Diabulimia: symptoms, causes and treatment

Eating disorders are one of the best-known mental problems, and one of the most more has increased in recent decades due to a culture and society with very aesthetic canons demanding. 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 control or even cessation of intake, continued and excessive exercise, the use of laxatives or the act of causing threw up.

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

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Preamble: type 1 or insulin-dependent diabetes

Diabulimia is a highly dangerous and potentially fatal condition for those who suffer from it, 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 which is characterized by the existence of a difficulty or impossibility of our body 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 blood levels are reduced.

However, in the case of people with diabetes, these cells do not function correctly, 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 the urine without processed), asthenia, blurred vision, polydipsia or urge to drink continuously and/or polyuria or frequent urge to urinate regardless of what drunk.

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

In type 2 there is secretion but the cells do not function correctly and less is produced than would be necessary, and in gestational it is the case that a woman A pregnant woman temporarily (generally) suffers from a dysfunction in the synthesis and management of insulin, mainly due to the hormonal changes typical of the gestation.

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

Diabulimia

Diabulimia is a condition or eating disorder that can occur in people with type 1 or insulin-dependent diabetes, which is characterized by the presence of distortions bodily and obsession with weight loss resulting from willful neglect, reduction, or cessation of insulin treatment as a method to reduce body weight.

This implies that the person who suffers from it does not carry out the treatment of her medical condition or that he modifies it with the purpose of losing weight, since as we have commented the loss of this is one of the typical symptoms of the hyperglycemia. In this sense, diabulimia is a particularly fearsome condition, since the already dangerous symptomatology of a eating disorder is added the fact of suffering from insulin-dependent diabetes whose treatment is systematically neglected.

In addition to manipulating and altering the use of insulin, it is possible that those with this alteration may come to manipulate the data reflected by their glucometers in order that when the controls are carried out with the doctors, they mark lower values ​​than those that correspond. Although in some cases they have an apparently normal diet, in general there are irregular eating patterns with severe restrictions and possible binge eating. It is also frequent that there are symptoms of anxiety and depression.

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

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

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Symptoms

Sometimes diabulimia can go unnoticed, since in some cases those who suffer from it can even make an apparently normal consumption of food despite later do not take medication in order not to gain weight. Likewise, it is sometimes confused with a patient with diabetes with poor adherence to treatment.

However, it is common for those who suffer from it to have difficulty and discomfort eating in public or show signs of discomfort if they had to inject insulin when eating in public. In the same way and as with other eating disorders, the rejection of one's own body shape, the fear of gaining weight and excessive concern about weight is a constant that also occurs in these cases. In addition, erratic behavior when going to the doctor to perform controls can be a symptom.

Possible consequences

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

The cardiovascular and cerebrovascular systems, the kidneys and the liver are also at risk., making the appearance of problems such as kidney failure more likely (kidney problems are much more common in diabetic subjects with eating disorders) and/or liver problems, cerebrovascular accidents or problems cardiac. It is also common for frequent hospitalizations for ketoacidosis, in which the body rapidly consumes body fat in an attempt to obtain energy. In fact, diabulimia can greatly reduce the life expectancy of those who suffer from it.

Causes

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

This disorder only present in diabetic patients, and it is common for it to appear during adolescence. It is not infrequent that the restriction of diabetes treatment occurs after the first moments of diagnosis, at the realize that not treating your condition can be used just like vomiting or restraining food.

Another factor that helps explain this disorder is found in the overestimation of the importance of the image body and weight (something that on the other hand is also favored by the canons of beauty of our society), in addition to a possible attempt to feel the ability to control your life that is projected onto the food sphere (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 seeming paradoxical could lead them to seek to increase their sense of control in losing weight by not take medication Likewise, emotional lability and low self-esteem together with possible experiences of rejection during growth due to weight can contribute to its formation.

Treatment

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

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

They also work on the control of stimuli and techniques such as exposure with response prevention (making the person face the anxiety that generates the perception of your body at the same time that you avoid making the response of decreasing the insulin injected and the rest of the strategies that you use use).

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

However, it must also be appreciated that, as occurs in people with anorexia or bulimia, many patients show great resistance to trying to change their behavior patterns. It is therefore essential to work first on the therapeutic relationship and adherence to treatment, among other things with interviews. motivational and assessing the consequences that it may have already had or the risks that are run in the face of current behavior (without resorting to scaring to the patient).

Bibliographic references:

• Cardona, R. (2018). Diabulimia. Diabetes Foundation. [On-line]. Available in: 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. Eating disorders, 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.