Type 1 Weight Matters

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Type 1 diabetes diagnosis and insulin use

The period of diagnosis can mark a difficult time in the lives of people with type 1 diabetes and the impact can extend to the loved ones, work colleagues and peers of those newly diagnosed. Adjusting to living with type 1 diabetes can often lead to a struggle with insulin intake, particularly as changes take place in diet and exercise.

Issues of control over blood glucose and diet can lead to concerns about body image and management of diabetes. The sudden and extreme weight loss in the period prior to diagnosis, followed by weight gain as the body becomes healthy again following insulin commencement, can be hard to manage for some.

Type 1 diabetes can be particularly hard to manage as it is usually diagnosed in childhood or young adulthood (although it can occur at any age) , impacting on one of the most exciting and dynamic points of a person’s life. It is at this time that other areas of life are key focuses; including work, education, relationships and travel. Therefore, learning to manage a newly diagnosed medical condition can often seem like a daunting task.

Some weighty issues facing Australians with type 1 diabetes

Living with type 1 diabetes and its impact on lifestyle, can often be difficult to accept for many people newly diagnosed with diabetes.

With the current focus on the growing number of Australians who are overweight or obese, and with body image stereotypes portrayed with increased frequency in the media, people are suffering complexities and pressures around body image.  Just like anyone else, particularly in the teenage years, people with type 1 diabetes have complexities and concerns around self-esteem, image and body weight. Along with this they have diabetes to deal with.

While we’ve all heard of fad diets and nightmare exercise regimes, the key point of difference for people with type 1 diabetes is that there is a powerful but risky weight loss tool – the omission of insulin.

The relationship between insulin and weight gain

Insulin is a hormone that affects metabolism and other body systems. It enables most of the body's cells to take up glucose – the body’s energy source - from the blood, storing it as glycogen in the liver and muscle.

Managing blood glucose levels requires a balance in the amount of food consumed, the level of physical activity undertaken and the amount of insulin absorbed. Blood glucose levels can also be affected by stress, infection, illness, medications and alcohol.

Exercise is a difficult area for people with type 1 diabetes. Often people exercise to stay fit and to help lose the weight they gain through insulin intake. However, exercise - especially when excessive - can lead to hypoglycaemia (low blood sugar or hypos) that in turn require glycogen. It is a cycle with which many people with type 1 diabetes struggle.

Skipping insulin to lose weight – survey results

respondents with type 1 diabetes who were specifically asked about whether they were living with eating disorders and diabetes, were regularly skipping or manipulating their insulin dose to gain control over their weight.

A total of 243 Australian people participated in the survey, including 201 with type 1 diabetes, revealing information about eating patterns and weight concerns in the resulting Insulin Misuse for Weight Loss research report.

Skipping and abusing insulin – the facts

• One in three (32.9 per cent) of the respondents to this survey about eating disorders and type 1 diabetes said they have skipped insulin as a way to help them lose weight;

• Almost half (48.5 per cent) of those respondents with type 1 diabetes who skip their insulin say they do so on a daily basis;

• Almost two in five (37.7 per cent) of those respondents with type 1 diabetes surveyed say they have taken less insulin than they required as a way to help them lose weight.

The wider implications and what this means

These statistics reveal an alarming trend for some people with type 1 diabetes who have problems with their weight and body image to use insulin to manage their weight - and highlights the need for an increased awareness amongst people with type 1 diabetes of the important role of insulin and how to manage this effectively to maintain healthy diabetes control and weight management.

While it is disturbing to think about, skipping or abusing insulin can lead to an earlier than expected onset of diabetes complications and an increased risk of death.

Complications of diabetes can include:

• Feet and eye problems, including amputation;

• Heart and blood problems;

• Erectile dysfunction;

• Nerve damage;

• Kidney complications.

The research also highlights the need for people with diabetes to talk with their General Practitioner (GP) or healthcare professional about their current therapy and how they can best manage their diabetes.

Diabetes and the potential for eating disorders

If a person with type 1 diabetes has an issue with insulin misuse, it can be a symptom of an underlying psychological problem or concern.  Insulin misuse is sometimes carried out as a means of controlling deeper psychological disorders, including depression.

Eating disorders are a very real danger for many people, particularly for teenage girls and young women, without even factoring in the increased risk of skipping or taking less insulin.  The Insulin Misuse for Weight Loss research report revealed that one in four girls with type 1 diabetes who responded to the survey, had developed some sort of eating disturbance in their teenage years. We know from other research as well that eating disorders are twice as likely to occur in teenage girls with type 1 diabetes than in girls who do not have diabetes.

If you think that things have gotten out of control and perhaps there are issues with an eating disorder, you need to speak to someone in your health care team about seeking help. This can include both an eating disorder specialist and a diabetes management team working togethor with you. You can access counselling via email on our online counselling pages here personal counselling.

I have type 1 diabetes - what does this mean for me?

Developing a healthy relationship with food and insulin can help prevent dangerous behaviors such as insulin misuse and restriction. It is important for people to embrace a balanced, flexible approach to eating. Whereas type 1 diabetes used to be about what you couldn't eat, it is now more about learning that food is not the enemy and that it is possible to eat a wide variety of foods, maintain a healthy weight and balance this with appropriate insulin use.

If your diabetes, insulin use and/or weight, are areas of concern or confusion, there are people you can talk to, including family, friends and healthcare professionals.

It is important not to feel ashamed and to ask for help if you need it.

Healthcare professionals and GPs are equipped to help with these issues and are able to offer advice on the best way to lead a happy life, whilst effectively managing your diabetes. It is also important that you communicate openly with your healthcare team and inform them of any changes or concerns you experience in your management of type 1 diabetes.

Stay informed and understand the different options that are available. Most of all, it is important to have the courage to face up to, and completely understand, the risks and health implications associated with skipping or manipulating insulin.

I know someone with type 1 diabetes who may manipulate insulin intake – what can I do?

If you know someone who might be at risk of insulin manipulation, it is important to appreciate that it is a sensitive and difficult topic. It may well be frustrating and difficult for you to fully understand the issues; however offering support to a friend or family member can often make all the difference.

It is important to recognise the signs of insulin misuse and to understand that if it’s something you are concerned about, you are not alone. While insulin manipulation may be difficult to come to terms with, it is a common cause of concern for people with type 1 diabetes, their loved ones, work colleagues and peers.

Warning signs of ongoing problems with insulin misuse can include:

• changes in eating habits (eating more but still losing weight)

• unexplained weight loss

• unexplained hyperglycemia (high blood sugar)

• low energy levels

• frequent urination

While insulin abuse can be an uncomfortable and disturbing topic for many, misusing insulin for weight control is a very real health concern that requires further media awareness and public education.

Remember....

Insulin misuse is dangerous and common

Offer support to loved ones and seek support yourself if concerned or unsure

You are not alone

It can and does get better

 

 

Further support and information

Check our Your Stories Page

Go to the Talking Type 1 pages, for more information and stories about these topics

Hop across to our forums to share with others and seek advice here Type 1 Weight Matters Forums

Download a copy of the NDSS Booklet re Type 1 diabetes and Eating Disorders here: NDSS_Eating_Disorders_Booklet

The Type 1 Diabetes and Eating Disorders Online Survey was supported by an unrestricted grant from Novo Nordisk.

References

Type 1 Diabetes, Diabetes Australia http://www.diabetesnsw.com.au/about_diabetes/type1diabetes.asp

Balancing Food, Activity and Insulin, Diabetes Australia Fact Sheet http://www.diabetesvic.org.au/Portals/0/BalancingFoodActivityInsulin_FactSheet.pdf

Insulin Misuse for Weight Loss, Diabetes Australia - Vic

Diabetes Australia – Vic, http://www.diabetesvic.org.au/LivingWithDiabetes/Complications/tabid/100/Default.aspx

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