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March 27, 2002

Weight and Weight Loss

Question from Rhode Island, USA:

I've had type 1 diabetes for 22 years in good control (my last hemoglobin A1c was 7.1%), and I was not overweight when I found out I had diabetes, but now I am about 150 pounds overweight, and I have a hard time exercising because I also have spinal stenosis. Whenever I stand or walk for a very short amount of time, my back hurts really bad, and I need to find a place to sit down right away. I also get out of breath very easily. My doctor told me that maybe I should try a liquid diet. There is a hospital here that offers that treatment, but I'm not sure that is a good way to lose weight for someone who has type 1 diabetes. I've heard that some commercial programs will not accept people who have type 1 diabetes because diabetes is such a complex disease, and I'm not sure if having my stomach stapled is such a good idea either.

Answer:

Sounds like you can’t exercise your way out of this. You will have to work on your diet. Get on a minimum of insulin. If you have any hypoglycemia, decrease your insulin dose. You need a physician to talk to in order to receive appropriate guidance regarding your treatment options.

Besides surgery, you might be a candidate for long-term obesity medication, either Meridia or Xenical. You need to speak with your physician about these medications. Trials involving patients with diabetes have demonstrated an ability to lose weight and decrease insulin requirements. There are no easy answers. You require an in-depth discussion of risks and benefits of the various interventions — diet alone, diet plus medication for weight loss, surgery plus diet, and avoidance of too much insulin.

JTL