"Diabulimia" — risky weight management for people with type 1 diabetes?

Dear The Wondering Diabetic,

As you've experienced, weight gain can be a common side effect of insulin therapy. Some diabetics do resort to skipping their insulin shots in order to lose weight, a disorder known as "diabulimia." Doing this can be dangerous to your health, but the good news is that diabetics and non-diabetics alike can safely control their weight through regular exercise and a healthy diet.

Normally, insulin allows body cells to absorb sugar from the food we eat. Cells burn the sugar as energy and any leftovers are stored as fat. Before being diagnosed, type 1 diabetics are often under-weight since their bodies are unable to use sugar properly. Insulin therapy enables type 1 diabetics to process sugar, and to convert excess sugar into fat, which then causes weight gain. Skipping insulin shots may seem like an easy way to lose weight, but denying the body insulin has harmful effects.

Without insulin to metabolize sugar, body cells are deprived of necessary fuel. To survive, the body breaks down fat and protein (instead of sugar) for energy, which releases toxic acids called ketones. This leads to a potentially deadly condition called ketoacidosis. According to the Mayo Clinic, signs of diabulimia and/or ketoacidosis include weight loss, excessive thirst, frequent urination, low energy, nausea, fruity-scented breath, neglecting blood sugar monitoring or insulin dosage, and uncontrolled blood sugar. Diabulimia and lack of insulin also cause sugar to build up in the bloodstream. Over time, high blood sugar can cause heart and blood vessel disease, nerve damage, and kidney damage.

Safe weight management strategies for diabetics (and people recovering from diabulimia) include a healthy diet, frequent exercise, and proper insulin therapy. Nutrition recommendations are similar for diabetics and folks without insulin disorders, and include eating mainly fresh fruits and veggies, whole grains, and a daily breakfast to keep your metabolism steady. The American Diabetes Association has several good resources for diabetics who are looking for healthy ways to keep off excess pounds and stay in shape. Take a look at their exercise plan and meal plan for diabetics. You might also want to check out Meal planning for people with diabetes in the Go Ask Alice! archives. Before making diet or exercise changes, it's recommended that diabetics talk with a health care provider.

Although it may be tempting to skimp on your insulin shots to lose a few pounds, diabulimia has serious health consequences so you're right to be wary of this weight loss strategy. Healthy diet and exercise are safe ways to manage your weight that will keep you healthy in the long run.