This week I was asked to deliver a lecture to a doctor’s seminar. The subject was diabetes. I decided to title my talk “A practical guide to weight loss in diabetes”. I wanted it to be exactly that, practical. I wanted each of the doctors to leave the room with some new ideas about what they could do to help their patients with diabetes to lose weight. It’s too easy for doctors to reach for their prescription pad and prescribe tablets. It’s too easy for their patients to take them. And though for many people with type 2 diabetes medication plays a vital role, the role of weight management shouldn’t be understated. Here’s why.
Ten percent body weight loss, around 14 pounds or a stone of weight for many people, can have a dramatic effect on diabetes. Research has shown that in newly diagnosed type 2 diabetics 10% weight loss would reduce blood sugar levels to normal in around half of them. In my Practice we see this all the time. After only a few weeks of weight management fasting glucose can return to normal, reducing the need for new diabetes medication or even stronger doses of that already prescribed. But not only does diabetes control improve, the sense of self-satisfaction and empowerment that patients can achieve is dramatic too. John is a 52 yr old who developed type 2 diabetes a few months ago. I saw him again recently. After 2 stones of weight loss his sugar level is now normal, and he’s looking and feeling great. He asked a very specific question. “Has my diet beat my diabetes?” My answer? “Yes, completely, for now at least”. Diabetes does develop over many years and in time John might require added help. But he has delayed the need for medications, and the unpleasant complications of diabetes, if not for good, for many years at least I’m sure.
The principles of weight loss in people with diabetes are no different to those without. Moving about more and eating less are still key. But people with diabetes do find it more difficult. More difficult because of the “insulin resistance” they have, but more difficult too because many of the medicines we use to treat diabetes actually cause weight gain. Ironic really, that weight gain causes diabetes and the treatment we use sometimes makes the weight gain worse! Insulin, gliclazide, and the “glitazones” are the most common culprits. But so too can other related medicines we use, such as statins for cholesterol, and beta blockers for blood pressure. You see it’s not just high blood sugar that causes problems for people with diabetes, its high blood pressure and raised cholesterol too. And guess what, both of those problems can also be helped with 10% of body weight loss.
I left the seminar happy that I’d had the chance to spread the word. Yes, even doctors need to be reminded that type 2 diabetes is in large part a “lifestyle disease” and one of the best ways of tackling it is through improving our lifestyle, losing weight, and becoming more active. Going by the questions they asked after my talk they’d already started to think about helping their patients lose weight. I hope so. It’s a win-win situation. So, if you have diabetes and want to lose weight, you need to know that it’s possible, it’s safe, and it’s very powerful. It’s never too late to start. I’d suggest you talk with your doctor or practice nurse straightaway though. That way they can work with you, and make sure your medication is adjusted appropriately as you progress. Once your diabetes starts to improve, make sure your doctor knows about it. Nothing beats a good case history to reinforce the message!