Why So Fat, yo?

#1

This was originally posted to my blog, Diabetes Odyssey.

I have a very serious problem and I need the help of my readers to hopefully figure it out or at least get some direction to put me on a path to figuring it out.

I have spoken to several of my doctors, especially my endocrinologist and primary doctor but they are not listening very well and aren’t concerned (and don’t seem to see how very concerned I am), and simply assume my problem is solely due to my lifestyle even though I have stressed that my lifestyle contradicts what is happening here!

My problem is that I am continuing to gain weight (fat) even though I have been working for months upon months to lose weight (fat)!

How is this even possible!?

I exercise and I do not overeat! I eat a healthy, low carb diet with lots of non-starchy veggies, protein, and healthy fats. I do not eat too many calories, either. It’s a great diet for type 1 diabetics and for weight loss! I’m not perfect, but I do very well most the time.

I have a million health issues, and yes some of them make it difficult to lose weight and very easy to gain. But the extent to which I have gained and continue to gain is extreme and I do not believe it is totally my health issues to blame here.

Type 1 diabetes, mild gastroperisis, mild PCOS, severe insulin resistance, peripheral neuropathy, heart disease, hypothyroidism, blah, blah, blah…

Researching all my medications I am not taking any that cause weight gain except my insulin which I do have to take a large amount of (at the very least 75 units a day but usually much more). But my endocrinologist tells me my insulin is probably not to blame here, at least not to a large extent.

I do take several supplements for several different reasons- deficiencies, immune health, and metabolism health. I am not taking zinc or selenium at the moment but I plan to start because I recently read that they may help with weight-loss because they help to treat hypothyroidism where medication fails (T3 conversion).

Just this year alone I have gained over 20 lbs while exercising and eating healthy (geared toward weight-loss). I have not been able to lose even one pound.

I’m sure you can imagine how heart-wrenching and frustrating this is!

I shouldn’t be anywhere near as big as I am! I shouldn’t look like this!

Why won’t my doctor’s do anything helpful! All they do is say “I can refer you to a dietitian” or “I can prescribe you some diet pills”.

I don’t need a dietitian, I know how to eat right, I am eating right!

I don’t need your stupid pills! I need to know what’s causing this and fix it! I need a permanent cure for this!

GAHHHH!

I don’t need or want another diagnosis of yet another illness. But since I am so lost and frustrated I looked up “reasons for weight-gain not related to lifestyle” or something to that effect, I don’t remember exactly. And the answer I got that does match literally all my symptoms is Cushing’s Syndrome (endogenous). The only problem here is that all the symptoms for Cushing’s can be explained by many of my other illnesses. At this point I don’t think I have it. It wouldn’t hurt to ask my doctor to run tests.

Any suggestions are appreciated.

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#2

Sorry you’re having to go through all this. Trying to tease out an answer with multiple conditions like this can be frustrating. I think even a doctor would find it difficult to diagnose what is going on without doing some further testing. But here are a couple of thoughts:

You mention 75 (or more) units of insulin. That seems like a lot for a low-carb diet. How much are you bolusing for a typical meal? Protein can raise glucose and needs insulin too. So, two questions: Are you eating rather large amounts of protein and/or have you accounted for all sources of hidden sugar? “Healthy” fruit juices and smoothies can contain sugar from which the fiber has been stripped away. That, combined with a high dose of insulin, can promote fat storage in the liver.

I have found three individuals that I think provide excellent insight into diabetes and metabolic issues.

First is Dr. Richard Bernstein, a doctor specializing in diabetes and other metabolic conditions. He offers a free monthly webinar called “Diabetes University.” He answers listener questions dealing with weight gain/loss, hypothyroidism, blood glucose control and more. Regarding thyroid issues, he discusses the role of free T3, free T4 and TSH. Past webinars are posted on YouTube. I met Richard almost 50 years ago by telephone conversation. And then I went out and bought my first blood sugar meter — the kind that was only meant for labs and doctors’ offices! It was a complete game changer. So, I suggest you review his past tele-seminars and perhaps submit a question.

Two additional resources are Dr. Robert Lustig and Gary Taubes. They both point the finger at sugar, including those hidden sugars we may overlook. Dr. Lustig goes deeply into the mechanisms of insulin action (“the fat storage hormone”) And both these men talk about the obesity epidemic worldwide. Again, both men have YouTube videos that may help.

None of these resources are guaranteed to isolate your specific problem. But I think reviewing their materials can help you ask better questions. And perhaps that means changing your doctors if they are unable or unwilling to deal with your specific issues.

Best of luck!

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#3

Are you taking metformin in addition to insulin? I’m guessing you may already be since you mentioned PCOS and insulin resistance, but if not, that seems like an obvious add-on to try. I take metformin ER, 2000mg a day (split into 2 doses)—started w 500mg once a day and gradually worked up to the max dose. Allowed me to lower my insulin doses and finally my efforts to eat well resulted in weight loss like the should.

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#4

If you weren’t a T1, you probably would have been a T2
insulin and leptin resistance is the problem… leptin resistance is treated the same as insulin resistance.

20g carb, 50g protein and the rest fats. just also adjust your basal insulin down as you go.
use cronometer and go to profile and set it up as ketogenic and then rigouous

#5

You mention the possibility of having Cushing’s Disease, whose distinguishing features are concentration of fat around the center of the body, thinner legs and arms, bluish striations in the skin, and a tendency to nervousness. If you don’t notice those symptoms, you probably don’t have it. If you do have it, I suspect your endocrinologist would have noticed it by now.

For weight control, the best strategy is to discipline food intake rather than to emphasize exercise, since that is the much more efficient approach. Figure out what your total caloric intake per day is, what your body mass index is, and determine exactly how much overweight you are. Then determine a weight reduction diet, say 1200 calories a day, compose your diet of healthy foods and portions amounting to that, and just stick to those foods and portions forever. If the conservation of mass-energy still holds, you will have to lose weight.

#6

You went through a period of hyperthyroidism not too long ago, didn’t you? When I was diagnosed with Graves’ disease I experienced a 25 pound weight gain after starting treatment, even though I’d changed nothing about my lifestyle. My endocrinologist said that it could have been from the fact that my thyroid was ramped up really high and I adjusted my calorie intake way up (because I was starving) and my exercise level way down (because I was weak, shaky, and tired) without realizing it. Then when I started medication, it slammed my thyroid level back down to normal really quickly, but it took me several months before those symptoms disappeared and I felt well enough that my eating and exercise were back to normal. I’ve also heard many people complain that the medication itself has weight gain as a side effect (although I realize you’re not taking the same thyroid medication as I am).

I also have quite a bit of weight to lose and have found that the only thing that works for me is a very low-carb diet combined with a lot of exercise (several hours of walking a day, or an hour or more of swimming every day, or similar). I think the key is getting a low insulin dose, at least that’s been my experience. When I can get my insulin dose to below 40 units a day I can lose weight, but the only way I can do that is eating low-carb and exercising. One or the other alone, or counting calories alone, accomplishes nothing for me.

Progress for me is extremely slow. I count anything that is not weight gain (such as just holding my weight steady) as a victory in order to stay motivated. It’s taken me two years to lose 20 of the 25 pounds I gained after my Graves’ diagnosis, and I have a lot more than that to lose. I can’t compare myself to others, because everyone seems to have a relatively easy time losing weight and it’s an exercise in frustration. I have never been able to lose one to two pounds per week or whatever the healthy weight loss rate is. I personally feel that women with diabetes and multiple chronic illnesses are in a bit of unique boat. Who knows where the actual cause is. Is it medications? Is it inflammation in general? Is it the fact that two of our most important hormones (insulin and thyroid) are messed up? Is it other hormones that affect our bodies? It doesn’t mean we can’t lose weight, but I do think ti takes an enormous amount of work, and that calories are not the whole answer.

I was tested for Cushing’s disease years ago, and if I recall it’s a 24-hour urine test and maybe some blood tests. I was told that there are very noticeable physical symptoms. I still got tested due to unexplained symptoms I was having (uncontrollable high BP and rapid heart rate, in my case), and thankfully results were negative.

Good luck in working towards weight loss! Let us know if you find anything that works for you. I, for one, would be interested to know as I might find it useful in my own journey.

#7

Thanks. I eat, usually, three meals a day, spread out, and try not to snack at all unless I am hypo (which rarely happens because my body insists on high BG despite tons of insulin and a healthy lifestyle). I bolus only for carbs (IC 1:6) which I think may be one problem, I need to consider protein. I try to keep my protein at normal amounts, I certainly don’t gorge on it. One serving of chicken or fish, usually, per meal. I watch my sugars very closely and avoid consuming them at all costs. I do not eat fruit at all, in any form, and do not partake of smoothie type drinks at all.

I am not perfect, no one is, but I do quite well on a day-to-day basis.

I often need correction boluses (ISF 1:12…but I think it needs adjusting now) and this may be due to protein I am not accounting for?

I often wonder if my insulin resistance (it’s getting worse over time despite meds (2K mg Metformin) and diet and exercise) is actually a problem elsewhere? Like maybe with my liver…but my liver labs always come back normal. It’s like my body is losing it’s ability to use insulin at all! Frightening.

I have gotten to the point where I am very resistant to the idea of taking even more insulin because, whether it is true or not, I think it just makes me fatter! I would like to figure out why my body is so resistant to insulin and fix it rather than just taking more!

I am very familiar with Dr. Berstein’s teachings on Diabetes. His book is where I first learned about LCHF. I didn’t realize he also covers thyroid issues. I will look into his web stuff.

#8

Yes, I am on 2K mg a day. It, at first, helped a tiny bit, but over the past 1.5 yrs it has stopped helping at all. My insulin resistance is worsening despite the Metformin and healthy lifestyle. And I am gaining weight rather than losing.

Very frustrating and frightening. I feel than soon insulin won’t work on me at all and I’m going to die!

#9

I will most definitely look into this. Thank you.

#10

Yes, I was hyperthyroid for a month or so before it plummeted to hypothyroidism. I am now on Levothyroxine and my labs are normal. But I understand that the medication doesn’t help with T3 conversion and that is possibly why the medication doesn’t help with the problem of weight gain. I read that zinc and selenium supplements may help with T3 conversion and so help with weight-loss.

I guess my problem may really actually be a combination of all my illnesses (primarily insulin resistance and hypothyroidism) and I just need to figure out how to live with it and how I need to adjust my life to be able to lose some weight.

The trials never end. But we just keep trying.

Thanks

#11

I have a T1 friend who goes through your entire day’s insulin allotment in one meal. With everything else you have to deal with hopefully this one concern you can put on the shelf and not worry about.

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#12

I am also experiencing this same type of situation. I’m about 30 pounds over weight. I take a lot of insulin every day, pushing close to 100 units total. I don’t over eat. I eat my meals and snack only when necessary. I take a daily brisk walk. I take Metformin. I can’t lose any weight. In order to lose weight, I think I would have to go on a starvation diet. I would like to be able to feel comfortable and satisfied with what I eat. I’m trying to avoid going on a diet that makes me feel hungry and frustrated all the time. That will ultimately fail.

I don’t know why I’m so fat either. It doesn’t make any sense. I don’t drink alcohol and I don’t drink any calories either. I only drink water, plain tea and a diet soda a few times a week. It’s not like I’m drinking a lot of juice and smoothies. I have been to a nutritionist before. I avoid all breads, cereals, processed foods. Eat lots of salads, lean proteins and vegetables. Fruit is limited.

Extremely frustrating…

#13

I hear you! This all makes me want to just give up. I do everything right and still I am gaining weight and no one listens and no one can help!

But yet here I am, still trying.

#14

I totally understand your frustration.

I gained 20+ lbs after starting levothyroxine, & my BGs went to crap. Both are common. Levo causes insulin resistance. No matter how much I exercised or how much I restricted calories (I’ve been low carb for years), I kept slowly gaining. In May my PCP finally tested my T3, & switched me from levo to NDT (natural dessicated thyroid). She also started me on low dose Naltrexone. My BGs began to level out again about 6 weeks after stopping the Levo, & I have now lost 19lbs.

In my case, selenium did nothing to help me convert. My T4 was high, but my T3 was extremely low. I’m due for labs in the next few weeks. I expect to see a huge improvement because I’ve definitely had major improvement in my symptoms.

If you haven’t had a full thyroid workup, that’s where I would start.

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#15

Interesting about the t3 conversion I think I’m having that problem too. But not weight gain. I have hashis. My tsh has gone up and I can barely function. Hopefully endo will start doing something now. I will be getting a second opinion. Other type 1 hashis sufferers have told me Levo makes insulin less powerful and you need t3.

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#16

Wow you’re lucky your pcp did this. Mine is an idiot who said she would not do anything to help treat my thyroid and I never go to her anymore.

#17

Honestly I was surprised. I thought I would have to persuade her. I had planned to ask about more testing & possibly trying something besides levo. Three years of escalating symptoms with TSH & T4 in normal range. I’ve done all the gluten/soy/nightshade/dairy-free stuff & the only thing that changed was I was more miserable. She’s aware of everything I’ve tried. The past year has been the worst. Much worse than pre-dx. Maybe that’s why she decided to try something different. Or it could be our past history (battles over my “pre-diabetes”), although she willingly agreed to antibody testing because of my multiple autoimmune issues. I’m just grateful I didn’t have to search for good treatment the way so many do, & I hope the effects last a long while.

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#18

I already commented to @Tamra11 about Dr. Richard Bernstein and his free online “Diabetes University.” But, more specifically, I’d like to suggest his Session 41, specifically on hypothyroidism. If you go to YouTube and search for “Dr Bernstein session 41”, you’ll find it. He goes into quite a bit of detail including the timing of taking supplements. If you want, you can ask him a question in one of his upcoming seminars. I’d be interested to know what others think of his comments.

#19

This is going to sound odd, but TD1 and thyroiditis are linked to celiac disease. I know…you are not wasting away, but if you have any vitamin or mineral deficiencies, it might be due to malabsorption. Your body can be fighting to hold on to weight to make up for not be able to absorb nutrients well. There are just as many heavy celiacs as thin.

It is just a simple blood test and all TD1 patients should be screened. Do not go gluten free as it will affect testing.

#20

I have always made sure i take my thyroid meds on an empty stomach. I prefer taking them at bedtime, especially the NDT (I take WesThroid). I’m actually surprised Dr Bernstein doesn’t mention NDT. I would never want to go back to Synthroid.

His list of symptoms is rather short, & doesn’t include my worst symptoms. I’m almost positive I would’ve failed his backward numbers test years before thyroid issues came along. I’ve always struggled with reciting numbers or letters backward. In my case it has nothing to do with hypothyroidism.

For me, Hashimotos is just another addition to my growing list of autoimmune disorders.