Losing weight on insulin

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5 Ways to Manage Your Weight While Taking Insulin

Gaining weight when you’re on insulin therapy for type 2 diabetes can be frustrating and discouraging. It may be tempting to blame the insulin — and even think about stopping it.

Using insulin can lead to extra pounds for several reasons, explains Don McClain, MD, PhD, a professor of internal medicine, endocrinology, and metabolism and director of the Center on Diabetes, Obesity, and Metabolism at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

At first, the insulin may reverse your body’s inability to use glucose from food for energy. As you become rehydrated and regain the ability to build muscle and start to store calories that used to spill out in the urine, you may “bounce back to the weight you were before the illness — or even more,” Dr. McClain says. “Changing long-held eating habits can be hard,” he adds. “You may gain weight if you eat more calories than you burn.”

Resist the temptation to stop taking the insulin in order to lose weight, McClain says. The cost to your health can be very high — uncontrolled diabetes can increase your risk of serious health problems like heart disease and stroke. And you’ll likely gain the weight back once you start taking insulin again.

Tips to Manage Your Weight

Avoiding weight gain while taking insulin plays an important role in managing type 2 diabetes. Maintaining a healthy weight can help you control blood sugar levels and reduce your risk of other health conditions. According to a study published in April 2013 in Diabetic Medicine, shedding pounds through healthy living can even help some people reverse type 2 diabetes.

The good news: Though managing your weight may seem difficult when you’re taking insulin, there are actually many steps you can take to keep the pounds off. “We’re really in a much better place in terms of things we can do to help our patients avoid gaining weight and still control their blood glucose,” says Michael Jensen, MD, an internist, endocrinologist, and obesity researcher at the Mayo Clinic in Rochester, Minnesota.

Try these strategies:

1. Talk to your doctor about your treatment plan.

You should never cut back on your insulin dose or stop taking insulin on your own. Not taking your insulin as prescribed can lead to high blood sugar and increase your risk of complications. If you’re struggling with weight gain, talk to your doctor about adjusting your treatment strategy.

Your doctor may also recommend other diabetes drugs. There have been advances in medications over the past five to 10 years that have the side effect of helping people lose weight, says McClain. Ask your doctor if these may be appropriate for you. Also confirm with your doctor that you’re not on medications that can actually cause you to gain weight, Dr. Jensen says.

2. Keep blood sugar levels steady and even.

Big swings in blood sugar can lead to weight gain, so the best approach is to try to keep levels steady, says McClain. “When blood sugar is low, you get a signal that you’re really hungry. In this situation, we teach people to have a snack containing 15 grams of carbohydrate, to bring their sugar level up.” People who tend to have frequent drops in their blood sugar may actually be overeating to treat these dips, which can lead to gaining weight, he adds.

Jensen says the goal — to the extent you can manage it — is to live in harmony with your insulin. You don’t have to eat the same exact food every day, or do the exact same activities, but it’s a good idea to aim for some regularity so your levels aren’t swinging around wildly from day to day. “That’s what can get people into trouble,” he says.

3. Count calories.

Eating more calories than you burn? That adds up to weight gain. The number of calories you need each day depends on several factors, such as your size, age, level of activity, and any other health conditions you may have — so talk to your doctor or nutritionist about what’s right for you. Your ticket to weight loss may simply involve eating fewer calories.

4. Exercise regularly.

Exercise helps to burn off extra calories. Two types of physical activity in particular are key, according to the American Diabetes Association: aerobic exercise and strength training. “Exercise not only decreases your resistance to insulin, it also accelerates glucose uptake into muscle,” says McClain. The National Institute of Diabetes and Digestive and Kidney Diseases explains that regular strength training, such as lifting weights or doing push-ups, builds muscle, and maintaining muscle burns more calories.

5. Eat about the same amount of food every day.

Skipping meals may make you feel extra hungry and cause you to overeat later on. Missing meals can also lead to low blood sugar if you don’t adjust your insulin dose. But eating smaller meals throughout the course of your day can help you keep your appetite, blood sugar, and weight under control.

With additional reporting by Andrea Peirce

Will insulin make me gain weight?

That being said, insulin is not actually responsible for weight gain – consuming more than your daily caloric needs is. However, insulin does make you susceptible for “fat gain” and changes in body composition since it’s an anabolic hormone and one of its roles is to store extra glucose consumed as fat for later use, which may or may not affect your weight depending on the amount of calories you are consuming and burning throughout the day. When a non-diabetic person eats carbs, their body automatically releases insulin so that glucose doesn’t accumulate in the bloodstream and cause hyperglycemia. Same thing goes for diabetics; only we have to take the needed dose of insulin by ourselves.

But still, even if insulin is not the reason behind weight gain, it is important to keep blood glucose levels as stable as possible in order to maintain a normal appetite, body weight and body fat percentage, because somehow it’s all related; when you control your blood sugar it means your diet has improved and vice versa. And this is achieved through the following:

  • Watching out for the quantity AND quality of the carbohydrates consumed.

Always go for wholegrain options, whole fruits and vegetables as they contain fibers that help stabilize blood glucose levels over time and keep you full longer instead of simple carbohydrates (white flour, sugar, candy bars, etc…)

8 Steps for Weight Loss Success if You Have Type 2 Diabetes

Losing weight by making small tweaks to your diet may reduce insulin resistance. Everyday Health

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Losing weight is at the top of many of our to-do lists. But for people who have type 2 diabetes, weight control is especially important. “Carrying excess body fat increases the body’s resistance to insulin, making blood glucose management more challenging,” says Sue McLaughlin, RD, CDE, a board member of the American Association of Diabetes Educators and a certified diabetes educator at Burgess Health Center in Onawa, Iowa.

According to the World Health Organization, 90 percent of people with type 2 diabetes are overweight or obese. Some research indicates that the longer someone has a high body mass index, or BMI (a common measure of being overweight or obese), the greater their risk of developing type 2 diabetes. Fat tissues are active, releasing and responding to hormones that increase the risk of metabolic syndrome, which can include diabetes. But losing even 10 to 15 pounds can make a big difference in improving your health and blood sugar levels.

Anyone who’s tried to lose weight — and keep it off — knows it isn’t easy. It is possible, and the benefits for people with diabetes are great, but how do you get started? Experts say the right way to lose weight is to incorporate a healthy diet into your overall diabetes management plan.

How Does Weight Loss Affect Type 2 Diabetes?

Here’s how to get started on the path to weight loss success.

1. Set small and realistic goals

Losing the weight is one thing; keeping it off is another. While everyone wants to see the pounds fall off in the first days of a diet, drastic diets and extreme exercise plans aren’t sustainable. Try to focus on changes you can maintain for the long haul.

“Don’t try to transform your body all at once,” advises McLaughlin. “That can be a recipe for failure.” Instead, set small, realistic targets, such as walking around the block four times a week or having dessert only on the weekend rather than every day.

After these goals become habits, move on to your next objective. You’ll have a feeling of accomplishment as you progress toward your ultimate weight loss goal. And remember that setbacks happen to everyone, so don’t give up!

2. Get active

Studies suggest that diet is hands-down the most important factor for losing weight, but exercise is key to successfully keeping the pounds off over time. “Research shows that people who increase physical activity along with reducing calorie intake will lose more body fat than people who only diet,” says McLaughlin.

One small study published in March 2019 in Obesity found that exercise was actually more important than diet for weight loss maintenance among people who lost 30 or more pounds. Just look at the National Weight Control Registry (NWCR), a database of 10,000 men and women who have lost a significant amount of weight and kept it off: About 90 percent of people who reached and maintained their weight loss goal said they exercise, on average, about an hour a day. Most people in the registry chose walking as their form of exercise.

Aim for 150 minutes of moderate exercise per week, or 30 minutes per day at least 5 days a week. And remember, fitness doesn’t necessarily have to involve sweating for hours at the gym. Try to find ways to stay active throughout the day. To hit the American Diabetes Association’s (ADA) goal of watching less than 10 hours of TV per week, take a 10-minute walk around the block after dinner instead of hitting the couch. Park farther away from each destination to add more steps, and take the stairs when possible. All of these incremental changes can make a big difference over time.

3. Schedule your meals, including breakfast

A common characteristic among the NWCR participants is that most of them ate breakfast. Skipping breakfast is thought to possibly lead to overeating later in the day, which can sabotage weight loss plans and cause blood sugar levels to fluctuate. People who eat breakfast may also have more energy to stay more active throughout the day.

The importance of a morning meal for weight loss has been debated. One meta-analysis published in September 2014 in Advances in Nutrition showed that eating breakfast was associated with better weight loss, but another review of studies, published in January 2019 in BMJ, found that breakfast may not always lead to weight loss. Still, the ADA recommends eating breakfast every day. Experts say an effective diabetes diet involves eating three meals at regular times of the day to help the body better use insulin.

Breakfast should include fiber-rich, healthy carbohydrates, such as whole grains, fruits, and low-fat dairy, to help keep blood sugar levels in check. Always review labels before you buy packaged foods, and skip cereals and other breakfast foods with added sugar.

4. Cut calories

Eating too many calories and too much fat can raise blood glucose levels. Cutting back on calories is key to losing weight.

It’s a good idea to work with a registered dietitian or diabetes educator to figure out a diet plan that works for your lifestyle, goals, and tastes. They can help you find the right number of calories to consume, depending on a number of factors — age, gender, current weight, activity level, body type — while managing your blood sugar levels.

5. Feast on fiber

Cutting calories isn’t always easy, especially if you’re hungry shortly after you finish your meal. Enter fiber: Your body can’t break down this plant-based carbohydrate, so it slows the digestion process as it moves through your system, which helps control blood sugar levels.

Foods that are high in fiber tend to be lower in calories, so you can eat a larger volume than other foods for the same number of calories. Since they take longer to eat and digest, they can help you feel fuller for longer. A study published in June 2019 in The Journal of Nutrition shows that people who eat more fiber are better able to stick to a lower calorie diet and lose more weight.

According to the U.S. Department of Agriculture’s (USDA) 2015-2020 Dietary Guidelines for Americans, women 31 to 50 should aim for at least 25 grams of fiber daily, while men in that same age range should eat about 31 grams. With age, calorie and nutrient requirements drop; women 51 and over require about 22 grams daily, while older men need at least 28 grams.

Most of us don’t get anywhere near the USDA’s guidelines. Try to find ways to incorporate fiber-rich foods, including whole grains, vegetables, fruits, legumes (beans), and nuts into more meals. Add chickpeas and black beans into salads, soups, and chili. Toss spinach into pasta sauce. Or snack on an apple with a tablespoon of nut butter.

6. Keep track of your goals and progress

Writing down the details of your weight loss journey helps you set healthy targets and notice patterns. You’ll be able to appreciate your progress over time, as well as notice when your diet might have gotten a bit off track.

Try jotting down all of the foods you eat, including the serving sizes, in a journal every day. Not a fan of pen and paper? Try one of the many free apps. It’s a good idea to weigh yourself at least once a week, per your doctor’s or diabetes educator’s recommendation, to keep track of your progress. You might also want to write down when you exercised, what you did, and how you felt after.

7. Get support

Staying motivated to stick with a weight loss plan can be difficult when you’re going it alone. Connecting with others can provide the emotional support you need to avoid giving up. Many weight loss programs are founded on the concept that support networks aid motivation.

Keep in mind that support comes in many different forms. “For some people, online support groups can be just as effective , as well as more convenient and less costly,” says McLaughlin.

8. Use tricks to prevent overeating

These sneaky strategies can help keep you from overdoing it on diet-damaging foods.

  • Fill up on low-calorie foods first. “Start every meal with the foods on your plate that are lowest in calories,” suggests McLaughlin. Non-starchy vegetables make the perfect low-calorie starter. By the time you get to the other foods, you won’t be so hungry.
  • Change your salad dressing system. Instead of sprinkling or pouring dressing on your salad, dip your fork into a side dish of dressing and then your salad with each bite. You’ll be amazed how much less you use and how many calories you save.
  • Take up a busy-hands hobby. If you’re idle, you’ll be more prone to eating when you’re not really hungry. Keep busy with activities like walking, knitting, scrapbooking, doing crossword puzzles, or gardening.
  • Carry a toothbrush and toothpaste. Keep them in your purse or briefcase. When cravings hit, brushing your teeth with peppermint-flavored toothpaste can dampen your desire to eat.
  • Arrive fashionably late to parties. Without as much time near the buffet table and calorie-rich appetizers, you’ll likely eat less.

It’s important to continue to eat healthy and exercise regularly even after reaching your weight loss goal. That’s why it’s so important to set realistic goals from the get-go: The healthy habits you initiate to lose weight should last a lifetime so you can keep it off.

Additional reporting by Colleen de Bellefonds

Losing Weight While Taking Insulin

When my friend and #SocialDiet compatriot Scott Mowbray wrote about solving for X to lose weight, he’s talking about the math required to take off pounds. Simple algebra: Calories consumed minus calories burned = X, where X is the caloric difference. If it’s a negative, you lose weight.

This formula is actually what most weight-loss advice is based on. Sure, you need support, the right environment, inspiration and dedication. But to really remove the pounds, you gotta burn more than you eat.

Struggling to cook healthy? We’ll help you prep.

Sign up for our new weekly newsletter, ThePrep, for inspiration and support for all your meal plan struggles.

If solving for X is simple algebra for a normal overweight person, solving for X is quantum physics for someone on an insulin pump. And I’m learning quantum physics on the fly.

I have had diabetes for nearly 15 years. I have a version of the disease often called type 1.5 (latent autoimmune diabetes of adults). It started out as classic type 2 diabetes—even though I was athletic and of normal weight. Over the years I’ve progressed to the point where I take insulin for every meal. (I will always take insulin—this is not a disease you can put into remission. But my old pancreas is probably still pumping a little insulin out. Losing weight and eating healthier could reduce the amount of insulin I’m taking.)

Last year I got an insulin pump, which allows me to inject doses when I eat. The pump also injects insulin at a particular rate over the course of the day. It has taken me nearly a year to get the pump and my body in sync. Our bodies, unfortunately, are not computers. They react to stress, to hormonal and emotional changes, to illness—even to seasonal changes. And that can throw off the carefully calibrated insulin doses doled out by my pump.

Habitual behavior—eating the same foods and exercising the same way at the same times—makes managing diabetes (types 1 or 2) easier. The body gets into a predictable rhythm. But changing rhythm can have substantial challenges.

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Since I started my weight-loss effort, these lows are occurring several times a week. Fortunately, I have a lot of experience dealing with the highs and lows of diabetes. And I test my blood sugar levels regularly to head off these problems and recalibrate. Still, it makes losing weight all the more challenging.

But being overweight with diabetes is far worse than dealing with a few hypoglycemic reactions. Whether it’s type 1, 1.5 or 2, being overweight can be a killer. It increases our already high risk of heart disease, the top complication of diabetes. It increases the risk of hypertension. And it makes managing diabetes more difficult.

I can deal with my blood sugar going low occasionally. What I don’t want to deal with: the complications of diabetes. That’s why solving for X has become more important as I’ve gotten older and my disease has progressed.

What are your unique weight-loss challenges? Share your experiences—comment here, email [email protected] and tweet @Cooking_Light using #SocialDiet.

Weight loss and diabetes

Weight is a sensitive issue for many people and getting to an ideal, healthy weight is easier said than done. But when you have diabetes, there are huge benefits to losing weight.

You’ll have more energy, feel better in yourself, and you’ll reduce your risk of serious complications like heart disease and stroke.

And if you have Type 2 diabetes, losing weight could even mean going into diabetes remission.

But millions of people with diabetes find keeping to a healthy weight a huge struggle – you’re certainly not alone. If you feel overwhelmed with your feelings about food and diabetes, we have plenty of information to help you.

Around 60% of people with Type 1 diabetes and around 85% of people with Type 2 diabetes are overweight or obese.

You’ve come to the right place. We’ve put together this weight loss guide to help you get started and stay motivated. You can use these links to skip to the information you need:

  • The benefits of losing extra weight
  • What’s a healthy weight to aim for
  • Diabetes diet plans to help you lose weight
  • Download your weight-loss planner
  • Your feelings about food
  • Being active to help with your weight loss journey
  • Weight loss surgery.

Benefits of losing extra weight

There are so many benefits to losing extra weight – both physically and emotionally.

Extra weight around your waist means fat can build up around your organs, like your liver and pancreas. This can cause something called insulin resistance. So losing this weight could help the insulin you produce or the insulin you inject work properly.

And as you start to lose weight and get more active, you and your healthcare team may need to look at your medication, especially if you treat your diabetes with insulin or sulphonylurea. This might mean reducing the dose or making other adjustments, but talk to your healthcare team about it. For some people, needing fewer diabetes medications is a great motivation for losing weight.

Although getting Type 1 diabetes has nothing to do with weight, losing any extra weight will help you reduce your risk of complications and could mean injecting less insulin.

And if you have Type 2 diabetes, losing around 15kg could even put you into diabetes remission. This could mean coming off your diabetes medication completely – a life-changing possibility. This is even more likely if you lose the weight nearer to your diagnosis and quickly – it’s a myth that losing weight slowly is better for you.

Most people say they also feel better in their mood, have more energy and sleep better.

“We know that losing even 5% of your weight helps improve blood pressure and cholesterol levels. This can have a big impact on your overall health and go a long way to reducing your risk of serious complications, like heart disease and stroke.”

Douglas Twenefour, our Deputy Head of Care and dietitian

What’s a healthy weight to aim for?

Before you get started, you need to know what a healthy weight is and what numbers you’re aiming for. This is about working out your Body Mass Index (BMI) and your waist size.

Know your weight

Research shows that the more weight you lose, the greater the health benefits, but even losing just 5% of extra weight will improve your health.

BMI uses your height and weight to work out if you’re a healthy weight. It doesn’t look at how much fat you have around the middle, so that’s why you need to measure your waist too. You can work your BMI out for yourself using this NHS tool – it will show you your target range.

For many people who are overweight, aiming for a healthy BMI may not be realistic.

Know your waist size

A healthy waist size depends on your gender and ethnicity. It should be:

  • less than 80cm (31.5in) for all women
  • less than 94cm (37in) for most men
  • less than 90cm (35in) for South Asian men.

Here’s our community champion Rohit to show you how to measure your waist.

Diabetes diet plans to lose weight

There is no such thing as a special diet exclusively for people with diabetes. There are a lot of different ways to lose weight – but there’s no one-size-fits-all diet.

It starts with finding a way to eat fewer calories than you need.

A calorie (or kcal) is a unit of energy, which is in the food and drink we consume. Your body uses energy for everything we do – from breathing and sleeping to exercising. When you eat, you’re replacing the energy you’ve used, which helps you to maintain a healthy weight.

As a general guide, government recommendations are that men need around 2,500kcal a day to maintain a healthy weight, and women need around 2,000kcal a day. But most people need different amounts of calories based on how their bodies work, how active they are and any weight management goals.

We’ve put together some 7-day meal plans to help you lose weight. They’re all clinically approved, nutritionally balanced, calorie and carb counted, and can help if you want to lose weight:

  • Low-carb diet plan
  • Mediterranean diet plan
  • Lower-calorie diet plans, like 1,200 or 1,500 calories a day

Evidence shows that the best approach is the one that you’re likely to stick to. So the key is to find a plan that you enjoy and fits in with the rest of your life. Everyone’s different and what works for some may not for others.

Low-calorie and very low-calorie diets

A low-calorie diet is made up of between 800 to 1200 calories a day – our DiRECT study used a low-calorie diet of around 850 calories a day. But DiRECT is not a diet. It’s testing a weight-management programme, delivered in GP practices.

Then there’s a very low-calorie diet, which means having less than 800 calories a day.

We haven’t created low or very-low calorie meal plans as these could be challenging using foods. Most people who follow these diets use special meal replacement products which are nutritionally complete. If you chose to try a low-calorie diet like the one in DiRECT, speak to your GP or nurse first, especially if you use medications like insulin.

Other diets

A low GI diet can help you manage your blood sugar levels, but the evidence for people with diabetes losing weight is not very strong.

There are other popular diets, like intermittent fasting (such as the 5:2 diet) and the Paleo diet. Unfortunately there isn’t enough strong evidence to say these are effective for weight loss in people with diabetes either.

Commercial weight-loss programmes

Some people feel that they need more support and choose to join a commercial weight-loss programme. These usually involve calorie-controlled eating plans or meal replacements, like milkshakes or bars.

It’s really important to ask lots of questions about these programmes, so you’ve got all the evidence and information you need to make an informed decision. Here are some ideas:

  • Has a healthcare professional been involved?
  • Does the programme offer advice on your diabetes (especially if you’re at risk of hypos)?
  • Are you getting all the nutrition you need from this programme?
  • Does the programme give support and education?

Weight-loss planner

“I keep a daily diary and log my weight and activity. It keeps me accountable and focused.”

Edward Morrison

You can download My weight-loss planner (PDF, 534KB) to set goals and track your progress. By putting a plan in place and noting down your progess, you’ll be able to see the positive changes you’re making.

Your feelings about food

The emotional part of trying to lose weight is important and can often be overlooked.

Do you feel guilty when you eat a treat? Do you eat more when you’re upset? Do you feel dejected if you can’t see progress straight away?
These are really common feelings and tackling them can help you on the road to a healthier lifestyle and a healthy weight.

Find out more about your feelings about food and diabetes.

Connect with others and share tips in our online forum – we’ve made a board especially for people who are looking to lose weight.

Being active for weight loss

Regular physical activity has many health benefits and will help you in your weight loss journey. We’ve got more information about how much activity you should be doing and different ways to get active.

But before you start any new physical activity, speak to your diabetes team. They can make sure you have all the information you need about how your diabetes might be affected. Especially if you treat your diabetes with insulin or certain diabetes medications like sulphonylureas, as being more active may increase your risk of hypos.

Your diabetes team will support you to make the right adjustments to your medications to reduce your risk of hypos.

Weight loss surgery

There’s strong evidence that having weight loss surgery (also called bariatric surgery) can also help people with diabetes lose weight, manage HbA1c better and increase the chances of putting Type 2 diabetes into remission.

Top 5 tips for losing weight

  1. Set clear goals and monitor your progress.
  2. Choose the diet that fits your lifestyle – you’re more likely to stick to it.
  3. Get support from your healthcare team, and talk to family and friends about how it’s going and how you’re feeling.
  4. Plan ahead and think about how special events and holidays fit into your long-term weight loss plans.
  5. Reward yourself for achieving short-term goals, and get support to cope with setbacks.

We’ve got lots of information to help you maintain a healthy weight too, to help keep you on track and prevent putting weight back on.

Losing weight can be difficult for anyone, and living with type 1 diabetes definitely doesn’t make it easier. However, there ARE people who set out to lose weight and end up so extraordinarily successful that you wonder if they have some inside information you don’t.

That information EXISTS. I’m here to give you the rundown on how to lose weight with type 1 diabetes (actually, most of the advice is relevant for people with any type of diabetes).

Without further ado…let’s GET TO IT!

Table of Contents

Temper expectations at the start

Most people have this intense need for instant gratification. They want that 15 lbs gone by yesterday! While I’m all for efficiency, I’m going to be short and sweet and show reality with a pop quiz:

True or false: it took more than a week to gain the weight you are trying to lose.

The answer is undeniably “True”. So if it took you X number of months to gain weight, why would it take you a week or two to lose it?

It doesn’t. It takes time and some concerted effort. Don’t expect to lose all of the weight immediately, but know that with proper habit formation and consistency, you WILL see the results you are after.

The general rule for healthy weight loss is to aim for A MAX of 1-2 lbs. per week.

It’s also quite common for people living with diabetes to take as long as 2-3 weeks before seeing any weight loss at all on a new diet.

“Why?” you ask.

Changing caloric intake and workout routines may require a reduction of insulin (or other diabetes medication) as well as diet manipulation, which takes a little trial and error to adjust.

BE PATIENT.

Once the ball is rolling, a slow and controlled weight loss makes it much more likely that the weight will come off and STAY off than if you crash dieted and lost a lot of weight quickly.

To learn more about setting realistic goals, read “How to set Realistic Diabetes and Fitness Goals and Find Your Positive Motivation”.

How many calories should you eat?

Weight loss can be summed up as follows:

Calories in (eating) < Calories out (burning) = weight loss.

From a thermodynamics standpoint, if you are eating fewer calories than you are expending, you should THEORETICALLY lose weight. No system is perfect, but this is the general premise.

However, this whole “eat less than you expend” advice gets blown out of proportion quite often as you see people slashing their diets to nearly nothing or eating just grapefruits all day. This will work in the very short term, but will seriously decrease your metabolism while you mostly lose water weight that will come right back when you finish your diet.

The first step in any weight loss program is, therefore, to calculate how many calories you should eat per day for a healthy weight loss.

Luckily, there is a guide here on Diabetes Strong that explains how to do this in 5 easy steps. So before reading on, please go to “How to Find Your Daily Calorie Need” and calculate your daily calorie need. Then come back here and continue this guide.

How about protein, carbs, and fat?

I’m not going to stand here and tell you that there is only one way to lose weight with type 1 diabetes. I’ve had experience losing weight on a high carb diet, low carb diet, and moderate carb diet.

They’re all predicated on the aforementioned “calories in, calories out” equation.

But, a couple of tips to consider as you plan your diet:

Protein is helpful in satiety AND retaining muscle mass

In other words, protein will help keep you fuller for longer after meals, which is key in a situation where you are eating less than you may be accustomed to normally.

Additionally, when people lose weight, the composition is typically 75% fat and 25% muscle1. However, a higher protein diet has been linked to a reduction in the amount of muscle lost during a caloric deficit.2

I could go on and on all day, but I’ll leave you with this:

Recommendation: Aim to eat 0.5-0.8 grams per pound of bodyweight per day. It will help you keep your hard-earned muscles while losing weight. So if you weight 200 pounds (91 kg), you should aim for 100-160 grams of protein per day.

Note: If you suffer from kidney disease or have any history of kidney problems, increasing your protein intake may not be recommended.3 Always consult your medical team before making major dietary changes.

Carbs and Fat are FRIENDS (and food)

So many people fear fat and carbs. It is too bad people won’t give them a chance and get to know them…

…and recognize that there is NOTHING scary about them, they deliver a great deal of benefits, and they are delicious!

Carbs are great for those quick bursts of energy you need during a workout. They also provide fiber, which is critical for digestive health and increasing satiety.

Fat will come in handy during a long, sustained workout as the primary energy source. Fat also provides omega-3s, which are useful for anti-inflammatory effects as well as visual acuity, and additionally is the building block for hormones, like testosterone and estrogen.

The keys are the sources from which you get them. Try to stick to the whole food, lesser processed varieties of fat and low-glycemic carbs, rather than the Frankenfoods that have been sitting on the shelf at the grocery store for ages.

The other key is HOW MUCH of each to eat.

At the end of the day, it truly comes down to what works best for you and your blood sugar management. Maybe fewer carbs work for you but more carbs work for me.

But, after determining calorie and protein needs, try to partition the remaining calories pretty evenly for fat and carbs.

For example, if your calorie requirement is 2000 per day and your protein needs require 800 calories, try to split the remaining 1200 calories evenly between fat and carbs (600 calories each) and work from there to determine the optimal amount for you and your goals.

Exercise is great, but nutrition is the key

Raise your hand if you’ve heard the saying “you can’t out-train a bad diet.”

Maybe you’ve heard it, maybe not. Either way, it is very true. It’s really difficult to overcome a poor nutritional intake. Really, REALLY difficult.

Don’t get me wrong. Exercise is CRUCIAL for a healthy lifestyle and for a successful weight loss initiative. It provides a ton of benefits that otherwise wouldn’t be attainable. But, in isolation, exercise alone will not result in as much weight loss as dieting will.4

However, what if we…dare I say it…utilize BOTH?

Both anecdotally and in the research, combining diet and exercise will result in the best outcomes while also setting you up for sustained success, as ideally, this weight loss should kick off a lifestyle change.

How much should you exercise, and what type of exercise?

If you are just starting out, you don’t want to go from 0 to 100 real quick, because you may burn out or get discouraged. I recommend a combination of resistance training and cardiovascular training for optimal results.

People overlook resistance training in the context of weight loss. This is what is going to help you KEEP your hard-earned muscle mass during the calorie reduction.

Guess what?

That muscle mass will keep your metabolism firing. Your metabolism firing means you’ll burn more calories ALL the time, working out or not!

Recommendation: Make resistance training a STAPLE in your exercise program. For help in designing your first routine, check out my post about how to design a resistance training program.

Combine this with some form of cardiovascular training multiple times a week for 20 minutes – get creative here and find something you enjoy – and you’ve got a recipe for success on the exercise front.

I love insulin…and you should too

When people first are diagnosed with type 1 diabetes, they typically start taking insulin. When they start insulin, they typically gain weight. Therefore, insulin is often associated with weight gain.

Insulin is necessary for people with type 1 diabetes to live. You already know this.

What you probably don’t realize, however, is that insulin is not what is causing weight gain. What causes weight gain is a hamster wheel of blood sugar control issues:

Low blood sugar → correct with carbs (aka calories) → overcorrecting leading to a high blood sugar and a correction bolus → too much insulin → low blood sugar…

The cycle is like a roller coaster that you just can’t get off, seemingly forever. You’re eating more calories than expected for your goals, and suddenly, BAM! There are a few pounds you did not plan to gain, or your weight loss goals derailed.

Yes, insulin is a part of the equation, but not THE WHOLE equation.

I get it: low blood sugars can be tough, and some of them you make you want to eat the whole fridge. But, for lows and weight loss, consider the following idea:

  • Keep a “carb/calorie reserve” for lows. If your calorie goal is 2000 per day, consider eating 1900 and leaving those last 100 calories for treating lows. If you end up low, you’ve already built it into your goal as opposed to exceeding it.
  • See your blood sugar trending downwards? Consider a decreased temporary basal insulin (if you use an insulin pump). The exact amount for basal decrease is determined through trial and error, but it could ultimately lead to fewer calories consumed to treat your low.

All in all, don’t worry about how much insulin you’re using – worry about keeping your blood sugars in great control and preventing lows, and the insulin amount will take care of itself.

To learn more about the best ways to treat lows, read “How to Treat a Low Blood Sugar (Without Eating Everything in Sight)”.

Summary

This journey may seem daunting, but just remember, slow and steady wins the race. Develop good, healthy habits with diet and exercise, focus on optimal blood sugar control, and stick to your calorie goal – the rest will all fall into place.

To lose weight with type 1 diabetes:

  1. Set realistic goals
  2. Calculate your daily calorie need and create a calorie deficit
  3. Consume enough protein and split remaining calories between carbs and fat
  4. Perform a combination of resistance and cardiovascular training
  5. Don’t be afraid of insulin. It doesn’t cause weight gain
  6. Strive to maintain good glycemic levels and have a plan for dealing with lows without over-eating
  7. Be patient! Healthy and sustainable weight loss takes time

You got this!

Suggested next posts:

  • Diabetes and Polyphagia (Excessive Hunger)
  • How to Stop Binge-Eating During Low Blood Sugars

If you found this guide to diabetes and polyphagia useful, please sign up for our newsletter (and get a free chapter from the Fit With Diabetes eBook) using the form below. We send out a weekly newsletter with the latest posts and recipes from Diabetes Strong.

March 8,2013— — At age 14, Erin Williams was tired of medicine. Williams was diagnosed as a type 1 diabetic at age 11, and after three years of enduring a never-ending regimen of insulin shots and strict diet restrictions, she was frustrated.

Embarrassed by her disease, she kept it a secret from everyone but her closest family and friends. At birthday parties, she made up excuses about why she couldn’t have soda or cake. When a classmate saw her drinking juice boxes in the nurses office, she endured weeks of being called the “juice box thief” rather than just tell her classmates she had low blood sugar because of diabetes.

Eventually, Williams rebelled the only way she could, she decided not take her insulin. She just didn’t want to adhere to the strict diet and medical regimen even though it was vital to her health.

“It wasn’t this dramatic moment,” recalled Williams. “It was mostly like I want to be like everybody else.”

The next morning when Williams woke up, she felt fine.

“Well, nothing bad happened to me,” Williams remembered thinking. “It creeps up on you. That’s how it does it.”

Emboldened by her experiment, she continued to restrict her insulin. Without a regimented amount of insulin in her body to process glucose, Williams’ body started to burn through fat and muscle. She lost weight very quickly even as she ate all the same foods. Classmates started commenting on her weight loss and remarked that she looked great.

“You hear all these things and you’re like, ‘This is the greatest thing in the world,'” said Williams. “It takes a hold of your life like nothing else.”

After living with type 1 diabetes for three years, Williams was exhibiting the first signs of a disorder often called diabulimia. The term refers to the dual diagnosis of type 1 diabetes and an eating disorder.

Many type 1 diabetics with eating disorders will not take their prescribed insulin so they can lose weight. Deprived of insulin, the body cannot break down sugars from food to use as energy. Instead the body’s cells break down fat already stored and try to flush out the excess sugar through the urine.

While it leads to weight loss, it can also lead to nerve damage, damaged eyesight, kidney damage and osteoporosis, among a host of other ailments.

A study from 2007 that followed diabetics who restricted their insulin over 11 years found their mortality risk was three times higher than those who did not restrict their insulin.

While anorexia or bulimia are familiar terms, diabulimia is little known, even though it can affect a significant portion of the type 1 diabetic population. Studies and research into diabulimia are not comprehensive, but a 1994 study found that up to 30 percent of type 1 diabetic women will intentionally stop taking their insulin at some point in their lives to lose weight.

When Williams was diagnosed with type 1 diabetes at age 11, she became one of the approximately 3 million Americans to suffer from the autoimmune disorder in which the pancreas does not produce insulin. According to the Juvenile Diabetes Research Foundation, 30,000 Americans are diagnosed with the disease every year.

Her diagnosis also meant that her chances of developing an eating disorder more than doubled. A study from the University of Toronto found that adolescent girls with type 1 diabetes were 2.4 times more likely to suffer from an eating disorder than girls without diabetes.

Ann Goebel-Fabbri, a clinical psychologist and assistant professor in psychiatry at Harvard Medical School, has worked with many type 1 diabetic patients suffering from eating disorders at the Joslin Diabetes Center.

She said that there isn’t a clear reason why type 1 diabetics have an increased risk for having an eating disorder, but she suspects that part of the problem is the way diabetics have to focus on food intake, their carb level and calories.

“The treatment itself paying close attention to food and time of eating,” said Goebel-Fabbri. “Oftentimes, that can mirror an eating disorder mindset.”

In high school, the effects of Williams’ diabulimia began to show.

She was constantly dehydrated because her body was trying to flush excess sugar through her urine. At night, she would go to the bathroom up to 20 times a night and was known for constantly carrying a two-liter bottle of soda with her at all times.

With her blood sugar running so high, Williams was also often sleepy and fell asleep in class. During her senior year, she was voted “Most Likely to Fall Asleep at Graduation.”

When she went to the doctor with high blood sugar levels, she made up excuses that she had forgotten to take her insulin or that she had injected it improperly.

“All I heard from doctors is ‘Why, can’t you manage this? … Is it that hard?” Williams said.

She said they never mentioned that she might be suffering from an eating disorder.

Diabulimia can be terrifyingly easy to hide. Williams could eat as much as she wanted and lose weight. Her other symptoms of fatigue and irritability could be explained as the normal behavior of a teenager.

Amy Criego, the chairwoman for pediatric endocrinology at the International Diabetes Center, said that the symptoms for diabulimia closely mimic poor diabetes control.

“Sometimes it gets hard to distinguish what’s going on,” said Criego, who added doctors can be wary of bringing up eating disorders with adolescent patients. “People get cautious of asking because they don’t want to give them ideas either.”

Eventually, in her junior year of high school, Williams’ family recognized that she was suffering from an eating disorder and put her in an eating disorder treatment center.

However, Williams said, the counselors at the center weren’t used to treating a type 1 diabetic and never monitored her insulin intake.

Even in treatment, whenever she started to gain weight she would simply reduce her insulin intake again.

“People with this combined diagnosis team with eating disorder people and a diabetes education staff. That’s the ideal,” said Criego. “The treatment is very different.”

Another problem is that common eating disorder treatments can conflict with basic diabetes care. For example diabetic patients have to pay careful attention to what they eat and how their body reacts to food, while eating disorder patients are encouraged to ignore food labels.

“A lot of the eating disorder programs take the focus off of food, you have to ignore your body perception,” said Criego. “You can’t do that with type 1 diabetes. You have pay attention to numbers.”

Goebel-Fabbri said that some diabetics who have reduced their insulin intake can become fearful of taking the drug again.

“They have a lot of hunger signals because, on the cellular level, the cells can’t access sugar. So the cells are starving. The body is starving,” said Goebel-Fabbri. “That has further their appetite and eating behavior. I think that then adds to the fear that if they take this insulin, their hunger is going to be really high and ”

Williams spent her junior and senior years of high school in and out of eating disorder clinics.

When Williams would start to use her insulin consistently, her body would swell with water weight. The temporary swelling, which was the result of her body trying to hold on to water after being dehydrated, could mean that Williams gained as much as 20 pounds of water weight. Her legs swelled so much that the skin looked like “putty.”

“I couldn’t bend my leg,” said Williams. “I thought I was going to say like that forever.”

The swelling was temporary, but it made Williams too scared to stick with her insulin regimen for any length of time.

Dawn Taylor, a licensed psychiatrist at the Melrose Center who treats people suffering from eating disorders and is affiliated with the International Diabetes Center, said many patients with diabulimia initially feel worse when they retake their insulin.

“Once they start taking care of themselves, that’s when the complications can start,” said Taylor. “You can get over a lot of these complications it’s not very rewarding.”

In college, Williams became so fatigued she spent most of her days asleep in bed.

Now over 18, Williams’ parents couldn’t force her into treatment anymore.

“What could my parents do? I’m sitting there telling them I’m fine,” she said.

In 2007, Williams went to the doctor with a swollen ankle. After an x-ray showed no fracture, Williams was sent home with medication. Six months later, Williams fainted suddenly and was rushed to the hospital with her ankle sizably swollen again.

She was sent into the operating room to clear out the infection from her ankle. But after the doctor made the incision the medical team realized her ankle was not just infected but shattered.

Because of nerve damage from high blood sugar levels, Williams had been walking around on a broken ankle for months without even realizing it. Her ankle was so damaged she would have to remain in a cast for two years as it healed.

After a decade of insulin misuse, Williams, then 24, was suffering from osteoporosis. Sitting in the hospital bed, Williams finally decided she needed help.

She remembered thinking, “This has got to stop or I’m going to have medical issues for the rest of my life.”

But in order to get help, Williams had to fashion a makeshift treatment team, which included a psychiatrist specializing in anorexia and bulimia, another counselor and a diabetes expert, in addition to her primary care doctor.

“It was really hard,” said Williams, who also went online looking for information or support groups on diabulimia, but found little.

There has been little research on effective treatments for patients with diabulimia. An article published on the Juvenile Diabetes Research Foundation website last year called for a multi-disciplinary approach to treating diabulimia by creating a team that includes a medical doctor, therapist and registered dietitian, at minimum.

As Williams recovered, she was featured in a Self magazine article about diabulimia. After it was published, she started to hear from women across the country suffering from the same symptoms — including many who thought they were the only one restricting their insulin.

One reader was 22-year-old Asha Brown. The college student had been diabetic since age 5 and had struggled with diabulimia since she was 14.

“This article was talking about me,” said Brown, now 27. “I thought I was the only one.”

Brown kept the article in the back of her mind for years before finally seeking treatment for diabulimia at the Melrose Institute in 2009. When she told a nurse about the article, the nurse happened to know Williams’ contact information and gave it to Brown.

The pair quickly bonded over their experiences with the disorder and decided they wanted to help other type 1 diabetics find support.

Last year, they launched We Are Diabetes, an organization that works to publicize diabulimia and support those with the disorder.

Williams, now 29, has been out of treatment for five years and is working to get her registered nurses license and studying to be a diabetes educator.

But her past with diabulimia still affects her. She has had bleeding behind her eyes, holes in her kidneys and severe nerve damage. By talking to others about her experiences, she’s hoping to encourage people suffering from diabulimia to get help before they suffer lasting damage.

“For me, it’s a chance to help myself not feel so much regret,” said Williams. “By helping other people, I feel what I went through at least has a purpose.”

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