Among women with type 1 diabetes, those who took less insulin than prescribed had a threefold risk of mortality. This was found among women with eating disorders.
Skipping insulin shots is deadlier than it seems.
According to a study conducted by researchers at the Joslin Diabetes Center, women with type 1 diabetes who took less insulin than prescribed had a three times higher risk of death and higher rates of disease complications that those who didn't.
The 11-year study, published in the March issue of Diabetes Care, concluded that moratily associated with less insulin dosage appeared in the context of eating disorder symptoms such as concern for body weight and shape, restrictive eating patterns, binge eating, and vomiting. In addition to risk of mortality, there was a higher problem rate in kidneys and feet as well.
"This is an incredibly important women's health issue in the area of diabetes," said lead author Ann E. Goebel-Fabbri, psychologist and investigator in the Section on Behavioral and Mental Health at Joslin Diabetes Center and instructor at Harvard Medical School. "The average age of death was significantly younger in the insulin-restricting group. This behavior emerged as a significant risk factor for mortality."
Goebel-Fabbri noted that other studies have shown that women with diabetes are nearly 2.5 times more likely to develop an eating disorder than women without diabetes. Warning signs include: unexplained elevations in A1c levels; repeated problems with diabetic ketoacidosis (DKA), which can be fatal; extreme concerns about weight and body shape; change in eating patterns; unusual pattern of intense exercise (sometimes associated with frequent hypoglycemia); and amenorrhea (skipping monthly menstrual cycles).
Goebel-Fabbri said that women with type 1 diabetes can manage their disease through proper insulin intake, but that eating disorders are creating barriers in their diabetes management. "The biggest frustration is knowing that these women, by virtue of their eating disorders, are unable to utilize that lifesaving set of tools," she said.
What is Type 1 Diabetes?
Type 1 diabetes is the autoimmune form of the disease, in which the body is no longer able to produce insulin, a hormone which allows the body to utilize and store calories for energy. Current treatment guidelines for type 1 diabetes aim at achieving near normal blood glucose ranges by taking multiple daily doses of insulin.
Eating disorders in type 1 diabetes such as "diabulimia," as it is known in the popular press, represent some of the most complex patient problems—both medically and psychologically. Women with eating disorders and diabetes typically struggle with symptoms similar to those of women with eating disorders who do not have diabetes. However, they exhibit a very dangerous symptom of calorie purging in the form of insulin restriction.
About Joslin Diabetes Center: Founded in 1898, Joslin Diabetes Center is the world's largest diabetes clinic, diabetes research center and provider of diabetes education. It is a nonprofit institute.
