Many U.S. women with type 1 diabetes skip or cut back on insulin to lose weight, experts say. It's a special problem among teen girls. The Associated Press reported on the practice June 18. It's called "diabulimia," and it's dangerous. Without enough insulin, a diabetic can go into a coma or even die. High blood sugar also can damage the eyes or kidneys.

By Henry H. Bernstein, D.O.
Harvard Medical School

What Is the Doctor's Reaction?

A recent Associated Press article points out that many females with eating disorders are also dealing with other diseases such as diabetes. It is estimated that as many as one-third of young U.S. women with type 1 diabetes will deliberately cut back on their insulin to lose weight.

The practice is known as "diabulimia." This term comes from the idea of a person with diabetes purging the body (like someone with bulimia) by not using insulin correctly.

According to this article, it is not yet a recognized medical condition. But the American Diabetes Association has known about it for a long time. In fact, people with diabetes and eating disorders are said to spread the word on this practice through Internet bulletin boards.

Having an eating disorder and diabetes together can be a very dangerous combination. When either condition is not well controlled, people risk damage to the body and serious health problems at younger ages. This can lead to early death.

In type 1 diabetes, the body's own immune system attacks insulin-producing cells in the pancreas. As a result, diabetics produce little or no insulin. They must take shots of it every day. We need insulin to move glucose (sugar) from the bloodstream into the body's cells.

Without insulin, the cells starve and cannot function properly. By reducing or skipping insulin shots, type 1 diabetics risk falling into a coma. They also could have long-term problems such as blindness, amputations and kidney failure.

Despite the serious risks, type 1 diabetic women may still skip insulin shots because it means weight loss. Studies show that this group of women is twice as likely to develop an eating disorder. People with eating disorders often go to extreme measures to lose weight. This leads to physical and emotional health problems.

Like others who do not have diabetes, these women think that by being thin, they will have more friends and be more popular. Women with eating disorders are obsessed with weight and body image. Type 1 diabetic women have one more unhealthy way of controlling it.

What Changes Can I Make Now?

If you are a type 1 diabetic, understand how critically important it is for you not to skip or reduce your insulin. If you think you are falling into this practice, reach out and get help.

Think about anyone you know with diabetes and be aware of "diabulimia." Educate your family and friends about this condition. Look out for warning signs, such as:

• Change in eating habits -- Someone eats more but still loses weight.
• Low energy -- The body has no fuel to work.
• Higher than expected blood-sugar levels -- The sugar is trapped in the blood and cannot pass into cells.v
• Going to the bathroom more frequently -- The kidneys work extra hard to remove the excess sugar through the urine.

Remember, too, that there are several types of eating disorders. They include:

• Anorexia nervosa -- A person starves herself to lose weight. She usually has an overwhelming fear of gaining weight and concern about her body image. Sadly, people with anorexia are severely (more than 15%) under their ideal body weight. Yet they still see themselves as overweight.



• Binge eating -- A person suffers from impulsive overeating. There is no forced vomiting, but there are usually severe feelings of shame or self-hatred. Body weight may range from normal to severe obesity.



• Bulimia nervosa -- A person secretively cycles binge eating and purging (forced vomiting). Usually weight remains normal. People with bulimia may abuse laxatives or exercise excessively as means to control their weight. Now we know they may stop using their insulin, too, if they have diabetes.

What Can I Expect Looking to the Future?

You can expect to hear more about "diabulimia." You may even know someone who has it. As a problem becomes better known, people are more likely to address it.

Knowing that there is a connection between these two conditions also can be valuable. This will allow caregivers and health care professionals to identify people who have a problem. This can lead to better treatments and help manage both conditions together much more effectively.

In addition, scientists may someday find out whether or not there is a gene that puts people at risk for developing these disorders.