'Diabulimic' Individuals Risk Health by Depriving Themselves of Essential Insulin

By Hugh C. McBride

One form of a disease that is often associated with obesity is also at the center of a potentially deadly disorder involving a type of self-starvation.
“Diabulimia” is the term given to the unhealthy practice by which individuals who have type 1 diabetes try to lose weight by depriving themselves of insulin.
Though diabulimia is not an officially recognized medical condition – and the name itself is a relatively recent creation – the behavior is believed to be widespread, with some experts estimating that as many as one-third of all female type 1 diabetics (or about 450,000 women in the United States) have engaged in insulin deprivation for the purposes of weight control.

ABOUT DIABETES

According to the U.S. Centers for Disease Control and Prevention, there are two primary types of diabetes mellitus – diseases that together affect more than 23 million Americans, or almost 8 percent of the population:

• Type 1 diabetes – Previously known as insulin-dependent or juvenile-onset diabetes, type 1 diabetes is characterized by a body’s inability to produce insulin, which regulates blood glucose levels. Though type 1 diabetes can occur in individuals of all ages, it usually develops in children or young adults.
  
  Experts estimate that between 5 and 10 percent of diabetics are afflicted with type 1 diabetes, the development of which has been associated with autoimmune disorders as well as genetic and environmental factors.

• Type 2 diabetes – Formerly referred to as non-insulin-dependent diabetes or adult-onset diabetes, type 2 diabetes is the most common form of the disease, affecting 90 to 95 percent of diabetics. This form of diabetes is marked by cells’ inability to properly use insulin, and the pancreas’s eventual inability to produce adequate amounts of the hormone.
  
  Risk factors for type 2 diabetes include obesity, physical inactivity, older age, and a family history of the disease.

Individuals who have type 1 diabetes must take regular doses of insulin (usually by injection or through an insulin pump). Type 2 diabetics can often control their condition by following an adaptive diet and exercise program, losing excess weight, and taking some oral medications.

INSULIN & WEIGHT

Individuals who are diagnosed with type 1 diabetes and begin to take insulin often gain weight as a result. As the insulin improves the body’s ability to regulate glucose levels, the glucose that the body had previously been unable to retain is now stored as fat. As information on the Mayo Clinic website indicates, what some patients see as a problem (weight gain) is actually evidence that the insulin treatment is working:
Think about it this way: Before you start taking insulin, you may be able to eat more food than you need without gaining weight because your body doesn’t use the food properly. But when you start taking insulin, all bets are off. When your body uses food properly, you may need less food than you think.

Type 1 diabetics who experience initial gains after starting to take insulin can usually control their weight by reducing their calorie intake, adopting a healthier diet, and increasing their levels of physical activity. In some cases, certain medications can be prescribed to offset extreme weight gains that result from insulin use.

TRADING HEALTH FOR THINNESS

Though most type 1 diabetics are able to maintain a healthy weight through proper nutrition and exercise, many have noticed that failing to take the prescribed amount of insulin can result in rapid weight loss.

As Carlin Flora wrote in her July 1, 2008 article on the Psychology Today website, the results of insulin deprivation can be both dramatic and devastating.

"Without insulin, cells can’t access the glucose and are left to starve, while the blood stream is saturated with the stuff, causing symptoms such as excessive urination, extreme thirst, low energy, and weight loss," Florin wrote.

"As the body turns to other tissues for energy sources, severe consequences unfold, including a high risk of falling into a coma,” she continued. “For those who consistently keep their blood-glucose levels too high by forgoing insulin, long-term damage to eyes, kidneys, nerves, and the circulatory system is likely."

In a June 30, 2007 Associated Press article that brought widespread attention to the existence of diabulimia, Jim Ellis reported on one woman whose teenage concerns over a 20-pound weight loss led her into a 17-year obsession with diabulimia:  
"I took just enough insulin to function," said Lee Ann Thill, now 34, of Magnolia, N.J.

Today, she worries about the long-term damage that may have come from her weight obsession. At 25, a blood vessel hemorrhage in her eye required surgery. At 28, doctors told her she had damaged kidneys.

"I’m fearful for the future,"Thill said. "I feel very strongly that had I taken care of myself, I could have lived as long as anyone without diabetes. I don't think that’s going to happen now."

GETTING HELP

"People who do this behavior wind up with severe diabetic complications much earlier," Ann Goebel-Fabbri, a clinical psychologist at the Joslin Diabetes Center in Boston, told Ellis for his AP article. And because young diabulimics are less likely to consider long-term consequences, and are much better at hiding their behaviors, the practice may be especially damaging to teens and adolescents.

"You see a lot of parents who are oblivious because their child has developed an enormously effective skill to be secretive about it," William Polonsky, director of the Behavioral Diabetes Institute in San Diego, said in a Feb. 27, 2008 article on the US News & World Report website.

According to the same article in which Polonsky was quoted, researchers with Children’s Hospital of Philadelphia have identified the following warning signs that a diabetic individual may also be developing an eating disorder:

• Rapid weight loss or quick weight gain
• Poor body image and low self-esteem
• Frequent urination
• Purging behaviors (for example, excessive amounts of exercise or the use of laxatives)
• Recurrent diabetic ketoacidosis (an acidic buildup in the blood resulting from less-than-adequate presence of insulin)