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Top Ten Reasons on Not Losing Weight For Diabetics

Misis, tumaba na naman kayo.”

“Doktora, hindi na nga po ako kumakain. Isang kutsarang kanin na lang sa tanghali at isang platitong salad na lang sa gabi. Nag wa-walking ako 30 minutes three times a week. Simula nang nagka-diabetes ako, tumaba na ako nang tumaba, doktora! Kahit anong gawin ko.”

“Naku, eh, gaano po ba kalaki yung kutsara at platito ninyo sa bahay?”

Woe to the diabetic patient with weight problems. Most patients with diabetes are already overweight at diagnosis, and likely gain more weight on treatment. Many factors contribute to this, the most popular culprit being medications. It is very frustrating for patients who are doing everything right, in terms of diet, lifestyle changes, and medicine compliance, to find out that they have gained 10 unwanted pounds after several months of sheer sacrifice.

To many, it just does not make sense. With the knowledge that treatment for diabetes can induce weight gain, some would unfortunately choose not to treat their diabetes, and thus sugar control is compromised. This article will attempt to address this issue: why do diabetic patients gain weight or find it difficult to lose weight once on treatment?

The following are the top 10 possible factors causing weight gain in diabetes.

1. Increased intake of food
Once diagnosed with diabetes, patients will hear the doctor or dietitian often say, eat more frequent meals. However, the qualification, that it should be “small” and frequent, is often missed. The emphasis should actually be on “small”, but maybe some have selective hearing.

If a diabetic patient is put on a medication regimen that compels him to eat often, then weight gain is inevitable. The medication regimen should fit the patient’s lifestyle and routine, not the other way around. Some patients, however, who are started on insulin, develop a false sense of new-found freedom when taught on how to cover food with extra insulin. This can lead to dietary recklessness with overeating.

The solution is for patients to be more vigilant when it comes to the increased tendencies to overeat. Medications should be adjusted. More awareness and more self-control are key to curbing the weight gain from mere overeating.

2. Lack of exercise
Whether diabetic or not, laziness or a sedentary lifestyle still contributes to weight gain or failure in weight loss. With the challenge of the side effect of weight gain arising from treatment, patients should realize that burning energy or losing weight takes double the effort for many.

3. Insulin
In the United Kingdom Prospective Diabetes Study (UKPDS), a landmark study in diabetes, an average of 7kg weight gain in 10 years of insulin treatment was demonstrated. Insulin being one of the best, if not the best and safest, drug for diabetes, it is just unfortunate that it has this side effect. The reasons are multifactorial, including caloric retention, because of improved glycemic control, and unphysiologic action of older insulin formulations.

Modern insulins and more physiologic treatment regimens are beginning to eliminate the need for a trade-off between sugar control and side effects when treating diabetes. Minimizing the insulin dose is one strategy to limit weight gain. This can be done by using insulin in combination with an insulin-sparing oral antidiabetic drug, such as metformin, which may allow a decrease in insulin dose by as much as 30 to 47 percent, promote weight loss, improve glycemic control, and lower the frequency of hypoglycemia.

4. Oral hypoglycemic medication
Thiazolidinediones are a class of drugs (which include rosiglitazone and pioglitazone) that work toward improving insulin resistance, and provide an excellent glycemic profile, meaning not much hypoglycemia. However, they are associated with the highest weight increase among the diabetes oral drugs, approximately 5kg after 1 year.

Sulphonylureas also increase weight by 1.8 kg after the first year of treatment. This class of drugs include glipizide, glibenclamide, glimepiride, and gliclazide. They work by stimulating insulin release from the pancreas.

Both above-mentioned classes of drugs have excellent blood sugar–lowering capacity. To balance their weight gain side effect, other drugs that are known to cause weight loss may be used in combination. The drugs known to promote some degree of weight loss are metformin and exenatide.

5. Artificial sweetener
The Purdue study showed that rats fed yogurt sweetened with sugar did not eat as much as the rats fed artificially sweetened yogurt. The premise is that eating real sugar sets off a response that lets the body know that real calories are being consumed.

In turn, the rat feels satisfied after eating. Meanwhile, rats that ate the artificially sweetened yogurt did not have that response of being satisfied with the amount of food being consumed. They ate more, which caused them to gain weight and body fat. This is consistent with human studies that documented increased risk of obesity in individuals consuming beverages sweetened with high-intensity sweeteners.

These days, sugar is not the enemy it once was in managing diabetes. Doctors used to feel that eating sugar would spike blood glucose levels too high and too fast. The current view of sugar is that it is metabolized at the same rate as any carbohydrate, and can be part of your total carbohydrate allotment for the day. Budgeting your total daily carbohydrates and having a small portion of a favorite dessert made with real sugar is not a bad thing.

Artificial sweeteners may not be as beneficial for weight loss as previously thought. Incorporating appropriate serving sizes of real sugar into your diet may make weight loss easier and might ultimately be more satisfying.

6. Hormonal problems, such as hypothyroidism or Cushing’s syndrome
If there is uncontrolled weight gain accompanied by other symptoms such as fatigue, constipation, cold intolerance, and dry skin, one can have concomitant hypothyroidism, which is not uncommon in patients with diabetes. This is failure of the thyroid gland to produce appropriate levels of thyroid hormone, rendering one’s metabolism to slow down. This disorder is easily treated with thyroid hormone.

Cushing’s syndrome is less common, and it is characterized by weight gain, high sugars, high blood pressure, weakness, and morphologic findings, such as central obesity, purple stretch marks, and a hump in the back of the neck. It is caused by increased cortisol production from the adrenal glands or increased adrenocorticotropic hormone (ACTH) production from the pituitary gland. Once diagnosed, it is treated by surgery.

7. Hypoglycemia
Hypoglycemia is the occurrence of a very low sugar level, associated with symptoms of weakness, dizziness, sweats, shakiness, and change in sensorium. If there is frequent hypoglycemia brought by over-medication, the patient’s tendency is to overeat to overcome the symptomatic episodes. Repeated or regular occurrences lead to overeating and thus, weight gain.

The key is to adjust the medication and eating pattern so as to eradicate hypoglycemic episodes or risk and, thus, decrease the stimuli for weight gain.

8. Is it weight gain from water retention?
Sudden weight gain from fluid retention may indicate a serious underlying medical problem, including heart disease, kidney disease, and uncontrolled high blood pressure, which are all common in diabetes. Fluid retention or edema can likewise occur in patients taking thiazolidinediones such as rosiglitazone and pioglitazone, and calcium channel blockers such as amlodipine. The occurrence of side effects of these drugs should be discussed with your doctor, before discontinuing any medication.

9. Depression
Comorbid depression is another factor that can complicate improving sugar control. In a recent meta-analysis, the presence of type 1 or type 2 diabetes doubles the odds of depression compared to a control group without diabetes. Concurrent depression has also been shown to be associated with poorer metabolic control, decreased adherence to medication and diet, and reduced quality of life.

Some patients become depressed simply from having diabetes; depression can worsen due either to weight gain or their perceived deprivation of favorite food. A highly skilled diabetes team can work with patients individually to help them learn how to incorporate their favorite food within the context of healthful eating, adjust medications for optimal glycemic control, and implement strategies to minimize potential weight gain.

10. Lack of support from family and friends
Often the hardest part of a diabetic patient’s life is when he or she is surrounded by family and friends who are indifferent to his or her internal struggles, mostly concerning food and lifestyle. It takes a whole household to help sustain a healthy, balanced diet. It will be depressing for someone who has some dietary restrictions, to be surrounded by unhealthy food or practices 24 hours a day. It is sad if one always has a separate plate and menu from the rest of the family. It takes a lot of empathy and effort within a household, to incorporate healthy food practices which will benefit the whole family anyway, rather than isolating the member who has diabetes.

In conclusion, awareness and anticipation of all the above-mentioned factors that contribute to weight gain in diabetes will help all patients, their caregivers, and their doctors attack the problem early on when it is still easy to control. Identifying the problem of weight gain, when it is too late, makes it significantly more difficult to reverse.

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