Diabulimia is often used to describe an eating disorder that centers on intentionally restricting insulin to stimulate weight loss. The result is high levels of glucose in the blood that spill over into the urine, leading to the excretion of the calories from glucose. The repercussions can be severe, including dehydration, loss of lean body tissue, and, in extreme cases, DKA. Diabulimia is shockingly common; as many as a third of women with type 1 diabetes report insulin restriction, with higher levels among those between the ages of 15 and 30.
Once insulin restriction or other disordered eating behaviors become engrained, a cycle of shame, guilt, and other negative feelings can make it difficult to get help and the condition difficult to treat. A team-based approach is the gold standard, with inclusion of a mental health professional along with the other team members (endocrinologist, nurse educator, dietician, etc.). In severe cases, hospitalization may be necessary until mental and medical stability are achieved. Monthly or more frequent appointments with members of the care team may be needed.