I have frequently heard from my patients that preventing weight gain when on insulin is nearly impossible. The research in the literature often states the same thing. The reason for weight gain is when you are taking insulin you are no longer losing large amounts of sugar and calories through your urine as when you are uncontrolled.Patients with diabetes type 1 usually take smaller amounts of insulin to control their blood sugars. Patients with type 2 diabetes are usually insulin resistant which makes them require larger amounts of insulin. Higher doses of insulin promote fat deposition.
Remember, weight gain CAN be managed with the right mind set and tools.
I want to share a story about a patient with type 2 diabetes who was recently enrolled in diabetes management sessions. She is 33 years old and has had diabetes for 6 years with no previous diabetes education. This was our third office visit and I could not understand why her eating habits or blood glucose readings had not improved. At the end of the visit she began to cry. As with many patients with type 2 diabetes she originally started treatment on one diabetes pill and had adequate control for a few years. As time went on she was increased to 2 types of diabetes medications and within 4 years eventually 3 different daily diabetes oral medications. This is a common practice among internists or endocrinologists who are trying to keep the A1C level controlled at 6.5 – 7.0%. This is done to prevent future complications including retinopathy (eyes), neuropathy (nerves) and nephropathy (kidneys). Diabetes is a progressive disease and it is not known how long it will take before one stops producing their own insulin. In the 6th year the oral medications were no longer controlling her blood sugars and she was switched to 2 types of insulin: basal (long acting) and bolus (rapid acting). She had now been taking insulin shots for 6 months and has noticed a significant weight gain, which was extremely upsetting to her. She blamed herself and tried to control the weight gain by barely eating her meals. She had daily blood sugars in the 40s-60s with severe symptoms of hypoglycemia. Then she would get more depressed and binge, bringing her blood sugars into the 300’s. She was constantly weak and felt miserable. Her vision was blurry and she was always tired. Finally, during the 3rd visit, she felt comfortable enough to share with me why she would not eat correctly; she hoped it would prevent weight gain. After some tears and much discussion I had finally convinced her how to properly care for herself and manage her diabetes. She had known what to do but she was resistant due to the weight gain.
I would like to share some of the tips I offered her to lessen the weight gain but still control blood sugars. I look forward to our next session hoping she will feel better and have improved blood sugars.
My suggestions to her:
- Regular exercise – Exercising routinely 5-6 days a week by doing aerobic activity and muscle strengthening can help control weight ,increase your body’s response to insulin, decrease stress (which also causes weight gain ) and improve your over all health. Try to get at least 30 minutes per day even if you need to break it up into smaller sessions. Walking, cycling, running, swimming or any other form of aerobic activity will help reduce weight gain. Adding strength exercises with weights increase muscle mass and helps burn body fat by increasing your metabolic rate. Always check with your health care provider to see if you have any limitations. Exercise may eventually allow your physician to lower your insulin dose since it increases your insulin sensitivity.
- Give healthy eating a chance – Find a dietitian or diabetes educator to learn proper eating techniques. Reduce refined carbohydrates which cause large increases in blood sugar. Go back to the basics. Eat fruits, vegetables, whole grains, and low fat dairy and lean proteins. Learn meal strategy planning from a professional. Never get hungry. Eat your regular meals and no snacks except for an evening snack when on basal /bolus routines. Eat moderate snacks when you are on mixed insulin’s like 75/25 or 70/30.
- Do not count calories but watch portion sizes – Invest in portion control plates, measuring spoons as well as dry measuring cups. After a while you will be able to estimate how much a ½ or 1 cup serving sizes look like. Portion size is extremely important. No fluids should contain calories except for milk. Stay away from regular sodas, fruit juices, power or energy drinks and stick to Crystal light, diet soda, unsweetened tea, coffee or water. If you drink an alcoholic beverage do not use sweet mixers. Most fluids offer empty calories.
- Never skip a meal – This will lead to a low if you are taking insulin and it usually backfires by increased snacking or eating more at the next meal. This creates large blood sugar swings. Your body tends to slow its metabolism and holding onto calories when skipping meals. Having 3 healthy meals with small snacks recommended by your CDE will result in weight management and blood glucose control.
- Take your insulin as directed – Do not skip insulin to prevent weight gain. Do not stop eating to prevent weight gain. Take insulin as prescribed and eat moderately. You will feel and look much better. Blood sugar control is always more important then weight gain.
- Check in with your health care team – Verbalize your questions and concerns with all members of your team. We want to help you succeed and stay on track. If you are doing everything you think you should be doing and getting poor results ask questions.
- Reduce stress – Stress hormones lead to an increase in weight gain so get help limiting stress. Try yoga, deep breathing, massages, and acupuncture or talk therapy to keep you calm.
Gaining weight is frustrating for everyone but especially when you have diabetes. Usually you are being told to lose weight to help control blood sugars. Be more aware and concerned with glucose control and follow the above tips. You will feel well and prevent future complications by taking your insulin correctly, eating on a schedule and doing routine exercise. Best of luck!
NOTE: Consult your doctor first to make sure my recommendations fit your special health needs.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.