I recently had a conversation with someone who suffered with diabetes. I was shocked at the abysmal blood sugar control and I was curious to know why. It didn't take long to discover that this person suffered with Diabulimia. When I heard that word, it immediately rang a bell. I knew that I had heard it somewhere before.
It was while watching a podcast on YouTube where a metabolic scientist was explaining one of the biggest problems we have with with health and healthy living in the society today— insulin resistance. Sadly, it is a phenomenon that is mostly driven by the kind of food we eat today, one that is recommended by the government and our health associations. I remember the shock I felt when I realized that most of the dietary recommendations where not a product of proper scientific research but the bias that a group of people had regarding food.
The Food Pyramid Scam
As a medical student, one of the ideas that was quite popular was the idea of macronutrients and the food pyramid. The food pyramid is a pictorial representation that shows the dietary recommendations for healthy eating. It is essentially what the government said is a healthy balanced diet that every body should eat. It became the guide for feeding in schools and hospitals. It is basically what has influenced our eating culture for a very long time. It was pushed forward as the product of years of research by scientists and various experts in the field of nutrition and health.
The problem is that the number of people with diabetes has risen significantly since the inception of the food pyramid. In other words, since the government decided to tell us how to eat, the number of people falling sick with diabetes has been increasing. Could it be a coincidence? Could it just be that we are having more testing and people are more aware of their health? Maybe. But it is definitely something to think about.
Another problem we have encountered is that the recommendations have fostered an unhealthy relationship with food in many people. A subject that deserves a post on it’s own.
Diabetes and Food
Ever since diabetes came to be recognized as a disease, people have found that changing their diet and their relationship with food could help them live longer and without complications even when there wasn’t life saving medication available. When insulin, came along, it brought with it so much hope and many people who lived with diabetes were able to live without fear of the devastating complications of diabetes.
But Insulin also brought some form of complacency. People with diabetes were told to eat whatever it was that they wanted as long as they were taking the dosage of insulin that matched what they ate. So, someone with diabetes could take 5 boxes of chocolate and still be fine as long as he/she took his insulin regularly.
Gaining weight on insulin
Another problem arose, people who took insulin were beginning to find out that the more insulin, they took, the more weight they gained. So it was, people with diabetes were eating whatever they wanted, taking more and more insulin to control their blood sugar and getting fatter every year. For some people, the increase in weight became a problem. They became quite obsessed with how they looked. They did not want to look fat, they wanted to be able to fit into their bikinis. They wanted to be lean. So they began to look for ways to get their weight down.
But they still loved to eat anything they wanted. They did not want to be that guy that would change his diet in other to loose weight. They still wanted to enjoy a full carrot cake and blueberry muffins. They still wanted to have 4 sugars in their coffee. They still wanted to have pizza and burger with fries and a soda. They wanted to eat everything they could and still not gain weight while taking insulin.
Accidentally, they discovered that if they do not take their insulin, they could eat as much as they could and still loose weight. These folks would denature their insulin injections, reduce the dose or completely omit it while eating as much as they have been eating and still not gain weight. This is what is known as Diabulimia.
Most people with this condition cannot help themselves. They know that it is dangerous to skip their insulin injections. They may have even been admitted in the hospital on occasion because they may have suffered some devastating effects of Diabetic Ketoacidosis. But they find it extremely difficult to stop, or regulate their food and take their insulin as appropriate.
Who does this affect?
This condition affects mostly people with type 1 diabetes, especially those who are young adults or adolescents. It has been found that up to 40% of women with type 1 diabetes try to mess with their insulin as way to control their weight. It seems to be more common in women, even though it does affect men.
What Causes This?
There are a lot of things that may contribute to the development of diabulimia but the most prominent one seem to be the psychological factors.
- Psychological/Mental factors: e.g. anxiety, depression, history of other eating disorders(bulimia nervosa), can increase the likelihood that someone would develop this condition.
In addition, if there is a family history of eating disorders or mental health issues, it can also increase the risk for an individual with diabetes.
- Social and Cultural Pressures-- for adolescents and women, there has been a gradual societal shift that emphasizes thinness/leanness. This emphasis does does not take into account the fact that the way people get thin might be unhealthy and even completely detrimental to their overall wellbeing. This pressure from social media and influencers can lead people towards behaviours that are unhealthy in other to control their weight.
The fact that insulin itself drives weight gain prompts people to avoid/ restrict their intake of the medication in other to avoid any weight gain.
What Can We Do About It?
Helping people with diabulimia is not the job of one person. It involves a lot of people coming together to help.
- In situations where the individual already has complications from high glucose levels, it is important for that to be treated promptly in the hospital.
- Psychological Therapy can help address the thoughts and mindset about food to help the individual gain control of how he or she relates to food.
- Dieticians can also help to provide an eating plan that is sustainable as well as balanced to help regulate blood sugar levels.
- In some cases, it might be important to have some medications especially when there are other mental health issues like depression and anxiety to deal with.
- Having a family and support system is also very important as it can help to improve long term recovery and encourage a person to stick to the treatment plan.
Conclusion
Diabulimia is serious. It is potentially life threatening. Being aware of the problem is one step towards solving it. In addition, understanding that it is not your fault is also important to begin the journey towards healthy living. It is important to seek professional help if you or someone you know suffers with this condition.
