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Home > Knowledge & support > Living with type 1 diabetes > Health and wellbeing > Eating disorders
Getting to this page is an important step. You are not alone and there is support available, from healthcare professionals and other people going through the same thing as you are.
Type 1 and disordered eating, known as T1DE, is an eating disorder in a person with type 1 diabetes. This can be when someone restricts the amount of insulin they take on purpose to lose weight or stop gaining weight, known as insulin omission, or are experiencing another form of disordered eating, like bulimia or anorexia, alongside their type 1.
There are many reasons someone with type 1 may experience an eating disorder. Evidence suggests that up to 40% of girls and women and up to 15% of boys and men with type 1 diabetes experience some form of disordered eating. If you’re feeling this way or experiencing disordered eating, you are not alone.
Diabulimia is a term used in the media rather than a medical term used by Diabetes Healthcare Teams. It refers to an eating disorder in a person with diabetes, usually type 1 diabetes, where the person doesn’t take the amount of insulin they need because they are worried about gaining weight or want to lose weight.
There are many reasons someone with type 1 may experience an eating disorder.
Managing type 1 diabetes is very closely linked with food and the body and can be stressful. Because of this, the risk of someone developing disordered eating is higher than in people without type 1.
If you have type 1, you have to think about food a lot. You need to carefully read food labels and have a constant awareness of the amount of carbohydrates in food so that you can take the right amount of insulin.
Having to eat to treat low blood glucose (hypos) can cause weight gain and having to eat when you’re not hungry can sometimes be counterintuitive. This can contribute to feelings of guilt around eating.
Managing type 1 diabetes means that you have to think about your body a lot of the time. Monitoring your own glucose levels and weight, along with a focus on weight at clinic appointments, may cause people to focus on their bodies more than people who don’t have type 1.
One of the main symptoms of undiagnosed type 1 is weight loss. When people start taking insulin, their body restores the weight they have lost which can cause them to associate taking insulin with putting on weight.
Reaching or maintaining a target weight can be difficult when you’re managing type 1.
Sometimes with type 1, you can feel like you’re not in control of your body. For some people, reducing how much they eat, or restricting or missing insulin doses can give them a sense of control. However, the person can find themselves out of control of these things too.
The stress associated with managing diabetes, including daily glucose monitoring and insulin injections, may increase the risk of developing disordered eating behaviours.
The fear of hypos, when blood glucose levels drop too low, may lead some people with type 1 to skip insulin doses on purpose or manipulate their blood sugar levels to try to avoid hypos.
The language that people use when they talk about type 1 can also have an effect on how you feel. If people use words like ‘control’ when it comes to type 1 management, it implies that it’s completely down to you to get it right every time. Realistically, managing type 1 isn’t like that, which is why using non-judgemental language is so important.
How your friends, family and colleagues see and talk about type 1 can affect how you feel, especially if they have misconceptions about what type 1 is and how it’s treated.
There are other reasons someone with type 1 might develop disordered eating, that aren’t related to their type 1. If someone has a history of disordered eating, dieting, or body image concerns, they might be more likely to develop disordered eating behaviours in relation to their type 1. Negative body image or low self-esteem may also be factors in developing disordered eating.
Made by the All Wales Diabetes Implementation Group (AWDIG), NHS Wales Health Collaborative, Cardiff and Vale UHB Psychology department, and funded by Public Health Wales NHS Trust. The project was facilitated by Katja Stiller (Therapeutic Arts Facilitator) and Jane Hubbard (Animation Producer) from Breathe Creative.
Much like eating disorders that aren’t connected to type 1 diabetes, spotting the signs and symptoms can be difficult because the person affected by an eating disorder might keep them hidden.
The signs and symptoms of T1DE can become apparent medically, like having increased HbA1c or erratic blood glucose levels. Someone with T1DE may also have episodes of diabetic ketoacidosis (DKA) or near DKA.
Someone with T1DE might become secretive about their diabetes management, or not go to their diabetes clinic appointments or engage in services. They may not take enough insulin on purpose, over-exercise or restrict food, or binge-eat and make themselves vomit. They may also use laxatives or diuretics for reasons they’re not intended for.
Emotionally, they may show signs of feeling overwhelmed and frustrated at having to constantly manage their type 1 (known as diabetes distress) and have a fear of hypoglycaemia. They may also show signs of depression and anxiety, have concerns about body image and have dieted or tried to lose weight in the past.
If you are concerned that any of these issues might be affecting you or someone close to you, please reach out to your Diabetes Healthcare Team or contact one of the organisations listed below for advice, as soon as you can.
Missing or restricting insulin doses, known as insulin omission, can leave someone at risk of developing short and long-term complications. Many of these complications can be life-changing or life-threatening. Thinking about complications might feel scary, but with support and help the risks can be reduced.
If you would like to speak to a professional about type 1 and eating disorders contact your Diabetes Healthcare Team as soon as possible or find more information below.
BEAT are a UK eating disorder charity that supports people living with eating disorders, including people you can talk to via chat, phone or peer support groups.
Diabulimia, the mental health equivalent of putting a hat on a hat – Lawrence Smith
Amybetic: Type 1 diabetes, mental health and the highs and lows in between – Amy Stevens
A series about type 1 diabetes and disordered eating from an NHS pilot project that treats T1DE.
Find out more about the NHS pilot treating T1DE, the Wessex ComPASSION project.
“The long (and continuing) road to recovery began with a visit to my diabetic care team.”
Lawrence talks about his journey with disordered eating and how he found support to help him with his mental health.
“I’m grateful I had the eating disorder therapy when I did.”
Ariella had already had eating disorder therapy when she was diagnosed with type 1. She talks about how the tools she learned in therapy helped her manage her type 1 and disordered eating.
We’re working with MPs, healthcare professionals and people who have experienced T1DE and their families to improve care and treatment for T1DE. The Parliamentary Inquiry report, published in January 2024, sets out priorities and recommendations for effectively diagnosing and treating T1DE, and we will be working to make those recommendations a reality.
When you get a bug or a virus, you might need to manage your type 1 diabetes a bit differently. Find out what you should do if you become unwell.
If you have type 1 diabetes, menstrual cycles can affect your type 1 management. Your glucose may rise higher and you may be more resistant to insulin during your period.
There are many different methods of contraception, and each has pros and cons when it comes to how it can affect your type 1 diabetes.
If you have type 1 diabetes there’s no reason why you can’t start thinking about pregnancy. Get advice about planning and managing a pregnancy through to giving birth and breastfeeding.
Learn about how menopause impacts type 1 diabetes, how to tell a hot flush from a hypo, and how to keep blood sugar stable during this challenging time.
Managing type 1 diabetes day in and day out can be tough. Find information and support about how to cope with type 1 and manage your emotional wellbeing.
