January 17, 2005
A1c (Glycohemoglobin, HgbA1c), Weight and Weight Loss
Question from Hammonton, New Jersey, USA:
I have been on the insulin pump for going on three years. I was diagnosed at age 19 with type 1 diabetes and weighed 154 pounds at the time. That was 25 years ago, and thankfully, I am healthy. My A1c levels are always below 8 but never less than 6.5. My doctor wants me to lose weight and get my A1c below 6, which seems like a great goal, but I have a lot of trouble with it. My goal weight is 165 pounds. I now weigh 198 pounds at 5 feet 8 inches tall. I have gained steadily since turning 40, about 20 pounds. I am 44. I was pregnant in 2003 and delivered in December 2003 after gaining about 24 pounds. The baby did not make it, as he was very premature, only weighing 1 pound, 12 ounces at birth. He lived for almost three months. I breast fed for those first two months, but I only pumped about four ounces daily, as the baby never really was able to use the breast milk. I am on an antidepressant, Effexor XR, that has really helped me survive this tragedy. I have had two other children that are older, ages 16 and 19. After each of these births, I was able to lose weight fairly easily. But now, being older, I am eating less and gaining more, it seems. I have always been active, but less so since having the baby. I have a membership at a gym where I do mostly aerobic exercise two or three times per week. The weight, needless to say, is not dropping off. I am a registered dietitian, so I am quite familiar with all of the diets, fad weight loss, and healthy weight loss plans alike. I, myself, follow a normal diet that is high in omega-3's, fruits and vegetables, and low fat, never fried meats and poultry. If I try a lower carbohydrate approach, like the South Beach diet, thereby decreasing my basal insulin and bolus insulin requirements, and am successful in losing the 30 pounds or so, will my leaner body be able to go back to eating a regular amount of carbohydrates (as in, include it with each meal, eat high fiber cereal, skim milk, fruit, and all that yummy stuff) and not regain the weight, even if my insulin requirements go back up? Right now, I am taking 40 to 50 units daily to cover my 'healthy' eating style.
My heart goes out to you on the loss of your baby. It sounds like you have rebounded very well and are trying to keep all things in perspective. You have asked a great question. As you know, it is hard to get good long-term data from large studies using these kind of dietary interventions because there are none. It is generally agreed to that weight loss may be more precipitous with a form of the high-protein, low-carbohydrate diet. However, tolerability and compliance with this has been a concern with most studies showing a significant drop-out rate for this kind of intervention. When the diet is stopped, some of the weight is regained. For patients with diabetes, who are at risk of nephropathy, I am concerned that these high-protein diets are not necessarily safe if they promote increased albumin excretion as they may induce hyperfiltration, a condition seen with the propagation of nephropathy. This leads me back to using a more traditional approach. I see nothing wrong with trying a variation of the high-protein diet and seeing how this works. However, the goal should be to be able to follow something that won’t change abruptly.