Women with Type 1 Diabetes Who Omit Insulin

Women with type 1 diabetes who have symptoms of bulimia, depression, illness-related distress, and high blood glucose levels are more likely than other diabetic patients to be skipping their insulin shots in an attempt to keep weight off, according to findings of a new study. Skipping insulin places them at much higher risk for the catastrophic complications of diabetes, including eye and kidney disease, and, in some cases, death.

The study, reported by Dr. Anne Goebel-Fabbri at the annual American Diabetes Association meeting held in New Orleans in June, included 400 women between the ages of 13 and 60 who were attending a diabetes clinic for routine care. All women were interviewed, and 70 admitted omitting their insulin injections in an attempt to control their weight.

In type 1 diabetes, the immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas. Thus, these patients must take daily insulin injections to survive. Previous studies have suggested that women with this type of diabetes are more than twice as likely as women without diabetes to have an eating disorder. About one-third of the women say that at some point they have skipped insulin shots as a way to control their weight.

In effect, a form of bulimia nervosa

Dr. Goebel-Fabbri, of the Joslin Clinic, Boston, reported that insulin omission was very strongly related to symptoms of bulimia nervosa and, in effect, was a form of bulimia nervosa. In the study, a woman who omitted insulin was 1.4 times more likely to have symptoms of bulimia compared to a woman who did not skip her insulin injections.

Factors such as depression, body mass index, blood glucose levels and symptoms of diabetes-associated distress can be used to predict whether a woman will become an “insulin omitter.” When patients at risk are identified, clinicians may be able to offer healthy ways of eating and exercising to help patients keep their weight under control.