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March 20, 2001

Weight and Weight Loss

Question from Manchester, England:

I'm not fat and I stick to a healthy diet, but find it very hard to lose weight. Do all people with diabetes grow up to be fat?


To some extent you have put the cart before the horse. It is probably more likely that fat people will become insulin resistant and develop type�2 diabetes, and these days this applies to the increasing number of young people in this category. I made a quick approximation of what is called your Body Mass Index and found it to be just below 23 which is quite normal. So I would suppose that you are not overweight, but worried about becoming that way. If you yourself have type�1A (autoimmune) diabetes, which seems most likely, then the most common cause of becoming overweight is by taking too much insulin. This is in absolutely no sense an invitation to reduce your insulin dose as a preventive measure (which can be very dangerous), but it is saying that to guard against abnormal weight gain, you need to always work carefully with your diabetes care team to make sure that the amount of insulin you get whether by several injections a day or by an insulin pump is carefully adjusted to keep blood sugars as near as possible within the normal range, without frequent hypoglycemia (which may be unrecognized). Of course, this does mean doing a lot of blood sugar levels before and two hours after meals as well as once in the very early morning and seeing how they relate to variations in food intake, exercise or stress. All this will become much easier when one of the continuous glucose monitors become available. You might ask your team whether they are one of the groups in England that are already trying this out.


[Editor’s comment: Several thoughts:

If you’re not fat, why do want to lose weight?
The most common cause of obesity is eating too much! Keep a diary in which, every time you eat something, you write it down including the amount. You might be surprised to find you are actually eating more than you think.
If you are frequently “chasing” high blood sugars with extra insulin, you probably need to look carefully at your regimen so that it can be changed to optimize control with as little insulin at possible.
Frequent hypos can cause inordinate amounts of excess food intake.
Have someone measure your percentage of body fat. If you are muscular, remember that muscle tissue weighs more than fat and you probably do not need to lose weight.
Look at the rest of your family’s and your own body frame size, and consult a dietitian who can advise you about ideal body weight.
One-half to a hour’s worth of aerobic exercise two to three times a week helps a lot.