Type 1 diabetes is a disorder in which the body's immune system attacks insulin-producing cells in the pancreas. People with this disease produce little or no insulin, so they take shots of insulin daily. Without an external source of insulin, a patient will not survive. Type 1 diabetes most often manifests at a young age in children and young adults. Young patients with type1 diabetes have many issues to deal with. There is the issue of dealing with a chronic illness and the fear that goes along with learning about the potential complications. Many younger patients also have issues with body image. "My injection sites make me look lumpy". "This whole needle thing is disgusting - look at my bruises". "I have diabetes - my body is different from everyone else's."
Some patients take things one step further. They learn that their body is dependent on insulin, and that insulin is an anabolic or storage hormone. While insulin keeps their muscle mass from breaking down, it also encourages fat storage. As a result, patients learn to manipulate their insulin - often skipping doses in an attempt to reduce weight gain. The term for this condition is "Diabulimia." Patients can become quite savvy with this technique, taking just enough insulin to avoid going into diabetic ketoacidosis, and narrowly avoiding hospitalization.
While diabulimia is a term that has only cropped up in recent years and is not a recognized medical condition, the American Diabetes Association has long known about insulin omission as a tactic to lose weight. Diabulimia can occur in any patient with type 1 diabetes, but unfortunately it is seen more often in young girls and women with the disease, similar to other body image disorders.
The repercussions of manipulating insulin in such a manner can be enormous. Patients who do this have higher blood sugar levels than are healthy, and as a result, become dehydrated, fatigued, and experience a breakdown in muscle tissue. In the long term, this condition is associated with an accelerated development of diabetic complications such as eye disease, kidney disease, and limb amputations due to vascular disease.
While this disorder is relatively well known to endocrinologists that treat a large number of patients with type 1 diabetes, it is not often recognized by primary care providers or by family members.
If you are a family member of someone with type 1 diabetes and you see patterns of behavior that are concerning, bring it to someone's attention. The long term damage that can occur can be profound, and early acknowledgement of the behavior along with early intervention can make a world of difference.
REFERENCE: Fauci, Anthony S., et al. Harrison's Principles of Internal Medicine. 17th ed. United States: McGraw-Hill Professional, 2008.