Is diabulimia a risky weight management strategy for type 1 diabetics?

Dear The Wondering Diabetic, 

As you mentioned, weight gain can be a common side effect of insulin therapy. Because of this, some individuals with diabetes choose to skip their insulin shots as a weight loss strategy—otherwise known as diabulimia. However, missing or intentionally skipping insulin doses can be dangerous to a person’s health and cause serious, long-term complications. The good news is that diabetics and non-diabetics alike can safely manage their weight through movement and the incorporation of whole foods into their life. 

Insulin plays a crucial role in the body by allowing cells to absorb sugar from the foods that are eaten. This process allows sugar to then be used for energy. When you consume food, the sugar that’s absorbed enters the bloodstream—now known as blood sugar—then sends a signal to the pancreas to release insulin. Insulin helps the blood sugar to get inside the cells. Insulin also sends a signal to the liver to store excess blood sugar so that it can be used later. However, individuals with type 1 diabetes lack sufficient insulin levels because the pancreas makes a small amount of insulin, or none at all. Without insulin to help blood sugar get into the cells, individuals with this condition usually have very high blood sugar.  Consequently, those with type 1 diabetes are often underweight prior to being diagnosed, since their bodies are unable to properly use and store sugar. Insulin therapy allows those with type 1 diabetes to not only process sugar, but also convert excess sugar into fat. Therefore, it's not the insulin itself that causes the weight gain, instead it’s likely caused by the glucose in the bloodstream that can now be successfully converted into energy or stored as fat. 

Skipping insulin shots may seem like an easy way to lose weight, but it can have harmful effects, such as: 

• Diabetes-related ketoacidosis (DKA): This life-threatening condition occurs when an individual has high amounts of ketones in their bloodstream, causing their blood to become acidic. This condition can also result in severe dehydration and require immediate medical attention and treatment. 
• Infections: Individuals are more at risk for bacterial infections because high blood sugar can cause your body to produce certain enzymes and hormones that put them at a higher risk. Because the immune system is negatively impacted when it lacks insulin, people who purposely skip their insulin may also be more susceptible to slow wound healing, which in turn can increase the risk of gangrene, sepsis, or bone infection. 
• Muscle atrophy: Also known as muscle loss, this occurs when the body breaks down muscle tissue for energy instead of using glucose (sugar) or fat. 
• Long-term conditions: Diabetes-related retinopathy, neuropathy—nerve damage—, gastroparesis, cardiovascular disease, kidney disease, and liver disease are all possible complications that may arise due to having persistently elevated blood sugar levels. 

That being said, there are other safer weight management strategies for individuals with diabetes (and those recovering from bulimia). These strategies include being mindful of the foods you choose to eat and when you choose to eat, exploring ways to incorporate movement, and undergoing proper insulin therapy. A well-balanced, nutritious meal may include a variety of whole foods like fruits and vegetables, fiber-rich foods, foods with a low glycemic index, healthy fats, and proteins. Limiting consumption of certain foods, like refined carbohydrates, processed foods, foods with a high glycemic index, sodium-rich foods, and trans fats can also help manage blood sugar. Before making any diet or exercise changes, consider checking in with a health care provider or regisetered dietitian to ensure that these changes align with any of your current treatment plans. They may also be able to provide you with additional resources or recommendations specific to you. The American Diabetes Association also has several resources for that may be helpful for you regarding weight management, such as their exercise plan and meal plan. 

Although it may seem like a quick fix for weight loss to skip insulin shots, diabulimia can have serious health consequences. Kudos to you for checking in and all the best in continuing to educate yourself on how to safely manage your type 1 diabetes!