The irony of diabetic treatment: weight gain

BB, 47, is a long-term diabetic who needs pills and insulin injections. She’s been off insulin for a year – just can’t afford it. Her eyes are blurred; she feels irritable. I refill her meds, switch her insulin, add metformin (more about that later), and send her out with my fingers crossed.

Two weeks later I see her. ”How’s the glucose?”

Better. Her numbers make me smile.

But she’s not smiling. “I gained eight pounds in two weeks,” BB said. “I can’t fit into my size 4 pants.”

The irony of weight gain in diabetic management is not lost on me. Excess weight exacerbates insulin resistance – the last thing a diabetic needs.

But it doesn’t have to be that way.

I explain to BB – two weeks too late – what’s happened to her and how we can fix it.

First, I expect some weight gain in the beginning because of rehydration.

Diabetics with uncontrolled blood glucose are perennially dehydrated. Excess glucose draws water from the body like a dry sponge. The body flushes it out through urine. Two prominent symptoms of poorly controlled diabetes are constant thirst and frequent urination, even at night.

Once glucose is controlled, the body stops losing water. The first pound(s) of weight gain is rehydration. It’s healthy.

Second, correcting “starvation.”

A body short on insulin is literally starving. A major job of insulin is moving glucose (a source of fuel) from blood into cells where it’s needed. Imagine insulin as the traffic control specialist who decides and facilitates who goes where. Unfortunately, when one eats more than one can burn, insulin helps convert the extra glucose/fuel into fat. That weight gain is not healthy.

Next, drugs for diabetes.

While there are other reasons diabetics gain weight, drugs are not wholly innocent or equal.

Three classes of diabetic medications may be better than others.

The front-line drug, metformin, is very weight-friendly. It’s cheap, safe, effective, lowers glucose without causing low-sugar reaction, and may promote weight loss. A three-month prescription starts at $10.

The other two classes of drugs are SGLT-2 inhibitors (Jardiance, Steglatro, etc.) and GLP-1 agonist (Trulicity, Victoza, etc.). They’re relatively new, expensive (no generic is available), and no better than metformin. If you want to learn more about a particular drug and its impact on weight, I found a very helpful article in the February 2018 Consumer Reports, titled “Best Treatment for Type 2 Diabetes” – you can google it.

I tell BB that her weight gain will slow down – or stop. But she needs to eat smart and count calories. Now she has more energy; she’s motivated to walk more.

BB laments that she used to eat whatever she wanted and not gain weight. I commiserate. I’d eat strawberry ice cream, salt-and-vinegar potato chips, caramel/cheddar mixed popcorns, and corndogs for breakfast, lunch, dinner and snacks if I could. But that privilege comes with a hellish cost.