Effective treatment of bulimia with fluoxetine, a serotonin reuptake inhibitor, in a patient with type I diabetes mellitus

The eating disorder bulimia is characterized by recurrent and uncontrolled binge eating, followed by self-induced vomiting, and overconcern about body shape and weight. This abnormality is prevalent among adolescent and young adult women and occurs in 5 to 19 percent of female college seniors. The incidence of bulimia is higher in patients with type I insulin-dependent diabetes mellitus. Because the control of blood glucose levels in type I diabetic patients depends on a balance between caloric intake and insulin administration, bulimia may upset this balance, thereby disturbing control of blood glucose levels and leading to increased blood glucose levels (hyperglycemia). Studies show that type I diabetics with bulimia also have excessive levels of glucose-bound hemoglobin, the oxygen-carrying pigment of red blood cells. A case is described of a 21-year-old woman with type I diabetes, bulimia, and long-term hyperglycemia. The antidepressant agent fluoxetine, which may have appetite-inhibiting properties, improved depression, changed bulimic behavior, and improved blood glucose control in this patient. Her glycosylated hemoglobin levels dropped from 13.4 to 8.6 percent after fluoxetine treatment, and she was free of bulimic behavior for more than two years. Fluoxetine increases the bioavailability of the naturally occurring substance serotonin, which has been shown to inhibit appetite. This antidepressant drug was recently approved by the Food and Drug Administration. Further investigation is needed to establish the effectiveness of fluoxetine in treatment of patients with bulimia. (Consumer Summary produced by Reliance Medical Information, Inc.)