The strong association between obesity and Type 2 diabetes has generally overshadowed obesity in relation to Type 1 diabetes. Obesity is relevant, however, as increases in body fat stores generally dictate an increase in insulin requirements, mainly as a result of a further decline in insulin sensitivity. Conversely, excessive dosages of insulin can lead to weight gain, presumably through the lipogenic effects of hyperinsulinaeima and possibly compounded by overeating during the hypoglycaemic episodes, which become more frequent as insulin therapy is intensified. Weight gain, following intensive treatment of those with Type 1 diabetes, has been shown to induce unfavourable changes in lipid levels and blood pressure, similar to those observed in the insulin resistance syndrome (12). However, if intensive therapy results in improvements in glycaemic control, this can reduce the impact of weight gain on such cardiovascular risk factors (13).
Of concern also is that obesity, or the fear of it, can have detrimental effects, particularly in young (predominantly female) patients with Type 1 diabetes. The desire to remain thin can lead these patients to reduce or omit insulin dosages and/ or to engage in purging and laxative abuse (14-16). This particular form of'eating disorder' is probably one of the prevailing causes of 'brittle' or unstable diabetes, and often leads to recurrent episodes of diabetic ketoacidosis with an increased risk of developing chronic diabetic complications and of premature death (17). Consideration should therefore be given to the management of those with Type 1 diabetes who are obese or at risk of becoming obese, and to vulnerable individuals who are in danger of adversely controlling their own treatment for fear of becoming obese. It remains true, however, that the prevalence of being overweight in Type 1 diabetes is lower than that in the general population (13).
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