Diabulimia is a dangerous practice where someone with type 1 diabetes intentionally skips or reduces the amount of insulin they take to lose weight. Here's what happens: the body needs insulin to process sugar from the food we eat. When the body can’t process sugar, the sugar comes out in urine and/or builds up in the bloodstream. If the body can’t use sugar for energy, it breaks down other sources, like protein and fat, to get the energy it needs. This can cause weight loss, but can also cause blood sugar to rise and potentially dangerous acids, known as ketones, to build up in the body.
Why is skipping insulin dangerous?
Skipping insulin doses, or reducing the amount you take, can cause:
- Increased A1C levels
- Increased risk of developing infections
- More frequent episodes of diabetic ketoacidosis (DKA)
- More frequent hospital and emergency room visits
- Higher rates of diabetes-related health problems, such as nerve damage, eye disease, kidney disease, and even heart disease
- An earlier than usual onset of diabetes-related health problems
Who is at risk?
Though anyone who uses insulin might skip doses or reduce them without telling his or her doctor, health care professionals most often tend to report this kind of behavior happening with teenage girls. While it is hard to get accurate numbers when trying to find out how frequently this is occurring (not everyone is willing to admit that they are doing this), the evidence shows that up to 30% of adolescents with diabetes mismanage their insulin to avoid weight gain or to lose weight.
What are the warning signs?
Warning signs of diabulimia and other eating disorders in teens with type 1 diabetes can include:
- Preoccupation with weight and body shape
- Changes in eating patterns
- High A1C numbers that cannot be explained
- Repeated episodes of DKA
- Exercising more than usual
- In girls, lack of menstrual period
As a care partner, if you notice these warning signs and suspect that your teenager may be trying this with their insulin, you should tell your child's diabetes care team as soon as possible.