SIGNS AND SYMPTOMS OF DIABULIMIA

It’s important for RDs to know that diabulimia may be an issue for the type 1 diabetes patients they counsel. They must ask appropriate questions to determine whether it exists and be ready to make appropriate referrals so patients can get the help they need. The following signs and symptoms of diabulimia can provide important clues:

• hyperglycemia;

• a hemoglobin A1c value much higher than would be expected, given recorded blood glucose values;

• changes in eating habits (eating more but still losing weight);

• dramatic shifts in weight;

• low energy;

• unusual food patterns;

• bingeing on carbohydrates and sweets;

• obsession with food and body image;

• anxiety about weight or avoidance of being weighed;

• delay in puberty or sexual maturation;

• irregular or no menses;

• severe family stress;

• frequent hospitalizations for diabetic ketoacidosis;

• preoccupation with label reading beyond typical dia­betes care;

• excessive exercise;

• hiding food;

• smell of ketones on the breath and in urine;

• frequent urination (eg, using the restroom during a counseling session); and

• physical signs of malnutrition (eg, hair loss, dry skin).