Intentional insulin omission for weight loss: a dangerous practice

Did you know that people living with type 1 diabetes (T1D) are at greater risk of developing an eating disorder  than people without T1D?

Managing T1D requires close attention to several additional tasks in daily life, like monitoring blood sugar levels, administering insulin, and making constant decisions about food intake. Over time, these demands may lead to burnout or distress.

Insulin is a lifesaving therapy for people living with T1D. Without it, the body cannot use glucose (broken down from carbohydrates), to effectively produce energy. If insulin is not taken (aka omitted), blood sugar rises to dangerous levels, and the body begins to break down fat for fuel instead, which produces ketones. If ketones build up, it can lead to diabetes ketoacidosis (DKA), which is life-threatening. Long-term insulin omission can lead to diabetes-related chronic conditions like kidney disease, nerve damage, or vision loss.

Despite these serious risks, an individual may intentionally skip or reduce insulin doses because they believe that it will help them lose weight. Intentional insulin omission for weight loss is considered a disordered eating behaviour and is sometimes referred to as “diabulimia”. Unlike other eating disorder behaviour or “purges” like self-induced vomiting, or excessive laxative use, insulin omission is unique to people living with T1D. This behaviour has historically been understudied, and there is a lack of practical evidence-based screening tools in clinics. 

To better understand insulin omission for weight loss, we analyzed data from 1,150 adults with T1D in Canada, enrolled in the BETTER registry. Overall, 7.3% participants reported that they have intentionally omitted insulin for weight loss at some point in their life.

What did we find?

1. Women were more likely to report insulin omission for weight loss  

Women had 5.7-time higher odds of reporting intentional insulin omission for weight loss than men. This may be related to body image concerns and a baseline greater risk of disordered eating behaviours in women and girls.

However, it is important to recognize that men may also engage in insulin omission for body-related reasons. For example, some individuals may use insulin omission to influence body composition, muscle definition, or athletic appearance rather than weight loss, which was not captured in this study. Future research needs to explore different motivations for insulin omission across the gender spectrum.

2. Older age of T1D diagnosis was associated with lower odds of insulin omission for weight loss

Participants diagnosed with T1D at an older age (22 vs 17 on average) were less likely to report intentional insulin omission for weight loss. One possible explanation is that individuals diagnosed earlier in life (childhood or adolescence) face difficult physical, emotional, and social challenges associated with puberty. Managing the complexities of growing up, alongside the management of T1D, may make younger individuals more vulnerable to disordered eating.

3. Insulin omission for weight loss was associated with diabetes distress and weight cycling

Participants who reported higher levels of diabetes distress and a history of weight cycling (repeated loss and regain of significant weight outside of the context of pregnancy, sometimes called yo-yo dieting), were more likely to report insulin omission for weight loss. Although insulin omission may be perceived as a rapid way to lose weight, it is neither safe nor sustainable. Weight cycling is associated with adverse health outcomes independent of weight gain and may reflect ongoing struggles with weight management and body image.

Why does this matter?

Intentional insulin omission for weight loss can lead to serious short- and long-term health consequences, yet it is hard to detect and not routinely screened for in T1D clinics. This may be due to the sensitive nature of the topic, and the lack of a brief and practical screening tool.

Our findings suggest that clinicians may benefit from paying particular attention to individuals living with T1D who experience higher diabetes distress, report weight cycling history, were diagnosed at a younger age, or identify as a woman. These factors may help identify people who could benefit from additional support and discussion around eating behaviours and insulin misuse for weight loss.

Importantly, intentional insulin omission should not be stigmatized or viewed as a failing. Living with T1D places a substantial burden on well-being and mental health challenges are common. Improving access to mental health providers, support groups, eating disorder treatment, and specific diabetes support may help prevent harmful behaviours, and improve T1D care.

This study is currently available online: South CA, Brazeau AS, Talbo MK, Bandini A, Kichler JC, Iceta S. Factors Associated With Intentional Insulin Omission to Lose Weight in People Living With Type 1 Diabetes: A BETTER Registry Analysis. Can J Diabetes. 2026 Mar 25:S1499-2671(26)00061-4. doi: 10.1016/j.jcjd.2026.03.004. Epub ahead of print. PMID: 41895661. 

References:

• Hanlan ME, Griffith J, Patel N, Jaser SS. Eating disorders and disordered eating in type 1 diabetes: prevalence, screening, and treatment options. Curr Diab Rep. 2013;13(6):909-916. doi:10.1007/s11892-013-0418-4
• Kontoangelos K, Raptis A, Lambadiari V, et al. Burnout Related to Diabetes Mellitus: A Critical Analysis. Clin Pract Epidemiol Ment Health. 2022;18:e174501792209010. Published 2022 Oct 21. doi:10.2174/17450179-v18-e2209010
• Goguen J, Gilbert J; Diabetes Canada Clinical Practice Guidelines Expert Committee. Hyperglycemic emergencies in adults. Can J Diabetes. 2018;42(suppl 1):S109-S114. doi:10.1016/j.jcjd.2017.10.013
• Kulkarni A, Thool AR, Daigavane S. Understanding the Clinical Relationship Between Diabetic Retinopathy, Nephropathy, and Neuropathy: A Comprehensive Review. Cureus. 2024;16(3):e56674. Published 2024 Mar 21. doi:10.7759/cureus.56674
• Swartz AZ, Wood K, Farber-Eger E, Petty A, Silver HJ. Weight trajectory impacts risk for 10 distinct cardiometabolic diseases. J Clin Endocrinol Metab. 2026;111(1):e49-e57. doi:10.1210/clinem/dgaf348.