Diabulimia Camille redmond, rdn, ld

Objectives YouTube Video What is Diabulimia? The Role of Insulin Types of Diabetes Mellitus Diabetic Ketoacidosis Warning Signs of Diabulimia Signs and Symptoms Health Consequences Guidelines for Practitioners

What is Diabulimia? Eating Disorders

What is diabulimia? Recognized in the Diagnostic and Statistical Manual of Mental Disorders as an “inappropriate compensatory purging behavior,” which is included under “misuse of medications for weight loss” in the criteria for bulimia nervosa and eating disorders not otherwise specified. Nickname for Eating Disorder – Diabetes Mellitus Type 1 (ED-DMT1) The dangerous practice of deliberately limiting insulin to control weight by individuals with type 1 diabetes mellitus. (Darbar & Mokha, 2008)

The Role of Insulin Hormone released by the pancreas in response to a rise in blood glucose. Insulin allows glucose receptors in the cells to migrate to the surface of the cell in order for the glucose to be transported into the cell to be used for energy. Insulin also triggers the liver to release VLDLs which carry triglycerides to be stored as fat.

Types of Diabetes Mellitus Type 1 Diabetes Mellitus Pancreas not producing or producing very little insulin Type 2 Diabetes Mellitus Pancreas producing insulin but cells nonresponsive (insulin resistant) Gestational Diabetes Diabetes during pregnancy

Diabetic Ketoacidosis Ketosis occurs when the body shifts from burning glucose to burning fat for energy. Insulin and glucagon balance. Glucagon produced by the liver to stimulate lipid breakdown. Protein is converted to glucose to fuel Kreb’s cycle. Insulin responds to glucose and keeps glucagon in balance. Glucagon produced without insulin on board produces a high number of ketones putting the body in a metabolic acidotic state that can lead to death.

Warning Signs of Diabulimia Preoccupation with body image, weight, or food intake Poor metabolic control despite the appearance of compliance Moodiness, being overly critical of one’s appearance, anxious or depressed, irritable, self-hatred (Darbar & Mokha, 2008)

Signs and Symptoms Hyperglycemia Changes in eating habits (eating more but still losing weight) Low energy Bingeing on carbohydrates Obsession with food and body image Anxiety about weight or avoidance of being weighed Hospitalizations for diabetic ketoacidosis Smell of ketones on the breath and in the urine Frequent urination Physical signs of malnutrition (Dada, 2012)

Health Consequences Short Term Long Term Dehydration Frequent urination and glucosuria Insatiable thirst Increased appetite High blood glucose levels Fatigue Decreased concentration Electrolyte imbalance Weight loss Heart attack Stroke Retinopathy Nephropathy Neuropathy Gastroparesis Vascular disease Gum disease Infertility (Dada, 2012)

Guidelines for Practitioners Explain in detail why proper insulin administration is important. Treatment plan should be conducted with patient and family. Diet and insulin intake guidelines should be precise and easy to understand. Goals should be easy to achieve. Frequent contact with the therapeutic team. (Juruć, Kubiak, & Wierusz-Wysocka, 2016)

References Dada, J. H. (2012). Understanding Diabulimia – Know the Signs and Symptoms to Better Counsel Femal Patients. Today’s Dietitian, 14(8), 14. Darbar, N., & Mokha, M. (2008). Diabulimia: A Body-Image Disorder in Patients With Type 1 Diabetes Mellitus. Athletic Therapy Today, 13(4), 31-33. Juruć, A., Kubiak, M., & Wierusz-Wysocka, B. (2016). Psychological and medical problems in prevention and treatment of eating disorders among people with type 1 diabetes. Clinical Diabetology, 5(1), 26- 31.