In Control and Gaining Weight
People with type 1 diabetes face a unique challenge with weight. Frequently, when they start getting their blood glucose levels under control with insulin injections, their weight goes up. When blood sugars are high, your body becomes dehydrated, and as they come under control and your fluid balance returns, you gain water weight.
This is actually a positive development when it occurs shortly after diagnosis; it's a sign that your body is no longer attempting to flush out the glucose overload through frequent urination. This post-diagnosis weight gain also helps you recover pounds you may have lost leading up to diagnosis.
Fact
If you or someone you know is at risk for developing type 2 diabetes, getting fit can help. The Diabetes Prevention Trial found that minor lifestyle changes, including just 30 minutes of exercise daily, cut the risk of developing type 2 diabetes in high-risk subjects by 58 percent.
The Role of Insulin
Injected insulin is also helping your body to utilize glucose energy from food. Before you started treatment for your type 1 diabetes, you may have found that you could eat virtually anything to quiet your ravenous hyperglycemia-induced appetite, and you would not gain a pound. Now that you actually have the insulin to help process the glucose, you'll gain weight, a sign that you're also gaining control over your diabetes. It may also take a while for you to get your appetite back in sync with your newfound control, which can also cause extra weight gain.
Don't get too discouraged by weight gain that occurs with the start of insulin treatment. Again, it's usually a sign you're getting better, not bigger. If you continue to gain weight or become concerned about the weight you've gained so far, a strategy session with your doctor and dietitian is in order. They may be able to recommend dietary and insulin adjustments that can help bring unwanted weight gain to a halt. Sometimes a switch to a different insulin type or an insulin pump can help you to get a handle on weight fluctuations.
Essential
Better control sometimes comes at the cost of a few extra pounds. The Diabetes Control and Complications Trial (DCCT) found that as blood glucose levels in type 1 diabetes came down to normal levels, subjects gained an average of ten pounds.
Type 2 and Insulin
People with type 2 diabetes who switch to insulin injections to achieve better control over their blood sugars can also find themselves gaining weight. If you have type 2 and are already overweight or obese, weight gain can increase your insulin resistance, which in turn will increase your insulin dose requirement. It's essential to talk to your doctor about possible adjustments to treatment before you find yourself in a vicious cycle of insulin resistance and weight gain.
Type 2 Medications and Weight Gain
Some of the hypoglycemic drugs prescribed for type 2 diabetes can cause weight gain as well. Insulin-sensitizing thiazolidinediones (also called TZDs or glitazones), including Actos (pioglitazone) and Avandia (rosiglitazone), and sulfonylurea drugs fall into this category. Because TZDs can also cause edema, weight gain from their use may mean a gain in fluids rather than fat.
Alert
A number of diabetes medications can have initial unpleasant side effects related to weight loss. Metformin is notorious for its gastrointestinal side effects, and Byetta and Amylin often cause nausea. The good news is that these side effects frequently disappear with time.
On the other hand, metformin can cause weight loss in some people. If you're taking one of these drugs, your doctor may add metformin to the mix if you're experiencing weight gain as a side effect. Combination drugs can eliminate the need for two separate prescription drugs, and so may be more convenient and less costly in some cases.
For Avandia users, the combination drug Avandamet (rosiglitazone and metformin) may be prescribed; DiaBeta, Glynase, and Micronase users may benefit from Glucovance (glyburide and metformin), and Glucotrol users may be prescribed Metaglip (glipizide and metformin). Combination drugs are not an option for all type 2 patients. Talk to your doctor about whether or not they may be right for you.
A new generation of type 2 injectable drugs has also shown some capacity for encouraging weight loss. In clinical trials, the drug exenatide (Byetta; Amylin Pharmaceuticals and Eli Lilly and Company) caused an average five-pound weight loss over 30 weeks. Pramlintide acetate (Symlin) also causes weight loss for many people. However, weight loss is considered a side effect, not an indication for use, in both of these drugs.
