July 6, 2004
A1c (Glycohemoglobin, HgbA1c), Meal Planning, Food and Diet
Question from Atlanta, Georgia, USA:
I am 16 years old. I am 5 feet, 4 inches tall and weigh 145 pounds. I am on the varsity basketball team at my school and am also very active at home. I have had diabetes for over 10 years and have been on a MiniMed insulin pump for almost four years. I really don’t like the way that I look. I want to lose 10 to 20 pounds. I have tried diets, eat around 1200 to 1600 calories a day, and work out at least 30 minutes a day. Just when I start to lose a couple of pounds, my blood sugars go crazy! My A1c was down to 7.6, the lowest it has been since I was five years old. But now, my A1c is back up to 8.2, which makes me sick! I am eating right and exercising. I do everything that the doctors tell me to do. Now, I don’t even want to go back to my endocrinologist because of what they’re going to say about my control.
I really think I am doing everything I can. I check my sugar three to six times a day, eat three meals a day, around the same time, and work out everyday. If I were getting better control, I could live with the weight thing. I hate to say it, but if I were losing weight, I could live with the 8.2 A1c level. But, I am not getting either of these results! What can I do? How can I lose weight safely? should I try one of those low carbohydrate diets? I am just very discouraged. If I didn’t care about my future so much, I would quit trying to control my diabetes for good. But I do care. I just don’t know what to do. And my doctor sure doesn’t seem to care. I never see the real endocrinologist, only the nurse practitioner and it’s really frustrating. Is there anything you can help me with? What is a healthy weight for a 16 year old girl who is 5 feet 4 inches tall and active? How can I lose weight by diet and exercise when it doesn’t even seem to be working? I play basketball, run, and power walk for work outs. Is there anything else I should be doing?
Answer:
It is easy and understandable to see your frustration.
In the city where you live, there are terrific pediatric endocrinologists/diabetologists. Prior scientific studies have well shown that the good news for tighter glucose control and lower A1c values is that the longer term complications, such as vision, kidney, or nerve problems, occur at much lower rates for those in good control. The downside of that, however, is that tighter control is associated with a three-fold increase in the episodes of hypoglycemia. And, tighter control is associated with increasing weight gain.
If you feel that you “only” get to see the Nurse Practitioner, who surely is well trained and who is required to have supervision by the physician, and you WANT to see the physician specifically, you should just speak right up and say so when you make the follow up appointments. I’d wager that the staff would be happy to accommodate you! In fact, a comprehensive visit to include the nutritionist, certified diabetes educator, and the doctor may be able to help.
Weight gain is frustrating, but do not choose the path of sacrificing good glucose control for weight loss. Maybe a change in the distribution of insulin dosages, etc. are in order. Maybe you have, in addition to your type 1 diabetes, a degree of insulin resistance. The addition of some other medications, such as metformin, might be proper. There are medications that suppress appetite or interfere with absorption of food to augment weight loss, but they would be tricky, if not downright dangerous, to use by someone with diabetes. Talk to your physician, nurse practitioner, and diabetes team about your individual issues and concerns.
DS
