Insulin Cutback Due to Eating Disorder?

Study Shows 'Diabulimia' May Lead Some Diabetes Patients to Reduce Insulin

Medically Reviewed by Louise Chang, MD on February 27, 2008
From the WebMD Archives

Feb. 27, 2008 -- Women with type 1 diabetes who skimp on their insulin are taking a dangerous gamble, increasing their risk of kidney damage, foot problems, and even death, say researchers at the Joslin Diabetes Center in Boston.

And the researchers say a key reason some women may forgo their insulin is related to eating disorder symptoms, part of an increasing problem known as "diabulimia."

In type 1 diabetes, the body doesn't produce insulin, the hormone needed for the body to use sugar (glucose) for energy. People with this condition need to take insulin every day to keep their blood sugar levels in check. Not getting enough insulin can lead to elevated levels of blood sugar and a number of serious complications, including eye and kidney damage.

Despite the dangers of not taking insulin correctly, many adults with type 1 diabetes are failing to keep their blood sugar at the level recommended by the American Diabetes Association. One study of women with type 1 diabetes done in 1990 showed that a third of the women were restricting their insulin intake.

Risks of Cutting Back on Insulin

Recently, researchers at the Joslin Diabetes Center decided to follow up with the participants of that study to find out whether cutting back on insulin led to higher rates of diabetes complications and deaths about 11 years later. They were able to track down 234 of the 390 women who had enrolled in the original study.

Women who had reported restricting insulin more than a decade before had a higher likelihood of developing kidney damage and foot problems, the researchers reported in the March issue of Diabetes Care. They were also three times more likely to die during the study period, and to die at an earlier age: on average 45 years as opposed to 58 years in women who did not restrict their insulin.

Why do so many women with type 1 diabetes not take enough insulin? The researchers found that deceased women who restricted their insulin had higher scores on measures of eating disorder symptoms and diabetes-related distress.

The researchers point to a type of eating disorder that the media has referred to as "diabulimia": Women are restricting their insulin doses in order to control weight. Because food control is a big part of diabetes care, eating disorders are more than twice as common in women with type 1 diabetes than in women without the disease, according to other studies. By purposely restricting their insulin, women with "diabulimia" are interfering with treatment that could save their lives.

"We know that current type 1 diabetes treatment is especially good at preventing complications and preserving longevity," researcher Ann E. Goebel-Fabbri, PhD, says in a news release. Goebel-Fabbri is a psychologist and investigator in the section on behavioral and mental health at Joslin Diabetes Center and an instructor at Harvard Medical School. "The biggest frustration is knowing that these women, by virtue of their eating disorders, are unable to utilize that lifesaving set of tools."

The researchers recommend that doctors routinely ask their female patients with type 1 diabetes whether they take less insulin than they should. Identifying women who are cutting back on insulin can help those women get appropriate help before they develop serious complications.

Show Sources


Goebel-Fabbri, A. Diabetes Care, March 2008; vol 31: pp 1-5.

News release, Joslin Diabetes Center.

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