What Sexual Assault Survivors With Diabetes Need Healthcare Teams To Understand

Editor’s Note: This article discusses sexual assault and trauma. If you’re in crisis, contact RAINN at 1-800-656-4673 or chat at rainn.org/get-help.

Sexual assault changes how you move through the world. It can change how you sleep, how you eat, how you let people touch you and how safe you feel in your own body. If you’re also living with type 1 diabetes, those changes don’t stay in one lane. They show up in your diabetes management and almost nobody in the diabetes care space talks about it.

The connection between violence and diabetes isn’t just behavioral—it’s physiological. A 2023 study in the American Journal of Preventive Medicine found that interpersonal violence was associated with a 23% increased risk of developing adult-onset diabetes. For survivors already living with diabetes, trauma doesn’t just affect how you manage daily life—it affects what your body is doing at a cellular level.

How does sexual trauma affect diabetes management?

Diabetes self-care requires things that can be deeply difficult for trauma survivors: tolerating needles and device insertions, allowing health care providers to touch your body, maintaining consistent routines during periods of emotional crisis and staying connected to a body you may have learned to disconnect from.

A 2025 review published in Diabetic Medicine found that adverse experiences like physical abuse, sexual abuse and neglect are directly linked to worse glycemic control in people with type 1 diabetes. The researchers described trauma as “a clinically significant factor in engagement with monitoring and self-management.” A separate study of young adults with T1D found that about 30% exhibited clinically relevant post-traumatic stress symptoms—and those symptoms were significantly correlated with higher depression, anxiety and diabetes-related distress.

For sexual assault survivors specifically, the intersection can show up in ways that look like “noncompliance” to a healthcare provider who isn’t asking the right questions. This could include: 

• Skipping appointments because the exam room doesn’t feel safe.
• Avoiding injections or CGM insertions because needles and body contact trigger flashbacks.
• Neglecting blood sugar monitoring during dissociative episodes.
• Losing control of eating patterns in ways that directly affect glucose.

Chronic stress from trauma also has a direct physiological effect. Elevated cortisol raises blood sugar. Hypervigilance can disrupt sleep, which disrupts glucose patterns. The body’s stress response doesn’t distinguish between a present threat and a remembered one. And for many survivors, the remembered threat is constant.

There’s another layer that’s specific to diabetes: medical emergencies can re-traumatize. A diabetes ketoacidosis (DKA) episode—where your body is in crisis, others are making decisions for you and your autonomy is temporarily gone—can mirror the powerlessness of assault. The loss of control over your own body, the dependence on strangers to stabilize you, the vulnerability of a hospital setting. For a survivor, a health emergency isn’t just a health emergency. It’s a trauma echo.

Why don’t healthcare teams ask about trauma?

Diabetes care and trauma care exist in separate systems. Your healthcare team likely isn’t trained to prioritize screening for a trauma history, and if you have a mental health provider, they may not automatically track or connect your symptoms to the physiological demands of diabetes. The result is a gap where providers often fail to connect the dots. A visit after a significant trigger or revictimization could lead to a healthcare provider seeing a rise in A1C levels and, if you’re Black, labeling you “nonadherent” without ever asking what’s getting in the way.

Trauma-informed care, a framework that recognizes the impact of trauma on health behavior and creates space for people to engage with treatment safely, has been gaining traction in diabetes research. The American Diabetes Association now offers continuing education on trauma in diabetes care for healthcare providers, which signals a shift in how the field is thinking about this. But implementation in routine diabetes practice remains limited. Many clinicians have never been trained to consider the physiological ripples of trauma and too many aren’t asking.

What does trauma-informed diabetes care look like?

It starts with providers asking different questions. Instead of “Why aren’t you checking your blood sugar?” it’s “Is there anything making it hard to check your blood sugar?” Instead of assuming noncompliance, it’s recognizing that avoidance can be a trauma response, not a character flaw.

Practically, trauma-informed care might look like: 

• Giving you control over the pace of an appointment.
• Asking permission before any physical contact or device placement.
• Providing a same-gender clinician if requested.
• Connecting you with a mental health provider who understands both trauma and chronic illness.

What can you do right now?

You don’t have to disclose your full history to your healthcare team. But naming the connection—even broadly—can open the door to better care. Here are some things you can say:

• “I have a trauma history that affects how I engage with medical care. Can we talk about how to make appointments feel safer for me?”
• “I sometimes avoid injections or device insertions because of past experiences. Can we explore approaches that give me more control over the process?”
• “I’d like a referral to a therapist who understands both trauma and chronic illness management.”

You can also ask your healthcare team to flag your chart for trauma-informed accommodations, so you don’t have to re-explain at every visit. 

If you’re not ready to talk to your diabetes team, a therapist who specializes in trauma and chronic illness can help you build a bridge between the two. The goal isn’t to fix everything at once. It’s to make it possible to get through an appointment, a device insertion or a blood sugar check without your body telling you to run.

And if your current healthcare provider doesn’t respond with care when you disclose, that’s information about the provider, not about you.

Remember: You’re not failing. You’re surviving.

If your diabetes management has taken a hit because of what you’ve been through, that doesn’t make you a bad person with diabetes. It makes you a person whose body went through something devastating and is still trying to keep going. The system should meet you where you are. You deserve care that holds both truths at once.

If you or someone you know has been affected by sexual violence, contact RAINN at 1-800-656-4673. 

Want to advocate for people living with type 1 diabetes to get the care they deserve? Join Beyond Ambassadors.