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Answer 5
  1. Intentional omission of insulin. This patient has poor glycemic control with significant nocturia as a result of osmotic diuresis associated with hyperglycemia. Long-standing hyperglycemia leads to glucosuria and resultant weight loss.7 This patient is likely skipping insulin doses to prevent weight gain. Insulin omission has been observed in approximately 30% of young women with type 1 diabetes as a means of preventing weight gain.8 Insulin noncompliance promotes a catabolic state and can lead to both short- and long-term consequences, including potentially fatal episodes of DKA in individuals with type 1 diabetes. Poor glycemic control can also hasten the devastating vascular consequences of diabetes. It is important to address healthy lifestyles and good glycemic control in all patients with diabetes. Eating disorders are more common in young women with type 1 diabetes than in nondiabetic women.9 This patient’s symptoms are not consistent with hyperthyroidism, and therefore she is not likely taking her mother’s thyroid medication.

    7. Kelly SD, Howe CJ, Hendler JP, Lipman TH. Disordered eating behaviors in youth with type 1 diabetes. Diabetes Educ 2005;31:572–83.

    8. Bryden KS, Neil A, Mayou RA, et al. Eating habits, body weight, and insulin misuse. A longitudinal study of teenagers and young adults with type 1 diabetes. Diabetes Care 1999;22:1956–60.

    9. Colton P, Olmsted M, Daneman D, et al. Disturbed eating behavior and eating disorders in preteen and early teenage girls with type 1 diabetes: a case-controlled study. Diabetes Care 2004;27:1654–9.

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