Bulimia and anorexia nervosa are both eating disorders where there is an obsession with food and body image. Both have similar characteristics and can be difficult to distinguish. Simply put, Bulimia is characterized by eating too much and anorexia by not eating enough. The conditions can be serious, distressing, harmful and sometimes fatal. Combine them with diabetes and the situation can become diabolical. Bulimia tends be kept secret by most sufferers and there is a lot of guilt and shame felt. It is associated with body image problems and the need to lose weight but other emotional problems are at the basis of it. The person becomes obsessed with food and embarks on repeated over eating binges with a loss of control around food. In an effort not to gain weight, food is purged (forced vomiting), and the use of laxatives, diuretics and enemas are common as well as excessive exercise programs. The constant vomiting can damage the stomach and the acid brought into the mouth can cause tooth decay. Bulimia was formerly recognized by the American Psychiatric association in 1980 but the condition was described as far back as Egyptian times.

Diabulimia (Diabulimia is not a medical term but certainly used) is a combination of diabetes and bulimia. It is often seen in teenage girls with type 1 diabetes where insulin is omitted and food purged. Insulin is a growth hormone and weight gain can occur with really good control. This weight gain can be managed but teenagers become fearful and irrational about taking insulin. Their fear of weight gain from insulin is much like the fear of food and weight gain experienced by anorexics The combination of bulimia and diabetes is a dangerous and unfortunately for young people complications of diabetes arise a lot earlier due to damage caused from really high glucose levels. People are also at high risk of ketoacidosis and hypoglycemic episodes and coma.

Anorexia nervosa doesn’t stay a secret for long as weight loss becomes evident. It is characterized by self starvation and unlike the person who can’t stop eating these people can’t stop dieting. Some people with anorexia will also binge eat and purge their food as well. It is a serious disease that is multi factorial where people tend to have obsessive natures and body image problems. They have a real fear of gaining weight and it gets worse as they see themselves as fat even when they are really underweight. They become frail as they lose fat and muscle and their bones protrude making them look like a living skeleton. As the condition worsens, the person can become very sick from malnutrition causing hair to fall out, heart and other body organ problems, sometimes resulting in death. Despite this, many will deny that it is having an effect on their health. Sadly the condition can become life threatening and many lives have been lost as families and health professionals struggle to help the sufferer. Girls suffer more than boys and boys tend to present differently as they become obsessed with an athletic appearance and/or success.

People suffering with type 1 diabetes and anorexia have the double whammy of being fearful of both insulin and food. Starving the body of food and insulin is a very dangerous combination and a really difficult condition to get on top of. Weight losses are significant with the omission of insulin and the risk of ketoacidosis and coma is very high. The long term complications of malnutrition from not eating are worsened by the omission of insulin leading to the early onset of diabetic complications.

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