"Diabulimia" in Type 1 Diabetes

According to the National Eating Disorders Association, eating disorders — such as anorexia, bulimia and binge eating disorder — include extreme emotions, attitudes and behaviors surrounding weight and food issues. Eating disorders are serious emotional and physical problems that can have life-threatening consequences for females and males.

Women with type 1 diabetes are more than twice as likely to develop an eating disorder than age-matched women without diabetes.

Eating disorders in type 1 diabetes such as "diabulimia," as it is known in the popular press, represent some of the most complex patient problems—both medically and psychologically.
Women with eating disorders and diabetes typically struggle with symptoms similar to those of women with eating disorders who do not have diabetes.  However, they exhibit a very dangerous symptom of calorie purging in the form of insulin restriction.
This condition is characterized by weight and body image concerns that lead to the mismanagement of diabetes.

The NHS National Diabetes Audit says a high proportion of women aged between 15 and 30 are skipping insulin injections to lose weight. Now a charity wants diabulimia, as it is known, officially recognised as a mental health condition.

"Between 1 April 2010 and 31 March 2011, 8,472 people included in the NDA [national diabetes audit] were admitted to hospital in the UK for diabetic ketoacidosis."

Recognize eating disorders in diabetes

Warning signs may include:

• unexplained elevations in A1C values
• repeated problems with diabetic ketoacidosis (DKA), which can be fatal
• extreme concerns about weight and body shape
• change in eating patterns
• unusual patterns of intense exercise (sometimes associated with frequent hypoglycemia)
• amenorrhea (skipping monthly menstrual periods)

Understand the medical risks associated with eating disorders and diabetes

• higher A1C levels
• higher risk of developing infections
• more frequent episodes of DKA
• more frequent hospital and emergency room visits 
• higher rates and earlier onset of diabetes complications - nerve damage, eye disease, kidney disease and possible heart disease

Resources:
http://www.mayoclinic.com/health/diabulimia/MY01793
http://www.bbc.co.uk/newsbeat/20988655
http://www.medicinenet.com/script/main/art.asp?articlekey=81960

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An oral pill to treat diabetes

Researchers have found a alternate for insulin to help treat diabetes orally, replacing painful pricks over 10 years, Erik Helmerhorst, professor at Curtin University, and colleagues looked at three million compounds on pharmaceutical databases to try to follow the molecular map of insulin they found one, and are increasing it to "take the needle out of diabetes".

"Our innovation is the expansion of a new chemical entity, a small drug molecule we have revealed and, developed, that can be taken orally as a tablet to replace insulin per se," said Helmerhorst.

The research has the capability to revolutionise the treatment of diabetes, which is a growing problem worldwide helmerhorst said there was a niche market for their drug molecule to target Type 2 diabetics to help delay the onset of insulin addiction according to a Curtin statement.

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New Clues to How Gastric Bypass Surgery Combats Diabetes

Gastric bypass surgery has been known to improve blood sugar control, often sending people with type 2 diabetes into remission, but experts have long wondered exactly how that happens. Now, a new study provides some clues. Circulating amino acids linked with insulin resistance decline dramatically in those who have the bypass surgery, the researchers discovered. They compared 10 obese people with diabetes who had the surgery with 11 who lost weight through dieting. "Something happens after gastric bypass that does not happen as much after the diet-induced weight loss," said Dr. Blandine Laferrere, an associate professor of medicine at St. Luke's Roosevelt Hospital Center and Columbia University, both in New York City.

The surgery, which reduces the stomach to the size of a small pouch, also modifies the junction between the stomach and small intestine. It leads to a dramatic reduction in the level of circulating amino acids that have been linked with diabetes. "The fact that gastric bypass results in the remission of diabetes in the majority of patients is not new," said Laferrere. According to background information in the study, 50 percent to 80 percent of diabetes cases go into remission after the surgery. What doctors have been trying to figure out, she said, is why the bypass surgery is so good at making the diabetes disappear. "The diabetes improves almost immediately, before a significant amount of weight loss occurs," she said. "That points out it is something other than the weight loss."

In the new study, the researchers evaluated biochemical compounds involved in metabolic reactions in the participants. Each group had lost about 20 pounds. The investigators found that the bypass patients had much lower levels of amino acids known as branched-chain amino acids, and the amino acids phenylalanine and tyrosine. "Those changes in the amino acids could be implicated in the mechanism of diabetes remission after gastric bypass," Laferrere said. Experts know the amino acids are linked with insulin resistance partly due to animal studies, she said. "If you supplement the diet of rats with branched-chain amino acids, you can induce more insulin resistance," she explained.

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Do Immune System Ills Help Drive Type 2 Diabetes?

New research suggests that the development of insulin resistance and type 2 diabetes may be linked to an immune system reaction gone awry. "The main point of this study is trying to shift the emphasis in thinking of type 2 diabetes as a purely metabolic disease, and instead emphasize the role of the immune system in type 2," said study co-author Dr. Daniel Winer, an endocrine pathologist at Toronto General Hospital in Canada. When the research began, Winer was a postdoctoral fellow at Stanford University in California. The researchers have identified immune system antibodies in people who are obese and insulin-resistant that aren't present in people who are obese without insulin resistance. They also tested a drug that modifies the immune system in mice fed a fatty diet, and found that the medication could help maintain normal blood sugar levels.

The findings were published online April 17 in the journal Nature Medicine. Funding for the study was provided by the U.S. National Institutes of Health. Nearly 26 million Americans have diabetes, according to the U.S. Centers for Disease Control and Prevention. Between 90 percent and 95 percent of these cases are type 2 diabetes, where the body doesn't use insulin efficiently, so the pancreas must make increasing amounts of insulin. Eventually, the pancreas stops making enough insulin to meet the increased demand. The less common form of the disease, type 1 diabetes, occurs when the immune system mistakenly destroys the insulin-producing beta cells in the pancreas. This type of diabetes is considered an autoimmune disease, and isn't linked to how much a person weighs.

Although the causes of type 2 haven't been clear, it's known that the disease runs in families, suggesting a genetic component. Also, while type 2 is strongly linked to increased weight, not everyone who is overweight gets type 2 diabetes. And, that's what got the researchers searching for another factor. Winer explained that excess weight has been linked to inflammation, which can cause the immune system to react. As visceral fat (abdominal fat) expands, it eventually runs out of room, explained Winer. At that point, the fat cells may become stressed and inflamed, and eventually the cells die. When that happens, immune system cells known as macrophages come to sweep up the mess.

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