How is diabulimia treated?
How is diabulimia treated?
The goals of treatment for diabulimia include:
- Using insulin appropriately.
- Healthily managing blood glucose levels and weight.
- Avoiding short-term and long-term diabetes complications.
- Treating psychological issues that may have contributed to the development of diabulimia.
- Developing long-term behavioral changes for diabetes management.
People with diabetes and people with eating disorders are more likely to have depression and/or anxiety. These conditions can further complicate diabulimia and diabetes management in general. If a person has one or both of these mental health conditions, their healthcare team will likely recommend treatment for the condition(s) as well.
Treatment for diabulimia most often involves a combination of the following strategies:
- Medical evaluation and/or hospitalization.
- Psychotherapy.
- Nutrition and/or diabetes education.
- Medication.
Because of the physical and psychological components of diabulimia, treatment involves care from multiple types of healthcare providers, including:
- Endocrinologists.
- Psychologists or therapists.
- Registered dieticians or nutritionists.
- Certified Diabetes Educators (CDEs).
Medical evaluation and/or hospitalization
First and foremost, it’s important to make sure a person with diabulimia is medically stable. If they’re experiencing diabetes-related ketoacidosis (DKA), which is common in people with diabulimia, they’ll need treatment in a hospital for the DKA.
In severe cases of diabulimia, treatment will require hospitalization so that healthcare providers can monitor the person’s insulin dosages to be sure that they are not restricting insulin. If the person has other eating disorder behaviors, such as purging, healthcare providers can also monitor these.
Healthcare providers will likely order certain tests, such as blood tests and a urinalysis, to check for possible short- and long-term diabetes complications that can be caused by diabulimia and persistently elevated blood sugar levels.
Psychotherapy
Psychotherapy is a type of counseling that focuses on changing your problematic or unhealthy thinking (cognitive therapy) and/or behavior (behavioral therapy).
Unfortunately, there’s been very little research into the psychological treatment of eating disorders in people with Type 1 diabetes. Existing research has revealed that the following types of therapy may help treat diabulimia:
- Cognitive behavioral therapy (CBT): This therapy’s goal is to address distorted views and attitudes about self-worth, weight and appearance and to practice behavioral modification (if “X” happens, I can do “Y” instead of “Z”).
- Psychoeducation: This therapy involves providing education and information to those seeking or receiving mental health services, such as people diagnosed with mental health conditions or chronic health conditions. The goal of psychoeducation is to help people better understand and become accustomed to living with mental health conditions and chronic health conditions.
People with diabetes are two to three times more likely to have depression than people without diabetes. In addition, people with diabetes are 20% more likely than those without diabetes to have anxiety at some point in their life.
Because of this, psychotherapy may also help people who have diabulimia treat their depression and/or anxiety, if applicable. Exploring your feelings about having diabetes and the effect it has had on your life through therapy can also help with and prevent diabetes burnout.
Nutrition and/or diabetes management education
Depending on the person’s situation and the cause of their diabulimia, nutrition education and/or diabetes management education may be a part of treatment.
Type 1 diabetes is a very complex condition that can be difficult to manage. Having a thorough understanding of the biology of diabetes as well as new diabetes technology and management strategies could help a person with diabetes feel more confident in their management capabilities and help them better manage their condition.
Nutrition education and counseling may also be necessary if a person with diabulimia has problematic thinking or misunderstandings about certain food groups (i.e. “carbohydrates are bad”) or other disordered eating behaviors.