The Catch-22 of Losing Weight with Diabetes

Wednesday, March 13th, 2013 | Posted under Diabetes

rollercoasterHere’s the thing that really bugs me about trying to lose weight with diabetes:

A good portion of the insulin that PWDs (people with diabetes) take on a daily basis comes from their size. The bigger you are, the more insulin you need, and vice versa. Of course, the food you eat, hormones (like birth control or stress), and activity level also play a big role. But your size matters. So when I exercise and subsequently start dropping the pounds, the amount of insulin I need starts to drop.

Which is great. In theory.

In practice, however, it usually ends up with me having a string of low blood sugars that actually prevents (or at least temporarily interrupts) my weight loss endeavors until I get to the point where I’ve managed to figure out where my new insulin needs are. But then give it another five pounds and we start the process all over again.

In short: Exercise equals less insulin, but the current doses equals low blood sugar preventing exercise. Plus: low blood sugar means treating it with juice. Juice = calories. Calories that I neither want nor need!

Sigh. Right?

In theory, it’s great that I need less insulin. I want to take less insulin because less insulin is yet another barometer of the fact I’m getting smaller. But it isn’t so easy to just change doses. The body is a fickle thing and what prevents a low blood sugar one day might actually cause a high blood sugar on another day if you start over compensating. High blood sugars are also frowned up on when exercising, although a moderate high can be a nice buffer to prevent a low blood sugar after working out. But if those high blood sugars are popping up all over the place, then that’s bad.

When you start experimenting to find your new dose, you might actually discover that you cut too much because changing one factor in diabetes management has repercussions throughout the whole day. You might find that preventing a low blood sugar at one part of the day now causes a high blood sugar somewhere else, which has you, guess what, taking more insulin!

You see where I’m going with this?

This is why I was always really nervous about changing my basal rates. It always seemed like — again, in theory! — that my simple modifications would solve the problem. But then it would either 1) not be enough and I would still go low or 2) it was too much and I would go high. And so then the experimentation continues until you have it figured out.

But then if you’re consistently losing weight, you might have 2-3 weeks of “stability” (ha!) and then you’re back to do this all over again.

No wonder people with diabetes hate to exercise!

Right now, I’m trying to not let it get in the way. I’m trying to keep my blood sugars stable while futzing around with the right dose so that I can prevent low blood sugars. I know this will be a consistent theme of my life for the next few months, because the Allison who weighs 160 lbs. (my goal weight) needs different insulin amounts than the current Allison (who is, uh, bigger). It’s not something that will happen in one fell swoop. It will happen slowly. Obnoxiously.



Comments on this post

  1. Scott E says:

    I know you’re happier not using a pump these days (and I respect your reasons and won’t try to change them), but I found exercise so completely incompatible with Lantus. I’d play a hockey game one night and be low through the next afternoon – well after the game had ended. It’s certainly not as bad as NPH, but it still brings on a “feed the insulin” pattern, which can be tough if you’re trying to lose weight. These days, I do lots of temporary basal decreases to prevent lows or fight them off (zero percent for one hour) if I sense them coming on. It seems to work well.

    Again, not trying to suggest what you should do, just saying that I can appreciate and relate to how tough it can be.

    1. Allison says:

      This has nothing to do with the type of insulin — this is just how it is when you start to need less insulin. I actually find exercise itself to be very compatible with exercise. I rarely go low, but I’m finding my lows to be sporadic throughout the day. I’m about 10 lbs. lighter than I was in the fall, so it’s logical to assume that my insulin intake is too high. I have already made some changes and things seem to be improving… just as I predicted. I actually had a very difficult time figuring out how to manage an insulin pump while exercising and I think I really prefer the way I do it.

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