Case study

Diabulimia issues uncovered by research at Abertay University

28 Sep 2017

New Scottish research into the experiences of young people with diabetes has cast fresh light on the potentially fatal condition of Diabulimia, suggesting it is “common” for young diabetic women to shun their insulin in a bid to lose weight.

Initial findings from an Abertay University counselling project looking specifically at issues for young people with type 1 diabetes has pinpointed a need for greater emotional support for those struggling to cope.

Researchers from the University’s Division of Mental Health Nursing and Counselling conducted interviews, focus groups, and counselling sessions with young diabetics aged 18-25 as well as a range of service providers.

Diabulimia is a little known condition in type 1 diabetes with potentially fatal consequences.

Most people with the condition will have started to under-use insulin as a way of losing weight in the short-term, however this can introduce a dangerous cycle of behaviour which can lead to eating disorders such as bulimia.

Once in that cycle, people may maintain a minimal engagement in their medication regime, or undergo binge-eating where over-eating is combined with insulin abstinence.

One of the study participants reported that her reduction in insulin control began after being ill and not injecting her normal insulin dosage. She felt the immediate weight loss and started a habit of withholding insulin in the days leading up to social events.

Another participant experienced diabetic retinopathy (sight loss) as a result of having Diabulimia in her mid-to-late teens.The damage done to her eyesight was irreparable and she was seeking emotional support to adjust and cope with a sense of responsibility and loss.

Dr Kate Smith, Academic Curriculum Manager for Abertay’s School of Social and Health Sciences, conducted the research, which was carried out at the Tayside Centre for Counselling and funded by the British Association for Counselling and Psychotherapy.

Abertay offers a BSc (Hons) in Mental Health Nursing, a BSc (Hons) in Psychology and Counselling and a well-respected MSc in Counselling.

Dr Smith said: “It is well established that there is a gap between the psychological and emotional needs of people with diabetes and the care and support that is offered.

“The project involved speaking to young people with the condition, talking to practitioners who work daily with young people within the NHS, and also offering counselling to young people.

“It aimed to provide an overview of the relationships between clients and the services provided, and seek to understand unaddressed needs as perceived by the young people themselves.

“The research showed that limiting insulin as a way of controlling weight in the short and longer term was common, particularly in young women.

“It was also clear that emotional support is needed to address the issues surrounding this, in recognising behaviours and signs that insulin therapy is being mismanaged, to help a person acknowledge and address issues around withholding insulin, and to look at key behaviours associated with their own insulin management.

“The research shows that Diabulimia is a complex issue which is further complicated by an absence of understanding of how healthcare can respond.”

Often people with Diabulimia may choose to disengage with healthcare or clinic staff may be reticent of raising concerns.

The research showed some practitioners reported not wanting to raise the issue for fear of alienating the patient, or giving the idea that this might be a way of losing weight.

Dr Smith added: “On the front line, finding a safe accepting person to talk to about what is going on is the first step to gaining help for Diabulemia. A counsellor will work to understand why a person might be engaged in withholding insulin, and be able to discuss the perspective of the client.

“Some people find it helpful to think about why they began the cycle, or how and when it might feel like a rationale decision, but in many cases people will seek help only when they feel overwhelmed by their condition and a counsellor will help them find ways of regaining control.

“Our suite of courses at Abertay ensure the next generation of counsellors and mental health professionals have the necessary skills and training to understand the complexity of conditions such as Diabulimia.”

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