Treatment Diabetes: insulin and diet (part 3)

Continuation of the article about diabetes and diet.

DIET AND INSULIN

My husband has been putting on weight since being diagnosed as having diabetes three months ago. What are the reasons for this?

Most people lose weight before their diabetes is diagnosed and treated. In uncontrolled diabetes, body fat is broken down and many calories are lost as glucose in the urine. As soon as the diabetes is brought under control, the body fat stops being broken down, the calories are no longer lost and the weight loss stops. Many people, like your husband, begin to put weight back on again.

If he starts to put on too much weight, your husband should discuss this with his diabetes specialist nurse and his dietitian. They will advise him about his diet and activity and, if he is on insulin, about reducing his food intake and insulin simultaneously.

I have been taking insulin for eight years and over this time I have put on a lot of weight. My doctor says that insulin does not make you fat, but if that is so, why have I put on so much weight?

Before starting insulin people often lose weight. This is because when diabetes is not controlled you lose lots of calories as glucose in the urine. When diabetes is controlled, the calories are no longer lost in the urine and the weight loss stops. There is then a tendency for people to put on weight or regain the weight they had lost. Insulin in the correct dose should not make you fat but if you are having too much insulin you have to eat more to prevent hypos. These extra calories will increase your weight. Also initially insulin can increase your appetite, as it lowers your blood glucose.

Trying to lose weight when you are on insulin is possible, but needs to be done slowly, as you cannot make drastic diet changes without upsetting your diabetes control. With careful reduction of both food and insulin, weight loss can be achieved but requires patience and perseverance.

My partner has diabetes and is trying to lose weight. She eats a low-carbohydrate diet and sticks to this rigidly. I cannot understand why she does not lose any weight.

Reducing a single food group, such as carbohydrate, in her diet will not necessarily lead to a loss of weight. Low carbohydrate diets are often much higher in fats and proteins so the total calories consumed are not necessarily reduced. A better and healthier approach would be to look carefully at what she eats and aim to reduce the higher calorie foods such as fatty foods and alcohol. Avoiding fried foods, using low fat dairy products, taking moderate amounts of protein as low fat meat, fish, chicken or meat substitutes such as tofu or Quorn, increasing fruit and vegetables, choosing carbohydrate foods with a lower glycaemic index, and including some regular activity would be the best long-term plan. Your partner may benefit from help and support from a dietitian or diabetes specialist nurse.

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