Eating Disorders and Insulin Restriction in Type 1

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Insulin becomes the enemy 

This practice of withholding insulin to lose weight is often called “diabulimia” by the media and lay public. However, the syndrome — officially known as ED-DMT1 — is considered a serious dual diagnosis and is especially dangerous because the person has to deal with two potentially lethal illnesses.

Dr. Goebel-Fabbri says insulin restriction is a byproduct of the “fear of being fat.”  Young women are especially vulnerable to messages from social media and friends about body size and self worth. At the same time, anxiety and depression, which are common in diabetes, often exacerbate the problem.

While withholding insulin can lead to rapid weight loss, it also increases the risk of serious complications such as ketoacidosis, long-term diabetes complications (eye, nerve and kidney disease), and even increases risk of dying, says Dr. Goebel-Fabbri.

Warning signs of “diabulimia” include:

  • Rapid weight loss
  • Elevated A1c
  • A preoccupation with dieting
  • Secrecy about blood sugars, eating and insulin shots
  • Depression, mood swings or fatigue
  • Unexplained episodes of ketoacidosis

Hitting rock bottom

As the eating disorder takes control over the person’s life, the need to drop a dress size or fit into skinny jeans outweighs how horrible the person may feel, or even the harm they’re doing to their body.  Skipping insulin shots for periods of time can cause irreversible damage to the body.

“Women often describe losing “everything” — professional opportunities, their energy and health; romantic ties, friendships, and family relationships, essentially their overall quality of life,” says Dr. Goebel-Fabbri.

3 Responses to Eating Disorders and Insulin Restriction in Type 1

  1. Walter Wasylko says:

    I’m a Type 1 for 48 years with bowel incontinence due to Cerebral Palsy autonomic neuropathy (AN). My gastroenterologist wasn’t able to diagnose specifically whether it could be connected with an eating disorder since AN is considered a symptom of long-term T1 complication.

  2. Michael O'Meara says:

    As a 65 year old male with type 1 diabetes for 54 years, I am curious about any such studies that may have focused on boys, male teens and/or men.

    The treatment modalities, technologies and insulins available in the 60s-early 80’s made it more challenging for physically active males to be able to avoid high blood glucose levels while more importantly avoiding the lows that forced an unpleasant interruption in physical activities and drew unwanted attention to the disease.

    In hindsight, this learned perspective that emerged from a learned tolerance for the experiences of high bg (and amazing “luck” related to avoiding the complications of high HbA1c levels) made remaining thin and relatively free of low bg an acceptable trade-off.

    For the last 20+ years, I have watched my intake, checked my bg 6+ times a day, treated high bg with ss dosing, visited my providers at least 4 times a year and now I struggle more with low bg and am obese, but , hey, my HbA1c scores are now below 7. Success? Now, my medical Team says, “…all (I) have to do differently is become more active and be more focused on checking (my) bg levels.” (Please refer to first and second paragraphs.)

    Point being: anymore, endocrinologists must help their patients with diabetes by implementing a Team-approach that includes, at least, a Nurse Practitioner (diabetes educator) and RD. Together, they can form a wholistic perspective that is better able to perceive, understand and respond to each of their patients’ unique collection of thoughts, emotions, questions, needs, behaviors and experiences. This may be challenging, but it pales in comparison with the challenges facing the person with diabetes.

    • dr suresh says:

      what regimen/dose of insulin you are following?
      what are your renal function reports?with increasing age low bl sugar is common,,renal/hepatic functions are affected.hence detals of reports required.

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