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July 29, 2000

Weight and Weight Loss

Question from Phoenix, Arizona, USA:

I've had type 1 diabetes for about seven years now. Can you recommend websites that provide information on type 1 weight loss? I have tried to explain to my doctor (who is not an endocrinologist) that, when I cut back on daily calories, I most often experience hypoglycemia. Any calorie deficient created by my diet is destroyed when I bring my blood glucose levels back to normal through snacks. My doctor does not seem to understand the relationship between daily insulin injections and food needed to match those injections.

Answer:

It must be frustrating to keep having your weight management efforts blown out of the water by hypoglycemia, and, even more so, when you’re not able to do the needed problem-solving with your doctor.

It’s true that daily insulin doses are greatly affected by food intake, of course. That’s why the current “gold standard” of insulin treatment for people with type 1 diabetes is insulin therapy that mimics what the body would do if you didn’t have diabetes. This is done by giving small amounts of “basal” or background insulin throughout the day and night and then, in addition, giving “boluses” or spurts of very short acting insulin (e.g., Humalog) to exactly cover the food that’s being eaten (Most people with type 1 diabetes need 1 unit of Humalog for each 12-20 grams of carbohydrate. Blood glucose results can help find the ratio that works best for you.) With that type of insulin regimen, it is much easier to keep your food intake and insulin in balance, preventing both highs and lows as food intake varies from day to day.

However, I’m guessing from the problems that you’re having, that you’re not currently on that type of insulin regimen. It requires more injections than older approaches to insulin treatment, but pays you back for the effort with greater flexibility — including the ability to eat less when you feel like it. You might want to print out this answer and take it to your doctor to help start a more productive discussion of what’s going on and what you’re trying to accomplish. If you’re going to stay on a less intensive insulin regimen, you might experiment with cutting back on fat in your meals to reduce calories. For most people, this has much less impact on insulin needs than cutting back on starches and sugars (carbohydrates) and may allow you to reduce your calories modestly without having a dramatic effect on your blood sugar levels. Blood tests are even more important when you’re trying to make changes in your routine than they are at other times, so be sure to keep track of how your changed food intake is impacting your blood glucose.

I’d also like to emphasize, though, that long term weight management is seldom accomplished through dieting. Diets are temporary for most people. Becoming more active is more likely to be helpful, in addition to a modest reduction in your overall fat intake.

BB
Additional comments from Dr. Tessa Lebinger:

It sounds like you would benefit from a consultation with an endocrinologist. Keep in mind, that if you are planning to either lower your food intake or increase your exercise to shed extra pounds, you will have to lower your insulin to avoid low blood sugars. This is best done gradually and working with an experienced endocrinologist.

TGL