Medics fighting ‘world’s most dangerous eating disorder’

It’s been called the world’s most dangerous eating disorder and diabulimia could be just that, according to a BMJ analysis by health specialist Ingrid Torjesen. So what is it?

Well, the name gives it away – bulimia in someone who’s diabetic.

Diabulimia is an eating disorder in which patients with Type 1 diabetes cut down on their insulin to lose weight. This can lead to early onset of serious complications such as ­blindness and amputations.

It’s most common in young people aged between 15 and 30, particularly women, and involves a complex ­interaction of factors of diabetes and mental health.

Dr Dasha Nicholls, past chair of the eating disorders faculty at the Royal College of Psychiatrists, said: “Because diabetes forces you to focus on what you eat, it’s not unusual for that to get tangled up with feelings about food, weight and body image. That can become dangerous very quickly.”

Now diabetes and mental health teams on the south coast of England and in London have joined forces in pilot studies to tackle diabulimia.

Before diabetes is diagnosed patients lose a lot of weight. However, when patients start taking insulin they put weight back on.

Around one in five women and two in five men with Type 1 diabetes are believed to forego their insulin at some point to try to lose weight.

The study will aim to identify patients at risk so that a multi-disciplinary team can provide early psychological support.

Issues can be explored by the team at joint clinics and through phone support. Patients will be encouraged to make slow changes to bring their blood sugar down, perhaps increasing insulin by just one unit a week.

“As diabetologists we have no idea how to manage eating disorders and the eating disorders team have no idea how to manage diabetes, so it’s very much a multi-disciplinary thing. You can’t separate them out, you can’t treat one without the other,” says Dr Helen Partridge clinical lead for diabetology at the Royal Bournemouth Hospital.

“Even their way of working is different, with diabetologists allowing patients to take ownership of their condition, whereas the eating disorders team take control”, she added. “It’s important to integrate the two approaches according to what the patient needs at that time.”

The second pilot, run by King’s Health Partners in London, which has been providing specialist support to patients with diabulimia for some years, will try to demonstrate the effectiveness of an integrated diabetes and mental health approach in 40 patients with severe symptoms.

If the two pilots prove successful, the multi-disciplinary approach will be rolled out across England.