Methods of Improvement in The Awareness & Treatment of Insulin Abuse

The purpose of this paper is to assess the need for methods of improvement in the awareness and treatment of insulin abuse and restriction in adolescent females with type 1 diabetes mellitus. 5-10% of all cases of diabetes in Canada are type 1 diabetes mellitus which typically presents between the ages of 4-6 with another peak in presentation between 11-13 (McCarvill et Weaver, 2014). This secondary age range aligns with puberty, a time when adolescent girls gain a significant amount of weight making them vulnerable for dissatisfaction with their body shape and size. (Streigel-Moore & Bulik, 2007).

Although the direct links between the two events is unclear, disordered eating behaviours have been found to be more common in adolescents with T1DM than in their cohorts (Jones et. al, 2000). It is estimated that between 20-40% adolescents with T1DM have intentionally under-dosed or skipped their insulin to lose weight (Young et. al, 2013). Insulin abuse and the subsequent hyperglycemia can leave adolescent women vulnerable to a variety of health complications including neuropathy, nephropathy, retinopathy and even early mortality (Merwin et. al, 2015).

Neuropathy is nerve damage associated with T1DM, typically exhibited in the lower legs and feet, which can lead to minor problems like blisters or ulcers, or if undetected, can lead to major complications like amputation (ADA, 2018). Nephropathy is a disease of the kidneys that can be caused by diabetes. When blood glucose is too high, the kidneys are forced to filter too much blood and as a result, they can become damaged. Valuable proteins can then be lost in the urine. In the early stages this is called microalbuminuria, but in later stages when more protein is excreted in the urine, it is referred to as macroalbuminuria and is indicative of end-stage renal disease. Kidney failure results in the necessity of either a kidney transplant or dialysis (ADA, 2018). Retinopathy is causes by damage to the small blood vessels that connected to the retina which can lead to vision loss (ADA, 2018).

Although it is hard to establish direct causation in disordered eating behaviours, there are a variety of factors, both external and intrinsic, that have been found to have an influence on the expression of restrictive insulin behaviours in adolescent females. Extrinsic factors are typically rooted in the motivation to improve appearance (Sebire et. al, 2009). In western cultures, the media constantly exerts pressure for young girls to value thinness and to strive to achieve an unrealistic standard of beauty (Peterson et. al, 2014). For young and impressinable women, this can have a major effect on their body image and self-esteem. The family environment can also impact treatment compliance with insulin dosing. An unsupportive relationship between parent and child, unstructured family meals, parental weight-loss efforts and emphasis on body weight have all been found to foster unhealthy eating behaviours (McCarvill et Weaver, 2014).

On a personal level, the onset of an insulin regime typically results in weight gain. In adolescent girls who are already experiencing changes in their bodies due to puberty, this weight gain is typically undesirable and can lead to body image dissatisfaction (Peterson et. al, 2014). Additionally, the implementation of a dietary regime, specifically carbohydrate counting in diabetic individuals, can lead to excessive preoccupations with food and disordered eating behaviours (Colton et al., 2004). T1DM is also associated with irregular amylin production, a hormone involved in regulating hunger and satiety. When combined with improper insulin dosing and resultant hypoglycemia, hormonal dysregulation can lead to loss of control over eating and perceived episodes of over-eating (Peterson et. al, 2014).