Type 1 diabetes and eating disorders - the worst of both worlds

Some teenagers with type 1 diabetes deliberately avoid taking the right dose of insulin. The short-term 'benefits' they crave - lack of insulin stops them processing food and therefore keeps their weight down - may be tempting, but the consequences can be deadly.

When our children are tiny, we sometimes feel helpless - perhaps at 4am when they're crying inconsolably or have been coughing for hours. But at least we know exactly what's going on, because we're in charge of every aspect of their lives. How much harder it is when our children are no longer entirely dependent and we have to rely on them to make the right choices.

Type 1 diabetes affects about one in 300 people in the UK . It is, in many ways, a very different condition from type 2 diabetes, which is the most common form of diabetes among people in the UK. Whether or not you get type 1 diabetes is nothing to do with your weight or your lifestyle. It's thought to be an autoimmune disease - your immune system, which normally fights off infection, turns on your own body and attacks part of the pancreas, which produces insulin.

The most common theory for type 1 diabetes is that the autoimmune process is triggered by a viral infection, and this often happens in childhood or young adulthood. Going through all the hormonal and emotional changes of adolescence is hard at the best of times, but adding the challenge of dealing with type 1 diabetes makes it more challenging still.

Among the many stresses of being a teenager (particularly, but not exclusively, a girl) is the pressure to be thin and attractive. About one in 5,000 Britons is diagnosed every year with the eating disorder anorexia nervosa but it affects up to one in 20 teenagers, and ten times more girls than boys. Thousands of newspaper columns are devoted to arguing about what's to blame - the obsession with appearance in the media and all those images of stick-thin models; the cruel gossip column stories about celebrities who are looking 'chunky' because they've gone up from a size 8 to a size 12; or the pressure to be perfect in today's society. Whatever the cause (or causes), anorexia is a cruel condition which causes huge distress to sufferers and their families and can even kill.

Perhaps, then, it's not surprising that some teenagers with type 1 diabetes deliberately avoid taking the right dose of insulin. The short-term 'benefits' they crave - lack of insulin stops them processing food and therefore keeps their weight down - may be tempting, but the consequences can be deadly. In the last year, almost 8,500 people were admitted to hospital with dangerously high blood sugar (a potentially lethal condition called diabetic ketoacidosis) and young females were the most common group affected.

Long-term consequences of high blood sugar include kidney damage and blindness. But in a recent interview, a young woman with type 1 diabetes, admitted that despite knowing the risks, she was 'consumed' with wanting to be thin and deliberately avoided taking her insulin.

I may look back wistfully to the days when my joints didn't ache and I could bounce out of bed after a late night out, but I would never want to be a teenager again. I remember only too well how painful growing up can be. I struggle all the time as a mother against the urge to protect my own teenage children - I know they need to find their own way in the world, and I know my job is to let them go, but it's so hard to trust them not to crumble under the pressure. As a GP, I see young people and their parents going through the same internal struggles every day.

The charity DWED (Diabetics With Eating Disorders) is campaigning to have 'diabulimia' - omitting insulin in order to lose weight - officially recognised as a mental illness, in the same way as anorexia or bulimia is. I would heartily support their efforts, for the sake of both sufferers and their families. To have a teenager diagnosed with type 1 diabetes or anorexia nervosa is devastating for parents; to have them suffering from both, doubly so. But to have your beloved child misdiagnosed or not given the help they need because of lack of understanding by the very specialists you've turned to for help? That's just unthinkable.

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