Disinhibited eating and weight-related insulin mismanagement among individuals with type 1 diabetes

Abstract

Objective Withholding insulin for weight control is a dangerous practice among individuals with type 1 diabetes; yet little is known about the factors associated with this behavior. Studies of nondiabetic individuals with weight concerns suggest that eating in a disinhibited manner (e.g., binge eating) predicts the use of maladaptive compensatory strategies (e.g., self-induced vomiting). The purpose of this study was to test whether individuals with type 1 diabetes are less restrained in their eating when they think their blood glucose (BG) is low and whether this contributes to insulin omission for weight control purposes and subsequently higher hemoglobin A1c (HbA1c). Methods Two-hundred and seventy-six individuals with type 1 diabetes completed an online survey of eating behaviors, insulin dosing and most recent HbA1c. We used structural equation modeling to test the hypothesis that disinhibited eating when blood sugar is thought to be low predicts weight-related insulin mismanagement, and this, in turn, predicts higher HbA1c. Results The majority of participants endorsed some degree of disinhibition when they think their blood glucose is low (e.g., eating foods they do not typically allow) and corresponding negative affect (e.g., guilt/shame). The frequency of disinhibited eating was positively associated with weight-related insulin mismanagement. Controlling for age, sex, education, and insulin pump use, the model explained 31.3% of the variance in weight-related insulin mismanagement and 16.8% of the variance in HbA1c. Conclusion Addressing antecedents to disinhibited eating that are unique to type 1 diabetes (e.g., perceived BG level), and/or guilt or shame for unrestrained eating when hypoglycemic may reduce weight-related insulin omission.

Eating patterns in adolescents with type 1 diabetes: Associations with metabolic control, insulin omission, and eating disorder pathology

“…We note that the 7-day timeframe on the ChEDE 35 nuanced data and improve recall to extend over a longer period to determine the persistence and stability of findings. We advise that future research in adolescent T1D populations also extend beyond investigations of restraint theory to include potential diabetes-specific triggers of binge or disinhibited eating behaviors, such as perceived blood glucose levels or hypoglycemia (49). Hypoglycemia, for instance, requires eating fast-acting carbohydrates to increase blood glucose levels to prevent insulin shock, and has been previously associated with disinhibited eating behavior among adults with T1D (49).…”

“…We advise that future research in adolescent T1D populations also extend beyond investigations of restraint theory to include potential diabetes-specific triggers of binge or disinhibited eating behaviors, such as perceived blood glucose levels or hypoglycemia (49). Hypoglycemia, for instance, requires eating fast-acting carbohydrates to increase blood glucose levels to prevent insulin shock, and has been previously associated with disinhibited eating behavior among adults with T1D (49). It is also important to note that the observed links between skipping meals and HbA1c may be influenced by other factors which were unmeasured, including the frequency of blood glucose monitoring, and psychological aspects related to self-care.…”

Biopsychosocial Aspects of Weight Management in Type 1 Diabetes: a Review and Next Steps

“…Unfortunately, insulin manipulation in the form of complete omission or intentional under-dosing results in rapid weight loss and thus is an effective but dangerous way to lose weight [64, 73]. …”

Delay discounting and parental monitoring in adolescents with poorly controlled type 1 diabetes

“…In youth with type 1 diabetes, adherence encompasses the set of health-promoting behaviors that are critical for good diabetes outcomes, which are not limited to daily medication adherence. For example, although not caused by obesity, type 1 diabetes management in youth does require decision-making at meal times (i.e., to ensure proper blood glucose checking, carbohydrate counting and insulin dosing) and dysregulated eating behaviors have been linked to poorer glycemic control (Merwin et al, 2014; Young et al, 2013). Research examining eating behaviors and obesity have also found links between greater discounting of future rewards and consumption of more calories and higher weight (Epstein, Salvy, Carr, Dearing, & Bickel, 2010; Rollins, Dearing, & Epstein, 2010; Weller, Cook, Avsar, & Cox, 2008).…”