Restricting Insulin to Control Weight: The Addiction of Diabulimia

Type 1 diabetics use insulin to help their bodies process sugar from foods, allowing the sugar to be absorbed from the bloodstream. When insulin doses are reduced or eliminated, the glucose passes through the blood and is eliminated in urine, significantly limiting the number of calories absorbed by the diabetic.

The practice of restricting insulin use in order to limit caloric intake is a dangerous weight control measure used among some diabetics. Often called “diabulimia,” the reduction of insulin can quickly become addictive. While it can result in immediate weight loss, the practice can also be very risky and have fatal consequences.

Bulimia is an eating disorder in which a person binge eats and then purges, usually by self-induced vomiting and by the use of laxatives. In diabulimia, however, the diabetic cuts back on insulin to restrict the number of calories absorbed.

Cutting back on insulin increases the risk of developing diabetic ketoacidosis, a condition in which acids build up in the bloodstream and can result in a coma or even death. In addition, reducing insulin use can also increase the risk of developing an infection or complications like nerve damage and kidney disease.

In 2008, Ann Goebel-Fabbri, PhD, an investigator of behavioral and mental health at Joslin Diabetes Center and an instructor in psychiatry at Harvard Medical School, led a study that examined the risks associated with limiting insulin in type 1 diabetics. Goebel-Fabbri and colleages recruited 234 women with type 1 diabetes and examined their insulin use over and 11-year period.

At baseline, nearly one-third of the participants reported taking less insulin than prescribed by their doctor. The consequences of decreasing insulin use were staggering: these women were three times more likely to die over the course of the study compared with those who at baseline reported taking insulin as directed by their doctor. The women who limited insulin use died younger (average age of death was 45 compared with 58 for those with normal insulin use) and had more problems with their kidneys and feet.

The women who had a history of restricting insulin and died during the course of the study’s follow-up period had reported more frequent insulin restriction than those who were alive at the end of the study. There were also reports of more eating disorder symptoms among those who died during the study.

Goebel-Fabbri’s team cautions that though diabulimia symptoms can surface at any age, parents of type 1 diabetics should be watchful of signs that insulin is being restricted. For instance, if a child seems to be eating significantly more but still losing weight, or if frequent urination or low energy levels seem to be a problem, the parent should seek help from a medical professional with both diabetic and eating disorder expertise.

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