The sad circumstances of the suicide of Megan Davison recently highlighted the little-known eating disorder diabulimia.
The term diabulimia refers to the deliberate and frequent reduction in insulin administration in people with type 1 diabetes due to concerns about weight management and /or body shape. The condition is often hidden, and individuals may look well and have a normal body weight. However, it is an extremely dangerous weight loss strategy, leading to increased diabetes complications and a shorter life span if used over an extended period
Although diabulimia is not currently recognised as a clinical diagnosis, it is a condition that is familiar to people with type 1 diabetes. This complex dual presentation is often missed by health professionals and there is little guidance on how to manage it (Allan 2017).
Diabetes UK reports that an estimated 40% of all women with type 1 diabetes between the ages of 15-30 frequently give themselves less insulin in order to lose weight. Longitudinal research from Canada shows that teenage girls and women with type 1 diabetes have a significantly increased risk of disturbed eating behaviours when compared to their non-diabetic peers.
Eating behaviours that can interfere with diabetes management include bingeing, fasting and deliberately manipulating insulin use as a compensatory behaviour (Colton at al. 2015)
Stories like Megan’s also highlight the difficulties people experience in getting the right help and advice for this condition. Currently in the UK, there is only one outpatient treatment clinic based in London dedicated for people with diabulimia. However, the recent publication of the updated NICE guidelines, Eating Disorders: recognition and treatment (NICE2017) goes some way to offer recommendations for health professionals.
People with type 1 diabetes are acknowledged in the guidelines as being at high risk of developing eating disorders and thus should be screened by professionals as a matter of course. The treatment recommendations demonstrate the recognition of this unique condition, however there is a continued call for diabetic related eating disorders to be categorised as a specific eating disorder which could lead to a more specialised approach to research and treatment (Allan 2017).
Further information is available from the Diabetes UK Helpline 03451232399 and through the National Charity: Diabetes with Eating Disorders (DWED)