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November 19, 2013

A1c (Glycohemoglobin, HgbA1c), Weight and Weight Loss

Question from Mandeville, Louisiana, USA:

My 16-year-old daughter’s A1c was 9.6 last year. Her blood sugar was running high all the time. She dieted, but had a very difficult time losing weight. She is 5 feet, 2 inches and then weighed 126 pounds. She was still considered to be within a healthy weight range, but we were concerned by the fact that the scale kept creeping upwards. All blood work was normal, including thyroid. Do you think that a consistent high blood sugar in the 200 to 300 mg/dl [11.1 to 16.7 mmol/L] range (not a blood sugar high enough to cause DKA of course) can prevent someone from losing weight even if they are eating a low calorie/low carbohydrate diet? My theory – A side effect of high blood sugar is hunger, which equals more insulin and a side effect of insulin is that it causes a person to store more fat, and the more fat one has, the more insulin resistant one becomes, which keeps the blood sugar high, which makes one hungry, etc., etc. and then the cycle becomes hard to break. Is my theory accurate? My daughter was hardly eating anything, but her blood sugar was staying high and I think that was the reason she was having trouble losing weight.

Jumping to the present, my daughter’s A1c is down to 7.6. She has worked hard over the last year and has been watching what she eats. Her weight is down to 110 pounds. That is still a normal weight range, but now I am concerned that she is losing too much weight. In the last couple of months, the weight seems to be coming off of her more quickly that it did before. Do you think that since her A1c is in a more normal range and she seems to be eating about the same diet as she did before, this has made it easier for her to lose weight? I have been trying to figure this out. Why is she suddenly able to lose weight so quickly when she was having such a difficult time before?


From: DTeam Staff

These are difficult questions and there is not much specific science to answer them. There are genes that control the way we gain and lose weight, metabolize fats and calories and our responses to exercise. The key seems to be able to increase daily activity at the same time as calories are cut. This is more difficult to do when one also has type 1 diabetes because insulin needs must also be added to the equation. Even more difficult are the effects of puberty hormones on all of these same factors. So, it is good news that the A1c has dropped significantly and this will be very important for future reduction of complications of all kinds. A dangerous way for kids and adults to lose weight is to skip insulin since, then, the hyperglycemia doesn’t allow the extra calories to become body fat. DKA risks and usually high A1c risks occur concomitantly. This does not seem to apply to your daughter. Our team coined the term for this back in the early 1980s called diabulemia.

in your daughter’s case, you imply that she has cut calories and increased activity at the same time that she has reduced her A1c levels significantly and this has resulted in moving her weight towards goal. So, I am not so worried. The A1c is a good monitor of overall how well she is doing.

Your theory about high sugars contribution to weight gain is not correct, however, but insulin resistance per se is directly correlated with weight gain in those with and without diabetes. There are also some people who did well with a high fat Atkins-like approach and others who do well cutting calories. Almost everybody does better trying to lose weight with increasing daily exercise enough to push up the heart rate and sweat a bit. We are searching scientifically for genes that would explain this and there is some early research that looks promising, but not yet ready to be tested outside of research studies just yet.