disorders (OSFED) it may be even more difficult for them to accept the necessity of gaining healthy weight from proper nourishment now that the insulin is helping their bodies process foods it otherwise couldn’t.
During the holiday season, diabulimia symptoms may be exacerbated by additional stressors like family and social events that revolve around food. In fact, peers may unknowingly encourage disordered eating habits when they make comments about overindulging. Family members might comment positively or negatively on the bodies of others. If you believe a loved one may be struggling with diabulimia, be on the lookout for signs and symptoms as outlined below.
What are the signs and symptoms of diabulimia?
Warning signs of diabulimia are not always easy to spot in others. Many symptoms are internal such as irregular heartbeat, bladder infections and unexplained blood sugar level fluctuations. However, there are some physical symptoms due to lack of insulin supply that you may notice in a loved one during holiday activities. Pay attention to:
- Drastic and/or rapid body changes like weight loss
- Exhaustion and/or body weakness
- Squinting and balance issues due to blurred vision
- Running to the bathroom frequently to urinate and/or vomit
If your friend or loved one with type 1 diabetes seems unusually down, anxious or distracted, self-isolates during mealtimes and/or spends much of the holiday gathering talking about body issues, they are likely struggling. They might focus on:
- Insulting their body shape
- Complimenting those in small bodies
- Fear around weight gain
- The negative effects of insulin on their weight
- Sadness, apathy and/or agitation
They may also miss medical appointments and/or avoid administering injections when others are around—even if they ask to help.
What are the risks of diabulimia?
The effects of diabulimia on the body are severe. Many health issues can occur with diabulimia that are related to poorly managed type 1 diabetes. Liver disease, osteoporosis, heart disease and reduced immune functioning are risks of diabulimia. Other serious effects include:
- Nerve and organ damage
- Diminished or complete loss of eyesight
- Loss of one or more extremities
- Loss of menstrual cycle and reproductive difficulties
- Diabetic ketoacidosis
People with diabulimia frequently skip insulin doses in an attempt to keep their weight down, which can result in diabetic ketoacidosis (DKA). DKA is a life-threatening state in which the body produces too many ketones too fast. Ketones are acids your body makes when it uses fat for energy instead of sending glucose to the cells. The buildup of ketones in the bloodstream can lead to coma and even death if prompt medical care is not received.
Who is at risk for diabulimia?
Anyone who receives a type 1 diabetes diagnosis can develop symptoms of diabulimia. They may also develop obsessive-compulsive behaviors that are linked to disordered eating, like counting calories, repeated body-checks and watching the scale too closely. These behaviors may be intensified by new T1D practices like checking food labels before consumption, tracking and lowering sugar and carbohydrate intake, and committing to a specific exercise regimen.
All these factors can combine to create mental and physical exhaustion, frustration, and shame around food and health. Adolescents and adults from all walks of life may experience these thoughts and feelings. Additionally, children may display symptoms of diabulimia and should not be ignored.
People who receive a type 1 diabetes diagnosis are also likely to develop co-occurring disorders with symptoms of mental health disorders like anxiety and depression around navigating next steps. They may struggle to keep up with the demands of a new regimen. They may also have past trauma that leads to behaviors of disordered eating and insulin restriction.
How can I help someone with diabulimia?
While you might hesitate to address diabulimia symptoms during what is traditionally thought of as a season of peace and joy, it might actually be the best time to offer an olive branch. If your friend or family member displays any combination of the above symptoms, you have every right to be concerned. Consider expressing your observations in a calm, non-judgmental tone.
Here are some ways you can approach the situation:
- Communicate your feelings using “I” rather than “you” statements.
- Patiently wait and listen to their response with an open mind.
- Let them know you’re here for them, and they are not alone.
- Suggest options for support and offer to accompany them to treatment.
Don’t be surprised if you are met with pushback and/or denial at first. Simply stay calm and speak honestly and directly. Avoid placing blame or shame on your loved one. The objective is to show them what a gift wellbeing is, especially during the season of gifting!
If you or a loved one are looking for supportive treatment options, Center for Discovery can help. Upon completing treatment, 97% of patients said they feel confident they have the coping skills to continue to improve their health and wellbeing.
Reach out to one of our caring professionals today to start the path to acceptance and healing this holiday season.
“I was at CFD for six weeks. They gave me my life back. I’m someone who has been in and out of treatment for my eating disorder and this program was by far the best. I feel so optimistic about my future.” — Natalie F. CFD Alum
Related reading:
https://centerfordiscovery.com/blog/returning-home-for-the-holidays-and-eating-disorder-recovery/
https://centerfordiscovery.com/blog/remaining-body-positive-through-the-holidays/
Sources:
https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
https://www.eatingdisorderhope.com/information/diabulimia
http://www.diabulimiahelpline.org/holiday-help.html
https://pmc.ncbi.nlm.nih.gov/articles/PMC7513317/
https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551
https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes