In the last 15 years, a new eating disorder phenomenon has gradually earned more and more attention. The condition is formally known as ED-DMT1, for eating disorder and diabetes mellitus Type 1. The condition is also frequently referred to by the more informal name diabulimia. As both names suggest, this condition refers to the diagnosis of an eating disorder in patients who are living with Type 1 diabetes (formerly referred to as insulin dependent diabetes).
It is likely that this condition has been around in some form ever since physicians began to prescribe daily insulin injections in order to treat Type 1 diabetes. However, the term diabulimia was not coined until about 15 years ago, when it became clear that the problem was widespread enough to demand attention.
What Is ED-DMT1?
ED-DMT1 can be a little confusing to understand, in part because it is not yet formally recognized as a distinct eating disorder. Currently, ED-DMT1 refers specifically to the practice among some patients with Type 1 diabetes of using their insulin to control their weight or to lose weight.
As more light has been shed on this practice, the term ED-DMT1 has gained favor over the shorter and easier to remember “diabulimia.” This is because the term diabulimia implies that these patients are suffering from a form of bulimia, which is not always the case.
Some people argue that withholding insulin in order to absorb fewer calories and lose weight is a form of purging—a classic symptom of bulimia. However, many experts feel that the condition may be more distinct, and that patients should not be thought of as having bulimia unless they regularly binge eat and purge through vomiting or laxatives. Many people with ED-DMT1 do exhibit these symptoms, but many others do not have any eating disorder presentation apart from their insulin misuse.
How Does ED-DMT1 Work?
People who suffer from Type 1 insulin dependent diabetes are unable to naturally produce the hormone insulin. Insulin is responsible for helping the body’s skeletal and muscle tissue absorb glucose from the blood stream.
Glucose is the body’s main source of energy, and the body will not begin to break down fat to use as energy until the body’s supply of glucose is used up. With little or no natural insulin in their systems, diabetics are not able to efficiently absorb glucose and eventually excrete most of it through their urine.
Most diabetics will carefully monitor their glucose levels and self-administer insulin on a regular basis. However, people with ED-DMT1 will give themselves too little insulin or sometimes no insulin at all so that they cannot absorb enough glucose. Without this natural energy source, the body will turn to breaking down fat much more quickly and weight loss will result.
Consequences of Diabetes and Eating Disorders
Many people with eating disorders face the risk of malnourishment and becoming dangerously underweight, as well as various other health consequences. However, diabetics with eating disorders face other and often greater health risks that are specific to their situation.
Insulin restriction can lead to kidney failure, nerve damage, vascular disease, visual deterioration, blindness and amputated limbs. Lack of insulin can also result in acute medical emergencies such as nonketotic hyperosmolar coma and diabetic ketoacidosis (which can also result in coma). Both of these conditions can be fatal.
How Common Is ED-DMT1?
A study published in BMJ (formerly the British Medical Journal) found that people with diabetes were 2.4 times more likely to be diagnosed with an eating disorder as people without diabetes. Other studies have reported that as many as 30 percent of females with Type 1 diabetes have had eating disorders or exhibited disordered eating. These rates are significantly higher than those found in the general population, where between 1 percent and 2 percent of females meet the diagnostic criteria for bulimia, while between 0.5 percent and 1 percent of females meet the diagnostic criteria for anorexia.