Why can’t I lose weight? All of my adult life I’ve weighed between 125 and 135 pounds. Since I was diagnosed with type 1 five years ago, I’ve gained 25 pounds. Where does it (the weight gain) end? I have always been active, adhered to a healthy diet, etc. In addition, my stomach appears to be (and is) bloated. Also, I have more fat, especially in the belly area, as opposed to muscle tone than ever before. My doctor does not think it has anything to do with taking insulin, but I suspect otherwise. He said type 1s typically maintain a healthy body weight or slightly below. My A1c is typically between 6.5 and 7.0. I’m very frustrated. My body/metabolism seems foreign these days. I used to get predictable and desirable results when I needed to adjust my diet or exercise plan to maintain a healthy weight. What used to work just doesn’t anymore. Any insights or advice is appreciated.

I am afraid that there are no magic bullets in this area. You and many others with diabetes are frequently frustrated by the inability to maintain a desired weight and indeed risk higher blood sugars with chronic weight gain. Several pieces of information are appropriate here. First, it has been shown in glycemic control trials involving patients with type 1 diabetes that better control was associated with more weight gain. I hope this doesn’t make you think you have to give up one to have the other. However, insulin does induce fat deposition and increases appetite. I would say that it would be important to avoid frequent hypoglycemia where you would be constantly taking in extra carbohydrates in order to keep your blood sugars up. Sometimes this is an age issue. Body fat does increase with time. There are not practical solutions for sculpting or managing weight gain in a fashion that people would like. Diet and exercise sounds good, but it becomes a broken record. One thing that might help is to have a problem solving session with a dietitian. The dietitian can take a history and determine your current calorie intake and determine whether it is close to what you should be taking in for your desired weight. If there are problems with calorie intake, they can often help with practical solutions. I would also make sure that you are regularly active using a combination of resistance training with weights and cardio (walking, running, jogging, etc.). Medications may be appropriate if you cannot lose weight after counseling for life style changes. I hope you will talk with your physician about this. In addition, you may want to talk with your local diabetes education team.

JTL