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Not All T1d Eating Disorders Are Diabulimia

Not All T1d Eating Disorders Are Diabulimia

Researchers are calling for a new diagnosis that would include all Type 1 eating disorders. We have seen heightened awareness on insulin manipulation, an eating disorder symptom that occurs in the Type 1 diabetes community. A new term was coined to describe this set of behaviors: “diabulimia”. While increased attention for individuals with an eating disorder and diabetes is welcome, I am troubled by the limited representation of the diabulimia diagnosis. The narrative is often the same in each story: a young woman binges on high-calorie or high-carbohydrate foods and then compensates for the binge by withholding insulin. I fear that if we reduce the narrative of Type 1 eating disorders to insulin omission that closely resembles a binge-purge cycle, we are missing the folks with Type 1 who exhibit other eating disorder symptoms. These narrow narratives miss men and boys; individuals who are over the age of 25; those who do not misuse insulin as part of a binge-purge cycle; and those with Type 1 diabetes who have an eating disorder that doesn’t involve insulin manipulation. It’s important to present Type 1-related eating disorders as a complex illness that may take many shapes and forms. I certainly thought I had to fit the narrow diabulimia narrative. Diabulimia didn’t fit because I didn’t withhold insulin after a binge-purge cycle. When I was still trying to understand my illness, I felt like I must not have a “real” eating disorder because I didn’t have bulimia or anorexia. My symptoms didn’t fit neatly into a diagnostic category, so I was thrown into the umbrella category of “eating disorder not otherwise specified” (EDNOS) or, recently renamed, “otherwise specified feeding or eating disorder” (OSFED). While I understand an individual wanti Continue reading >>

Diabulimia: The Little-known Eating Disorder That's Killing Women With Type 1 Diabetes

Diabulimia: The Little-known Eating Disorder That's Killing Women With Type 1 Diabetes

Lisa Day, a 27-year old student nurse from North London, died after waiting nearly five hours for an ambulance in September 2015. Diagnosed with type 1 diabetes as a teenager, she had purposely missed vital insulin jabs in order to lose weight on multiple occasions. But this time, without the crucial hormone to mop up excess sugar in her blood, she had developed life-threatening diabetic ketoacidosis, whereby toxic chemicals build up in the body. Lisa's story is devastating, but sadly it is far from unique. It's estimated that in the UK, a third of diabetic women between the ages of 15 and 30 are regularly skipping their insulin injections in order to lose weight. Campaigners and doctors in the know call this eating disorder diabulimia, but it is, as yet, an unrecognised disease. Unlike type 2 diabetes, often caused by lifestyle factors, where the body becomes less responsive to insulin, type 1 happens when the immune system accidentally destroys the cells in the pancreas which produce the hormone. This essential chemical ferries the energy from food around the body. But without it, the symptoms of diabetes appear: frequent urination, dehydration and utter exhaustion. The condition also often results in rapid weight loss. "Ironically though, particularly if you are female, people start telling you how good you look, they ask you what your secret is and despite feeling half dead you start thinking 'Hey this is great! I'm losing weight!'. Then you find out that actually you aren't the luckiest girl in the world. You have a life threatening chronic illness and treating it involves endless mental arithmetic about carb to insulin ratios and adjusting for exertion and time of the month and most horrifically of all, that weight goes right back on. It's a strange feeling to kno Continue reading >>

Living With Diabulimia, The World’s Most Dangerous Eating Disorder

Living With Diabulimia, The World’s Most Dangerous Eating Disorder

You don’t get a day off when you’ve got diabetes. Every day is about blood sugar levels, needles and numbers. When you’ve got diabetes and an eating disorder, well, that’s a lot of numbers dictating your life, from calorie counting to watching the scales. I have diabulimia. The term is a combination of diabetes and bulimia, and it’s used to describe someone with type 1 diabetes who deliberately reduces the amount of insulin they take to lose weight – someone like me. I was diagnosed with type 1 diabetes 10 years ago, aged 19. Unlike type 2 diabetes, which is linked to your diet and lifestyle, type 1 is an autoimmune disease. It has no known cause and can’t be cured. I couldn’t shake the idea that people would assume my diabetes was caused by my weight. The basic science behind diabulimia is that, without insulin to process glucose, the body cannot break down sugars from food to use as energy. Instead, the body's cells break down fat already stored in the body, flushing out the excess sugar through the urine. If there’s not fat to burn, the body will start burning through muscle and organs. Some people binge eat and then omit their insulin - but I just starved myself, as well as omitting insulin. The worst cases result in heart failure, loss of limbs, and death. I’ve had to resort to crutches numerous times over the last couple of years, because of the damage I’ve done to my feet. Through not taking insulin, the bones in my feet have disintegrated into what the Doctor described as “honeycomb and mush”, meaning they’re so fragile they regularly break. The nerve damage is so bad I can’t even feel it – I can just see how swollen they are. In the UK, 400,000 people live with type 1 diabetes, meanwhile Canadian research suggests as many as 60% Continue reading >>

Highly Increased Risk Of Type 2 Diabetes In Patients With Binge Eating Disorder And Bulimia Nervosa.

Highly Increased Risk Of Type 2 Diabetes In Patients With Binge Eating Disorder And Bulimia Nervosa.

Abstract OBJECTIVE: We aimed to examine the prevalence and incidence of type 2 diabetes (T2D) in a large patient cohort treated for binge eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa. METHOD: Patients (N = 2,342) treated at the Eating Disorder Unit of Helsinki University Central Hospital over the period up to 16 years were compared with matched general population controls (N = 9,368) in three stages: before entering to the treatment for an eating disorder, after the entrance until the end of the study period, and combined any time before, during, and after the treatment. The study population was linked with the oral TSD medication data of 17 years from The Medical Reimbursement Register. Data were analyzed using conditional and Poisson regression models. RESULTS: Before entering to the treatment for eating disorders, the risk of T2D was substantially increased in patients compared with controls (OR 6.6, 95% CI 4.0-10.7). At the end of the study period, the lifetime prevalence of T2D was 5.2% among patients, 1.7% among controls (OR 3.4, 95% CI 2.6-4.4), and in male patients, it was significantly higher compared with females. Of those treated for BED, every third had T2D by the end of the study period (OR 12.9, 95% CI 7.4-22.5), whereas the same was true for 4.4% of those with BN (OR 2.4, 95% CI 1.7-3.5). DISCUSSION: Our findings provide strong support for the association between T2D and clinically significant binge eating. Disturbed glucose metabolism may contribute to the onset and maintenance of BED and BN. © 2014 Wiley Periodicals, Inc. Continue reading >>

Highly Increased Risk Of Type 2 Diabetes In Patients With Binge Eating Disorder And Bulimia Nervosa

Highly Increased Risk Of Type 2 Diabetes In Patients With Binge Eating Disorder And Bulimia Nervosa

ABSTRACT We aimed to examine the prevalence and incidence of type 2 diabetes (T2D) in a large patient cohort treated for binge eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa. Patients (N = 2,342) treated at the Eating Disorder Unit of Helsinki University Central Hospital over the period up to 16 years were compared with matched general population controls (N = 9,368) in three stages: before entering to the treatment for an eating disorder, after the entrance until the end of the study period, and combined any time before, during, and after the treatment. The study population was linked with the oral TSD medication data of 17 years from The Medical Reimbursement Register. Data were analyzed using conditional and Poisson regression models. Before entering to the treatment for eating disorders, the risk of T2D was substantially increased in patients compared with controls (OR 6.6, 95% CI 4.0–10.7). At the end of the study period, the lifetime prevalence of T2D was 5.2% among patients, 1.7% among controls (OR 3.4, 95% CI 2.6–4.4), and in male patients, it was significantly higher compared with females. Of those treated for BED, every third had T2D by the end of the study period (OR 12.9, 95% CI 7.4–22.5), whereas the same was true for 4.4% of those with BN (OR 2.4, 95% CI 1.7–3.5). Our findings provide strong support for the association between T2D and clinically significant binge eating. Disturbed glucose metabolism may contribute to the onset and maintenance of BED and BN. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:555–562) Continue reading >>

The Correlation Of Binge Eating And Type 2 Diabetes

The Correlation Of Binge Eating And Type 2 Diabetes

When we think about diabetes, we often think about sugar – too much sugar, not enough sugar, glucose levels. If we are not familiar with diabetes because of a history in our family or within our own lives, it can be a very confusing topic for many people. According to the American Diabetes Association, type 2 diabetes is the most common form of this disease. In fact, many people may not even know they are at risk. An individual who engages in unhealthy habits because of an eating disorder, for instance binge eating, may not know that there is a direct correlation between type 2 diabetes and bingeing. In order to understand the correlation, it is important to understand precisely what type 2 diabetes is. There are two factors involved in type 2 diabetes. On one hand, the body may simply not produce enough insulin. On the other, the body may produce the insulin but the cells of the body may ignore it. Insulin is important to the proper operation of our bodies because it is responsible for taking the sugar out of the blood and into the body’s cells. If the insulin is not the correct level in the body, glucose can build up in the blood causing the complications related to diabetes. For men, the complications of diabetes can be wide-ranging. Instances of heart disease and stroke, damage to the kidneys, vision problems including blindness, as well as gum disease or damage to the nerves can occur. In the case of a stroke, an individual can expect a range of possible outcomes: Trouble walking Difficulty speaking in a manner that can be understood by others Paralysis or partial paralysis Partial blindness Severe headache The complications may be slightly different for women. For instance, one complication of diabetes is coronary heart disease which kills more women than brea Continue reading >>

What Is Diabulimia? - We Are Diabetes

What Is Diabulimia? - We Are Diabetes

Most people are familiar with the more widely known eating disorders anorexia nervosa, bulimia nervosa and even binge eating disorder, but few recognize the link between type 1 diabetes and eating disorders. The term "diabulimia" (also known as ED-DMT1) has often been used to refer to this life-threatening combination and the unhealthy practice of withholding insulin to manipulate or lose weight. People suffering from ED-DMT1 may exhibit any number of eating disorder behaviors or they may only manipulate their insulin and otherwise have normal eating patterns. This risky practice can have catastrophic health consequences. Often these individuals take just enough insulin to function and consistently feel dehydrated, fatigued and irritable. More critically, they face long-term health complications ranging from blindness and nerve disorders to kidney failure and diabetic ketoacidosis (an acidic buildup in the blood resulting from inadequate insulin levels). ED-DMT1 is a relatively new term and the link between type 1 diabetes and eating disorders is not yet recognized as a medical or psychiatric condition. As a result, it is greatly under-diagnosed and left untreated. The first step in treating this dangerous disorder is understanding the causes and symptoms. Numerous studies conclude that woman with type 1 diabetes are twice as likely to be diagnosed with an eating disorder compared to their non-diabetic peers. Although many of these studies suggest that there is a higher rate of woman engaging in this risky practice, type 1 diabetic men can and do suffer from eating disorders as well. There are many factors that can contribute to the increased risk of ED-DMT1: the necessary emphasis on food and dietary restraint associated with the management of type 1 diabetes can creat Continue reading >>

Bulimia Nervosa Tied To Increased Risk Of Type 2 Diabetes

Bulimia Nervosa Tied To Increased Risk Of Type 2 Diabetes

(HealthDay)—Binge eating disorder (BED) and bulimia nervosa (BN) are associated with increased incidence and prevalence of type 2 diabetes (T2D), according to a study published in the September issue of the International Journal of Eating Disorders. Anu Raevuori, M.D., Ph.D., from the University of Helsinki, and colleagues examined the prevalence and incidence of T2D in a 2,342 patients treated at the Eating Disorder Unit of Helsinki University versus 9,368 matched general population controls over 16 years. T2D incidence was examined over three stages: before entering treatment for an eating disorder; after entering treatment until the end of the study; and combined any time before, during, and after treatment. The researchers found that the risk of T2D was increased in patients versus controls (odds ratio, 6.6) before entering treatment for eating disorders. The lifetime prevalence was 5.2 percent among patients at the end of the study period, compared with 1.7 percent among controls; prevalence was significantly higher in male patients versus female patients. By the end of the study, every third patient treated for BED had T2D (odds ratio, 12.9) and 4.4 percent of those with BN had T2D (odds ratio, 2.4) "Our findings provide strong support for the association between T2D and clinically significant binge eating," the authors write. "Disturbed glucose metabolism may contribute to the onset and maintenance of BED and BN." Continue reading >>

Highly Increased Risk Of Type 2 Diabetes In Patients With Binge Eating Disorder And Bulimia Nervosa

Highly Increased Risk Of Type 2 Diabetes In Patients With Binge Eating Disorder And Bulimia Nervosa

Abstract Objective We aimed to examine the prevalence and incidence of type 2 diabetes (T2D) in a large patient cohort treated for binge eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa.Method Patients (N = 2,342) treated at the Eating Disorder Unit of Helsinki University Central Hospital over the period up to 16 years were compared with matched general population controls (N = 9,368) in three stages: before entering to the treatment for an eating disorder, after the entrance until the end of the study period, and combined any time before, during, and after the treatment. The study population was linked with the oral TSD medication data of 17 years from The Medical Reimbursement Register. Data were analyzed using conditional and Poisson regression models.ResultsBefore entering to the treatment for eating disorders, the risk of T2D was substantially increased in patients compared with controls (OR 6.6, 95% CI 4.0–10.7). At the end of the study period, the lifetime prevalence of T2D was 5.2% among patients, 1.7% among controls (OR 3.4, 95% CI 2.6–4.4), and in male patients, it was significantly higher compared with females. Of those treated for BED, every third had T2D by the end of the study period (OR 12.9, 95% CI 7.4–22.5), whereas the same was true for 4.4% of those with BN (OR 2.4, 95% CI 1.7–3.5).DiscussionOur findings provide strong support for the association between T2D and clinically significant binge eating. Disturbed glucose metabolism may contribute to the onset and maintenance of BED and BN. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014) Continue reading >>

Does Bulimia Predict A Future Diagnosis Of Diabetes? Binge Eating, Depression May Increase Risk Of Type 2 Diabetes

Does Bulimia Predict A Future Diagnosis Of Diabetes? Binge Eating, Depression May Increase Risk Of Type 2 Diabetes

For some time now, scientists have wondered whether some link exists between depression and diabetes, but any research into the matter has proved inconclusive due to limitations of the observational method. Today, a new study published in Diabetologia connects the dots between diabetes and depression while also tying in other key mental health conditions: impulse control disorders, including bulimia and binge eating disorder. “So now we know that depression and impulse control disorders are probably the most important mental health problems associated with diabetes,” Dr. Peter de Jonge, professor in the Interdisciplinary Center for Psychopathology and Emotion Regulation at the University of Groningen, Netherlands, told Medical Daily in an email. The possible connection between depression and diabetes has intrigued scientists for good reason. If researchers could prove the presence of depression increases the risk of future diabetes, then treatment and alleviation of depression might very well translate into a decreased risk of diabetes. Consider, too, that the typical age when depression begins (25 years old) is substantially younger than the typical age when type 2 diabetes begins (45 years or older). This means, then, there would be significant lead time to cure depression and in so doing, reverse a possible diabetes diagnosis. Yet de Jonge, who understood the potential relationship between depression and diabetes, suspected there might be other more important factors in play. “Mental health conditions are often associated, that is, if a person has condition A, this person will have an increased risk of having condition B as well,” de Jonge told Medical Daily. “There has been a lot of research that suggests that depression relates to diabetes. But it remains Continue reading >>

Classification Of Type 1 Diabetic Females With Bulimia Nervosa Into Subgroups According To Purging Behavior

Classification Of Type 1 Diabetic Females With Bulimia Nervosa Into Subgroups According To Purging Behavior

OBJECTIVE—To classify type 1 diabetic females with bulimia nervosa (BN) by type of inappropriate compensatory behavior in order to prevent weight gain (ICB) and to investigate the group differences. RESEACH DESIGN AND METHODS—Type 1 diabetic females with BN, diagnosed by structured diagnostic interview based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) criteria, were classified by type of ICB as follows: 1) only severe insulin omission as an ICB (BN-I) (n = 22), 2) both severe insulin omission and self-induced vomiting and/or laxative abuse (BN-IP) (n = 22), or 3) no insulin omission but another ICB (BN-NI) (n = 11). The clinical characteristics of these three groups and a binge-eating disorder (BED) group (n = 24) were compared. RESULTS—The BN-IP and BN-I groups had the highest HbA1c levels. The BN-IP group had the highest rates of diabetic neuropathy, retinopathy, and nephropathy. The BN-NI group had the second highest rates of neuropathy and retinopathy. The BN-IP group had the highest frequencies of diabetes- and ketoacidosis-related hospital admissions, and the BN-I group had the second highest frequencies. The BN-NI group showed the highest scores on psychological tests related to depression, anxiety, eating disorder psychopathology, and perfectionism. The BN-NI group had the highest rate of history of visits to a psychiatrist, and the BN-IP group had the second highest history. CONCLUSIONS—Type 1 diabetic females with BN seem not to be homogenous and can be classified into three distinctive subgroups by type of ICB. Individuals with BN-IP had the most severe problems with both medical and psychological/behavioral aspects. Individuals with BN-NI manifested the highest psychological distress. The BN-I group had comparatively mi Continue reading >>

The Truth About Diabulimia

The Truth About Diabulimia

According to Marilyn Ritholz, PhD, (Senior Pychologist at Joslin Center for Diabetes) and Ann Goebel-Fabbri, PhD, a licensed psychologist who worked at Joslin for 16 years, women with Type 1 have close to two and a half times the chance of developing an eating disorder. Those are striking odds. And when you look at the psychological challenges that come with managing a chronic illness on your own, coupled with a uniquely attentive relationship to food and a life-saving medication that can sometimes cause weight gain, it may not be surprising that having Type 1 diabetes puts so many women at risk. Beyond Type 1 wanted to know how eating disorders are unique in populations with Type 1 diabetes. What are the warning signs of the Type 1 eating disorder “diabulimia”? What are the best forms of treatment? What behaviors or psychological characteristics can put a person with Type 1 at a higher risk for developing it? What is anorexia nervosa? Anorexia is an eating disorder characterized by an abnormally low body weight, intense fear of gaining weight and a distorted perception of body weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with activities in their lives. To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively (Mayo Clinic). What is bulimia nervosa? Bulimia nervosa is an eating disorder usually characterized by periods of binging – or excessive overeating – followed by purging. People with bulimia have a fear of gaining we Continue reading >>

Diabulimia: The Little Known Eating Disorder That's Killing Diabetic Women

Diabulimia: The Little Known Eating Disorder That's Killing Diabetic Women

Lisa Day was just 14 when she was diagnosed with type one diabetes. At the time she was a healthy-looking teenager, but shortly after her diagnosis, her weight plummeted and she became incredibly thin. She was also diagnosed with anorexia. “The two basically came hand-in-hand,” says her sister Katie Edwards, now 31. “Lisa lost a lot of weight. As a diabetic she had to look really closely at what she ate, but because of her eating disorder, she looked way too much - and became obsessed. “As a diabetic she had to look really closely at what she ate, but because of her eating disorder, she looked way too much - and became obsessed” Katie Edwards “She would eat the bare minimum, and as she got older, she realised if she didn’t take her insulin, she could lose weight that way. She knew different techniques to do it and would drop several dress sizes in matter of days.” Lisa was seen by a psychiatrist at an eating disorder clinic, but they knew little about diabetics and were only about to focus on her relationship with food – not insulin. It meant her problems continued on and off for the next decade. At the age of 27, her family think she stopped taking overly low doses of insulin - but the damage was done. Lisa was left with serious health problems, including kidney damage, bilateral cataracts and severe eye disease. On 12 September 2015, she tragically died. “It’s just such a waste of life,” Katie tells me, eight months on. “I really didn’t think my sister would get into old age, but I thought she’d at least make 40. Because she didn’t look after herself in her early years – and didn’t receive the right help to do that - she’s really paid for it now. “Her condition ruined her life. When my mum and I were clearing through her things Continue reading >>

Diabulimia Is The ‘most Dangerous Eating Disorder’ Most Of Us Have Never Heard Of

Diabulimia Is The ‘most Dangerous Eating Disorder’ Most Of Us Have Never Heard Of

We’re all too painfully aware of the effects of bulimia and anorexia. They can be life-ruining disorders. But what happens when you already have a chronic illness and you’re battling an ED? Around 350,000 people are estimated to have type 1 diabetes in the UK, and more than 725,000 people are living with eating disorders at any one time. And research now suggests that as many as 40% of all young women aged between 15 and 30 with type 1 diabetes are also living with an ED, or diabulimia. In fact, 60% of women with type 1 diabetes will experience an ED by the time they reach 25. But what exactly is diabulimia? It’s deliberately injecting less insulin than you need in order to lose weight. Unlike type 2 diabetes, type 1 is nothing to do with lifestyle or diet – sufferers need to inject insulin because they can’t produce enough themselves. Without it, the body can’t break down sugars from food to use as energy and is forced to feed off existing fat, muscles and organs. By purposely depriving the body of insulin, you risk things like kidney damage, fertility problems, heart failure and death. So why do it? Well, because if you can’t produce insulin, you can eat whatever you want without putting on weight – in fact, you’ll lose weight. The damage, however, can set it way before you get down to a noticeably small size and it’s that fact that is causing so many sufferers to fall through the net…and die. ‘You can look quite well and have a normal body size and yet because you’re restricting insulin inside you, you’re running very high blood sugars,’ Professor Khalida Ismail, lead psychiatrist for diabetes at King’s Health Partners tells the BBC as part of their documentary on the phenomenon. ‘And these blood sugars run the risk of diabetes compl Continue reading >>

Eating Disorders And Diabetes

Eating Disorders And Diabetes

Tweet Having diabetes can make the physical effects of eating disorders more dangerous due to the impact on blood sugar levels. An eating disorder is when you have an abnormal attitude towards food that causes significant problems for your health or well being. Eating disorders may vary from overeating to undereating and some eating disorders, such as bulimia, may involve alternating between the two. Diabulimia Diabulimia is a term which has been used to describe deliberate missing of insulin injections in an attempt to lose weight. When people with type 1 diabetes skip insulin injections, it starves the body from getting energy from food eaten. Read more about Diabulimia Diabulimia is particularly prevalent in teenage girls and young women with type 1 diabetes. Diabetes UK reports that prevalence could be as high as 1 in 3 women with type 1 diabetes may have deliberately missed injections to lose weight. Diabulimia is an especially dangerous way to lose weight which greatly increases the risk of suffering diabetic ketoacidosis in the short term and increasing the risk of developing complications such as nerve damage and blindness later in life. Binge eating disorder Binge eating disorder is when people eat large amounts of food in a short space of time and feel unable to stop themselves from doing so. Overeating despite being full and compulsive snacking are examples of binge eating. Binge eating may take place because of psychological issues but can also result from, or be amplified by, the effect food has on our blood sugar levels. This can apply to people with and without diabetes, particularly if food that is sugary or particularly dense in carbohydrate is eaten. Binge eating can lead to significant weight gain, raising the risk of heart disease and, for people wit Continue reading >>

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