A danger called diabulimia
By Express News Service
27th January 2013 12:00 AM
When one suffers from Type 1 Diabetes, he or she needs to take insulin, because the body isn’t making it on its own. That’s the way to tackle the problem. But there are some who skip taking insulin to facilitate weight loss. And experts say it is a dangerous thing to do as it can be fatal, since skipping insulin will mean less food will be used by the body. This insulin omission is known as diabulimia, and leading doctors and psychiatrists are saying that it should be recognised as a mental health problem.
Often, people with diabulimia are those who have been diagnosed with conditions like anorexia nervosa, bulimia nervosa and/or compulsive eating. When they get into the habit of skipping insulin, they do not realise what might be the repercussions. And those effects can be as bad as blindness and damage to the kidney. And it can even kill the person, say the doctors. But the urge to stay thin makes many to take the risk, till they are forced to consult the physician due to some side effect.
While the long-term effects of the condition can be as bad as of Type 1 Diabetes, the short-term consequences include dehydration, frequent urination and glucosuria, insatiable thirst, increased appetite, high blood glucose levels, fatigue, decreased concentration, electrolyte imbalance, and weight loss. Long-term consequences include heart attack, stroke, retinopathy, nephropathy, neuropathy, gastroparesis, vascular disease, gum disease, and infertility. There’s also the possibility of death.
Not surprisingly, most of the people who skip insulin in order to lose weight are young women. Some of them suffer from poor self-image as weight gain due to insulin becomes a concern for them. Says Gauri Panchbhai, a literature student in Pune: “I was diagnosed with Type 1 Diabetes and I felt the need to keep a check on what I am eating in order to control weight. I guess this constant need to control my diet led me to decide that I must do away with the insulin as it was leading to weight gain.” It did affect her appetite and she became less alert. When she consulted her doctor, he wanted to know about insulin intake. “On learning that I have been skipping them, the doctor told me the damages that can be caused,” says Gauri who has since gone back to the insulin routine.
To tackle the condition, the patient must be educated, say experts. Using motivational interviewing and Cognitive Behavioural Therapy (CBT) works best with such patients. The CBT helps patients to have a better understanding of the thoughts and feelings that influence their behaviours. Mental health professionals should be part of the team dealing with the patient. The patient needs to be told that they don’t have to restrict food because of diabetes, but match carbohydrate intake with insulin doses instead. Losing sight is worse than gaining weight. Once that is understood, the mental block against insulin will go. Gauri could do it. What about others?
Signs and Symptoms of Diabulimia
A haemoglobin A1c value much higher than would be expected, given recorded blood glucose values;
Changes in eating habits (eating more but still losing weight);
Dramatic shifts in weight;
Bingeing on carbohydrates and sweets;
Obsession with food and body image;
Anxiety about weight or avoidance of being weighed;
Physical signs of malnutrition (eg, hair loss, dry skin).
Delay in puberty or sexual maturation;
Irregular or no menses.
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