What steps can be taken to help prevnt the addictive cycle of insulin restriction for weight control?

1. For parents, remain involved , in a developmentally-appropriate way, in your child’s insulin administration, especially over the transition to adolescence, when weight gain normally happens with the onset of puberty and physical maturation.

2. For persons with diabetes: Find a diabetes provider (CDE, nurse, nutritionist, physician) with whom you can talk about your frustrations with your body weight or shape. It is very important to have a diabetes clinician who will help you work on your two important goals: (1) healthy blood sugar control and (2) healthy weight. If you are not comfortable discussing your weight concerns with your diabetes clinicians, you need to talk with your parents or a counselor or social worker about finding a new diabetes team. Twenty-five years ago, no one understood how common and addictive this vicious cycle of insulin restriction for weight control is. That meant that in the past, this condition was not identified and certainaly was not preventable. However, with today’s knowledge, it is critical to find a diabetes team with whom you can discuss your weight concerns and any fears about taking insulin which you may have (such as fear of weight gain, or fear of hypoglyecmia). Persons with type 1 diabetes today deserve to be working with a health care team who will help them maintain optimal blood sugar control and maintain a healthy weight! Achieving these 2 goals is possible, although like everything involved in caring for diabetes. this is very challenging, a lot of work, and demands teamwork!

3. For diabetes clinicians: If you are unfamiliar with bulimia, or uncomfortable with eating disorders, or if you feel you need more expertise to help a patient who is struggling with insulin restriction for purposes of weight control, contact a psychologist, social worker, or psychiatrist who is knowledgable about eating disorders. Also, for an excellent, brief and practical guide, read the chapter “Detecting and treating eating disorders in young women with type 1 diabetes” by Anne Goebel-Fabbri, Ph.D., a very experienced psychologist who works in this area at the Joslin Diabetes Center in Boston. This chapter is in the book PRACTICAL PSYCHOLOGY FOR DIABETES CLINICIANS (2ND EDITION), which I edited together with my colleague Richard Rubin, Ph.D. and was published by the American Diabetes Association in 2002.

I am now training again, and dieting strictly and sensibly, but frustratingly, the more I diet the more weight I gain. I put this down to my blood sugars being consistently lower, therefore my system is not “wasting” as much fat/energy.

This has led me to consider reducing (not skipping) my insulin for say 4 weeks, til I reach my target weight. I will then resume my insulin intake for tight BG control and continue training 3 times a week at the gym to avoid gaining weight again.

Does this sound reasonable, risky or stupid, given my my problem is shedding the weight? I am confident I can maintain my correct weight once I reach it.

I would welcome your thoughts / advice.

Best wishes to all…

Some of you have gotten back on insulin and lamented the weight gain that came with that (although you may have been seriously underweight before consistently taking your shots again) but appreciated the physical well being that returned.

As far as what can be done, there are short term bridges and longer term solutions to consider. As I said, finding a psychologist with experience with this is challenging. One of our authors on this post, Barbara Anderson, is one of those individuals. All psychologists have familiarity with eating disorders. The key is to really attack the problem as an eating disorder while recognizing that insulin omission must be dealt with during the acute treatment phase. In teens with diabetes, I recruit the family to step up and administer the injections to the patient. I liken it to using a cast to support a broken bone providing it time to heal. But even if behavioral management is successful and help is found for the insulin administration, the typical diabulimic will have these thoughts running through their mind for years and require ongoing help and support. Recidivism is high after successful treatment. It’s this relapse rate that leads up to alf of all these people to develop serious diabetes related complications at an accelerated rate with serious consequences as was pointed out in a more recent post.

It has not been explored very well whether or not the nutritionally deprived state that many diabulimics exist contributes in some way to the accelerated rate of onset of complications. This deprivation often includes a wide array of micronutrients lost in the purging of calories through the kidneys. Perhaps these deficiencies in some fashion increase the risk of complications. The answer to this is unknown at this time.

In summary, identify the problem of diabulimia in a non-judgmental way. Recognize it as an eating disorder unique to persons with insulin requiring diabetes. It does seem to affect more women than men, but men are not immune as the first post in this thread proves. Family and friends are needed to support the diabulimic, especially when the patient is a child or teen. This often includes administering insulin injections or reviewing bolus histories on pumps. Finally, even with excellent treatment there exists a high risk of relapse and ultimately the development of permanent long term complications at a relatively short disease duration.

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I too have fought against weight gain for the past 12 years with type 1 (& a quarter…my doc says)….. I think maybe there are different degrees of diabulimia……I was always such a “fighter” for diabetes and diabetics …..I finally lost 28 of the 60 or so pounds I had to lose in ‘06, in ‘07 I hurt my hip and back and just could not exercise the way I was and started to lose hope more so than I even have in the past years with diabetes…….as each pound crept on I felt as if “My fight” was gone……..and depression to a degree set in…….I finally have relief in my pain but now over the past year have gained back more and then some leaving me about 70 pounds heavy at the moment…….I tinker with thought in my head all the time about if I should take my insulin today and that maybe that would be the easy way to finally get rid of the guilt and frustration of fighting it all these years…….I have let my sugars run on the higher side before and dropped maybe 5-10 pounds and then I catch myself and tell myself that I can’t do this because of my kids and what it will do to my body and then I get in tight control again…….but lately this cycle of good/bad seems to be getting worse……it is a mind game…..and I can see where it can take over if you are not careful……..

okay I’m rambling……..although I have never been full blown into diabulimia as to where I have ended up with sugars super high or in the hospital I can certainly understand mild forms of it and my heart aches for anyone in my situation with weight and feeling like your body just does not match the fight in your heart…….you want to reach for that easy way out and I think about it often………