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What is diabulimia? -

Diabulimia is a life-threatening eating disorder where a person with T1D withholds insulin in order to lose weight. People who suffer from diabulimia may also have other disordered eating behaviors, such as purging.

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What is type 1 diabetes? -

Type 1 diabetes is a chronic disease in which the immune system attacks the insulin-producing cells in the pancreas. People with T1D need to inject synthetic insulin in order to manage their blood glucose levels.

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Diabulimia and binge eating -

Not everyone who has diabulimia binge eats, which is a defining feature of bulimia nervosa. The term diabulimia is used to describe restricting insulin in order to lose weight.

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What is insulin? -

Insulin is a hormone made in the pancreas. The body needs it to help glucose from food enter cells, where it is used for energy.

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Where is glucose stored? -

The body and its cells need energy to survive. Any glucose that hasn't been used for energy is stored in the liver, muscles, and fat tissue.

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Why does a lack of insulin lead to weight loss? -

If a person with T1D doesn’t have enough insulin, their body starts breaking down fat and muscle for energy because it can’t access glucose. As a result, glucose builds up in the bloodstream, leading to high blood sugar levels; the body’s inability to use food energy causes weight loss.

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Dehydration -

A persistent lack of insulin can lead to severe dehydration, which also causes weight loss in the form of water loss, which is a dangerous form of weight loss.

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Does insulin make you gain weight? -

Insulin doesn’t directly cause weight gain. Before a T1D diagnosis, rapid weight loss occurs as the body breaks down fat and muscle instead of using glucose. Once treated with insulin, people regain weight as their bodies can use glucose for energy or store it as fat.

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Persistently high blood sugar -

Having persistently high blood sugar can cause severe dehydration, so once individuals receive treatment for their T1D, they may also gain water weight.

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Who does diabulimia affect? -

Diabulimia only affects people with T1D. A person who has type 1 diabetes can develop diabulimia at any point. It is more common in adolescents and young adults assigned female at birth.

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How common is diabulimia? -

According to research, up to 40% of people assigned female at birth and 10% of people assigned male at birth with T1D aged 15 to 30 take less insulin needed in order to lose weight.

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Signs and symptoms of diabulimia -

Physical signs of diabulimia include unexplained weight loss, an A1C of 9.0 or higher, persistent thirst and frequent urination, and multiple diabetes-related ketoacidosis (DKA) episodes without any explainable causes.

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Signs and symptoms of diabulimia -

Other physical symptoms include fatigue, frequent urinary tract infections, deteriorating or blurry vision, and dry hair and skin.

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Behavioral signs and symptoms of diabulimia -

Behavioral signs of diabulimia include not administering insulin for meals, neglect of diabetes management, secrecy about diabetes management, and infrequently filled insulin prescriptions.

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Emotional and psychological signs of diabulimia -

Emotional and psychological signs and symptoms include fear that insulin causes weight gain, anxiety about body image, feeling drained by diabetes management, and having an obsessive interest in food and calories.

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Emotional and psychological signs of diabulimia -

Some people with diabulimia may also have a fear of low blood sugars due to needing to eat food to treat them. They may also struggle with depression and anxiety.

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What causes diabulimia? -

All eating disorders, including diabulimia, are complex conditions, with no one cause. Reasons why diabulimia may develop may be a combination of physical, social, and mental health problems.

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Triggers -

The things individuals with T1D have to do to manage the condition can play a part in triggering diabulimia and other eating disorders. These include having to read nutrition labels carefully and needing to track several numbers, such as blood glucose levels, A1C results, and weight.

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Other contributing factors -

Diabetes burnout causes frustration and exhaustion with diabetes management, leading to behaviors like less frequent blood sugar checks and insulin guesses rather than precise measurements. This can raise blood sugar and lead to weight loss. Burnout may also result in deliberate insulin restriction to lose weight.

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Wanting a sense of control -

Some people with T1D may feel a lack of control over their bodies and worry about diabetes complications. This can lead to increased anxiety and a need to control other aspects of life, such as weight and eating habits.

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Body image issues -

A distorted self-image can contribute to the development of eating disorders, including diabulimia. Stigma and the misconception that excess body fat directly causes diabetes may drive some individuals to focus on losing weight.

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A desire to lose weight -

If a person with T1D wants to lose weight, they might try to restrict their insulin to lose weight instead of doing it in a healthy way.

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Bullying, teasing, or peer pressure -

For children and adolescents, teasing, bullying, or peer pressure because of appearance or for having diabetes can contribute to the development of diabulimia.

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How is diabulimia diagnosed? -

Due to the secretive nature of eating disorders, they are generally difficult to diagnose. Many with eating disorders don't seek treatment on their own and this may be especially true for those with diabulimia, who may fear being criticized for mismanaging their diabetes.

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How is diabulimia treated? -

Treatment for diabulimia includes using insulin properly, managing blood glucose levels and weight, and treating psychological issues that may have contributed to the development of diabulimia.

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Diabulimia and anxiety and depression -

People with diabulimia are more likely to have depression and anxiety. These conditions can further complicate diabulimia and diabetes management, so it's important to seek appropriate treatment.

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Treatment for diabulimia -

Treatment for diabulimia often combines psychotherapy, medication, and medical evaluation. Because of the physical and psychological elements of diabulimia, treatment involves care from multiple types of healthcare providers.

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Diabulimia prognosis -

Diabulimia is a potentially life-threatening disorder if it's left untreated. One study found that people with diabulimia died an average of 13 years earlier than people with only type 1 diabetes.

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Long-term complications of diabulimia -

Although the long-term complications of diabulimia are the same as those associated with diabetes, individuals with diabulimia may experience these complications sooner due to continuously elevated blood sugar levels. These complications include kidney disease, liver disease, and diabetes-related retinopathy, which can lead to blindness.

Sources: (Cleveland Clinic) (BBC) (The Recovery Village)

See also: Are eating disorders on the rise with young men and boys?

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