by Julie K. Silver, M.D., Harvard Medical School

Kudos to Jennifer Love Hewitt for striking back at the media who labeled her "fat." If you missed this story, the paparazzi took unflattering photos of this actress on a recent vacation with her fiancé. Love Hewitt retaliated on her blog.

This message of extreme thinness is not healthy. It makes people take dieting and exercise to unhealthy extremes. For example, a few months ago, the media began reporting that some women with type 1 diabetes, especially teenagers, skip or cut back on insulin to lose weight. People have dubbed the practice "diabulimia." Whatever you call it, it's dangerous. Without enough insulin, a diabetic can go into a coma or even die. High blood sugar also can damage the eyes or kidneys.

Though diabulimia is not yet a recognized medical condition, the American Diabetes Association has known about it for a long time. People with diabetes and eating disorders are said to spread the word on this practice through internet bulletin boards.

Having an eating disorder and diabetes together is a very dangerous combination. When either condition is not well controlled, people risk damage to the body and serious health problems at younger ages. This can lead to early death.

In type 1 diabetes, the body's own immune system attacks insulin-producing cells in the pancreas. As a result, diabetics produce little or no insulin. They must take shots of it every day because without insulin, the cells starve and cannot function properly. Insulin moves glucose (sugar) from the bloodstream into the body's cells. By reducing or skipping insulin shots, type 1 diabetics risk falling into a coma. They also could have long-term problems such as blindness, amputations, and kidney failure. Despite the serious risks, women with type 1 diabetes may still skip insulin shots because it means weight loss.

If you have type 1 diabetes, understand how critically important it is for you not to skip or reduce your insulin. If you think you are falling into this practice, reach out and get help. Think about anyone you know with diabetes and be aware of "diabulimia." Educate your family and friends about this condition. Look out for warning signs, such as:

Changes in eating habits - Someone eats more but still loses weight.

Low energy - Without insulin, the body cannot access its "fuel".

Higher than expected blood-sugar levels - The sugar is trapped in the blood and cannot pass into cells.

Going to the bathroom more frequently - The kidneys work extra hard to remove the excess sugar through the urine.

Remember, too, that there are several types of eating disorders. They include:

Anorexia nervosa - A person starves herself to lose weight. She usually has an overwhelming fear of gaining weight and concern about her body image. People with anorexia are severely (more than 15%) under their ideal body weight, yet they still see themselves as overweight.

Binge eating - A person suffers from impulsive overeating. There is no forced vomiting, but there are usually severe feelings of shame or self-hatred. Body weight may range from normal to severe obesity.

Bulimia nervosa - A person secretively cycles binge eating and purging (forced vomiting). Usually weight remains normal. People with bulimia may abuse laxatives or exercise excessively as means to control their weight. If they have diabetes, they may stop using their insulin.

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

Diabetes

Nearly 21 million Americans suffer from diabetes, and as anyone who has been affected by the disorder knows, it is about much more than a statistic: it means a new way of life. Diabetes: A plan for living is a special report from Harvard Medical School that will help you learn how to better understand and manage your diabetes, including type 1 and type 2, as well as other variations of the disease. This report will show you that it's not just possible to live with diabetes; it's possible to live well.