A follow-up for caregivers of young type 1 diabetics

Some medical professionals have hesitated to talk about this publicly not wanting to unintentionally promote it among young people, but the findings of a recent study are so disturbing, they need to be known. The information could perhaps help healthcare professionals and parents save a young life.

Surrounded by incessant anti-obesity messages, young people have learned that it’s important to be thin at all costs. Young type 1 diabetics, however, have discovered an especially dangerous weight control technique: skipping their insulin doses. While this practice has been noted in the medical literature for decades, a study presented at this year’s meeting of the European Association for the Study of Diabetes in Amsterdam, found that it’s much more common than doctors or parents realized. Even more startling to learn is that it’s not just among girls — almost as many males as females are skipping insulin specifically to avoid gaining weight. The costs for young diabetics could be tragic.

In an earlier article, JFS reviewed the motivations, dangers and clinical signs to watch for.

This new study was by the Hvidøre Study Group on Childhood Diabetes of Novo Nordisk. It was led by Dr. Soren Skovlund, a neurobiologist and health psychologist who is senior adviser and manager of the DAWN (The Diabetes Attitudes, Wishes, and Needs ) Study at Novo Nordisk in Copenhagen. DAWN is an international program of Novo Nordisk with the International Diabetes Federation to understand the concerns of diabetics and identify barriers that adversely affect diabetes care. For this study, questionnaires were completed by 2,062 teens and their parents or caregivers in 21 centers around the world and the teens’ HbA1c levels were measured.

When asked specifically how often they skipped insulin to control their weight, 91.7% of the girls and 93% of the boys replied at least once a month. Clearly, almost all young diabetics know the link between their insulin doses and weight. The next possible answer they could give was “once a week” and 2.5% of the girls and 2% of the boys admitted to doing it this often. Only just over 5% of girls and 4% of boys said they never missed insulin.

As Dr. Skovlund said at the EASD meeting and was reported in Internal Medicine News, what was startling was that nearly the same numbers of boys as girls were trying to control their weight through these extreme methods. “A lot of the insulin omission literature has focused on this being a female phenomenon,” he said.

For healthcare providers and parents feeling that those on insulin pumps versus having to administer injections are less likely to skip doses, the researchers actually found it among both groups. The young people who were skipping doses, were also more likely to be engaging in other forms of eating disordered behaviors trying to lose weight, including fasting, restricting certain food groups, vomiting and using diet pills or laxatives. As previously reviewed, the focus on diet that accompanies diabetes management already makes young diabetics six times more vulnerable to eating disorders.

The researchers also found a significant association between insulin omissions and poorer glycemic control, which could have serious health consequences for these young people. This study, however, didn’t examine clinical outcomes. Dr. Francine Kaufman, a Los Angeles pediatric endocrinologist, was reported as cautioning that we don’t know what a safe spectrum of HbA1c levels is for teens and the cut-off of highest concern. More research is needed. But this study pointed out the importance of addressing weight concerns among young people and it highlights another potential tragic consequence of this war on obesity. Young people need help to appreciate the natural bodies they have and not believe that they must lose weight at all costs.