1. Diabulimia
Camille redmond, rdn, ld

2. Objectives YouTube Video What is Diabulimia? The Role of Insulin
Types of Diabetes Mellitus
Diabetic Ketoacidosis
Warning Signs of Diabulimia
Signs and Symptoms
Health Consequences
Guidelines for Practitioners

3. What is Diabulimia? Eating Disorders

4. What is diabulimia?
Recognized in the Diagnostic and Statistical Manual of Mental Disorders as an “inappropriate compensatory purging behavior,” which is included under “misuse of medications for weight loss” in the criteria for bulimia nervosa and eating disorders not otherwise specified.
Nickname for Eating Disorder – Diabetes Mellitus Type 1 (ED-DMT1)
The dangerous practice of deliberately limiting insulin to control weight by individuals with type 1 diabetes mellitus.
(Darbar & Mokha, 2008)

5. The Role of Insulin
Hormone released by the pancreas in response to a rise in blood glucose.
Insulin allows glucose receptors in the cells to migrate to the surface of the cell in order for the glucose to be transported into the cell to be used for energy.
Insulin also triggers the liver to release VLDLs which carry triglycerides to be stored as fat.

6. Types of Diabetes Mellitus
Type 1 Diabetes Mellitus
Pancreas not producing or producing very little insulin
Type 2 Diabetes Mellitus
Pancreas producing insulin but cells nonresponsive (insulin resistant)
Gestational Diabetes
Diabetes during pregnancy

7. Diabetic Ketoacidosis
Ketosis occurs when the body shifts from burning glucose to burning fat for energy.
Insulin and glucagon balance.
Glucagon produced by the liver to stimulate lipid breakdown.
Protein is converted to glucose to fuel Kreb’s cycle.
Insulin responds to glucose and keeps glucagon in balance.
Glucagon produced without insulin on board produces a high number of ketones putting the body in a metabolic acidotic state that can lead to death.

8. Warning Signs of Diabulimia
Preoccupation with body image, weight, or food intake
Poor metabolic control despite the appearance of compliance
Moodiness, being overly critical of one’s appearance, anxious or depressed, irritable, self-hatred
(Darbar & Mokha, 2008)

9. Signs and Symptoms Hyperglycemia
Changes in eating habits (eating more but still losing weight)
Low energy
Bingeing on carbohydrates
Obsession with food and body image
Anxiety about weight or avoidance of being weighed
Hospitalizations for diabetic ketoacidosis
Smell of ketones on the breath and in the urine
Frequent urination
Physical signs of malnutrition
(Dada, 2012)

10. Health Consequences Short Term Long Term Dehydration
Frequent urination and glucosuria
Insatiable thirst
Increased appetite
High blood glucose levels
Fatigue
Decreased concentration
Electrolyte imbalance
Weight loss
Heart attack
Stroke
Retinopathy
Nephropathy
Neuropathy
Gastroparesis
Vascular disease
Gum disease
Infertility
(Dada, 2012)

11. Guidelines for Practitioners
Explain in detail why proper insulin administration is important.
Treatment plan should be conducted with patient and family.
Diet and insulin intake guidelines should be precise and easy to understand.
Goals should be easy to achieve.
Frequent contact with the therapeutic team.
(Juruć, Kubiak, & Wierusz-Wysocka, 2016)

12. References
Dada, J. H. (2012). Understanding Diabulimia – Know the Signs and Symptoms to Better Counsel Femal Patients. Today’s Dietitian, 14(8), 14. Darbar, N., & Mokha, M. (2008). Diabulimia: A Body-Image Disorder in Patients With Type 1 Diabetes Mellitus. Athletic Therapy Today, 13(4), Juruć, A., Kubiak, M., & Wierusz-Wysocka, B. (2016). Psychological and medical problems in prevention and treatment of eating disorders among people with type 1 diabetes. Clinical Diabetology, 5(1),