"M" was an attractive, effervescent 18 year old girl when I first met her. As one of my roommates, she loved to be around her friends and talk non-stop. She also would steal several bags of Milanos double chocolate cookies from the kitchen cabinet; eat them all in one sitting, and not gain and ounce. She was hiding a huge weight-loss secret. She had diabulimia; the diabetic's eating disorder. This disorder has joined other well-researched eating disorders such as Anorexia and Bulimia, and lesser known unstudied eating disorders like Wannarexia.

The facts:

Up to about 1/3 of young women and teens with Type 1 diabetes skimp or withhold on their insulin doses in a scary attempt to lose weight, according to new research out of the Joslin Diabetes Center. Girls and women who skip or skimp on these doses are more likely to suffer negative and serious side effects such as kidney failure, foot problems, and even death at a young age. In fact, diabulimia triples the risk of premature death about women who have diabetes.

Other studies on diabulimia indicate that these young women have higher rates of both nerve damage and eye problems.

In addition, young women with Type 1 diabetes are more than twice as likely to develop a full blown eating disorder (i.e. anorexia, bulimia) than women without diabetes who are the same age as them.

The Warning Signs:

• unexplained elevations in A1C values

• persistent problems with diabetic ketoacidosis (DKA)

• unusual/extreme concerns about weight and body shape

• an obvious change in food-related behavior

• exercise bulimia (extreme patterns of exercise)

• missing monthly period—called, amenorrhea

The Risks:

• higher A1C levels

• higher risk of developing infections

• more frequent episodes of DKA

• more frequent hospital and emergency room visits

• higher rates and earlier onset of diabetes complications - nerve damage, eye disease, kidney disease and possible heart disease

What should you do?

The Strait Approach: Ask them about Diabulimia

Have they ever heard of diabulimia? Thought about it? Do they know the risks? Sometimes hearing about it or having a conversation about it can reveal what's going on in the other person's head.

The Direct Check: Verify their insulin intake

Is insulin being used? If insulin is being used correctly, there should be a consistent decrease in the bottle, insulin syringes used, and medical supplies discarded (i.e. alcohol swabs, gauze).

Weight Loss Monitoring: Witness side effects

Are they losing weight? Are they binge eating? Are they losing weight, showing signs of dehydration, exhaustion, depression, or ketoacidosis? If they are using insulin correctly and eating a healthy diet, they should have normal energy and typical and predictable weight patterns.

Intervention: Getting Help

Are you certain that there is a problem? If so, talk to the person who you believe to be affected by Diabulimia. Express your concern and your support. Turn to a trained doctor who can help the person deal with these very real issues. They typically do not go away by themselves.

Call the National Eating Disorders Association (NEDA) for more information or a referral (800-931-2237). They can also provide you with a referral if you fill out their referral form that is available on their website. You can also submit a question. Finally, parents, friends, and family members can also learn how to support their loved one through this trying time through the Parents, Family, and Friends Network.

As Powerful Parents, we all need to stay ahead of the curve and know what our children are doing. While we are making progress everyday to help our teens move forward and people speaking out on behalf of girls and women, we still have a long way to go. Let's help our teens together.