October 3, 2004
Weight and Weight Loss
Question from White Oak, Pennsylvania, USA:
I would like to know if there are any type 1 adolescent girls (diagnosed before puberty) having trouble losing weight? I’ve noticed that a lot of adolescent girls with type 1 are overweight. Are there any studies looking at insulin resistance? If you were diagnosed after puberty started, are you having weight problems?
Answer:
I think the real answer lies in a slightly different perspective.
Yes, weight changes in diabetics (adults, children, type 1, type 2) are well recognized.
Insulin is an extremely potent “anabolic” hormone. That means it is involved in the manufacture and storage of proteins, fats, and help to store sugar in a form called glycogen. Thus, it is involved with muscle development and fat deposits.
You know that the foundation of diabetes management is the triad of insulin, meal planning, and EXERCISE. Often, this latter aspect is less stressed upon by patients and their doctors.
The Diabetes Control and Complications Trial (DCCT), published in the early 1990s and other similar trials from other places, involved thousands of patients with type 1 diabetes. Most were adults but some were teens. A major purpose of the study was to assess the effect(s) of “tight” glucose control and the risk of developing or progressing with diabetes complications, such as vision, kidney, and nerve issues, when compared to patients treated less aggressively.
One of the findings of the DCCT was that tighter glycemic control was indeed associated with faster degrees of weight gain! (This was not a surprise – clinicians have recognized this – but it was a major formal study of this in published form!) Makes intuitive sense, doesn’t it? If your glucose is well controlled then your insulin is doing it’s job; you’re not urinating out your calories, with as much “spilled” glucose in the urine, and you store the extra energy that you aren’t using in the form of glycogen and fat!
So…it once again places the emphasis and importance of meal planning and EXERCISE on glucose control – and NOT JUST doing so by adding more and more insulin.
DS
