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.


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.
Biggs
M M
MM
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas 75235.
Basco
M R
MR
Patterson
G
G
Raskin
P
P
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D001068:Feeding and Eating Disorders / Q000150:complications; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D016312:Treatment Refusal; D015431:Weight Loss
D006442:Glycated Hemoglobin; D007328:Insulin