INSULIN WITHHOLDING FOR WEIGHT CONTROL IN WOMEN WITH DIABETES

OBJECTIVE - To provide a description of the clinical characteristics t hat distinguish individuals who withhold insulin for weight control fr om those who do not. Some individuals with insulin-dependent diabetes mellitus (IDDM) control their weight by withholding insulin and purgin g excessive calories. This process places patients at risk for develop ing severe hyperglycemia, diabetic ketoacidosis, and increases the ris k of long-term complications of diabetes. RESEARCH DESGN AND METHODS- Forty-two women with IDDM, ages 16-40, were interviewed and divided in to two groups: insulin withholders (IWs) and non-insulin withholders ( non-IWs). These groups were compared on physiological, behavioral, psy chological, and psychiatric variables. RESULTS - Compared with non-IWs , patients who withheld insulin to control their weight exhibited poor er glycemic control, reported more negative attitudes toward diabetes, were more likely to have pathological scores on the Eating Disorder I nventory 2, and were more likely to report current or past symptoms of anorexia or bulimia nervosa. IWs were also more likely to report lyin g to physicians about their degree of compliance with their diabetes r egimens. CONCLUSIONS- The results of this study indicated that IWs exh ibit more symptoms associated with the spectrum of eating disorders th an non-IWs. This study showed that insulin withholding for weight cont rol not only exists, but is associated with some maladaptive symptoms and behaviors that need to be addressed by diabetes treatment teams.