How to treat 'diabulimics': Diabetics with eating disorders

Like other overweight teens, Erin M. Akers longed to be slender.

Unlike other girls, she discovered that she possessed a powerful weight-loss gimmick, a secret reward for being diagnosed at age 10 with her detested disease, type 1 diabetes.

"When I was 14, I realized that by not taking my insulin, I could eat anything I wanted and lose weight," recalls Akers, now 21, of Seattle. "For an overweight kid, that's like a dream come true. I lost 55 pounds that summer. I thought I was a genius. I thought no one else knew about this."

Akers spent the next six years in and out of hospitals, recovering from the life-threatening complications of skipping her insulin shots, before confronting the fact that she had an eating disorder. In 2008, she underwent intensive therapy, then set up an online nonprofit group to help women like her.

She is part of a recent wave of attention, activism, and research focused on type 1 diabetics who restrict their insulin for weight control.

The ranks of these complex patients are growing, according to eating-disorders treatment programs such as the Renfrew Center of Philadelphia. Yet recognition and understanding of their pathological pursuit of thinness remain sketchy.

In fact, there was no formal name for the dual diagnosis until three years ago, when an international group recommended "Eating Disorders-Diabetes Mellitus Type 1."

Patients and the media have embraced a catchier label: diabulimia.

"Clinicians have qualms about using that term because it's a media" invention, said Ann Goebel-Fabbri, a clinical psychologist and eating-disorders specialist at the Joslin Diabetes Center, a Harvard Medical School affiliate. "But it has given voice to a lot of women who are struggling with this, and now realize they aren't alone."

Type 1 diabetics, typically diagnosed in childhood or adolescence, can't make insulin, the hormone that cells need to convert sugar from carbohydrate foods into energy.

Without insulin, the body effectively goes into a state of speeded-up starvation, dumping unused sugar into the urine and breaking down muscle, fat, and liver cells for fuel. This process produces acids called ketones, which build up in the blood, leading to a metabolic crisis called diabetic ketoacidosis.