Eating disorders are one of the best known mental problems, and one of the ones that has increased the most in recent decades due to a culture and society with very demanding aesthetic canons.If we talk about these problems, two names come to mind, which represent the best known, common and dangerous diagnoses within this category: anorexia and bulimia nerve.
We know that these are potentially fatal conditions if a treatment is not received, and that these people resort to practices such as control or even cessation of intake, continuous and excessive realization of exercise, the use of laxatives or the act of provokingThe vomit.
But ... what happens when food problems are added to a metabolic or endocrine pathology or disease, such as diabetes?In this sense, there are also alterations within the specific eating disorders of this sector of the population.This is diabulimia, a dangerous eating disorder that some people with insulin -dependent diabetes can suffer.
preamble: type 1 diabetes or insulin -dependent
Diabulimia is a highly dangerous and deadly potential condition for those who suffer from it, but to understand what we are talking about first it is necessary to know what type 1 diabetes is.
Diabetes mellitus is a metabolic and endocrine disease which is characterized by the existence of a difficulty or impossibility of our body to metabolize glucose, due to the presence of alterations in the so -called beta cells of the Langerhans islets of our pancreas.Under normal conditions these cells are responsible for synthesizing and secreting insulin, which allows food glucose to be processed and their blood levels be reduced.
However, in the case of people with diabetes, these cells do not work properly, so that when eating glucose it rises to a large extent and the body is not able to process it.In the case of the Diane, what is known as hyperglycemia appears, in which glucose levels are above 126 mg/dl.
It is a dangerous situation in which symptoms appear such as increased hunger, weight loss (sugar is eliminated through unprocessed urine), asthenia, blurred vision, polydipsia or need to drink continuously and/or polyuria or polyuria or needFrequent to urinate regardless of the drunk.
There are several types of diabetes: type 1 or insulin -dependent, type 2 or non -insulin -dependent and gestational.In type 1 diabetes the person the person of the person is not able to secrete insulin naturally, which needs to inject it externally: it is insulin -dependent.
In type 2 there is secretion but the cells do not work properly and occurs less than what would be necessary, and in gestational there is the case that a pregnant woman temporarily suffers (generally) a dysfunctionality in synthesis and managementof insulin mainly due to the hormonal changes of pregnancy.
It is a known cure disease but with effective treatments that must be maintained throughout life, and that if it is not controlled, it can have serious effects on the nerves, the heart, the blood vessels, the liver, the kidneys, the eyes, the eyes, the eyes, the eyes,The skin, mouth and teeth, kidneys or feet.Without treatment, it could cause neuropathies, sensitivity losses, facilitates the possibility of vascular accidents, erectile dysfunction, blindness, diabetic foot, insulin coma or even death.
diabulimia
A condition or disorder receives the name of diabulimiaFood that can occur in people with type 1 diabetes or insulin -dependent, which is characterized by the presence of bodily distortions and obsession with weight loss that cause voluntary negligence, reduction or cessation of insulin treatment as a method to reducebody weight.
This implies that the person who suffers does not carry out the treatment of their medical condition or that modifies it with the purpose of losing weight, since as we have commented on the loss of this is one of the typical symptoms of hyperglycemia.In this sense, diabulimia is an especially fearsome condition, since the already dangerous symptomatology of an eating disorder is added to suffer from an insulin -dependent diabetes whose treatment is systematically negligible.
In addition to the manipulation and alteration of the use of insulin, it is possible that those who have this alteration come to manipulate the data reflected by their glucometers in order that when the controls are carried out with the doctors they mark values lower than those corresponding.Although in some cases they carry apparently normal diet, there are usually irregular food guidelines with severe restrictions and possible binge restrictions.It is also frequent that there are symptoms of anxiety and depression.
As with most eating disorders, diabulimia is especially common in adolescent women or young adults, although cases in men are also observed.Although the name of Diabulimia is a composition between diabetes and bulimia, in fact it is an eating disorder that could be considered by itself as it has very specific characteristics (although the use of insulin could also be considered as a behavior of purge of the own of thebulimia).
In addition, this alteration has also been identified not only in bulimia but also in anorexia.It is a disorder that is currently not yet found as such in diagnostic manuals such as DSM-5, but that could be considered as another eating disorder and specified food ingestion.
symptoms
Sometimes diabulimia can go unnoticed, since in some cases those who suffer from it can make an apparently normal food consumption even though they do not medicate in order not to gain weight.Also, sometimes it is confused with a patient with diabetes with little adherence to treatment.
However, it is common for those who suffer from having difficulty and discomfort to eat in public or give samples of discomfort if they had to inject insulin when they eat in public.In the same way and as with other eating disorders, the rejection of the body figure itself, the fear of weight and excessive concern for weight is a constant that also occurs in these cases.Also, erratic behavior when going to the doctor to perform controls can be a symptom.
possible consequences
The effects can be devastating, and are largely resemble those of hyperglycemia or lack of control between hyperglycemia and hypoglycemia: not applying a treatment or doing it to a lower amount than necessary together with the realization of other behaviors such as fasting can affectto the nervous system and contribute to the appearance of a neuropathy that can affect among other parts of the body to the eyes (it can lead to blindness).
The cardiovascular and cerebrovascular system, kidneys and liver also are in danger, making problems like renal failures more likely (renal problems are much more common in diabetic subjects with eating disorders) and/or/orhepatic, stroke or heart problems.It is also common for frequent hospitalizations for ketoacidosis, in which the body consumes at high speed the fats of the body in an attempt to obtain energy.In fact, diabulimia can greatly reduce the life expectancy of those who suffer from it.
causes
As with the rest of eating disorders, a single cause or origin of diabulimia is not known.It is considered that we are facing a disorder whose causes are multifactorial.
This disorder is present only in diabetic patients, and it is common for adolescence to appear.It is not uncommon for the restriction of diabetes treatment to be behind the first moments of diagnosis, realizing that non -treatment of your condition can be used as well as vomiting or food restriction.
Another factors that help explain this disorder is in the overvaluation of the importance of body image and weight (something that on the other hand is also favored by the beauty canons of our society), in addition to a possible attemptof feeling the ability to control your life that is projected on the food field (the subject may feel control when losing weight).
In this last sense there may be a rejection or feeling of loss of control when the diagnosis is confirmed, which although it may seem paradoxical could cause them to increase their feeling of control in weight loss through not medicating.Also, emotional lability and low self -esteem along with possible rejection experiences during growth due to weight can contribute to their formation.
treatment
The treatment of diabulimia is complex and requires a multidisciplinary approach in which professionals such as endocrine, nutritionists, psychologists and psychiatrists or educators will be necessary.Keep in mind that both conditions will have to be treated at the same time: eating disorder and diabetes.
In this sense, it will be necessary to perform a diabetological education and establish an adequate diet as well as perform psychoeducation (which should also be carried out to the environment to favor the understanding of the process that the individual is happening and allow the guidance and generation of strategies and guidelines of action), along with psychological treatments such as cognitive restructuring to modify the beliefs of the person with respect to himself and his body or about the beliefs and myths of diabetes and their treatment.
It also works on the control of stimuli and techniques such as exposure with response prevention (make the person face the anxiety generated by the perception of his body at the same time that avoids making the response to reduce the injected insulin and the rest ofstrategies to use).
On the other hand it can be useful to use strategies that allow favoring the feeling of self -efficacy and control.They can be beneficial techniques such as stress management and social skills training, and the use of programs that include differential reinforcement of behaviors incompatible with the problem is also recognized as very useful.
Now, we must also assess that as is the case in people with anorexia or bulimia, many patients have great resistance to try to change their action guidelines.It is therefore essential to work in the first place the therapeutic relationship and adherence to treatment, among other things with motivational interviews and valuing the consequences thatIt has already been able to have or the risks that are run before the current behavior (without resorting to scare the patient).
Bibliographic references:
Cardona, R. (2018).DiabulimiaDiabetes Foundation.[On-line].Available at: Link
Criego, A., Crow, S., Goebel-Fabbri, A.E., Kendall, D & Amp;Parkin, M.S.(2009).Eating Disorders and Diabetes: Screening and Detection.Spectrum diabetes, 22 (3): 143-146.
Crow, S.J., Keel, P. & AMP;Kendall, D. (1998).Eating Disorders and Insulin-Dependent Diabetes Mellitus.Psychosomatics, 39: 233–243
Davidson J (2014) Diabulimia: How Eating Disorders Can Affect Adolescents With Diabetes.Nursing Standard.29, 2, 44-49.
Sánchez, S. (2014).Dietary-nutritional treatment in eating disorders with diabetes mellitus.Eating disorders, 20.
Pinhas-Hamiel, O., Hamiel, U., Levy-Shraga, Y. (2015).Eating Disorders in Adolescents with Type 1 Diabetes: Challenges in Diagnosis and Treatment.World J Diabetes, 6: 517.
By Oscar Castillero Mimenza
Source: Psychologiaymente.com/clinica/diabulimia
