Type 1 diabetes whilst a manageable condition, is in fact a very serious and life threatening conditioning which is often misunderstood. It’s about more than just eating well. In reality, you need to be a mathematician! Imagine having to check your sugar levels countless times a day, add up the carbohydrates in every single food you eat, calculate how much insulin you need, deduct or add more for exercise. And then… it still all goes out the window because you’re stressed, sick or one of the million other things that can cause your blood sugar levels to rise. There is also the fear of going to bed and not waking up due to a dramatic drop in blood sugar levels. This is commonly known as dead in bed syndrome. Type 1 diabetes is relentless; it’s a fulltime job on its own. It’s scary, and it takes a huge toll on ones physical and mental health. How do I know this? I’ve been living with it for 20 years. It’s no wonder that individuals with diabetes also experience mental health problems as a direct consequence of living with the condition.
Diabulemia -> what is it?
The name diabulemia arose from the combination of diabetes and bulimia. It is an eating disorder specific to people with type 1 diabetes. In an effort to lose weight; people with diabulemia intentionally restrict their insulin. In type 1 diabetes, the immune system destroys the cells in the pancreas, which are responsible for producing the hormone insulin. When the body doesn’t produce insulin, our body’s cells cannot convert glucose (otherwise commonly referred to as sugar) into energy and as a result individuals must inject insulin daily so that their bodies can utilise the glucose.
So what does this mean?
When someone restricts their insulin, the body cannot use the glucose floating around the bloodstream. As a result, the excess glucose is excreted through urine and the body has to burn fat to gain energy, thus significant weight loss may occur. Unfortunately, this condition isn’t formally recognised as a medical or psychiatric condition, despite the severe impact that it can have among those affected.
- Significant weight loss
- Hyperglycaemia as a direct result of higher glucose concentration in the bloodstream
- Higher risk of developing infections
- Frequent episodes of diabetic ketoacidosis
- Increasingly frequent hospital and emergency room visits
- Earlier onset of diabetes complications, which are greatly accelerated including microvascular disease and peripheral nerve.
- Other complications of diabetes can also be seen at a higher rate including nerve damage, eye disease and kidney and heart diseases.
- In more extreme circumstances, coma or death are possible.
Opposing treatment methods
Due to the low prevalence of diabulemia within the population, there is limited knowledge and awareness of the condition. As a result, those affected are faced with difficulties when it comes to accessing appropriate treatment options.
Diabulemia has been happening for a long period of time, but hasn’t officially been recognised as the serious condition that it is. It is a very challenging condition to treat, because the combination of diabetes and bulimia are very conflicting, in treatment. Type 1 diabetes requires a real focus on nutrition, food labels and carbohydrate counting. Yet on the flip side, when we look at it from the bulimia perspective; treatment is focussed on NOT obsessing over these very things are that absolutely crucial to diabetes management.
It’s really important to understand that that type 1 diabetes is one of the most demanding chronic diseases both psychologically and behaviourally because 95% of the management is the responsibility of the individual. It’s important that all health professionals don’t just assume that the diabetes is being poorly controlled when things don’t add up. It’s important to ask questions such as how often do you think about body weight or are there times when its really hard to take insulin? As with other mental health conditions and eating disorders, psychiatrists are also needed in the management of diabetes. Regardless of your position, take time to look at the big picture and pick up on the cues from your patients. Eating disorders can take over your life and it’s so important as health professionals that we are there to support and guide them as they cope with the significant burden.