From Manhattan, Kansas, USA:
Our daughter, 19 years old and diagnosed with Type 1 at age 8, has had extreme difficulty losing weight for the last 5 years, despite recording what she eats, attending Weight Watchers this summer, and now her 2nd year of intense college softball practices. Her weight has been a problem since 10th grade. Her diabetes specialist is not extremely concerned, but this is the time of her life when she detests her weight (210 lbs., 5'9") and she is concerned with what she will weigh as she ages and is not as active as now. I caught a portion of Dateline (NBC program) last evening and want to ask you if you believe that Polycystic Ovarian Syndrome (PCOS) can ever be a factor in Type 1 diabetes? In researching PCOS on the web I'm seeing references to insulin resistance in PCOS cases which can lead to Type 2 diabetes. She does respond well to her insulins (Regular in A.M., Humalog before dinner and NPH at bedtime).
I think I'm grasping at straws here, and I realize increased dosages of insulin make it difficult for diabetics to lose weight, but our daughter is a very strong, solid person and at age 13/14, she was not that solidly built; i.e., she was quite happy with her 150 lbs, and kept it there. Then, her periods began. Just makes me wonder if there is some connection with a prepubertal condition. Note that she has no amenorrhea, no anovulation, no uterine bleeding, no excess facial and/or body hair -- she is just a good-sized young lady. Any help you could give us would be appreciated. (Her thyroid has been tested twice in the last 5 years or so, but not recently; we will pursue the thyroid test again, but feel it will be another strike out).
You didn't mention if there is a family history of weight problems and/or type 2 diabetes. If a person with type 1 diabetes has relatives who are overweight, it will be particularly hard (but important) to try and keep her weight as close to normal as possible. Your daughter is right. If she is already overweight as a teenager, she may have more problems as an adult.
I have not particularly found Weight Watchers to work well with people with type 1 diabetes as this weight control program is based on frequent changes in diets as you lose weight. If is extremely hard to lose weight on insulin (but not impossible). Insulin requirements usually peak around puberty, and then decrease somewhat after growth is stopped. If insulin isn't decreased, the teen often "eats up to her insulin." Insulin also makes you hungry.
Your daughter will probably not lose weight unless she can lower her insulin dose somewhat. You should discuss with her doctor whether she could cut back on her insulin a little, say 10% and try to decrease the food intake or increase exercise if the blood sugars are too high. (She may find she's actually less hungry on a smaller dose of insulin.) Of course, she shouldn't make any changes without the advice of her own doctor.
Theoretically, there is no reason why someone can't have both type 1 diabetes (insulin deficiency) and insulin resistance (the main contributing factor to type 2 diabetes and possibly related to the cause of polycystic ovary syndrome even when blood sugars are normal.) By definition, if your daughter is overweight, she must have some degree of insulin resistance that most likely would improve if she could lose weight. I think more research needs to be done on individuals with type 1 diabetes and a family history of obesity or type 2 diabetes. It is possible that in the future people like this might actually benefit by a combination of insulin injections to replace the insulin the body can't make and oral medication that helps decrease resistance to the injected insulin.
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