The new contact form we launched here recently to make it easier for people to share their thoughts and contribute ideas is bringing in some very interesting stuff. One note that caught our attention was a query from a woman named Sarah:
“I was diagnosed with type 2 diabetes in 2001. I currently am well-controlled on oral medication, but I am also fat (not, I’m sure you will agree, an unusual situation). When my endo says I should lose weight, I ask ‘how do I do that without becoming hypoglycemic all the time, since I’m taking glucose-lowering meds?’ The endo sends me to a dietitian, who hands me a diet sheet, but can’t answer the medication question either.“
We don’t often cover weight loss, or even oral meds for type 2 diabetes on this blog. So this seemed like a perfect opportunity to look a little 
closer at both.
As we all know, if you’re overweight, then losing weight is incredibly important for lowering your risk of heart disease (which folks with diabetes are at an increased risk for), lowering and maintaining your cholesterol levels, and decreasing your risk of some cancers and other illnesses. But what you might not know is that once a person has type 2 diabetes, the impact of weight loss on blood sugars becomes more and more minimal, according to Hope Warshaw, diabetes educator, dietitian, and ADA author who has guest posted here a few times.
In a post on her own site, Hope writes, “By the time the diagnosis of type 2 diabetes is made, and especially several years afterwards as the disease has progressed further, weight loss tends to have minimal, if any, impact on blood glucose control. Where research shows you get the bang for your effort with weight loss is with pre-diabetes.” Clearly, you want to make sure that whatever you’re doing, your blood sugar management is your number one priority.
But since weight loss is still important, how does someone with type 2, like Sarah, make sure they don’t drop dangerously low? Information is power, of course; you need to know your meds.
Medications that are known to cause hypoglycemia include:
Amaryl, Glucotrol and Glucotrol XR, Diabeta, Glynase, Micronase, Prandin and Starlix
Medications that are not known to cause hypoglycemia include:
metformin (brand names include Glucophage and Fortamet), Actos, Precose, Glyset, Januvia, Onglyza, Welchol, Clycloset and the injectable drugs Byetta and Victoza.
Some oral meds work by decreasing the output of glucose from the liver, while others increase insulin secretion when blood sugar levels are high. Still others work by increasing insulin secretion regardless of blood sugar levels. It’s important to take a look at your medication, see what you’re at risk for, and let your doctor know if you’re experiencing any adverse effects. And yes, hypoglycemia is an adverse event! Nowadays, with so many drug options, it’s more important than ever that we patients are educated about what we’re taking, and let our doctors know if the regimen isn’t working for us.
Anyone taking Victoza? Some folks discussing our seminal post on that drug, “The Jury’s Still Out on Victoza” (426 comments and counting!) state that they’ve had some luck shedding a few pounds, while others swear by losing weight on Byetta.
If you are taking one of the drugs that could cause BG lows, the obvious solution is to eat a small snack prior to working out — but only if you need it, and we mean small! The Mayo Clinic recommends mini-munches like a small banana, yogurt or granola bar, and watching how far in advance you’re eating (two to three hours in advance of exercise is best, according to this ABC News story). Of course, for PWDs, the real trick is to work with someone, ideally a diabetes educator who can personalize these answers for you, and make any necessary adjustments.
Diabetes and exercise specialist Sheri Colberg-Ochs (who’s also a repeat guest blogger here) actually says that exercise alone won’t get you very far, unless you work on your eating habits, too. She says, “Research shows that you can lose weight through exercise alone, but it may take more like an hour a day as well as monitoring your food intake.” In other words, don’t just focus on pumping iron at the gym — but think also about staying hydrated, eating fiber and protein to help you feel full, and overall, cutting calorie intake.
It’s commonly known that people often gain weight when they start insulin — mega frustrating! But the same rules of exercise + good food habits apply. We want to note here that it’s dangerous to fall into the temptation to skip insulin doses in order to lose weight. According to the Joslin Diabetes Center, it’s never the insulin alone that is causing people to gain weight, or prevents them from losing it. “And while taking less than the correct amount of insulin will lead to rapid weight loss, the weight lost will be mostly water and muscle being broken down, and not all fat… And losing weight that quickly is unhealthy — not to mention the fact that keeping your blood glucose high makes you increasingly prone to long-term diabetes complications.”
Losing weight for people with diabetes is definitely a challenge. If you happen to have type 2 and you’re struggling, here’s a nice little checklist from Everyday Health that could be helpful.
At the end of the day, eating smart and staying active is a just a darn good thing to do, no matter who you are or what you have.
Hi Allison,
Great post! I just wanted to point out that the checklist you have cited as being from HealthCentral is actually from Everyday Health. (I’m the diabetes editor).
Thanks,
Amy
Hi Amy –
Thanks so much for the correction! I have fixed it.
-Allison
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This is excellent info for diabetics trying to lose weight
What works with T2 is to forget eating meals. The thing to do is to graze — eat snacks of about 200 calories every 2.5 – 3 hours, with an emphasis on fresh fruits and vegetables, and fill in with high-quality proteins (legumes, low-fat/fat-free dairy, low-fat meats and fishes, hard-boiled eggs, egg whites). This regime has you stocking up (to raise blood glucose) before you crash, and having little enough at any given time to stop you from going too high.
This is very interesting since I have a few friends who were diagnosed with type 2 diabetes and then lost a lot of weight. The result was an extreme drop in use of medication and even not taking any at all.
To say that losing weight does not affect BS management in any type of diabetes sound questionable.
@Michael: I agree with Tmana. The point Hope was trying to make is that as weight loss progresses, weight loss will do less and less for a PWD. Pre-diabetes, and even early diagnosis, can sometimes be helped greatly by weight loss. But if a person is diagnosed with type 2 diabetes several years down the road (and it can be hard to tell how long a person has been living with type 2) then weight loss may not be as effective as one would like. That’s not to say weight loss isn’t important, or won’t have some impact. But as Tmana says, it does vary from person to person.
Michael, the effect of weight loss on medication requirements depends at least to a degree on where in the T2 progression one is diagnosed and on what the underlying causes are.
If obesity is an underlying cause (fat tissues release hormone-like chemicals that interfere with insulin metabolism), then dropping weight will reduce insulin resistance; however, if diagnosis did not occur until more beta-cell function was destroyed than we normally expect, that person will still need a low-carb diet, oral medications, and/or insulin.
If, however, the Type 2 diabetes is caused by errors in protein folding, issues with the insulin receptor sites, or issues with other chemicals that affect insulin metabolism (but which are not produced by adipose cells), then weight loss will not affect insulin sensitivity or the need for medications and/or insulin.
All –
Nice job on this piece Allison! This is a very confusing area which is filled with outdated information and numerous misconceptions. Tmana – thanks for good clarifications. Today, I think it’s incredibly important for people with T2 to understand the expected progression of disease. It is simply the reality of T2. I try to frame this in a positive manner in that the earlier in the progression people act aggressively to manage glucose, lipids and blood pressure (and this often, unfortunately, requires medications for all), the healthier they will be over the long haul. And yes, eating healthy and being physically active will assist all medication regimens and will likely slow down the progression of disease and need for medications.
Let’s keep dialoging!
Hope Warshaw
Read the Victoza warning. . . . .yeah, this stuff is safe:
In animal studies, Victoza® caused thyroid tumors—including thyroid cancer—in some rats and mice. It is not known whether Victoza® causes thyroid tumors or a type of thyroid cancer called medullary thyroid cancer (MTC) in people which may be fatal if not detected and treated early. Do not use Victoza® if you or any of your family members have a history of MTC or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). While taking Victoza®, tell your doctor if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
Inflammation of the pancreas (pancreatitis) may be severe and lead to death. Before taking Victoza®, tell your doctor if you have had pancreatitis, gallstones, a history of alcoholism, or high blood triglyceride levels since these medical conditions make you more likely to get pancreatitis.
I have t2 and have had it for over 25yrs. I have gone through weight loss surgery and have lost 100lbs plus now iam struggling with the last 20lbs and am having trouble keeping metformin down also iam on byetta which works wonderfully.My a1c is 6.7 so iam looking for a sampler pill that wont make gain weight. I have admit that i dont exersice as much as i should but iam trying to do better.