Are all diabetics overweight?

I think not!  More than thirty-two years following my diagnosis of juvenile-onset diabetes at age 12, I am still thin by any standards.  I do not exercise for hours on end to maintain that weight.  I do not starve to death.  I have and attempt to attain “normalized” blood sugar targets. 

So then, why do most articles, news clips and commercials on diabetes assume all diabetics are overweight and need to lose weight?  Why do so many newly diagnosed diabetics write and ask, “Will I gain weight?  My doctor says insulin will make me gain weight.”  Others write asking, “I take insulin; I can not lose weight.  Help me!” 

These fallacies seem to be a fairly, new occurrence.  I sure never heard these assumptions for the first 25 or 30 years following my diagnosis.  I also never felt inundated and annoyed by “lose weight,” “lose weight” articles.  Welcome to the world of 6% type 1, 94% type 2 diabetes?

So, what is the truth?  The truth is not all diabetics are overweight.  Not all diabetics were ever overweight and not all diabetics who take insulin gain weight. 

So, what do we tell insulin dependent diabetics?  We tell diabetics that if they eat more than they need to eat, take more insulin to cover the excess food, and do not “spit” excess nourishment into their urine, the body allocates it to fat.  Insulin takes any excess nourishment and converts it to fat.  Therefore, like anyone else, it is fairly simple.  Do not eat more food than you need!

We also tell diabetics who take excess long acting (or basal) insulin and experience frequent low blood sugar (because of the excess insulin) to do basal testing and properly balance their long acting insulin.  When diabetics take too much long acting (or basal insulin) for whatever reason, (e.g. the doctor said so, to extend the duration to match pharmaceutical claims, because it is easier than dealing with late digesting food, they perceived insulin resistant, etc.) and they subsequently have low blood sugar caused by insulin peaks, they eat/treat the low blood sugar with further excess nourishment.  Frequently, diabetics over treat these lows due to panic or due to the “hungry horrors” at 2 a.m. and frequently, it leads to rapid weight gain.

However, this weight gain does not have to occur and poor glucose levels do not have be the alternative.  In addition, not every article written needs to assume and describe how diabetics have to lose weight. 

What the articles should describe is how many total calories a person of a particular age, height, target weight and activity level needs.  The articles should describe how to count ALL food (not just carbohydrates) in order to assess total calorie requirements.  The articles should describe how to properly take insulin at appropriate times (to address varied digestion) to address all food intake (not just carbohydrates) to avoid low blood sugar followed by high blood sugar.  They should describe how to do basal testing and multiple long acting doses in order to avoid peaks, lows, and gaps.

So, to the editors of diabetes journals and websites, Certified Diabetes Educators, endocrinologists, primary care physicians, etc. PLEASE stop assuming all diabetics have weight to lose.  Please DO address the difficult topics diabetics need to understand the not so easy topics (digestion, multiple doses of insulin, basal/bolus testing, etc.). 

With proper treatment information, insulin dependent diabetics do not have to be overweight or ever have weight to lose.  However, if they are repeatedly told to take too much insulin (because no one has a better answer) or not told how to properly calculate either basal or bolus (long acting or short acting) insulin requirements, they will continue to fear weight gain by virtue of a life sustaining hormone.  And, please, there are plenty of other vitally important topics on which to focus.  Listen to your patients; they will tell you what they are.