Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

How Can Diabetics Lose Weight?

Monday, 26 July 2010 09:34 AM

Question: How can I lose weight and when I am on insulin and other medication for blood sugar? It seems impossible.

Dr. Hibberd's Answer:

Weight loss on insulin is possible if you modify your caloric intake and combine that with an appropriate exercise program to encourage muscle maintenance and efficient calorie usage. Remember that as a diabetic, your body has a problem with glucose-management and replacing insulin when deficient.

Your body will only gain weight if you consume more calories than your body uses each day. It will store the excess unused calories as fat (the body's storage depot!). Unfortunately, some of us are less active and more prone to fat-accumulation by virtue of genetics, medication, medical condition, or just plain inactivity.

The accumulation of fat is affected by other factors that affect metabolic rate, such as thyroid hormone, genetics, medical conditions that favor or result from increased fat deposition (Type 2 diabetes), and certain medications that shift the normal metabolic balance.

Assuming you are active and healthy, muscle will usually build and maintain itself before fat deposition takes place. Be cautious about blaming insulin for your weight gain. Remember that muscle tissue is far more dense and compact than fat tissue, and muscular tissue is far more metabolically demanding and consumes far more calories than tissues containing excessive fatty deposits. In other words, lots of muscle translates into a slimmer size and an increased calorie burn. This allows you to increase the amount of food you eat without accumulating fat.

Type 1 diabetics have an insulin deficiency, are often not overweight, and do very well with insulin replacement. In general, weight gain will occur only when there is an imbalance between calories ingested and calories expended. Like anyone else, you will gain weight if your caloric intake exceeds your "burn" rate, whether or not you use insulin.

Type 2 diabetics actually have plenty of insulin on board, but suffer from insulin resistance. An example is: Fat cells require insulin to accept glucose, and as this adipocyte (medical term for fat cell) enlarges, it becomes less responsive to insulin.

The blood-glucose levels rise abnormally in the bloodstream and the insulin levels are elevated, yet less glucose is actually available to the cell without elevating the blood insulin levels. Hence, we have glucose resistance at the cell level with excessive insulin levels. This actually promotes fat accumulation, creating a Type 2 diabetic scenario. This is a special case where the problem is insulin resistance that promotes fat accumulation and generates the adverse problems identified with Type 2 diabetes. Again, weight gain only results from unused calories being directed into fat tissue.

So, do not see insulin as the prime offender. Because you need insulin does not give you an excuse to be inactive or overweight. Often, your underlying disorder improves with appropriate diet, activity, and judicious use of insulin.

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