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Duke Research Team's Focus

The Duke Diabetes Research Team is committed to enhancing the lives of individuals with Type 1 Diabetes (T1D). We do so through clinical practice, advocacy and research. In our studies, we investigate factors that contribute to difficulty managing eating and insufficient insulin and develop and test novel treatments. 

Disordered eating behaviors are fairly common among individuals with T1D and exist on a continuum. At any level, behaviors such as restricting food, overeating or binge eating, or taking less insulin than is needed because of concerns about weight can interfere with management and increase risk of diabetes-related medical complications. One of the most dangerous eating disorder symptoms is the intentional withholding of insulin. This may be referred to as "ED-DMT1" or sometimes "diabulimia." It is important for treatment providers to understand both the complexities of disordered eating as well as type 1 diabetes.  


Health Risks of Insulin Restriction:

  • High glucose levels               

  • Glucose in the urine

  • Exhaustion

  • Thirst

  • Inability to think clearly

  • Severe dehydration

  • Muscle loss

  • Diabetic Ketoacidosis - DKA (unsafe levels of ketones in the blood)

  • High Cholesterol

  • Bacterial skin infections

  • Yeast infections

  • Menstrual disruption

  • Staph infections

  • Retinopathy

  • Neuropathy

  • Peripheral Arterial Disease

  • Atherosclerosis (a fattening of the arterial walls)

  • Steatohepatitis (a type of liver disease)

  • Stroke

  • Coma

  • Death


Possible signs of disordered eating behavior can include:

  • Hemoglobin A1C level of 9.0 or higher on a continuous basis.

  • Unexplained weight loss.

  • Persistent thirst/frequent urination.

  • Preoccupation with body image.

  • Reactivity to weighing.

  • Blood sugar records that do not match Hemoglobin A1c results.

  • Depression, mood swings and/or fatigue.

  • Secrecy about blood sugars, shots and or eating.

  • Repeated bladder and yeast infections.

  • Low sodium/potassium.

  • Increased appetite.

  • Cancelled doctors' appointments.


About T1D & Eating Disorders

Please consider signing up for our Registry. Individuals on the registry receive notifications for studies for which they may be eligible. 





Note: Anyone with T1D is encouraged to join our registry - our studies involve individuals with and without eating disorders.


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Resources about T1D and Eating Disorders as well as T1D Support


Insulin Nation: Not all T1D eating disorders are Diabulimia


USA Today: Risk deadly for diabetic women who restrict insulin.


Diabetes Care: Insulin Restriction associated with Morbidity and Mortality in Women with T1D


Juvenile Diabetes Research FoundationT1D Intel: Learning about the Dual Diagnosis of an Eating Disorder and T1D


Psychology Today: The Dangers of Diabulimia


Diabetes Health: Diabetes and Eating Disorders Come Together


The Mayo Clinic: Living with Diabetes Blog. Recognizing the Signs of Diabulimia


Websites Offering Support and Additional Resources:


We Are Diabetes

We Are Diabetes is an organization primarily devoted to promoting support and awareness for type 1 diabetics who suffer from eating disorders. We are dedicated to providing guidance, hope and resources to those who may be struggling, as well as to their families and loved ones.


Diabetes Sisters

DiabetesSisters offers a range of education and support services to help women of all ages with all types of diabetes live healthier, fuller lives. We understand the fear and isolation that often comes with living with diabetes because we are an organization that is managed by women who are living with diabetes.


Diabulimia Helpline

We're a non-profit organization dedicated to education, support, and advocacy for diabetics with eating disorders, and their loved ones. We have a 24 hour hotline available via (425) 985-3635, an insurance specialist to walk clients or their loved ones through the complicated world of insurance coverage, and a referral service to help people find the right treatment center, doctor, and/or therapist that will be the right fit on the road to recovery. 




Current Study
Enrollment begins March 2023

A randomized controlled trial of iACT, a novel mHealth intervention for eating disorders in type 1 diabetes

Minimum Qualifications:

  • 16-50 years old 

  • Diagnosed with type 1 diabetes

  • Engages in binge eating and/or maladaptive weight control strategies (including withholding insulin) 

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