Dr. Goebel-Fabbri in The Boston Globe Dr. Goebel-Fabbri on CNN  Dr. Goebel-Fabbri on Good Morning America

Eating disorders in type 1 diabetes such as "diabulimia," as it is known in the popular press, represent some of the most complex patient problems—both medically and psychologically. Women with eating disorders and diabetes typically struggle with symptoms similar to those of women with eating disorders who do not have diabetes.  However, they exhibit a very dangerous symptom of calorie purging in the form of insulin restriction.

This condition is characterized by weight and body image concerns that lead to the mismanagement of diabetes.

-- Recognize eating disorders in diabetes 

Warning signs may include:

• unexplained elevations in A1C values
• repeated problems with diabetic ketoacidosis (DKA), which can be fatal
• extreme concerns about weight and body shape
• change in eating patterns
• unusual patterns of intense exercise (sometimes associated with frequent hypoglycemia)
• amenorrhea (skipping monthly menstrual periods)

Women with type 1 diabetes are more than twice as likely to develop an eating disorder than age-matched women without diabetes.

-- Understand the medical risks associated with eating disorders and diabetes

• higher A1C levels
• higher risk of developing infections
• more frequent episodes of DKA
• more frequent hospital and emergency room visits 
• higher rates and earlier onset of diabetes complications - nerve damage, eye disease, kidney disease and possible heart disease

The cycle of negative feelings about body image, shape, and weight; chronically elevated blood glucose levels; depression, anxiety, and shame; and poor diabetes self-care and insulin restriction is difficult to treat (see figure below).      

Given the extent of the problem among women with diabetes and the severe medical risks associated with it, further research aimed at targeted and effective treatments is critical to the future health of this at-risk population.  

All images on this page are copyright by Ann Goebel-Fabbri, Ph.D.
Psychologist, Joslin Diabetes Center
Investigator, Behavorial and Mental Health, Joslin Diabetes Center  
Instructor in Psychiatry, Harvard Medical School  
 
For more information or to schedule an appointment, please call 617-732-2594.