I am a 15 year old female who has had diabetes for 10 years, have had an insulin pump for two years, and I have finally got my hemoglobin A1c down to 7.6% from 9.8%. I know that the doctors want it lower, but I am proud of myself for achieving this much!

I am 5 feet 4 inches tall, weigh 140 pounds, I exercise two hours every day, and I am on a 1800 calorie diet. I want to lose about 20 pounds, and I don’t understand why I am not “skinny” because I exercise way more than the calories I eat. I watch how much fat I eat, and I don’t load up on the carbs. I am a varsity (high school) basketball player, also play volleyball, and I do track. When I am not at practice, I lift weights and do about 200 crunches twice weekly. Could my diabetes be the reason I am not losing weight? Can you give me any information that could help me lose weight safely and stay gone?

You are doing a perfectly splendid job of controlling your diabetes and keeping fit generally. Perhaps, though, you are exaggerating the need to lose weight. If you look at the Body Mass Index seeker, you will see that your Body Mass Index is only at the 62nd percentile level for your age, which means you are only a little above the mean and well within the normal range. 150 years ago if you had been emigrating over the prairie and food was scarce, this would have been a biological advantage, but nowadays of course its fashionable, but not necessarily healthier to be ‘skinny’. My advice is to keep on as you are, and I expect too that your BMI will get lower as you reach your early twenties.

DOB
Additional comments from Dr. Stuart Brink:

You need to determine if the extra pounds you are worried about is ft or muscle. Ask your doctor or nurse educator or dietitian. They will know how to assess this during a simple physical examination. If the extra weight is really fat, then there are only two ways to lose excess fat: more activity to burn it off or fewer calories.

It sounds like your activity is rather good. Any chance you could increase any of this? It takes about 3500 calories to add one pound of fat and therefore 3500 calories deficit to lose that same pound of fat. If you create a system with 100 fewer calories each day, then it would take about 35 days to lose the pound if activity stayed the same. If you burned off an extra 100 calories and decreased 100 calories of food/snack intake, then you would lose one pound every 17 days or so. The math is always the same since energy balance is involved.

The difficulty if you also have diabetes comes about because you must then also make insulin adjustments. Using the insulin pump should help you accomplish this goal. Go back and talk to your diabetes team and see if you can all work something out that makes sense without causing hypoglycemia that needs to be treated (with extra calories counteracting your weight loss plan).

SB