Weight Loss

[warop31]

Hi,

My Type 2 diabetes is under reasonable control, but only currently thanks to the maximum dosage of three different drugs, Metformin, Gliclazide and Sitagliptin.

My biggest current concern is weight loss, which I think may be caused by these medications - I'm hovering on the borderline with being underweight at around 10st and 6ft tall.

I know that many people suffer the opposite problem with diabetes, but for me I'd love to put a few pounds on, so any ideas would be welcome. Does anyone else have the same issue?

Thanks in advance.

 

[ianf0ster]

Hi @warop31 and welcome to the forum.
I can give you 2 suggestions as to how you could increase your weight, but I think that the first one would be bad for your health. So I have to ask - Is your weight more important than your health?

OK, your weight loss could be caused by Metformin (it's reduces appetite in some people). It reduces the amount of Glucose produced by your liver.
Gliclazide 'forces' your pancreas to produce more insulin, so in theory it could cause weight gain, but some people report weight loss though A). they are almost certainly using it in combination with Metformin. B). They are almost certainly trying to reduce weight in any case - so may be restricting either calories or carbohydrates.
Sitagliptin is thought to have no effect on weight. It causes you to pee out extra glucose and so increases the chances of UTIs (Urinary Tract Infections).

So this one I definitely would NOT do: 1. Since both Insulin and carbohydrates (in Type 2's) are both associated with weight gain (if you eat more carbohydrates), then you could switch to just insulin and eat a 'standard diet'.

My preference would be : 2. Reduce the metformin and eat more fat and protein. This will increase your calories (fat contains twice as many as carbohydrates or protein). What many have done to reverse their diabetes is to reduce their carbohydrates and replace the lost calories by increased eating of natural fat and protein since carbs increase Blood Glucose much more than proteins and fat doesn't affect Blood Glucose at all. But these people re normal or overweight and so didn't mind some weight loss. In your case you would need to increase eating fat and protein so as to be consuming more calories than before plus doing weights or other muscle building exercises.

 

[Trevor vP]

Hi,

My Type 2 diabetes is under reasonable control, but only currently thanks to the maximum dosage of three different drugs, Metformin, Gliclazide and Sitagliptin.

My biggest current concern is weight loss, which I think may be caused by these medications - I'm hovering on the borderline with being underweight at around 10st and 6ft tall.

I know that many people suffer the opposite problem with diabetes, but for me I'd love to put a few pounds on, so any ideas would be welcome. Does anyone else have the same issue?

Thanks in advance.

Have you had your A1C checked lately when sugars are running very high you can loose weight. The explanation given to me was something like this. "When glucose does not arrive in your cells your body thinks it's starving itself and finds a way to compensate it creates energy from burning fat and muscle". Reason it is not getting to cells, not enough Insulin produced by pancreas or cells are Insulin resistant.
Both options need to speak to healthcare provider.
Have you been checked if you potentially LADA or type 1.5.

 

[JoKalsbeek]

Hi,

My Type 2 diabetes is under reasonable control, but only currently thanks to the maximum dosage of three different drugs, Metformin, Gliclazide and Sitagliptin.

My biggest current concern is weight loss, which I think may be caused by these medications - I'm hovering on the borderline with being underweight at around 10st and 6ft tall.

I know that many people suffer the opposite problem with diabetes, but for me I'd love to put a few pounds on, so any ideas would be welcome. Does anyone else have the same issue?

Thanks in advance.

Losing weight isn't exactly common with those meds for a T2... What does your current diet look like, (a blow by blow of an average day'd be good) and what do you consider "reasonable control"? What numbers are you seeing before and 2 hours after meals, or what is your HbA1c doing? Because Trevor made a good point... High blood sugars can trigger weight loss, and that'd be very, very bad indeed. Weightloss may be a symptom of something that needs further investigation. Time to ask for a C-Peptide as well as a GAD test. Not saying you're a T1 or a variant thereof, but unexplained weightloss is practically always a red flag that should be taken seriously. If those tests don't turn up anything and your blood sugars are not outrageously high, it'd be wise to get a full check up.

Good luck, and keep us posted eh. (And do call your GP please. Something's fishy.)

 

[warop31]

Thanks so much for the replies so far. I'll reply to them all individually.......................

 

[warop31]

Hi @warop31 and welcome to the forum.
I can give you 2 suggestions as to how you could increase your weight, but I think that the first one would be bad for your health. So I have to ask - Is your weight more important than your health?

OK, your weight loss could be caused by Metformin (it's reduces appetite in some people). It reduces the amount of Glucose produced by your liver.
Gliclazide 'forces' your pancreas to produce more insulin, so in theory it could cause weight gain, but some people report weight loss though A). they are almost certainly using it in combination with Metformin. B). They are almost certainly trying to reduce weight in any case - so may be restricting either calories or carbohydrates.
Sitagliptin is thought to have no effect on weight. It causes you to pee out extra glucose and so increases the chances of UTIs (Urinary Tract Infections).

So this one I definitely would NOT do: 1. Since both Insulin and carbohydrates (in Type 2's) are both associated with weight gain (if you eat more carbohydrates), then you could switch to just insulin and eat a 'standard diet'.

My preference would be : 2. Reduce the metformin and eat more fat and protein. This will increase your calories (fat contains twice as many as carbohydrates or protein). What many have done to reverse their diabetes is to reduce their carbohydrates and replace the lost calories by increased eating of natural fat and protein since carbs increase Blood Glucose much more than proteins and fat doesn't affect Blood Glucose at all. But these people re normal or overweight and so didn't mind some weight loss. In your case you would need to increase eating fat and protein so as to be consuming more calories than before plus doing weights or other muscle building exercises.

Thanks for taking the time!

I've steadily had to increase the Metformin over recent years, and at no point have I felt that my appetite was affected - I currently eat three meals a day and I'm clearing my plate each time! Therefore I'm not sure reducing the Metformin would work unless I really cut back on carbs which I already to anyway. My average daily carb intake is around 50-60gms, and I have no huge desire to lower this further, and my diet is already more fat and protein oriented.

So of the two options you suggest, I'm actually more inclined to favour option 1, but I think I need to explore other things first. Interesting what you say about Sitagliptin - is that likely to make you want to pee more generally? My overnight loo visits are something I'd gladly reduce!

 

[warop31]

Have you had your A1C checked lately when sugars are running very high you can loose weight. The explanation given to me was something like this. "When glucose does not arrive in your cells your body thinks it's starving itself and finds a way to compensate it creates energy from burning fat and muscle". Reason it is not getting to cells, not enough Insulin produced by pancreas or cells are Insulin resistant.
Both options need to speak to healthcare provider.
Have you been checked if you potentially LADA or type 1.5.

Thanks for taking the time.

My last A1C came back in April at 49, and prior to that they were in the low 50's. I normally have it checked 3-monthly, but I'm running late this time - I've no reason to suspect that it will be significantly different as I do my own checks and nothing much has changed overall. I don't think my sugars are running excessively high - I've had the odd reading in the 13-15 range but those have came after I've treated myself to fish and chips or something similar, which I do once or twice a month.

I had to google LADA, so thanks for bringing that to my attention, so no, I haven't been checked for that.

 

[warop31]

Losing weight isn't exactly common with those meds for a T2... What does your current diet look like, (a blow by blow of an average day'd be good) and what do you consider "reasonable control"? What numbers are you seeing before and 2 hours after meals, or what is your HbA1c doing? Because Trevor made a good point... High blood sugars can trigger weight loss, and that'd be very, very bad indeed. Weightloss may be a symptom of something that needs further investigation. Time to ask for a C-Peptide as well as a GAD test. Not saying you're a T1 or a variant thereof, but unexplained weightloss is practically always a red flag that should be taken seriously. If those tests don't turn up anything and your blood sugars are not outrageously high, it'd be wise to get a full check up.

Good luck, and keep us posted eh. (And do call your GP please. Something's fishy.)

Thanks for taking the time! I need to just quantify my weight loss firstly - it's a loss of around 4lbs in the last month, which has coincided with me not taking the protein shake I had been taking daily, so the answer could be as simple as that? I am concerned though that it may be something else.

I'd like to gain weight regardless, as I've been stuck just on or just above the 10st mark for a number of years and I'm currently just a couple of pounds below that. I feel well, I exercise regularly, and I'm fairly disciplined with my diet, but my weight only ever seems to nudge downwards and I'd like it to go up.

My numbers after meals are rarely over 10, and are generally around 8.5 - 9.5 but that varies depending on which meal. My A1C is around the 50 mark generally, which I'm aware could be improved on, but I don't believe my numbers are "high", hence my "reasonable control" comment.

I lost around four stones in the year or two after I was diagnosed in 2013, and have remained roughly around the same since, but heading further down rather than ever being able to gain much. It's a catch 22 as always - I could try stuffing my face with carbs but that would be hugely counter-productive, so I' a bit stuck really.

I've had to google the tests you referred to, but essentially are you saying I need to be checked to make sure I'm not Type 1?

 

[warop31]

Losing weight isn't exactly common with those meds for a T2... What does your current diet look like, (a blow by blow of an average day'd be good) and what do you consider "reasonable control"? What numbers are you seeing before and 2 hours after meals, or what is your HbA1c doing? Because Trevor made a good point... High blood sugars can trigger weight loss, and that'd be very, very bad indeed. Weightloss may be a symptom of something that needs further investigation. Time to ask for a C-Peptide as well as a GAD test. Not saying you're a T1 or a variant thereof, but unexplained weightloss is practically always a red flag that should be taken seriously. If those tests don't turn up anything and your blood sugars are not outrageously high, it'd be wise to get a full check up.

Good luck, and keep us posted eh. (And do call your GP please. Something's fishy.)

Sorry, I didn't answer your diet question......................

I'm a creature of habit for two of my three meals most days;

Breakfast is always two boiled eggs and a small slice of toast - 10-12gms carbs

Lunch is generally soup with possibly a small lower carb bag of crisps, or something like smoked salmon with cheese and coleslaw. Carbs on average 20-25gms. Pre-lunch is when I'm most likely to have a low reading, so depending on that I might have 4-6 chocolate buttons with my cup of tea.

Dinner can vary - the missus always cooks but knows how many carbs to allow and it's normally around 30, with potatoes. rice, pasta only a rare sight and in small portions.

 

[Daibell]

Hi. None of those three meds will normally cause weight loss. You need to suspect you may be late onset T1 (LADA). Ask the GP for the two tests C-Peptide and GAD. The weight loss is likely to be due to the body burning it's fat as it doesn't have enough insulin to metabolise carbs. I was on those three meds with the same problem and finally was given insulin which was the right fix. So if the weight loss continues with ever rising BS do ask to be started on insulin. In the meantime have plenty of fats & proteins.

 

[muzza3]

I think the answer maybe in your responses. A healthy way to increase weight is to increase your protein. So I would reintroduce your daily protein shake or better still increase it by eating more or larger portions of meat or fish.