Diabetes Self-Harm + The Conversation We Need To Have

Editor’s Note: This article discusses self-harm, insulin misuse and suicidal ideation. If you’re in crisis, text HOME to 741741 (Crisis Text Line) or call 988 (Suicide & Crisis Lifeline).

There’s a conversation happening in diabetes care that not enough people hear and one that’s never too late to have. It’s about what happens when the things keeping you alive, like insulin, becomes what you use to hurt yourself. Underdosing insulin, not taking insulin (aka insulin omission) and insulin overdose are forms of self-harm that are specific to diabetes. They exist at the intersection of mental health, eating disorders, diabetes burnout and crisis. 

What do the numbers say?

A 2024 meta-analysis published in Diabetes Care found that 15.4% of adolescents and young adults with type 1 diabetes reported suicidal ideation—and 3.5% had attempted suicide. Among those who attempted, 50 to 73% used methods directly related to their diabetes care: insulin overdose, insulin omission, refusing to eat or self-harm with syringes.

Intentional insulin omission—sometimes called diabulimia when it’s linked to weight control—affects a staggering number of people. Research suggests that 30 to 39% of young women with T1D and up to 60% of all people with T1D have misused insulin at some point. A 2026 systematic review in the Journal of Clinical Medicine described intentional insulin omission as a “high-risk behavioral phenomenon” that remains “under-recognised due to stigma, diagnostic ambiguity, and overlap with routine diabetes self-management.”

That last part is critical. The line between “I forgot my insulin” and “I didn’t take my insulin” can look the same  from the outside. And because diabetes management already involves constant decision-making about insulin dosage, the behavior can hide in plain sight from healthcare providers (HCPs) and caregivers.

Self-harm through diabetes management exists on a spectrum, not in a single category. Recent case reports also show what’s called “dual misuse,” when the same person both omits insulin (to lose weight or during burnout) and overdoses on insulin (during a crisis). The two behaviors may seem to be opposite of each other, but they share the same root: a relationship with insulin that has become a relationship with harm. A 2026 case study of an adolescent described both deliberate diabetic ketoacidosis (DKA) through omission and a suicide attempt by insulin overdose.

Why is this so hard to talk about?

Diabetes self-harm can fall between the cracks of your care team. Your HCP is tracking your A1C, not your mental health. Your therapist—if you have one—may not understand that skipping insulin is a form of self-injury, not just poor management. And the dominant language of diabetes care still frames everything through compliance: you’re either “adherent” or you’re not. When the system reads self-harm as nonadherence, care teams may think that education is an appropriate response instead of intervention. But that’s a dangerous miss.

Shame compounds the silence. People who restrict insulin for weight control know the medical risks. People who omit insulin during a crisis aren’t doing it because they don’t care. And people who’ve used insulin to attempt suicide carry that knowledge alongside every injection for the rest of their lives. Talking about any of this requires a level of safety that most clinical settings don’t provide.

What should care teams be doing?

Screening matters. A 2020 review in the Journal of Diabetes Science and Technology argued that diabetes care teams should regularly assess for suicidal ideation, self-harm and disordered eating, not as add-ons but as core components of diabetes management. Research shows that depression is the most common barrier to effective diabetes self-management. So if your care team isn’t asking about your mental health, they’re missing a clinical signal.

But screening alone isn’t enough. HCPs need to understand that insulin misuse exists on a spectrum: from occasional omission during periods of crisis or burnout, to deliberate restriction for weight control to intentional overdose during crisis. Each point on that spectrum requires a different response. More importantly, none of them should be met with judgment.

What can you do if this is you?

If you’re restricting, omitting or misusing your insulin in any way, know that you’re not alone and you’re not a failure. This is a recognized pattern in diabetes care and there are people who can help. Here’s where to start:

If you’re in crisis right now, text HOME to 741741 or call 988.

• Tell one person on your care team. You don’t have to tell the whole story.
  You can say: “I’ve been struggling with my insulin and I think it’s connected to how I’m feeling.” If your HCP doesn’t respond with care, that’s information about them, not about you. Ask for a referral to a mental health provider who understands diabetes, specifically someone trained in eating disorders and chronic illness. 

Find a mental health professional who understands diabetes. You can find a provider in the American Diabetes Association’s directory.

The fact that insulin is both your lifeline and a potential means of harm is a reality unique to diabetes. Naming it doesn’t make it worse, but silence can. 

If you’re a friend, partner or family member reading this, watch for patterns—not events. This may look like:

• Recurring unexplained DKA
• Insulin supplies that run out too quickly or too slowly
• Withdrawal from diabetes management conversations
• Sudden changes in eating behavior. 

Be mindful that these aren’t always signs of self-harm, but they’re always worth a gentle conversation.

If you or someone you know is struggling, text HOME to 741741 (Crisis Text Line) or call 988 (Suicide & Crisis Lifeline). For more on mental health and diabetes, visit Beyond Type 1’s mental health resources.