Last Reviewed: 04 Feb 2026
In the past 30 years there has been an increased awareness of the higher prevalence of disordered eating (DE) and eating disorders (ED) with Type 1 Diabetes (T1D) and associated risk factors.
Supporting someone with a co-diagnosis of T1D and DE or an ED is a big responsibility and can go hand in hand with considerable personal strain and distress. It is possible that this experience is completely new to you and at the end of this resource, you will find a link to online carer support programs to help you.
Disordered eating occurs on a spectrum from mildly abnormal thoughts and behaviours regarding weight, shape, and eating, to more concerning thoughts and behaviours that have consequences on physical and mental health. Disordered thoughts include preoccupation with food, weight, and shape, distortion in body image, over-evaluation of weight and shape in terms of self-esteem, and fear of weight gain. Disordered behaviours include restrictive eating practices, skipping meals, food rules, erratic oral intake, excessive or compulsive eating/exercise, binge eating, not drinking enough, and inappropriate use of medication (for example, laxatives, diuretics, prescribed medications, or GLP-1 agonists).
One disordered eating behaviour that is unique to those with T1D is reducing or cutting out insulin in order to lose weight/not gain weight. This is especially dangerous and can cause serious health issues.
Even if someone does not meet the diagnostic criteria for an eating disorder, it is of concern if they experience disordered eating, thoughts, or behaviours, as this can negatively impact their physical, mental, and emotional health, and put them at high risk of developing an eating disorder.
For more information, see InsideOut Institute’s Type 1 Diabetes and Insulin Misuse resource.
From the outset, it is important to establish a trusting relationship with your loved one’s clinical team. As carers, you are central to the care, treatment and wellbeing of your loved one, and goals and treatment plans must be made jointly with the team.
Things for you to consider:
The clinical team is aware that you are a key member of the team and maintaining openness for everyone will be vital.
The very nature of T1D has the emphasis of food and glycaemic control at its very heart so be sure to ask as many questions as you need, including guidance and resources to help understand the physical and psychosocial implications of a combined diagnosis of T1D and DE or ED.
Establish with the team how you will communicate with them, and how often would be helpful.
Make any notes between consultations of questions/situations that arise and need clarifying.
Ask how you can best support your loved one and convey any concerns you may have to the team. Carers are the eyes and ears at home and any concerning food or insulin-related issues, or unusual behaviours can be directed back to the team – but this must be openly established and agreed upon at the outset.
Anticipate and discuss each transitional stage such as puberty, moving out of home, starting high school or university. Such transitions can impact anxiety and trigger DE/ED behaviours.
Language is vitally important in these circumstances and how you speak has power and can persuade, change or reinforce beliefs.
Avoid using judgemental or labelling language such as:
“You’ve put on weight – that’s fantastic!” Making comments about your loved one’s weight or physical appearance at any time, even if well meaning, can be extremely unhelpful and can result in triggering the eating disorder and exacerbating anxiety. It’s best to take weight and body talk off the table.
“You have to eat! You make me feel so anxious when you don’t finish a meal.”
- Pressuring your loved one to eat, making them feel guilty, or blaming/shaming them rarely works. Trying to validate how difficult it is and asking what you can do can help them feel more supported: “I can see that it’s challenging to have this meal/snack. Is there anything I can do or say to help you feel less anxious? We can talk it through together.”
Focusing on the person’s strengths and interests – such as work or school progress, more time for friends, getting back to their hobbies, can help to remind the person of the bigger picture of why they need to eat, not use eating disorder behaviours, and/or take their insulin.
Try to remain calm, compassionate, and empathetic - how you would feel if the positions were reversed? Tone of voice, eye contact and body language are all as important as the spoken word.
It’s not unusual for tensions to soar when your loved one experiences deep feelings of fear and anxiety. In such circumstances the caregiver is the one on the receiving end of an outpouring of anger and blame and it is quite normal for you to want to react in a similar way. However, at such a time, take a deep breath and think before you speak.
Avoid any confrontation towards the end of the day when you are both tired and possibly frayed. Nothing positive can be achieved at such times and often things are said and immediately regretted - it becomes guilt-fuelled and difficult for both parties to sleep. Validate what your loved one may have been triggered to say but verbalise your need to take a break. Leave the room and stay calm. Take some deep breaths and resist the temptation to react. Instead, postpone any discussion till the next day if appropriate and approach again with empathy and validation.
Initially mealtimes can be the most difficult and challenging time your support is needed, and with T1D, this may also include support in administering the appropriate amount of insulin. There are excellent resources providing practical tips to help caregivers with mealtimes, and you will find a link at the end under ‘Resources’.
Read the resources below for practical tips to help:
The combination of T1D and DE or an ED imposes a tremendous strain at times on family members.
As mentioned earlier, it’s important that the family messaging is consistent. The ED or DE will be looking for ways to split and divide family members.
It can be particularly difficult for siblings who can often feel resentful of the attention and focus on your loved one. Be mindful of this and invite siblings to talk to you, your partner and/or both of you.
Recommended resources for siblings:
Stay calm, clear and confident (the three ‘Cs’).
Be compassionate – always acknowledge the difficulty of eating and/or insulin administration but remain clear and calm about what is not negotiable.
Be caring and concerned – offer help/support and ask your loved one what they think could best support them.
Maintain a consistent, joint family approach when possible – there is potential otherwise for the DE or ED to split and divide family members.
Don’t get drawn into reassurance-giving. Another example could be similar: ‘I feel so fat’. Again, don’t reassure but offer validation of the feeling but then consider adding, ‘I hear that you are anxious, but remember this is an eating disorder thought and I don’t think it would be very helpful for me to engage in that'.
Don’t give in to an automatic emotional response when you feel angry or frustrated. Anxiety and anger are ‘catching’. Count to 10, take deep breaths or quietly remove yourself from the room.
Don’t focus on discussing food at mealtimes and don’t appear to be watching every mouthful. That too, can be unnerving and possibly provoke conflict. Think of other ways to distract such as conversation around a favourite topic. Consider doing a crossword or playing a game together.
Supporting someone with a combined diagnosis of T1D and DE or ED is a huge responsibility and can take its toll.
It’s important for you to engage in activities you enjoy outside of your caring role. Some suggestions might be to meet friends, go for a walk, take yourself off and read a book, have a massage – do something that will be uplifting and just for you.
Resources to explore are:
We encourage you to thoroughly explore the resources indicated – in your own time. By doing so, you can gain confidence, knowledge and trust in your ability to care.
Remember to be calm, confident and compassionate – but validate your own difficulties and challenges and needs and keep communication open with all parties.
It’s important to always hold the hope that your loved one can recover. It can be a long hard road and when your loved one knows and hears you say ‘I’ve got you, I’m holding the hope’, is compassionate, encouraging and supportive.
InsideOut Institute – insideoutinstitute.org.au
National Eating Disorders Collaboration – nedc.com.au
NSW Health – health.nsw.gov.au
Eating Disorders Victoria – eatingdisorders.org.au
Eating Disorders Families Australia – edfa.org.au
Butterfly Foundation – butterfly.org.au
Eating Disorders Queensland – eatingdisordersqueensland.org.au
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