Diabulimia Treatment
What is Diabulimia (ED-DMT1)?
Diabulimia sometimes referred to as ED-DMT1 (Eating Disorder–Diabetes Mellitus Type 1), 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.
Frequently Asked Questions About Diabulimia (ED-DMT1)
Diabulimia can be confusing and is often misunderstood. These are some of the most common questions we hear from individuals and families trying to make sense of it.
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Diabulimia (or ED-DMT1) is not currently a formal medical diagnosis the DSM-5. However, it is widely recognized by healthcare professionals as a serious and dangerous pattern involving insulin omission in people with type 1 diabetes. Many providers treat it under the broader category of eating disorders while addressing the unique medical risks of diabetes. People with diabulmia still receive an eating disorder diagnosis such as Bulimia or OSFED depending on their specific presentation.
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Diabulimia most commonly affects individuals with type 1 diabetes, particularly adolescents and young adults, but it can occur at any age. Risk factors include body image concerns, fear of weight gain, perfectionism, diabetes burnout, and a history of dieting or disordered eating behaviors.
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Managing type 1 diabetes requires constant attention to food, insulin, and ones body, which can increase vulnerability to disordered eating. For some, insulin-related weight changes, pressure to maintain “perfect” blood sugars, or emotional burnout can contribute to insulin manipulation as a way to cope or feel a sense of control.
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Yes! People with type 1 diabetes can have all kinds of eating disorders, not just diabulimia (which refers specifically to insulin omission as an eating disorder behavior). All forms of eating disorders with type 1 diabetes should be taken seriously and treated by experts.
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Diabetes burnout involves feeling overwhelmed, exhausted, or disengaged from diabetes care. Diabulimia may include burnout, but it specifically involves intentionally manipulating insulin for weight or shape reasons. The two can overlap, which is why careful assessment and specialized support are important.
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If you’re concerned about a loved one, approach the conversation with empathy and without judgment. Focus on expressing concern rather than trying to control their behavior. Encouraging professional support from providers experienced in both diabetes and eating disorders can be an important next step.
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Yes, recovery from diabulimia is absolutely possible with the right support! Treatment that addresses both the medical and psychological aspects of the condition can help individuals rebuild a safer relationship with insulin, food, and their body over time.
Treatment for Diabulimia (ED-DMT1): How to Get Started
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
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Lauren Newman
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Maria Kim
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Hannah Auldridge
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Amanda Ruiz
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Emily Hayes
