Momentary Predictors of Insulin Restriction Among Adults With Type 1 Diabetes and Eating Disorder Symptomatology

Abstract

OBJECTIVEIndividuals with type 1 diabetes who restrict insulin to control weight are at high risk for diabetes-related complications and premature death. However, little is known about this behavior or how to effectively intervene. The aim of the current study was to identify predictors of insulin restriction in the natural environment that might inform new treatment directions.RESEARCH DESIGN AND METHODSEighty-three adults with type 1 diabetes and a range of eating disorder symptomatology completed 3 days of ecological momentary assessment. Participants reported emotions, eating, and insulin dosing throughout the day using their cellular telephone. Linear mixed models were used to estimate the effects of heightened negative affect (e.g., anxiety) before eating and characteristics of the eating episode (e.g., eating a large amount of food) on the risk of insulin restriction.RESULTSIndividuals who reported greater-than-average negative affect (general negative affect and negative affect specifically about diabetes) during the study period were more likely to restrict insulin. Momentary increases in anxiety/nervousness and guilt/disgust with self before eating (relative to an individual’s typical level) further increased the odds of restricting insulin at the upcoming meal. Insulin restriction was more likely when individuals reported that they broke a dietary rule (e.g., “no desserts”).CONCLUSIONSResults suggest that insulin restriction might be decreased by helping patients with type 1 diabetes respond effectively to heightened negative affect (e.g., anxiety, guilt) and encouraging patients to take a less rigid, punitive approach to diabetes management.

Factors associated with disordered eating behaviours in adolescents with Type 1 diabetes

“…The present study also builds on previous studies that have reported associations between more disordered eating behaviours and poorer psychosocial attributes in individuals with Type 1 diabetes [13,27,30]. In a sample of 199 adolescents with Type 1 diabetes, Grylli et al [27] found that young people with disordered eating behaviours had a less positive attitude toward life, more somatic complaints, lower self-esteem, and more depressive symptoms than young people without disordered eating behaviours.…”

“…The present study also builds on previous studies that have reported associations between more disordered eating behaviours and poorer psychosocial attributes in individuals with Type 1 diabetes . In a sample of 199 adolescents with Type 1 diabetes, Grylli et al .…”

“…In a study of 83 adults with Type 1 diabetes assessed using momentary sampling, Merwin et al . found that more negative affect regarding diabetes was associated with a higher likelihood of insulin restriction. Olmsted et al .…”

“…In a sample of 199 adolescents with Type 1 diabetes, Grylli et al [27] found that young people with disordered eating behaviours had a less positive attitude toward life, more somatic complaints, lower self-esteem, and more depressive symptoms than young people without disordered eating behaviours. In a study of 83 adults with Type 1 diabetes assessed using momentary sampling, Merwin et al [30] found that more negative affect regarding diabetes was associated with a higher likelihood of insulin restriction. Olmsted et al [13] followed 101 girls with Type 1 diabetes for 5 years, none of whom had disordered eating behaviours at baseline, and assessed factors related to the development of disordered eating behaviours over time.…”

‘Diabulima’ through the lens of social media: a qualitative review and analysis of online blogs by people with Type 1 diabetes mellitus and eating disorders

“…The pattern of fear of weight gain leading to insulin omission, as well as insulin overdose after binge‐eating episodes are patterns which have been previously described , but the deeper‐seated motives behind the insulin manipulation that bloggers described, such as the ‘thrill’, ‘addictive’, ‘experimental’ or ‘secretive’ aspects of insulin omission were novel observations. Preliminary evidence has found highly processed foods share pharmacokinetic properties with addictive drugs .…”