Better sugar control is often associated with weight gain which is ultimately bad for diabetes management. What causes this frustrating cycle?

I saw two Type 2 diabetes patients back to back the other day. One was not checking her sugars regularly but was happy with her care because she had easily lost about 20 pounds over the previous 6 months without being on a strict diet. She figured she must be doing well because her weight was down and she felt okay. The other patient was diligently taking her medication and checking her sugars, but she had gained 10 pounds in two months. She was totally frustrated and worried about the long term effects of her weight gain. Turns out, the first patient’s diabetes was under terrible control, with a fasting glucose over 300 (normal is less than 110) and a HbA1c over 11 (target for control is less than 7), putting her at high risk for kidney disease, vision loss, nerve damage, stroke and heart attack. In contrast, the second patient’s glucose was 90 and her HbA1c was 5.5. Her hard work was clearly paying off with respect to her sugar control. But instead of being happy with her health management, she felt defeated, knowing her weight was increasing. This treatment dilemma occurs all too often in diabetes. But why? What is going on?

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In Type 2 Diabetes, patients typically have plenty of insulin in their systems, especially early on. It just doesn’t work right because of what we call insulin resistance. And the body tries to compensate by producing even more insulin. Once an effective treatment is started, the blood sugar levels start to decrease because glucose is being appropriately taken up by tissues where it may be utilized as fuel. But if it is not utilized, that fuel gets incorporated into the tissues and stored as fat. So that is why patient two wound up with excellent sugar control but weight gain. Patient one lost weight because her blood sugar was not being taken up by tissues. Despite having lots of glucose in the bloodstream, her tissues were in a state of relative starvation and had begun to waste away, hence the weight loss phenomenon. And the high sugars circulating in her system were probably causing great harm, even though she wasn’t feeling bad (yet).

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All of this needs to be taken into consideration when treating diabetes. And it is why patients should regularly check their sugars, keep their doctor appointments, and follow a good diet and exercise plan (preferably under the direction of a registered dietitian or diabetes educator). Chasing sugar control by adding medications or increasing doses of current medication, without paying attention to calorie consumption and exercise can be a definite mistake. And ignoring unexplained weight loss without checking on blood sugars can be many times worse because of the damage done to internal organs from high blood glucose. Some of the newer treatments on the market for Type 2 Diabetes may help patients both control their blood sugars and their weight. Patients can talk with their primary care physician or endocrinologist to find out if any of these might be right for them.

Stay tuned to our blog for more health information and educational content. Future blogs will deal with battling obesity, managing migraine, and more. Anyone in the Greater St Louis Area who might be interested in opportunities to volunteer for a research project in diabetes, obesity, or migraine management can call StudyMetrix Research at 636.387.5100 or email us at recruitment@studymetrix.com.

Thanks for reading my blog! See you next time!

Timothy R Smith, MD, RPh

 

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