**6. Specific behavioral anomalies in type 1 diabetics**

It is well-known the association of chronic illness, such as type 1 diabetes, asthma, attention deficit disorder, physical disabilities and seizure disorders, with DEB (Neumark-Sztainer et al, 1995; Neumark-Sztainer et al, 1998). Adolescents with chronic illness present higher body dissatisfaction engaged in more high risk weight loss practices (Neumark-Sztainer et al, 1995). These data were confirmed by other studies (Neumark-Sztainer et al, 1998).

While adjusting to the changes of puberty, the adolescence is a period of rapid physical and psychological growth and development. During this time to control weight and to overcome body dissatisfaction, some adolescents commonly diet or exercise. Other may present more severe misbehaviors such as bingeing and purging, the use of laxatives or the adherence to an overly strict exercise regimen.

Before diagnosis and treatment, individuals with type 1 diabetes are likely to lose a large amount of weight. However, once the treatment begins the weight usually returns. By controlling diabetes with insulin injections many diabetics face a constant struggle with their weight (Collazo Clavell, 2010). As insulin encourages fat storage, many people with type 1 diabetes have discovered the relationship between reducing the amount of insulin they take and their corresponding weight loss (Mathur & Conrad, 2008; Mathur & Conrad, 2008). It is well-known that adolescents with type 1 diabetes tend to exhibit increased difficulty in maintaining optimal weight and also are more inclined to be concerned about their weight than their non-diabetic counterparts (Bryden et al, 1999).

Since weight management during this state of development can be especially difficult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control (Baginsky, 2009; Hasken et al, 2010; Ruth-Sahd et al, 2009). This is not a medically recognized condition yet, but describes the situation of a considerable number of type 1 diabetic patients.

they found that the prevalence of AN in type 1 diabetes was not significantly different from that in controls, being 0.27 vs. 0.06 %, respectively, while the prevalence of BN was 1.23 vs. 0.69 %, respectively, p < 0.05, in line with previous studies (Affenito et al, 1997; Jones et al,

The cited data indicate that young type 1 diabetic patients have a higher prevalence of BN, EDNOS and subthreshold ED than their non-diabetic peers. Data are summarized in Table 1.

**Clinical forms Globally Girls Boys** 

AN 0.0-1.8 % 0.27 % -

BN 0.0-5.8 % 1.23-13.3 % -

DEB 16.9 % 14.9-49.4 % -

Insulin misuse - 3.1-35.6 % -

1995). These data were confirmed by other studies (Neumark-Sztainer et al, 1998).

Table 1. Estimated prevalence of ED and DEB in type 1 diabetic patients.

their weight than their non-diabetic counterparts (Bryden et al, 1999).

considerable number of type 1 diabetic patients.

**6. Specific behavioral anomalies in type 1 diabetics** 

an overly strict exercise regimen.

EDNOS 7 % 5.3 % 1.7 %

It is well-known the association of chronic illness, such as type 1 diabetes, asthma, attention deficit disorder, physical disabilities and seizure disorders, with DEB (Neumark-Sztainer et al, 1995; Neumark-Sztainer et al, 1998). Adolescents with chronic illness present higher body dissatisfaction engaged in more high risk weight loss practices (Neumark-Sztainer et al,

While adjusting to the changes of puberty, the adolescence is a period of rapid physical and psychological growth and development. During this time to control weight and to overcome body dissatisfaction, some adolescents commonly diet or exercise. Other may present more severe misbehaviors such as bingeing and purging, the use of laxatives or the adherence to

Before diagnosis and treatment, individuals with type 1 diabetes are likely to lose a large amount of weight. However, once the treatment begins the weight usually returns. By controlling diabetes with insulin injections many diabetics face a constant struggle with their weight (Collazo Clavell, 2010). As insulin encourages fat storage, many people with type 1 diabetes have discovered the relationship between reducing the amount of insulin they take and their corresponding weight loss (Mathur & Conrad, 2008; Mathur & Conrad, 2008). It is well-known that adolescents with type 1 diabetes tend to exhibit increased difficulty in maintaining optimal weight and also are more inclined to be concerned about

Since weight management during this state of development can be especially difficult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control (Baginsky, 2009; Hasken et al, 2010; Ruth-Sahd et al, 2009). This is not a medically recognized condition yet, but describes the situation of a

2000; Vila et al, 1995).

Insulin restriction becomes a more significant problem in older adolescents, perhaps as parental supervision of insulin administration decreases. It becomes more common a potential worsening in severity and frequency throughout early adulthood. Once the pattern of frequent and habitual insulin restriction became entrenched, the cycle of negative feelings about body image, shape and weight; chronically elevated blood sugars; depression, anxiety and shame; and poor diabetes self-care can be complex and difficult to treat.

In a study that looked at 143 adolescents with type 1 diabetes who completed the Assessing Health and Eating among Adolescents with Diabetes survey; unhealthy weight control practice was observed in 37.9 % of females and 15.9% of males. Among the females, 10.3% reported skipping insulin and 7.4 % reported taking less insulin to control their weight (Neumark-Sztainer et al, 2002). Only one male reported doing either of these behaviors. In another 4 years follow-up study of 91 girls with diabetes aged 12 to 18, dieting was reported by 38% of the sample, binge eating by 45%, insulin omission by 14 % and self-induced vomiting by 8% at baseline, these behaviors were even more common at follow-up, when most of the girls were in the age of the highest risk for ED. At this time, more than half of the sample reported dieting for weight loss and binge eating, and one-third reported deliberate insulin omission to prevent weight gain (Rydall et al, 1997).

In general terms, it is estimated that between 30% and 40% of adolescents and young adults with diabetes skip or reduce insulin after meals to lose weight (Hasken 2010).
