The cycle of inexact insulin dosing can cause weight gain which increases insulin requirements and resistance.
And there's another factor at work: the insulin producing-cells attacked by the disease also make amylin which works with other appetite regulating hormones such as leptin to regulate the sensation of fullness. The resulting difficulty of diabetics to determine whether they are full has been documented in anorexia.
Interestingly, most type 1 diabetics lose a lot of weight before diagnosis because they excrete rather than metabolize calories. For a period of months, they may be able to eat large amounts of food and not gain weight. When they start taking insulin to "control" their disease, they can gain a lot of weight quickly. "It's not hard to see how the treatment of the disease can lead to disordered eating behavior to control weight gain," Dr. Young-Hyman said.
As a psychologist, Dr. Young-Hyman has treated many type 1 diabetics diagnosed with an eating disorder. In fact, one patient she describes as accomplished, funny and discouraged by her inability to control how much she ate and her subsequent weight gain, helped inspire Dr. Young-Hyman to learn more about eating disorders in patients with diabetes.
The conundrum expressed by this patient can lead, particularly for young women, to unhealthy behavior such as skipping or reducing insulin doses or binging-purging in an effort to avoid weight gain. The behaviors create immediate risks such as hypoglycemia or extreme high blood sugar levels, and are associated with long-term complications of diabetes such as eye, nerve and heart damage.
Controversy persists about whether type 1 patients have incre
|Contact: Toni Baker|
Medical College of Georgia