Diabulimia – A New Eating Disorder?
News article published on: 24th September 2019
Diabulimia – A New Eating Disorder?
A recent TV documentary highlighted the problem Diabulimia. It is not a medically recognised condition, but it is a condition that affects people with Type 1 Diabetes. It occurs when a person with Type 1 Diabetes takes too little insulin in order to lose weight. It is usual after injecting with insulin for a diabetic person to eat a meal, snack or drink with carbohydrates shortly afterwards. However, the less insulin being injected leads to less food being consumed and any food eaten will lead to the body breaking down the fat in the food for energy and this can lead to an increase in the build-up of acid (ketones) in the blood.
What is Type 1 Diabetes?
Approximately 400,000 people in the UK live with type 1 Diabetes. This type of diabetes means that the body does not make or produce its own supply of insulin and so that person is unable to control how much sugar is in the blood. The pancreas is the organ that makes insulin and it is no longer able to do so. Insulin controls the level of glucose in the blood and if there is too much glucose in the blood a person can suffer hyperglycaemia. This is when the blood glucose level reading is over 14mmol/L. This can often happened if a person becomes unwell with another medical complaint such as an infection, stressed, less active, drinking alcohol to excess or not having enough insulin for the level of carbohydrates eaten. This can be dangerous as very high blood sugars lead to diabetic ketoacidosis and this can happen very quickly.
Hypoglycaemia is a potentially dangerous condition, it is when a person’s blood glucose level reading is less that 4mmol/L. This can happen when a person has their insulin but does not eat enough carbohydrate in their meal, exercises without eating enough carbohydrate, drinks alcohol on an empty stomach or takes too much insulin.
Recently, I have advised a family whose 26 year old son died of a hypoglycaemic attack. He had experienced over 100 of these due to the fact that he did not want to suffer a hyperglycaemic attack, he had experienced one and had to be admitted to hospital but the experience had left him with unpleasant memories. He suffered from autism as well as ADHD and he became focussed on keeping his blood glucose level under 4mmol/L to prevent him from suffering a hyperglycaemic attack. He was found deceased at home after suffering a severe hypoglycaemic attack.
Eating disorders and our mental health
It is clear that mental health issues had a part to play in the death of the 26 year old man. Eating disorders are a mental health issue. It has only been recently that people in the UK with Diabetes have access to help if they also suffer with an eating disorder. Professor Khalida Ismail, who leads the largest diabetes and mental health clinic in the UK at King’s College in London, wants that to change. The unit that she leads at Kings College in London seeks to unite psychiatrists and diabetes experts. She says “They never meet patients together and it’s an inefficient use of current resources …..I would argue we’d actually be saving money by joining up services“. I would agree with this. The 26 year old man who died was seeking help from diabetic specialists and the mental health services. His diabetic control was chaotic for many years, yet the mental health services refused to see him until his diabetes was under control and his blood glucose levels were maintained as a normal level. This never happened. He was unable to control his diabetes because of the fixed views he had on keeping his blood glucose low to prevent him suffering hyperglycaemia.
A Charity DWED (Diabetics With Eating Disorders http://dwed.org.uk/) has campaigned to have the omission of insulin for weight loss officially recognised as a mental illness. An insight into one diabetics difficulties can be found here https://www.beateatingdisorders.org.uk/your-stories/drifting-between-services. It clearly highlights how it is often difficult to get the diabetic and mental health services to work together as a team to get to the route of the problem.
“There is an awareness that this is probably bigger than we think, no-one really knows how big it is or how to detect it,” says Prof Ismail.
Author: Stephanie Prior (Medical Negligence and Personal Injury)