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Insulin Abuse or Mis-use

M

MarkUniqueUserName

Member
Hi, my stepson has type 1, is 24 and is as skinny as a rake. However, his diet is high sugar, high Lucozade and Ribena (he glugs the stuff), high carbohydrate. If I ate like him I would have been 24 stone at 24 yrs old. Yesterday evening he ate two dinners at a friends house (curry and rice, hunters chicken and roast potato), followed by two puddings (sticky toffee), followed by figs with marscapone cheese. Then he came home and during the night (he doesn't sleep well) he ate the remaining 75mm slab of home baked white bread and goodness knows what else. He became type 1 at 12 yrs of age and has always had a fine instinct of knowing when he needs to dribble insulin and how much. I think he goes through a lot of insulin. When I say he is thin, his thighs almost match my biceps and he has NO bum. He is continually anxious and whizzing, doesn't sleep well, is on medication for depression and anxiety. The medical community articles I have looked at tend to talk about control of blood sugar, its all about control of blood sugar (understandably), but looking elsewhere I catch the odd reference to body-builders abusing insulin to lose weight and there is a thread here that talks about anxiety, hormones and brain triggering a hunger for carbs. Surely it is better to control your sugar/carb intake and have a low dose of insulin, without going hypo, rather than always being on a high burn with commensurate high levels of insulin (even if they are the perfect levels for that intake of carbs)? Any ideas? can you point me to any research articles ?
 
How is his blood sugar control @MarkUniqueUserName ?

Someone who is very thin but eating a lot, and is insatiably hungry, raises the question as to whether there might be high blood sugar causing that.

But no. A type 1 diabetic who takes insulin to cover the food they eat, no matter how much or what food, and control their blood sugar cannot be said to be "abusin" insulin. All they are doing is using the same amount of insulin anyone else would be producing naturally, they just have the inconvenience of having to inject it.
 

If he was matching his insulin to the food he is eating, it would be seriously unlikely that he is as skinny as you say. It sounds like his BG is running high judging by the amount of food he is eating and his weight. Google diabulimia to see if anything else written sounds familiar.

Even if he was matching insulin to the carbs he is eating, there is no way he can be having stable BG with a diet like that. The insulin diabetics inject is not like the insulin a healthy body produces. It can't deal with the swings and peaks that high carb drinks/foods create. This means it will bring his BG within range eventually, but only after hours of ups and possibly downs.

It sounds like he needs to speak with a dietician to get a better understanding of how to look after himself.
 
@MarkUniqueUserName I agree with the post above. Although most people with Type 1 tend to keep carbs below 200g a day, many eat more carbs than that. Carbs aren't forbidden. The important thing is to control blood sugar. Carbs aren't forbidden - that bears repeating.

Some people do abuse insulin by, for example, missing meal time injections on purpose. This will cause high blood sugars and can cause weight loss.

You talk about him "dribbling insulin". It's not clear what you mean by that, but injecting frequently when eating lots wouldn't be abnormal, especially if the eating took place over a few hours.

You also mentioned Lucozade. That's a very popular hypo treatment. Perhaps your stepson was low and needed to raise his blood sugar a bit?

I eat lots and I'm very slim. The important thing is my blood sugar is controlled. Do you know if his is?

You also mention he's "whizzing" and anxious. That can cause weight loss too.
 
@MarkUniqueUserName it sounds as if you're very concerned for your stepson, and you've come to an excellent place for support and information.

Given that it sounds as if he's not thriving, I would strongly recommend that he be encouraged to go to the doctor sooner rather than later for a chat and some blood tests - both the diabetes ones, and thyroid function.

Two different things are coming to mind to me, and I have experience of both of these so am writing from the point of view of my own experience rather than as the result of any medical training (which I don't have). In my opinion it could be the case that either:

1. He is not taking the amount of insulin he needs for the amount of carbohydrate he is consuming, leading to frequent hyperglycaemia. Hyperglycaemia causes dramatic weight loss. Too little insulin could be a cause of this, not too much.

or:

2. He is so hungry and not putting on weight because of a thyroid condition. Graves' disease (hyperthyroidism) can cause, amongst other things, extreme hunger and weight loss.

Sending strength.

 
Hello @MarkUniqueUserName - It's difficult to make assumptions as you can see from the responses already. You show genuine concern for him so have you ever had a chat with him about how he manages his insulin ? He may appreciate the opportunity to off-load and talk about it, or he may clam up as we are all different but it will show him that you are interested in him and want to show your support. If he is struggling then this is the chance to get him to seek help
 


Thanks for that, he has currently lost his driving licence due to a couple of hospital admissions. I get the lucozade / hypo thing, but he will drink lucozade normally and not just when he is hypo - indeed, all his hypo stocks (orange juice, mars bars etc) get used as consumables rather than "medicine". He hardly ever tests his blood sugar, he has ALWAYS flown by the seat of his pants, relying on how he feels. He regularly has hypos - averaging out at one a day maybe? Hmmm, it does sound like he is used to binging, then running lean on insulin before injecting and then going hypo. If you did that consistently cyclically, would that lead to a HBA1C within acceptable limits? He has just moved back home, so we are trying to get a handle on his physiology.


Thank you, please see response below.
 

I agree about dietician, see my further response below, thanks.
 

Thank you, from your response and the others it is possible he is running lean on insulin regularly, but the thyroid possibility is also interesting, which we will cover with him..
 

Yes thanks, his mum is always talking to him about his control habits and it may be that he has "gone deaf" over the years, but the reason I have posted is we want to take a fresh approach. He does tend to not take enough care I feel.
 
@MarkUniqueUserName The thing that stands out to me there is that he's not testing his blood sugar. If he doesn't test his blood sugar, then that makes things harder.

Yes, he might think he knows when he's high, but confirmation on a meter allows much better control.

I'm not sure what you mean by "running lean on insulin" but he should be testing before he eats, counting the carbs in what he's about to eat, injecting the correct amount of insulin, then eating.

Does he count carbs? That's crucial to good control.

The book Think Like A Pancreas is fantastic - and a friendly read. There are also online courses like BERTIE that can help with good control.

Edited to add that there's also something called Diabetes Burnout, where the person just gets mentally exhausted by the effort of controlling diabetes day in, day out.

Do you know his HbA1C, by the way?
 


Great, thank you. I agree, he can't have a clue of his blood sugar levels and I think he has consistently gotten it wrong in recent years. When he was younger and his mum would challenge him, he would take it and it would be fine, but perhaps his calibration has drifted over the years (thereby "running lean on insulin"). He also doesn't count carbs, everything is done by how he feels. I think he needs to be far more disciplined. Thanks for the book recommendation, I will get it.
 

I think his depression and anxiety has not helped, so burn out is a worthy consideration. We don't know his HbA1C or when he last had it checked and need to press him on that.
 
Hi @MarkUniqueUserName - I'd say that you're in a tricky position here. If he has depression and anxiety, this is not unusual in people with T1D. As he is 24, it sounds as though he is unlikely to welcome pressure to do anything, and it may be historic pressure from his mum that has brought him to here.

I'd say that you and his mum need to offer encouragement and positive support, and avoid negativity and direction as much as you can. While it is heartbreaking, the only way that change will happen is if he wants it to. I'd suggest that the place he probably needs most help is with the mental side of the condition. A lot of the issues that are showing up (not taking insulin, pretending that he's not diabetic by eating anything and everything, etc) are often best addressed through that.

Do you know whether he'd look at participating in the online communities on Twitter or Facebook? Does he consider himself a person with diabetes or does he spend most of the time denying it or ignoring? I know these are difficult questions to answer, but they lie at the heart of his treatment. I think it's also worth a brief chat with his GP (if they are the same as yours) to try and explain how severe this is and find out what you can do. I'll not pretend it's going to be easy, but he's got a lifeline with you and your wife looking out for him.
 
@MarkUniqueUserName having just read all of your responses to the posts on this thread I am really glad for your stepson that he has such support from you and his mum - now he's moved back home it sounds as if you've got the opportunity to all work together on this.

I've had patches in my 31-year life with diabetes (I'm now 42) where I wasn't monitoring my blood glucose and throwing caution to the wind. I was diagnosed at a similar age to your stepson. Life with diabetes is not easy, but speaking for myself I am in much better health both in body and mind now I keep a closer eye on things. He'll get there.

Hugs all round, love Snapsy
 
It does sound like he is in a state of denial about his diabetes and is trying his best to rebel against it @MarkUniqueUserName

Can I ask if he's under the care of a hospital diabetes team, if not then I do think he would benefit from being referred over to see one as they are more specialised in dealing with type 1 diabetes.

As well as speaking with them and a dietitian he would also benefit immensely if he received some psychological support, so if he is open to the idea maybe ask his GP/Consultant if he could be referred over to be seen by a Psychologist.

Best wishes and good luck.
 
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