Diabulimia: symptoms, causes and treatment

This disorder can lead people to interrupt their diabetes medication.

Eating disorders are one of the best known mental problems, and one of the ones that has increased the most in recent decades due to a culture and society with very demanding aesthetic standards. If we talk about these problems, two names come to mind, which represent the most well-known, common and dangerous diagnoses within this category: anorexia nervosa and bulimia nervosa.

We know that these are potentially fatal conditions if left untreated, and that these people resort to practices such as controlling or even stopping their food intake, excessive and continuous exercise, the use of laxatives or the act of making themselves vomit.

But... What happens when eating problems are added to a metabolic or endocrine pathology or disease, such as diabetes? In this sense, there are also alterations within the eating disorders specific to this sector of the population. This is diabulimia, a dangerous eating disorder that some people with diabetes may suffer from. that some people with insulin-dependent diabetes may suffer from.

Preamble: type 1 or insulin-dependent diabetes.

Diabulimia is a highly dangerous and potentially life-threatening condition for the sufferer, but to understand what we are talking about it is first necessary to know what type 1 diabetes is.

Diabetes mellitus is a metabolic and endocrine disease characterized by the existence of a difficulty or impossibility of our organism to metabolize glucose, due to the presence of alterations in the so-called beta cells of the islets of Langerhans of our pancreas.. Under normal conditions these cells are responsible for synthesizing and secreting insulin, which allows glucose from food to be processed and its levels in the Blood to be reduced.

However, in the case of people with diabetes these cells do not work properly, so that when eating glucose rises to a great extent and the body is not able to process it. In the case of diane What is known as hyperglycemia appears.in which glucose levels are above 126 mg/dl.

This is a dangerous situation in which symptoms such as increased hunger, weight loss (sugar is eliminated through urine without being processed), asthenia, blurred vision, polydipsia or the need to drink continuously and/or polyuria or the frequent need to urinate regardless of how much is drunk.

There are several types of diabetes: type 1 or insulin-dependent, type 2 or non-insulin-dependent and gestational diabetes. In type 1 diabetes, the person's pancreas is not able to secrete insulin. pancreas is not able to secrete insulin naturally, so it needs to inject insulin injections.and therefore needs to inject it externally: it is insulin-dependent.

In type 2 there is secretion but the cells do not function correctly and less than necessary is produced, and in gestational diabetes a pregnant woman suffers temporarily (generally) a dysfunction in the synthesis and management of insulin due mainly to the hormonal changes inherent to pregnancy.

It is a disease with no known cure but with effective treatments that must be maintained throughout life, and if not controlled, it can have serious effects on the nerves. can have serious effects on the nerves, heart, blood vesselsIf left unchecked, it can have serious effects on the nerves, heart, blood vessels, liver, kidneys, eyes, skin, mouth and teeth, kidneys and feet. Without treatment it could lead to neuropathies, loss of sensation, facilitates the possibility of vascular accidents, erectile dysfunction, blindness, diabetic foot, insulin coma or even death.

Diabulimia

Diabulimia is a condition or eating disorder that can occur in people with type 1 or insulin-dependent diabetes, characterized by the presence of body distortions and obsession with weight loss that cause willful neglect, reduction or cessation of insulin treatment. obsession with weight loss that results in the willful neglect, reduction, or cessation of insulin therapy as a method of reducing body weight. as a method of reducing body weight.

This implies that the sufferer does not carry out the treatment of his or her medical condition or modifies it for the purpose of losing weight, given that, as we have mentioned, weight loss is one of the typical symptoms of hyperglycemia. In this sense, diabulimia is a particularly frightening condition, since to the already dangerous symptoms of an eating disorder is added the fact of suffering from insulin-dependent diabetes whose treatment is systematically neglected.

In addition to the manipulation and alteration of the use of insulin, it is possible that those with this alteration may also manipulate the data reflected by their glucose meters. manipulate the data reflected by their glucometers, so that when they are so that when they are checked by their doctors, these readings are lower than the corresponding values. Although in some cases they have an apparently normal diet, there are usually irregular eating patterns with severe restrictions and possible binge eating. Symptoms of anxiety and depression are also common.

As with most eating disorders, diabulimia is especially common in adolescent or adult women. is especially common in adolescent or young adult women, although cases are also seen in adolescents and young adult women.although cases are also seen in males. Although the name diabulimia is a composition between diabetes and bulimia, it is in fact an eating disorder that could be considered on its own as it has very specific characteristics (although the use of insulin could also be considered as a purging behavior typical of bulimia).

Moreover, this disorder has also been identified not only in bulimia but also in anorexia. This is a disorder that is not yet found as such in diagnostic manuals such as the DSM-5, but it could be considered as an other disorder.but which could be considered as Other Specified Eating and Food Ingestion Disorder.

Symptoms

Sometimes diabulimia can go unnoticed, since in some cases those who suffer from it may have an apparently normal food intake despite the fact that they then do not medicate in order not to gain weight.. It is also sometimes mistaken for a patient with diabetes with poor adherence to treatment.

However, it is common for sufferers to have difficulty and discomfort eating in public or to show signs of discomfort if they have to inject insulin when eating in public. Similarly, as with other eating disorders, rejection of one's body shape, fear of gaining weight and excessive preoccupation with weight is also a constant in these cases. Likewise, erratic behavior when it comes to going to the doctor for check-ups can be a symptom of this. for check-ups can also be a symptom.

Possible consequences

The effects can be devastating, and are very similar to those of hyperglycemia or the lack of control between hyperglycemia and hypoglycemia: not applying a treatment or doing it in less quantity than necessary, together with other behaviors such as fasting, can affect the nervous system and contribute to the appearance of a neuropathy that can affect the eyes, among other parts of the body (it can lead to blindness).

Also at risk are the cardiovascular and cerebrovascular system, the kidneys and the liver, making the onset of problems more likely.The cardiovascular and cerebrovascular systems, kidneys and liver are also at risk, making problems such as kidney failure (kidney problems are much more common in diabetics with eating disorders) and/or liver failure, strokes or heart problems more likely. Frequent hospitalizations for ketoacidosis, in which the body rapidly consumes body fat in an attempt to obtain energy, are also common. In fact, diabulimia can greatly reduce the life expectancy of those who suffer from it.

Causes

As with other eating disorders, there is no known single cause or origin of diabulimia. It is considered to be a disorder whose causes are multifactorial.

This disorder is present only in diabetic patientsand it usually appears during adolescence. It is not uncommon that the restriction of diabetes treatment occurs after the first moments of diagnosis, when realizing that the non-treatment of their condition can be used as well as vomiting or food restriction.

Another factor that helps to explain this disorder is the overvaluation of the importance of body image and weight (something that on the other hand is also favored by the beauty standards of our society), in addition to a possible attempt to feel in control of one's life that is projected onto the eating environment. of feeling in control of one's life, which is projected onto the food area (the subject may feel in control of his or her own life). (the subject may feel in control when losing weight).

In this last sense there may be a rejection or feeling of loss of control when the diagnosis is confirmed, which, although it may seem paradoxical, could lead them to seek to increase their feeling of control in losing weight by not taking medication. Likewise, emotional lability and low self-esteem together with possible experiences of rejection during growth due to weight may contribute to its formation.

Treatment

The treatment of diabulimia is complex and requires a multidisciplinary approach in which professionals such as endocrinologists, nutritionists, psychologists and psychiatrists or educators will be necessary. It should be borne in mind that both conditions will have to be treated at the same time: the eating disorder and the diabetes..

In this sense, it will be necessary to carry out diabetological education and establish an adequate diet as well as psychoeducation (which should also be done to the environment to favor the understanding of the process that the individual is going through and allow the orientation and generation of strategies and guidelines for action), at the same time as psychological treatments such as cognitive restructuring to modify the person's beliefs about himself and his body or about the beliefs and myths of diabetes and its treatment.

We also work on stimulus control and techniques such as exposure with response prevention (making the person face the anxiety generated by the perception of his body while avoiding the response of reducing the insulin injected and the rest of the strategies he usually employs).

On the other hand, it may be useful to use strategies that favor a sense of self-efficacy and control.. Techniques such as training in stress management and social skills can be beneficial, and the use of programs that include differential reinforcement of behaviors incompatible with the problem is also recognized as very useful.

However, it should also be noted that, as in the case of people with anorexia or bulimia, many patients are very reluctant to try to change their behavioral patterns. It is therefore essential to work first of all on the therapeutic relationship and adherence to treatment, among other things with motivational interviews and assessing the consequences that may have already occurred or the risks involved in the current behavior (without resorting to scaring the patient).

Bibliographic references:

• Cardona, R. (2018). Diabulimia. Diabetes Foundation. [Online]. Available at: https://www.fundaciondiabetes.org/general/articulo/212/diabulimia
• Criego, A., Crow, S., Goebel-Fabbri, A.E., Kendall, D & Parkin, M.S. (2009). Eating Disorders and Diabetes: Screening and Detection. Diabetes Spectrum, 22 (3): 143-146.
• Crow, S.J. Keel, P. & Kendall, D. (1998). Eating Disorders and Insulin-Dependent Diabetes Mellitus. Psychosomatics, 39:233-243.
• Davidson J (2014) Diabulimia: how eating disorders can affect adolescents with diabetes. Nursing Standard. 29, 2, 44-49.
• Sanchez, S. (2014). Dietetic-nutritional treatment in eating disorders with diabetes mellitus. Disorders of eating behavior, 20.
• Pinhas-Hamiel, O., Hamiel, U., Levy-Shraga, Y. (2015). Eating disorders in adolescents with type 1 diabetes: challenges in diagnosis and treatment. World J Diabetes, 6: 517.