Q. One of my patients, a woman in her early 20s with diabetes type 1 (T1DM) and binge eating disorder (BED) has been eating erratically, including withholding her insulin doses in an attempt to lose weight. Have you heard of any approaches that might help her counteract these practices? (A.J., Baltimore)
A. A relatively new term, ‘diabulimia,’ refers to the practice of skipping insulin doses to lose weight. A recent study (Endocrinology, Diabetes & Metabolism, 2024; 0:e473), establishes a significant connection between eating disorders and T1DM, particularly bulimia and binge eating. Moreover, female diabetics are at higher risk of insulin misuse/omission than males, although much more study is needed to differentiate any differences by gender.
No clear approaches have been reported to counteract the wish to lose weight by skipping insulin doses, followed by the risk of hypoglycemia. The best approach for this population seems to include early proactive screening and tailored, comprehensive, intervention. Early referral to a specialized psychiatrist is also recommended.
