Diabulimia: Diabetes and Bulimia

06 January, 2020
Diabulimia, a newly created media term for diabetes and bulimia, contains the risk factors of both a major endocrine disease and an eating disorder.

What happens when you mix an eating disorder with a hormonal deficit? The consequences are rather devastating. Such is the case with diabulimia.

But first, what exactly is diabulimia?

Well, it’s a relatively recent disease caused by the combination of two diseases: insulin-dependent diabetes and bulimia. Unfortunately, both are equally dangerous.

What is the role of diabetes in diabulimia?

In the case at hand, we’re going to refer to type I diabetes, the kind that requires exogenous insulin contributions because a person’s pancreas can’t synthesize the necessary amount.

Thus, the lack of insulin is an important factor in the weight loss of these patients. This is because insulin is necessary for bringing glucose molecules to the cells for their proper functioning. So, when there’s no insulin, the sugar remains in the bloodstream until it goes away. The kidneys usually take care of it, but it leads to the kind of weight loss that’s sometimes extreme.

Under normal conditions, young patients with type I diabetes begin to regain their weight. That is, after diagnosis and chronic insulin treatment accompanied by highly regulated feedings. However, a person with diabulimia takes advantage of the action of the insulin in their metabolism to maintain an excessively low weight instead of recovering their good state of health and optimal weight.

A woman vomiting.

You may be interested in: Why is a ketogenic diet good for you?

Patient type

Diabulimia can appear in both genders. However, most patients are females. The type of person with diabulimia usually has the following characteristics:

  • Young women diagnosed with type I diabetes at an early age.
  • Intelligent youth with good academic and perfectionist tendencies.
  • However, they often have very low self-esteem.
  • Also, they usually have complex family environments with low problem resolution, high levels of demand, and emotional communication deficits.
  • Thus, the appearance of depressive traits is common. It’s also often not clear what came first: depression or diabulimia.

So, a person with bulimia who also has type I diabetes begins to replace binge eating, subsequent vomiting and excessive exercise with the use of insulin to lose weight. They inject insufficient doses and these sometimes produce hyperglycemic comas. The same that are rather serious episodes that could end their lives. However, the desire to be thin, sickly thin, is stronger. This perverse use of insulin begins as a kind of game in which they’re entangled without being able to leave as their symptoms progress.

Read also: What is Night Eating Syndrome?


A person holding a foot.
In patients with diabulimia, the effects of insulin-dependent diabetes increase and accelerate.

As you can imagine, there are countless complications to this dangerous disease. Here are just some of them:

  • Diabulimia increases the risk of kidney damage and it might require dialysis
  • It affects the retina and can lead to blindness.
  • It compromises the peripheral blood circulation giving rise to diabetic foot, which in severe cases might end in amputation.
  • Diabetic foot pain may arise.
  • There may be a delay in menstruation or lack thereof.
  • Stunted growth
  • Hair loss and skin problems.
  • Ketoacidosis due to hyperglycemia in the blood that could lead to irreversible cell damage and subsequent coma.
  • Frequency in the appearance of neuropathies due to metabolic acidosis on the nerves.
  • The average life of patients with diabulimia is 45 years.

As you can see, the prognosis of this type of patient is very bleak.

Factors that could indicate diabulimia

Many authors recommend that the family and medical environment of patients with type I diabetes monitor certain factors, especially those that may lead to suspicion of an eating disorder. Among them:

A woman with diabulimia holding a plate with a piece of lettuce.

  • Periods of lack of control over diabetes.
  • Extreme weight loss
  • Hospital admissions due to hypo or hyperglycemia.
  • Eating disorders that manifest as lies regarding the patient’s data when compared to laboratory tests.

Diabulimia is a disease that’s rather difficult to diagnose and often still unknown by non-specialized medical staff. Its prognosis is very serious, so you must pay attention in order to make an early diagnosis that allows for timely treatment.


This treatment of endocrine disease with involvement of the emotional and psychic sphere is complex. Therefore, it requires the collaboration of a multidisciplinary team such as:

  • A primary attention doctor
  • A psychologist
  • Nutritionists
  • An endocrinologist

All professionals involved must maintain a fluid communication channel between them. This way, they can adapt their medical and psychological treatments. Also, it’s important to communicate well with the family to decide what’s best for the ill person.

In conclusion, diabulimia is more than an eating disorder and much more than insulin-dependent diabetes. If you suspect that you or a loved one may suffer from this order, seek medical assistance immediately.

  • Larranaga A, Docet MF, Garcia-Mayor RV. Disordered eating behaviors in type 1 diabetic patients. World J Diabetes. 2011;2(11):189-95.22.
  • Orit Pinhas-Hamiel, MD, Uri Hamiel, ,Yuval Greenfield, Valentina Boyko, Chana Graph-Barel, Marianna Rachmiel, Liat Lerner-Geva, Brian Reichman. Detecting Intentional Insulin Omission for Weight Loss in Girls with type 1 Diabetes Mellitus. International Journalof Eating Disorders 46:8 819–825 201323.
  • Sancanuto C, Tébar FC, Jiménez-Rodríguez D, Hernández-Morante JJ. Factores psicosociales en la diabetes mellitus tipo1 y su relación con el riesgo de desarrollar trastornos alimentarios en la infancia y la adolescencia. Avances en Diabetología. 2014; 30,5; 156-16224.
  • Jessica T. MarkowitzDeborah A. Butler, Lisa K. Volkening, Jeanne E. Antisdel, Barbara J. Anderson, Lori M.B. Laffel. Brief Screening Tool for Disordered Eating in Diabetes. Internal consistency and external validity in a contemporary sample of pediatric patients with type 1 diabetes. Diabetes Care 33:495-500; 2010.25.
  • Custal N, Arcelus J, Agüera Z, I Bove F, Wales J, Granero R, Jiménez-Murcia S, Sánchez I, Riesco N, Pino Alonso, Crespo JM, Virgili N, Menchón JM, and Fernandez-Aranda F. Treatment outcome of patients with comorbid type 1 diabetes and eating disorders. BMC Psychiatry. 2014; 14: 140.