Almost three-quarters of adults 20 years or older in the United States are overweight, with 42.5% of adults meeting the C.D.C.’s definition for obese.1 For people with type 1 diabetes, the incidence may be even higher according to studies over the past ten years, partially due to the increase in weight gain when on intensive insulin therapy.2 Increased weight adds additional challenges for people with type 1 diabetes, including insulin resistance and increased risk for complications.
One of the biggest barriers to losing weight for people with diabetes is fear of hypoglycemia that goes along with exercise, weight loss and dietary changes.3 Losing weight with type 1 diabetes can be really challenging, but there are a lot of new tools available to help make it easier. In this article, we’ll summarize what the latest science says about T1D and weight loss.
Exercise and Diabetes
Sometimes it feels really defeating to start a new exercise routine with diabetes because you often have to eat food to prevent the lows associated with exercise, especially with aerobic exercise.3 When your goal is to increase the calories burned and decrease the calories taken in, eating in order to exercise seems maddening. Here are some tips to reducing hypos with exercise:
- Lower insulin before exercise – if you plan ahead, you can lower your basal 60 to 90 minutes ahead of time or set a higher target BG in your hybrid-closed loop system (e.g., in Tandem, there is “exercise mode”). You can also time your exercise to be after a meal and take 25 to 75% less insulin for that meal.3
- Lower insulin overnight after exercise – it’s also common to have delayed hypo’s overnight after intense aerobic exercise, so lowering the basal or setting a higher target overnight can help prevent these lows.
- Time the exercise well – limiting the amount of active insulin before starting exercise, exercising in the morning when we are most insulin resistant, and doing anaerobic exercise before aerobic can all help reduce the risk of lows.
- Keep notes on what works for you – as you probably know, everyone’s diabetes is different, so figuring out what works best for you or your child is the best way to create the exercise routine that works for you. And always keep fast-acting carbs on hand, just in case.
Continuous Glucose Monitors
Having a CGM can not only help reduce the amount of hypoglycemia someone experiences, but also helps reduce the fear associated with lows. Being able to personalize alerts and alarms, having access to data sharing features, and using systems that automatically suspend or reduce insulin can really help when working towards a goal of weight loss.3 However, sometimes using hybrid closed-loop systems can result in weight gain. This does not mean that the system is not beneficial for increasing time in range and reducing lows, though.
Additionally, wearing a CGM can help show people with diabetes in real-time how different foods affect their blood sugars. For example, when eating larger meals or meals with higher carbohydrate or fat content, the rise on the CGM will correlate with what was consumed. For meals high in fast-acting carbohydrates, such as white rice or breakfast cereals, you will likely see a large post-meal spike unless you time the insulin perfectly and count the carbs perfectly (good luck!). This can be motivation to eat meals that are more balanced nutritionally with higher fiber or protein, which can help with weight loss.
Nutrition for Weight Loss
There are many suggestions about what the “best” nutrition is, and there are many resources for people with and without diabetes. Talking to a dietitian or diabetes educator who has knowledge about diabetes and healthy eating is probably the best way to create a plan that is right for you and your family. The overall goal with nutrition for weight loss is reducing the energy intake and increasing glycemic index in foods to help maintain satiety (fullness).2,4
Eating regular, well-balanced meals and avoiding skipping meals helps reduce the risk of weight gain for people with T1D.4 Many people swear by low carb diets, but such diets are not always right for everyone. As with most things, everything has its own benefits and challenges. Dietitian and Diabetes Educator Constance Brown-Riggs has a recorded session on carbohydrate controversies, which can help give insight into lower carb diets as well.
Medications for Weight Loss
Given that many people living in the U.S. are overweight or obese, the market for medications to help people lose weight has been growing steadily over the last decade. There are two newer medication classes that have been helpful for reducing blood glucose levels as well as promoting weight loss: GLP-1 Agonists and SGLT-2 Inhibitors.4 They were developed for people with type 2 diabetes and are typically considered “off-label” when used by people with type 1 diabetes, especially youth with type 1 diabetes. These medications also reduce the risk of cardiovascular complications, and SGLT-2 inhibitors are protective of the kidneys as well.
Metformin has been used for many years by people with type 1 diabetes who have challenges with insulin resistance, and can help with weight loss in the way of reducing the amount of insulin needed.2 Pramlintide, which is a synthetic hormone that has similar effects of the GLP-1 agonists, can also help. The challenge with this medication is it has to be injected before each meal, making it less likely that people will continue using it. There are other anti-obesity medications that have not been studied in people with type 1 diabetes, but some health care teams may recommend them depending on your circumstances.
Overall Recommendations
The common theme for these recommendations is that people with diabetes need individualized education and support to help meet their weight-loss needs. Additionally, there can be many other factors that contribute to increased weight such as depression, anxiety, other metabolic conditions, thyroid imbalances, genetic factors, and social determinants of health (SDOH).
Figuring out what works best for you may take some time and will definitely require motivated efforts. There are many resources available online and through your healthcare team. There also could be groups in your community that could help you with sustaining exercise routines. Making SMART goals can help ensure your goals are achievable and sustainable.
Losing weight should not be about wanting to “look better,” and all these recommendations are not just to help with losing weight, but to help improve health and reduce risks. There are times where your healthcare team may tell you that losing weight is important for your health, in which case, hopefully these tips will come in handy. Otherwise, they’re tips that can help you stay and feel healthier.
- National Center for Health Statistics: Obesity and Overweight
- Weight Management in Patients with Type 1 Diabetes and Obesity
- Weight Management in Youth with Type 1 Diabetes and Obesity: Challenges and Possible Solutions
- Biopsychosocial Aspects of Weight Management in Type 1 Diabetes: a Review and Next Steps
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
