I have type 1 diabetes, and 13 years ago I gained over 100 pounds during pregnancy. They kept on telling me I would l lose the weight, but this never happened. I am now 240 pounds, and I keep trying to lose weight.

I have a personal trainer come twice a week who works me out for one to two hours, and I am currently on a 1400 calorie diet, but I do not lose any weight. I know this is not good to be carrying all this weight. My doctor tells me just leave it alone because it would be too difficult to regulate me to lose weight. My blood sugars are good, and my hemoglobin A1cs are 5.5-6.4%, but I am worried if I don’t do something, I could be in serious jeopardy. Do you have any suggestions?

I have a lot of empathy for your problem. I have my share of patients with this, and we struggle with this very question. Your are correct that it is not healthy to carry the extra weight.

I have to tell you that you are doing the correct things. I think you could probably regulate your diabetes with a further decrease in your calorie intake, if you wanted to go that way. For instance, take off 100 calories and see what happens. If no response, try another 100 calories. However, that is quite painful.

Another direction is to consider medications for obesity. Xenical and Meridia have both been approved for long-term weight loss. The experience in patients with diabetes is that with weight loss there is a decrease in insulin requirements. The most difficult decision would be to consider surgery. However, if your body mass index is above 40 kcal/m2, this would be a consideration. I think your blood sugars could be controlled with any of the above intervention strategies.

JTL