Type 1 diabetes is a common chronic illness for children and adolescents. It's also a condition that puts individuals at 2.4 times higher risk for disordered eating behaviors (DEB). Among these is diabulimia, which has become prevalent in adolescents and young adults who try to manipulate or skip insulin doses as a means for losing weight.

What is diabulimia?

In diabulimia, a person with diabetes fails to take insulin, causing blood sugar levels to rise. To rid the body of excess sugar, the kidneys must work overtime, meaning the individual will urinate frequently. When the body "purges" sugar like this, it results in rapid weight loss. "Diabetes is managed 24/7 by counting every morsel one puts in their mouth," explains Jewels Doskicz, RN and T1D. "We are taught to control our diabetes by manipulating foods eaten, insulin used, and moving our bodies to achieve a magic glucose range. For some women…this pressure is overwhelming."

A study in Germany followed participants age 11 to 21 and found that one in three girls and one in six boys reported disordered eating, insulin restriction, or both. Another study from the Joslin Diabetes Center followed adult women and found similar results with 30 percent of participants engaging in insulin restriction.

> The women who practiced insulin restriction died on average 13 years earlier than those who did not.

Some experts assert that the strict care and dietary management required for diabetes can cause some to develop an unhealthy relationship with food, and, subsequently, an eating disorder.

What are the risks?

Skipping insulin doses may seem like a quick and easy way to lose weight, but it puts you at risk for many health problems. In the short term, these problems can include:

• Severe dehydration
• Muscle loss
• Diabetic ketoacidosis (buildup of the byproducts of fat breakdown)
• Bacterial skin infections
• Yeast infections
• Menstrual disruption
• Staph infections

Long term, these consequences become retina damage, nerve damage, partial paralysis of the stomach, kidney damage, peripheral arterial disease, atherosclerosis (a fattening of the arterial walls), stroke, and even death. "Anorexia is the most lethal psychiatric diagnosis that exists, and the risk of mortality is so much more heightened when type 1 diabetes is added," said Ann Goebel-Fabbri, psychologist in Brookline, Mass, in an interview with the New York Times.

What are the signs?

With any eating disorder, the signs of diabulimia can vary from person to person, but some key signals to look for include:

• Changes in eating habits (eating more but still losing weight)
• Unexplained weight loss
• Unexplained hyperglycemia (high blood sugar)
• Low energy levels
• Frequent urination

Getting help

Individuals who omit or skip insulin should see both an eating disorder specialist and their diabetes management team for effective treatment. If you suspect that someone close to you may be restricting their insulin to lose weight or if you have this problem, you can find education, support, and advocacy for diabulimics and their families at the Diabulimia Helpline.