Disordered Eating and Diabetes
Disordered eating and diabetes share a complex, two-way relationship. For decades, attention has focused on how living with diabetes — with its strict routines, food monitoring, and weight pressures — can lead to disordered eating. But evidence increasingly shows the reverse is also true: certain disordered eating patterns can precede and even contribute to the development of type 2 diabetes (T2D).
Understanding this relationship helps us shift away from blame and toward balance — recognising that disordered eating is not a failure of willpower, but a signal of emotional and metabolic distress that deserves understanding and care.
History and Background
The early years: insulin, survival, and silence (1920s–1960s)
When insulin was discovered in 1921, it transformed type 1 diabetes (T1D) from a fatal disease into a chronic, manageable one. Before insulin, survival depended on starvation diets that were extremely low in carbohydrates and calories — sometimes as little as 400 kcal per day. These early “diabetic diets” kept people alive for a short while but left them weak and malnourished.
Once insulin therapy became available, people with diabetes could eat normally again, and many rapidly regained weight. For some — especially young women — this sudden change was distressing. But medicine at the time focused on physiology, not psychology. Emotional reactions, fear of weight gain, or distress about body image were seen as irrelevant to treatment.
The language of control that dominated diabetes care (“good” vs “bad” sugars, “compliant” vs “non-compliant” patients) took root in these early decades. It created a culture where guilt and self-criticism around food, weight, and glucose numbers became normal — an environment in which disordered eating could quietly grow, unseen.
1970s–1980s: the first clues
As eating disorders such as anorexia and bulimia nervosa gained attention in the wider population during the 1970s, a few clinicians began noticing similar patterns among their patients with diabetes.
By the early 1980s, scattered case reports described young women with T1D who deliberately withheld or reduced insulin doses to lose weight. A 1983 paper in Psychosomatic Medicine is often cited as one of the first formal recognitions of this phenomenon. The authors described how insulin omission functioned like purging in bulimia — leading to rapid weight loss through glucose loss in the urine, but at enormous medical cost.
Throughout the 1980s, these reports multiplied. Clinicians realised that some of their “non-compliant” patients were not simply forgetful or rebellious; they were terrified of gaining weight. Yet emotional wellbeing still received little emphasis in diabetes care, and insulin omission was often punished rather than explored with empathy.
1990s: recognition grows — but slowly
By the 1990s, research began to show that disordered eating behaviours were common among people with diabetes, particularly adolescent girls and young women. The landmark 1991 work of Polonsky and colleagues described diabetes distress — the emotional burden of managing a demanding, lifelong condition. This concept helped shift thinking from “non-compliance” to psychological struggle.
Around the same time, studies confirmed that intentional insulin omission was widespread and dangerous. It was linked with higher HbA1c levels, frequent hospitalisations for diabetic ketoacidosis (DKA), and accelerated complications such as retinopathy and neuropathy.
The term “diabulimia” emerged in this decade — coined by people with lived experience and later amplified by advocacy groups and the media. Though never an official diagnostic category, it raised awareness that eating disorders could be specific to diabetes and needed specialist attention.
2000s: public awareness and broader understanding
During the early 2000s, research expanded rapidly. Population studies confirmed that disordered eating was two to three times more common in people with T1D than in peers without diabetes. Roughly one-third of women with T1D reported deliberately omitting insulin at some point to manage weight.
At the same time, researchers turned their attention to type 2 diabetes. They found that binge eating disorder (BED) and emotional eating were highly prevalent in people with obesity or insulin resistance. Crucially, many of these disordered patterns preceded diabetes diagnosis, suggesting that disturbed relationships with food could contribute to metabolic dysfunction long before blood sugars crossed the diagnostic threshold.
By the end of this decade, the field was widening. Disordered eating was no longer seen as a rare psychiatric complication of diabetes, but as part of a continuum — from emotional eating and restrictive dieting to clinical eating disorders — all influencing metabolic health.
2010s–2020s: a holistic view emerges
Over the past two decades, the link between mental health and metabolic health has become undeniable. Several key developments have shaped modern understanding:
- Screening tools such as the Diabetes Eating Problem Survey-Revised (DEPS-R) were created to detect disordered eating early.
- International diabetes guidelines began recommending regular screening for disordered eating and diabetes distress.
- Research on T2D highlighted that restrictive dieting, weight cycling, and binge eating are not only consequences of insulin resistance but can help cause it.
- Patient advocacy — especially from people who’ve recovered from “diabulimia” — helped replace judgment with compassion and education.
Today, disordered eating is recognised as both a cause and a consequence of diabetes. This understanding allows for prevention strategies that focus on relationship with food, body image, and emotional wellbeing alongside glucose management.
How common is it?
Type 1 diabetes (T1D)
People with T1D have significantly higher rates of disordered eating than those without diabetes.
- Around 30–40 percent of young women report some level of disordered eating.
- 15–35 percent have intentionally under-dosed or omitted insulin for weight control at least once.
- Males and older adults are not immune, though less frequently studied.
Type 2 diabetes (T2D)
In T2D, disordered eating often takes the form of binge eating, emotional eating, or chronic restrictive dieting.
- Estimates suggest 10–20 percent of people with T2D meet criteria for binge-eating disorder.
- Many more experience sub-clinical patterns — guilt around food, “all-or-nothing” eating, or compulsive dieting — that undermine stable glucose control.
Before diagnosis
Disordered eating can also precede diabetes:
- Chronic dieting and yo-yo weight cycling can lower resting metabolism and increase insulin resistance.
- Binge eating on high-glycaemic foods stresses the pancreas and promotes visceral fat.
- Weight stigma and shame discourage help-seeking, allowing insulin resistance to worsen unnoticed.
In this way, disordered eating sits on both sides of the diabetes timeline — as a potential contributor before diagnosis and a complication after.
Why diabetes increases risk of disordered eating
Several intertwined factors make people with diabetes particularly vulnerable:
- Weight and body-image pressure – Fear of weight gain from insulin or medication is common. For some, the pressure to stay slim collides painfully with the need to maintain glucose control.
- Constant attention to food and numbers – Carb counting, monitoring, and “good” versus “bad” foods can lead to obsession or guilt.
- Diabetes distress – The daily burden of self-care, fear of complications, and emotional fatigue may trigger maladaptive coping, including bingeing or insulin omission.
- Biological fluctuations – Blood glucose swings affect appetite and mood, creating physiological cravings that reinforce disordered patterns.
- Cultural and social messages – Stigma around both diabetes and body size can drive secrecy and shame.
Recognising the red flags
- Recurrent hyperglycaemia or unexplained DKA
- Repeatedly missed insulin doses
- Preoccupation with food, weight, or calories
- Secretive eating, purging, or excessive exercise
- Avoidance of medical appointments
- Mood swings, anxiety, or depression linked to eating
These are not signs of “poor control” or “non-compliance” — they are signs of distress that need compassionate enquiry.
Getting on top of it: strategies for recovery
Rebuild trust with food
Shift from restriction to rhythm. Structured, balanced meals restore metabolic stability and reduce binge urges. Working with a dietitian skilled in both diabetes and eating disorder recovery helps re-establish safety and satisfaction with eating.
Reframe blood-glucose monitoring
Treat glucose readings as information, not judgment. Viewing numbers neutrally reduces anxiety and helps separate self-worth from results.
Address emotions, not just behaviour
Emotional eating is a coping mechanism for stress, fear, or loneliness. Learning alternative emotional regulation strategies through Cognitive-Behavioural Therapy (CBT-E) or Dialectical Behaviour Therapy (DBT) can break the cycle.
Work with a multidisciplinary team
Effective treatment blends medical, nutritional, and psychological expertise:
- Diabetes specialist or endocrinologist
- Diabetes nurse or educator
- Psychologist/psychiatrist experienced in eating disorders
- Dietitian
- Family or whānau support
Confront weight stigma
Health outcomes improve when the focus shifts from weight loss to wellbeing, energy, and quality of life. Reducing shame helps prevent relapse.
Simplify management where possible
Technology (continuous glucose monitors, pumps) and flexible insulin plans can ease the self-care burden and reduce distress-driven behaviours.
Seek community and peer support
Hearing others’ recovery stories lessens isolation. Diabetes and eating disorder organisations, online or in-person, provide lived-experience guidance and hope.
Preventing type 2 diabetes through understanding disordered eating
Because disordered eating can contribute to insulin resistance and weight cycling, prevention should address relationship with food, not just diet composition.
- Avoid extreme diets. Promote sustainable eating patterns rather than short-term restriction.
- Encourage body respect. Reduce stigma that drives secretive or emotional eating.
- Teach mindful or intuitive eating. Help people reconnect with hunger and fullness cues.
- Screen early. Identify binge-eating or chronic dieting behaviours in primary care and offer early psychological support.
- Promote culturally grounded wellbeing. In Aotearoa, Māori and Pacific approaches to food, whānau, and hauora provide a strengths-based framework for prevention and healing.
Why this perspective matters
Separating the eating disorder from the diabetes allows a clearer view of causation and compassion.
- Some develop disordered eating first, which contributes to metabolic stress and eventual diabetes.
- Others develop it later, as a response to the pressures of living with diabetes.
- In both cases, shame, fear, and stigma sustain the cycle.
Recognising this bi-directional relationship reframes treatment: from compliance to care, from punishment to partnership.
Key takeaways
- Disordered eating and diabetes influence each other in both directions.
- Type 1: higher risk of restrictive behaviours and insulin omission.
- Type 2: bingeing, emotional eating, and weight cycling may precede diagnosis.
- Prevention and treatment must address emotional and cultural context, not just food and numbers.
- Compassionate, multidisciplinary care makes recovery possible — and early help saves lives.
Support in Aotearoa New Zealand
- Diabetes New Zealand – diabetes.org.nz
- EDANZ (Eating Disorders Association NZ) – whānau and individual support
- Mental Health Foundation – mentalhealth.org.nz
- 1737 – free call or text for 24/7 counselling support
Page updated October 2025
| DIABETES AND MENTAL HEALTH |
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| Healthy Thinking |
| Coping with Stress |
| Diabetes Distress |
| Anxiety and Depression |
| Disordered Eating and Diabetes |
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