I have a friend who is 21 years old and type 1 diabetic since she was 8 years old. I am very worried about her. She is using her insulin to lose weight and to keep it off. She is out of control now. She is a full-time college student that lives 2 hours away from home. She is skin and bones, hair loss, sleeps all the time, does not check her blood level, depressed. This has been going on for 2 years.

She said she would get it under control, which has not happened. Her last visit at the doctor, her blood count was 600. Her parents and I are fearful for her life at this point. Have you heard of this? Where can we get help for her? How can we help her? She has changed doctors often. I would think they would notice how unearthly she is.

From your description, your friend is suffering from a common form of eating disorder found in adolescent and young adult women with diabetes. This involves purging insulin as a means of losing weight. It also sounds as if she is depressed.

She needs immediate help. The best thing you and her family can do for her is to take her to an emergency room of a relatively large hospital, preferably one that has a multidisciplinary diabetes team. (You may wish to call a local chapter of the American Diabetes Association to find out which programs are in your area.)

She will not want to go, nor will she likely give any of the information that you describe to the doctors. That would be the job of her parents and you. If she does not get help immediately, she could become dangerously ill. Don’t let her distance from you prevent all of you from getting her and bringing her to the help she desperately needs.

JWB