Diabetes is not an eating disorder. It is a metabolic condition that affects how your body processes blood sugar. However, diabetes and eating disorders overlap in ways that matter: people with diabetes are significantly more likely to develop disordered eating behaviors, and a specific pattern of insulin misuse for weight control has become so common it has its own name, “diabulimia.”
Why the Two Get Confused
Living with diabetes means thinking about food constantly. You count carbohydrates, time your meals, monitor how what you eat affects your blood sugar, and adjust medication accordingly. That level of food-focused attention can look and feel a lot like the preoccupation with eating that characterizes an eating disorder. For some people, it crosses the line into one.
The confusion also stems from the fact that diabetes treatment directly affects weight. Insulin encourages fat storage, and many people with type 1 diabetes notice they gain weight after starting or increasing their insulin dose. That creates a tension between what’s medically necessary and what feels psychologically distressing, especially for adolescents and young adults already navigating body image pressures.
How Common Eating Disorders Are in People With Diabetes
People with type 1 diabetes are roughly 2.5 times more likely to develop an eating disorder than people without diabetes. The risk is especially high for bulimia nervosa (about 2.8 times the general population risk) and binge eating (about 1.5 times). These numbers hold up across different screening methods, suggesting the connection is real and not just an artifact of how clinicians ask the questions.
Type 2 diabetes carries its own risks. Binge eating disorder affects anywhere from 1.4% to 25% of people with type 2 diabetes, depending on the study and how strictly the diagnosis is applied. Night eating syndrome shows up at similar rates. The wide range in estimates reflects how difficult it can be to separate disordered eating from the constant dietary management that diabetes demands.
What Diabulimia Is
Diabulimia is not an official medical diagnosis, but it describes a well-documented behavior: people with type 1 diabetes deliberately reduce or skip their insulin to lose weight. When you take less insulin than your body needs, glucose stays in your bloodstream instead of entering your cells. Your kidneys eventually flush that excess sugar out through urine, and you lose calories your body never absorbed. It works, in the short term, as a form of purging.
About 10.3% of people with type 1 diabetes engage in insulin omission or misuse, and women are at significantly higher risk than men. The DSM-5 TR, the manual clinicians use to diagnose mental health conditions, does not include a diabetes-specific eating disorder diagnosis. It does, however, recognize insulin restriction as a purging behavior, which means it can factor into a diagnosis of bulimia nervosa or other specified eating disorders.
Why Insulin Restriction Is Dangerous
Skipping insulin to control weight creates a cascade of serious medical problems. In the short term, blood sugar climbs high enough to trigger diabetic ketoacidosis, a life-threatening emergency that requires hospitalization. Over the long term, persistently elevated blood sugar damages nearly every system in the body: nerves (causing numbness and pain in the extremities), kidneys (potentially leading to dialysis), eyes (risking blindness), and blood vessels (raising cholesterol and cardiovascular risk). Osteoporosis and extreme fatigue are also common.
The stakes are not abstract. People who regularly omit insulin are three times more likely to die prematurely than those who follow their prescribed treatment. That makes the intersection of diabetes and disordered eating one of the most medically dangerous combinations in mental health.
The Screening Problem
Standard eating disorder screening tools were designed for people without diabetes, and they don’t always capture what’s happening in this population. Behaviors that would be considered disordered in someone without diabetes, like carefully measuring portions or avoiding certain foods, are routine parts of diabetes self-management. Meanwhile, the most dangerous behavior specific to this group, insulin manipulation, doesn’t appear on most standard questionnaires.
When researchers use diabetes-specific screening tools that account for insulin omission as a purging behavior, the apparent rates of eating disorders in people with type 1 diabetes climb substantially. This suggests that many cases go undetected in clinical practice, especially when providers focus on blood sugar numbers without asking about the psychological relationship with food and medication.
How Treatment Works
Treating disordered eating in someone with diabetes is complicated because you can’t simply separate the two. A person recovering from anorexia or bulimia is typically encouraged to stop obsessing over food, but someone with diabetes needs to keep monitoring what they eat to stay alive. That tension requires a team approach: endocrinologists manage blood sugar, dietitians help build a meal plan that supports both metabolic health and psychological recovery, and mental health providers address the underlying body image distress, anxiety, or depression driving the disordered behaviors.
Recovery often involves gradually rebuilding trust with insulin. For someone who has been restricting their dose for months or years, returning to full doses means accepting temporary weight gain as their body rehydrates and begins storing glucose normally again. That transition is one of the hardest parts, and it’s where having a therapist who understands both diabetes and eating disorders makes the biggest difference. Treatment also addresses the diabetes-specific distress, the burnout and frustration of managing a relentless chronic condition, that often fuels the disordered behavior in the first place.