Karimnagar's food scene is firmly local — Telangana cuisine and Irani café culture are the things to look for. The Irani cafés, a legacy of Persian settlers from the Nizam era, are the best places to start the day: strong tea in small glasses, keema pav or bun maska, and a particular kind of bun called Osmania biscuit that turns up across this part of Telangana.
For Telangana cooking, look for sakinalu (rice-flour spiral crisps, made especially around Sankranti), garelu (lentil fritters), and jowar roti with spicy mutton curries. The local hotels around the main bus stand and market area serve thalis at lunch that are the most reliable way to eat well cheaply.