A Hidden Struggle: Eating Disorders in Type 1 Diabetes

Living with type 1 diabetes means constantly thinking about food—counting carbohydrates, timing meals with insulin doses, and watching how every bite affects blood sugar levels. For many people, this intense focus on food and weight becomes more than just diabetes management. It can spiral into a dangerous eating disorder that puts both mental and physical health at serious risk.

A Surprisingly Common Problem

If you or someone you love has type 1 diabetes, you should know that eating disorders are far more common in this population than most people realize. Research shows that people with type 1 diabetes are more than twice as likely to develop an eating disorder compared to those without diabetes. [1-2] Among young people with type 1 diabetes, studies have found that approximately 1 in 5 struggle with disordered eating behaviors. [3] For those with type 2 diabetes who use insulin, the rates are even higher—up to 50% in some studies. [3]

This isn't a coincidence. The very nature of diabetes management can create a perfect storm for eating disorders to develop. From the moment of diagnosis, people with type 1 diabetes must calculate the carbohydrate content of every meal, constantly evaluate how food affects their blood sugar, and often experience rapid weight changes when starting insulin therapy. [4] Add typical adolescent concerns about body image, and the risk becomes even greater.

Understanding "Diabulimia"

Perhaps the most dangerous eating disorder behavior unique to type 1 diabetes is insulin omission—sometimes called "diabulimia" (a combination of "diabetes" and "bulimia"). This occurs when someone deliberately skips or reduces their insulin doses to lose weight. [5-6]

Here's how it works: Without enough insulin, the body cannot use glucose for energy. The sugar builds up in the blood and spills into the urine, taking calories with it. The result is weight loss—but at a devastating cost. This behavior leads to dangerously high blood sugar levels, frequent episodes of diabetic ketoacidosis (a life-threatening emergency), and accelerated development of diabetes complications like kidney disease, nerve damage, and vision loss. [4][7]

Studies show that about 15% of people with type 1 diabetes restrict insulin for weight control, with some research finding rates as high as 1 in 11 adults engaging in this behavior. [6][8] What makes this particularly heartbreaking is that many people who do this understand the risks but feel trapped by their fears about weight gain and their complicated relationship with insulin. [9-10]

The Real-World Impact

The consequences of eating disorders in type 1 diabetes extend far beyond the scale. People with both conditions face significantly higher hemoglobin A1C levels (a measure of long-term blood sugar control), more emergency room visits and hospitalizations, and higher rates of depression and anxiety. [3][6] They also tend to have lower quality of life and more diabetes-related distress. [3]

Young people are particularly vulnerable. Adolescents with eating disorders and type 1 diabetes often have longer diabetes duration, are more likely to develop kidney complications, and struggle with poor blood sugar control. [11] The combination creates a vicious cycle: poor diabetes control leads to more distress, which fuels disordered eating behaviors, which further worsens diabetes management.

Warning Signs to Watch For

Because eating disorders in diabetes can look different from typical eating disorders, they're often missed. Warning signs include:

• Unexplained high blood sugar levels despite reported insulin use

• Frequent episodes of diabetic ketoacidosis

• Avoiding diabetes clinic appointments

• Secrecy around insulin administration

• Excessive concern about weight despite being at a healthy weight

• Skipping meals or restricting food groups

• Exercising excessively

• Preoccupation with body image

Hope and Help Are Available

The good news is that with proper support, recovery is possible. Treatment requires a team approach that addresses both the eating disorder and diabetes management. [8][12] This typically includes:

Medical care from healthcare providers who understand both diabetes and eating disorders. The treatment plan may need adjustment to reduce behaviors that inadvertently reinforce disordered eating, such as overly rigid carbohydrate counting or excessive focus on weight. [8]

Mental health support from therapists trained in eating disorders and familiar with diabetes. Cognitive behavioral therapy has shown promise in helping people with type 1 diabetes and disordered eating improve their eating behaviors, reduce diabetes distress, and manage anxiety and depression. [8]

Nutritional counseling from dietitians who can help establish regular eating patterns and work through the complex relationship between food, insulin, and blood sugar.

Peer support appears particularly valuable. Many people recovering from diabulimia report that connecting with others who share their experience—who truly understand the unique challenges of managing both conditions—has been crucial to their healing. [9-10]

Moving Forward

If you're struggling with disordered eating and diabetes, please know that you're not alone and that help is available. The American Diabetes Association now recommends routine screening for eating disorders using validated questionnaires, and healthcare providers are increasingly aware of this issue. [8][12]

Recovery isn't about achieving perfect blood sugar control or reaching a certain weight. It's about developing a healthier relationship with food, insulin, and your body. It's about learning that you deserve care and support, not judgment. And it's about understanding that managing diabetes and maintaining mental health aren't competing goals—they work together.

If you recognize these struggles in yourself or someone you care about, reach out to team where we have a diabetes specialist and eating disorder specialist at our clinic to help manage your relationship with food while also fostering optimal blood sugar control. The intersection of these two conditions is complex, but with the right support, it's possible to find a path forward that honors both your physical and emotional well-being.