DIABULIMIA; The Deadly Eating Disorder Affecting Women With Diabetes

On August 4, 2017, Ms Megan Davidson, 27, commited suicide after battling with diabetes and diabulimia.

Megan was driven to suicide after her battle with her eating disorder and diabetes.

She died three days after she was discharged from mental health services after they thought she did not to have clinical depression and had full capacity according to the inquest.

On the morning of her death she had texted therapist, Renata Harris, saying: ‘Please make sure the emergency services find my body so my parents don’t have to.’

The 27-year-old’s body was found by police who had eventually been alerted by the therapist who received Ms Davison’s text message.

Ms Davison had previously tried to kill herself at the end of 2016 through an overdose.

The therapist decided the text had no ‘immediate implications’ and so did not tell anyone about it for almost an hour.

When police were contacted they went to Ms Davison’s home in Cheshunt, Hertfordshire, and found her body.

 

Megan is not alone,

The word diabulimia is a merger of the word diabetes and bulimia.

Though this word is not officially recognized, Diabulimia describes the situation where somebody deliberately and regularly reduces the amount of insulin they take due to concerns over their body weight and/or shape.

The American Diabetes Association indicates that 30-40 percent of female teenagers and young female adults with diabetes alter or skip insulin to control their weight. “If you have diabetes, then the risk of developing an eating disorder is about twice as likely than if you didn’t,” says Ronald Steingard, M.D., of Walden Behavioral Care in Waltham, MA and research consultant for Harris Center for Eating Disorders at Harvard University.

 

Individuals suffering from diabulimia intentionally misuse insulin for weight control, including:

  • Decreasing the prescribed dose of insulin
  • Omitting insulin entirely
  • Delaying the appropriate dose
  • Or, manipulating the insulin itself to render it inactive

 

On the long term, there is severe hypoglycemia and weight loss because the body would break down fats for energy since there is no insulin to help the tissues utilize glucose effectively.

Diabulimia is a mental health issue and health care providers should be able to recognize this and refer appropriately for psychological help if need be.

Although, this might not be popular among Nigerians, it just might  be because we do not have enough statistics and so many people with mental health issues do not regularly reach out for help.

Warning signs and symptoms of diabulimia

Emotional and behavioural

 

  • Secrecy about diabetes management
  • Increased neglect about diabetes management
  • Avoiding diabetes related appointments
  • Fear of low blood sugars
  • Fear that “insulin makes me fat”
  • Extreme increase or decrease in diet
  • Extreme anxiety about body image
  • Restricting certain food or food groups to lower insulin dosages
  • Avoids eating with family or in public
  • Discomfort testing/injecting in front of others
  • Overly strict food rules
  • Preoccupation with food, weight and/or calories
  • Excessive and/or rigid exercise
  • Increase in sleep pattern
  • Withdrawal from friends and/or family activities
  • Depression and/or anxiety
  • Infrequently filled prescriptions

 

Physical 

  • A1c of 9.0 or higher on a continuous basis
  • A1c inconsistent with meter readings
  • Unexplained weight loss
  • Constant bouts of nausea and/or vomiting
  • Persistent thirst and frequent urination
  • Multiple DKA or near DKA episodes
  • Low sodium and/or potassium
  • Frequent bladder and/or yeast infections
  • Irregular or lack of menstruation
  • Deteriorating or blurry vision
  • Fatigue or lethargy
  • Dry hair and skin

It would be of immense help if

  • Psychological factors should always be considered, assessed and excluded in all episodes of DKA.
  • Sufficient time, resources and training must be in place to enable diabetes healthcare professionals to identify and support people with diabulimia effectively.

References

1) Colton, P. A., Olmsted, M. P., Daneman, D., Farquhar, J. C., Wong, H., Muskat, S., & Rodin, G. M. (2015). Eating disorders in girls and women with type 1 diabetes: a longitudinal study of prevalence, onset, remission, and recurrence. Diabetes care, 38(7), 1212-1217.

2) Svensson, M., Engström, I., & Åman, J. (2003). Higher drive for thinness in adolescent males with insulin‐dependent diabetes mellitus compared with healthy controls. Acta Paediatrica, 92(1), 114-117.

  1. http://www.dailymail.co.uk/news/article-5554981/Patient-27-killed-asked-therapist-note-send-Dignitas.html
  2. Nationaleatingdisorders.org

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