DIABULIMIA: The Restriction of Insulin for Weight Loss

Studies show that Diabetics are 2.5 times more likely to develop an eating disorder. Diabulimia, though not an official (DSM IV) psychiatric diagnosis, describes an emerging weight loss practice among some diabetics.

Research suggests that in addition to an increased risk of complications such as foot and vision problems, along with kidney damage, Diabulimics triple their risk of death over diabetics who do not restrict their insulin.

"People with type 1 diabetes have completely lost the ability to produce their own insulin, the hormone necessary to usher glucose into cells, where it is stored for energy. Regular injections of insulin essentially replace what the body used to produce naturally. But shortchanging insulin doses means glucose levels are not controlled ..."states Amanda Gardner in her article, "'Diabulimia' Triples Risk of Death Among Women With Diabetes."

"The repercussions of manipulating insulin in such a manner can be enormous. Patients who do this have higher blood sugar levels than are healthy, and as a result, become dehydrated, fatigued, and experience a breakdown in muscle tissue. In the long term, this condition is associated with an accelerated development of diabetic complications such as eye disease, kidney disease, and limb amputations due to vascular disearse.

While this disorder is relatively well known to endocrinologists that treat a large number of patients with type 1 diabetes, it is not often recognized by primary care providers or by family members.

If you are a family member of someone with type 1 diabetes and you see patterns of behavior that are concerning, bring it to someone's attention. The long term damage that can occur can be profound, and early acknowledgment of the behavior along with early intervention can make a world of difference," says Dr. Ruchi Mathur, M.D. FRCP (C).

According to Mayo Clinic endocrinologist Maria Collazo-Clavell, Md. a Diabulimic may exhibit the following warning signs:

• Weight loss
• Excessive thirst
• Frequent urination
• Low energy
• Nausea
• Fruity-scented breath (a sign of diabetic ketoacidosis)
• Decreased attention to blood sugar monitoring or insulin doses
• Loss of blood sugar control

"Often, diabulimia is suspected by a friend or parent before the person who has diabetes admits that anything is wrong. If you have diabulimia or you suspect that a loved one has diabulimia," she warns, "seek help immediately. Ideally, treatment will involve specialists in both eating disorders and diabetes. Early intervention may save a life."

See "Eating Disorder Help" in sidebar for listing of Helpful Hotlines, Organizations, and Websites

Information compiled from the following sites:
http://www.medicinenet.com/script/main/art.asp?articlekey=87460
http://www.medicinenet.com/script/main/art.asp?articlekey=81960
http://www.mayoclinic.com/health/diabulimia/AN01737

Parenting and Eating Disorders: What You Can Do.

As I wandered the internet I came across an article by a woman in her early 20's, who goes by the initials "AEM". She recounts her struggles with eating disorders as a teenager. "It was a sunny Friday afternoon in the middle of March and most kids my age were throwing their book bags in the corner, laughing with their friends, and busily concocting plans for the weekend," she says in 'Fighting for Perfection: My Battle With Eating Disorders as a Teenage Girl."

"I pushed open the front door to my house, threw my book bag in the corner, and plopped myself down on the kitchen table with my head in my hands. I could see my thighs spreading out on the chair. Look at all that cellulite. They're huge. I stood up and made my way to the pantry. My stomach growled and I made a promise to myself that I could have a few pieces of cereal and that was it for the rest of the night. A few pieces of cereal turned into a handful which turned into a couple Oreos which turned into a box of Oreos and a bag of tortilla chips and half a jar of peanut butter..."

Later, her stomach full, her mouth dry and dehydrated, she attempts to purge. She is unsuccessful using her fingers and tries using a hairbrush, silverware and straws to help her vomit. "Nothing would make the sickening amount of food I ate come back up. I fell to the bathroom floor hitting it with my fists and screaming. Grabbing the skin and "fat" on my 105 pound body, I screamed, "Anne, you are so ******* fat, you disgust me! Look at yourself! You're nothing and you're nothing to anyone. I hate you, I hate you, I hate you."

Reading those words, my heart sank. I felt so badly for the child she was. The mother in me became so incredibly sad and I wanted badly to protect her. "I grabbed one of the knives I used to shove down my throat and held it an inch away from my wrist. After a few minutes of working up all the courage I could muster, I dropped the knife and hugged my knees into my chest, rocking myself back and forth in my own arms. Following what seemed to be an eternity, I heard the front door open again and my mother's cheerful voice, "Hi sweetie! I'm home!" I quickly gathered up the items littering the bathroom floor and shoved them under the sink. Wiping the tears away from my eyes, I brushed myself off and transformed once again into the happy, successful, and confident teenager that I showed the world. But in reality, I was trapped inside this imaginary image, screaming for someone to notice."

Being the mother of a teenage daughter, the fear I felt as she recounted her struggle to keep from harming herself made me feel physically ill. It washed over me in a cold wave of nausea. It was a reminder of how secretive teens can be and that no matter how much we think we know what is going on, there is always the possibility that our child is suffering without us being aware. AEM's mother, oblivious to what her daughter had just gone through and what her daughter had just been contemplating doing, unknowingly puts a stop to this episode by her arrival home.

We, as parents, cannot assume that our child will disclose to us any struggles they may be having with disordered thinking or behavior towards food.

As Parents We Need To:
*Keep the lines of communication open with our children.
*Educate them so they know the dangers of eating disorders.
*Foster a strong sense of self in our children.
*Educate ourselves so that we can recognize warning signs that our children may exhibit.
*Get the proper help for our children if they are suffering from an eating disorder.

We need to do these things while are children are young as disordered attitudes about food are becoming more an more common in grade-school aged children.

Here are some signs that may indicate an eating disorder in your child:

• "Eating tiny portions or refusing to eat
• Intense fear of being fat
• Distorted body image
• Strenuous exercising (for more than an hour)
• Hoarding and hiding food
• Eating in secret
• Disappearing after eating—often to the bathroom
• Large changes in weight, both up and down
• Social withdrawal
• Depression
• Irritability
• Hiding weight loss by wearing bulky clothes
• Little concern over extreme weight loss
• Stomach cramps
• Menstrual irregularities—missing periods
• Dizziness
• Feeling cold all the time
• Sleep problems
• Cuts and calluses across the top of finger joints (from sticking finger down throat to cause vomiting)
• Dry skin
• Puffy face
• Fine hair on body
• Thinning of hair on head, dry and brittle hair
• Cavities, or discoloration of teeth, from vomiting
• Muscle weakness
• Yellow skin
• Cold, mottled hands and feet or swelling of feet"

"If you suspect your child has an eating disorder here are some tips to help you discuss this with them":

• "In a calm and caring way, tell your child what you saw or heard. Use "I” statements and let him or her know you are concerned. For example, "I'm worried about you because you haven't eaten lunch this week.”
• Listen carefully to what your child says. Teens with eating disorders might feel ashamed or afraid. They may think that life doesn't matter. Feeling out of control is also common.
• What if they get mad or deny it? It is very common for kids with problems to say that there is nothing wrong. Tell them you want to help. You may need to approach them several times.

Questions to ask your child:

• Are you terrified about being overweight?
• Have you gone on eating binges where you feel you may not be able to stop?
• Do you feel extremely guilty after eating?
• Do you vomit or have the impulse to vomit after meals?
• Do you feel that food controls your life?

The American Academy of Pediatrics also suggests asking your child:

• What do you think you ought to weigh?
• What is the most you ever weighed? How tall were you then? When was that?
• What is the least you ever weighed in the past year? How tall were you then? When was that?
• Exercise: how much, how often, level of intensity? How stressed are you if you miss a workout?"

"Once you suspect an eating disorder, further evaluation is important. This might include a medical evaluation from your Pediatrician and a psychological evaluation with a psychiatrist and/or psychologist," Says Vincent Iannelli, M.D.

What should you do if your child has an eating disorder?

*"If your child shows signs of an eating disorder, avoid denial. Get him/her a thorough evaluation and treatment if it's indicated. The sooner the treatment is begun, the sooner recovery can be achieved. Remember too that early symptoms are much easier to reverse than behaviors that have become entrenched. "

*"If your child's doctor or counselor recommends hospitalization, do it. It maybe be lifesaving. It also may interrupt deeply ingrained behavior patterns that no other intervention can touch."

*"If family or couples counseling is recommended, do it. The purpose of such sessions is not to blame you for the eating disorder but rather to help everyone create and maintain satisfying ways of relating and negotiating conflicts. Family and couples counseling has another bonus: It shows your child or partner how reasonable people consult experts to solve overwhelming problems. It also gives you a safe place to deal with your painful feelings. You are hurting. You deserve relief."

*"Model healthy, effective coping behavior for you loved ones. When you are stressed, avoid turning to alcohol, other drugs, anger, or other destructive habits. Teach your children, or your partner, by your example how to solve problems and meet needs by making, and following, logical action plans."

*"Model healthy food and exercise behaviors, too. Talk about the differences between dieting (does not work and can lead to binge eating) and healthy meal plans. Prepare healthy meals for your family and keep healthy snacks on hand.
Never criticize your own body. Never criticize anyone's body. If you do, you send a message to your loved ones that you accept nothing less than perfection.
Follow an exercise plan that includes regular, moderate amounts of healthy activity, not compulsive, driven competition. Encourage other family members to be active too. Fun activities like hiking, biking, and swimming are usually more successful than regimented exercise at a gym. Turn off the TV, video games, and computer. Do something outside instead."

*"Don't participate in power struggles over food. You will lose.
Don't play food police either. You will lose, and the person will withdraw from the relationship. Leave food, eating, and weight issues with the person and her/his therapist. A good therapist will insist on medical intervention if the person gets into danger.If your child is a picky eater, offer healthy, well balanced meals and let him/her decide what to eat. If food is refused and a snack demanded later, don't provide it. Offer more of what was on the plate at mealtime."

*"Eat together as a couple or a family at least once a day. As much as possible, keep mealtimes social, happy, and fun. Talk about things other than food, calories, and weight. Even if the person will not eat with you, or even if s/he eats only celery sticks, insist s/he be present to share in family life."

*"Last but not least, take care of yourself. Participate regularly in some sort of stress reduction program -- maybe tai chi, maybe bowling with friends, maybe a sport or hobby, but something that relaxes your body, soothes your mind, and gives you something else to think about for a few hours.Use family or couples counseling to find relief for your own distress. The person with the eating disorder is not the only one who hurts."

"Remember to take time out regularly from the eating disorder. Don't let it dominate your life. Now and then eat in a restaurant that you choose, not one deemed safe by your loved one. Make sure your child is safe, and then take a weekend trip just for fun with your partner or with friends. Participate in satisfying activities that bring you pleasure. If your partner will not accompany you because s/he wants to stay close to the refrigerator and bathroom, go alone or with friends. The eating disorder has already crippled one life. Don't let it restrict yours as well."


Please See "Eating Disorder Help" in sidebar for listing of helpful Hotlines, Organizations, and Websites.
Read more of AEM's battle, here.
Source:http://www.associatedcontent.com/article/13367/fighting_for_perfection_my_battle_with.html
List of warning signs source:http://www.med.umich.edu/1libr/yourchild/eatdis.htm
Questions to ask your child by Dr. Vincent Iannelli, M.D. source: http://pediatrics.about.com/cs/conditions/a/eatingdisorders.htm
What should you do if your child has an eating disorder. Source: http://www.anred.com/pnp.html
picture source: http://www.flickr.com/photos/yourdon/3841848227/