Diabulimia (eating disorders and type 1 diabetes)

Diabulimia is an eating disorder that occurs in people with type 1 diabetes who restrict or skip insulin in order to lose weight. Clinicians often call it ED-DMT1, meaning an eating disorder in the setting of type 1 diabetes. It is one of the most dangerous eating disorders, because the method of losing weight, going without enough insulin, directly attacks the body. It is also treatable, with care that addresses the diabetes and the eating disorder together.

This page explains what diabulimia is, why it is so risky, and how to recognize it. If you are trying to understand eating disorders more broadly, see what is an eating disorder.

What diabulimia is

People with type 1 diabetes do not make insulin and must take it to move glucose from the blood into the body's cells. When insulin is deliberately reduced or skipped, the body cannot use that glucose, so it is excreted in the urine, carrying calories out with it.¹ That is why insulin restriction works as a form of weight control, and why eating-disorder specialists describe it as a kind of purging. The eating disorder may involve restriction, bingeing, or both, layered on top of the daily demands of managing diabetes.

How common it is

Insulin restriction is more common than many people expect, particularly among girls and women with type 1 diabetes. A systematic review and meta-analysis estimated insulin omission or misuse in about 10 percent of people with type 1 diabetes, and found that having type 1 diabetes was associated with roughly two and a half times the risk of an eating disorder, with women at notably higher risk.² Clinic-based studies have reported even higher figures, including that as many as a third of women with type 1 diabetes restrict insulin at some point.³ The numbers vary widely depending on how they are measured, but the pattern is consistent: this is not rare.

Why it is so dangerous

Going without enough insulin keeps blood sugar chronically high and lets ketones build up, which can tip into diabetic ketoacidosis, a life-threatening emergency. Over time, the high blood sugar accelerates the serious complications of diabetes: damage to the eyes (retinopathy), nerves (neuropathy), and kidneys (nephropathy).¹ The long-term risk is stark. In an 11-year study of women with type 1 diabetes, those who restricted insulin were about three times more likely to die during follow-up, and died on average more than a decade younger, than those who did not.⁴

Warning signs

Getting help

Diabulimia needs care that treats both conditions at once. Standard eating-disorder treatment alone is often not enough, because the eating disorder is bound up with insulin and blood-sugar management, so the most effective approach pairs a diabetes team with eating-disorder specialists who understand insulin restriction.⁵ If you recognize this in yourself or someone you love, an assessment is the first step. See how to help a loved one start treatment or search for programs.

References