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There have been numerous discussions regarding how hard it can be to losing weight with diabetes for athletes through exercise. I have collated some ideas on what can make one gain weight. And also what keeps one from losing weight with diabetes and what one can do about it.
Somebody I knew, a graduate student with type 1 diabetes who went on an insulin pump ,gained around 10 pounds. Although his blood glucose level improved somewhat marginally. Let’s see why did it happen to him and why does it happen to so many insulin users .
Insulin is a naturally occurring anabolic hormone. It promotes the uptake and storage of amino acids, glucose and fats into insulin sensitive cells around your body, muscle and fat cells basically. Whether it’s released naturally, injected or pumped, doesn’t matter. The effects are the same with all insulin and insulin analogues. Going on intensive insulin therapy is associated with fat weight gain:
- For people with both type 1 and type 2 diabetes. If you’re using insulin to keep your blood glucose in control. You will keep storing all of the calories that you’re eating instead of losing some glucose through urine (during hyperglycemia) and ultimately will gain weight. Unfortunately people have started to skip or limit their insulin usage to help them lose weight.
- But this is a dangerous practice that can lead to loss of excess muscle mass and life threatening conditions like Diabetic Ketoacidosis or DKA.
In my opinion, the best way to balance your insulin use and body weight is to be physically active. It will keep your overall insulin levels lower. It is comparatively easier to lose weight if you are taking less insulin or releasing less of your own if your pancreas still does that.
Having said that, I need to add that what you choose to eat has a huge impact on your insulin needs as well as your body weight. My known graduate friend found that by doing frequent dosing with his insulin pump. Overall he was eating more, just because he could without having to take another injection with a needle. One more thing, Insulin makes it easier for you to eat cake and other formerly “Forbidden” foods doesn’t mean that you need to eat them. Having some control over the taste buds sure helps !
People advocate all sorts of diets for people with diabetes, including ultra-low-carb diets, vegan diets, etc. I strongly advocate a balanced diet for weight management. Nothing in excess, nothing in shortall. People do not necessarily lose weight with low-carb diets, even though their insulin requirements are lower. Because fat is much denser in calories (over 9 calories/gram of fat) than carbs or protein (both 4 calories/gram of fat). You need to replace carbs with something in case you wish to cut them out from your diet. And it’s really easy to overdose on fat calories without realizing it, and even when your muscles become insulin resistant due to any reason, insulin still works to put fat into storage depots around the body.
What I am suggesting is not to completely avoid carbs, but to choose them wisely. Eating more lower glycemic index or GI carbs that are absorbed more slowly and don’t cause spikes in blood glucose that you need to match with large doses of insulin that often lead to hypoglycemia later on when the carbs are long gone and the insulin is still hanging around. Most of the carbs you consume are absorbed within the first one or two hours after eating. Rapid acting insulin can linger for up to 8 hours afterwards.
Also there are other factors to insulin requirements rather than just carbs, as proven in a study in 2013. It shows that eating fat with the same number of carbs increases insulin requirements. It’s not just about carb counting anymore. It’s more of picking the right balance and type of carbs as well as total amount of protein and fat.
There was another US Olympic team handball player with type 1 diabetes who contacted a friend of mine, who happens to be a doctor asking him what made her gain weight while doing all her training. My friend simply asked her if she was treating a lot of lows. He knew her answer even before hearing back from her.
He went on to explain me that gaining weight from lows is not uncommon in people using insulin. Whether they are active or not. One of the biggest deterrents to successful weight loss and prevention of weight gain with diabetes is being forced to treat frequent bouts of hypoglycemia with glucose, sugary rinks or food. Even though these calories are necessary to treat a medical condition, they still are calories to the body and they obviously result in weight gain.
He adds that one way to cut back on lows is to decrease your insulin intake to prevent them, which may include decreasing mealtime insulin doses before exercise, insulin taken for food after exercise , and basal insulin doses to prevent later-onset hypoglycemia following activities. It also helps to more precisely treat lows instead of over treating them. Immediately treat lows first with glucose. Be it in the form of tablets, gels or candy containing dextrose like Smarties. Re assess later if you need additional food intake to fully correct the low and prevent lows later on. Juice, is the best treatment for hypoglycemia. It contains fructose(fruit sugar) that is much, much more slowly absorbed than glucose and can lead to over treating lows while you’re waiting for the juice too kick in. Don’r eat more calories treating a low that you need to!
Lack of Physical Movement
Finally, the most important aspect of this article or should we say this website. Expending more calories can help prevent weight gain, even if you take insulin. In adults with type 1 diabetes, if you have an active lifestyle, you will have a lower BMI. The more you move, the less insulin your body needs to get the same glucose lowering effect. Requiring smaller doses of insulin allows you to :
- Treat lower with fewer calories overall, and
- Avoid having as many lows from being off on your dosing.
In anyone who is insulin resistant (Most people with type 2 diabetes and many with type 1 who are inactive), total insulin requirements will be so much higher that there is a lot more room for error. Injected or pumped insulin is generally absorbed at a speed dictated by the dose, meaning that larger doses take longer to fully absorb and the insulin “tail” hangs around for longer. Taking or releasing less insulin due to being physically active means that all of the carbs you take will be stored as carbs in muscle or liver and not converted into fat to be stored. Stay regularly active-even if that means just standing up more of taking more daily steps. It would help keep your calorie expenditure high and your insulin needs low.
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