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August 15, 2004

Diagnosis and Symptoms, Weight and Weight Loss

Question from Tinley Park, Illinois, USA:

My daughter, age 19, was diagnosed with type 1 diabetes two months ago. She had symptoms probably going back about eight months and saw our family practitioner for fatigue, heart palpitations, and shakiness. Our family doctor ordered a test for vertigo, which came back negative, then put her on Zoloft and said her symptoms were probably due to anxiety. She went back to the doctor in May and mentioned the extreme thirst she was having over the past few months, and, then, the doctor did a blood test. Her sugar level was 717 mg/dl [39.8 mmol/L]. She was immediately hospitalized for four days, diagnosed with type 1, and is now with an endocrinologist. He has her on three shots of NovoLog and one shot of Lantus at bedtime. I am concerned because she has gained 30 pounds since diagnosis. We are just beginning to work with a new endocrinologist and will meet with his dietician in two weeks. Will she always be fighting weight gain? She is devastated with this fast weight gain. What is it from? Ever since she's been diagnosed we have been careful counting carbohydrates and eating only sugar-free foods. She also exercises and is still rapidly gaining weight. Also, we do not know of any diabetes on either side of the family. How did she get it? Most say probably a virus, however, my husband thought he heard a class action lawsuit was being issued for anyone who took a diet supplement? He thinks it was Xenadrine or ephedra. Last year, she did take diet supplements unknown to me with these ingredients in them.

Answer:

The new diagnosis of type 1 diabetes is devastating. However, have hope as people live with this problem and help is available. The marked weight gain is seen in one form or another as insulin therapy is administered. At the time of diagnosis, your daughter’s body was “starving in the face of plenty.” She had access to food but her body could not use it. Her body was having to revert to alternate energy sources in the form of fat and muscle protein. All the while, she was spilling lots of calories in the form of urinary glucose. When insulin therapy is initiated, it turns off the spilling of the urinary glucose and the calorie sink is gone. Her muscles start storing energy again. Her fat cells start taking up glucose again. Insulin, by its very nature, lays down fat and prevents body breakdown. When a person goes from poorly controlled to better glucose control, there is some degree of weight gain. In most tight control clinical trials, one of the side effects of tight control is weight gain, in addition to the episodes of hypoglycemia.

It seems that one of the goals of avoiding the marked weight gain is getting a better handle on the number of calories she consumes. If her calorie consumption is excessive, her weight gain will be excessive. The dietician will review her diet, determine what a reasonable amount of calories should be consumed on a daily basis, and how they will be divided up throughout the day. One of the keys to good therapy is matching the calories to the right amount of insulin. It is a lot to comprehend, but you take it in steps.

As far as how you get type 1 diabetes, it is an autoimmune disease that results in the eventual destruction of the beta cells in the hormone producing regions of the pancreas called islets. The process evolves over years. At the time of diagnosis, only 20% of the insulin-producing cells survive. They eventually are all killed by the underlying disease process. Type 1 diabetes does not have a strong family history associated with it, although it does have some. It is thought that you inherit a particular way your immune system works and some additional environmental trigger induces the autoimmune process that leads to destruction of the insulin-producing cells. Type 1 diabetes makes up only about 10% of all patients with diabetes. I am not sure about the medications as a cause of the diabetes.

JTL