Eating disorders that meet DSM-IV criteria, especially bulimia nervosa and EDNOS are more than twice as common in adolescent girls with Type 1 Diabetes (DM) than in their nondiabetic peers. The prevalence of subthreshold eating disorders is especially high in this group and may be found in 14% of girls with DM. Insulin omission is a common weight loss behavior in girls with DM and eating disorders. Insulin omission and binge eating inevitably contribute to the increased rate of hyperglycemia and increased risk of long-term diabetes related medical complications, including retinopathy and nephropathy. The weight gain and dietary restrictions associated with diabetes treatment and the ready availability of insulin omission to promote weight loss are most likely responsible for this increased prevalence of eating disorders. A high index of suspicion for eating disorders is recommended in the diabetes clinic setting to enable early identification of disordered eating attitudes and behavior before they progress to clinical eating disorders. Clinic-based psychoeducational programs may be effective for prevention or early intervention. Severe eating disorders require more intensive intervention, tailored to address the DM context.