Taking less insulin bad for diabetics

Taking less insulin than required to control type 1 diabetes can cut a woman's lifespan by more than a decade. Fear of hypoglycaemia (low blood sugar) and concern about gaining weight may lead patients with type 1 (insulin-dependent) diabetes to restrict their insulin doses. American researchers studied 234 women with type 1 diabetes for a period of 11 years. Diabetes self-care behaviour, diabetes-specific distress, fear of hypoglycaemia, psychological distress and eating disorder symptoms were assessed at the beginning of the study. At the outset, 71 women (30 per cent) had been classified as insulin restrictors, based on a positive response to the screening item "I take less insulin than I should." Among them, 26 women died during follow-up, including 10 insulin restrictors. It was found that those who restricted their insulin intake had a higher risk of dying as well as higher rates of kidney and foot problems as compared to women who did not restrict their insulin dose. In addition, the average age of death was younger for those involved in insulin restriction: 45 years of age as compared to 58 years for those who did not restrict. Insulin restriction increased the relative risk of death more than three-fold after adjusting for other factors. Insulin-restricting women who died reported more frequent insulin restriction and reported more eating disorder symptoms at the study's outset than those insulin-restrictors who were still living at study's end. Studies have shown that women with diabetes are nearly three times more likely to develop an eating disorder than women without diabetes. The data shows that insulin restriction has higher rates of diabetes complications and increased mortality risk. Death associated with insulin restriction appeared to occur in the context of eating disorder symptoms, rather than other psychological distress. Appropriate screening as part of routine diabetes care may improve the detection of this problem.