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July 6, 2002

Weight and Weight Loss

Question from London, England:

For about five years, I've been skipping insulin shots in order to maintain or lose weight, I started seeing a counsellor about two months ago, was up front about my situation with my endocrinologist, and I also started taking all my shots. As a result, my A1c dropped from 14 to 11%, and I haven't gained any weight. However, I don't feel that I'm in recovery because I still have this need to restrict calories. The dietitian I saw wasn't very helpful. She asked if I knew the risks, and said that I really ought to eat more, which I refuse to do. Am I doing any potential harm to my body by restricting calories? I'm not underweight, so I don't see myself as having a problem like anorexia, and I don't purge, so I don't see it as bulimia. I try to eat a balanced diet, and I'm hungry all the time, but I can't gain weight. I just can't --or won't. I'm sure if I ate whenever I was hungry, I'd gain 50 pounds!


This is not an uncommon problem. However, I think it’s important to be specific about one thing. You have not provided any evidence that you are not underweight. This, coupled with your dietitian’s advice, makes me strongly suspect that, in the eyes of the professionals, you are less than your ideal body weight. I have never known a dietitian to suggest an increase in calorie intake for someone who’s weight is perfect. This is probably the key.

Furthermore, if you have been taking all of your prescribed insulin for two months and your hemoglobin A1c is still 11%, then there is something wrong with your prescription — i.e. you need more insulin (assuming there has not been a long delay since you submitted this question).

You say that you have been up front with your diabetes team, and I would encourage more of this. However, ask them why they believe you are underweight.