Endocrine Abstracts

Introduction: Bulimia is an eating disorder characterized by constant preoccupation with food, irresistible cravings for food and binge eating episodes. The data regarding the incidence of bulimia in people with diabetes are contradictory. The glycemic variations subsequent to binging and vomiting leads to complications like retinopathy, kidney or liver failure, hypoglycemic comas and electrolyte imbalances.

Case presentation: A 57-year-old female, diagnosed with type 2 diabetes at the age of 33, complicated by diabetic polyneuropathy and under treatment with Metformin (2 g/day), glargine (96 IU/day) and glulisine (32 IU/day) was admitted to our center for persistent hyperglycemia (Gl max=430 mg/dl), polyuria, polydipsia, nocturnal enuresis, xerostomia and nocturnal paresthesia in the upper and lower limbs. Despite her associated disorders (recurrent depression and bulimia) untreated properly, she underwent a gastric plication procedure with an initial weight loss of 20 kg regained after a period of 2 years. At admission: depressive facial affect, BMI=42.87 kg/m², distended abdomen due to fat tissue with multiple surgical scars, psoriatic lesion on the posterior thorax, elbows and lower limbs and acanthosis nigricans on the neck. Labs exams revealed: Gl=304 mg/dl, hypertriglyceridemia, low calcium and magnesium levels, glycosuria and poor glycemic control in the last 3 months (A1c=11.4%). The 24-hour weighed food diary showed a caloric intake higher than her daily requirements with 3 main meals and 4 snacks (consisting of fruits, sweets, bread and yogurt). To improve the glycemic and weight control the prandial insulin was stopped and Exenatide 10 μg bid was initiated, alongside with a low caloric diet of 1200 Kcal/day and resumed therapeutic education with a favorable outcome. The psychological and psychiatric consults confirmed the previous diagnoses and recommended increasing the Fluoxetine to 40 mg/day, monthly reevaluation and cognitive behavioral therapy. The hormonal profile excluded other secondary causes of obesity. The neuropathic symptoms diminished significantly under i.v treatment with α-lipoic acid. The Doppler exam displayed decreased values of the ankle-brachial index.

Conclusions: The data regarding the incidence of bulimia in people with diabetes are contradictory and the factors which may underlie the link between diabetes and bulimia have not been systematically investigated. The screening for bulimia and other eating disorders may be an efficient tool for detection and implementation of the multidisciplinary approach in order to obtain the therapeutic success.