weight gain and diabetes

[sean290873]

hi , i was diagnosed with type 1 in july this year, had lost a lot of weight before that, but while taking insulin ( apidra and lantus) i have put on weight, would be grateful if anyone could give me advice as to how to lose weight, and what to eat,

sean

 

[gem09]

hi,

I found the same thing happened to me, i was diagnosed july last year and since then i have gained 2 stone and my diet has (obviously) been better and i take a fair amount of exercise. I know that insulin is an anabolic hormone and also that fat is being spared when insulin is administered to break down glucose but I am now getting frustrated as my diet and lifestyle is good but I can't shift weight. I think the only thing is to really up the exercise regime...

 

[fergus]

Hi Sean,

Insulin is the (anabolic) hormone primarily responsible for building fat. If you want to successfully lose weight, you need to keep insulin levels low, while maintaining normal blood sugar levels.
This means a diet low in the foods which require a lot of insulin (carbohydrates) and correspondingly higher in those that don't (protein and fat).

All the best,

fergus

 

[Iambackwards]

I think the reason why type 1's find it so hard to lose weight is because when there is a lot of insulin active in your body, it blocks all the things that break down fat and helps to store fat. I'm not positive but, I think when a non diabetic eats and insulin is released from their pancreas, it takes a shorter amount of time to be cleared from their systems.

In between meals is important for weight loss because this is when the body breaks down it's stores and uses them for energy, but since a lot of the GM insulin's we use take 5 hours to get out of our system, like novarapid, there doesn't seem to be a break where there is only a small amount of insulin and the body can break down stored fat, so we lose weight.

The way I found around this is to stop taking bolus insulin. Using only basal insulin, there isn't enough insulin to stop the body from breaking down it's stores and I've found I can lose weight very quickly doing this. Since I'm not taking bolus, I have to eat a ketogenic diet which is 65% fat, 35% protein, 5% carbs. The body adapts to using fat as energy instead of glucose, by using free fatty acids and ketones as energy.

Keeping your sugar levels stable while doing this is even more important, because you'll be producing a lot of ketones for energy, but if your sugar levels are high this can lead to ketoacidosis. One thing to remember is ketones are only bad when your sugar level is high (above 7.6mmol/l) and are just a sign that your body is disposing unused energy when your sugar levels are fine.

It seems the less basal I take, the faster I lose weight, but you need to find a balance of how little you can take while keeping perfect sugar levels. The low carb diet will make you more sensitive to insulin and I also have to exercise everyday to stay sensitive enough to keep my basal injections low. I've lost 40lbs doing this I've read that Doug Burns does something similar when he lost weight to compete in Mr Universe. He is type 1 and exercises after eating carbs so he doesn't have to inject insulin, the exercise and basal insulin lowers his sugar levels after eating. You'd be surprised how little insulin you can use when you eat tiny amounts of carbs and exercise a lot.

 

[hanadr]

If you cut back a lot on your bolus, keep checking that Bg and watch out for too many ketones. It's potentially risky, but you can keep safe IF YOU KEEP CHECKING :roll: .
There have been tragedies with youngsters wanting to be stick thin and doing themselves a lot of damage. One girl lost her sight.

 

[gem09]

with the ketogenic diet does your cholesterol not increase?? I know that the exercise should somewhat balance the adverse effect but is there no danger of that happening?

 

[fergus]

Interesting.
However, type 1's are usually slim, unless of course they routinely combine a high carb diet with high doses of insulin. I don't honestly know what proportion of T1's are overweight, but I'd imagine it's probably quite low.
My experience, as a formerly overweight T1, was that significantly lowering both basal and bolus doses was possible on a low carb diet (25% of my former doses, 4 stones of weight loss) while improving bg control at the same time.
I'm a bit puzzled about stopping bolus doses and using only basal. Surely the basal doses then have to be much higher and since by definition they have a much longer half-life, insulin levels may actually remain higher through the day?
I completely agree that lowering insulin levels generally is the key to successful weight loss, whether you are diabetic or not.

fergus

 

[Iambackwards]

gem09, loads of people on the ketogenic diet actually improve their cholesterol because of such a high intake of good fats.

fergus, the idea of using just basal insulin works because you eat such a small amount of carbs and exercise a lot to keep your insulin sensitivity at it's highest. This allows you to use very low levels of basal, because on this diet/exercise regime your body requires such a small amount of insulin. Basal insulin also doesn't peak like bolus, which is what seems to be the problem when it comes to weight loss. With bolus insulin you have peaks where a high level of insulin is in your blood, but with basal it's always a slow steady release so there isn't as much at one time.

 

[fergus]

I get the idea and I also try to maintain control by eating very few carbs (only vegetables) and exercising every day. Even so, without a bolus to cover meals, I'd be experiencing much bigger fluctuations in bg numbers so I don't think your method would work for me I'm afraid.
I'm guessing you might still have some residual beta cell function which is helping to smooth out the peaks?
My basal is pretty low, 4 units twice a day, and it keeps my bg quite stable. If I increased it to cover meals, I'd surely be asking the basal to do something it isn't designed to i.e. cover the metabolism of food rather than gluconeogenesis? It would also become virtually impossible to use a correction dose to fix the odd slip-up if I didn't have some fast-acting to do the job.
Rapid acting insulins have a very short half-life, between 4 to 7 minutes so are pretty good at mimicing a non-diabetics 1st stage insulin response, while the longer acting basal takes care of the 2nd stage.

All the best,

fergus

 

[janabelle]

Hi Fergus
You speak a lot of sense regarding the low or lower carb way of managing diabetes. I've always stuggled with my weight,since being diagnosed as a skinny teenager. However I have been able to lose a bit recently by lower carbing, and it's been really enlightening for me realising that I don't need to shovel in the carbs to have enough energy to get through the day!
I've been on a basal bolus remime for years, and get infuriated when dietitians suggest I HAVE to take 3 short acting injections to cover my meals, and label me as "non-compliant" when I don't follow this to the letter. On my last visit to the dietitian I explained that for lunch I would have a no-carb soup,therefore I wouldn't need an injection. She appeared completely flumoxed, and wrote in my notes that I was not following her advice! She insisted it was important that I take my 3 short-acting injections. To advise a high carb meal, just for the sake of taking a large dose of insulin doesn't make sense to me.
The "one size fits all" attitude to diet and insulin regimes given by the NHS is crazy, as we are all very different. A more common sense attitude would enable type-1s to be more flexible with diet and lifestyle, and perhaps without piling on the pounds.
Lowering insulin levels and lowering carbs is the only way I've been able to lose weight, sensible advice Fergus.
Jus