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A Different Face of Eating Disorders: Diabulimia

October 30, 2000

Type 1 diabetes is a relatively common illness among children, affecting one out of every 600 kids. And, like every disease, diabetes has a whole host of issues that accompany it, especially during adolescence.

"One of the major problems with girls is eating disorders," explains Paula Yutzy, Diabetes Educator. "Everyone wants to be as skinny as models." For teens with diabetes, however, this weight issue has a name all its own: diabulimia.
A dangerous disorder that can cause life-altering complications, diabulimia is a specific eating disorder that only affects people with type 1 diabetes.

"When your blood sugar is high, you lose weight," explains Yutzy. "One way to do this is to skip injections. Some girls learn pretty quickly that if they want to drop a few pounds, they just need to skip a few doses of insulin."

Don't be shocked if it sounds dangerously easy, it is.

"You don't have to vomit. You don't have to purge. You don't have to use laxatives," says Stuart Brink, M.D, Senior Endocrinologist at New England Diabetes and Endocrinology Center. "You just have to let your sugar stay high."

"This can make you very sick and can even be life threatening," says Yutzy. "They're playing Russian Roulette." Some long-term complications include blindness, kidney disease, renal failure and impotence.

"In the short term, your sugars are high, you're peeing more, drinking more and there's unexplained weight loss," explains Dr. Brink. "If you do it long enough you go into diabetic ketoacidosis. And then you'll get limited joint mobility. In its extreme forms you get liver enlargement and a lack of puberty development."

"We know that diabulimia is common," says Dr. Brink. "At least in the 10-20 percent range. Some people cite it as high as 30 percent."

And while girls are more prone to eating disorders than boys, Dr. Brink cites the ratio as two to one, some teenage boys have an eating disorder all their own.

"I had one patient who didn't skip insulin, instead, he exercised excessively."
Of course, teens with diabetes fall prey to the usual pressures in our society. Magazines, movies and television promote the idea that beauty only comes in a size six.

However, in addition to the "thin is in" message, diabetes management requires patients to focus compulsively on food. Many in the medical community believe this could lead to an unhealthy relationship with food.
"Every time you go to the doctor you talk about food. You focus on food all the time."

Because many teens are in charge of their own diabetes care, it can be difficult to spot the warning signs.

"Frequently, kids who are omitting the most insulin are scared about what they're doing," explains Dr. Brink. "So, there's not too much resistance to that."

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