Diabulimia should be an area of concern if you have patients with Type 1 diabetes. It's a serious eating disorder that causes someone to reduce or stop taking their insulin in order to lose weight — yet it's not a recognised medical or psychiatric term.
People with diabulimia will get diabetes complications sooner and are likely to have a shorter life expectancy.
Watch our video on what diabulimia is and why it's so serious.
"It is an invisible condition and yet a destructive one."
Khalida Ismail, Professor of Psychiatry and Medicine & Honorary Consultant Psychiatrist in Diabetes King's College London, King's College Hospital and Guy's and St Thomas' Hospitals, King's Health Partners
How to spot signs of diabulimia in your patients?
Diabulimia is a condition that can be difficult to spot. Here is a list of signs to look out for in your patients:
- recurrent episodes of DKA or hyperglycemia
- high HbA1c
- delay in puberty
- irregular periods/amenorrhea
- severe fluctuations in weight or severe weight loss
- unwillingness to be weighed
- reluctance to checking blood glucose levels
- missing appointments
How diabulimia develops
Diabulimia can be a tough subject to talk about. There are lots of reasons why diabulimia might develop. It’s often not just down to one thing – it can be a combination of physical, social and mental health problems. Managing Type 1 diabetes is complex. The recommended treatment can trigger diabulimia in your patients. For example:
- having to carefully read food labels
- the focus on weight at appointments
- having to eat to treat hypos, causing weight gain and guilt
- being constantly aware of carbohydrate or calorie content of food
- feeling shame over diabetes management
- a bad relationship with your healthcare team
- difficulty keeping to a healthy weight.
Supporting your patients if you think they have diabulimia
A healthy mind for a person with diabetes is vital to the relationship they have with the condition. Helping your patients to feel comfortable with having diabetes is crucial to their management.
Here is a list of actions you can take to support someone with diabulimia:
- offer sensitive support and being non judgemental
- avoid comments or procedures that may trigger insulin omission, eg unnecessary monitoring of weight
- set small, realistic goals towards better diabetes management, rather than focusing on perfect blood glucose levels
- agree goals and targets with your patients
- refer to specialist services without delay
A multidisciplinary approach to managing diabulimia is crucial. Good communication between services is fundamental to supporting your patients. For more information about diabulimia advice, go to the Diabetics with Eating Disorders (DWED) website.
Our recommendations on diabulimia
We've set out our guidelines on improving recogniton and management of diabulimia as well as guidelines on treatment. To find out more, go to our position statement page.