Diabulemia: symptoms, causes and treatment

Eating disorders are one of the most well-known mental problems, and the one that has increased the most in recent decades due to a culture and society with very demanding aesthetic standards. If we talk about these problems, two names come to mind, which represent the most well-known, common and dangerous diagnoses in this category: anorexia nervosa and bulimia nervosa.

We know that these are life-threatening conditions if you do not receive treatment, and that these people resort to practices such as controlling or even stopping their use, continuous and excessive exercise, the use of laxatives. or the act of inducing vomiting.

But … what happens when eating problems are added to a metabolic or endocrine pathology or disease, such as diabetes? In this sense, there are also alterations within eating disorders specific to this segment of the population. It’s diabulimia, a dangerous eating disorder which some people with insulin-dependent diabetes may have.

    Preamble: type 1 or insulin-dependent diabetes

    Diabetes is a very dangerous disease with life-threatening potential for those who suffer from it, but to understand what we are talking about you first need to know what type 1 diabetes is.

    Diabetes mellitus is a metabolic and endocrine disease characterized by the existence of a difficulty or inability of our body to metabolize glucose, due to the presence of alterations in the so-called islet of Langerhans beta cells in our pancreas. Under normal conditions, these cells are responsible for the synthesis and secretion of insulin, which helps process food glucose and lower its blood level.

    However, in the case of people with diabetes, these cells do not function properly, so when the consumption of glucose increases dramatically and the body is unable to process it. In the case of Diana What is called hyperglycemia appears, Wherein the glucose levels are greater than 126 mg / dl.

    This is a dangerous situation in which symptoms such as increased hunger, weight loss (sugar is excreted in the urine without treatment), asthenia, blurred vision, polydipsia, or craving continuous drinking and / or polyuria or a frequent urge to urinate regardless of what you drink.

    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 naturallyYou must therefore inject yourself externally: it is insulin-dependent.

    In type 2 there is secretion, but the cells are not functioning properly and the production is less than what would be necessary, and during gestation a pregnant woman temporarily (usually) suffers from a dysfunction of synthesis and insulin management mainly due to changes inherent in pregnancy.

    It is a disease with no known cure but with effective treatments that must be maintained throughout life, and which if not controlled it can have serious effects on the nerves, Heart, blood vessels, liver, kidneys, eyes, skin, mouth and teeth, kidneys or feet. Left untreated, it could lead to neuropathy, loss of sensitivity, lessen the possibility of strokes, erectile dysfunction, blindness, diabetic foot, insulin coma, or even death.

    The devil

    This is diabulimia, an eating disorder or disorder that can occur in people with type 1 diabetes or insulin-dependent diabetes, which is characterized by the presence of bodily distortions and obsession with weight loss that results in willful neglect, reduction or discontinuation of insulin therapy as a method to reduce body weight.

    This implies that the person who suffers from it does not proceed to the treatment of his condition or modify it with the aim of losing weight, because as we have mentioned, the loss of it is one typical symptoms of hyperglycemia. In this sense, diabetes is a particularly frightening condition, because in addition to the already dangerous symptoms of an eating disorder, having insulin-dependent diabetes is routinely overlooked.

    In addition to handling and altering the use of insulin, it is possible that people with this alteration manipulate the data reflected by their glucometers with the aim that when the checks are carried out with the doctors these marks lower values ​​to which they correspond. Although in some cases they have a seemingly normal diet, there are usually irregular eating habits with severe restrictions and possible binge eating. Symptoms of anxiety and depression are also common.

    As with most eating disorders, diabetes it is especially common in teenage girls or young adult women, Although cases are also seen in men. Although the name diaboulimia is a composition between diabetes and bulimia, it is actually an eating disorder that could be considered on its own because it has very specific characteristics (although it could also be considered as the use of insulin as a purging behavior specific to bulimia).

    Moreover, this disorder has also been identified not only in bulimia but also in anorexia. It is a disorder which currently not yet found as such in diagnostic manuals such as the DSM-5But this could be considered another specific eating and food ingestion disorder.

      symptoms

      Sometimes diabulimia can go unnoticed, as in some cases those who suffer from it may have a seemingly normal food intake, although later on. they are not medicated so as not to gain weight. It is also sometimes mistaken for a diabetic patient 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 inject insulin while eating in public. Likewise and as with other eating disorders, figure rejection, fear of gaining weight, and excessive worrying about weight are a constant that also occurs in these cases. Likewise, erratic behavior when going to the doctor performing checks can be a symptom.

      possible consequences

      The effects can be devastating and are very similar to those of hyperglycemia or the lack of control between hyperglycemia and hypoglycemia: failing to apply treatment or doing it in smaller amounts than necessary while adopting other behaviors. . contribute to the development of neuropathy which can affect the eyes among other parts of the body (can lead to blindness).

      The cardiovascular and cerebrovascular system, kidneys and liver are also at risk, Make problems such as kidney failure (kidney problems are much more common in diabetics with eating disorders) and / or liver problems, strokes or heart problems more likely. It is also common for ketoacidosis hospitalizations to be frequent, in which the body consumes body fat at high speed in an attempt to obtain energy. Indeed, diabetes can significantly reduce the life expectancy of those who suffer from it.

      the causes

      As with other eating disorders, no single cause or origin of diabetes is known. We are considered to be dealing with a disorder the causes of which are multifactorial.

      this disorder it is only present in diabetic patients, And it usually appears during adolescence. It is not uncommon for the restriction of treatment for diabetes to begin early in the diagnosis, knowing that not treating your condition can be used in the same way as vomiting or restricting food. .

      Another factor that helps to explain this disorder is the overestimation of the importance of body image and weight (which in turn is also favored by the beauty canons of our society), in addition to a possible try to feel the ability to control your life which is projected onto the food realm (Subject may feel in control when losing weight).

      In the latter sense, there may be rejection or a feeling of loss of control upon confirmation of the diagnosis, which, although it may seem paradoxical, could lead them to seek to increase their sense of control over the loss of control. weight by not taking medication. Additionally, emotional lability and low self-esteem as well as possible experiences of rejection during growth due to weight can contribute to their training.

      treatment

      The treatment of diabulimia is complex and requires a multidisciplinary approach in which professionals such as endocrines, nutritionists, psychologists and psychiatrists or educators will be needed. It should be noted that both conditions will need to be treated at the same time: eating disorder and diabetes.

      In this sense, it will be necessary to conduct diabetes education and establish an appropriate diet as well as psychoeducation (which should also be done in the environment to promote understanding of the process that the individual goes through and allow the orientation and generation of strategies and guidelines for action), together with psychological treatments such as cognitive restructuring to modify a person’s beliefs about themselves and their body or about beliefs and the myths of diabetes and their treatment.

      He also works on stimulus control and techniques such as exposure with response prevention (dealing with the anxiety generated by the perception of your body while avoiding the response to decrease the injected insulin and the rest of the strategies you usually employ).

      On the other hand, it can be useful to use strategies to foster a sense of self-efficacy and control. Techniques such as stress management and social skills training can be beneficial, and the use of programs that include differential reinforcement of behaviors incompatible with the problem are also recognized as very helpful.

      However, it should also be noted that, as is the case with people with anorexia or bulimia, many patients are very reluctant to try to change their behavior. It is therefore essential to work first on the therapeutic relationship and adherence to treatment, among others with motivational interviews and by evaluating the consequences that may have had or the risks of the current behavior (without resorting to the fear of the patient ).

      Bibliographical references:

      • Cardona, R. (2018). Diabulimia. Diabetes Foundation. [Online]. Available at: https://www.fundaciondiabetes.org/general/articulo/212/diabulimia
      • Criego, A., Crow, S., Goebel-Fabbri, AE, Kendall, D & Parkin, MS (2009). Eating disorders and diabetes: screening and detection. Diabetes Spectrum, 22 (3): 143-146.
      • Crow, SJ, Keel, P. and Kendall, D. (1998). Insulin-dependent eating disorders and diabetes mellitus. Psychosomatics, 39: 233-243
      • Davidson J (2014) Diabulimia: How Eating Disorders May Affect Adolescents With Diabetes. Nursing standard. 29, 2, 44-49.
      • Sánchez, S. (2014). Dietetic and nutritional treatment of 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.

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