Insulin Cutback Due to Eating Disorder?
Study Shows 'Diabulimia' May Lead Some Diabetes Patients to Reduce Insulin
Feb. 27, 2008 -- Women with type 1 diabetes who skimp on
their insulin are taking a dangerous gamble, increasing their risk of kidney
damage, foot problems, and even death, say researchers at the Joslin Diabetes
Center in Boston.
And the researchers say a key reason some women may forgo their insulin is
related to eating disorder symptoms, part of an increasing problem known as
In type 1 diabetes, the body doesn't produce insulin, the hormone needed for
the body to use sugar (glucose) for energy. People with this condition need to
take insulin every day to keep their blood sugar levels in check. Not getting
enough insulin can lead to elevated levels of blood sugar and a number of
serious complications, including eye and kidney damage.
Despite the dangers of not taking insulin correctly, many adults with type 1
diabetes are failing to keep their blood sugar at the level recommended by the
American Diabetes Association. One study of women with type 1 diabetes done in
1990 showed that a third of the women were restricting their insulin
Risks of Cutting Back on Insulin
Recently, researchers at the Joslin Diabetes Center decided to follow up
with the participants of that study to find out whether cutting back on insulin
led to higher rates of diabetes complications and deaths about 11 years later.
They were able to track down 234 of the 390 women who had enrolled in the
Women who had reported restricting insulin more than a decade before had a
higher likelihood of developing kidney damage and foot problems, the
researchers reported in the March issue of Diabetes Care. They were also
three times more likely to die during the study period, and to die at an
earlier age: on average 45 years as opposed to 58 years in women who did not
restrict their insulin.
Why do so many women with type 1 diabetes not take enough insulin? The
researchers found that deceased
women who restricted their insulin had higher scores on measures of
eating disorder symptoms and diabetes-related distress.
The researchers point to a type of eating disorder that the media has
referred to as "diabulimia": Women are restricting their insulin doses
in order to control weight. Because food control
is a big part of diabetes care, eating disorders are more than twice as common
in women with type 1 diabetes than in women without the disease, according to
other studies. By purposely restricting their insulin, women with
"diabulimia" are interfering with treatment that could save their
"We know that current type 1 diabetes
treatment is especially good at preventing complications and preserving
longevity," researcher Ann E. Goebel-Fabbri, PhD, says in a news release.
Goebel-Fabbri is a psychologist and investigator in the section on behavioral
health at Joslin Diabetes Center and an instructor at Harvard Medical
School. "The biggest frustration is knowing that these women, by virtue of
their eating disorders, are unable to utilize that lifesaving set of
The researchers recommend that doctors routinely ask their female patients
with type 1 diabetes whether they take less insulin than they should.
Identifying women who are cutting back on insulin can help those women get
appropriate help before they develop serious complications.