Does my 14 yr old stepdaughter have diabulemia?

[gemmom]

I know there is much controversy on this subject. But I also know that my stepdaughter lies about her insulin, her diet and everything else.
She has had Type 1 for 2 yrs. In the last 3 months, she has DKAd three times. The last time she was hospitalized for 4-5 days. In my previous post, I had written that her pH was so low that the ER dr initially didn't believe it, as he had never seen one that low before. She was a total mess. Vomiting, peeing on herself, hallucinating...and stayed a mess for several days in the hospital. She is home now (with my DH and I) but I don't know how much control to take. Should I insist that she show me her BG levels? Should I just leave her alone? My DH works all the time and her mom is out of town. My stepdaughter has a horrible diet, shunning most major food groups aside from white carbs and milk.
She is very thin, and always wears extremely loose clothing -- sweatshirts even in the South's 95 degree heat and humidity. She was actually a little chubby before being diagnosed with D1.
My DH dismisses the possibility of diabulemia b/c I think he's in denial. Please help. I am worried about her. Thanks.

[Adinsmom]

I just wanted to say what an amazing and caring step mom you must be. I do not have any advice because I don't know much about diabulimia. But it seems to me that you have every right to be concerned. Have they (her Endo and team) put her in touch with a therapist who can help her deal with D and her feelings?

Good Luck.

[gemmom]

Hi Shelly
Thank you so much. I do love her very much. Right after my post, I asked her to test herself in front of me....she was 394, after being in the 100s for the last couple of days. But she and her sister were alone this afternoon and she had 3-4 pieces of Texas toast without doing anything about her insulin. When I expressed my concern to my DH (her dad) he told me to back off. Do I guess I will. He doesn't want to deal with it, yet leaves her in my care all the time. I am very frustrated.:(

[Nancy in VA]

Well, I don't have a lot of advice on your step-daughter, but you and your husband have GOT to get on the same page - she will play you against each other if you don't, and you will lose, because you are the step-parent.

HAve you looked into counseling for you and for her? Might be worth considering.

[KatelinsMom]

I really feel for you. Being a step parent is so very hard. I am also a step parent to a 14-year-old girl (non-D). It is hard to just stand by and watch them make bad choices, especially ones that put their life in danger. I feel your frustration. Does your step-daughter's mom help her with her diabetes management? Does her dad help her when she is with him?

[gemmom]

Nancy
Yes, she had been in counseling already, more for the issues surrounding her parents' divorce than anything else. The therapist said she was worried about Lauren (my stepdaughter) more than her sister b/c Lauren wouldn't talk. At all. Still doesn't. And this was before her diabetes. After her hospitaliztion this week, I asked her if she was scared, if it frightened her. "Nope!' she replied quite unaffected. "I don't remember anything!" Hence the BG levels today.

I have suggested more counseling but I can't overstep my boundries (which I feel I am constantly doing...yet I am put in charge of her all the time, which is very frustrating. I have all of the responsibility but none of the control.)
Anyway, just a vent.
Thank you all for your help.

[coni]

gemmom -
I admire you for reaching out on behalf of your step daughter. I do not have personal experience with what you are facing (other than the step parent part, which is often difficult without additional concerns added in); however, if dad won't face reality or get counseling (with or without the daughter) from a person who specializes in diabetes issues (does the endo have a counselor on staff?), I would suggest at a minimum that you get counseling. I suggest this because you have just been handed a heaping pile of mess to deal with. If it were me, I would want to be very clear on my commitments and boundaries - with my husband and with my step-daughter. I also would want support.

And, to answer your question, if it were me, yes, I would want to see the blood sugar readings. I would not want to be a part of watching a child destroy themselves. I would feel compelled to do something.

My thoughts are with you. How terribly distressing.

[Kris60]

I think the first thing that needs to happen would be to have a sit down talk with your husband/her father and try to get on the same page. You really need to try and be a team with this. good luck and don't give up on her.

[Abby-Dabby-Doo]

I have suggested more counseling but I can't overstep my boundries (which I feel I am constantly doing...yet I am put in charge of her all the time, which is very frustrating. I have all of the responsibility but none of the control.)
Anyway, just a vent.
Thank you all for your help.
I'm not trying to be a jerk, it's probably going to sound that way, so I'm going to apologize before hand.
First off I'm applauding you for caring, learning, and asking for advice. You're a good person. I don't see how this would be an argument with your husband, but I'm realistic to know that's probably what's going to happen. I would like to know how your over stepping your bounds if Dad leaves her in your care and Mom is out of town? That sure heck sounds like it's all in your "bounds" for that time being. If your way is being around when she tests and properly counting her carbs- then it's your way or the parents need to come home and do it the child's way. Your not the evil step mother treating her like Cinderella making her clean all day and not have any fun are you? You're trying to help this young girl and do the right thing, so this is where in my opinion you become the parent and she becomes the child. Your husband needs to understand that. I wouldn't make that negotiable.

Working in prior law enforcement I'm going to give you a little tip. The baggy clothes being worn in a hot climate suggests drugs to me. I'm not saying I'm right- I could be way off base, and frankly I hope I am. But in my experience the kids that do this are hiding something such as needle marks. You can buy home drug test kits for your child's urine. I don't have any experience in diabulemia. So again I hope I'm wrong, but I would assume you would have a lot of lows from diabulemia. I really don't know a lot on this subject, so maybe I shouldn't be going there.

I would give her a lot of love, with a lot of watching over. Make sure she knows that your doing it out of love and care. I'm serious when I say this, give her lots of hugs. Has she been explained the outcome of repeated high blood sugars for years? The risks? I also would have a long talk with your husband. I'd like to know his reasonings for him telling you to back off. Maybe some suggestions from people on the outside looking in to give their opinions (yours) because what they're doing doesn't seem to be working.

How did you know about the toast? Don't have the other child squeal on the other, that could get ugly.

These are all my opinions. I really wish you much luck. It's sounds like a scary situation. I hope you take charge while she's in your care!

[Hollyb]

Actually baggy sweatshirt, thin teenage girl and hot weather suggest anorexia to me... my niece went through that at the same age. So, yes, I would be worried that your stepdaughter may be skipping insulin on purpose to lose weight.

Would it be possible for you, dad, mom, and s-d to schedule an endo appointment altogether? Express your concerns to the endo and ask for help -- help for all family members to understand the gravity of the situation and agree on a FAMILY plan of treatment, and help for your step-daughter who is obviously struggling with something. It seems crazy that you would have to be in a position where this initiative is coming from you, but whatever is going on with this girl it sounds like she really needs some help.

[Ellen]

lies about her insulin, her diet and everything else....
she has DKAd three times. The last time she was hospitalized for 4-5 days. My stepdaughter has a horrible diet, shunning most major food groups aside from white carbs and milk....
She is very thin, and always wears extremely loose clothing -- sweatshirts even in the South's 95 degree heat and humidity. She was actually a little chubby before being diagnosed with D1.
My DH dismisses the possibility of diabulemia b/c I think he's in denial. Please help. I am worried about her. Thanks.

Trust your instincts. I would say it's URGENT she be evaluated for an eating disorder. I would contact the pediatric endocrinologist ASAP and if you can't contact that doctor, call the pediatrician ASAP and express your concerns. I'd want to get her in to see someone tomorrow morning. Her life may be in danger. Do you know how much she weighs and how tall she is. To meet criteria for "anorexic" she would have to be 85% or less than expected body weight along with an overwhelming desire to be thin and other criteria. It certainly sounds like she's restricting and has food rituals. Omission of insulin is a form of purging and diabulimia could be classified under Eating Disorder NOS (not otherwise specified). You are wise to notice and to take action. You can read about the criteria here: http://www.poppink.com/dsmiv/

If she does have an eating disorder, she will need a team of professionals to help her including a skilled therapist with experience in eating disorders, registered dietician, psychiatrist etc. Often in patient treatment is the way to go.

[wendyc]

I have a question. You said she dka'd this last time and was in for 4-5 days. Did she see her endo? Did they do an A1c? How were her bg's in the hospital? You would think the endo would see some red flags. Do you think what she is doing is a cry for help considering her parents breakup?

Does her mom have any say in her care? Can everyone in the family get together for a family counseling session? I do stress that your husband needs to see that something drastic is going on and you both need to be on the same page.

My hat off to you for being such a caring and aware parent. I hope you all get the help you need to come to the bottom of this.

[jvoyles]

Baggy long sleeve clothing could also mean cutting.

[hold48398]

Wow, I don't know where to start. ((((((hugs to you))))))). I respect you for sharing such a personal, frustrating and scary situation in order to help your step daughter. Please take Ellen's advise. Please please. I am scared for your step daughter, too, just from reading about her struggles. Please get her help. Make your husband listen. It could mean life or death. He needs to understand the seriousness of this all. And take good care of yourself. Keep fighting for your step daughter's life. ((((Hugs))))))

[AJsmom]

I just recently read an article on diabulimia...I would trust your instincts. Maybe get on line and find some info. on diabulimia and show it to dad. I would also talk to the endo and express your concerns. I'm sure it's hard, but in this case I certainly think it's o.k. to over step your boundries! Stay in touch and let us know how things are going! Your step daughter is very lucky to have you!

[Ellen]

There's some good information here, especially how to approach the subject.

http://www.kidshealth.org/parent/emotions/feelings/eating_disorders.html

[gemmom]

Thank you so much, everyone, for your support and insight. I feel like I am hitting my head against a brick wall when I try to talk with my DH.Yes, he agrees she has "issues" and needs to manage her D better. But he will not accept the possibility (well, probability) of diabulemia. I think he's in denial. If I say too much, he gets very defensive and the conversation is closed. He also doesn't tell me everything as far as what her numbers are, but I know they are high. Her A1C (is that the right term?) was over 10 I think. It was high, anyway, and they made some dosage adjustments after her test. My DH will always ask her where she's at, BG-wise, as do I, but rarely does he ask to see the monitor. I think now he will, but I'm sure as time goes on everyone will back off of her and it'll happen again. How much control do you exert on a teen who isn't managing their D? My DH asked me today if I wanted her to help me babysit our 19-month-old, but I said no because she isn't managing herself and I'm not comfortable being responsible for that. I think she needs to get back on track before I let her babysit again, for both her and my son's sake. I think her mom is so stressed out from dealing with her (there are other issues, too) that she has basically thrown up her hands. I have four other kids, including triplets and a toddler, so I can't micro-manage my stepdaughter. Anyway, thanks again for all of your help and advice.

[Kris60]

this is a posting from one of the other forums on here, it was dated last year, I just saved it to my hard drive so I will always have it and hopefully never need to show it to my daughter. I was going to pm it, but I decided to put it out here in the open in case there are those too scared to talk about their own problems. disclaimer, bring a tissue.
Kris.

My sons death can not be in vain

Hello this is memory of my son Michael survived Type 1 for only 4 years. He died on May 30 2005, he had just turn 18 years old in February.

My son Michael was just 14 years old when we found out that he had Type 1 He had been very sick with what we thought was just the stomach flu. We had taken him to see the doctor just a few days before. I took him to the ER. His sugar was so high that they said if I would have put him to bed that he would not have made it though the night.

Michael had a terrible time with this illness. He was insulin resistant they had him on 3 different types to try to get it under control. This was the beginning of the terrible journey at we had to face. Michael hated be diabetic more then any thing in this world. He wanted to be a Marine but they would not let him join. He was doing so good to begin with keeping it under control. It was his last year in Jr. High the school was so great with giving him his work to do at home. He would still get good grades. High school was terrible he got so behind that he was failing from all the sick days. I made the mistake of taking him out of regular school trying to home schooling him. This was bad because it isolated him so much and made him so lonely.

He started working teen jobs at 16 The movie theater and McDonalds. He would do so good for months then he would quit testing and faking his numbers. His sugars would get out of control and he would end up in the hospital for a week. He got so depressed we had him seeing a counselor for awhile. It seemed to help him for awhile. He went back to school at a high risk school to get his high school diploma. He was able to graduate he was very proud of this accomplishment. But he still rebelled against all of the rules of testing with illness. We tried to ground him and took away his car until he would test like he was to do. At 17 teen at Christmas time he got really sick again he went to the hospital for another week. It was very bad this time it was hitting his liver and the doctors did not know why. After he turn 18 he got his first grown up job he was very excited and doing so good.

He stayed home that holiday weekend by him self he had to work. He was found died by his father and sister. It was later found out that he had only been testing maybe once every few days for months even though he was writing numbers in a book for us to look at. We had been trusting him to do his insulin and testing on his own. He would get so mad when he said we would treat him like a baby watching him test and give him his shots.

If I could do things differtently. I would have made him show me what the meter was really reading no matter how mad he got. I hope that with talking to teens and letting them know that with this illness.You can not just take it for granted and ignore it. It will not go away it can kill you. The things that I learn would be pushy!!! Bug them about testing watch them test. If needed give them some of the shots also. I would have kept him in school so that he would have been able to have more friend his age. I would fight the school more for sick days and the make up work. There is nothing I can do to bring my son back. I love and miss him with all of my heart. I have no idea if this will help any one or not. But I have to do something to help others in Michael memory.


Michael’s mom Barbara

All of us with children of this disease mentally know how dangerous this disease is but I cannot fathom your feelings of helplessness when dealing with an older child who is rebelling so much against this insidious disease. Those of us with young children feel the pressure of continuously monitoring everything our children eat and do that can affect their sugar control - but we at least have the control. What is frightening is having to give up some of that control as our children age - needing independence and yes chafing from the yoke of this disease.

I have printed out a copy of your post and am keeping it in a very secret place. At the right time...when Mariel gets older and is emotionally ready for me to turn our conversations from "Diabetes is "serious" but very controllable and you will have a wonderful and normal life" which is what we talk about now - to "Diabetes can be "Deadly" but very controllable and you can have a wonderful and normal life if you take it seriously and are responsible".... then I will share with her your touching post. Thank you.

[gemmom]

Wow, that is so sad. How tragic and preventable. I think that is every parent's fear and nightmare when they have a child with diabetes.:(

[Mama Belle]

gemmom-

I'm late chiming in, but I wanted to let you know how much I admire your efforts to be involved in your step-daughter's life in such a supportive way. Many step-parents are not as hands on as you appear to be -- thank god for people like you!

Second, I agree with those who have said that it is important for her to see someone ASAP. A high A1c, the DKA, the weight issue, it is all very indicative that at a minimum she is not taking care of herself and needs help. I would say point blank to your husband that he can't have it both ways. If he wants your (significant amount of) help raising his daughter then you need to be involved in issues like this. You cannot be responsible for caring for a child and then turn a blind eye when you see them struggling in such a way that could end their life. That isn't fair to you or your step-daughter. I would ask him what he is afraid of? Clearly he is afraid of something, which is why he won't face the fact that this could be diabulemia. Call it what you want, but the fact is that she is not doing well, and the consequences of her actions are beyond her realm of understanding at this point. An A1c of 10 is an average BG of approx. 278, that is too high. If you know she is eating and not covering it with insulin, you have your answer, she can't handle this alone--she keeps showing you this. Has her dad thought of the fact that this may be her way of screaming for help? Teens do this, they act out when they have shut down emotionally. They express through their behavior what they feel like they cannot express with words. I would think that your DH would be more afraid of her dying or ending up with horrible complications like neuropathy, blindness, or kidney failure, than he would be of calling a spade a spade and getting her some help.

You and your DH need to figure your stuff out so you can be a united front. But if that isn't possible right now, you need to make sure that your step-daughter is safe. Your husband will understand down the road.

[gemmom]

Heidi
Thanks for the kind words. I can only "nag" so much. My DH told me last night he knows what's going on more than I think so I guess I need to just stay out of it. I alternate between throwing my hands up and chanting to myself. "she's not my child, she's not my child..." and getting very frustrated and concerned.
Her last AC1 was 10.5. Way too high.
Maybe I know too much and I should just not ask anymore.

[Ellen]

Even if she's taking her insulin and it's not "diabulimia", it sounds as if she has an eating disorder and that needs to be addressed. The fact that she is so ritualistic about only having "white foods", she's restricting, she's thin, she's covering herself up with loose baggy clothes in hot temperatures are all warning signs. You care because you know she is a child that needs help, even if she's not your child. You also have very good instincts that should be honored, not dismissed.

[MrsBadshoe]

gemmom...I was going to post the same story that Kris60 did. I think you should print it out and give it to your hubbie. As you are well aware D is very serious. An A1C of 10.5 means her average BS reading was 300. I have a 14yr old son his A1C is 6.9 his BS average is 168. Teens can do it but unfortuntely some rebel against there D which can have deadly results. I hope your DH realizes that he could lose his dd and your could lose "she's not my dd"

You seem loving and caring and some how I pray you get your dh to understsand the gravity of the situation of a teen that rebels against their D.

Lots of prayers.

[czardoust]

Often, people with Type 1 diabetes who omit insulin injections will have already been diagnosed with an eating disorder such as anorexia nervosa, bulimia nervosa and/or compulsive eating. In cases where a person with Type 1 diabetes has another eating disorder, there is a tendency to discuss the other eating disorders more openly than they do about diabulimia as many people with diabetes are not happy that they have lost control of their diabetes. These individuals are often not aware that diabulimia is more common than what they think and is also very difficult to overcome. Unlike anorexia and bulimia, diabulimia only sometimes requires the afflicted individual to stop caring for a medical condition. Unlike vomiting or starving, there is sometimes no action or willpower involved. Diabulimia may be more appealing to individuals who want to lose weight and do not want to feel hungry, or to not engage in vomiting in order to purge. Often there is an obsessive compulsive urge to engage in this activity for the purpose of emotional disassociation or a need to satisfy feelings of 'control'.



I found that the www.wikipedia.com site. I had never heard of diabelimia so I looked. Has your stepdaughter ever been previously diagnosed as having an eating disorder. I think you answered your question already on whether or not this is what she has. You cant change the interpretation of the obvious. If her parents are divorced, that could be a cause. Whatever caused the divorce could also be a cause, and it may never have been addressed with a counselor because by doing so, she would lose some sense of control over what happened. (I've been there). The fact that he throws her on you and then tells you to not get involved with her must be frustrating, I dont know how that must feel because Ive never gone thru that. I tell you what though....you can try getting involved with her about undiabetic related things. Touching base....creating a basis for trust, and something might unfold, a new door might reveal itself and unlock her from this cage she has put herself in to protect herself...from whatever it is she doesnt want to see.

[Momof4gr8kids]

First let me say that I think you are a wonderful person, and step mom to be stepping in this way. That takes a special kind of person.

These are my two cents on what I'd do if it were my kid.
I'd need to see the number on the meter, and I'd need to see her inject. If you don't see her inject and she says she did, you wait 2 hours, and see where her bg is, then reinject. If she wants you to, go ahead and draw, dose, and inject for her. You can even be the one to test her if she wants.

I wouldn't worry about her diet right now. While her diet may not be healthy right now, to much change to fast, while she is already going through this might put her over the top of what she can take.

Take care, Jamie

[gemmom]

Yes, when she is in my care I now ask to see the BG reading (which is how I found out she was 396 on friday -- not two days after her hospitalization!) I am not well versed on how many units she needs for correction, however. That is a very good point on watching her draw it up and injecting -- I will do that from now on. She underestimates, on purpose I think. As far as an eating disorder goes, I have always thought she had disordered eating, if not a flat-out eating disorder. The D has intensified everything, focusing on food so much. And of course being 14 yrs old. I do connect with her regularly and sometimes I feel like I'm getting somewhere....I just have to keep trying.

[MLH]

This is extremely difficult and a very sensitive issue. IMHO I could only hope that if I were not around or in denial of any issue my daughters had, I would hope someone would try to help them. I have a sister who has suffered from eating disorders, addiction, abuse, and that just names a few. A caring person brought it to my mom's attention and she did something about it.

Several years back I was very concerned about my husbands cousins who were 7, 5 and 4. We happened to share the same pediatrician and I went to him confidentially to share my concerns. He took care of it.

I know this is a very emotional position to be in--I hope it gets resolved in a positive way very soon. You are in my thoughts and prayers.

[clb1968]

I dont have a solution for you either, but it does sound like it could be diabulemia or an eating disorder. I just read an article in Self magazine on this subject. Here is the link to the article online
http://www.self.com/livingwell/articles/2007/10/1022diabulimia

[Ellen]

Thanks for sharing that article Charlotte. It's excellent.

[saxmaniac]

I think it's vitally important you and the husband need to get on the "same team" you can't wait until then. As far as I'm concerned, you are perfectly in your right to require seeing her actual meter readings and seeing actual injections.

It can be passive at first, no changes other than "I need to see you do this". If your husband doesn't agree on doing this when you're together, then you still can require this when you are watching her. You're responsible for her during that time, you get to enforce that rule. Write everything down and make sure it gets to the endo when they see her A1C.

[badshoe]

Wow.

Coming to this late.

I think it is important for your mariage and your ability to be effective for the teen that you not become the Nag.

It sounds like, to some extent, your DH may not be as well versed in D care as he honestly needs to be. That when pressed he may not know or may not be sufficiently confident of his D knowlage to be a strong advocate for her health. Not that he doesn't wnat to be - he may be embarassed to say he doesn't remember what to do - there is a sh*t load of stuff to remember, so he would be in good company if he forgot a little.

Putting it in the context of there is a lot to remember and we may have forgotten some is a nice face saving path to take regardless.

You as a family could then reach out to the local hoispital for a diabetes training refresher. If nothing else, you the step mom need to learn the stuff you don't know, dosing, i:c, correction factors, a partridge in a pear tree, etc.

You, the step mom, can shift the burden of nag a.k.a setter of "da rules" to the professionals, I am sure the hospital can find support teams for both physical and metal care. To be right up front the metal care part is something we all probably overlook for ourselfs.

I am getting to be a zellot about this: CWD's convention is outstanding and there are some very tallented people there who can help. If you can't get there try reaching out to some of them, Animas has some folks on staff that are stars at the conference, maybe they can get yu pointed in the right direction.

Lastly if nobody has made changes to correction factors and i:c ratios an all that fun stuff there is a very real chance that she is doing what she was told but (and ya know I was gonna say this right?) YDMV - Your Diabetes May (have) Varied. What her dosing was before may not be what it needs to be now.

You need to know how to confirm that, she needs to and so does the DH.
My best wishes for you all to find better results.

[Ellen]

How is your step daughter doing? Her restriction rituals around food were a red flag.

Did anyone see the CNN segment today on the model who died from anorexia - less than 66 pounds :-( .

We must empower our daughters and all women to feel good about their bodies. I suggest that all women who are interested in acceptance of the female body read the book Eating in the Light of the Moon (http://www.amazon.com/Eating-Light-Moon-Relationship-Storytelling/dp/0936077360). It is wonderful.

To understand more about what goes on in the mind of a person with an eating disorder read the book Life Without ED (http://www.amazon.com/Life-Without-Ed-Declared-Independence/dp/0071422986/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1195327921&sr=1-1). This book really opened my eyes to the battle with an eating disorder.

http://ecx.images-amazon.com/images/I/41FTO9H-otL._BO2,204,203,200_PIsitb-dp-500-arrow,TopRight,45,-64_OU01_AA240_SH20_.jpg

[3js]

Ellen , was the cnn segment on tv or on the internet? If the latter, could you post the link- thanks:)

[Ellen]

Caution this is difficult

http://www.wjla.com/news/stories/1107/473488_video.html?ref=newsstory

[Mama Belle]

Ellen, thank you for posting that.

[Nancy in VA]

Caution this is difficult

http://www.wjla.com/news/stories/1107/473488_video.html?ref=newsstory

Hey, that's my local news station!

[Ellen]

How is your step daughter? I just stumbled upon this abstract.

Diabetes Care. (javascript:AL_get(this, 'jour', 'Diabetes Care.');) 2007 Dec 10
Insulin Restriction and Associated Morbidity and Mortality in Women with Type 1 Diabetes.

Goebel-Fabbri AE (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Goebel-Fabbri%20AE%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus), Fikkan J (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Fikkan%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus), Franko DL (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Franko%20DL%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus), Pearson K (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Pearson%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus), Anderson BJ (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Anderson%20BJ%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus), Weinger K (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Weinger%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus).
Joslin Diabetes Center.
Objective: To determine whether insulin restriction increases morbidity and mortality in women with type 1 diabetes. Research Design and Methods: This is an 11-year follow-up study of women with type 1 diabetes. 234 women (60% of original cohort) participated in the follow-up. Mean age was 45 years and mean diabetes duration was 28 years at follow-up. Mean BMI was 25kg/m(2) and mean HbA1c was 7.9%. Measures of diabetes self-care behaviors, diabetes-specific distress, fear of hypoglycemia, psychological distress, and eating disorder symptoms were administered at baseline. At follow-up, mortality data were collected through state and national databases. Follow-up data regarding diabetes complications were gathered by self-report. Results: Seventy-one women (30%) reported insulin restriction at baseline. Twenty-six women died during follow-up. Based on multivariate Cox regression analysis, insulin restriction conveyed a three-fold increased risk of mortality after controlling for baseline age, BMI, and HbA1c. Mean age of death was younger for insulin restrictors (45 vs. 58 years, p<0.01). Insulin restrictors reported higher rates of nephropathy and foot problems at follow-up. Deceased women reported more frequent insulin restriction (p<0.05) and reported more eating disorder symptoms (p<0.05) at baseline than their living counterparts. Conclusions: Our data demonstrate that insulin restriction is associated with increased rates of diabetes complications and increased mortality risk. Mortality associated with insulin restriction appeared to occur in the context of eating disorder symptoms, rather than other psychological distress. We propose a screening question appropriate for routine diabetes care to improve detection of this problem.
PMID: 18070998 [PubMed - as supplied by publisher]