Diabulimia

I’ve been meaning for a couple days to write about “diabulimia,” an eating disorder that’s apparently frighteningly common among female diabetics, wherein they don’t take their prescribed doses of insulin, in order to lose weight. An AP article about it came out the other day, and The F-Word and Junkfood Science have covered pretty much everything I wanted to say. Check out the latter for a horrifying story of an “18-year-old living in a 90-year-old’s body” — as in, knowing she’s going to die very soon — because she wanted to be thin so badly.

As always, Sandy nails it in one paragraph:

The take home lesson for anyone who knows a young person, whether or not they’re diabetic, is to first recognize the harm of today’s diet and thin-obsessed environment and understand these complications, according to doctors Ira M. Sacker, M.D. and Marc A. Zimmer, Ph.D. in Dying to be Thin. Most often, the early signs of anorexia or other eating disorders are missed because everyone is happy for the person involved in “successful” dieting or “taking more responsibility for managing his/her food intake. That generally positive feeling can prevail to the point where it is very difficult to see that the person’s eating habits are really not appropriate at all.”

The only other thing I’ll add is that I find this especially horrifying because I have two little diabetic cousins, 12 and 13 — just the right age to start developing eating disorders. They’re both beautiful — and thin — girls, but anyone who’s ever been a teenaged girl knows that being thin has very little to do with thinking you’re fat. Of necessity, these girls have been obsessively counting calories and avoiding sugar — i.e., chronically dieting — for pretty much their entire lives, and now they’re about to be thrown into the snakepit of high school. Diabetes already substantially increases the risk of developing eating disorders, and for these girls, taking the dieting a step further would mean inviting blindness, loss of limb, kidney failure and heart failure — not somewhere way down the line (which is already looming out there for them), but like, in their twenties.

And a lot of girls are already making that choice. Sandy mentions a study published in The New England Journal of Medicine that found 34% of diabetic young women skipped or cut down on their insulin to lose weight.

If you don’t agree with any of the other reasons I ramble about for why this culture needs to quit being so goddamned fatphobic, think of that. Teenaged girls would rather go blind at best and die extraordinarily young at worst than be fat. Something’s gotta give.

Posted in Fat

12 thoughts on “Diabulimia

  1. Oftentimes when I point how how deadly EDs can be to people the response I get is, “But that’s only a few people, compared to endlessgodzillions of obeeeeese people.” I mean, really. I just pointed out the guy sitting on the park bench playing Russian roulette, and their response is, “Well, what about all the people out here on the streets who have loaded guns at home?” Talk about Not Getting It and Not Wanting It!

  2. Or maybe that should be, “Well, what about all the people who don’t have any guns to protect them?” Dang, I’ll have to work on that metaphor, I guess.

  3. I have to say, I’m sensing a media-made-phenomenon here. There are so many qualifiers in all the info I’ve seen on this “may be,” “up to,” etc. The article does present some anecdotal evidence, and one “diabulemic” is too many, but I don’t know that we have any reason to believe that this is really widespread.

  4. It’s true, even the NEJM study referenced above only covered 91 diabetics. That’s a pretty small sample size. Thanks for pointing that out, Sara.

    Still, the story points out how little is really understood about diabetes, even now. Exceptionally high blood sugars can lead to weight loss, but still, diabetics (especially type 2′s) are rapped over the head constantly about “weight management” and told that if they’re thin enough they’ll be “cured.” I can see how kids, especially, can get confused enough to think high blood glucose = healthy, or at least healthy looking enough to get people off their case.

  5. This isn’t a media made-up term, sadly, and describes a problem that’s been in the medical literature for decades (I could only reference a handful in this post). Luckily, diabetes in children isn’t widespread (despite the media hype), but I honestly don’t believe that lessens the importance of this research. The most credible medical studies consistently report inordinately higher rates of eating disorders and body image issues among young diabetics — JUST like the studies on young people who begin controlling their eating with diets they’re told is for their health. Diabetics have an especially deadly and dangerous tactic they can use — and consistently pediatric endocrinologists are finding it is the most common weight management technique used by weight-conscious diabetics. I think there’s a critically important issue screaming out here about how this obesity insanity is messing up kids — fat and thin ones. That these young people would resort to this is simply heartbreaking. I agree with Kate, this has to stop. I hope your cousins do well and desperately hope that this information can help girls like them.

  6. I hadn’t heard about this and it’s rather frightening. I work as a social worker in a dialysis facility and diabetes is one of the 2 major causes of kidney failure. It’s terrifying that these kids, no matter how many, have latched on to this….and unfortunately, it’s not like russian roulette. There is no chance that you are going to dodge the bullet if you mess with your diabetes management.

  7. These girls’ experience (and I presume some boys are doing it too, but as usual nowhere near as many) contrasts so much with what I know of how my brother manages his Type 1 diabetes. He’s had it since kindergarten.

    The thing I have really noticed over the years when I’ve been doing (amateur non-health-professional) research on type 1 management and treatment is there seems to be a massive difference between the way it’s done in the USA and in Australia. Nearly all the info from the USA talks a LOT about counting calories and carbs and portions and exchanges and is very much about micro-management and having ‘perfect’ blood glucose readings.

    This contrasts with the the advice and literature my brother’s been given, which is much more generalised, talking about “these foods will give you a big sugar dump, eat less of them” and working out what works for you. My brother actually eats a relatively normal diet (except he tends to go for diet soda, most of the time), with no carb-counting or meal plans and such, and his endocrinologist is pretty happy with him, and from what I can tell, this more relaxed attitude is fairly common. The highly-managed stuff is left for people who tend to be older type 1s, who are getting the body/metabolism changes that come with being 45+, or younger ones who are having a very hard time of it.

    And I wonder if this difference in attitude has anything to do with it, as we all know that carb/calorie/etc-counting is very triggering for eating disorders.

  8. Sandy, no prob about jumping in — thanks! I was away from the computer all afternoon, so I’m glad you were here to clarify things.

  9. La Di Da, my (fairly sketchy) understanding is that the method you’ve described of tight diet control and constant insulin dosage is pretty much the “old” way of type I diabetes management.

    In Australia these days, while control of blood sugar is still expected to be tight for the prevention of complications, most endos seem to be recommending it be achieved in a way far more compatible with normal life (and rather more physiologically normal!) – eating a normal, healthy, varied diet, while measuring blood sugar frequently and adjusting insulin dosage accordingly, often using combination basal/bolus (long-acting/rapid-acting) insulin regimes to achieve a reasonably constant sugar level.

    So the carb counting is still done, but not in the sense of “I’m only allowed 30 g of carbs” – more “I’m about to eat 50 grams of carbs, therefore I’ll inject x units of insulin”.

    It’s far more sensible to expect people (especially teenagers) to adjust their insulin to their carb intake rather than the other way around.

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