SOME DIABETICS RISK ALL TO LOSE WEIGHT

Nearly two years ago, Ashley Wolfe was dancing in a nightclub and then blacked out. Rushed to a hospital, she remained in a diabetic coma for days.

"I woke up to see about 15 of my family members, standing around my bed not knowing whether or not I was gonna make it," says the now 21-year-old Kokomo resident."

Wolfe, a type 1 diabetic, skipped doses of her insulin in order to lose weight, but doing so could have killed her. Dubbed by the media as "diabulimia," the condition doesn't have a true clinical name. It's simply an eating disorder in the context of diabetes, says Ann Goebel-Fabbri, a psychologist at the Joslin Diabetes Center affiliated with Harvard Medical School in Boston. She specializes in diabulimia treatment.

For people with diabulimia, insulin is the enemy which makes them gain weight. But when they don't inject themselves with insulin to maintain a healthy body, it actually causes them to lose weight.

Most bodies naturally produce the insulin hormone. It's used to break down food into sugar that can later be used as energy to keep the body functioning normally. But type 1 diabetics have a problem with their immune system, which mistakenly destroys insulin in their pancreas, significantly limiting the amount of insulin produced.

"Basically, people who are taking less insulin than they need and running their blood sugar as high are spilling calories out in their urine," Goebel-Fabbri said.

Those with diabulimia often disregard all of the warnings that their bodies send them. They forge right through the lethargy and aches and continue to skip their insulin shots. All they care about is getting and staying skinny.

It sounds great, right? All you have to do is skip your medicine and you lose weight, while eating whatever you want! Well, keep reading. The consequences may include hair loss, kidney failure, heart and blood vessel disease, and a shorter lifespan. Skipping insulin can also lead to cataracts, causing blindness.

"I would probably say I have done some damage to my body that will cause health problems in the long run, maybe even having to be put on dialysis from kidney failure," says Wolfe, who had suffered with diabulimia since eighth grade. "Until you get older, you never know what kind of long-term complications you have caused yourself until they come up."

Sadly, a study led by Goebel-Fabbri, published in the March 2008 issue of "Diabetes Care," found that women with type 1 diabetes triple their risk of dying when they take less insulin seeking to lose weight.

But these risks haven't stopped insulin abuse. Roughly about a third of all type 1 American diabetic women, about 450,000 of them, have manipulated their insulin to lose weight at least once in their lifetime. That's according to research by the Joslin Diabetes Center.

Goebel-Fabbri emphasizes that it's not easy for people with this disease to stop manipulating their insulin, even when they recognize the health risks.

"This is an emotional and psychological problem, and it may have felt to the patient as though it started as a conscious choice, but once it's a recurrent pattern of behavior, it has its own fuel," she says. "Intervention based on education alone or based on methods of 'scaring people straight' doesn't work. 

"These patients are very well-informed, and I think the problem is they feel trapped in a cycle, and they're actually really ashamed of it and really afraid of it."

At Joslin, as a psychologist, Goebel-Fabbri counsels those with diabulimia  and collaborates with other experts to provide comprehensive treatment. These health l providers include a diabetologist (an endocrinologist who specializes in diabetes), a nurse educator, a nutritionist and an exercise physiologist.

Despite her own fears, Wolfe decided to speak out publicly with Y-Press for the first time about her disorder.

"I need to share my experiences now because I know it's not easy growing up as a kid, let alone a girl, with diabetes because it does put issues on you as far as weight, and what everybody else is gonna think of you," says Wolfe. One of her co-workers suspects that her own diabetic teenage daughter has skipped insulin doses, and Wolfe has offered to talk to her.

Both Wolfe and Lee Ann Thill, a 35-year-old art therapist in New Jersey, used to hide their diabetes and their diabulimia from most of their family and peers.

     "I was always very ashamed of it because it made me different," Thill says. "I think that made me also kind of a shy, introverted person to some extent... That certainly affected all my relationships."

Adds Wolfe: "I did what I did behind closed doors. I would always tell my mom I'm gonna go to my room and take my insulin, or I'm gonna go to my room and take my blood sugar, and of course naturally never do it."

Fear has played a big part in Wolfe's and Thill's struggles, too. There was fear that they were going to gain too much weight, which initially made them turn to insulin misuse; next, they feared hurting themselves; then hurting their family, and finally they still fear relapse.

"It doesn't go away. It's always there in the back of your head that there's that chance of you relapsing and doing that stuff again," Wolfe says.

At Joslin, as a psychologist, Goebel-Fabbri counsels those with diabulimia  and collaborates with other experts to provide comprehensive treatment. These health providers include a diabetologist (an endocrinologist who specializes in diabetes), a nurse educator, a nutritionist and an exercise physiologist.

     Most eating disorders have one thing in common -- a cycle that the people don't know how to break. Thill says that diabulimia was her way of coping with life. She knew it was wrong, but she felt that she needed to manipulate her insulin to survive. She also figured she was only hurting herself, but that changed when she met  her husband-to-be.

     "Once you're married, you have to be responsible for yourself as part of the relationship," she says. "I felt like I was not honoring his trust in me by not taking care of myself."

Thill entered an intensive outpatient treatment program when she was 32. She had first struggled with diabulimia at age 14 and would get treatment, then relapse.. She felt disgusted with herself, asking: "Is this what my life is gonna be? Am I always going to be in one of these stupid programs never getting better?"

After the therapy program ended, she finally stopped, she says. "It was really a matter of finding the motivation and desire to get better."

Wolfe also received help from a therapist, who kept her focused on getting healthy.

"Once I started taking my insulin and my medicine the way I'm supposed to, it really made my body feel physically better," she says. "I didn't feel real fatigued like I always had. I had a better relationship with my family after that.  So just everything got better."

 She and her husband look forward to a bright future – including children.

 "That's one of the things that helps keep me on track: I want to be healthy," says Wolfe. "With out-of- control diabetes, having kids is a big risk."

Assistant Editor: Tony Quintana, 16; and Paige Thomas, 18