Restricting Insulin to Lose Weight Increases Problems
Women with type 1 diabetes who take less insulin than they
should to try to lose weight triple their risk of dying compared to women who do
not skip insulin doses, according to a report in Diabetes
Care.
"This is a very important women's health issue in
diabetes," says Ann E. Goebel-Fabbri, Ph.D., lead author of the study.
"It happens at shockingly high rates, and, if we can detect
this problem sooner and earlier, one would hope that we could direct patients to
effective treatment," says Dr. Goebel-Fabbri.
Insulin treatment has been linked to weight gain. The
practice of restricting insulin is referred to as "diabulimia," and is a
dangerous way to shed pounds quickly.
Previous studies have shown that women with diabetes are
almost 2.5 times more likely to develop an eating disorder than women without
diabetes.
Research also suggests that diabulimia can increase the
risk of complications such as foot and vision problems, along with kidney
damage, but there has been little research on mortality.
Persons with type 1 diabetes have completely lost the
ability to produce their own insulin, the hormone necessary to move glucose into
cells, where it is used for energy.
Regular injections of insulin essentially replace what the
body used to produce naturally.
But shortchanging insulin doses means glucose levels are
not controlled and, as the landmark Diabetes Control and Complications Trial
established, persistently high blood glucose levels lead to serious
complications, including eye and kidney trouble, and even death.
"Insulin is the hormone that allows the transport of
glucose from the bloodstream into cells for use, so either the sugar gets used
then and there for energy or it gets stored for later use," explains Dr. Goebel-Fabbri,
a psychologist at the Joslin Diabetes Center in Boston.
"So, if you're not taking enough insulin, sugar increases
in concentration in the blood, the body needs to find a way of excreting it, and
the calories from that sugar get excreted in the urine," she says.
Unfortunately, half of adults with diabetes do not maintain recommended glycemic
levels.
This study included a total of 234 women, average age of
45, who were followed for 11 years. Participants had had diabetes for a mean of
28 years by the end of the follow-up.
Almost one-third of the women reported taking less insulin
than they should.
These women tripled their risk of dying compared with women
who did not restrict their insulin. They also died younger (45 versus 58) and
had higher rates of kidney and foot problems.
Women in the two groups did not differ when it came to
depression, anxiety, fear of hypoglycemia (low blood sugar), or general
psychiatric symptoms. This left an eating disorder, rather than general
psychological issues, as the likely culprit.
Dr. Goebel-Fabbri says physicians and other healthcare
providers need to start including this kind of screening for diabetes.
Always consult your physician for more information.
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