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FARGO – “Eat whatever you want and still lose weight!”

It sounds like a late-night infomercial for the latest diet craze or fitness equipment. But it’s actually the driving force behind what some are calling “the world’s most dangerous eating disorder that you’ve probably never heard of.”

Diabulimia occurs when people with Type 1 diabetes deliberately limit the amount of insulin they inject so they can lose weight. It’s the subject of a popular BBC documentary released this fall featuring three young sufferers, including a 22-year-old mother from London named Gemma who says limiting insulin is addicting because you lose weight no matter what you eat.

“It’s like two birds with one stone and all that,” she says in the documentary. “But it’s kind of like the perfect diet gone wrong.”

The reason diabulimia is so dangerous is because of what a lack of insulin does to the body of someone with Type 1 diabetes.

Stephanie Critchley, a certified diabetes educator at Sanford Health in Fargo, says people with Type 1 diabetes don’t produce enough insulin on their own so they must inject it into their bodies where the insulin helps break down sugars from food for the body to use as energy. If there’s an insufficient amount of insulin, the body will be forced to use its existing fat, muscle and tissues for energy.

The patient is bound to lose weight, but also runs the risk of suffering from eye damage, kidney damage, circulatory problems, loss of limbs, fertility issues and even death because of the excess sugar in their bloodstream.

“It’s kind of a hidden eating disorder,” Critchley says. “Doctors don’t always pick up on it. They just think (their patients) aren’t managing their diabetes well. It’s very easy to hide. Some people with diabulimia could have been manipulating their insulin intake for years.”

Even though many people have never heard of diabulimia, it’s remarkably common.

According to Jacqueline Allan, the founder of Diabetics with Eating Disorders (DWED), 40 percent of all women between the ages of 15 and 30 with Type 1 diabetes suffer from some degree of deliberate insulin restriction.

Canadian researchers suggest 60 percent of women with Type 1 diabetes will experience a clinically-significant eating disorder by the time they are 25.

Critchley says some of her diabulimia patients have told her they don’t want to live the way they are, but they can’t stop.

“They know what they need to do, but the eating disorder is so strong,” she says. “They focus so much on being this certain size that they’re not concerned about losing their eyesight or having problems with their feet.”

Critchley says the eating disorder has a hold on their thoughts.

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“I’ve had young women tell me ‘When I have to pinch my skin for my shots, it reminds of of how fat I am’ or they have the mindset that insulin plus food equals fat,” Critchley says.

To overcome that mindset and get back on the road to health, Critchley says professionals need to address three areas: medicine, nutrition and psychology.

For example, doctors and nurses can work with the patient on better ways to manage the insulin dosage. Dietitians can advise the patient on normal eating patterns, and psychologists can get to the bottom of the depression and anxiety that could be contributing to the eating disorder in the first place.

Critchley says it’s important to have a team approach to treating diabulimia because patients are not only battling their eating disorder, they’re also trying to manage the chronic disease of diabetes and all of its daily challenges.

“Women with diabetes are twice as likely to have disordered eating because they have to be so focused on food and how their body is responding to it,” she says. “Of all the eating disorders, the hardest one to stop is insulin withholding because it’s so easy to do.”

If you or someone you know has needs help with diabulimia, visit the National Eating Disorders Hotline or contact your local doctor to begin taking steps toward a healthier lifestyle.

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