This paper explores existential and spiritual concerns related to living with chronic disease, such as type 1 diabetes; its purpose is to support clinical social work practitioners serving clients who face these concerns. The paper cites the work of existential philosophers and therapists, contemporary Buddhist thinkers, and psychodynamic psychotherapists, tracing ways that existential dilemmas can manifest in the lives of people with chronic conditions. The view taken is that these dilemmas are universal, and that exploring them is an inherently therapeutic act. The paper concludes by discussing ways to support clients who might benefit from such an exploration of existential concerns.