Insulin Omission Research Articles

Precipitating factors, clinical features and outcome of diabetic ketoacidosis in children and adolescents admitted in a tertiary care hospital in Dhaka

Background Information: Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (DM). It is an acute complication of type 1 DM. Objective: This study was designed to identify the precipitating factors, clinical features and immediate outcomes of DKA in children and adolescents. Method: This was a retrospective study which was done in the department of Pediatrics, BIRDEM, from January 2002 to April 2007. Data were collected from the hospital record for all diabetic children below 18 years admitted with DKA. Result: Fourty nine children and adolescents were admitted with DKA. Sixty one percent were known cases and the remaining (39%) were new DM. Majority were female (63%). Most (49%) of the children were between 11- 15 years. Infection was the commonest (49%) precipitating factor followed by insulin omission (24%). Major clinical features were kussmaul breathing (94%) and dehydration (94%).Eighty eight percent patients improved after treatment and mortality was 12%. Conclusion: Infection was the commonest precipitating factor of DKA. Kussmaul breathing and dehydration were the commonest clinical features. Most of the patients improved after treatment.DOI: http://dx.doi.org/10.3329/bjms.v13i1.17429 Bangladesh Journal of Medical Science Vol. 13 No. 01 January2014: 53-57

Disturbed Eating Behavior and Omission of Insulin in Adolescents Receiving Intensified Insulin Treatment

OBJECTIVETo establish the prevalence of disturbed eating behavior (DEB) and insulin omission among adolescents with type 1 diabetes using intensive insulin treatment in a nationwide population-based study.RESEARCH DESIGN AND METHODSThe Diabetes Eating Problem Survey–Revised (DEPS-R) is a diabetes-specific screening tool for DEB. Clinical data and HbA1c were obtained from the Norwegian Childhood Diabetes Registry.RESULTSA total of 770 children and adolescents 11–19 years of age with type 1 diabetes completed the DEPS-R. A total of 27.7% of the females and 8.6% of the males scored above the DEPS-R cutoff. Participants scoring above the cutoff had significantly higher HbA1c (9.2% [77 mmol/mol]; SD, 1.6) than participants scoring below the cutoff (8.4% [68 mmol/mol]; SD, 1.3; P < 0.001). The prevalence of DEB increased significantly with age and weight, from 7.2% in the underweight group to 32.7% in the obese group, and from 8.1% in the youngest age-group (11–13 years) to 38.1% in the oldest age-group (17–19 years). A total of 31.6% of the participants reported insulin restriction and 6.9% reported insulin omission after overeating. Patients reporting insulin restriction had significantly higher HbA1c (9.0% [75 mmol/mol]; SD, 1.7) than nonrestrictors (8.3% [67 mmol/mol]; SD, 1.2; P < 0.001).CONCLUSIONSOne-fourth of girls with type 1 diabetes scored above the cutoff for DEB and one-third reported skipping their insulin dose entirely at least occasionally after overeating. Both DEB and insulin restriction were associated with poorer metabolic control, which may increase the risk of serious late diabetes complications.

Eating Disorders May Pose Greater Risk in Type 1 Diabetes

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessEating Disorders May Pose Greater Risk in Type 1 DiabetesLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:25 Jun 2013https://doi.org/10.1176/appi.pn.2013.6b18AbstractClinicians must discern whether poor diabetic control is just that, or something more troubling in patients with type 1 diabetes.When treating patients with type 1 diabetes (DM-1), clinicians often focus on the potential for microvascular and macrovascular complications, such as retinopathy and cardiovascular disease. But many DM-1 patients are at much greater risk for a different complication: an eating disorder.DM-1 is among the most common chronic illnesses of childhood, with a prevalence of 0.1 percent in the general population, affecting both genders equally. “The highest risk for an eating disorder appears when patients are diagnosed with DM-1 between ages 7 and 18 years,” explained Erin Sterenson, M.D., a psychosomatic medicine fellow at the Mayo Clinic in Rochester, Minn., who led the Academy of Psychosomatic Medicine’s seminar “Eating Disorders Through the Lifespan” at APA’s 2013 annual meeting in San Francisco in May. Routine methods for monitoring and controlling blood glucose levels can be mistaken for signs of an eating disorder in DM-1 patients.Dmitry Lobanov/ShutterstockSterenson explained that although the prevalence of anorexia nervosa in DM-1 patients is thought to be equal to that in non-DM-1 patients—which she noted are between 0 percent and 3.2 percent—the prevalence of bulimia nervosa is much higher, up to 35 percent compared with 1 percent to 2 percent in the general population. DM-1 patients with disordered eating, informally known as diabulimia, have an unusual and potentially dangerous method for purging calories at their disposal: insulin restriction or omission. When insulin is underdosed in these patients, muscle and fat are broken down into ketone bodies, sugar is unable to enter cells and be used for energy, and sugar (calories) is purged via urination, resulting in weight loss. How common are eating disorders in DM-1 patients? Sterenson pointed out that studies suggest DM-1 patients are two to four times more likely to experience an eating disorder than are nondiabetics. Consistent with other forms of eating disorders, 95 percent of DM-1 patients with eating disorders are female, and 45 percent are aged 15 and 30. Rates of insulin omission also appear to peak between the ages of 15 and 30 in diabulimic patients. But detecting an eating disorder in a DM-1 patient can be challenging, Sterenson said. There are many legitimate reasons why DM-1 patients might restrict their insulin intake, such as simply forgetting to dose themselves. Fear of hypoglycemia and its social implications, uncertainty about carbohydrate counts, increased physical activity, and limited access to food or medical supplies in certain settings can also result in insulin restriction.Identifying DM-1 patients with eating disorders is made even more complicated by the lack of a validated screening tool. Tools designed for non-DM-1 patients can be misleading. “The general screening tools often ask questions that most of our patients with DM-1 are encouraged to incorporate into their daily life, such as being aware of calorie content and carbohydrate content,” said Sterenson. “On the other hand, these screening measures don’t evaluate patients for insulin omission or underdosing.” Normal aspects of management of DM-1 can also create risk factors for an eating disorder. Dietary restraint and preoccupation with food, disregard for hunger and satiety cues, perceived and actual loss of control and independence, and a focus on exercise are all aspects of daily management of DM-1, as well as potential triggers for an eating disorder. But there are signs and symptoms that should raise a clinician’s “index of suspicion” for an eating disorder in a DM-1 patient, Sterenson emphasized, including extreme concerns about body shape or weight, intense exercise regimens, and low-calorie meal plans. Unexplained elevations in HbA1c, repeated episodes of diabetic ketoacidosis, and resistance to treating hypoglycemia should also be investigated. And while detection of an eating disorder in a DM-1 patient can be tricky, treatment and prevention are even more complicated, she noted. Psychotherapy, assessment and treatment of psychiatric comorbidities, and less-intensive dietary management are some appropriate approaches, but little information about the effectiveness of any specific treatment is available, and Sterenson stressed the need for greater focus on evaluating and treating diabulimic patients. “For many DM-1 patients, eating disorders present a much greater risk than the microvascular and macrovascular complications on which we so often focus,” she said. ■To watch a video interview of Sterenson, go to http://www.youtube.com/watch?v=eAW5wqDxeyE. ISSUES NewArchived

Dealing with the devil: weight loss concerns in young adult women with type 1 diabetes

To examine the weight loss concerns of young adults with type 1 diabetes. Eating disorders are prevalent in young women with type 1 diabetes. Qualitative. Interviews with 35 young adults (23-30 years of age) with type 1 diabetes and 13 healthcare professionals. Most female interviewees were concerned about the difficulties of losing weight when having diabetes. Six female interviewees developed severe eating disturbances when they were younger. These women initially regarded their disturbed eating behaviour positively and engaged in weight loss activities intermittently. However, over time, they lost control of their behaviour, and it came to dominate their lives. Family conflict often intensified disordered eating behaviours. Eventually all of these women managed to transition away from their behaviour, although this process took, for some of them, several years. Several of them (now in their early to late twenties), however, continued to struggle with weight loss impulses. Healthcare professionals felt that eating- and weight-related issues often went undiagnosed and undocumented in young adult women with type 1 diabetes. Many young women with type 1 diabetes are worried about their weight, but will not engage in risky weight loss activities because of concerns about their health. A minority of young adult women will develop more severe eating-related disturbances. These eating disturbances may last a significant amount of time before clinicians become aware of them. These women may also experience disordered weight loss impulses for sometime after clinical interventions. Clinicians should screen young adult women with type 1 diabetes for eating disorders and monitor young adult women who have developed eating disorders over the longer term. There may be a need to provide asymptomatic young women with diabetes with information about the potential risks of insulin omission.

Risk behaviors for eating disorder in adolescents and adults with type 1 diabetes

To evaluate the frequency of risk behaviors for eating disorder (ED) in patients with type 1 diabetes (T1D) and their association with gender, nutritional status, variables related to T1D, and body satisfaction. 189 individuals with T1D (12-56 years old) answered the Bulimic Investigation Test (BITE), the Eating Attitude Test (EAT), the Binge Eating Scale (BES), Stunkard's Figure Rating Scale, and questions regarding control of T1D. Association between ED risk behaviors and the selected variables was assessed with the chi-square test and Student's t-test; factors that influenced the risk of ED were identified by means of logistic regression. Of the patients with T1D, 58.7% were at risk of ED (45, 40, and 16% according to the EAT, BITE and BES, respectively). There were significant differences between groups with and without risk for ED related to BMI (p = 0.009), gender (p = 0.001), insulin omission (p = 0.003), use of the carbohydrate counting method (p = 0.019), and body dissatisfaction (p = 0.001). The risk of ED was nine times higher in patients who reduced or omitted insulin (p = 0.036). Patients with T1D demonstrated a high frequency of body dissatisfaction and ED risk behaviors; the omission or reduction of insulin was an important risk factor.

Detecting intentional insulin omission for weight loss in girls with type 1 diabetes mellitus

Intentional insulin omission is a unique inappropriate compensatory behavior that occurs in patients with type 1 diabetes mellitus, mostly in females, who omit or restrict their required insulin doses in order to lose weight. Diagnosis of this underlying disorder is difficult. We aimed to use clinical and laboratory criteria to create an algorithm to assist in the detection of intentional insulin omission. The distribution of HbA1c levels from 287 (181 females) patients with type 1 diabetes were used as reference. Data from 26 patients with type 1 diabetes and intentional insulin omission were analysed. The Weka (Waikato Environment for Knowledge Analysis) machine learning software, decision tree classifier with 10-fold cross validation was used to developed prediction models. Model performance was assessed by cross-validation in a further 43 patients. Adolescents with intentional insulin omission were discriminated by: female sex, HbA1c>9.2%, more than 20% of HbA1c measurements above the 90th percentile, the mean of 3 highest delta HbA1c z-scores>1.28, current age and age at diagnosis. The models developed showed good discrimination (sensitivity and specificity 0.88 and 0.74, respectively). The external test dataset revealed good performance of the model with a sensitivity and specificity of 1.00 and 0.97, respectively. Using data mining methods we developed a clinical prediction model to determine an individual's probability of intentionally omitting insulin. This model provides a decision support system for the detection of intentional insulin omission for weight loss in adolescent females with type 1 diabetes mellitus.

Type 1 Diabetes Mellitus

1. Justin M. Gregory, MD* 2. Daniel J. Moore, MD, PhD† 3. Jill H. Simmons, MD‡ 1. *Pediatric Endocrinology Clinical Fellow, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN. 2. †Assistant Professor of Pediatrics, Assistant Professor of Pathology, Microbiology, and Immunology, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN. 3. ‡Assistant Professor of Pediatrics, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN. * ADA: : American Diabetes Association DKA: : diabetic ketoacidosis HbA1c: : glycosylated hemoglobin I:C ratio: : insulin-to-carbohydrate ratio IV: : intravenous TDD: : total daily dose T1DM: : type 1 diabetes mellitus T2DM: : type 2 diabetes mellitus 1. All children with type 1 diabetes mellitus (T1DM) should have their blood sugar managed with basal-bolus insulin treatment by either multiple daily injections or an insulin pump. 2. All children with T1DM should have access to a pediatric endocrinologist with a diabetes management team with resources to support patients and families. 3. All children with T1DM should be monitored for symptoms and/or screened for commonly associated conditions such as thyroid and celiac disease. After completing this article, readers should be able to: 1. Recognize the presenting signs and symptoms of type 1 diabetes mellitus (T1DM). 2. Know the key principles of effective diabetes self-management and the diabetes care team’s role in facilitating effective self-management. 3. Know the acute and chronic complications of (T1DM). 4. Identify how different categories of insulin analogues are used in daily insulin regimens. True, it is a fight, but there is pleasure in the struggle. Victory comes to the courageous; and without courage and common sense, success awaits no one. I look upon the diabetic as charioteer and his chariot as drawn by three steeds named Diet, Insulin, and Exercise. It takes skill to drive one horse, intelligence to manage a team of two, but a man must be a very good teamster who can get all three to pull together.EP Joslin, 1933 Type 1 diabetes mellitus (T1DM) is a disorder of glucose homeostasis characterized by autoimmune destruction of the insulin-producing pancreatic β-cell that progressively leads to insulin deficiency and resultant hyperglycemia. If left untreated, insulin deficiency leads to progressive metabolic derangement, with worsening hyperglycemia, ketoacidosis, starvation, and death. In …

Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitus

Preserved Proinsulin Production in Homozygous Protein Tyrosine Phosphatase Nonreceptor Type 22 C1858T Variant Type 1 Diabetes: A Possible Explanation for Absence of Overt Ketoacidosis Despite Omission of Exogenous Insulin

To report a postulated mechanism for resistance to overt ketoacidosis due to prolonged insulin omission in a severely hyperglycemic woman with a 14-year history of autoimmune type 1 diabetes (T1D). History, physical examination, laboratory testing, and genotyping were performed. We also review the medical literature pertinent to this patient's phenotype and genotype. Proinsulin levels remained within the normal range (suppressed with hypoglycemia) despite simultaneous almost unmeasurable C-peptide levels during hyperglycemia. We confirmed a homozygous (TT) variant of protein tyrosine phosphatase nonreceptor type 22 (PTPN22) 1858T, a T1D susceptibility gene associated with higher proinsulin levels. The extraordinarily preserved proinsulin biological activity may explain the unusual resistance to overt ketoacidosis despite omission of exogenous insulin administration for extended periods of time. The role of the associated PTPN22 1858TT variant remains speculative.

Hyperglycemic Emergencies in Adults

Hyperglycemic Emergencies in Adults

Type 1 Diabetes in Children and Adolescents

Type 1 Diabetes in Children and Adolescents

Awareness of Diabetic Patients About Their Illness and Associated Complications in Ethiopia

Diabetes mellitus is the commonest of all metabolic diseases all over the world, as it is as well in Ethiopia. At present it is estimated that about 150 million people are affected by diabetes mellitus worldwide. In Ethiopia diabetes is being recognized as one of important health problem. Diabetes mellitus is associated with chronic complications like neuropathy, nephropathy, retinopathy and cardiovascular disease. Cardiovascular complications are the major cause of morbidity and mortality in diabetic patients. To assess the awareness of diabetic patients about their illness and associated complications in Ethiopia. Institutionbased cross sectional study was conducted in Tertiary care hospital Ethiopia. Current medication use data were collected by reviewing patients’ charts in the diabetic care follow up clinic and by interviewing diabetic patients who were on follow-up during data collection period using semi-structured questionnaire in Jimma University Specialized Hospital (JUSH). A total of 118 diabetic patients were included in the study. 53 (44.92%) of the respondents did not know the type of diabetes they were inflicted with, of those who know the type,40 (33.90%) of respondents were type II and 25 (21.20%) were type I. Incidental finding, or medical checkup as the main cause of first presentation with the disease was 61(51.69%) respondents. 52(61.18%) patients replied that meal omission is the main cause for developing acute complications, followed by insulin omission. 80 (67.79%) had knowledge about long-term complications. Majority of patients had good knowledge on actions to be taken on occurrence of acute complications and reasons for developing acute complications. In order to increase patients awareness, health care providers should provide regular diabetic education for patients during follow-up and pamphlets should be prepared and distributed consistently.

Eating Disorders in Adolescents with Type 2 and Type 1 Diabetes

Diabetes is associated with increased risk for eating disorders; with different types of eating disorders associating with different types of diabetes. Binge eating disorders show increased prevalence among individuals with type 2 diabetes (T2DM). Intentional omission of insulin for the purpose of inducing weight loss presents among individuals with type 1 (T1DM). Similarly, some individuals with T2DM intentionally omit oral hypoglycemic drugs, resulting in poor glycemic control, and weight loss. Common dominators for the development of eating disorders in T1DM and T2DM are female gender, increased body weight, body dissatisfaction, a history of dieting, and a history of depression. Patients tend to deny the existence of the problem. Clinical signs that should raise suspicion are: poor glycemic control, missed clinical appointments, recurrent episodes of diabetes ketoacidosis, recurrent hypoglycemia secondary to intentional overdose, poor self-esteem, and dietary manipulation. Eating disorders are associated with poorer glycemic control, and therefore increased risk of diabetes associated comorbidities.

The impact of insulin administration during the mixed meal tolerance test

The mixed meal tolerance test is the gold standard measure of endogenous insulin secretion. Practical issues limit the routine clinical use of this test, including omitting insulin prior to the ingestion of a high-carbohydrate liquid mixed meal, which can result in marked hyperglycaemia. We aimed to assess whether insulin omission is necessary during the mixed meal tolerance test and whether fasting C-peptide was a practical alternative to the test. Ninety-one adults with insulin-treated diabetes (Type 1 n = 56, Type 2 n = 35) underwent two mixed meal tolerance tests; one standard without insulin and one with the patient's usual morning insulin. The 90-min serum C-peptide was highly correlated in the standard mixed meal tolerance test and the test with insulin (r = 0.98, P < 0.0001). There was a 20% reduction in the peak C-peptide value when insulin was given {test with insulin [0.39 (0.01-1.16) vs. test without insulin 0.48 (0.01-1.36) nmol/l, P = 0.001]}, but the original serum C-peptide cut-off for significant endogenous insulin secretion (≥ 0.2 nmol/l) still correctly classified 90/91 patients (98% sensitivity/100% specificity). Fasting serum C-peptide was highly correlated to 90-min serum C-peptide during the test (r = 0.97, P < 0.0001). A fasting serum C-peptide ≥ 0.07 nmol/l was the optimal cut-off (100% sensitivity and 97% specificity) for significant endogenous insulin secretion (defined as 90-min stimulated serum C-peptide ≥ 0.2 nmol/l). Insulin omission may not always be necessary during a mixed meal tolerance test and fasting serum C-peptide may offer a practical alternative in insulin-treated patients.

Disordered eating in adolescent females with T1DM

Disordered eating behaviors are common in the adolescent population. These behaviors are especially dangerous for young females with type 1 diabetes due to frequent alterations in insulin levels. This article provides an overview of disordered eating in adolescent females with type 1 diabetes, including prevalence and morbidity, insulin omission and associated health outcomes, risk factors, and suggestions for screening and prevention.

Characteristics of diabetic ketoacidosis in Chinese adults and adolescents – A teaching hospital-based analysis

ObjectiveTo investigate the diabetic ketoacidosis (DKA) episodes occurred in diabetic adults and adolescents. MethodsWe reviewed diabetic patients of admissions with DKA in West China Hospital in Chengdu from January 1, 2008 to December 31, 2008. Clinical and laboratory data including β-cell function and autoantibody status were collected respectively. Patients were classified as having type 1 or type 2 diabetes or atypical diabetes based on clinical diagnosis and treatment history. And groups were compared for differences in vital statistics and biochemical profiles at presentation. ResultsDetailed and accurate information was obtained in relation to 263 of patients accounted for the 287 admissions admitted for DKA, of whom 41 patients had type 1 diabetes (15.59%) meanwhile 178 patients were diagnosis as T2DM (67.68%), and 37 patients could not be “typed” were classified as atypical DM (14.07%). In addition, there were two gestational diabetes mellitus (GDM) and five patients with other specific types. Sixty admissions (22.81%) were newly diagnosed diabetes, of which 28 admissions (46.67%) were atypical diabetes. The most common contributing factor for DKA was infection (39.16%), followed by noncompliance with anti-diabetes treatment including omission of insulin (25.5%), unknown causes (25.86%) and other medical conditions (11.73%). Of note, these middle-age obese male patients with atypical diabetes often lapse into diabetic ketoacidosis without identifiable precipitating factors. ConclusionsDKA could occur not only in T1DM but also in patients with T2DM under infection or stress condition, furthermore without any identifiable precipitant. The prevalence of DKA and its clinical heterogeneity have significant implications for diagnosing and classification of diabetes. More attention and prevention strategies are needed in ketosis-prone atypical diabetes.

Heartbreak to Happiness: Striving to Improve Outcomes for the Patient in Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that warrants prompt recognition and a multidisciplinary approach to provide intensive management and monitoring of both mother and fetus. DKA is estimated to occur in 1 to 2% of pregnancies complicated by preexisting diabetes, with 10 to 30% of women having a serum glucose less than 250 mg/dl upon diagnosis, and it poses a significant risk for the fetus, with perinatal mortality rates reported between 9% and 35%. Factors that increase the risk of DKA in pregnant patients include stress, trauma, infection, poor patient compliance, insulin pump failure, accidental omission of insulin, and medications utilized in the obstetric setting. It is crucial that nurses are familiar with the clinical signs of DKA so that prompt and appropriate treatment can be initiated to optimize outcomes for both the pregnant woman and her fetus. To better understand the signs and symptoms of DKA, an outline of the multisystem effects of a patient in DKA will be provided.

The role of comfort and discomfort in insulin therapy.

Despite the recognized importance of optimal insulin therapy, patient adherence to insulin therapy is an ongoing clinical care challenge. Insulin omission continues to be frequent and underestimated and has been correlated with poorer glycemic control and increased rates of diabetes-related complications. Insulin users consistently identify multiple factors that contribute to insulin injection-related anxiety and to non-adherence. Injection-related discomfort continues to bear a significant contribution. Over the last decade, with advances in needle manufacturing technology, shorter and narrower needles have been associated with progressively improving patient self-rating of injection discomfort. Consequently, patient surveys of insulin users show discomfort to rank in the bottom third of significant contributors by prevalence. However, healthcare providers (HCP) and family member care providers continue to demonstrate a high level of anticipated and perceived pain for the patient. HCP anxiety and pain anticipation are each associated with patient anxiety and may therefore play a significant contributing role in patient non-adherence.

The clinical biochemistry of anorexia nervosa

In anorexia nervosa, under-nutrition and weight regulatory behaviours such as vomiting and laxative abuse can lead to a range of biochemical problems. Hypokalaemia is the most common electrolyte abnormality. Metabolic alkalosis occurs in patients who vomit or abuse diuretics and acidosis in those misusing laxatives. Hyponatraemia is often due to excessive water ingestion, but may also occur in chronic energy deprivation or diuretic misuse. Urea and creatinine are generally low and normal concentrations may mask dehydration or renal dysfunction. Abnormalities of liver enzymes are predominantly characterized by elevation of aminotransferases, which may occur before or during refeeding. The serum albumin is usually normal, even in severely malnourished patients. Amenorrhoea is due to hypogonadotrophic hypogonadism. Reduced concentrations of free T4 and free T3 are frequently reported and T4 is preferentially converted to reverse T3. Cortisol is elevated but the response to adrenocorticotrophic hormone is normal. Hypoglycaemia is common. Hypercholesterolaemia is a common finding but its significance for cardiovascular risk is uncertain. A number of micronutrient deficiencies can occur. Other abnormalities include hyperamylasaemia, hypercarotenaemia and elevated creatine kinase. There is an increased prevalence of eating disorders in type 1 diabetes and the intentional omission of insulin is associated with impaired metabolic control. Refeeding may produce electrolyte abnormalities, hyper- and hypoglycaemia, acute thiamin depletion and fluid balance disturbance; careful biochemical monitoring and thiamin replacement are therefore essential during refeeding. Future research should address the management of electrolyte problems, the role of leptin and micronutrients, and the possible use of biochemical markers in risk stratification.

Doenças do comportamento alimentar e diabetes mellitus tipo 1.

Type 1 Diabetes mellitus is a chronic disease, often diagnosed in youth and associated with important psychological, familial and social disorders. Its intensive treatment with insulin and dietary changes is an extra stress factor in a stage of life already complicated. This vulnerability, coupled with low self-esteem and psychological factors typical of the youth, makes eating disorders twice as common in young girls with type 1 diabetes. The omission of insulin is the sole purging behavior used to lose weight, culminating in a poor glycemic control and increased acute and chronic complications. The treatment seeks to achieve specific objectives, depending on the associated psychiatric pathology. Because of its frequency, the clinician should be alert to early manifestations of this association. We present four clinical cases of young people with type 1 diabetes and eating disorders, which show the complexity of the approach and monitoring of these patients.