Diabulimia: Q & A with Dr. Joel Jahraus

Chief Medical Officer Dr. Joel Jahraus, MD, FAED, CEDS is well-known and respected for his two decades of specialization in the medical management of patients with eating disorders. A board-certified physician for over 30 years, he is a recognized expert on diabetes and the medical complications of eating disorders. In this week’s blog post, Dr. Jahraus shares his insight and knowledge regarding diabulimia, a contemporary term for individuals with both Type I diabetes and an eating disorder where the individual purges by withholding his or her insulin.

1. How would you define diabulimia? 

Diabulimia is a contemporary term for individuals with Type 1 diabetes and an eating disorder where the individual purges by withholding his or her insulin, thereby, making food ingested ineffective for use by the body. This action results in weight loss and severe systemic complications, including diabetic ketoacidosis which is potentially lethal.

2. Do you consider diabulimia to be a real diagnosis, or just a way to describe a variation of bulimia (since it is not specifically in the DSM 5)?
It is a contemporary word that bridges the terminology between diabetes and bulimia, but is not stated specifically as diabulimia as a mental health diagnosis in the DSM V.

3. How common is this type of eating disorder? Especially for women?
I co-chaired an international consensus panel on this evolving illness in 2009 in Minneapolis, MN.  In doing that literature search we found it exists in the following percentages among different age populations:

2% of preteen girls
11-15% of midteen girls
30-39% of late teen girls

4. What are the top signs of this eating disorder?
The typical presentation is similar to other eating disorder patients with body image issues, and other mental health concerns. However, the difference is these individuals “purge” by withholding their insulin. Insulin is important in effectively utilizing calories ingested for health. Without insulin the body does not utilize these calories and the individual loses weight; the net impact is similar to anorexia or bulimia. However, the typical complications of diabetes are then much accelerated and the mortality or death rate from premature death increases dramatically:

Mortality rates (Nielson 2002):
Type 1 DM:  2.5%
Anorexia nervosa:  6.5%
Combined Type 1 DM and Anorexia nervosa:  34.8%



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