Warning signs of diabulimia in type 1 diabetes

Diabulimia Treatment

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What is Diabulimia?

Diabulimia is a term used to describe the intentional restriction, manipulation, or omission of insulin for the purpose of influencing weight or shape in people with type 1 diabetes. While not a formal eating disorder diagnosis, it is a serious and well-recognized pattern that exists at the intersection of diabetes management and eating disorders. It often develops alongside concerns about weight, body image, and the emotional burden of managing diabetes.

Warning signs of Diabulimia

Diabulimia can be difficult to detect, especially because some behaviors may look like typical diabetes challenges. Recognizing the signs of diabulimia early can help prevent serious complications. Common warning signs include:

  • Insulin omission or under dosing insulin

  • Skipping or delaying insulin after eating

  • Frequent high blood sugars (hyperglycemia)

  • Recurrent episodes of diabetic ketoacidosis (DKA)

  • Unexplained or rapid weight loss

  • Avoiding diabetes appointments, provider follow-up, or data sharing

  • Reluctance to share glucose data (CGM, pump, logs)

  • Fear of weight gain related to insulin use

  • Increased focus on body weight, shape, or appearance

  • Binge eating without appropriate insulin coverage

  • Feelings of guilt, shame, or distress around blood sugar levels

Dangers of Diabulimia

Diabulimia can lead to both immediate and long-term health complications. Risks include:

  • Diabetic ketoacidosis (DKA), a life-threatening medical emergency

  • Severe dehydration and electrolyte imbalances

  • Rapid progression of diabetes-related complications

  • Damage to the eyes (retinopathy), kidneys (nephropathy), nerves (neuropathy), and heart

  • Increased risk of cardiovascular disease

  • Chronic fatigue and reduced quality of life

  • Higher risk of hospitalization

  • Increased risk of early mortality

How is Diabulimia treated?

Diabulimia treatment requires a specialized, multidisciplinary approach that addresses both the eating disorder and type 1 diabetes at the same time. Effective care typically includes a team of providers who are experience in the unique overlap between these conditions, including a therapist, dietitian, and medical provider

Treatment focuses on rebuilding a safe and consistent relationship with insulin, improving the relationship with food and body, and reducing shame, fear, and distress related to blood sugar management. A weight-inclusive, non-judgmental approach is essential for supporting long-term recovery and sustainable diabetes care.

When to seek help for Diabulimia

If you or a loved one may be struggling with diabulimia, it’s important to seek support sooner rather than later. You don’t need to wait for a crisis or severe medical complications to reach out. Early signs like ongoing distress about diabetes management, fear of weight gain, or feeling out of control with food or numbers are enough to warrant support.

Early intervention can help prevent serious health risks, reduce emotional distress, and make recovery feel more manageable. With the right support, it’s possible to feel better sooner, rebuild a more stable relationship with insulin and food, and move toward more sustainable diabetes management.

What to look for in Diabulimia treatment

Not all providers are trained to recognize or treat the overlap of diabetes and eating disorders. Look for a team that understands (and is trained in) both diabetes care and eating disorder treatment. Credentials that indicate a diabetes specialist are “CDCES” (Certified Diabetes Care and Education Specialist), and credentials that indicate eating disorder expertise include “CEDS (Certified Eating Disorder Specialist).

Treatment should go beyond “better control” and focus on reducing shame, supporting sustainable diabetes care, and addressing the underlying relationship with food, body, and insulin.

How to get started:

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Step 1: Free Phone Consult

Let’s chat! Schedule a free 15 min phone call with a member of our team so we can talk through your concerns, match you with a clinician who will be a great fit, and answer any questions you have.

Step 2: Initial Assessment

Our first appointment together (75-90 min) is a chance for us to get to know each other better! We’ll take a deep dive into your past and present relationship with food, your body, and your diabetes care. We will explore what type of support you need to meet your goals, answer your questions, and establish a plan for moving forward.

Step 3: Follow Up Care

Follow up sessions (50 min) are where we’ll do the hard work together. During these appointments, we will reflect on progress, celebrate wins, and unpack struggles to help you move toward a healthier relationship with food, your body, and your diabetes care. We will provide you with tools, education, and structure to support you through the inevitable ups and downs of this journey.

Meet Our Team of Eating Disorder and Diabetes Experts