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 associated guilt or shame may reduce weight-related insulin omission.

Keywords: Diabetes; Eating disorder; Insulin mismanagement.

Conflict of interest statement

Conflicts of Interest: No conflicts of interest were declared.

Copyright © 2014 Elsevier Ltd. All rights reserved.

Figures

Figure 1. Hypothesized relationships among disinhibited eating, weight-related insulin mismanagement and HbA1c

Figure 2. Structural equations model and estimated model parameters (standardized)

Notes: *p<.05. ***p < .001. Loss of Control: Q1 = Frequency at which participants reported this experience occurred: “Do you feel like you lose control over your eating when your blood sugar is low?”; Allow Foods: Q2 = Frequency at which participants reported this behavior occurred: “When you think your blood sugar is low, how often do you eat foods that you do not normally ‘allow’ yourself to have (e.g., chips, candy etc)”; Continue to Eat: Q3 = Frequency at which participants reported this behavior occurred: When you think your blood glucose is low, how often do you continue to eat until you feel better, rather than waiting 15 minutes or so between servings to see if your symptoms remit?”; Guilt/Shame: Q4 = Frequency at which participants reported this experience occurred: “Does eating in a way that is out of your normal routine, for example, having a snack in between meals, when your blood sugar is low, make you feel guilty, shameful or regretful?”; Keep BG High (DEPS-R9) = Diabetes Eating Problems Survey-Revised item 9: “I try to keep my blood sugar high so that I will lose weight,”; Spill Ketones (DEPS-R10) = Diabetes Eating Problems Survey-Revised item 10: “I try to eat to the point of spilling ketones in my urine”; Feel Fat (DEPS-R11) = Diabetes Eating Problems Survey-Revised item 11: “I feel fat when I take all of my insulin.”