Type 1 disordered eating, also known as diabulimia, should be an area of concern if you have patients with type 1 diabetes.
What is diabulimia?
Diabulimia is a serious eating disorder that causes someone to reduce or stop taking their insulin in order to lose weight. This can happen alongside other behaviours such as restricting the food they are eating, over-exercising, binging, making themselves sick and using laxatives to try to control weight.
Some people don't reduce or stop their insulin but instead control their weight and shape through food restriction or over-exercise, which indirectly limits the amount of insulin required.
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 hyperglycaemia
- high HbA1c
- delay in puberty
- irregular periods/amenorrhea
- severe fluctuations in weight or severe weight loss
- depression/anxiety
- 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.
Useful resources
Here are some resources that may be helpful for you when supporting your patients with T1DE or diabulimia:
- CPD accredited online courses on understand how to talk to patients with diabetes about their emotional health to help you understand the most appropriate ways to support them.
- Take a look at the Eating problems chapter in our Emotional health professionals guide which offers strategies and tools for how to recognise and have conversations about emotional problems, as well as for providing appropriate support.
- Reading A guide to risk assessment for type 1 diabetes and disordered eating (T1DE) by the Wessex ComPASSION Team in our shared practice library.
