(105) A Case of Diabulimia in a 23-Year-Old Woman with Extensive Comorbidities

Abstract: Title: A Case of Diabulimia in a 23-Year-Old Woman with Extensive Comorbidities



Aim: To produce a case report on a type of eating disorder unofficially known as diabulimia in a complex patient presentation supplemented by a literature review.



Background: A 23-year-old woman presenting with diabetic ketoacidosis for the sixth time in as many months is determined to have diabulimia as the underlying cause of her repeated episodes. Diabulimia includes behavior such as intentionally withholding insulin injections for the purpose of weight loss in the setting of type 1 diabetes (T1D). It is characterized as an eating disorder but lacks DSM diagnosis status. As such, recognition of the condition among medical professionals is limited but growing.



Methods: Conducted searches of Pubmed database using key terms "diabulimia", "diabulimia prevalence", "diabulimia comorbidities", "diabulimia diabetes", and "diabetes eating disorder".



Results: Review of literature suggests that diabulimia is a significant problem among female diabetics. In an American study of females with T1D ranging in age from 13-60 years, 31% reported having intentionally omitted insulin over the course of their disease, with nearly 9% of respondents indicating that this behavior occurred frequently. Among those omitting insulin, half stated that weight control was their primary reason for their behavior. Many individuals with diabulimia persist in their behavior despite full awareness of the potential detrimental medical consequences.



Conclusion: The need exists both for greater awareness of the condition among physicians and for recognition of the condition as a legitimate diagnosis. Patients require greater access to specialized care as well as more options for treatment. Diabulimia remains underrecognized in the patient population and can only be adequately addressed with a multidisciplinary response from healthcare professionals educated in this condition.



References:

Winston AP. Eating Disorders and Diabetes. Curr Diab Rep. 2020;20(8):32. Published 2020 Jun 15. doi:10.1007/s11892-020-01320-0

Polonsky WH, Anderson BJ, Lohrer PA, Aponte JE, Jacobson AM, Cole CF. Insulin omission in women with IDDM. Diabetes Care 1994; 17: 1178–1185.

Coleman SE, Caswell N. Diabetes and eating disorders: an exploration of 'Diabulimia'. BMC Psychol. 2020;8(1):101. Published 2020 Sep 23. doi:10.1186/s40359-020-00468-4