Type 1 diabetes and eating disorders
Eating disorders and type 1 diabetes
Understanding disordered eating, insulin misuse, warning signs and the importance of coordinated, specialist care.
Reviewed June 2026
Living with type 1 diabetes involves continual attention to food, insulin, glucose levels, exercise and the body. For some people, this necessary focus can contribute to food anxiety, body-image concerns, disordered eating or an eating disorder.
These difficulties can affect children, adolescents and adults of every gender, body size and cultural background. A person does not need to look underweight or meet every diagnostic criterion before their concerns deserve assessment and support.
Eating disorders are serious, treatable mental illnesses. They are not a choice, a failure of diabetes management or something a person should be expected to overcome through willpower.
Why can type 1 diabetes increase vulnerability?
Type 1 diabetes does not directly cause an eating disorder. Eating disorders develop through a complex interaction of biological, psychological and social factors. However, aspects of living with diabetes can increase vulnerability or make an existing eating disorder more difficult to recognise.
- The need to think about food, carbohydrate and insulin throughout every day
- Frequent exposure to weight, glucose and food-related numbers
- Weight changes before and after diagnosis
- Fear of hypoglycaemia or fear of treating low glucose levels
- Diabetes distress, burnout, anxiety or perfectionism
- Feeling judged about glucose results, food choices or body weight
- Diet culture, weight stigma and pressure to achieve an ideal body
- Using food or diabetes-management behaviours to cope with difficult emotions
Disordered eating exists on a spectrum
Disordered eating may include distressing thoughts, rigid rules or behaviours that do not yet meet the diagnostic criteria for an eating disorder. These concerns are still important because they can affect physical health, emotional wellbeing and diabetes care.
People with type 1 diabetes may experience anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, other specified feeding or eating disorder, or a mixed pattern that changes over time.
Early support is appropriate even when the person is unsure whether their experiences are serious enough to be called an eating disorder.
Possible warning signs
No single sign confirms an eating disorder. Changes should be considered together and discussed with clinicians who understand both type 1 diabetes and eating disorders.
Food, body image and exercise
- Increasing preoccupation with food, weight, shape or exercise
- Rigid food rules or avoiding entire food groups
- Skipping meals or eating an insufficient amount
- Episodes of binge eating or feeling out of control around food
- Vomiting, laxative misuse or other compensatory behaviours
- Compulsive or excessive exercise
- Fear, guilt or distress after eating
- Avoiding eating with other people
- Frequent body checking or weighing
Diabetes-specific signs
- Deliberately reducing, delaying or omitting insulin
- Avoiding glucose checks, diabetes appointments or diabetes-management tasks
- Repeated unexplained high glucose levels
- Increasing HbA1c without another clear explanation
- Frequent ketones or episodes of diabetic ketoacidosis
- Using diabetes technology or glucose data in a rigid or punitive way
- Repeatedly restricting carbohydrate to avoid taking insulin
- Fear of treating hypoglycaemia because treatment involves eating
- Removing or hiding pump, glucose or insulin information
Physical and emotional changes
- Unplanned weight change or marked weight fluctuation
- Fatigue, dizziness, weakness or difficulty concentrating
- Abdominal pain, nausea, constipation or early fullness
- Menstrual changes or reduced sex hormones
- Feeling cold, faint or unable to complete usual activities
- Depression, anxiety, irritability or social withdrawal
- Increasing secrecy around food, insulin or glucose results
- Feeling ashamed, hopeless or frightened about diabetes management
Insulin misuse requires medical attention
Some people deliberately take less insulin, delay insulin or omit doses because of concerns about food, weight or body shape. This is usually described clinically as insulin misuse, restriction or omission.
The term "diabulimia" is sometimes used informally, but it is not a formal diagnosis and does not describe every person's experience.
Insulin restriction can cause high glucose, dehydration, ketone production and diabetic ketoacidosis. Over time, it can also increase the risk of diabetes-related complications. Any deliberate insulin restriction deserves prompt, compassionate medical assessment, even if it happens only occasionally.
Do not wait for the behaviour to become frequent or for the person to appear visibly unwell before seeking help.
What does effective treatment involve?
Treatment needs to address diabetes, nutrition, mental health and medical safety together. The exact team will depend on age, medical risk, diagnosis and available services.
Safety comes first
Medical assessment is important because insulin restriction, inadequate intake, purging and dehydration can become dangerous quickly. Treatment should include a clear plan for glucose, ketone and physical-health monitoring.
Diabetes and eating-disorder care must be integrated
Treating the eating disorder without understanding type 1 diabetes can be unsafe. Focusing only on glucose results can also reinforce shame, restriction or perfectionism. The teams should communicate and work towards shared goals.
Insulin is essential treatment
People with type 1 diabetes need insulin to remain well. Changes to insulin should be made collaboratively with the diabetes team rather than used as a response to weight, eating or body-image distress.
Nutrition rehabilitation is individual
The plan may involve regular meals and snacks, adequate carbohydrate, protein and fat, correction of nutritional deficiencies and gradual restoration of nutritional health. The pace and structure depend on medical risk and individual needs.
Glucose targets may need to be staged
During recovery, aiming immediately for perfect glucose results may be unrealistic or distressing. The diabetes team may use gradual, agreed goals that prioritise immediate safety, engagement and sustained recovery.
Care should be compassionate and non-judgemental
Eating-disorder behaviours are not a failure or a lack of motivation. Shame and blame can make disclosure harder. Support should acknowledge the mental load of diabetes and involve the person in decisions wherever possible.
Who may be involved in care?
Coordinated care may include:
Where possible, the dietitian providing the eating-disorder nutrition intervention should have recognised eating-disorder training and experience, as well as competence in type 1 diabetes.
How can a dietitian help?
- Establishing a regular and nutritionally adequate eating pattern
- Reducing rigid food rules while maintaining safe diabetes care
- Supporting adequate carbohydrate intake without moralising food
- Developing practical meals and snacks around daily routines
- Supporting treatment of hypoglycaemia when eating feels frightening
- Reviewing gastrointestinal symptoms and nutritional deficiencies
- Supporting restoration of weight, growth, strength or menstrual health where needed
- Helping reduce anxiety around carbohydrate counting and food labels
- Working with the diabetes team on realistic nutrition and glucose goals
- Supporting families and carers with meal planning and meal support
Support for families and carers
- Listen without blame, threats or arguments about food, insulin or weight
- Avoid commenting on body size, weight changes or the amount eaten
- Use neutral language about glucose results rather than good or bad
- Encourage attendance at both diabetes and eating-disorder appointments
- Ask the treatment team how to support meals, insulin and safety at home
- Take insulin misuse, vomiting, severe restriction and ketones seriously
- Seek support for yourself as a family member or carer
When to seek urgent help
Follow the person's diabetes sick-day or emergency plan and seek urgent medical assistance for:
- Moderate or high ketones that are not improving according to the sick-day plan
- Vomiting or being unable to keep fluids down
- Rapid or difficult breathing
- Severe abdominal pain
- Increasing drowsiness, confusion or difficulty waking
- Fainting, collapse, chest pain or severe weakness
- Severe hypoglycaemia, seizure or loss of consciousness
- Thoughts of suicide, self-harm or being unable to remain safe
Call 000 or attend the nearest emergency department when there is an immediate medical or safety emergency.
Additional support in Australia
Butterfly National Helpline
Call 1800 33 4673 for eating-disorder and body-image support.
Lifeline
Call 13 11 14 for 24-hour crisis support.
Your diabetes team
Contact your endocrinologist, diabetes educator or hospital diabetes service promptly when insulin, ketones, severe restriction or recurrent hypoglycaemia are concerns.
References and further information
- 1. InsideOut Institute — NSW Disordered Eating and Eating Disorders in Children, Adolescents and Adults with Type 1 Diabetes Guideline
- 2. InsideOut Institute — Type 1 Diabetes and Insulin Misuse
- 3. InsideOut Institute — Resource for Caregivers and Families of People with Type 1 Diabetes and an Eating Disorder
- 4. InsideOut Institute — Diabetes Eating Problem Survey–Revised
- 5. National Diabetes Services Scheme — Diabetes and Disordered Eating
- 6. ISPAD Clinical Practice Consensus Guidelines — Psychological Care of Children, Adolescents and Young Adults with Diabetes
- 7. American Diabetes Association — Eating Disorders and Diabetes
- 8. ANZAED Connect·ed — Find a Credentialed Eating Disorder Clinician
Resource prepared by Dr Kellie Millard, Accredited Practising Dietitian and Credentialed Eating Disorder Dietitian.