Diabetic Clare Allison was gripped by an eating disorder that could have cost her life.
INSULIN is literally a lifesaver for people with diabetes. Without it they can slip into a potentially life-threatening coma, as well as risk blindness and amputations.
But Clare Allison didn't see it that way.
As a teenager gripped by an eating disorder, she realised missing an insulin injection could make her lose weight.
Despite the risks and horrific side effects it caused, she went on for months skipping the vital doses.
"I knew what it was doing and it really scared me," said Clare, now 24.
"I knew all of the complications that could be caused by it. But when I weighed myself it thrilled me."
Clare had been diagnosed as having Type 1 diabetes at the age of two.
Sufferers of the condition cannot produce insulin, a hormone which the body needs to convert glucose from food into energy.
In order to stay healthy, they have to replace that insulin through frequent injections or sometimes an insulin pump which delivers a continuous low dose.
Otherwise blood sugar levels can rocket to dangerously high levels.
Clare, from Rothwell, had controlled her illness throughout her childhood and the start of her teens.
But at the age of 13 she developed an eating disorder, restricting food or sometimes binge eating.
She was struggling with low self-esteem, depression sparked by family bereavements and also self-harmed.
By the time she was 17, she was suffering from bulimia.
Despite all this, she still managed to keep her diabetes relatively well controlled.
However moving from her home town of Basingstoke to study at Oxford Brookes University at the age of 18 was when she started skipping insulin.
She said she was so tired of her eating disorder that she was beyond caring and desperate to do anything to lose weight.
"When I went to uni my already existing eating disorder spiralled out of control and one day I didn't take my insulin," she said.
"The next day I had lost a few pounds and it all went from there."
Soon she felt she was being controlled by not only the eating disorder, but this need to deprive herself of insulin.
She lost three stone, missing doses for up to five days at a time.
The effect on her health was dramatic – her hair started to fall out, she was exhausted, had a raging thirst and was very sick.
Her body was breaking down its stores of fat and protein as it did not have enough insulin to convert energy from glucose.
That does cause weight loss, but high blood sugar levels can lead to a condition called ketoacidosis which can cause coma and death if untreated.
Clare was also at risk of the serious complications of diabetes, such as strokes, blindness, heart attacks and kidney disease.
Her mum was terrified for her life, her friends didn't know what to do and her doctor was surprised she hadn't been admitted to hospital already.
The low point came when, while on a placement from her nursing course at a children's ward, she had gone five days without insulin.
At the hospital she was violently sick and went home, then managed to get back home while still being sick but also feeling incredibly thirsty.
Eventually she collapsed on her bed but luckily gave herself a dose of insulin before being asleep for 24 hours.
"That was my closest call with death - I think I got that insulin in me just on time," she said.
"That experience really frightened me and was a real wake-up call to how sick I had become."
Too ill to do placements in hospitals, she swapped her degree to nutrition and early childhood studies.
"I was exhausted all the time, drinking constantly and going to the loo constantly," said Clare.
"I would stop taking it for up to five days and by the end of the five days I would almost be at the point of collapse. I was throwing up involuntarily.
"I would let myself get to the point where I was struggling to breathe and my muscles were in spasm and then I would give myself a massive dose of insulin."
After breaking down on the phone to her parents, Clare went back home and her mum told her diabetes team about her bulimia.
She was referred first for counselling, then therapy, treatment as a day patient at an Eating Disorders Unit and later as an in-patient.
After two months she went back to day patient treatment and later back to her family to continue her recovery.
Now she still classes herself as being in recovery but is working as a mental health support worker and got married to Ben in 2007.
"Sometimes I have eating disorder thoughts and urges but I don't act on them," she said.
"It might always be with me but I can work through it. I don't know if there is such a thing as a complete recovery."
Clare now has an insulin pump to help keep her blood sugar levels stable, but she suffers from the after-effects of her eating disorder.
She has poor circulation in her feet which causes numbness, diabetic retinopathy - leaking blood vessels behind the eye and gets kidney pain when she is unwell.
She is also determined to educate other diabetes sufferers about the dangers of missing their insulin.
Clare has set up a website about her experiences, is writing a book and backing a Diabetes UK campaign against so-called diabulimia. The charity estimates that one in three teenage girls with diabetes - about 3,000 nationwide - has the problem.
"When I was really struggling I was looking online for information and I couldn't find much so it made me feel really alone," she said.
"I want to put my story out there so that others who are struggling with the same thing will know it is possible to overcome it."
"I want to speak out about it to let people that are suffering know with it at the moment know that there is hope, that you can recover and have a normal life."
Diabetes UK care advisor Caroline Butler said it was hard to know just how many girls could be behaving the same way Clare did.
"Teenagers and young adults need appropriate and rapid access to psychological care and support to help them manage their condition effectively.
Anyone who is skipping their insulin can get support from counsellors in confidence on the Diabetes UK Careline on 0845 120 2960 between 9am and 5pm, Monday to Friday, or email firstname.lastname@example.org .
Clare's website is at www.freewebs.com/diabolicaldiabulimia.
l Diabetes UK is bringing its Measure Up Roadshow, which encourages people to measure their waists to see if they are at risk of Type 2 diabetes, to Leeds on September 2 and 3. For more information visit www.diabetes.org.uk/measureup.