Gaining Body Fat May Be Good For Those With Type 1 Diabetes?

According the research in this article:
people with higher BMI and type 1 had a lower mortality rate then people with a skinnier BMI.

This seems kinda shocking to me as I am really striving to maintain a healthy bodily figure. However perhaps the “skinnier” people in this study were just unable to keep good insulin/BG levels and were skinny because their bodies were unable to properly store the glucose.

What do you think?

Fascinating, but to be taken with a grain of salt, to be sure. I think one would have to look at the ages of the people in the study and their diagnosis dates - in particular, what the methods of treatment were for people diagnosed between 1950 and 1980 before the study began in 1986 and what other factors might be at play in the development of long-term complications pre-study. Maybe that was considered. Doesn’t say here though.

It’s not that I wouldn’t love to hear that my overweight BMI is fine and dandy for my health, but I think what they’re saying is that we run greater risks from being underweight than we would from being slightly overweight or even obese. And that seems like common sense to me. We’re on a hormone that results in weight gain and many of us eat carb-rich diets. If we’re below the average weight for a non-diabetic person, something else may be wrong - like you said. Maybe their bodies don’t store glucose the same way or maybe there’s not good absorption into fatty tissues when they take insulin or something. Just my thoughts, anyway.

For a good read from a Men’s Health writer about being thin and Type II/Pre-diabetic, check out Even a thin person can get diabetes.

The following is actually a response I posted in another group about an article from June about this same research…

It isn’t exactly saying that weight gain is good, per se. It’s saying being underweight is bad. There was no difference in mortality between people with normal BMI’s and people with BMI’s in the 25-30 range (overweight). It was the below normal BMI people who died sooner, which would be consistent with a higher likelihood of poorly managed diabetes. It sounds to me like the weight is really secondary to what informs longevity. It’s more about controlling your BG’s. Anyone who tightly controls their BG is more likely to be a few pounds heavier, although that doesn’t have to be the case. If you carefully balance insulin and food intake, it’ll be less necessary for you to “feed the insulin” and gain weight.

It’s a poorly written, and even more poorly titled article [June 7th article]. I’m irritated that anyone would present a misleading article like that. It’s bad enough that non-diabetic people are already uneducated about type 1 - I don’t want to see people with type 1 feeling like they’re justified in gaining weight. Being overweight is a known risk factor for CVD, and we’re already at risk for that.

I agree with Lee Ann on many points, but I would also add that I tend not to consider a study that followed 655 patients with type 1 diabetes for 20 years too seriously, as the sample population size is not large enough to draw any real conclusions (as a point of reference, that would not be sufficient for an FDA clinical trial). The issue of being underweight is probably accurate, but similar conclusions could be reached using HbA1c alone … for example, 7% of the DCCT study sample died from hypoglycemia (they don’t generally tout that statistic), and changes were subsequently made to the criteria to exclude anyone who had an instance of “severe” hypoglycemia from the trial … ironic, since the average patient with type 1 has at least 1 incident of such “severe” hypoglycemia once each year according to large, population surveys.

The bottom line is that the widespread claims about weight gain aimed at the type 2 universe are not necessarily applicable to people with type 1, obviously maintaining a “normal” weight is ideal, but is not necessarily realistic with a non-physiologically replaced hormone like insulin.

This seems strange to me, there’s got to be more to the story. This articles smell like funny like the Accord Study. I guess its probably where you store the body fat. If its stored as subcutaneous fat around the body, not really much of a concern as subcutaneous fat is rather benign and increases insulin sensitivity, and when appropriate correlates with good health and longevity. But if the fat you store goes to the belly as visceral fat, that can be cause for concern as this type of fat is pro inflammatory leading to increased risks for a variety of health complications and insulin resistance.

If you are on a low carb/low insulin regime you are not going to have allot of body fat or a high BMI in general compared to those on a higher carb/higher insulin regime. You wont be storing as much fat as you’re more likely to metabolize it in the presence of low insulin levels. Also on lower carb diets you won’t be storing as much your energy as glycogen. On a higher carb diet allot of your weight comes from extra muscle glycogen from carbohydrates, extra body fluid packaged with this muscle glycogen, general extra body fluid as insulin causes sodium/fluid retention, and of course extra body fat from surplus carbohydrates not burned or stored as glycogen.

Larger people have more tissue reserves of protein and fat to draw off of in times of need and the skinnier people may have had other factors complicating the disease. If I had to put my money on somebody with a BMI of 25 with a HbA1c of 7.5 and somebody with a BMI of 20 and HbA1c of 5.3, my money would go on the 5.3 anytime.

Larger people have more protein stores and body fat store to draw off of in times of need such as sickness and old age. Muscle is what you want to store above all. A healthy amount of fat along with this muscle should be no problem. Once you reach old age the body begins to breakdown due to physical inactivity and improper nutriture. Old age brings on sarcopenia, osteoporosis, osteopenia, etc, and is a difficult time to add extra body weight. So my guess is add body weight now and mostly as muscle. Here’s an interesting article of the benefits of protein from the American Journal of Clinical Nutrition: There was a recent follow up to this article in the June 25 2008 Journal of the American Medical Association but I can’t access the full article as of yet.