Type 1 diabetes mellitus and bulimia nervosa: insulin restriction does not always represent purging of unwanted calories

Abstract

In the current case study we present a patient with type 1 diabetes mellitus and bulimia nervosa who reported intentionally restricting her insulin intake in order to avoid hypoglycaemic episodes. However, she was not concerned about the occurrence of the typical symptoms of hypoglycaemia such as shaking, sweating, drowsiness, nausea, poor motor coordination, mental confusion or unconsciousness. Her fear of hypoglycaemia was solely based on her perception that hypoglycaemia would inevitably lead to binge eating. With the help of regular food intake, optimised insulin treatment and psychological help, the patient succeeded in reducing the number of binge eating episodes and in achieving a better control of her bulimic symptoms as well as of her diabetes mellitus.

Fear of hypoglycemia—An underestimated problem

“…The FOH may determine the behavior of patients and influence their insulin dosing, physical activity, and food intake (Brazeau et al, 2008;McCoy et al, 2013;Zander et al, 2014). When there is an anticipated risk of low blood glucose levels, patients consume additional meals, especially those rich in simple carbohydrates, and tend to snack at night (Desjardins et al, 2014;Richmond, 1996).…”

A cognitive behavioral therapy intervention to reduce fear of hypoglycemia in young adults with type 1 diabetes (FREE): study protocol for a randomized controlled trial

“…Previous negative experiences of hypoglycemia influence diabetes self-management behaviors [9, 15–20]. Diabetes self-management is defined as the knowledge, skills, and behaviors needed for diabetes self-care [21].…”