25 Jan, 13 | by Dr Dean Jenkins
The charity DWED (Diabetes with Eating Disorders) is “campaigning to have omitting insulin to lose weight officially recognised as a mental illness“.
It is alarming that as many as 30% of adolescent Type 1 females may have altered their insulin doses to lose weight . Reducing insulin causes glucose to rise, many calories are ‘excreted’ in the urine and there is a risk of ketosis and dehydration. In the longer term the poor control increases the risk of microvascular complications of diabetes. Adding binge-eating with vomiting or anorexia to this insulin manipulation makes for a dangerous venture in weight control.
A patient perspective case report  gives a good account of how a young person with diabetes started using insulin manipulation and vomiting to control her weight after diagnosis:
“I developed a fear that my weight would continue increasing and never stop. I began cutting back on my insulin to lose a few pounds. When I moved away to college, I started using insulin manipulation again to lose weight. This time, my body was more fragile. One night, I was nauseated, throwing up, and on the verge of diabetic ketoacidosis. I realized I no longer needed to wait until my blood sugar became dangerously high to throw up; I could just make myself do it. It was then that I came to believe that, between insulin manipulation and bulimia, I had found the perfect ‘diet’.”
Giving some ‘condition’ a name is a very useful way of increasing its recognition. The more academic and descriptive ‘disordered eating behaviour in people with type 1 diabetes’ is nowhere near as succinct as the combination of two terms ‘diabetes’ and ‘bulimia’ into a single word ‘diabulimia’. What is in a name? What matters most is what something is, not what it is called.
Is there sufficient reason for labelling this condition as a mental illness? For those that have an eating disorder there is already a classification system and an evidence base for management . I think the additional manipulation of insulin does not necessarily represent another diagnosis; instead, it should be a marker of increased risk and urgency for management under existing guidelines.
1. Rydall AC, Rodin GM, Olmsted MP, Devenyi RG, Daneman D. Disordered Eating Behavior and Microvascular Complications in Young Women with Insulin-Dependent Diabetes Mellitus. New England Journal of Medicine 1997;336(26):1849–1854. Available from: http://www.nejm.org/doi/full/10.1056/NEJM199706263362601
2. A battle to overcome ‘diabulimia’. Am Fam Physician 2009 Feb;79(4):263; discussion 263.
3. NICE Eating disorders (CG9): Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. 2004. http://www.nice.org.uk/cg009