I have been exploring through literature the dangerous combination of withholding insulin for weight management. There are many reasons for number fluctuations.  I would like to explore other  educators lived experience, when they were suspicious, or when the knew there was deeper trouble.  

According to  Diabetes Care 2017 there are warning signs:  high sugars, unexplained weight loss, high rating of diabetes distress, fear of lows.  We teach to measure food, and be accurate, which can lead to preoccupation with food and unhealthy perspectives.  Risk factors include low self esteem, depression, lonliness, and anxiety.  This may lead to thoughts that food and weight can be controlled to manage emotions.  

Disordered eating warning signs (Huifeng Shih, 2011) are consistent high A1c (over 10.5%), body image concerns, irregular eating behaviors, excess exercise, irregular menses, repeat DKA, limited clinic follow through, and doubtful sugar monitoring.   

As health care providers, we need to pay attention to the "signs" as early intervention with skilled team is preferred. Thank you for keeping watch for this dangerous weight loss strategy. 

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