Weight gain with diabetes

Understanding Excess Weight and its Role in Type 2 Diabetes brochure

Please Note: Throughout this brochure, the words “glucose” and “sugar” are used interchangeably.

This brochure is designed to help you better understand the impact of excess weight and its role in type 2 diabetes. Excess weight, obesity and severe obesity are all risk factors for developing type 2 diabetes. Often times, individuals are not aware of the health risk of excess weight until they are diagnosed with pre-diabetes or type 2 diabetes.
Through this educational brochure, we hope to provide you with the information needed to improve your quality of health. We will cover various topics, such as:

      • Type 2 diabetes
      • Complications of high blood sugar levels
      • Risk factors for type 2 diabetes
      • and much more

What is type 2 diabetes?
Type 2 diabetes is a chronic, potentially debilitating and often fatal medical condition requiring regular monitoring of an individual’s blood sugar level and treatment. In type 2 diabetes, the body either does not properly produce or use insulin, a hormone produced by the pancreas that helps move sugar into cells. Therefore, the body becomes resistant to insulin. This resistance causes high blood sugar levels.

What are the complications of high blood sugar levels?
Excess sugar in the blood causes many health-related problems. The cells cannot get enough of the sugar they need, and when sugar levels in the blood become too high, it causes damage to nerves and blood vessels, usually in the heart, feet, hands, kidneys and eyes. Other complications of high sugar and insulin resistance include:

  • Increased risk of heart disease and stroke
  • Neuropathy (nerve damage, especially in extremities)
  • Nephropathy (renal impairment, kidney failure)
  • Retinopathy (vision problems, blindness)
  • Cardiovascular disease (heart disease and increased risk of stroke)
  • Erectile dysfunction in men and decreased sexual desire in both men and women
  • Depression
  • Amputation

How Does the Body Manage Excess Glucose?
During a fast, or between meals, the body may rely on stored glucose in the liver – glycogen – for energy. Glycogen is composed of several thousand glucose molecules held together with water molecules. If the fast is very long, however, the body may instead use amino acids or fatty acids to help with its metabolic processes.

After we eat a meal, the processes of chewing and chemical digestion produce glucose (sugar), which is the most readily available for of fuel for our organs – especially muscle and brain tissue. In a normal state, the glucose produced from these digestive processes enters our cells to help with other metabolic processes.

Insulin acts a key that unlocks the door to let glucose in to feed our cells. When insulin is present, it also turns off the process of using glycogen from the liver to ensure that the glucose level does not rise further after a meal. In fact, insulin reduces blood glucose by collecting any excess glucose that is present in the blood stream so that it can be stored as glycogen for future use.

However, if the adequate amount of insulin is not available, as is the situation in diabetes, then this glucose is unable to enter cells. Instead, the glucose remains in the blood stream in a higher than usual concentration. This condition is referred to as elevated blood glucose or hyperglycemia.

Exercise and Glucose
Exercise can also be a meaningful tool to reduce blood glucose levels. When we use our muscles, they need more fuel to stay active. In patients without diabetes, glucose is taken in from the blood stream while a simultaneous rise in the liver’s glucose production keep the muscles supplied with fuel. However, when type 2 diabetes is present, the liver may not match the muscle’s need for glucose, which can result in a lowering of the glucose level with moderate exercise. Thus, exercise is widely prescribed to treat patients with diabetes.

How does excess weight impact type 2 diabetes?
Excess weight can greatly affect your health in many ways, with type 2 diabetes being one of the most serious. There are many forms of measurement used to evaluate someone’s excess weight; however, the most commonly-used method is calculating your body mass index (BMI). BMI is a number calculated by dividing a person’s weight in kilograms by his or her height in meters squared. BMI is a useful tool used in determining the degree of an individual’s excess weight. There are five weight status categories that you may fit into:

  • Underweight
  • Normal weight
  • Overweight
  • Obesity
  • Severe obesity

When an individual predisposed to diabetes has excess weight, the cells in the body become less sensitive to the insulin that is released from the pancreas. There is some evidence that fat cells are more resistant to insulin than muscle cells. Individuals affected by type 2 diabetes, who exercise, appear to reduce the severity of insulin-resistance because the exercising muscles use the extra sugar found in the blood; therefore, the body does not secrete insulin and the sugar is no longer diverted to excess fat cells.

It’s not just how much an individual weighs, but also where they carry the weight that puts them at greater risk for health problems. Individuals carrying more weight around their waist (apple-shaped) are more likely to suffer from obesity-related conditions than someone who carries more weight in their hips and thighs (pear-shaped).

Individuals affected by excess weight, particularly obesity and severe obesity, are more likely to develop type 2 diabetes as a related condition of their excess weight. Obesity and severe obesity greatly increase your risk of having heart disease, type 2 diabetes, certain types of cancer, sleep apnea, osteoarthritis and much more.

To calculate your BMI, and determine your weight status category, please .

Are you at risk for type 2 diabetes?
What you consume throughout your day and how active you are affects your risk of developing type 2 diabetes. Being overweight (BMI of 25-29.9), or affected by obesity (BMI of 30-39.9) or severe obesity (BMI of 40 or greater), greatly increases your risk of developing type 2 diabetes. The more excess weight you have, the more resistant your muscle and tissue cells become to your own insulin hormone. More than 90 percent of people with type 2 diabetes are overweight or affected by a degree of obesity.

In addition to excess weight, there are many other factors that increase your risk of developing type 2 diabetes, such as:

Sedentary Lifestyle
Inactivity and having excess weight overweight go hand-in-hand with a diagnosis of type 2 diabetes. Muscle cells have more insulin receptors than fat cells, so an individual can decrease insulin resistance by exercising. Being more active also lowers blood sugar levels by helping insulin to be more effective.

Unhealthy Eating Habits
Unhealthy eating is a contributor to obesity. Too much fat in your diet, not enough fiber and too many simple carbohydrates all contribute to the development of type 2 diabetes.

Family History and Genetics
It appears that people who have family members with type 2 diabetes are at a greater risk for developing it themselves. Asians, Pacific Islanders, American Indians, Alaskans, African Americans and Hispanics all have a higher rate of diabetes than Caucasians or Europeans.

Increased Age
As we age, the risk of type 2 diabetes becomes greater. Even if an elderly person is thin, they still may be predisposed to developing diabetes. The pancreas ages right along with us and doesn’t pump insulin as efficiently as it did when we were younger. As our cells age, they become more resistant to insulin as well.

High Blood Pressure and High Cholesterol
These two factors are the hallmark risk factors for many diseases and conditions, including type 2 diabetes. Not only do they damage heart vessels, but they are two key components in metabolic syndrome, a cluster of symptoms including obesity, a high fat diet and lack of exercise. Having metabolic syndrome increases the risk of heart disease, stroke and type 2 diabetes.

History of Gestational Diabetes
Women affected by obesity are more insulin resistant when compared to women of normal weight. When pregnant, gestational diabetes generally lasts the duration of pregnancy and approximately 5 to 10 percent of females with gestational diabetes will continue to be affected by diabetes after delivery.

How do you test for type 2 diabetes?
There are a variety of blood tests that may indicate whether you have type 2 diabetes. Let’s take a look at each test and see what different results could mean for you and your health.

  • Fasting Blood Sugar Chart
  • Sugar Level Indicates
  • Under 100 mg/dL Normal
  • 100 to 125 mg/dL Prediabetes
  • 126 mg/dL or higher on Diabetes
  • 2 separate tests

Fasting Blood Sugar Level Chart

Blood Sugar level HGbA1c Indicates
Under 100 mg/dL Normal
100 to 125 mg/dL Pre-diabetes
126 mg/dL or higher on 2 separate tests Diabetes

Fasting Blood Sugar Test
The amount of sugar in your blood naturally fluctuates but stays within a normal range. The preferred way to test your blood sugar is after fasting overnight for at least eight hours. A fasting blood sugar level less than 100 milligrams of sugar per deciliter of blood is considered normal.

If your blood sugar level measures from 100 to 125, you have impaired fasting glucose, and this may be an indication that you have pre-diabetes. If your blood sugar level is above 200 mg/dL, with symptoms of diabetes (see below), a second test may not be necessary to reach the diagnosis.

Symptoms that You May be Developing or Have Type 2 Diabetes

  • Frequent urination
  • Increased thirst
  • Unplanned weight-loss
  • Weakness and fatigue
  • Numbness or tingling in hands, legs or feet
  • Blurred vision
  • Dry, itchy skin
  • Frequent infections
  • Slow healing of cuts and bruises

Random Blood Sugar Test
This test is done without any special preparation, such as fasting overnight. Even if you’ve recently eaten and your blood sugar level is at its peak, the level shouldn’t be above 200 mg/dL. If it is and you also have symptoms of type 2 diabetes, you can expect a diagnosis of type 2 diabetes.

Oral Sugar Tolerance Test
(2-hour Post-Glucose Challenge)
This test requires you to visit a lab or a healthcare professional after at least an eight-hour fast. At the office or lab, you will drink about eight ounces of a sweet liquid that contains a lot of sugar (about 75 grams). Your blood sugar level will be measured before you drink the liquid, then after one hour and again after two hours. If your blood sugar level is 200 mg/dL or above after two hours, you may have diabetes.

What can you do to improve your health and prevent type 2 diabetes?
Losing weight is one of the most beneficial ways you can help prevent type 2 diabetes. Moderate and sustained weight-loss (5 percent to 10 percent of body weight) can improve insulin action and decrease fasting sugar concentrations.

For many individuals, simply adjusting their caloric intake and beginning an exercise program can greatly improve their type 2 diabetes and overall health.

Healthy Meal Plan
Weight-loss occurs when energy expenditure exceeds energy intake. Creating a calorie deficit will result in weight-loss. Writing down the food, portion size and calorie amount in a food diary will help you become aware of the foods you consume and provide objective evidence of calorie intake.

Exercise Program
Regular exercise helps maintain weight-loss and prevent weight regain. It also improves insulin sensitivity and glycemic control (measurement of the effects of carbohydrates on blood sugar level) and may decrease the risk of developing type 2 diabetes.

A goal should be set for 30 to 45 minutes of moderate exercise five times per week. The exercise does not need to occur in a single session to be beneficial. Dividing the activity into multiple and short episodes produces similar benefits and can enhance
compliance.

In addition to incorporating a healthy meal plan and exercise program, today’s world of technology and social networking may enhance a person’s ability to monitor their health. There are many online and app-driven resources, such as food journals, calorie trackers, exercise tools and more available online, for your smartphone and more!

What can you do to learn more about type 2 diabetes and excess weight?
To see if you are at risk for type 2 diabetes, please schedule a visit with a healthcare professional for more information. To help you prepare for your visit, we’ve provided you with some great sample questions that you may be asked by a healthcare professional and sample questions for you to ask a healthcare professional.

Sample Questions
Questions a Healthcare Professional May Ask You

  • When was the last time you saw a healthcare professional?
  • When did you last have blood work completed?
  • Are you currently taking any medications?
  • Have you been previously diagnosed with any medical conditions?
  • How physically active are you on a weekly basis?
  • Can you describe your eating habits?
  • Does anyone in your family have type 2 diabetes?
  • Do you feel fatigued or tired more than usual?
  • Do you have dry-mouth or find yourself drinking fluids often?
  • Do you find yourself urinating often?
  • Do you have blurred vision or experience headaches?
  • Have you recently gained weight?

Questions for Your Healthcare Professional

  • Do you have special training in treating diabetes?
  • Do you have special training in obesity?
  • Does your office have a registered dietitian on staff with type 2 diabetes and obesity training?
  • Do you have diabetes educators available?
  • What kind of tests do you use to determine if I have type 2 diabetes?
  • How do you prefer to treat someone with type 2 diabetes?
  • Am I at risk for any complications associated with type 2 diabetes?

Special thanks to Holly F. Lofton, MD, for assistance in creating this brochure and thank you to the Yale Rudd Center for Food Policy and Obesity for providing the photography found in this brochure.

The information contained in the Understanding Excess Weight and its Role in Type 2 Diabetes Brochure is not a substitute for medical advice or treatment from a healthcare professional. The OAC recommends consultation with your doctor and/or healthcare professional.

To view a PDF version of this brochure, please click here.

What to know about insulin and weight gain

People who take insulin to manage their glucose levels may experience weight gain. However, people should not stop taking insulin or skip doses, as this can cause long-term complications.

Effective ways to avoid insulin-related weight gain include:

Tracking calories

People who have diabetes often focus on managing their carbohydrate intake. However, it is just as important to track overall calorie consumption.

Eating too many calories can lead to excess blood glucose levels and increased fat storage. This may be especially true while taking insulin.

Premeasuring portions and keeping a food log can prevent a person from eating more calories than their body needs. Over time, people learn what portion sizes work best for them and no longer need to measure and track their food intake.

Exercising regularly

Regular exercise keeps the body healthy and strong. It also helps burn calories, regulates blood glucose levels, and promotes fat loss.

The WHO recommend that adults aged 18 to 64 aim for at least 150 minutes of moderate-intensity exercise each week.

Findings from a recent review suggest that structured exercise programs could offer significant benefits for people who have insulin resistance and type 2 diabetes.

Working with a healthcare team

Healthcare providers can share valuable resources with people struggling to maintain a healthy body weight.

The American Diabetes Association’s 2019 guidelines state that “There is not a one-size-fits-all eating pattern for individuals with diabetes, and meal planning should be individualized.”

Registered dietitians (RDs) can advise people about what foods to eat and avoid based on their current health status and goals. RDs can even develop personalized meal plans.

Healthcare providers can also recommend ways for people to improve their health while lowering their risk of developing diseases, such as diabetes, obesity, and cardiovascular disease.

They can test people’s glucose and insulin levels, as well as their lipid profiles. These tests can give people an idea of their overall health status. People can use this information to track their progress toward achieving their health goals.

Tips to gain weight

If you have diabetes and you’re underweight or struggling with your appetite, it’s important to eat the foods you like rather than being too restrictive with your diet.

This may mean eating foods that are higher in fat and calories. Speak with your diabetes team to review your medications and talk to a dietitian to help you make any changes.
It’s important to see your GP if you have been losing weight without meaning to. We all have different body shapes, but if your body weight has changed and you’re not sure why, or it isn’t normal for you, then it’s important to speak to a healthcare professional.

Do you want to put on weight?

If you need to gain weight, it’s best to get individual advice from a dietitian. Below are some things they might suggest. But you might also have to make changes to the way your diabetes is managed, so speaking to your healthcare team is important. They will also help you to understand why you might be losing weight.

  • It might be easier to eat smaller meals and snacks — this can also help increase your appetite.
  • Use full-fat dairy products like milk, cream, cheese and yogurt which can be added to your meals or used a snack. For example you can grate cheese into soups or pasta dishes or add a tbsp of cream to porridge or rice pudding.
  • Add unsaturated fats to your food where you can. Vegetable oils like olive, rapeseed or sunflower can be used to cook dishes or in dressings.
  • Other healthy fats come from avocados, nuts and seeds, which make good snacks.
  • Serve vegetables with spread or grated cheese.
  • Add cream or full-fat milk to foods like mashed potato or soups.
  • Have nourishing milky drinks.
  • Add powdered milk to cereals.
  • You may have heard of nutritional supplements, in the form of food or drink. These can be useful for some people who are finding it hard to gain weight or who have a poor appetite. Get some advice from a dietitian about whether they are right for you.

Losing Weight with Diabetes: What Prevents It and Causes Weight Gain

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I recently was included in a discussion on a Facebook group for athletes with diabetes about how hard it can be to lose weight through exercise. While I would never claim to have all the answers on this topic, here are some ideas about what can make you gain weight or keep you from losing weight with diabetes, based on my decades of professional and personal experience with diabetes and weight management, and what you can do about it.

Insulin

My former graduate student with type 1 diabetes went on an insulin pump and promptly gained about 10 pounds, even though his blood glucose control improved only marginally. Why did this happen to him (and why does it happen to so many other insulin users)?

As a naturally occurring anabolic hormone, insulin promotes the uptake and storage of glucose, amino acids, and fat into insulin-sensitive cells around your body (mainly muscle and fat cells). It doesn’t matter whether it’s released naturally, injected, or pumped—all insulin and insulin analogues have these same effects. Going on intensive insulin therapy is associated with fat weight gain (1), for people with both type 1 and type 2 diabetes. Some of the weight gain comes from that if you’re using insulin to keep your blood glucose in control, you’ll be keeping and storing all of the calories that you’re eating instead of losing some glucose through urine (during hyperglycemia). Unfortunately, this realization has led some people to try skipping or limiting their insulin use to help them lose weight (2), but that is a dangerous practice that can lead to loss of excess muscle mass and life-threatening conditions like DKA.

The best way to balance your insulin use and your body weight, in my opinion, is to be physically active to keep your overall insulin levels lower. It’s easier to lose weight, too, when you’re taking less insulin—or releasing less of your own if your pancreas still does that.

Food Choices

Having said that, I have to say that what you choose to eat has a huge impact on your insulin needs as well as your body weight. My graduate student found that by doing frequent dosing with his insulin pump, he was eating more overall, just because he could without having to take another injection with a needle. Just because insulin use can make it easier for you to eat cake and other formerly “forbidden” foods doesn’t mean that you need to eat them!

There are advocates out there for all sorts of diets for people with diabetes, including ultra-low-carb ones (like Dr. Bernstein’s), vegan ones, etc. Personally, what I have always founds works best for weight management with diabetes is a balanced diet, nothing too extreme in any direction. People don’t necessarily lose weight on low-carb diets, even though their insulin requirements are lower, because fat is so much denser in calories (at over 9 calories/gram of fat) than carbs or protein (both 4 calories per gram). If you cut carbs out of your diet, you have to eat something in its place. It’s just too easy to overdose on fat calories without realizing it, and even when your muscles become insulin resistant for any reason, insulin still usually works to put fat into storage depots around the body.

My trick is not to completely avoid carbs, but rather to choose them wisely—eating more lower glycemic index, or GI, carbs that are absorbed more slowly and don’t cause spikes in blood glucose that you have to try to match with large doses of insulin that often lead to hypoglycemia later on when the carbs are long gone and the insulin is still hanging around. Remember, most carbs are fully absorbed in the first hour or two after you eat them, and even rapid-acting insulin can linger for up to 8 hours afterwards.

Besides, insulin requirements are determined by more than just carbs, as finally proven in a study in 2013 showing that eating fat with the same number of carbs increases insulin requirements (3). (I knew this through personal experience already!) It’s not just about carb counting anymore (and never has been for me); it’s about picking the right balance and type of carbs, as well as total amounts of protein (good for preventing lows 3 to 4 hours later) and fat (fully absorbed in 5 to 6 hours, causing insulin resistance).

Treating Lows

I was contacted once by a US Olympic team handball player with type 1 diabetes who wanted to ask me why she was gaining fat weight while doing all her training. My first question to her was, “Are you treating a lot of lows?” I knew she was going to answer yes before I even heard back from her.

This phenomenon (gaining weight from treating lows) is not uncommon in people using insulin, whether they are active or not. One of the biggest deterrents to successful weight loss and prevention of weight gain with diabetes is being forced to treat frequent bouts of hypoglycemia with glucose, sugary drinks, or food. Even though these calories are necessary to treat a medical condition, they still count as calories in the body, and they can result in weight gain.

One way to cut back on lows is to decrease your insulin intake to prevent them, which may include decreasing mealtime insulin doses before exercise, insulin taken for food after exercise, and basal insulin doses to prevent later-onset hypoglycemia following activities. It also helps to more precisely treat lows instead of overtreating them (it’s harder to follow this advice when you’re low, though!) Immediately treat lows first with glucose—in the form of tablets, gels, or candy containing dextrose like Smarties)—and then reassess later if you need additional food intake (often a mix of carbs, protein, and fat) to fully correct the low and prevent lows later on. Juice, although often touted as a treatment for hypoglycemia, contains fructose (fruit sugar) that is much, much more slowly absorbed than glucose and can lead to overtreating lows while you’re waiting for the juice to kick in. Don’t eat more calories treating a low than you need to!

Lack of Physical Movement

Finally, and I probably should have listed this section first, expending more calories can help prevent weight gain, even if you take insulin. In adults with type 1 diabetes, having an active lifestyle compared with a more sedentary one has been associated with a lower BMI (body mass index) and percentage of total and truncal fat mass (5). The more you move, the less insulin your body needs to get the same glucose-lowering effect. Requiring smaller doses of insulin allows you to 1) treat lows with fewer calories overall, and 2) avoid having as many lows from being off on your dosing.

In anyone who is insulin resistant (most people with type 2 diabetes and many with type 1 who are inactive), total insulin requirements will be so much higher that there is a lot more room for error. Injected or pumped insulin is generally absorbed at a speed dictated by the dose, meaning that larger doses take longer to fully absorb and the insulin “tail” hangs around for longer. Taking or releasing less insulin due to being physically active means that all of the carbs you take will be stored as carbs in muscle or liver and not converted into fat to be stored. Stay regularly active—even if that means just standing up more or taking more daily steps–to keep your calorie expenditure high and your insulin needs low.

(3) Wolpert HA, Atakov-Castillo A, Smith SA, and Steil GM. Dietary Fat Acutely Increases Glucose Concentrations and Insulin Requirements in Patients With Type 1 Diabetes: Implications for carbohydrate-based bolus dose calculation and intensive diabetes management. Diabetes care 36: 810-816, 2013. (http://www.ncbi.nlm.nih.gov/pubmed/23193216)

As a leading expert on diabetes and exercise, I recently put my extensive knowledge to use in founding a new information web site called Diabetes Motion (www.diabetesmotion.com), the mission of which is to provide practical guidance about blood glucose management to anyone who wants or needs to be active with diabetes as an added variable. Please visit that site and my own (www.shericolberg.com) for more useful information about being active with diabetes.

3 Reasons It’s Harder For People With Type 2 Diabetes To Lose Weight

Approximately 90% of people with type 2 diabetes are overweight or obese.¹ While obesity often contributes to the development of diabetes, the bigger driver of weight gain is the high insulin levels that are found well before the diagnosis of diabetes.There are some good reasons why the standard advice of “eat less, exercise more” doesn’t deliver results for people living with type 2 diabetes.

Reason #1: With type 2 diabetes, insulin is high, and insulin is a fat-storage hormone²

Everyone has glucose, a type of sugar, in their blood at all times. Glucose is a source of energy that largely comes from eating carbohydrates. Simply put, when you eat carbohydrates, your blood sugar rises.

Insulin is produced by your pancreas, and insulin has many functions in the body. One of insulin’s functions is to help get glucose out of the blood and into cells where it can be used. In order to do this, insulin rises along with glucose. So when you eat carbohydrates and glucose rises, the insulin is rising as well. Once in the cells, glucose is mostly used for energy. If you have type 2 diabetes, this process doesn’t work well anymore: your body has become resistant to the signal of insulin, so the insulin isn’t as effective at moving the glucose out of your blood. That’s how you end up with high blood sugar levels after eating carbohydrates. Having chronically elevated blood sugar levels is dangerous, so your body needs to do something about it.

Your body responds by making more and more insulin to try to get the job done. Recall now that insulin has many functions, not just to facilitate the removal of glucose from the blood. Insulin also works to promote the storage of fat and to block the release of fat from fat storage. So instead of losing weight, you just keep gaining, thanks to all that insulin.

Reason #2: Typically recommended eating patterns often backfire by keeping you hungry and keeping your blood sugar high³

If you’re like most people with type 2 diabetes, you’ve been told to eat carbohydrates but eat fewer overall calories, and to eat small meals throughout the day to keep your blood sugar steady; you’ve probably been advised to count your carbs and eat enough of them to keep your blood sugar up after taking medication to lower it—confusing, right?

What many find as a result is that they’re always hungry, always thinking about food and facing cravings. What’s at work is a survival instinct that even the strongest-willed person can’t withstand for long. This is a situation where your physiology is fighting against you. Even worse, those frequent small meals with carbohydrates create spikes in your blood sugar followed by drops in your blood sugar—a blood sugar roller-coaster that stimulates frequent hunger.

Reason #3: Type 2 diabetes medications can drive weight gain⁴

Remember how your body’s own insulin is a fat-storage hormone? That’s also true for insulin that has been prescribed to you, whether delivered by injection or by pump. That’s why a common side effect of prescribed insulin is weight gain. Another class of medicine for type 2 diabetes, Sulfonylureas, work by stimulating the pancreas to produce more insulin. And once again, more insulin in your body means more fat storage and more weight gain.

What’s the solution?

People living with type 2 diabetes are insulin resistant, meaning their tissues are not responding as they should to insulin. Insulin moves sugar from your blood into your cells. If your body does not respond to its own insulin, then your blood sugar will remain chronically elevated, and your body will produce more insulin. The most direct solution is to decrease the source of high blood sugar itself—carbohydrate consumption.

In fact, insulin resistance can be fundamentally referred to as “carbohydrate intolerance” because when carbohydrates are consumed by someone who is insulin resistant, blood glucose is not lowered as effectively. So, by eating fewer carbohydrates, we both reduce the glucose load in the blood, and decrease the release of insulin.

Nutritional ketosis is a natural metabolic state in which your body adapts to burning fat over carbohydrates as its primary fuel. While carbohydrate consumption triggers spikes in blood sugar, fat consumption does not, making it a better source of fuel for people with insulin resistance.

In a clinical trial, patients lost an average of 12% of their starting body weight within six months by using a medically supervised treatment that included the employment of nutritional ketosis. In addition, 56% of patients with type 2 diabetes reduced their HbA1c to below diabetic levels.⁵

Read more about nutritional ketosis and how it can be an effective diabetes reversal method when paired with physician supervision here.

To learn more about how food affects blood sugar, watch my video series here:

Many of us are concerned about how we look. Diabetes can at times cause us to be more aware of our body image, particularly if we get bruises as a result of injecting or either gain or lose a significant amount of weight.

Lumps or bruises on the skin

The occasional bruise is part of type 1 diabetes and is likely you have hit a vein when injecting. If you get a lump along with the bruise, this should settle down within a day or two and then the bruise should fade.

Getting stiff or lumpy skin from injections (without bruising) is usually a sign that you are injecting in the same place too often. This can be prevented by rotating your injection sites

If your skin becomes lumpy or takes on an abnormal appearance, speak to your diabetes team who will be able to advise you.

Underweight with type 1 diabetes

Following a diagnosis of type 1 diabetes, it is common to be underweight. Usually once you’re put onto insulin you should find you settle back into your normal weight within a few weeks.

If your blood sugar levels are consistently high, you may find it more difficult to put on weight. It is important not to allow your blood sugar levels to run high for long periods as this can lead to a very real chance of diabetic complications occurring.

Insulin and weight gain

Being overweight is not a risk factor for type 1 diabetes, but that doesn’t mean being immune from putting on weight either.

Gaining weight with type 1 diabetes is not uncommon but this can be managed.

The following part of this article looks at some strategies that can be employed to help reduce weight gain.

If weight gain is a concer, or causing problems, speak to your diabetes health team or a dietitian to help formulate a plan to help you to manage your weight.

Slowly released carbohydrate

Having either high or low blood sugar levels can lead to feelings of hunger. Having foods with a low glycaemic index (low GI) helps to prevent the sharp peaks in blood sugar levels and can reduce feelings of hunger between meals.

Vegetables typically have a low GI and, as you’d expect, are a good option for weight management. On the other side of the spectrum, refined carbohydrates such as pastry and dough based foods hit blood sugar levels quickly and can leave us feeling hungry soon after eating them.

  • Read more about the glycaemic index

Over eating in response to hypos

When we have low blood sugar, it can be very difficult to resist the urge to over eat. The reason we get so hungry is because the body is sending us a strong signal to eat to get our blood sugar levels up. The best way to treat a hypo and end the hunger without facing a big calorie intake is to quickly treat the hypo with quick acting carbohydrate such as glucose tablets or sweets.

  • Read more about hypos and controlling hunger

Exercise and carbohydrate

If you exercise to lose weight, it can be very annoying having type 1 diabetes because it can mean that you take in as many calories, in the form of carbohydrate to keep your sugar levels up, as you can hope to lose by doing the exercise. There are a couple of methods you can use to reduce the amount of carbohydrate you need to take before exercising

  • Read more on exercise, insulin and weight management

Heavyweight Champs: How to Gain Weight When You Have Diabetes

Gaining weight can come with risks, especially if you treat it like a Vegas buffet.

To keep your blood sugar in check, it’s essential to follow a healthy diet full of nutrient-dense food that’s also higher in calories and includes carbs that are lower on the glycemic index.

Make sure to talk with your doctor or a dietitian before you change your diet and exercise plan to gain weight.

1. Find your number

In some ways, gaining weight is similar to losing weight: You need to know what your ideal number is and how much you need to gain to get there.

Start by comparing your current weight and BMI to this calculator from the CDC. Based on the results, set one overall goal that states the total amount of weight you want to gain. Then, set several mini-goals that involve gains each week and month.

2. Make a date with a dietitian

Whether you’ve tried to gain weight on your own and failed or you just want to start off on the right foot, making an appointment to see a registered dietitian who specializes in diabetes might be exactly what you need.

When choosing an RD, look for credentials that point to a specialization in diabetes education, such as CDE (certified diabetes educator).

3. Crank up the calories

Determine the number of calories you need to eat each day for weight maintenance, and then add 500. The Dietary Guidelines for Americans outline estimated calorie needs per day by age, sex, and physical activity level.

4. Fill your plate with nutrient-dense foods

Getting the green light to up your calorie intake doesn’t mean you have permission to eat everything in sight. Sure, loading up on sugary and fatty foods will help you pack on the pounds, but eating a few pints of ice cream every day is not the way to go.

So, what should you focus on? When planning your shopping list, make sure it’s full of nutrient-dense whole foods that are also high in calories.

5. Eat like a hobbit

Instead of eating breakfast, lunch, and dinner, make like the Shirelings and throw in an elevensies, afternoon tea, and supper.

Build your diet around four substantial meals, with two snacks — one midmorning and one before bed. Each meal should be nutrient- and calorie-dense, with the final meal being enough to hold you until the morning.

6. Get swole

If you haven’t already, it’s time to get familiar with the weight room (or at least a couple of machines). For optimal health, the weight you gain should include muscle, not just fat, which means hitting the weight room at least 3 days a week.

Aim for exercises that target all your major muscle groups, and focus on a resistance level that is challenging but doesn’t leave you gasping for air.

7. Swipe right on low-GI carbs

If you’re trying to increase the number on the scale, there’s nothing wrong with slipping a few extra sources of complex carbohydrates into your meal plan.

But if you do carb up, make sure the majority of your choices are lower-glycemic-index carbs, which won’t spike your blood glucose levels.

Oatmeal, yams, beans, legumes, whole-grain bread, whole-grain pasta, and brown rice are just a few top picks from the American Diabetes Association.

8. Go pro(tein)

If you’ve dialed it up in the weight room, make sure your diet is rich in lean sources of protein to help support muscle growth. For active adults, the American College of Sports Medicine recommends a range of 0.5 to 0.8 grams of protein per pound of body weight.

That’s quite a bit more than the recommended dietary allowance for the average adult, which is 0.37 grams per pound of body weight. To hit this number, opt for around 7 ounces of meat, poultry, or fish at mealtimes.

BUT — this is a big ol’ but — consult with your doc before going HAM on protein.

Since people with diabetes have an increased risk of developing kidney problems, you need to be mindful of how much protein you’re actually consuming. A healthcare professional can help you figure out exactly how much to eat each day.

9. Make friends with fats

When it comes to increasing calories, you can’t argue with math. Gram for gram, you’ll get the most bang for your buck by eating healthy sources of fat. That’s because, unlike carbs and protein, which have only 4 calories per gram, fat has 9 calories per gram.

Stick to healthy fats like monounsaturated and polyunsaturated fats. Tracy recommends adding nuts, seeds, avocado, and oils such as olive oil to meals and snacks to increase your caloric intake.

10. Remember, there’s an app for that

Rather than play the nutrition guessing game each day, why not try an app designed to help you track your macros and calories? Even though some of these food trackers are designed for weight loss, anyone can use them.

And the best part? Most of them are free. Some of the top trackers include MyFitnessPal, Calorie Counter by FatSecret, Lose It!, SparkPeople, and MyNetDiary.

11. Ditch the diet food

…at least for now. Diet soda, low calorie drinks, and even coffee and tea can temporarily fill your belly without providing any real calories. To avoid filling up on fillers, eliminate (or at least limit) low and no-calorie foods and drinks.

12. Take snack time seriously

You did in kindergarten, and you def should now.

Make snack time count by choosing nutrient-dense foods like whole grain avocado toast, apple slices with nut butter, full fat Greek yogurt, or nuts and seeds (try a mix of walnuts, almonds, cashews, macadamia nuts, pumpkin seeds, sunflower seeds, and chia seeds).

Fun fact: One small serving of nuts can net you 180 calories. Win!

13. Shake it up

Whenever possible, opt for whole foods. But on those days when squeezing in one more meal doesn’t seem likely, you can always blend up your calories.

You can make any of these delish recipes at home or reach for a store-bought supplement shake, says Tracy.

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