Insulin withholding for weight control in women with diabetes

OBJECTIVE - To provide a description of the clinical characteristics that distinguish individuals who withhold insulin for weight control from those who do not. Some individuals with insulin-dependent diabetes mellitus (IDDM) control their weight by withholding insulin and purging excessive calories. This process places patients at risk for developing severe hyperglycemia, diabetic ketoacidosis, and increases the risk of long-term complications of diabetes. RESEARCH DESIGN AND METHODS - Forty-two women with IDDM, ages 16- 40, were interviewed and divided into two groups: insulin withholders (IWs) and non-insulin withholders (non-IWs). These groups were compared on physiological, behavioral, psychological, and psychiatric variables. RESULTS - Compared with non-IWs, patients who withheld insulin to control their weight exhibited poorer glycemic control, reported more negative attitudes toward diabetes, were more likely to have pathological scores on the Eating Disorder Inventory 2, and were more likely to report current or past symptoms of anorexia or bulimia nervosa. IWs were also more likely to report lying to physicians about their degree of compliance with their diabetes regimens. CONCLUSIONS - The results of this study indicated that IWs exhibit more symptoms associated with the spectrum of eating disorders than non-IWs. This study showed that insulin withholding for weight control not only exists, but is associated with some maladaptive symptoms and behaviors that need to be addressed by diabetes treatment teams.