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This disorder involves a complex interaction of factors, including: insulin, blood glucose, emotions and body image, that cross over between diabetes management as such, and the mental health of the individual.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">From a physiopathological viewpoint, the mechanism leading to weight loss by omission of insulin in diabetes type 1 may be summarised as 3 basic concepts: loss of glucose in urine (energy motor of the human body), loss of body water through osmotic diuresis and destruction of fat deposits in the search for an alternative energy substratum, with the production of ketone bodies.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although any of the mechanisms described may provoke harmful effects in the individual, people who produce ketone bodies are at risk of developing ketoacidosis. The brain, kidneys, muscles and small intestine are able to use ketone bodies to obtain energy. But if ketogenesis and ketolysis are not treated and the accumulation of ketone bodies continues, the acidic nature of them affects the buffer capacities of blood. This results in a lowering of pH levels and a greater risk of developing diabetic ketoacidosis, dehydration and death.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The nurses who, as potential members of a multidisciplinary team, treat this type of patient, should bear in mind that people with diabetes type 1 generally consider themselves “expert patients”. In this sense the repeated repetition by professionals of the consequences of bad administration or the need for exhaustive monitoring may create a condescending or paternalistic image. It should not be forgotten that these people are aware of the consequences of their actions to a larger extent than most and that these problems may extenuate the division or distancing between patient and professional.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In addition to this, we should acknowledge that for the patient who suffers from them, eating disorders produce a feeling of shame which leads to a veil of secrecy around them, making recognition of them on a social and even health level improbable. Against this backdrop, people with an eating disorder find themselves in the situation where the anxiety caused by the disorder overtakes the possibility of sharing their concerns and problems. Diabulimia also has an equally powerful and dangerous weapon: patients not only lose weight without experiencing visible side effects, they discover a way to control their weight without anyone else around them perceiving it. This is why the job of the professionals in recognizing this situation is crucial.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The tools for early diagnosis of this disorder imply, firstly, recognizing the clinical signs suggestive of the suspected diagnosis. On the one hand there is a mixture of possible signs, such as those derived from the manipulation of the insulin treatment itself, with other signs derived from the perception of their body image. Injecting insulin in secret or avoiding injections is part of the first group, together with limited monitoring of blood sugar or resistance to self-control, high levels of HbA1c, frequent episodes of diabetic ketoacidosis, the actual symptoms of hyperglycaemia and polyuria or polydipsia, amenorrhoea, early initiation of complications from diabetes and/or an increase in the number of lost diabetes consultations. From the second group the following are of note: distorted body image, weight loss or variation of weight between consultations, refusing to be weighed in the practice, modifying regular activities and eating patterns, change in appetite or obsessive calorie counting.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">At present, existing scientific evidence referring to the validation of specific questionnaires on diabulimia is insufficient. On the one hand the application of generic questionnaires on eating disorders may lead to an overstatement of the problem and on the other, more specific questionnaires could underestimate its prevalence, as they would not include questions on the omission of insulin as a weight loss strategy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financing</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study did not receive any financing.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financing" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ferrero Franco R, Garcia de Lorenzo A, Gonzalez Castro A, Diabulimia: una perspectiva actualizada, Enfermería Clínica, 2021;31:396–397.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabulimia, a type I diabetes mellitus-specific eating disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.F. Kınık" 1 => "F.V. Gönüllü" 2 => "Z. Vatansever" 3 => "I. Karakaya" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Turk Pediatr Ars" "fecha" => "2017" "volumen" => "52" "paginaInicial" => "46" "paginaFinal" => "49" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabulimia: the world’s most dangerous eating disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I. Torjesen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.l982" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2019" "volumen" => "364" "paginaInicial" => "l982" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30824423" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin omission for weight control in adolescents with type 1 diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Gottesman" 1 => "J. Ziegler" 2 => "A. Parker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Top Clin Nutr" "fecha" => "2015" "volumen" => "30" "paginaInicial" => "314" "paginaFinal" => "323" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of social identities in the management of and recovery from ‘Diabulimia’: a qualitative exploration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Hastings" 1 => "N. McNamara" 2 => "J. Allan" 3 => "M. Marriott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.abrep.2016.10.003" "Revista" => array:6 [ "tituloSerie" => "Addict Behav Rep" "fecha" => "2016" "volumen" => "4" "paginaInicial" => "78" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29511728" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetes, eating disorders and body image in young adults: an exploratory study about “diabulimia”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.A. Falcão" 1 => "R. Francisco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40519-017-0406-9" "Revista" => array:6 [ "tituloSerie" => "Eat Weight Disord" "fecha" => "2017" "volumen" => "22" "paginaInicial" => "675" "paginaFinal" => "682" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28597360" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24451479/0000003100000006/v1_202110310547/S2445147921000527/v1_202110310547/en/main.assets" "Apartado" => array:4 [ "identificador" => "66560" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24451479/0000003100000006/v1_202110310547/S2445147921000527/v1_202110310547/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147921000527?idApp=UINPBA00004N" ]
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Vol. 31. Issue 6.
Pages 396-397 (November - December 2021)
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Vol. 31. Issue 6.
Pages 396-397 (November - December 2021)
Letter to the Editor
Diabulimia: An updated perspective
Diabulimia: una perspectiva actualizada
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Raquel Ferrero Francoa, Abelardo Garcia de Lorenzob, Alejandro Gonzalez Castroc,
Corresponding author
a Grado en Enfermería, Gerencia de Atención Primaria del Servicio Cántabro de Salud, Spain
b Miembro de Honor de la Academia Española de Nutrición y Dietética, Catedrático de Medicina Intensiva, Departamento de Cirugía, Facultad de Medicina, Universidad Autónoma de Madrid, Director de la Cátedra FUAM-Fundación Abbott de Medicina Crítica y Metabolismo, Jefe del Servicio de Medicina Intensiva, Hospital Universitario La Paz-Carlos III, Madrid, Spain
c Médico Especialista en Medccina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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