How to lose weight with Type 1 diabetes

[magkenmare]

My daughter has had diabetes for 10 years and has experienced significant weight gain.  She has tried over the years to lose with diet and exercise but to no avail.  She has recently done Weight Watchers for one month and followed it religiously.  She lost practically no weight.  She also exercise at least five times a week for an hour and a half.  She is very frustrated and I don't have any answers.  Unfortunately, her doctors over the years don't seem to be able to help.  Should we be looking at type of insulin?  She presently talkes Lantus and Humalog.  Does high protein help?  Her weight is in her back across her shoulders, in her middle and thighs.  She usually injects in her stomach and sometimes her thighs.  Does site matter?  Any suggestions would be so appreciated.  Thank you.

[JDRF-Team-SS]

Hello magkenmare,

First I want to tell you that I am not a medical professional, so the input that I give you is not to be taken in place of medical advice.

I am a mother of a 9 1/2 yr. old boy who was diagnosed with Type I diabetes at the age of 3.  Also, my sister was diagnosed (2 yrs. prior to my son) at the age of 24.  She is now 32.

My sis takes lantus and humalog, just like your daughter does. I do not have diabetes, however, I do understand that the weight issue is frustrating and sometimes even depressing.  My sister has had a very similar situation to your daughter's.  It wasn't until recently that she lost some weight.  Like your daughter, she tried everything she could think of.  Although this is unhealthy and I am not at all suggesting this, but she told me there were days she barely ate anything and no matter what she did she could NOT lose weight.

I have a question for you....is your daughter on any other medication in addition to insulin?  The reason I ask is that there are certain meds, like antidepressants that can cause weight gain and / or make it very hard to lose weight while on them.  I know this from personal experience.

magkenmare, I am going to talk to my sister as soon as I can and then post again.  I know that my mother is doing the South Beach diet, but my sis, because she has diabetes cannot follow it to a "t".  She mentioned something like she is doing a variation of it.  Please do not perceive me as saying your daughter should do that diet.  I do really need to talk to my sister and find out exactly what has helped her to lose some lbs.  It has been over the past month to month and a half that she has noticed some weight loss.  I believe she is really watching her fat intake and carb intake, however, she is not doing anything like Atkins.  When someone with diabetes is low, we all know they need carbs and in general need a certain amt. to balance out the blood sugars when insulin is taken.  We know this disease called diabetes is a balancing act.

Every time I have seen my sis take a shot, it has been in her arm.  Honestly, I am unsure if the injection site has any bearing on weight gain or where an individual gains weight.  I am sorry.  I am certain that you will get a lot of great responses to your questions.

I am definitely going to talk to my sister, as I mentioned previously.  I do believe she is wathcing carb intake, as well as fat intake.  I do know that her weight loss has not been dur to exercise because she is not on a regular exercise routine since she has fibramialga and her legs sometimes really hurt.

I will post again ASAP.  

Although I am not a person living with diabetes, I can relate to the frustration when you do not know what to do when your weight is not where you would like to to be.  

Warm Regards,
SS

[vprrchk]

You know what magkenmare?  I would also love to know how to lose weight.  For two months now I have cut back on my fat intake to about 20 grams per day, I am exercising every day (20 minutes per day) and the whole nine yards.  Over two months guess how much weight I lost.  I didn't, I gained a pound.  Anyway, I will be waiting for a response, because I am anxious to get rid of the "junk in the trunk" :)

[JDRF-Team-LRS]

I have a few thoughts on this subject.  I'm also not a physician, but a long-time DMer.  

Two things come to mind (1) "feeding" our insulin and (2) sluggish thyroid.

I'll talk about #2 first cuz it'll be short ;-)  Many DMers also have issues with our thyroid, so I'd recommend anyone with "junk in the trunk" issues (Great phrase!) be sure to have your endo check your thyroid functioning.  Thyroid is another endocrine gland and when it's not producing all it's supposed to, I think that our metabolism is slowed.  That can lead to weight gain.

"Feeding insulin" results when we're unwittingly taking too much insulin adn therefore have to eat to cover it.  Sometimes, it shows up as going low; other times it shows up as simply eating too much all day.  When I first started pumping, I actually LOST weight ... I wasn't trying to.  In figuring out why I lost, I realized that I am no longer waking up 2-3 nights a week to drink a juice box cuz I'm low; or eating an extra snack at night to prevent going low.  Each juice box and extra snack (that I didn't otherwise want) were examples of feeding my insulin.  I think this is most common with long-acting insulins that have a peak, like Lente or NPH.  My suspicion is that Lantus, which has little, if any peak, is less likely to require feeding.

Do either of these suggestions seem like fruitful paths to look into?

As a final note, does this "junk in the trunk" look at all like similar body characteristics in adult family members?  Parents?  Siblings? Aunts, uncles or cousins?  If so, there may be some genetic component of body shape that'll be really tough to overcome.

Well, I suppose I have one more "final note" ... It may be worth while to check your BMI or your weight/height ratios.  In the US especially, there is a diseased perception of what a good weight is.  Often, folks at a healthy weight want to loose to a point where they'd be underweight.  Young women are more prone to that misperception of good health, but it's not uncommon among men.  I know a fellow who suffered that way.  I'm not suggesting that either of you are "off" in your self-perception, but I wanted to add this note for the many others who may be reading and who may not have a healthy self-perception.

I wish you well and hope that this has been of some help.

[JDRF-Team-SS]

What was posted (above) by JDRF-Team-LRS:
"I realized that I am no longer waking up 2-3 nights a week to drink a juice box cuz I'm low; or eating an extra snack at night to prevent going low. Each juice box and extra snack (that I didn't otherwise want)" makes a lot of sense!

My sister did switch from NPH to Lantus...not sure exactly when, however, I know there were and might still be times that she wakes up low during the night and munches and doesn't always even remember it until she finds something half eaten near her bed.  LOL....I am not laughing at the "night low," or diabetes, but my sis and I always laugh about the time she woke up and there were a few squashed grapes on the floor that she must have stepped on during her grape eating and the time she found a cookie in her bed.

I do know that ea. person living with diabetes is different and responds differently.  My son has never done the waking up and eating bit during the night...even before the pump when he was son humalog & NPH.  I have tested him during the night and he was (on occasion ) low and I squirted the gel frosting I keep on his night table and had him take a few sips of juice and then he went back to sleep (he was already half asleep) and I waited to re-test him.

I am going to ask my sister when she changed from NPH to Lantus and if she is still having then night lows and doing the night eating.  To be honest, I believe that she is been on Lantus for several months now and that it was hard on lantus to lose the weight that she thought she needed to. (you know...it is the "I need to get back into my normal or usual size" thing)

One thin gI do have to add about my sis who an adult living with Type 1 is that, as I mentioned, like magkenmare's daughter she is on Lantus and Humalog, but I believe that an antidpressent or similar med. may have caused some weight gain and kept her from losing even when desperately trying to.  I believe her other doc either cut back on that particular med or took her off of it.

I agree with and relate to our perceptions of ourselevs are sometimes off.

Here is a link where you can enter your current weight, height, whether you are male or female and your age range and click calculate and see what it tells you.

http://www.halls.md/body-mass-index/av.htm

and another that is a chart

http://www.med.umich.edu/1libr/primry/life15.htm

I definitely agree with LRS about your daughter having her thyroid tested if that has not been done in a while.  While searching this morning, I found the same advice.

I do understand that when you are trying to lose and nothing is happening , it can be depressing and very frustrating.  

I am on the Internet a lot and I will see my sister tomorrow to ask her what she changed in the last 2 months to help her lose some lbs. and then I will post again in hopes that it will help your daughter:)

[jdrf team dm]

Dear magkenmare and vprrchk,

SS and LRS have both given you great information. Weight gain and type 1 diabetes is a very serious problem. I would like to suggest that if it is at all possible to bring in a type 1 diabetes nutritional specialist that may help out with information that can help with weight loss.

There is another website that I would recommend dealing with this subject. It is www.childrenwithdiabetes.com/dteam/indexweight_2002.htm. This is a well known and very much respected site.

None of us here are physicians, but volunteers that can give our life experience and knowledge in dealing with type 1.

Please keep in touch and let us know how things are going.

Best to you,
dm

[JDRF-Team-SS]

Hello magkenmare,

It is SS and I am back:)  As I mentioned previously, I am not a medical professional, so my input is based on experience.  

My sister is here next to me and she is going to dictate some info. re: what helped her to lose some lbs.  She was diagnosed with Type 1 at the age of 24, 8 years ago.

I am not sure how much weight your daughter has to lose, but my sister wanted to drop a couple sizes to get down to what was her usual size.  She said she was very frustrated because some days she would eat low carb bars and a normal dinner and nothing else (unless low) and still NO Results.  My sister found this very frustrating just as your daughter does.  As we know, insulin is fat-producing.  The one thing my sis wants to mention is, if your daughter is on any OTHER medications (non-related to diabetes) possibly look at those and see what their side effects could be.  

As I mentioned, my Mom started doing the South Beach diet and what my sister has done is a modified version of it because in the beginning of the diet you are not intaking carbs and as you know people with diabetes CANNOT do this.  Here is what she did and is still doing:

She limits white flour and modifies her carb intake.  She chooses foods that are low in fat.  

For example, she might eat lowfat cottage cheese with fruit or sliced tomatoes in the a.m. depending on her BG.

For lunch, she might have a salad with cashews or some type of protein in it and pita bread with some avocado or tuna in it.  

Throughout the day she primarily drinks water, limits morning coffee to 2 cups.  She avoids eating pasta, pizza, bagels  - anything that is high fat and too much white flour.

Instead of eggs, she has egg beaters, turkey bacon instead of regular bacon.

My sister also suffers from fibramyalga (sp?) and hasn't been able to stay on a regualr exercise routine (as I mentione din my earlier post), so the recent weight los has not been due to exercise, but has to be due to her change in eating.  

There are 2 books on the South Beach Diet 2 choose from.  One tells how it works, food choices, etc. and is only around $5-$7.
The other one has recipes and my sis and my Mom did not buy that one at the beginning.  This one is approx. $12-$15.  Neither of us are saying your daughter should follow this meal plan, but the changes my sis has made have helped.

She dropped approx. 2 sizes in clothing in 2 months, so she knows the food ahcnges have helped.

My sister and I wish your daughter luck.

Please keep us informed:)

Warm regards

[J J's mom]

Hi,
Regarding injection sites and fat deposition, I have noticed that my 4 year old son has definate enlarged pads of fat over all his injection sites. I was aware that insulin played a role in fat deposition within the body, but surprised to see local deposits where the insulin had been injected.

Some Thoughts On Weight Loss with Insulin:(These are personal thoughts drawn from life and observation.I am not offering medical advice):

Regarding weight loss, I can't see that this can easily be done by a person with Diabetes, unless they make educated reductions in their insulin along with an informed and appropriate reduction in carbohydrate intake. This is so complicated for even a doc to do on someone else's behalf, and they will always be overly cautious, as it is preferable that you are a bit overweight than sick or dead!
The fat reduction is generally a red herring(type of fat matters), and will only make you feel worse if you reduce it unduly.
As I see it, one can opt for calorie control, which will make you miserable and probably regain the weight quickly,(and this would only work if  insulin was reduced aswell), or you can work along the principles of how fats and carbs are metabolised. If you take a certain amount of insulin, you must take a certain amount of carbs(feeding the insulin), and the end result will be weight maintenance or weight gain. As soon as we feed insulin with unrequired energy, it is deposited as fat.( or glycogen if you are short on the stuff.).Diabetics are regularly forced to take excess carbs to "feed" the insulin and raise the blood glucose level. Excess carbs lay down fat. Limited carbs burn body fat(but only if the insulin is appropriatly reduced).If a non-diabetic person reduces their carb intake, their insulin production is also reduced. No-one likes to suggest altering intake of insulin for fear that one might go overboard and become really sick. Ketosis could be a problem if extreme restrictions were made(Some degree of ketosis is normal if one is losing body fat). Dietary fat cannot be properly utilised in the absence or shortage of carbohydrate, and will not, therefore cause you to gain weight under these conditions.

I guess your daughter needs to work out a plan with her endo,on principles that she really understands, and that allows her to reduce insulin on a sliding scale with her proposed carb reduction and exercise plan. Increased exercise will also reduce her need for insulin, and if she exercises so much that she goes hypo, then she'll end up feeding the BG and limiting her weight loss on that day. I guess there will be some trial and error required, and it would be good to have a close buddy know what her plan is and to be there incase she overdoes things and doesn't feel well. Weight loss for people with Diabetes is tricky but it can be done.

I really sympathise with you, and hope you find a manageable and safe plan for weight control.

J J's mom

[Lesley40]

It took me so many years to understand I was feeding insulin, I can't even tell you how many. For a long-time diabetic like myself, I feel like I got a set idea in my mind of how much insulin I needed and simply stuck to it, regardless of the number of reactions, so the feeding and feeding went on. And no doctor ever mentioned cutting back on the insulin in terms of weight control.
Anyway, I now feel like I'm closer to actually taking the amount I need. But it requires a ton of testing! Wishing you much luck.
Lesley

[dagis]

Some background: I've been diabetic since I was 3 and am now 25. I got an insulin pump about 5 years ago and it makes a big difference in my ability to control what I eat. I have played competitive sports my entire life - all star ice hockey, soccer at the provincial, national and college level, mountain bike racing, snowboarding, XC running, tennis and volleyball. I now rock climb, run and lift weights.

Unfortunately, due to working on my grad degree, I put on about 25 pounds of unwanted weight. However, I discovered that by balancing my calories in with calories burned I was able to lose all of that weight.  Through reducing my food (and my insulin pump basal rate), increasing my workout times or intensities, and keeping a journal of what I ate, I lost all of the weight I desired.

Here's the trick:
1. you need to figure out how many calories you burn (your basal metabolic rate + activity level):

For women: 661 + (4.38 x weight in pounds) + (4.38 x height in inches) - (4.7 x age)= Basal Metabolic Rate (BMR)

Then add your BMR to the calories you burn during activities: look this number up on the internet - type in something like "calories burned running" (or more generally: BMR x activity level.
Sedentary: BMR x 1.15,
for light activity-normal everyday stuff: BMR x 1.3,
moderately active-exercise 3-4 times a week BMR x 1.4,
Very active-more than 4 times a week: BMR x 1.6,
Extremely active-exercise 6 or 7 times a week: BMR x 1.8

2. You need to figure out how many calories you are eating (keep a journal and write everything down)

3. If you want to lose 1 pound of body fat in 1 week, you need to reduce the calories you need to maintain your current body weight by 500 per day for 7 days (this is equal to 3500 calories or 1lb of bodyfat). 2 pounds of bodyfat per week = 1000 calorie deficit per day. Can't lose anymore than 2 lbs of bodyfat a week, most people with their activity level can only burn 1.

4. Don't drop below 1300 calories a day or you'll lower your metabolism and gain weight.

5. Most people think just becasue they exercise they'll lose weight. If you're just starting out, working out for 20 mins is great, but consider the average female will only burn about 200-250 calories during a 20 minute run. That's 1/2 a cup of granola or less than a full bagel in most cases.

6. here's my personal example I started out weighing 160, I followed the above advice and lost 2 pounds of bodyfat per week. My schedule: Monday, Wed, Fri 5:45am - 30 min weight circuit, work 7:30-5:30, 6-7 bouldering at indoor rock gym for 1 hour (get to hang out with friends and family). Tuesday, Thursday, Saturday 5:45am - 1 hour run, work 8-6, occasional walk with the family and dogs 20 mins in the evenings. At some point in time in the evenings I also worked on my thesis - so weight loss can be done even with a very busy schedule.  

7. Figure out how many calories you need to eat per day to lose your desired amount of weight in a week. Adjust your insulin according to this new eating plan. Ensure you are still getting the proper percentage of carbs, protiens, fruits, veggies and fats. Remember not to drop calories below 1300 pounds for women or you'll put on weight.

Hope this helps, good luck to all of you.

[triskit82]

I've been type 1 diabetic for 17 yrs, on tight control therapy for 16, I'm a woman and I'm a professional dancer. So the weight issue has always been a big one in my life.

You've got some good info already. However, I didn't read through everything, there were some rather long posts...so if I'm repeating anything I apologize but here's my two cents ;)

First off, insulin is a growth hormone, if you are taking more then you need, you will gain weight. So number 1 it's important to work closely with your physician to make sure your basal or base insulin is the right amount for you. (body type, lifestyle, diet and exercise all affect this)

Secondly, cutting back on unhealthy fats is good, especially since its important for diabetics to have really good cholesterol numbers. But the biggest diet change that will help to lose weight is carbohydrates. If you eat a piece of cheese or some almonds do you take a shot? no, why? because there is no carb content and what you ate will not significantly alter your BG.

Carbs are important for giving us energy, so I don't think it's healthy to cut them out completely as in the Atkins diet, but just being mindful of your carb intake can make a huge difference.

Another factor is low blood sugars. The more hypoglycemic episodes a person has, the more excess calories and carbs one is taking into their body. It also means that the body is receiving more insulin then needed. So really that's a double whammy.

For women we have a wonderful hormones called estrogen and progesterone which affects the bodies response to insulin. Now this is the tricky part, because it's different for each woman. Take me for example, I use an insulin pump and my Dr. and I recently figured out that I need 3 different patterns to go with my cycle. I have my base pattern, then I have another pattern for the week before my period and a third for the week of and after, then it's back the my base pattern.

Each pattern has a different daily base rate, low, middle, and higher, to follow my hormone cycle. Until we set this up, I was constantly up and down with my BG. One week everything would be text book perfect numbers, the next I'd be getting low more then once/day, another week my numbers would sky rocket.

Diabetes is a very complex disease, but the medical industry is learning more and more all the time and new technology is changing the face of diabetes for the better.

The important thing is to keep on truckin! Work closely with a good Dr. and a diabetes educator (can't recommend that one enough) and hopefully you can stay on top of it.