Bulimia

Bulimia nervosa is characterized by episodes of binge eating, followed by a variety of compensatory methods to negate the increase in calories consumed (e.g., purging through vomiting, excessive exercise, using laxatives or enemas, starvation). A binge is defined as occurring during a discrete period of time, involves eating an amount of food that is significantly larger than what most people would eat during similar circumstances, and a sense of being out of control during the episode (71). Other symptoms that may become evident in the clinical setting include dehydration, abdominal pain, and the emergence of dental problems (as continuous vomiting wears away the tooth enamel) (74).

Bulimia is diagnosed in approximately 1% to 3% of the population, with males displaying one-tenth the rate for females (71). Since individuals with bulimia often appear physically healthy and are not grossly underweight, prevalence may, in fact, be much higher. In addition, 30% of those with bulimia show a lifetime diagnosis of comorbid disorders, such as substance abuse or dependence disorder (71).

A meta-analysis of controlled studies composed of 748 persons with diabetes and 1587 female participants found that patients with DM1 are significantly more likely to develop bulimia when compared to those without diabetes (75). In addition, it is also estimated that 60% to 80% of people with DM1 engage in episodes of binging at a subclinical rate (76). This binging and purging behavior makes it incredibly difficult to keep BG levels stable. This is because the activity of binging and purging makes it difficult to accurately gauge the amount of food a person is ingesting, and it becomes impossible to accurately assess the amount of insulin that is necessary. In addition, binges often include foods that are high in fats, which may have no immediate impact on blood sugar levels, but may cause them to rise hours later. The results of this can be disastrous. The inability of people with bulimia to keep their BG levels stable can result in BG levels that are perpetually too high, or too low. In turn, this leads to higher HbA1c levels and poorer overall glycemic control.

A recent study compared patients with DM1 and bulimia, to those with DM1 and binge eating disorder. Although both of these are serious forms of disordered eating, the study found that the presence of bulimia nervosa was highly associated with severe disturbances related to depression, anxiety, and eating disorders. In addition, the group with bulimia nervosa showed an overall higher rate or co-occurring mental disorders, psychosocial dysfunction and poorer overall glycemic control (77).

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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