Diyabette Karşılaşılan Yeme Bozukluğu: Diabulimia
Özet
Diabulimia, özellikle tip 1 diyabetli bireylerde kilo kaybı sağlamak veya kilo alımını önlemek amacıyla insülin dozlarının kasıtlı olarak kısıtlanması ya da atlanmasıyla karakterize, yaşamı tehdit eden ciddi bir yeme bozukluğudur. Literatürde tip 1 diyabetli ergen ve genç yetişkin kadınlarda görülme sıklığının daha yüksek olduğu ve bu oranın yaşla birlikte arttığı belirtilmektedir. Genetik, biyolojik ve çevresel faktörlerin yanı sıra beden memnuniyetsizliği, düşük benlik saygısı ve depresyon gibi psikolojik durumlar bu bozukluğun gelişiminde önemli risk faktörleridir. Diabulimia; yüksek kan glukozu, tekrarlayan ketoasidoz atakları, aşırı yorgunluk gibi kısa ve orta vadeli belirtilerin yanı sıra uzun vadede nefropati, retinopati, nöropati, osteoporoz ve böbrek hasarı gibi çok ciddi mikrovasküler komplikasyonlara ve mortalite riskinde artışa yol açar. Erken teşhis için DEPS-R ve mSCOFF gibi diyabete özgü tarama araçlarının rutin klinik kontrollerde kullanılması önerilmektedir. Hastalığın tedavisi ve bakımı bireye özgü olmalıdır; diyabet eğitimcisi, endokrinolog, psikolog ve diyetisyen gibi uzmanlardan oluşan multidisipliner bir ekip yaklaşımı gerektirir. Bu süreçte hastaya insülinin önemi anlatılmalı, glisemik kontrol desteklenmeli ve bilişsel davranışçı terapilerle psikolojik destek sağlanmalıdır.
Diabulimia is a life-threatening eating disorder characterized by the intentional restriction or omission of insulin doses, primarily in individuals with type 1 diabetes, to achieve weight loss or prevent weight gain. Literature indicates that its prevalence is higher among adolescent and young adult females with type 1 diabetes, and this rate increases with age. Along with genetic, biological, and environmental factors, psychological conditions such as body dissatisfaction, low self-esteem, and depression constitute significant risk factors for developing this disorder. Diabulimia leads to short and medium-term symptoms like high blood glucose, recurrent ketoacidosis episodes, and extreme fatigue, while causing severe long-term microvascular complications including nephropathy, retinopathy, neuropathy, osteoporosis, kidney damage, and an increased risk of mortality. For early diagnosis, utilizing diabetes-specific screening tools such as DEPS-R and mSCOFF during routine clinical visits is highly recommended. The treatment and care must be customized to the individual, requiring a multidisciplinary team approach comprising diabetes educators, endocrinologists, psychologists, and dietitians. Throughout this process, patients should be educated on the vital importance of insulin, encouraged toward optimal glycemic control, and provided with psychological counseling through cognitive behavioral therapy.
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