According to the American Diabetes Association, diabetic women are nearly three times more likely to develop an eating disorder than non-diabetic women.

Diabulimia is one of the more prevalent eating disorders among Type 1 diabetic women, that is reducing the amount of insulin one takes to lose weight. Scary, right? It certainly is.

Because not only do eating disorders lead to their own series of problems (slow heart rate, low blood pressure, brittle bones, hair loss, severe dehydration, etc.), but when a Type 1 diabetic does not take the insulin he or she needs, this just adds to the complications which may lead to diabetic ketoacidosis, stroke, and even death.

Unfortunately, I was one of those Type 1 women, and still am, to a certain extent because I believe one never completely finishes the battle with body image. But my story started before I was diagnosed with Type 1 diabetes in 2009. It started at 13 when I noticed I no longer fit into my clothes and asked the one irrevocable question: Am I fat?

Am I Fat?

I don’t know why I ever questioned my body image – maybe it was the continual exposure to skinny women in magazines and movies and the cultural phenomenon known as “thin?” Maybe it was my own sense of perfectionism? Even when I was technically thin, I didn’t consider myself thin.

So at 15, I went on my first diet. I was 5’3 and weighed 123 pounds, but I was determined to lose 10 more. I started running cross-country and ate less than 1,000 calories per day. Could this be considered an eating disorder? At the time, I didn’t think so. I had completed a health education course a year earlier – I knew the tell-tale signs. But in my mind, I was eating at least once every four hours, exercising regularly, and drinking plenty of water. I cut out sugar and other liquids.

What I didn’t realize was that I may have been physically okay, but I was headed down a mental spiral. My mind and the way I viewed my body was not okay, and the more I critiqued myself, the more I hated myself, and the more I wanted to lose. I even wrote a poem about it because that’s how 15-year-old writers deal with things. It was called “I Hate Myself.” I know – truly original, right?

Fast forward six weeks that summer of 15, and I weighed 111. I had done it. I had lost my 10 pounds, actually more than 10, to be precise. But I wasn’t happy. I felt weak and hungry all the time. And I hated myself for not being happy with how I looked. I wanted to lose more. It wasn’t enough.

And then standing on my parent’s scale in the bathroom, among the chipped pink tiles, I cried. I tell this story many times, but it was a pivotal moment for me. I recognized then that I was on my way to having an eating disorder, and I needed to improve my body image if I really wanted to be happy. Of course, there’s a difference between realizing and doing. Although I tried in those seven years before I was diagnosed with diabetes, by the time I was faced with daily insulin injections, I had struggled through my fair share of bulimic and anorexic episodes.

An Era of Diabulimia

When I moved to a new city a year after my diagnosis, the troubling signs returned. But this time, losing weight wasn’t just the issue – I was binging on every high-carbohydrate food item I owned with the exception of peanut butter. I was addicted; I needed it on a daily basis, and it could only come straight from the jar. Unfortunately, Whole Foods, who sells my favorite brand of peanut butter, wasn’t nearby so I often visited the CVS or 7-11 down the street, sometimes late at night when my jar was empty and I needed my fix.

Once I noticed the weight gain, I was furious (I don’t know why I was surprised – maybe I was hoping my 23-year-old metabolism would help?). Exercising wasn’t enough so I started throwing up anytime I binged. But then I realized I couldn’t keep this up. For one, I hated vomiting and peanut butter is not as smooth coming back up, and two, I worried about what the constant vomiting would do to my heart and throat. Yes, that was my concern.

It was partly a guilt complex. I felt I shouldn’t have been binging in the first place, and I needed to throw up to rid my body of the extra content. I couldn’t stop the binging, either, which in and of itself is another type of eating disorder. And then it occurred me one night in my basement apartment after binging on peanut butter, throwing up, and completing some heavy cardio exercises that one of the symptoms of diabetes is weight loss. That is, when the body cannot process the carbohydrates and sugar, it turns to the fat for energy. I had lost at least 10 pounds without effort before I was diagnosed with the disease. But this type of weight loss is dangerous for the body, as this increases the level of ketones in the urine, which poison the body and can lead to coma and even death — also known as diabetic ketoacidosis.

But regardless I thought if I couldn’t stop the binging, I could at least stop the weight gain? So in the winter of 2010-2011, anytime I binged, I wouldn’t take insulin. I felt like crap, my blood sugar rising so high I would fall asleep soon after. I never checked my blood sugar during this time, so as not to feel guilty and so that my doctor wouldn’t know. I was still on the shots so even though I wasn’t taking a fast-acting insulin injection for the carbs I was eating, I still took my long-lasting insulin, which helped keep my blood sugar stable over a 24-hour period.

In the morning, I usually tested my blood sugar and took a correction dosage if it was still high. I continued this routine until one night after binging, my friends invited me out, but rather than taking a correction dosage, I sweated it out. When my friend, who was studying to be a nurse, asked to check my blood sugar, and found it soaring at 350, she was alarmed. I was a little drunk so I admitted to my friends what I had been doing. They all looked at me like I was insane, and I realized I was.

A Healthy Body Image

This was no game. After years of working to regain a healthy body image, I was back at the bottom again. I’d like to say everything changed after that, that I started taking insulin again, and stopped binging. But the truth is, it still took another few years to shake those habits. They were not constant, but every now and then, that evil voice would creep inside my head and tell me how awful I looked and how much I needed to lose a few. That voice still exists and probably always will, but I do my best to keep it at bay. And never once do I consider sacrificing all I’ve done to manage my diabetes for a few pounds.

One recommendation I often give to young girls and others in my situation is a simple exercise one of my former high school teachers taught me. Make a list of five things you like about yourself. Then post that list next to your bathroom mirror. In addition to that list, every time you look into the mirror, tell yourself five more things you like about yourself. And then force yourself to smile, whether you feel like it or not. Sounds silly, right? I did this often in high school. It wasn’t a solve-all measure, but it was a good first step, and you know what – it actually did make me feel better.

But now when I look in the mirror, I think about more than five physical attributes. I think about the strong woman that exists. I think about the diabetes that hasn’t defeated me yet. I think about the support of family and friends who helped me get here. And then I smile. Because I may still scowl at my love handles every once in awhile, but I recognize they’re just one part of me, and I’m okay with that.

For additional resources on diabulimia, I recommend reading Maryjeanne Hunt’s memoir, Eating to Lose: Healing From a Life of Diabulimia. I also posted an update to my binging experience in “Food Junkie” last December.

Note: This blog post was included in qualitative research on ‘Diabulima’ through the lens of social media: a qualitative review and analysis of online blogs, published in 2018 in Diabetic Medicine, a journal of the British Diabetic Association.