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May 12, 2003

Weight and Weight Loss

Question from Atlanta, Georgia, USA:

I have gained very significant weight on insulin, even though I exercise and would like to convince my doctor to take me off the insulin. Injecting insulin is painful enough, and I don't want to add more pain of not being able to lose the excess weight in my mid-section. A doctor once told me Glucophage could help me shed some pounds in addition to bringing down my glucose, and just recently it was added to my treatment. Does Glucophage really help a person with diabetes lose weight?


My honest opinion is that blood sugar control is the top priority. It is not reasonable to sacrifice good control for a few pounds. That may sound insensitive, but I do not mean for it to be. There is often a gap between the rise in blood sugar and the knowledge people need to go out and really change lifestyle. In my opinion, it is not appropriate to just wait till the weight loss happens while the blood sugars remain high. Hopefully, you have had plenty of contact with instructors who can work with you to give insulin in such a way that it is not significantly painful. If not, I would request more education.

With regard to the Glucophage [metformin], there have been women who have used Glucophage in addition to proper nutrition and have experienced weight loss. Whether this is the result of lifestyle changes or the medication is less clear. It has recently been used frequently in the setting of Polycystic Ovary Syndrome with some success in allowing for the resumption of menstrual periods where they were not regular before. These women have also had changes in exercise and weight.

In your situation, you would still be on insulin as the Glucophage is added. I anticipate that the insulin is still the most potent drug in your treatment. Glucophage is not classified as a weight loss agent by the FDA. I would continue to think in terms of successful glucose control with medications, weight loss, and exercise. The combination of factors will give you the best result.