From Atlanta, Georgia, USA:
I am 27 and have been a Type 1 diabetic for 2 years. Recently I have had a problem with weight gain even though I have cut out fatty foods and I exercise at least every other day. Is this an inevitable consequence of being diabetic?
No, it is not inevitable; but it is a common and tiresome problem. For some people insulin does increase appetite, this in turn leads to an increased food intake and a rise in insulin requirements, a vicious circle. To remedy this you will need the help of both your doctor and an experienced nutritionist. The first thing is to assess your insulin dose in relation to your ideal weight, it should be about 0.8 Units/kg. of ideal body weight/day. If the dose is now substantially in excess of this you need to talk to your doctor about lowering this. Occasionally a draconian reduction to a normal level will solve the appetite and weight problems without distorting control. Much more commonly you have to inch back along the path you came. For this reason you also need the help of a nutritionist who can help you adjust calorie intake with a minimal increase in hunger.
Try to avoid the various 'get slim quick' regimens; but don't be under any illusions that the process will be easy. Group programs like Weight Watchers can be a real help.
Original posting 16 Mar 97
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