T1D needs to gain weight

Type 1 and LADA
1

As a T1D for 30 years, I have always been thin, never exceeded 165 pounds with lifetime average around 150-155. About 2 years ago I found myself tightening my belt slightly and that my weight was 140 (and still at 140). Was not overly concerned UNTIL my Endo put me on a low dose of Farxiga to see if it would help with daily swings of my BG. Farxiga supposedly can result in weight loss which I cannot afford. A summary of what I found online for weight gain is below (yes, I did find a few items mentioned in an older post here) and hoping this group might suggest what a T1D should add or remove:
Protein Foods: Ground Beef 70%, Thick Bacon, Chicken with Skin, Pork, Eggs, Steak, Salmon, Tuna, Sardines and other Fish
Fruits and Veggies: Banana, Grapes, Avocado, Pear, Mangos, Papaya, Pineapple, Sweet Potato, Potato, Corn, Peas, Artichoke and Dried – Banana, Raisins, Prunes, Craisins, Dates, Figs
Nuts and Legumes: Peanut Butter, Peanuts, Almonds, Pistachios, Walnuts, Peas, Black Beans, Lentils and Seeds – Sunflower, Pumpkin, Flax
Dairy: Whole Milk, Butter, Heavy Whipping Cream, Cream Cheese, Cheddar Cheese, String Cheese, Cottage Cheese
Carbs and Grains: Brown Rice, White Rice, Quinoa, Pasta, Wheat Bread, Oats, Oatmeal, Wheat Germ, Flax Meal
Oils and Misc: Olive Oil, Coconut Oil, Safflower Oil, Peanut Oil, Frozen Pizza, McDouble, Beef and Bean Burrito, Almond Butter, Chocolate Chips, Honey
Drinks: 100% Fruit Juice, Cream Based Liquids

I also recognize that when gaining weight, to avoid fat but gain muscle, I will need to begin regular exercise in addition to my preferred (occasional) physical work (where results are immediately seen).

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So, I have a similar issue (although I’m newly LADA and not yet on exogenous insulin). I’ve been struggling for about two months to gain weight, and have managed to put on about three pounds in that time!

I don’t have any comments about your food choices, although they wouldn’t work for me. Because I’m getting by on endogenous insulin production, I have to eat low-carb to avoid going higher than my target BG range; many of your foods are carb-heavy, which only works if you can bolus for the carbs.

What I see as a common thread, however, is that they tend to be higher fat options. This makes sense, since you want to be eating more calories than “maintenance” in order to gain weight. Eating more fatty ground beef, whole milk, etc. is a pretty decent way to add calories above and beyond what you might be used to eating. That’s not necessarily enough, however. Although I’m (clearly) not the master of actually putting on weight, I know the scientific principles behind it, and can only suggest the following:

  • Estimate your TDEE using an online calculator so that you know, roughly, how many calories you need to maintain weight on a “normal” day (including exercise).

  • Use a food tracking app or website to track not only your macros (protein, fat, carbs) but also your total calories eaten and expended (through exercise). I use myfitnesspal. Most diabetics are familiar with this because of the necessity of tracking carbs: in addition to tracking carbs, track everything!

  • Start eating at 100-200 calories more than your estimated TDEE, and don’t weigh too often (it gets discouraging, because weight fluctuates a lot due to water retention and loss, as much as 5 lbs a day for me… I weight twice a week, at the same time of day, before I have any fluids or food, and after I use the bathroom, and then average the results). If you still aren’t gaining weight after a few weeks, add another 100 calories (per day) to your target.

  • Multi-muscle movements with heavy weight are the most efficient way to build muscle (which adds weight): deadlifts, squats, bench press, push ups, pull ups, barbell (or bodyweight) rows, dips, etc. Doing a lot of cardio will burn a lot of calories, so if you do endurance training it needs to be offset by eating more calories and doing more strength work…it’s very easy to lose fat and muscle by doing a lot of cardio while not eating enough.

  • In order to build muscle, it’s generally necessary to consume enough protein and calories. Fat and carbs are great, but you need protein to gain muscle (or not lose it while cutting weight). Many people suggest 1 gram of protein per day per pound of lean mass (estimate your BF and then do the math to figure out how much lean mass, or get measured at a doctor’s office). Scientific sources suggest that eating between 0.7-0.83 grams per pound of total bodyweight is also valid: any more is generally converted to glucose rather than used to build muscle.

tl;dr: eat big and push weights. I know you probably know all this, just putting it down in case someone else is curious. As for my own routines, I’ve been doing the following for the last two months:

  1. I eat 2,600 calories on rest days.

  2. I eat 3,000 calories on strength training days.

  3. I eat 3,200 calories on days I do at least 1 hour of endurance or cardio (and add 200 calories for every extra hour of intense activity).

  4. I’m 6’0" and currently 182.4 lbs (measured this morning!), about 17% bodyfat. 41 years old. My estimated TDEE at “light exercise” levels is about 2,500 calories per day, so I try to eat more than that (and even more on workout days).

  5. I workout with weights 3 days a week, do quite a bit of walking (to work, around campus, around the house and property, etc.), and do cardio 2-5 days a week depending on time of year (cycle during the summer, elliptical or bike or shoveling snow during the winter).

  6. I probably underestimate my level of exercise and/or amount of cardio, which is why I have had a hard time gaining weight the last couple of months.

  7. I can’t seem to realistically eat 3,000 calories a day, especially since I eat less than 100g of total carbs a day (most I can handle without my BG getting wonky), so I’m considering giving up on muscle gain for the moment and cutting down to 10% bodyfat and trying again in the summer :slight_smile:

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Thanks David - BTW, I am 5’ 11" and 60 years young. You have confirmed many things that I thought. You have discipline that I currently lack; whereas I prefer to cut and stack firewood or dig up the garden rather than lift weights, etc. everyday.
I probably consume an average of 1800 to 2000 calories per day while http://www.healthycalculators.com/calories-intake-requirement.php suggests I need 2400 to gain 1 pound per week especially after I develop a regular exercise habit.

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I tell you what, it is difficult to gain weight while low on insulin. Anyone else eating as much as I do and working out as often (and, honestly, twenty years younger) would be yuuuuggee by now. I’m mostly just focused on maintaining what muscle mass I can. People in my family have a bad history of wasting away with T1D, and I’ve got a brand-spanking new son to enjoy and take care of.

I can say this, although it might be controversial to some: it’s a lot easier to gain weight (and put on muscle) if you can eat moderate to large amounts of carbs. When I start on insulin therapy, I may very well switch my diet up to try to add some more muscle. If that doesn’t work, I’ll likely just give up and shoot for the worn-thin old cowboy look :slight_smile:

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I’ve struggled to keep my weight up since diagnosis. I’ve recently been able to put on a few pounds and this morning I hit 153 lbs (5’10" 67 years old) for the first time in a long time.

I would remove foods that make it hard to maintain steady blood sugars. I find myself eating less when I’m struggling with highs. If you can manage all the foods on your list you’re a better insulin jockey than I am by far. I would give up the dried fruit, fruit juice, white rice, pineapple and honey.

The core of my weight maintenance plan includes an 800 calorie breakfast which includes 80 grams of peanut butter as well as egg beaters and an apple. Nuts are really a powerful tool for weight gain.

Good luck,

Maurie

6

I definitely agree with that! Hazelnuts, pecans, almonds, sunflower kernels, and pumpkin seeds have become my go-to snacks and salad additions to add calories, fiber, and not a lot of digestible carbs. I love peanuts and cashews, but I have to be careful with them: they seem to have a greater effect on my BG, and I’m also inclined to eat more of them.

So nuts (of some sort) I eat as snacks between meals, salad toppers, part of stir-fries, in chicken salads, as dessert, on chia pudding for breakfast, and about any other way I can. I’ve even tried baking with almond butter and flour, and can make a decent bread substitute that is pretty darn low-carb.

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Nuts, ice cream and don’t forget … beer :wink:

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If everything else is OK, dr bernstein would say to eat more protein, when you are getting enough fats, extra fat doesn’t put on weight. he gave his trial patients an extra 500 cal of olive oil and it did nothing.

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I actually would suggest a strategy for weight gain that focuses on what @David49 has said. Do heavy resistance training like deadlifts, squats etc. Then after your workout specifically eat. Bolus heavy and go heavy on the carbs and protein. I don’t mean out of control, but after training your body becomes both glycogen depleted and insulin sensitive. And the two hours after training are the golden hours where what you eat gets used very effectively by your body for recovery. Training itself doesn’t build muscle mass, recovering from training builds muscle mass.

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Eating less with highs - is likely a large part of my weight loss. After years of Humulin regimen of 2 shots and 2 to 4 blood tests daily, even with CGM, I tend to eat light when running high and finally recognizing that Apidra in the pen makes it easier and practical to bolus in 1 unit selections.
I figured the fruit juice and honey would be OUT d/t high concentration of sugars unless treating fast dropping Lows.

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I am newly T1DM for 3 years now. 160# at 6foot was 170-172 when diagnosed. Have lost wt and need to gain as well. Being a registered dietitian nutritionist, I have recently added good fats (omega 3s and 6s via avocado, grapeseed, MCT and olive oils, nuts also with low CHO greek yogurt snacks (Two Good). I still cant gain wt however have also cut the carbs to 30-60 per meals for better BG management (current A1C 6.7 however want it <6.5). As a Registered Dietitian I am adding more kcal via fat and protein but not consistently. Tired of hearing, “your too skinny”. Mentally is challenging. Anyone having success with wt gains? TIA
Brett

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Weight gain was always more of a struggle when customers came into my store. It takes a real consistent effort. As you know you have to consume more calories than you need and it’s just really hard sometimes to do. I used to recommend people add a couple of shakes/smoothies with a variety of higher calorie food, from oils to bananas etc. It’s just sometimes easier to drink some extra calories than to eat them. You might be able to find some premade drinks for extra calories that will work. Or there are weight gain mixes.

It might be easier to calculate insulin needs when eating less carbs. But it’s not necessary for better control. I have found timing has more to do with better control.
My A1c is 5.2%.

13

The drug you are on is an odd choice by your doctor.
That drug causes the glucose threshold to drop. Normally At 170 . Drops to 140.
So your kidneys work harder, you are more likely to be dehydrated and you will lose calories into your urine.

Even if you eat more the extra food is going to be removed by your kidneys. Well the protein won’t

It might be worth talking to your doc about a different drug.
Are you type1 or 2?

I am type 1 and I could never gain weight until I started intense insulin therapy and good control.

Im6’3 and I was 160 at diagnosis. I’m 199 now. I could drop 10.

14

Are you pre-bolusing? Most people need to bolus 20-40 minutes before eating, depending on starting bg.

There is also an inhaled insulin that works quicker than injected insulin. I think @Terry4 is still using this.
I have used in past, but not currently.

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More protein and enough fats for energy. delay bolus for up to 50% of the I:C ratio for the extra protein

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Yes need to adjust bolus timing for added fats and increase in protein.
Thanks Jack

Brett Conlin, RDN, CDN, LDN

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You misquoted. Just to clarify, You bolus as normal for carbs. you may need to protein bolus or square wave about an hour after eating, for upto 50% of the protein, using your I:C ratio. Fats are 10% but most people don’t bother. Total glucose availability TAG.

You have enough fats to complete your calories.`Protein for weight gain. Some would have 150-250g a day and see how it goes. Normal is 0.8g/kg LBW, Low carb/keto is 1.25g/kg. This would be 1.5-2.5g/kg

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Hi Jack
Not sure I understand the treatment your stating. Square wave?

Say I take 30-40gm CHO at meals. I:C 1:22, insulin for CHO would be 1.8U. I usually do 50% now and 50% extended over 0.5 hr. Absorption depends no how much fat and protein i take. Difficult to time as digestion is slower with higher fat/protein meal.

Thanks
Brett

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Thanks to all who replied - much appreciated. This whole T1DM is 3 years new to me and it is frustrating especially when BS are not ideal and people continue to say “your skinny”. Psychologically is harmful and would be like me telling an obese person they are fat. I understand the added fat however if it is saturated fat, aren’t we risking hyperlipidemia. My Ca score is only 14 and do not need to be on a Statin at this point but the " horse is out of the barn" as my cardiologist stated. Cholesterol is 153-175. I have added more good fat oils" avocado, olive, grapeseed, and others. Ill even have a tablespoon of oil in my yogurt (greek two good) and walnuts for mid-morning snack. I do need to exercise with weights more which may in fact be what is needed for gains. The tricky part is adjusting bolus’s for added protein and fats. Delay absorption and risk of hypo initially after hr insulin hitting. I have the Omnipod which makes it bit easier to manage but still experimenting.
Also I am recently unemployed (5 weeks out and no insurance for prescriptions) Does anyone know about how I would get my omnipod supplies covered? Durable medical equipment is not covered which would cost me hundreds. Being unemployed is now a new change for me. Any recommendations from this awesome group I would appreciate.
TIA
Brett

21

Hu chocolate covered almonds are a fun way to eat them. But not cheap. They also have chocolate covered cashews. I am a chocolate fan lol…So melting chocolate chips or chocolate bars and spreading peanut butter or almond butter on top is a fast way to have “PB cups” that you control what’s in it. You can use chocolate that has a stronger cocoa content like 90% and really keep the carbs down if you choose.

I had an employee years ago that really struggled with trying to gain weight. It took a real effort to methodically make sure to eat enough. The hardest thing about it is, it would take months to put on some weight and just a little stress or not paying close enough attention and she would lose it faster than it took to put it on. I have always heard that it is harder to gain than to lose and to see her struggle with it made me realize that’s probably true in a lot of cases. We also had customers that had issues with gaining weight and a lot would make the mistake of eating the wrong foods and ended up with other issues.

Here is information on an assistance program for Omnipod for people without insurance.