As of this writing, there has been much speculation about the cause of the recent death of a young celebrity actress. As you may know, the young woman passed away recently due to a cardiac arrest that occurred after "flu-like" symptoms. Why my interest in this most recent tragedy?
I was intrigued after reading a report that the celebrity's mother informed the first responding paramedics that she had diabetes. I began thinking... and continued my research in the popular literature. Past and present reports have speculated that the young woman was connected to recreational drugs. She also was noted to have a recent significant weight loss. The general public might therefore assume that the actress's demise may have been secondary to illness, drug use (perhaps prescription) with resultant cardiac arrest. The cause of death is currently under investigation and toxicology studies will undoubtedly be obtained. However, until we know the cause of death, I would like to speculate about the possibility of diabulemia contributing to her death. (Diabulemia is the result of weight loss secondary to insulin omission, thus, using insulin as means to control body weight. It is considered a serious eating disorder with a high rate of morbidity and mortality.)
Clues regarding the possibility of diabulemia and subsequent morbidity include the fact that the woman in question recently lost a significant amount of weight, and cardiac arrest following "flu-like" symptoms. A differential diagnosis might include infection by the H1N1 virus or other viral illness with abuse of prescription (or other) medications or Diabetic Ketoacidosis in association with Diabulemia. I was not aware that this celebrity had diabetes (not all celebrities disclose that information). In view of this information, it is possible that she used insulin (or NOT) to control her weight and may have succumbed to severe DKA. Those flu-like symptoms may indeed be secondary to the development of ketones due to insufficient insulin promoting increased acid in the blood with resultant vomiting and dehydration. Severe DKA can cause massive electrolyte disturbances and prompt cardiac arrest. Clearly, I do NOT know if these are the circumstances of this young lady's death; however, the tragedy provides me with a soapbox to alert the public on the dangers of insulin omission resulting in diabulemia.
In a Canadian Cross-Sectional Study (Jones, et al. British Medical Journal, 2000), eating disorders were twice as common in women 12 to 19 years of age with type 1 diabetes as compared with non-diabetic peers. Hb A1c levels were higher (9.4 vs. 8.1) respectively. After dieting, insulin omission was most responsible for weight loss.
A recent paper in Diabetes Care, 2008 (Goebel-Fabbri, AE) noted that in an 11-year follow-up of 234 women, insulin restriction increased morbidity and mortality in women with type 1 diabetes.
-30 percent (71) were insulin restrictors at baseline
