Diabulimia: The Dangerous Eating Disorder That Isn’t Yet an Official Diagnosis

If you or someone you love has Type 1 diabetes (T1D), you know that getting the right amount of insulin is important to staying healthy. What you may not know is that people with T1D have a significantly increased risk of developing eating disorders. In adolescent girls, the risk of eating disorders is twice as high in those with T1D than those without it. 

Diabulimia is likely related to the constant focus on weight, nutrition, and medication that comes with having T1D. Add to this the very typical preoccupations with body image, self-esteem, relationships, family pressure, and educational stress that come with adolescence and early adulthood — and you can see how this creates the perfect recipe for disordered eating. 

What is diabulimia?

Diabulimia is a type of eating disorder that affects about 10% to 40% of people with Type 1 diabetes, especially females. It’s a nonmedical term that combines the words “diabetes” and “bulimia.” People with diabulimia skip or limit their insulin in order to lose weight. This can have serious effects on both mental and physical health. Diabulimia isn’t yet an official diagnosis, but it’s among the most dangerous eating disorders. Research is underway to find out more about the lived experience of people with diabulimia and determine how best to treat it.     

Promotional Disclosureinfo_outlined

SPECIAL OFFER

Save every month on GLP-1 meds with GoodRx

Save an average of $235 on FDA-approved GLP-1s like Ozempic and Zepbound.

Get Savings

How does skipping insulin affect weight?

Insulin is a hormone that plays an important role in balancing your blood sugar levels (also called “glucose”) after a meal. Insulin helps your body use the glucose it needs for energy and then stores the rest in the liver, muscles, and fat. 

When someone doesn’t make enough insulin (such as in T1D), they cannot balance their glucose intake with their energy needs. This causes high blood glucose levels, weight loss, and other concerning symptoms (more on this below). 

For some people with T1D, the risk of serious, long-term health complications from untreated diabetes may seem a price worth paying for short-term weight loss. But this is a dangerous game to play. Here’s why.

Risks and complications of diabulimia

Intentionally skipping insulin (or not taking enough) when you have T1D causes high blood glucose levels and a whole host of short-term and long-term health complications. 

Short-term health consequences

• Increased risk of bacterial and yeast infections

• Slow healing when you cut yourself

• Loss of muscle mass

• Dehydration

• Diabetic ketoacidosis (a life-threatening condition that happens when blood glucose is dangerously high)

Longer-term health consequences

• Permanent damage to your nerves (neuropathy)

• Permanent damage to your eyes (retinopathy and macular edema), which can lead to blindness

• Osteoporosis

• Kidney damage that can lead to kidney failure

• Heart disease

• Increased risk of death and of dying younger

Many of these health problems are irreversible once they set in, so diagnosing and treating T1D and diabulimia early is very important. 

What are the symptoms of diabulimia?

The warning signs and symptoms of diabulimia can be both physical and emotional. 

Physical symptoms

A higher blood glucose level than what’s safe for the body is the main cause of the physical symptoms. In this way, the symptoms are similar to untreated or undertreated diabetes: 

• Constant thirst

• Weight loss

• Blurry vision

• Frequent urination (peeing) 

• Feeling tired

• Decreased or no menstrual periods

• Frequent nausea and/or vomiting

• Fruity or sweet-smelling breath (a sign of ketoacidosis, a life-threatening complication) 

• Collapse

Emotional and behavioral symptoms

Psychological symptoms of diabulimia can be similar to other eating disorders. They can include feelings and behaviors like:

• Fearing that “insulin makes you fat”

• Overexercising and binge eating

• Being secretive or evasive about diabetes management

• Not filling insulin prescriptions

• Not checking blood glucose levels regularly

• Having anxiety about body image or weight gain

• Having depression or mood changes

• Being overly focused on food or calories

• Feeling depressed or anxious

• Withdrawing from friends of family

Who usually gets diabulimia?

Anyone with T1D can develop diabulimia. Some estimates show that 40% of women and 10% of men with T1D have symptoms of diabulimia. It can affect any age, but it most commonly begins in early adulthood.

People who have experienced trauma, abuse, or bullying may be more likely to develop diabulimia. Negative feelings toward diabetes and insulin are also associated with insulin restriction. People with T1D may be especially likely to experience these feelings because they often gain weight after starting treatment with insulin.

Although people with Type 2 diabetes (T2D) are also at increased risk of having an eating disorder, it usually isn’t diabulimia. Even though some people with T2D use insulin for treatment, skipping or restricting insulin does not cause weight loss in the way that it does in T1D.   

Getting help if you think you have diabulimia

There’s no single test to diagnose diabulimia. Your provider may ask you questions about your eating habits and any concerns you have about your weight or body image. It may be hard to talk about, but it’s important to be open and honest about what you’re feeling and how you are managing your diabetes. They may also ask you specific questions about your diabetes data, such as your:

• Blood glucose values

• Continuous glucose monitoring

• Insulin use

• Recent hemoglobin A1C (HbA1C or A1C) value

Using all this information, together you and your provider will determine what the next best steps are for you. This may include meeting with a therapist or other provider who specializes in treating diabulimia.

Treating diabulimia

Treatment for diabulimia involves a team approach that addresses many issues at once. This includes an endocrinologist, a nutritionist, and a mental health specialist who treats eating disorders. Treatment may incorporate these different components:

• Participating in psychotherapy or counseling (like with family-based therapy, cognitive behavioral therapy, or motivational interviewing)

• Developing a realistic and flexible diabetes management plan

• Monitoring glucose to keep it within target range 

• Managing nutrition to have a healthy and balanced diet

• Taking medications (antidepressants like fluoxetine are especially helpful when there’s depression or anxiety)

Diabulimia support and resources

If you have Type 1 diabetes and find yourself skipping insulin to change your weight, help is available. It’s important to recognize the signs of diabulimia early and get treatment. If you’re not sure where to start, talk to your provider or visit one of these resources:

• Diabulimia Helpline (425-985-3635) 

• National Eating Disorder Helpline (800-931-2237)

• Diabetes UK

Why trust our experts?

Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Our editorial standards

Meet our experts