The little-known eating disorder we should be talking about
Blackouts are unfortunately all too familiar to many college freshmen but when Della (name has been changed for privacy purposes) woke up in haze, she had more questions than most. Not only did she not know where she was, what was happening or how long she'd been out but she didn't even know how it happened — she hadn't had any alcohol nor had she taken a drink from a stranger. In fact, she hadn't even left her dorm.
Yet as the paramedics worked on her, the cause quickly became apparent: Ketoacidosis, a condition caused by uncontrolled diabetes that can lead to serious injury, coma and even death. The worst part, she says, is "I realized I'd done this to myself. It hit me like a ton of bricks."
Wanting to drop a few pounds before spring break, Della had intentionally been manipulating her insulin to give her "free calories" so she could eat what she liked and still lose weight. Despite knowing that it could have severe consequence to her health, she'd restricted her insulin too much and her blood sugar had shot up into the danger zone.
Della is part of a growing trend of "diabulimics," the popular term used to describe people who have a dual diagnosis of an eating disorder and Type 1 diabetes, says Ovidio Bermudez, M.D., Medical Director of Child and Adolescent Services at Eating Recovery Center and Affiliates. "This happens when a diabetic intentionally misuses insulin to serve eating disordered purposes." And, he says, it's a lot more common than people think.
Diabetes education is one of the things doctors do very well now but, he says, that can be a two-edged sword. Young patients are taught exactly how to use their insulin but it also gives them knowledge of how to abuse it, if they're vulnerable to an eating disorder or already in the grip of one.
"It's a vicious cycle. One of the early signs of Type 1 diabetes is weight loss so they understand very early on that lower insulin leads to lower weight," he explains. "Then they are diagnosed and insulin therapies start and their weight starts to go back up so they associate taking insulin with weight gain."
Bermudez adds that diabetics must focus on numbers, measuring their grams of carbs and units of insulin religiously, thereby teaching young diabetics that you can measure "success" with food by numbers. "Doctors can easily plant seeds for an eating disorder and this is why Type I diabetes is considered a risk factor by itself for developing an eating disorder."
Once a patient has decided they want to use their insulin to lose weight, it's a fairly simple process to do so. Bermudez explains that there are many techniques for manipulating insulin and diabetics share tips with each other, not to mention all the tricks on the internet.
One of the biggest problems with diabulimia, Bermudez says, is that it works and works fast. "They do see results but they become poorly controlled diabetics. High blood sugar can damage small vessels in the eyes, damage the heart muscle, kill peripheral nerves and cause gastroparesis. They are the normal complications of diabetes but this way there is an early onset of complications and a very rapid progression of symptoms. The mortality rate becomes many folds higher," he explains.
Like Della, they do it full well knowing the risks they're taking. "I often hear, 'I'll just do it a little while' or 'I can control this' or 'I'll stop if something goes wrong,'" Bermudez says. Indeed, Della's plan was just to limit her insulin until she reached her goal weight and then return to normal dosing. "I didn't want to do anything crazy, I didn't think it was a problem," she says.
And that's exactly the problem, according to Bermudez. "People don't recognize how vulnerable diabetes makes people to an eating disorder. We need to raise awareness in patients and in doctors so we can catch these cases early." In addition, he says that we need to rethink the way we teach young diabetics how to manage their disease by focusing not on what's wrong with them but rather what is right with them.
"People internalize that thin ideal and they have a highly effective weight loss weapon; it's very alluring and this is just the tip of the problem."
Della agrees. While she says she "usually" doesn't intentionally manipulate her insulin anymore, "I do have lots of friends messing with their insulin. Lots of them."