Study Sheds Clues on Female Insulin Skippers

By Keith Mulvihill

Tuesday, June 17, 2003

NEW ORLEANS (Reuters Health) – Women with type 1 diabetes who show symptoms of bulimia, depression, illness-associated distress and high levels of blood glucose are more likely than other patients to be skipping insulin shots to keep weight off, new study findings suggest.

“This is incredibly dangerous behavior,” said principal investigator Dr. Anne Goebel-Fabbri of the Joslin Diabetes Center in Boston, Massachusetts.

“We know from previous research in this area that women who skip insulin for weight control reasons have much higher rates of the catastrophic complications of diabetes, including eye and kidney disease,” she added.

In type1 diabetes, the immune system launches a misguided attack against insulin-producing beta cells in the pancreas. People with this type of diabetes must take daily insulin injections to survive.

Previous studies have suggested that women with type 1 diabetes are more than twice as likely to have an eating disorder compared to women without diabetes. And about one third of these women say that at some point in their lives they have omitted insulin injections for weight control purposes.

Instead of self-induced vomiting as a means to purge calories, these women know that by neglecting to take insulin, their body will dump excess calories into their urine, instead of storing them in cells.

However, only about nine percent of the women actually fall into the category of having an eating disorder, according to Goebel-Fabbri.

In the new study, which was presented this week at the American Diabetes Association’s annual meeting, Goebel-Fabbri and colleagues aimed to identify what factors drive insulin omission.

The researchers interviewed 400 women between the ages of 13 and 60 attending a diabetes clinic for routine care.

In all, 70 women admitted to omitting insulin injections for weight control purposes (so called “omitters”) and 330 were not insulin omitters, Goebel-Fabbri told Reuters Health.

“What we found was that insulin omission is very strongly related to symptoms of bulimia nervosa, so it is, in and of itself, a symptom of bulimia nervosa,” said Goebel-Fabbri.

Bulimia is an eating disorder in which people binge eat, then purge themselves by vomiting or taking laxatives.

A woman who was an insulin omitter was 1.4 times more likely to have symptoms of bulimia compared to a woman who did not skip insulin injections.

Other factors such as depression, body mass index, blood glucose levels and symptoms of diabetes-associated distress also appear to play a role.

“All taken together, these factors can be used to predict whether a woman is going to become an insulin omitter and so what it gives us now is different avenues to try to intervene,” said Goebel-Fabbri.

“Most of these women are suffering in silence … and they keep it a secret from their physicians and from their family that they are omitting and so they can’t access adequate care,” she added.

But these women need to know that having chronically high blood sugar from insulin skipping can damage tiny capillaries, leading to eye and kidney disease, explained Goebel-Fabbri.

With the results of this study, Goebel-Fabbri hopes doctors may be able to identify these women and teach them healthy ways of eating and exercising instead of avoiding insulin.

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