You might have heard that managing diabetes mellitus is not a science, it is in fact, an art. Being diagnosed with diabetes is not the end of the world — if you manage your disease properly with the help of diet and exercise along with your medication, then you can ensure that even though you have diabetes, diabetes does not have you.
A common question in the mind of people diagnosed with type II diabetes is, did my being fat cause the disease or did my disease cause me being fat? Well, the following text will help you determine what exactly the relationship is between the two, or if it is all just a rumor.
Is My Weighing Scale Drunk?
It is no coincidence that many diabetics are obese, nor that many obese people are diabetic. Having a high Body Mass Index (BMI) is a major risk factor for diabetes. Many diabetics with previously undiagnosed or uncontrolled diseases notice an increase in their weight once they start regular medication or insulin therapy.
While those around them might tell them to not blame everything on diabetes, this weight gain is in fact, secondary to diabetes. Your weighing scale is not lying to you, nor is it drunk. There are a number of factors associated with weight gain secondary to diabetes and diabetic medication, and we will be looking at these factors shortly.
Although many diabetes medications indeed cause you to gain weight, the good news is that many newer classes of anti-diabetes medication actually help you lose weight. Taking insulin does not mean you are adding a pouch to your tummy — once you begin your diabetes medication, it is common to have ups or downs in your weight.
This weight problem can be managed easily with dietary modifications and medication adjustment. Discuss your concerns regarding weight gain with your healthcare provider, who can allay your fears and answer any questions you may have about your condition.
Some people think that cutting back on insulin or antidiabetes medication can help you shave a couple of pounds in a day or two by increasing blood glucose.
However, treating insulin like anorexics treat food is not a helpful approach at all. It can lead to both long and short-term complications as well as rapid weight gain once the regular dose of insulin is reinstated.
Medications That Increase Weight In Diabetics
There are different classes of drugs that are used to lower blood glucose levels in diabetes which work through different mechanisms of action. Of these, the drugs associated with weight gain are:
- Sulfonylureas: These work by stimulating what little is left of the beta cells in the pancreas to secrete Insulin. The side effects of this type of medication include hypoglycemia e. a drop in blood glucose levels due to too much insulin secretion and weight gain. The trade names include: Diabinese®, Glucotrol ®, DiaBeta, Amaryl®, Micronase®, Glynase® etc.
- Thiazolidinediones (TDZ) or glitazone: Glitazone stimulates insulin production from the pancreas while inhibiting glucose production from the liver. The fluid retention produced as a result of this medication can cause an increase in weight of about 5-6lbs. Moreover, this medication also causes an increase in the production of fatty acids and their storage in fat cells. The latter process is accelerated by the production of an enzyme i.e. triggered by TDZ. Thus, this group of medication causes weight gain through multiple mechanisms of action.
In one clinical trial, individuals were divided between two groups — those given placebo and those given glitazone treatment. In the group given glitazone, an average weight gain of 3.6 kg was found, as compared to a gain of <1 kg in the group treated with placebo, with most of the weight gain subcutaneous fat. The trade names of TDZ are Avandia® and Actos®.
- Insulin: Insulin injections result in the weight gain because once enough insulin is present in the blood, it can manage the glucose entry with in the cells. This way it will become a part of energy and no more glucose will be left circulating within the blood stream or getting excreted through urine. At one place, Insulin which is targeted to manage blood glucose will end up giving you extra pounds.
Medications That Decrease Weight In Diabetics:
The newer class of anti-diabetic drugs are helpful, in that, they either cause no weight gain or help decrease weight. These include:
- Metformin: Going by the trade name Glucophage®, metformin works by decreasing the production of glucose from the liver. The added benefits of this drug are that it curbs hunger and does not cause excessive lowering of blood glucose (hypoglycemia) e. seen with the sulfonylureas and the TDZs.
- Incretin-like drugs: For example, Byetta® acts by stimulating insulin production, as well as mimicking gut hormones. It causes early satiety by slowing down the rate of stomach emptying, is available in injectable form and when combined with sulfonylureas and metformin, affords better glucose control in resistant patients.
- Amylin-like drugs: For example, Symlin® mimics another hormone called Amylin e. released from the pancreas to decrease appetite. This is also available in injectable form that has been shown (by the Medicine Plus: Journal of Clinical Endocrinology in a study with over 100 people in a 16-week trial) to be very effective in reducing weight in patients with an average BMI of 37.8 (Body Mass Index of >30 equals obese).
How Does Diabetes Cause Weight Gain?
There is no direct mechanism by which there is an increase seen in the weight of the diabetics. In fact, in unmonitored, or undiagnosed diabetic population there is rapid weight loss, which is due to the loss of blood glucose in urine, and the dehydration that occurs subsequently.
Usually kidneys do not lose glucose in the blood, but when there is hyperglycemia (increase in blood glucose), then the kidneys rid the body of this glucose, and in doing so, lose a lot of water as well. The rapidly dehydrating patient feels lethargic most of the time as he keeps urinating his energy.
Mechanism # 1: High Initial HbA1C
HbA1C, referring to glycosylated hemoglobin, is a test that indirectly shows the average glucose levels in the last three months. HbA1C also refers to the combination of glucose-and-hemoglobin. Hemoglobin is a component of the red blood cell that is responsible for carrying oxygen in the body and apparently, is good at multi-tasking, because it also lets glucose join with it.
In undiagnosed diabetic patients, HbA1C, is naturally higher (>6.5%) than normal (<5.7%), while in pre-diabetics its range is between 5.7% to 6.4%. In such individuals, there is weight loss and dehydration consequent to high blood glucose, as mentioned before.
Once the patient is diagnosed and their medication is adjusted, glucose levels are controlled and HbA1C normalizes; the patient then stops losing the excess glucose in the urine and their medication makes the body able to use the glucose by enabling its entry into the cells. The cells either utilize this glucose or store it for future use. Once this starts happening, a perception of weight gain is created, as the lost energy is gained back.
Mechanism # 2: Eat More Than You Deserve
In healthy individuals, insulin is released by the pancreas to regulate the blood glucose levels. High blood glucose levels further stimulate the body to produce insulin, which tackles glucose by increasing its entry in the cells, and allowing the body to store it.
In diabetic people, administration of exogenous insulin performs the task of decreasing blood glucose. Again, the insulin acts by shepherding the excess glucose into the cells and allowing the body to store it in muscles and fats for use in times of need. Although this is the goal of insulin therapy, the trouble/weight rises when the energy stores exceed the energy demands.
Most diabetic individuals do not increase their daily activities when on insulin therapy, although they should be instructed to do so. As a result of increased calorie intake and less activity, the cells store more than they use—this storage is known as fat.
Mechanism # 3: Snack More
Hypoglycemia is a common side effect of the aforementioned drugs (sulfonylureas, TDZs, insulin). To combat this and to prevent it from becoming dangerous, diabetics are advised to snack between meals to keep their energy levels up. When allowed to snack between meals, most individuals take it to mean they are allowed to eat candy, crisps and sweets whose effect is seen in the form of an expanding waistline.
Mechanism # 4: A Vicious Circle
Type II diabetics are mostly overweight (about 90%) with one-third of American adults either obese or en-route there. Moreover, when combined with increasing childhood obesity, this number is likely to increase.
In overweight individuals, diabetes develops due to exhaustion of the pancreas as well as insulin resistance. Insulin resistance is produced as a side effect of increased adipose deposition especially around the abdomen—a lot of belly fat, in other words, which does not allow glucose to enter the cells. This can lead to increased insulin requirements to overcome the resistance but we already know that initiating insulin therapy can also lead to weight gain. Thus a vicious circle of weight gain and increased insulin resistance develops in such individuals.
Why Me — Those At Risk Of Becoming Huge
The American Diabetes Association (ADA) published a research (CREDIT Study—Cardiovascular Risk Evaluation in type II Diabetics on Insulin Therapy), studying the factors associated with cardiovascular events and glycemic control in people with type II diabetes who were on insulin. The study also provided data for weight gain in people starting insulin therapy in type II diabetes.
About 2000 patients were followed for a period of one year and weight changes were noted — with the average gain of about 4lbs and 24% gaining about 11lbs. Factors which were associated independently with greater weight gain included insulin dose requirement and high HbA1C at the time of diagnosis while insulin regimen was not found to be a risk factor for weight gain.
What Can Help You Maintain Your Weight?
Insulin does not always equal to weight gain. With proper management — diet, exercise and medication — anything can be achieved. Here are a few tips to help guide you towards a better weight control:
ADA recommends “assessing your lifestyle” before you embark on the journey to weight loss in diabetes. Know your current health status and your environment that affects you and your weight loss as it can help you when discussing your health and weight loss plan with your doctor. Assess your BMI to know which category you fall in, and make realistic goals to achieve weight loss.
Know What You Eat
The old adage — you are what you eat — will never leave you alone—because it is true. Make an estimate of your required calories per day based on your activities of daily living, and try not to exceed them and consult a doctor or a dietitian while planning meals.
In a study conducted to see what the effects of Pioglitazone (TDZs) were if combined with portion control diets, it was found that not only did this diet help prevent weight gain, but it also reduced visceral fat as well as weight circumference, when compared with other medications.
Combined Regimen Or Altered Regimen Of Medication
TDZs or sulfonylureas are not the only medications used to treat diabetes. Ask your healthcare provider about newer class of drugs, like the ones mentioned above, that do not cause weight gain. Combined regimen can also be considered in resistant cases. If you want to know about all antidiabetic medications read this.
increase in physical activity cannot only help you lose weight but can also decrease your daily insulin/medication requirement by managing high blood glucose levels. Physical activity can also improve the mobility of glucose into cells, and decrease insulin requirement.
Halle Berry once said, ‘I always had to diet. I’m diabetic, so it’s a lifestyle for me anyway just to stay healthy and not end up in the hospital.’
Be like Halle and make lifestyle changes to manage your disease.