Diabetes and Eating Disorders: What Is Diabulimia?

Diabulimia is a complicated and severe eating disorder found in people with type 1 diabetes who purposefully omit insulin to lose weight.

Diabulimia statistics show that the prevalence rates of Diabulimia are 11 to 15 percent in adolescent girls and 30 to 39 percent in adult women. 

Diabetic women with type 1 diabetes have more than twice the risk of developing an eating disorder than women without diabetes.

Here we take a look at this complex medical condition.

Type 1 Diabetes

The Diagnosis of type 1 diabetes often occurs after a person experiences sudden symptoms, including weight loss, fatigue, frequent urination, and extreme hunger. Diagnosed eating disorders include Bulimia and Anorexia Nervosa, which are both forms of mental illness.

When a person is diagnosed with Type 1 diabetes, they will always require insulin treatment and possibly oral medications. When one’s blood sugar stabilizes, weight gain can occur.

Anorexia typically involves food avoidance and restriction. Bulimia involves uncontrolled binge eating and possibly purging.

While a person with diabetes needs to be engaged in their care, hyper-focusing on items such as blood glucose numbers, label reading, meal planning, and carbohydrate counting is detrimental. Food restrictions and “rules” can increase a person with type 1 diabetes from developing an eating disorder.

What Is Diabulimia?

Diabulimia is a medical term that describes insulin omission to perpetuate weight loss. Health professionals have used the word “Diabulimia” since the early 2000s. But physicians note the behavior back 50 or more years.

For people with Diabulimia and other co-occurring mental health disorders, treatment can be even more complicated. People seeking recovery with co-occurring disorders require a complexity of care. Interventions from multiple medical disciplines are necessary.

Eating disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. They can be extreme conditions affecting physical, psychological, and social function.

Eating disorders often co-occur with other psychiatric disorders, most commonly mood and anxiety disorders, obsessive-compulsive disorder, and alcohol and drug abuse problems.

Evidence suggests genes and heritability play a part in why some people are at higher risk of eating disorders. Still, these disorders can also affect those with no family history of the condition.

The term dual diagnosis refers to two or more states in the same person simultaneously. Still, it is also a broader term that could apply to any combination of physical conditions that apply to one person. 

The word Diabulimia does not exist in medical coding, but the disorder is real. A person’s specific diagnosis will depend on their eating disorder behaviors. Further, the diagnostic manual classifies withholding insulin as a purging behavior.

Bulimia nervosa if the person is binging then undertakes an insulin restriction. It will be diagnosed as purging disorder if the person usually eats and restricts insulin or anorexia nervosa if they severely restrict both food and insulin.

Often Diabulimia will be interpreted as Other Specified Feeding and Eating Disorder (OSFED). 

An Example of Diabulimia

Noor was Diagnosed with type 1 diabetes at age 5, and Diabulimia behaviors began at age 12. Noor remembers wanting to be healthy and happy. But she found her fear of losing control over how her body looked if she were to take care of diabetes differently was too overwhelming.

“The most important thing to me was that I was skinny,” I was afraid of being fat; but also of dying. I was afraid of my parents finding out and stopping me. But also of them finding out and losing their trust”. 

Her breaking point was falling into a coma after experiencing a low blood sugar level. The consistent extreme high blood sugar had her body used to running that way. So dipping to a 79 caused her to go unconscious.

Signs and Symptoms of Diabulimia

According to the National Eating disorder Association (NEDA), there are specific things you may want to note if you have concerns about a loved one.

First and foremost, a person may be more neglectful of their diabetes management or less willing to share information with you. If the person is eating less and not managing blood glucose well, they may be more tired and sleep longer.

Moodiness may occur due to irregular blood sugar levels. Weight control may be a forefront concern. And food avoidance may occur. Teenage girls are specifically at risk when concerning Diabulimia.

Points of concern

  • Avoiding diabetes-related appointments

  • Fear of low blood sugars

  • Fear that insulin makes you fat

  • Extreme increase or decrease in diet

  • Excessive anxiety about body image

  • Restricting particular food or food groups to lower insulin dosages

  • Avoids eating with family or in public

  • Discomfort testing/injecting in front of others

  • Overly strict food rules

  • Preoccupation with food, weight, and calories

  • Excessive or rigid exercise

  • Withdrawal from friends and family activities

  • Infrequently filled prescriptions

Furthermore, beyond changes in behavior that you may notice, there are specific health markers that a physician will note. However, if the person is avoiding health care appointments and laboratory draws, it becomes increasingly difficult to identify beyond physical observations. 

Physical Observations

  • A1c of 9.0 or higher continuously

  • Unexplained weight loss

  • Constant bouts of nausea or vomiting

  • Multiple diabetic ketoacidosis (DKA) or near DKA episodes

  • Fatigue or lethargy

  • Dry hair and skin

Health consequences of Diabulimia 

The human body is resilient, and people with Diabulimia often manage to function with much higher blood sugars. The significant consequences of Diabulimia are usually related to prolonged elevated blood sugar.

Women with diabetes will likely experience yeast infections more often due to high blood glucose levels.

In addition, irregular menses and difficulty conceiving. Binge eating disorder carries risks such as swelling of the feet, irregular heartbeat, irregular menstruation, and infertility.

Prolonged elevated blood sugar levels wreak havoc on our delicate organs, such as our eyes and kidneys. Nerve damage is eminent and can cause a host of issues ranging from neuropathy, nephropathy and kidney failure, and kidney disease. 

Without the proper insulin dosage, people with type 1 diabetes can develop diabetic ketoacidosis DKA-1 (DKA), a severe and hazardous condition. Chronically elevated blood sugars can cause both microvascular and macrovascular complications. These include retinopathy, neuropathy, vascular disease, gastroparesis, and more.

Moreover, people with Diabulimia may experience low sodium and potassium. Both of these electrolytes help maintain fluid and blood volume in your body. Symptoms of low sodium and potassium levels include irregular heartbeat, confusion, lethargy, and weakness.

Diabetes Complications

Frequent high blood glucose levels can lead to long term diabetes complications.

  • Frequent bladder or yeast infections

  • Irregular or lack of menstruation

  • Deteriorating or blurry vision

  • Ketoacidosis


The primary goal in initial treatment is blood sugar stabilization. Direct care from an Endocrinologist or Diabetologist and Registered Dietitian is essential. It is required to monitor those that are unstable in an inpatient situation constantly.

Because the person’s system acclimates to running with high blood sugars, insulin introduction can be tricky in disorder treatment. The insulin dose must be closely regulated and monitored. In severe cases, observation of accuracy in the patient’s insulin injection is necessary.

From the behavioral aspect of Diabulimia treatment, Psychotherapy is a crucial part of altering eating behavior change. Continued support is necessary to help the individual create change in how a person thinks about body weight, body, and food.  

Treatment includes a multidimensional approach with a combination of the following.

Cognitive Behavioral Therapy

CBT treats problems and boosts happiness by modifying dysfunctional behaviors and thoughts.

Acceptance and Commitment Therapy

Therapists may approach disordered eating behavior with Acceptance and Commitment Therapy (ACT). Patients learn to stop avoiding, denying, and struggling with their inner emotions. And instead, they accept that these deeper feelings are appropriate responses to certain situations.

Dialectical Behavioral Therapy

DBT targets acceptance of the patient’s behaviors then teaches skills to apply in recovery from disordered eating.

Relapse Prevention

Relapse prevention is a primary focus of eating disorder treatment. Once a patient stabilizes, there may still be a risk of eating disorder behavior relapse.

Most relapse prevention plans include:

  • Identifying Triggers

  • Distraction techniques

  • Replacement behaviors

  • Coping strategies and identifying supports to contact.

Expressing concern without judgment can be helpful when starting a conversation about eating disorder behaviors. A diabulimia helpline is a toll-free service aiming to help people who have an eating disorder or those seeking advice for a loved one. 


Diabulimia is a complicated and severe eating disorder found in people with type 1 diabetes who purposefully omit insulin to lose weight. There are both short-term and long-term physical severe complications to omitting insulin.

Frequent screenings are essential, especially during puberty. In addition, a multidisciplinary approach to treatment is vital.

Further, it is not uncommon for a person newly diagnosed with diabetes to undergo a period of stress and confusion that can lead to anxiety and possibly depression. The emotional rollercoaster can lead to healthy or unhealthy changes.

Watching someone struggle with an eating disorder is hard. But the key is to spot disorder behaviors at the appropriate time and always to seek support.

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