weight gain

[Rami]

I have been injecting now for the last 12 months, I am eating healthy but I have put on one and half stone mostly round my tum area. This is very upseting for me what can I do to get rid of this weight gain.

[Denise Kennedy]

Hi Rami - thanks for your question. It is really important for your diabetes control to try to be a healthy weight. There are two main areas you can focus on - the first is your diet and the second is exercise and activity.

With regard to your food think about what you eat - some people find it helps to keep a food diary. Are extra foods creeping in? Has the insulin made you more hungry so you are eating bigger portions? Are you now eating more snacks in order to avoid going hypo? Some people find when they go on insulin they get scared of hypos so compensate by eating more and more often. From your food diary you need to find where you can cut down a bit - try making sure your meals are based around vegetables, with some lean meat/fish or pulses and some carbohydrate food such as pasta, rice or potatoes. Avoid too many sweet and sugary foods, and fat loaded snacks (such as crisps, cheese and crackers) as these are high in calories. When you make adjustments to your diet you may need to reduce your insulin a little as well.

The second thing you need to do is increase your activity - either through exercise or by being more active as part of daily living. Try to find ways to put this into your normal day. Can you walk more? Maybe cycle to work? Or just make sure you always use the stairs, walk to the post box, help with the housework etc. This will burn up more of the energy (calories) from the food so you won't store it as fat. Being more active is also likely to mean that you will need less insulin, so you will need to test you blood sugars regularly to make sure they are not going too low.

If you have further concerns or queries perhaps you could arrange an appointment to see your diabetes specialist dietitian?

[Dr Masud Haq]

Hi Rami

Am I correct in assuming you have type 2 diabetes?

If this is correct and have put on weight whilst on insulin then it's quite possible this may be a major contributing factor.

I think your treatment regimen should be carefully reviewed. Most type 2 diabetes patients will remain on metformin and a suphonylurea before additional insulin is added. This combination often helps to limit the frequency of insulin injections that are required and will limit the amount of insulin needed.

If you have type 2 diabetes with a BMI of above 35 and your recent HbA1c is above 7.5% then injectable GLP-1 therapy rather than insulin would be the best treatment option for you. This potentially may help you lose weight.

Masud