News & Research

By: Almas Eftekhari

Weight gain is a common, unintended side effect in people undergoing insulin treatment for type 1 diabetes. Insulin doses lower blood-sugar levels but can also cause an increase in appetite. Due to this and other metabolic changes that can prevent the sensation of feeling full, patients can find themselves in a perpetual cycle of excess food intake requiring more insulin. Compounded with strict diet guidelines like obsessive carbohydrate-counting, the struggle to maintain healthy control of blood-sugar levels while avoiding weight gain can be especially challenging for teenagers with the disease.

Deborah Young-Hyman, PhD, a pediatric psychologist from the Georgia Health Sciences University’s Medical College of Georgia, has observed that adolescents with type 1 diabetes show a greater susceptibility to developing eating disorders. In efforts to avoid gaining weight, teens have admitted to skipping insulin doses and adapting abnormal eating behaviors like binging or purging as seen in anorexia or bulimia.

More recently in her Association-funded project, Dr. Young-Hyman found that teens seeking insulin-pump therapy, an attractive treatment for those concerned about their weight, are more vulnerable to eating disorders. Insulin pumps provide a continuous and consistent delivery of insulin that matches rises in blood glucose, thus avoiding large doses of the hunger-inducing hormone and reducing the chance of weight gain. While the pump-seeking teens were not prone to developing disordered eating habits based on general criteria, they showed an increased risk when evaluated with a novel tool that helps diagnose diabetes-specific eating disorders.

This shows that the contributing risk factors and pressures for developing eating disorders in diabetic teens differ from those without the disease. Adolescents transitioning to insulin-pump therapy reported that self-dissatisfaction in their body size alone did not spur abnormal eating behaviors. Rather, teens felt more pressured by diabetes-related issues concerning appetite, fullness, and satisfactory disease management.  Dr. Young-Hyman identified that the most significant contributor to risk was high A1c levels (poor long-term control of blood sugar).

One month after transitioning to use of an insulin-pump, the teens were less likely to develop abnormal eating behaviors. Thus, Dr. Young-Hyman speculates that insulin-pump therapy may help improve eating patterns and hence reduce the risk for eating disorders.  In addition, the research stresses the importance of using criteria relevant to diabetes to properly diagnose disordered eating behaviors in patients with diabetes. The successful diabetes-specific diagnosis tool pioneered for the study could potentially prove to be clinically useful in the future.

Dr. Young-Hyman presented the results of her project on June 25, 2011 at the American Diabetes Association’s 71st Annual Scientific Sessions in San Diego, California.