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March 6, 2004

Insulin, Weight and Weight Loss

Question from Brownstown, Michigan, USA:

My child was diagnosed in August of 2003 with type 1 diabetes. Since then he has become pretty heavy for his age. He just turned eight and weighs 67 pounds. Granted, his sugars were running high for a good two and a half months due to his insulin doses not being accurate. I kept in touch with the clinic via phone and they never asked if he gained weight during those months, so they just assumed he was stressed or eating things he wasn't supposed to. I knew it wasn't the latter and doubted the stress thing but followed their advice. Well, by national standards he is about 17 pounds overweight. His insulin doses have been adjusted so his sugars are normal, but he's not losing any of the weight. He is also extremely active, which should have helped in some weight loss. I don't understand why he is still overweight. Can you please help me understand why? How can I help him lose the weight safely?

Answer:

I’m sorry that I can’t quite tell from your letter whether or not your child is in very good glycemic control or not. A landmark study completed in about 1992, called the Diabetes Control and Complications Trial (DCCT) nicely demonstrated that, while “tighter” control did indeed lessen the risk for diabetes eye, renal, and nerve complications, it is also associated with easier weight gain. This does not mean that you should sacrifice good control. But it does stress the importance of exercise. I recognize that you see your child as active, and I’m sure he is, but, if the weight is climbing, then it implies that the caloric intake is out-pacing the exercise and that, perhaps, the good glucose control is with insulin rather than as optimal balance of food-exercise-insulin.

Speak with your Diabetes Team members as they may want to adjust the meal plan. They may also wish to screen for hypothyroidism, which is a common association with Type 1 diabetes and could, in some cases, exacerbate weight gain.

DS