Diabetes and weight loss

Stop eating carbs? Get tested to make sure you aren't T1? Whatever's best for you at the end of the day.

Check that you are really slim.
There is a TOFI (thin on the outside fat on the inside) group where fat is clustered around the internal organs instead of being evenly distributed.
Then cut out the carbohydrates (assuming that you still eat them).
You would probably have to increase the amount of fats you eat to maintain weight.

Definitely try cutting down on the carbs and replace with just enough fats to keep your weight stable. LCHF/ketogenic style diets are NOT purely for weight loss although they get treated as such - they are also specifically intended to improve glucose levels.

Aim to balance carbs and fats consumption so that you keep your glucose levels as close as possible to pre or non diabetic levels, and at the same time to keep your weight where you want it to be. So basically try to eat just enough combined carbs and fats for your energy needs, but not so much of either that your glucose levels are too high or that your body's tucking away surplus fat for a "rainy day".

I was actually very overweight when diagnosed with T2 , although I'd spent much of my early life underweight. My GP did suggest that I lose some weight, but I started seriously reducing my carbohydrate consumption purely to reduce my glucose levels which has worked very well. Initially as a bonus I did lose a lot of my surplus weight as well, but after a few months it actually stabilized, and for most of my T2 life it has remained so. And the fact that I'm still overweight has had very little effect on my T2 - it's essentially the fact that I'm now using fat as my main fuel source instead over-indulging in carbs that keeps it under control.

Edited to correct spelling error

mkashani said:

I am truly fed up with the talk of weight loss in relation to diabetes! Almost everything I hear is about losing weight to fix/control the disease! Could any one in hell or heaven explain what do diabetics who do not have weight problem do? I am diabetic type2, I am slim, so I do not want to lose weight! What do I do ?!

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Ignore the hype about weight loss. As you've gathered by now, TOFI exists: there might be some fat around your organs, maybe marbled through your liver, and there's no way to tell without an ultrasound, because it's just not visible with the naked eye. While LCHF and Keto are usually pushed for weight loss, the main thing it does is get your blood glucose down. So don't be wary of those diets just because some fitgirl somewhere on TikTok swears by it. You'll get your blood sugars down, the fat that is compacted in places it shouldn't be should go away, and you'll be nicely in the normal, non diabetic range from there on in.

mkashani said:

I am truly fed up with the talk of weight loss in relation to diabetes! Almost everything I hear is about losing weight to fix/control the disease! Could any one in hell or heaven explain what do diabetics who do not have weight problem do? I am diabetic type2, I am slim, so I do not want to lose weight! What do I do ?!

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I know the feeling. Like you, I am T2 and slim and don't want to lose weight yet we seem to be flooded with weight-loss advice as if that was the answer to everything.

Since being diagnosed last autumn I've been on a low-carb diet (120g/day) which has brought my HbA1c down from 50 to 43 which is good but I've lost a stone in weight in the process and my BMI is now around 18 ( = definitely underweight ). I'm stuffing myself with fat and protein (meat, eggs, cheese) and fortunately, my Cholesterol is staying low (3.7) so I can do that but it just isn't doing any good. My trousers belt has shortened by two notches.

When I look up the offical advice on what to do if you are underweight, it recommends eating more carbs or, if you are elderly (which I am) to do something about your lack of appetite (what lack of appetite?).

Sorry if this comes over as not very constructive. If I knew the answer I would gladly pass it on.

You are not alone in finding a one track mind behind advice for diabetics.
Several times I have said low carb and natural fats and it has been heard as low fat with natural (wholemeal) carbs.
When the nurse weighed me on my last visit to the surgery she asked what slimming club I had joined. She said I had done well to stick to the diet. I had to restrain my laughter.

Weight loss certainly helped me get my BG numbers under control. But by far the biggest impact was building muscle. Initially I lost weight and controlled BG with weight loss and low carb - HbA1c went from 97 to 39.

Once I started resistance training and building muscle my HbA1c had dropped to 35 and I can eat most carbs within reason and not get spikes.

If you are “slim” and sure that you are not carrying too much fat around organs, focus on building muscle.

Thanks for the tip I’m feeling really bloated so I’m going to do a walk and have a look at some strength training.

I did Aqua aerobics yesterday but heard that strength training is good for people with pre diabetes

mkashani said:

I am truly fed up with the talk of weight loss in relation to diabetes! Almost everything I hear is about losing weight to fix/control the disease! Could any one in hell or heaven explain what do diabetics who do not have weight problem do? I am diabetic type2, I am slim, so I do not want to lose weight! What do I do ?!

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Get an ultrasound check for fatty liver.

Be Kind said:

Thanks for the tip I’m feeling really bloated so I’m going to do a walk and have a look at some strength training.

I did Aqua aerobics yesterday but heard that strength training is good for people with pre diabetes

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Aquarobics is excellent exercise. To quote the BHF:

• It gives you a good cardiovascular workout, gently increasing your pulse and breathing rate, so it’s great for helping to improve your heart health.
• It strengthens and tones muscles – the resistance of the water means that opposing muscle groups are worked in each movement as you push and pull against it.
• It improves flexibility, while the support of the water greatly reduces the risk of muscle and joint injuries.
• It’s a great stress reliever – the water massages and cools you, giving you a feeling of weightlessness and an enormous sense of wellbeing.

EDIT: Also, it's low impact which is good if your have joint problems.


If you like it, keep going, but look at adding something else as well. There is a lot of information on strength training on the Internet, and some of the most basic & important exercises are various types of squat. They use the biggest muscles in your body. Don't rush exercises. Do them carefully & slowly, with good control through the whole movement. There are two types of exercise for muscles - contraction, and also controlling the muscle lengthening which is known as eccentric (lengthening) muscle contraction. These are at least as powerful as normal contractions and are used a lot in exercises from physios.

"A significant body of evidence suggests that compared to concentric contractions, chronically performed eccentric contractions promote greater gains in strength, muscle mass and neural adaptations"


I do walking, and I walk as fast as I can. I'm also lucky that from my house I can walk up a couple of small-ish hills, and doing that brisky is decidedly good exercise. Walking down is good as well because pretty much the same muscles are now doing eccentric work. I have a cheap fitness tracker and aim for 7,000 steps per day - it seems that's the 'sweet spot' and past that the benefits decline. I also do Pilates once a week, and when my shoulder permits will start playing badminton again.

I'm in a similar position. Drives me insane! Also, there is no evidence of TOFI (I have had ultrasound of pancreas/liver, etc.) so I've reluctantly accepted it just is what it is. T2 for no obvious reason. Was low carbing for years before being diagnosed which is even more frustrating. Clinicians don't offer any advice. Nurse told me her normal advice is to eat smaller portions sizes but since that doesn't apply to me I should read forums and websites to educate myself! Only diagnosed 5 months ago and it was a case of "here's some metformin, not much else we can advise you on so see you in six months."

MarthaD said:

I'm in a similar position. Drives me insane! Also, there is no evidence of TOFI (I have had ultrasound of pancreas/liver, etc.) so I've reluctantly accepted it just is what it is. T2 for no obvious reason. Was low carbing for years before being diagnosed which is even more frustrating. Clinicians don't offer any advice. Nurse told me her normal advice is to eat smaller portions sizes but since that doesn't apply to me I should read forums and websites to educate myself! Only diagnosed 5 months ago and it was a case of "here's some metformin, not much else we can advise you on so see you in six months."

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AFAIK you have have TOFI without evidence on the pancreas / liver, and the only definitive diagnosis is from MRI or CT scans. And I think you have been unlucky to receive such poor support.

I think the advice to eat smaller portions might well be pragmatic - switching to (usually) no carbohydrates at my evening meal has been an 'interesting' journey. You might also be someone who is more sensitive to the carbs you eat than some of us are. I've effectively cut out rice, cous cous, pasta & potatoes.

It's not cheap in the long term, but you might find a few weeks of Continuous Glucose Monitoring helpful to find out what carbs affect you the most. There's information about them here:


Libre has a 14 day free trial, you need a suitable Android or iPhone:

CatsFive said:

AFAIK you have have TOFI without evidence on the pancreas / liver, and the only definitive diagnosis is from MRI or CT scans. And I think you have been unlucky to receive such poor support.

I think the advice to eat smaller portions might well be pragmatic - switching to (usually) no carbohydrates at my evening meal has been an 'interesting' journey. You might also be someone who is more sensitive to the carbs you eat than some of us are. I've effectively cut out rice, cous cous, pasta & potatoes.

It's not cheap in the long term, but you might find a few weeks of Continuous Glucose Monitoring helpful to find out what carbs affect you the most. There's information about them here:

Flash glucose monitors (Freestyle Libre) and continuous glucose monitors (CGM)

Update, 11 March 2025: Abbott, the makers of the FreeStyle Libre, have confirmed that FreeStyle Libre 3 sensors will be phased out in the UK by the end of 2025, meaning that people living with diabetes who use the sensors will need to transition to using FreeStyle Libre 3 Plus sensors. If you're...

www.diabetes.org.uk

Libre has a 14 day free trial, you need a suitable Android or iPhone:

Sampling | Diabetes Care | Abbott

Claim your 15 day free sensor if you have diabetes and have not tried the FreeStyle Libre 2 plus sensor before

www.freestyle.abbott

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Thank you. I have considered trying a CGM in the short term so might give it a go.