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August 5, 2003


Question from Canada:

My 18 year old cousin, who is really active and has a past history of anorexia (which she claims to have recovered from), was diagnosed with type 1 diabetes about nine months ago, but now doctors do not really know. Her body mass index (BMI) is 22, and she is not on insulin right now. About four months ago, they tested her C-peptide which was 2.1 with a blood sugar of 4.8 mmol/L [86 mg/dl] and her hemoglobin A1c was 4.8%. Her blood sugar started creeping a bit up to a diabetic level (fasting around 7mmol/L [126 mg/dl]; premeal around 8 mmol/L [144 mg/dl]). She got upset over the numbers, and now, instead of doing 45 minutes of cardiovascular exercise per day, she does two hours. Instead of eating 100 grams of carbohydrate, she just eats salads and low starch vegetables(about 30-40 grams of carb per day), and she eats about 500-600 calories per day. The result has been that her fasting levels are around 5mmol/l [90mg/dl]. My concern is that I do not think she has energy for anything during the day and can not keep living in this way. She says she is fine as long as she is not taking insulin as she is afraid of gaining weight, but she fainted twice last week.. The anorexic behaviors are showing up, except that she is not losing much weight because she probably screwed her metabolism. I am afraid she will end up in coma as when she was diagnosed, and now she is dealing with eating disorder. She has not told her doctor about what she is doing because she feels badly about it, but it certainly does not sound right. Will she be able to do this for a long period of time as she is not using much of her insulin with food? What can I do?


Her eating behaviors have the potential to cause her harm — and are not helping her diabetes. I suspect she has an eating disorder that should be seriously considered by her physician. There are excellent treatment programs available for eating disorders which can be treated when they are promptly recognized. She needs an appointment with her physician.


[Editor’s comment: Your concern is admirable and warranted. Unfortunately, about all you can do is to encourage your cousin to discuss this with her doctor. You might offer to go with her as a support, but ultimately, she is the one who needs to see she has a problem and do something about it.