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Warning signs for diabulimia include a change in eating habits -- typically someone who eats more but still loses weight -- low energy and high blood-sugar levels, Goebel-Fabbri said. Frequent urination is another signal. When sugars are high, the kidneys work overtime to filter the excess glucose from the blood.
This purging of sugar from the body through the kidneys is similar to someone with bulimia, who binges and then purges, or vomits, Anderson said.
Studies show that women with Type 1 diabetes are twice as likely to develop an eating disorder. Ironically, good diabetes management, which requires a preoccupation with food, counting carbohydrates and following a diet, may lead some to form an unhealthy association with food, Goebel-Fabbri said.
Jacq Allan, 26, of London, is a diabulimic. When recently interviewed, she said she had not taken her insulin shots for two weeks and rarely takes them regularly. She weighs 42 pounds less than she did a year ago.
Allan is stuck between two fears: taking insulin, which may lead to weight gain, and the damage her destructive compulsion is doing to her body.
"I'm terrified of insulin," Allan said. "Every morning I wake up and think maybe I should go to the hospital."
Diagnosed with Type 1 diabetes nearly three years ago, Allan said she can feel the constant, sky-high sugar in her blood. Her list of ailments -- chest pain, heart palpitations, muscle cramps, bacterial infections and lower back pain -- are not the usual health problems of a twenty-something.
"I'm constantly worried that my eyes are going to go, but they seem relatively OK for the moment," she said. "I always wonder if this will be the day that some major organ fails. I kind of want something to happen because then maybe I'll stop."
Gwen Malnassy, 21, of Santa Monica, Calif., detailed her struggle with diabulimia for three years in a diary she posted on the Internet.
"If you don't think it will happen to you, don't fool yourself," writes Malnassy, diagnosed with diabetes at 9, in her final entry 11 months ago. "I believed the same."
Doctors diagnosed Malnassy with both anorexia and bulimia at 13, she said.
"I would look at magazines and think that if I looked like the models, I would have more friends and be more popular," Malnassy said in a recent interview.
She began withholding insulin at 17 after learning of the practice during a doctor's visit and continued withholding insulin off and on until last year.
Malnassy continues in her online diary: "I will say it again. Reach out; get help. Do not fall; do not let the disorder consume you. It's a miserable way to exist."
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