Diabulimia

When diabetes and eating disorders meet

TW: DCA, Death

In the collective imagination when you think of the DCA we think of the blood faces of the models, the people who vomit after the binges, the fatty bodies that eat dramatically. But that's not all black or white: a lean body is not necessarily a healthy body. Over the years, the range of eating disorders has been expanded more and more: disorders that are subtle, smart, which escape everyone's attention, even doctors and diagnostic manuals. All this because, for a long period of time, we remain normal and apparently healthy. In particular, today we will deepen the diabulimia.

What is diabulimia?

This term was coined by the media to indicate a type of eating disorder, while some doctors use the ED-DMT1 term, that is Eating Disorder-Diabetes Mellitus Type 1, a term that indicates any eating disorder in comorbidity with type 1. diabetes. Diabulimia concerns, in fact, people with type I diabetes, where the person limits insulin with his sponte in order to lose weight or prevent the 'weight gain. Generally it affects teenagers, in particular girls. This condition has not yet been recognized from a diagnostic point of view, but it is possible to include it within the disturbances of nutrition and nutrition without specification. Very himself with this behavior also associate episodes of Binge Eating. 

Diabulimia risk factors

The same type I diabetes presents a risk factor for the development of eating disorder. The disease forces to always be focused on food, labels, blood glucose levels, food limitations: constant control that can lead to developing various related disorders. First of all, the burnout by diabetes, but also depression, anxiety and Body perception disorders which then lead to the development of the DCA. The set of these disorders then does nothing but complicate the treatment of diabetes, which in itself is already a disease where there is a high rate of abandonment of care and little success of the treatments. Another risk factor that transversely concerns all eating disorders is the use of restrictive diets, which could trigger purple circles of diets, binges and weight control compensatory behaviors (Colton et al., 2009). 

Symptoms of diabulimia

What should make us worry? Among the most obvious signals that can be seen are the adoption of particularly rigid food regimes, the obsessive counting of ingested calories, problems related to the perception of one's body, seen as too fat despite being normal, the tendency to have bulimic behaviors to compensate in case of excessive food income. In addition to this, there are several changes in mood tone, which can oscillate between anger, sadness, anxiety and depression. In addition to these behavioral and emotional symptoms, there are gods physical symptoms Like an inexplicable weight loss, nausea or vomiting attacks, constant thirst and frequent urination, sodium and/or low potassium, frequent bladder infections, irregularity or absence of menstruation, worse or blurred view, fatigue, dry hair and skin. 

Consequences of diabulimia

People manage to survive for some time with levels of sugar in the blood very much compared to normal, therefore the consequences of diabulimia are linked to the prolonged increase in blood sugar. These consequences can be potentially serious and irreversible: timeliness, in this regard, is a decisive factor for effective treatment. Among the short -term consequences of diabulimia we have the worsening of symptoms, including: 

- slowdown of wound healing: A high level in the blood involves a worsening of the circulation;

- bacterial infections: a high blood sugar can lead to a weakening of the immune defenses and greater exposure to infections;

- candidosis: the excess of sugar promotes exponential growth of the mushroom;

- muscle atrophy: without insulin, the body begins to destroy the muscles to draw energy;

- amenorrhea or dysmenorrhea: without adequate diet, the levels of estrogen drop considerably, preventing the beginning of menstruation and causing their irregularities or total blockage;

- dehydration, electrolytes imbalance, diabetic ketoacidosis: The ketones accumulate in the blood without insulin, causing problems with the kidneys and the acidification of the blood. Acid blood damages the blood vessels, nerves and organs, leading to the collapse of the organs, to the coma, and possibly also to death.

Among the other long -term negative consequences we have the retinopathy, which can lead to blindness, themacular edema which can cause permanent damage to the eye if not treated in time, problems of peripheral neuropathy, Vasovagal syncope, gastroparesis, chronic diarrhea or constipation, renal diseases, liver, cardiac, All potentially lethal conditions

Diabulimia treatment

Contact a Multidisciplinary team It is essential for the treatment to be as effective and lasting as possible. Among the team members would be appropriate to the presence of an endocrinologist, a dietician expert in eating disorders and a mental health professional always specialized in DCA. In particular, the Cognitive-behavioral therapy (CBT) It can help modify the destructive thoughts and behaviors associated with diabulimia. If hospitalization is necessary, it is important that the staff is trained in the management of diabetes, addressing, if necessary, to the Diabulimia Helpline, which offers a national database for both centers and operators who have experience both in diabetes and eating disorders. Only through the creation of a relationship of trust between professional and patient is it possible to adhere to the treatment and educate the patient to management of diabetes, food and to conduct a healthy lifestyle (Callum et al., 2014). 

Sources:

Colton, P., Rodin, G., Bergenstal, R., Parkin, C. (2009). Eating Disorders and Diabetes: Introduction and Ovserview. Diabetes Spectrum, 22 (3), 138-142.

Callum, A.M, Lewis, L.M. (2014). Diabulimia Among Adolescents and Young Adults with Type 1 Diabetes, Clinical Nursing Studies, vol. 2, No. 4

Antonella Patalano