Diabulimia – a diagnostic and therapeutic challenge in the emergency department

Diabulimia is the intentional omission or reduction of insulin administration in a patient with insulin-dependent diabetes mellitus (IDDM) and coexisting eating disorder in the attempt to reduce or avoid weight gain. Although the true incidence of diabulimia is unknown, it is estimated that between 20-30% of girls and up to 40% young women with IDDM have experienced diabulimia since their diagnosis of IDDM was made. Patients with diabulimia frequently present to the emergency department, therefore early recognition of the eating disorder and prompt psychiatric consultation are essential. The aim of this review article is to summarize the existing literature about diabulimia and to raise awareness amongst emergency physicians about how to identify and treat these patients.