June 29, 2005
Other Illnesses, Weight and Weight Loss
Question from Laurel, Maryland, USA:
I am 33 years old and have had type one diabetes for 23 years. I was diagnosed with PCOS about seven years ago and my doctor is experimenting with different oral medications on my diabetes, which I now see as both type one and type 2 as I now have insulin resistance from the PCOS.
Over the last three years, I have been maintaining an A1c of 7.0 to 7.2 on an insulin pump with NovoLog and have, since that time, gained 40 pounds that I can’t seem to lose. I went to a dietitian when I was on a very low carbohydrate diet. She advised me to eat more carbohydrates like fresh fruits. I think the woman is crazy because that simply increases my insulin requirements and insulin is a fat producing hormone.
On her advice, I started eating breakfast in the morning, which seems to have lowered my metabolism instead of increasing it. I exercise five times a week on a treadmill for 30 to 35 minutes at a time and I have a 1200 calorie diet. I now weigh 173 pounds at 5 feet, 4 inches. My insulin requirements keep going up with my weight. What can I do to lose weight?
Answer:
Fad diets, including the very low carbohydrate, high protein diet, may not be the most healthy diet for you in the long run. An alternative is to make a moderate increase in carbohydrates to ensure good nutrition and keep the protein and fat content down to healthy levels. It is true that carbohydrates increase insulin resistance to some degree. Please review your insulin dosing with your physician to make sure you are not overdosing your insulin, especially if you have repeated low blood sugars. In addition, consider evaluating your exercise prescription. Is it enough? Some medications, such as those from the thiazolidinedione class of medications (Actos, Avandia) can cause weight gain while improving insulin sensitivity. This is a complicated problem without a simple answer. Keep working at it. It will eventually pay off.
JTL
