My 19-year-old daughter has type 1 diabetes and has had celiac disease for five years. Her A1c typically runs between 6.8 to 7.0. She is 5 feet, 6 inches tall and weights around 160 pounds. She works out two hours a day typically and continues to struggle with her weight. She would ideally like to weigh around 140 pounds. Her nurse practitioner indicates that due to her tight control, it will be challenging for her to lose weight, that individuals with tight control typically weigh more. Is this correct and could you provide additional information in this area?

Insulin’s physiologic and pharmacologic effect is to inhibit fat breakdown and lay down more fat. In every large clinical trial where tight glucose control is maintained, patients gain weight, compared to those not well controlled. It is a very common result of the treatment. There are no easy treatments. Knowledgeable insight into food choices and good exercise habits are very important and I am glad your daughter has bought into this.

We do not usually try additional pharmacologic therapy for the weight gain. For one, it would have to be continued lifelong. Second, there are only a limited number of agents that are FDA-approved for weight loss and they have their own set of side effects. When patients talk to me about this, I try to empathize with their feelings, but clearly try to indicate that glucose control is extremely important for long-term health and should not be sacrificed over desire to lose weight. Despite this, many patients, especially women, avoid insulin injections in an effort to lose weight. You can only imagine what this does to their HbA1c level and their overall glucose control. This remains an active area of investigation. We still have much to learn about managing the diabetes and weight separately.

JTL