5 months in... any advice?

Type 1 and LADA New to Type 1 Diabetes
1

Hi,
I’m hoping for some advice on a couple of things. I’ve been on insulin for about 5 months now, since my diagnosis. I went to the doctor yesterday and found out that my weight in now 73kg. This really upset me, as my last appointment was 3 weeks ago, and I weighed in at 71kg.

I really dont get it. I’ve been eating very well, watching my carbs, and even started going to the gym 2 weeks ago, and have been going 4-5 times a week. I dont feel as heavy, if anything, I feel smaller. But the scales tell a different story. My BMI now states that I’m overweight. I know BMI isn’t everything, but it is really getting me down. I’ve had so much motivation with this new lifestyle and I worry that this could really affect my efforts. My HbA1c is slowly coming down (now to 7.4% from 10) which I’m pleased with.

I’m just wondering if it could be the insulin which is making me put weight on? I lost alot of weight just before my diagnosis (as type 1’s usually do) and so I know this weight can be expected to go back on once on the insulin. However, I’ve always been around the 65 mark, and I thought it would have settled down by now. I have completely changed my way of eating, exercising and had hoped to see improvements. Just so you know, I am 22, 5’5. My new BMI, of yesterday is 27. It used to be a perfectly healthy 22 : '( I just dont get it!

I’ve recently been put on Tetracyclin for my skin, as it’s not been very clear recently. I think my hormones are going a little crazy. I dont know if this could have anything to do with it but thought it was worth a mention. I was told by my doc that I might have PCOS but I went to the gynocologist and I dont.

Could water retention perhaps be what is making me heavier? I have noticed, especially in the last few weeks, that I have been feeling rather bloated, as if I am about to get my period/am on it.

Any help, advise, suggestions would be really appreciated, as I’ve been feeling very down about it all this week and finding out that my BMI is no longer healthy is concerning me. I just feel miserable, and want to feel that I am in control of my diabetes, not the other way round.

Emma : )

2

Hi Emma, I’m afraid I don’t have any answers but just want to reassure you that you’re not alone. At dx I was 59kg (23.9 BMI) and in the first four weeks after dx and being put on insulin, I piled on 10% of my body weight despite being too scared to eat anything. Dx was June 2010 and I’m now 20% heavier than at dx.

I wouldn’t worry too much about BMI because it is really quite meaningless. I tell myself I’d rather be officially overweight but with normal-ish BG, than officially ‘normal’ weight and in DKA in the ICU. But I have noticed I need more insulin per carb now and the only reason for that is the weight gain - I’m concerned about that and that’s the next step in my diabetes management!

PS For what it’s worth, I think there are studies that say the ‘healthiest’ BMI is actually the slightly overweight range

3

Have you have your thyroid function checked? Thyroid problems and diabetes often go together, and if you have untreated hypothyroidism that would contribute to the weight as well as feeling the way that you do.

4

Keep working at it. Remember that at the start of working out you’re building muscle, especially if you haven’t been doing it before. You said you are noticing a change in your shape, that’s a good thing. The saying that muscle weighs more than fat is wrong, but fat is also much bulkier and can retain more water. The more you workout, the more muscle you will put on and after awhile your muscle will plateau, but if you keep at it you will continue to lose fat. Also there is a correlation between amount of muscle and fat loss, the more muscle you have the easier it is to lose fat. One of the reasons is fat generates its own aromatase (makes more estrogen) and produces inflammatory molecules (cytokines) that are detrimental to weight loss. So as you continue to workout you will become healthier not just from losing the fat but from reducing systemic inflammation. Your hormones will continue to fluctuate until your have stabilized your BG levels and that may not happen until the end of the honeymoon period.

I am gaining weight, but I am also trying to. Sometimes I think I’m the only one that is! I lost 20% (~20 kg) of my bodyweight before I was dx.

I wrote a really long forum post about something similar to this topic, see it here.

5

I agree with Sarah about getting thyroid checked. But I also urge you not to worry about it too much. Insulin in and of itself doesn’t cause weight gain, unless you get into the “I can eat whatever I want and cover it with insulin” school of diabetes treatment and are eating more, taking larger amounts of insulin to cover it, etc. As you stated, since you lost weight before diagnosis your body is now returning to homeostasis with improved blood sugars. You don’t mention how many carbs you are eating. If you are concerned with weight you could cut your carbs somewhat in addition to the exercise you are adding. The less carbs you eat, the less insulin you need and the less weight you will gain. Also if you feel your current weight is too heavy you can ask your doctor for an oral med in addition to insulin that will help you not put on more weight. Perhaps someone will mention which one it is. Also some say Levemir is less inclined to weight gain than Lantus.

Bottom line is I wouldn’t worry about that small weight gain but only work to prevent it from continuing.

6

I don’t know the conversion from kgs to lbs but I am about 5 months in and have similar issues. My BMI went from 23 to 27. I think the biggest shock was how quickly it happened and how yucky I feel despite my good sugar ranges. According to my dietician, some of the weight is water… we were dehydrated with high sugars because we excreted it with our access sugar and now about bodies want to retain it. But that doesn’t account for everything.

I am finally realizing that the goal range of carbs given to me by my endo and dietitian are way too much for me. I am 5’1". So I am trying to cut back on my carbs. I get low and have to eat so I had to decrease my basal in order to stop feeding my insulin. I am also trying to eat carbs at dinner so that I can workout after and not having to take my rapid acting. I am just a few days in so obviously no results haha But hopefully over the next month I will start to see changes.

It’s going to be harder than those without DM 1 but I am keep telling myself I have time and at least my blood sugar is under control. So it’s frustrating, but focus on the good: good blood sugar and stopping long-term damage on your body!

7

2.2 lb/kg.

8

Good points, Jackie! Lots of people have a pattern of lows and just treat them, rather than seeing this as an indication to lower their insulin, or they wait for their 3 month visit to their endo to make changes and just treat the lows. Also many people feel hunger when they are low and eat a lot, or use “tasty treats” to treat and overtreat rather than waiting to see if it works. My suggestion is always to use glucose tabs to treat lows because you can figure out the exact amount you need and they don’t taste good enough to want to overuse them! Also they are much quicker to raise blood sugar than things like say ice cream where the fat slows down the action.

9

thanks :wink:

10

Thanks for your advice Zoe. I have been watching my carbs, usually eating 0-20g at breakfast, 30-40g at lunch and 40-50g at dinner. I am on a 10:1 carb:insulin ratio (Novorapid) as well as 6 units of Lantus at night. No one has mentioned oral meds to me to help with the weight. I might mention this next time if I continue to gain weight… 4.4 pounds in 3 weeks seems a little ridiculous!! Esp with my current diet and gym routine!

11

Hiya Sarah, yes I’ve had my thyroid checked recently. They said that it was a little high after my diagnosis but earlier this month it was taken once again and now is in range. Apparently just after diagnosis this can be affected but it has settled back down again now.

12

Jackie, thanks so much for this! It’s comforting to hear that I’m not the only one with these frustrations! It certainly can feel that way. One thing my doctor did advise is to workout after meals, instead of say mid afternoon, ie less insulin, more exercise. I must admit, I’ve been scared of lows, so eating say 1/2 banana before and after, or a piece of rye bread… not a lot but it adds up.

13

I am going to invest in some glucose tablets tomorrow! : D My diet is good, APART from when I go low and my brain decides that hey, I can eat what I want : s

14

Another thing along those lines that seems to work for me (I have lost a bunch of weight, although it was long and slow and after years of piling it on…The saga is on my page…) is to have the carbs for the low and wait more like 20-30 minutes? Glucose tabs might work fast but a lot of stuff seems really hit 20-30 minutes. A lot of the 15 minute readings are maybe moving in the right direction but aren’t quite “there” yet. I also have been working on treating lows with less carbs, maybe more like 7-12 than 15-20, depending on insulin on board. This seems to help keep my weight at least steady, although I wouldn’t mind shaving off another 10 lbs or so? I like V8 a lot for lows too, as I get sort of a cathartic buzz reading the vitamins on the label while I’m lolling around waiting for my BG to return to normal?

15

We attach so much to our weight. And in truth, that is really just silly. We think that being really thin is healthy, but it isn’t. We think it makes us attractive, but it doesn’t.

It is very common to gain 5-10% in weight once you go on insulin, it is simply your body trying to restore itself. Your body has eaten itself up trying to keep you alive before diagnosis and you naturally restore your glycogen levels once you have normal levels of insulin. From everything you have said, you BMI is entirely normal and although you have gained weight, it is entirely within what you should expect.

Yes, work toward getting healthy and fit, but don’t obsess over this. Personally, I sit here with an “overweight” BMI and I don’t worry about it. I worry about my health and my fitness, but my BMI and the weight in the scale are not good indicators.

16

Good to hear that your A1c is coming down. I think insulin is a make fat drug for some people and not totally sure what to do. The oral drug metformin does work marvels to help with weight loss in some people. I would certainly try it some food stores in the US give it away for free. My ophtalmologist loves metformin and the thinks it is the cause for the decline in diabetic eye damage. A minority of people cannot take it. It is prescribed for PCOS. Best of luck.

17

Do you think that this is something that will settle? I’m not as much worried about the weight itself as how it is making me feel. It is hard not seeing results (apart from HbA1c) when I’m doing all I can towards living an active and healthy lifestyle. I am not really fussed about being ‘thin’, I never have been. Just the best I can be. And I dont feel like I am that at the moment. Maybe this is something I just have to accept.

18

In my case settled is 260 lb and this requires effort to keep it there gives a BMI of 33 you don’t want to go there. I would fight and try additions to the insulin to counter its nasty effect. Metformin, symlin or very low carb diet to minimize the insulin you inject. Don’t accept.

19

My weight easily fluctuates 2 kilos by the time of day or how much clothes I have on (especially in winter!!!). So I would not worry about the change too much.

Also, as I wrote on your blog post, you could be adding muscle mass since you started to work out!

My weight changed a lot during my first couple years with diabetes, but once I got into more of a habit of a healthy lifestyle and stopped having constant lows (which I usually OVER treated), then I settled into a weight that is slightly less than I was
BEFORE I lost the weight before diagnosis.

As others mentioned, you should also have your thyroid function (TSH, Free T3, Free T4) checked and get the test for antibodies (in Hungary it is called ATPO). Autoimmune hypothyroidism (called Hashimoto’s) is very common with type 1 diabetes and can cause weight gain or difficulty in losing weight.

20

Some food stores in the U.S. give Metformin away for free?? You need a prescription in the U.S.