Background The overlap in prevalence between type 2 diabetes (T2DM) and binge eating disorder (BED) is substantial, with adverse physical and mental health consequences. Little is known about patients’ efforts at managing these two conditions simultaneously. The research objective was to explore patients’ experiences managing co-existing T2DM/prediabetes and BED. Methods Qualitative descriptive study using semi-structured interviews. Participants included 21 women with T2DM or prediabetes (90% non-Hispanic White; mean age 49 ± 14.8 years, mean BMI 43.8 ± 8.4; 48% with T2DM and mean HbA1c was 8.4%). Interviews were analyzed using thematic analysis and NVivo software. Results Qualitative analysis revealed that participants reported binge episodes frequently started in childhood or adolescence and went undiagnosed for decades; notably, they recalled that diabetes diagnosis preceded BED diagnosis. They also described trying to lose weight throughout their lives and how feelings of deprivation, shame, and failure exacerbated binge eating. Participants further reported how binge eating made diabetes self-care and outcomes worse. Finally, participants observed that when BED treatment and diabetes management were synergistically integrated, they experienced improvements in both binge eating and glycemic outcomes. This integration included reframing negative thoughts surrounding BED and diabetes self-management and increasing their understanding of how the two disorders were connected. Conclusions Findings highlight the importance of increasing healthcare providers’ awareness of and screening for BED in the treatment of diabetes and for developing specific integrated interventions that address both diagnoses.