Islets of Hope for persons newly diagnosed with diabetes

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Article by Lahle Wolfe. For reprint information e-mail: Editor@isletsofhope.com

diabetes forums
diabetes support lists
diabetes blog

Links to more comprehensive information about disorders sometimes associated with diabetes

Addison's Disease
Asthma and Allergies
Celiac Disease (Sprue)
Cyclic Vomiting Syndrome
Cystic Fibrosis 
Eating Disorders
Fibromyalgia Syndrome
Frozen Shoulder
Hashimoto's Thyroiditis
Hemochromatosis
  (Iron Overload)
Infertility
Irritable Bowel Syndrome
Polycystic Ovarian 
    
Syndrome 
Weight Gain
Weight Loss


think like a pancreas  Gary Scheiner, CDE
Think Like a Pancreas:
 Many books offer advice on managing diabetes, but few focus specifically on the day-to-day issues facing those who use insulin.  Scheiner, a certified diabetes educator and himself an insulin user himself since 1985, gives you the tools to "think like a pancreas"--that is, to successfully master the art and science of matching insulin to the body’s ever-changing needs. Free of medical mumbo jumbo, comprehensive, and packed with useful information not readily available in other books.


Newly Diagnosed (easier reading) Problems & Complaints with Diabetes

Comprehensive Information on Diabetes Problems & Complaints


Resource Links to
Addison's Disease Sites

Addison's and Diabetes

Addison's Disease in Type 1

The Diabetes Monitor:
 
Addison's Disease May Co-Exist with Type 1 Diabetes

NIH - Addison's Disease, Adrenal Insufficiency

addisons disease 
Official Patient’s Sourcebook on Addison’s Disease: This  Official Patient's Sourcebook has been created for patients who have decided to make education and research an integral part of the treatment process. Although it also gives information useful  to doctors, caregivers and other health professionals, it tells patients where and how to look for information covering virtually all topics related to addison's disease.


Resource Links to
Celiac Disease Sites

Celiac.com

Celiac Disease Foundation

National Digestive Diseases Clearinghouse  (NIH)

Camp Info for Kids with Celiac

Books On Celiac Disease

gluten free food for kids
Incredible-Edible Gluten Free Food for Kids

Sheri L. Sanderson is the mother of three children, including one with gluten sensitivities. Her cookbook is the result of personal need---wanting to offer her family gluten-free meals that look and taste just as good as those she made before the change in diet. In addition to many years of... Read more


Anorexia Nervosa and Related Eating Disorders (ANRED):

Impact of Anorexia, Bulimia and Obesity on the Gynecologic Health of Adolescents


Hashimoto's Thyroiditis
Resource Site Links

American Thyroid Association
Endocrine Web
Mary Shoman's Site

(About Thyroid)
Sinai Div. of Endo. & Metabolism

the thyroid diet Mary J. Shoman
The Thyroid Diet:  
For more than 25 million Americans it may be, due to the metabolic slowdown of a malfunctioning thyroid gland. The Thyroid Diet will help many previously unsuccessful dieters get diagnosed and treated -- and proper thyroid treatment might be all that’s needed to successfully lose weight. Even after optimal treatment, however, weight problems plague many thyroid patients. For those patients, The Thyroid Diet will identify the many frustrating impediments to weight loss, and offer solutions-both conventional and alternative -- to help. Discussing optimal dietary changes, thyroid-damaging foods to avoid, and metabolism-supporting herbs and supplements, it contains several different eating plans, food lists, and a set of delicious and healthy gourmet recipes. With handy worksheets to use in weight-loss tracking and a special resource section featuring Web sites, books, and support groups, here is vital help for millions..



Diabetes Forecast:  Helps people with diabetes and their families lead normal, healthy lives by providing information and support on all aspects of diabetes treatment, management and self care. Contains profiles of people with diabetes, recipes, diet and exercise articles.     IOH Rating 5/5 


Infertility Links

American Society for Reproductive Medicine

International Council on Infertility Information Dissemination (INCIID)

The American Fertility Association (Offers support and advocacy for those dealing with infertility and reproductive health.)

RESOLVE: nationwide infertility nonprofit since 1974

Personal accounts of infertility and fertility treatments

A Torah Infertility Medium of Exchange (A T.I.M.E. a non-profit organization devoted to the support and education of Jewish infertile couples.)

The Infertility Network (a registered Canadian charity which provides information & support to patients, parents & adult donor offspring)


Resource Links to
PCOS Sites

The Jewish Hospital Cholesterol Center  (Dr. Glueck  is  a champion for women with PCOS)

Polycystic Ovarian Syndrome Support Association (PCOSA)

SoulCysters

The U of Chicago Center for PCOS

Verity

healing syndrome o  Dr. Ronald Feinberg
Healing Syndrome O:  
Understanding and overcoming the leading undiagnosed cause of infertility, miscarriage, menstrual problems, obesity, and hormonal disruption.  Thus far, medical science has had little to offer women with PCOS. In this book, however, leading reproductive specialist Dr. Ronald Feinberg provides a new way of looking at the disorder, linking it to bodywide metabolic irregularities, insulin resistance, nutrition, activity, and stress-a combination of health issues that collectively make up what he has termed "Syndrome O." And this understanding brings new hope for overcoming it.  IOH Rating 5 /5  

new glucose revolution for living well with pcos  Brand-Miller/Farid
New Glucose Revolution: Living Well With PCOS:   Dr. Brand-Miller --author of the NY Times bestseller The New Glucose Revolution, the authoritative guide to the glycemic index--along with Dr. Nadir Farid and Kate Marsh, address the root cause of PCOS--insulin resistance--and show you how eating a low-GI diet can help alleviate even your most troublesome symptoms, including: weight gain, excess facial hair, fatigue, irregular periods, infertility, low blood sugar, acne, mood swings.

Filled with indispensable advice on switching to the low-GI diet, incorporating exercise into your lifestyle, and preserving your overall health and well-being, as well as thirty delicious recipes, this book can help you beat your PCOS symptoms and take back control over your life


Important Medical Disclaimer

All information and material presented on the IOH's web site is intended for personal informational purposes only .  No one should attempt to self-diagnose, self-treat, or alter a medical care plan without first consulting their physician

Newly Diagnosed Diabetes Information

Information for those Newly Diagnosed with Diabetes      
Disorders sometimes associated with diabetes

Print Entire Article on Disorders Associated with Diabetes


Disorders discussed on this page:   

Addison's Disease, Asthma & Allergies, Celiac Disease (sprue), Cyclic Vomiting Syndrome (CVS), Cystic Fibrosis (CF), Eating Disorders (anorexia, bulimia, binge-eating disorder), Fibromyalgia Syndrome (FMS), Frozen Shoulder, Hashimoto's Thyroiditis, Hemochromatosis (iron overload or "bronze" diabetes), Infertility (primary & secondary), Irritable Bowel Syndrome (IBS), Polycystic Ovarian Syndrome (PCOS), Weight Gain, and Weight Loss


Click on any link below to read more in-depth information about each topic.  

Addison's Disease

Addison's disease is an endocrine (hormonal) disorder in which a person does not make enough cortisol and other hormones in the adrenal glands. It can be difficult to diagnose in early stages but when cortisol levels become too low various symptoms occur; untreated Addison's can be fatal.  Treatment includes oral medication to replace vital hormones.  When pills cannot be swallowed injections are necessary.

The Type II form of Addison's disease (also called Schmidt's syndrome) usually afflicts young adults. Features of type II may include:

  • an underactive thyroid gland
  • slow sexual development
  • diabetes
  • vitiligo
  • loss of pigment on areas of the skin

Addison's occurs in all age groups and afflicts men and women equally. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin in both exposed and unexposed parts of the body.


Asthma and Allergies

Asthma and allergies may be more commonly seen in persons with autoimmune disorders such as diabetes, polycystic ovarian syndrome (PCOS), and thyroid disorders.

Asthma is a disease of the human respiratory system in which the airways narrow, often in response to a “trigger” such as exposure to an allergen, cold air, exercise, or emotional stress. This narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing, which are the hallmarks of asthma. Between episodes, most patients feel fine.

Allergies are a hypersensitivity (over reaction) to a substance or environmental trigger.  There are many causes and classifications of allergies.

For diabetics, allergic reaction to the older, animal insulins were not uncommon.  However, allergic reaction to the newer synthetic insulins are rare.  If someone has an allergic reaction to insulin it is more likely to be from an additive or buffering agent in the insulin.  (IOH Founder's daughter Elizabeth is allergic to long-acting insulins but can take rapid acting without an allergic reaction).

A person with diabetes that has latex allergies will need to either inject via a pump, a latex-free syringe or pen, and if the allergy is extreme may need to use a type of insulin that does not contain a latex stopper.  Be sure to report any reaction after taking insulin to your doctor.  

Allergic reactions include hives, swelling of the hands, face, mouth, eyes, or tongue, and rashes, bumps, itching, watery eyes and nasal passages, and wheezing, coughing, or sneezing.  


Celiac Disease (Sprue)

Celiac disease is an incurable autoimmune intestinal disorder that has a genetic component to acquiring it.  A person with celiac is intolerant to all forms of the food protein gluten.  Gluten is a protein found in all forms of wheat and related rye grains.  Persons with celiac must completely eliminate wheat and rye grains and barley from their diets, including:  durum, semolina, spelt, kamut, einkorn, faro, rye, barley, triticale.  Traditionally, oats have also been considered toxic to those with Celiac.  New research may suggest otherwise but it is best to consult with your doctor about what is safe for you.

When a person with celiac eats gluten there is an immunologically toxic reaction to the gluten ingested.  This causes many problems (and symptoms) including damage to the mucosal surface of the small intestine.  The villi in the intestines become shorter and flatter when offending foods are eaten and the condition and symptoms worsen.  It is imperative that persons with Celiac receive good medical care and stick to their gluten-free diet faithfully. 

A change in diet can help control the sometimes debilitating symptoms of gluten intolerance which include diarrhea, constipation, bloating, gas, irritable bowel syndrome, weight loss, malnutrition and vitamin deficiency, unexplained anemia and fatigue, join pain, abdominal pain, and early onset of osteoporosis

A diet for celiac may prohibit:

  • Foods with wheat:  pizza, bread, pasta, cereal, ice cream, soup, and beer.
     
  • Everyday products such as medicines, vitamins, makeup, toothpaste, or licking postage stamps and envelopes.
     
  • People who suffer from the genetic disorder celiac disease face these challenges everyday. The only treatment is to avoid eating foods that contain the protein gluten, which is found in wheat and other grains. Celiac disease can cause severe intestinal problems and lead to serious complications such as diabetes, osteoporosis, and cancer.

For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within days of starting the diet. The small intestine is usually completely healed in 3 to 6 months in children and younger adults and within 2 years for older adults. Healed means a person now has villi that can absorb nutrients from food into the bloodstream.

Unfortunately, celiac is often associated with type 1 diabetes and anyone diagnosed with type 1 should be tested for celiac disease.  A simple blood test can help determine if celiac antibodies are present, however, a blood test can come back negative and a person can still have celiac disease. Sometimes, a biopsy of the intestine is performed to diagnose celiac sprue if lab work is inconclusive.  


Cyclic Vomiting Syndrome (CVS)

This disorder is not necessarily associated with diabetes but is sometimes mistaken for gastroparesis, which may occur in diabetes.

In CVS, people experience bouts or cycles of severe nausea and vomiting that last for hours or even days and alternate with longer periods of no symptoms. CVS occurs mostly in children, but the disorder can affect adults, too.

CVS has no known cause or cure and each episode is similar to the previous ones. The episodes tend to start at about the same time of day, last the same length of time, and present the same symptoms at the same level of intensity. Although CVS can begin at any age in children and adults, it usually starts between the ages of 3 and 7. In adults, episodes tend to occur less often than they do in children, but they last longer. Furthermore, the events or situations that trigger episodes in adults cannot always be pinpointed as easily as they can in children.

Episodes can be so severe that a person may have to stay in bed for days, unable to go to school or work. No one knows for sure how many people have CVS, but medical researchers believe that more people may have the disorder than is commonly thought (as many as 1 in 50 children in one study). Because other more common diseases and disorders also cause cycles of vomiting, many people with CVS are initially misdiagnosed until the other disorders can be ruled out. What is known is that CVS can be disruptive and frightening not just to people who have it, but to the entire family as well.  


Cystic Fibrosis (CF)

A secondary form of diabetes can occur in those who have cystic fibrosis.  Excess mucus can clog ducts in the pancreas creating diabetes-type problems. Cystic fibrosis related diabetes (CFRD) shares features of types 1 and 2 diabetes, but it is a unique and distinct form of diabetes that requires a special management approach.

CF is a chronic, genetic (hereditary), debilitating disease where the body over produces mucous.  CF affects approximately 30,000 children and adults in the U.S.  It can lead to serous life-threatening lung infections because the thick mucous clogs the lungs.  This mucous can also block ducts in the pancreas causing permanent damage that can lead to the onset of type 1 diabetes.

Most persons with CF are diagnosed prior to age three, with approximately 1,000 new cases diagnosed each year.


Eating Disorders (EDs)

Why should you know about eating disorders?  If you, your child, or loved one has one of the many metabolic disorders that carry a medical demand of closely monitoring eating habits, there is a significant increase in the risk of developing an eating disorder. Eating disorders (EDs) are not just a problem for young girls; an all too common belief.  EDs can develop at any age and also affect boys and men.  In Australian type 1 diabetic children as young as 11 years old purposely under bolus insulin with meals in order to lose weight.

In the United States studies suggest up to 25% of all females with diabetes – a prevalence of 2-6 times higher in women with diabetes than in the general population – have an eating disorder.  The findings from a study by Flinders Medical Centre in Adelaide, also showed children in Australia with diabetes were markedly affected by disordered eating behavior:

  • 39% of young children with type 1 diabetes were binge eaters,
  • 25% exercised excessively to lose weight,
  • 10% had reduced their dose of insulin or omitted it completely to lose weight,
  • 8% restricted their diets to lose weight.

While diabetes does not actually cause an eating disorder, having to pay close attention to weight management and food choices places an unnatural and unhealthy focus on eating and leads to distortion of self and body image.  Once a person has ED issues, it is often easy for them to hide their problem under the guise of “it is part of my diabetes care plan.” 

Restricting, the elimination of certain foods or entire food groups, is a common factor in ED behavior, as is developing “safe” and “unsafe” food lists.  A person may become overly concerned or anxious when offered something from their “restricted or unsafe list.”  The initial limitation and focus of a food may stem from legitimate management issues (eating high glycemic index carbohydrates causes a rapid rise in blood sugars, fat prolongs highs) that develop into compulsive avoidance.  Fear may also stem from weight gain which can happen with all forms of diabetes, and for diabetics, the body conscious, ultra-thin-is-desirable- culture we live in, is made even worse because diabetics are weighed at every visit and constantly reminded from a health standpoint about excess body weight and diabetes.  And those with metabolic challenges, especially type 2 and pre-diabetes, hear the “thin message” from culture, health professionals, parents, and even their own still voice from within.  In fact, many believe that diabetics are to blame for their onset and readily point the finger at a lifestyle out of control.


Fibromyalgia Syndrome (FMS)

..."The American College of Rheumatology recognizes Fibromyalgia as a chronic condition with widespread and changing degrees of multifocal tenderness, involving the limbs and trunk. Many diabetics with nerve compression have symptoms in the arms and legs that could be confused with Fibromyalgia.  Patients with diabetes may also suffer general tiredness, soreness, and muscle aches, associated with loss of energy..." Could this be Fibromyalgia?

FMS is a widespread musculoskeletal pain and fatigue disorder.  FMS causes severe pain in muscles, ligaments, and tendons. The cause is still unknown, but it has become widely accepted as a true disorder.  FMS is often associated with fatigue, chronic headaches, irritable bowel syndrome (IBS), and Temporomandibular Joint Dysfunction Syndrome (TMJ) and may be more commonly seen in persons with certain thyroid disorders (especially Hashimoto's thyroiditis) that are often associated with diabetes as well. 

Symptoms include pain in the soft fibrous tissues including tendons, muscles, and ligaments and profound lack of energy (fatigue).  Many persons with FMS feel pain throughout the body but pain can also be localized to a particular area(s).  The pain can feel like a burning, stabbing, or shooting sensation, or like an overworked or pulled muscle.  Sometimes the muscles themselves will twitch.

FMS has similar symptoms of chronic fatigue syndrome (CFS) and some researchers believe that they are the same syndrome or may have the same epidemiology (cause, or, origin).  FMS also is very similar to the problems persons with Gulf War Syndrome may experience.  


Frozen Shoulder

Frozen shoulder is a condition called "adhesive capsulitis."  It may begin with shoulder pain from overuse or mild injury which causes a person to "favor" the shoulder, not moving or using it to avoid pain.  But not using the shoulder makes this condition worse, not better.

While the reason is not known, diabetes is also a risk factor for frozen shoulder.  Some scientists feel that it may be related to collagen, a substance in ligaments, that helps hold bones to joints.  Because glucose molecules can attach to collagen, it is thought that people with diabetes may deposit abnormal amounts of collagen in cartilage and tendons of the shoulder.

About 20% of people with diabetes have frozen shoulder, a much higher percentage than is seen in the general population (about 5%).

Untreated, frozen shoulder can last from eight months to 17 months or more.  Early treatment is important and includes physical therapy and anti-inflammatory drugs as needed.


Hashimoto's Thyroiditis

Low thyroid is an "in" diagnosis for an entire host of problems.  However, those with diabetes type 1 or type 2, and those with other metabolic disorders (including insulin resistance, metabolic syndrome X, pre-diabetes, PCOS) should be tested for antibodies for Hashimoto's.  Antibodies for this disorder can appear years before symptoms occur so it is a simple, worthwhile blood test for anyone with a metabolic disorder.

Symptoms include weight gain, fatigue, hair loss, heavy or abnormal menstrual bleeding, dry skin, inability to concentrate, clumsiness, depression, change in sleep habits, and intolerance to temperature, especially the cold.  Even in the presence of normal TSH levels, these symptoms (called subclinical) may exist and your physician may decide to being therapy with a low dose of a thyroid replacement drug.

Your doctor should run a specific test for Hashimoto's antibodies and not just a TSH  (thyroid stimulating hormone) test since a person can have Hashimoto's (evidenced in an antibody test) years before thyroid levels fall.  Your doctor may also take a sonogram of your thyroid.  It is important for all persons diagnosed with diabetes, insulin resistance, or PCOS to have the specific antibody tests performed.  There is a genetic component to Hashimoto's and it tends to run in families.  

Treatment involves daily medication to replace certain hormones.  There are several types of medications available and your doctor can help you decide which one is best for your needs.  Medications available include both T4 (thyroxine) and T3 (liothyronine) replacement.  Treatment often helps reduce the size of the enlarged thyroid gland (which can become large enough to make swallowing more difficult) but there is no cure for Hashimoto's Thyroiditis.  Once a person starts taking thyroid medication they will usually be required to stay on it for life.  


Hemochromatosis (Iron Overload)
Sometimes called "bronze diabetes."

Hemochromatosis is a disease in which a person stores excessive amounts of iron in the body.  It is an inherited disorder that can lead to the onset of type 1 diabetes after years of iron "overload" which can damage the pancreas.  About 40% of those diagnosed with hemochromatosis will also be diagnosed with type 1 diabetes at the same time.  Diabetes did not cause hemochromatosis, but hemochromatosis causes diabetes.  For this reason, this form of diabetes is considered a “secondary” diabetes because it is caused by damage to the pancreas from excessive levels of iron.

Symptoms of the disease include, joint pain, thyroid problems, hair loss, bronzing of the skin (hence the term "bronze diabetes), chronic fatigue, diabetes, menstrual irregularities, impotence, abdominal pain, liver disease, and liver or pancreatic cancer.  Joint pain is the most common complaint of people with hemochromatosis. Other common symptoms include fatigue, lack of energy, abdominal pain, loss of sex drive, and heart problems. Symptoms tend to occur in men between the ages of 30 and 50 and in women over age 50. However, many people have no symptoms when they are diagnosed.

Hemochromatosis is usually treated by a specialist in liver disorders (hepatologist), digestive disorders (gastroenterologist), or blood disorders (hematologist). Because of the other problems associated with hemochromatosis, several other specialists may be on the treatment team, such as an endocrinologist, cardiologist, or rheumatologist. Internists or family practitioners can also treat the disease.*

Treatment involves removing excess iron from the body and to give supportive treatment to damaged organs.  Excess iron is removed through phlebotomy (removal of blood). One-half liter of blood is removed from the body each week for 2 to 3 years until the iron stores are depleted. After that, less frequent phlebotomy is needed to maintain iron levels within normal limits. How often additional phlebotomy will be required depends on levels of hemoglobin, serum ferritin (iron), and patient symptoms.  Persons with hemochromatosis must follow a special low-iron diet and there is cure for hemochromatosis.

Persons with hemochromatosis must follow a special diet to help maintain a lower serum ferritin.  A low-iron diets does not substitute or replace the need for phlebotomy.  A diet for hemochromatosis  prohibits alcohol (especially for patients who have suffered liver damage.), avoidance of all iron supplements or vitamins containing iron, vitamin supplements, iron cookware, ingesting raw seafood or fortified processed foods such as 100% iron breakfast cereals.


Infertility

Both primary and secondary infertility can be a concern to those with metabolic disorders.  Infertility strikes both men and women.  Read more...  


Irritable Bowel Syndrome (IBS)

IBS manifests with alternating bouts of diarrhea,  and/or constipation, abdominal gas and bloating can leave you feeling sluggish and interrupt normal activities in life.  Many persons may have IBS, which is often diagnosed by ruling out other disorders first, without realizing it.  This syndrome is treated with medication when necessary and through lifestyle changes including a fiber-rich diet.   


Polycystic Ovarian Syndrome (PCOS)

As recently as 15 years ago few women were diagnosed with this serious syndrome when it was still known as "Stein-Levinthal Syndrome."  Now, it is estimated that more than 15 million women in the United States have PCOS.  PCOS is the most commonly diagnosed cause of infertility in women of child-bearing age.  Once thought of as a cosmetic gynecological disorder brought upon from obesity, it is now known that PCOS can cause rapid, abnormal weight gain, infertility, is often associated with Hashimoto's thyroiditis, and can lead to cancer, heart disease, and diabetes and is not a gynecological disorder, but a complex endocrine disorder affecting many systems and functions of the body.

The symptoms and severity of the syndrome vary greatly between women. While the causes are unknown, insulin resistance (often secondary to obesity) is heavily associated with PCOS. Metabolic problems and symptoms include:

  • Hyperinsulinemia.  Elevated insulin levels (despite normal blood glucose on GTT).  For this reason, women with PCOS should have their insulin levels checked in addition to their blood glucose.  Hyperinsulinemia may be an indication of insulin resistance or pre-diabetes)
     
  • Insulin resistance, Metabolic Syndrome (formerly called Syndrome X), or diabetes, especially type 2 diabetes.

  • Weight problems and carbohydrate sensitivity.  Weight gain may be both rapid and significant.  This may be due in part to elevated insulin levels, insulin resistance, or type 2 diabetes, and carbohydrate sensitivity.  Women with PCOS typically need to follow a special diet, low in simple carbohydrates, high in fiber, low in fat, with healthy protein choices, and low to moderate intake of low-glycemic carbohydrates.
     
  • Hashimoto's Thyroiditis - as many as 4 times more common in women with PCOS than in the general population, this autoimmune disorder causes hypothyroid (low) levels of TSH.  It is possible for persons in the early stages with Hashimoto's to have normal thyroid levels so it is important to have a test done for specific antibodies for Hashimoto's.  Low thyroid may cause mental confusion, depression, sleep disorders, weight gain, skin conditions, and hair loss.  

Treatment includes lifestyle changes; diet modifications, weight and stress management, and an exercise program.  Medications are usually prescribed for insulin resistance (insulin sensitizing drugs such as Glucophage), to help restore the menstrual cycle (birth control pills and/or insulin sensitizing drugs), to address cosmetic issues (Aldactone and/or Vaniqa for hirsutism) and possible acne and/or weight loss drugs.  

When infertility is an issue various courses of action may be necessary to achieve pregnancy.  Infertility treatment needs to be tailored for each individual woman with PCOS but often begins with trying a combination of Glucophage and clomid, (a fertility drug) aimed at inducing ovulation, as the first step.


Weight Gain

Weight gain can be the result of an unhealthy lifestyle including lack of physical activity and eating too much.  But other factors can also contribute to weight gain including certain oral medications prescribed for diabetes, stress, insufficient sleep, and too much insulin.  Hashimoto's thyroiditis, a hypothyroid (low) autoimmune disease can also cause weight gain and people with diabetes have a 4 times greater chance of having this thyroid disorder than non-diabetics.

Certain metabolic disorders, including type 2 diabetes, pre-diabetes, gestational diabetes, polycystic ovarian syndrome, metabolic syndrome, and insulin resistance can also lead to weight gain.  Many people with these disorders may be insulin resistant and therefore overproduce insulin in response to eating.  Insulin is not only a fat-storing hormone that instructs the body to store energy, but excess insulin cannot be excreted and can also be stored as fat.

When a person with insulin resistance eats certain foods (many types of carbohydrates, excessive protein, or high-fat foods) their body may over respond by producing too much insulin in order to maintain normal blood glucose levels.  This is because cells in the body do not respond effectively to insulin so the body keeps on producing more until the cells finally "unlock" and move glucose into cells for nourishment.

Insulin resistance can be improved.  Exercise, especially anaerobic (such as weight lifting and resistance training) activity can improve muscle sensitivity to insulin and increase insulin sensitivity by as much as 15% -- the same percentage of improvement as may be seen when taking oral insulin-sensitizing medications.  Losing weight also improves insulin resistance, as does following a healthy, low-fat, moderate protein diet, rich in complex carbohydrates.

Many with insulin resistance find it easier to meet their weight loss goals by following low-glycemic index diets, or carbohydrate controlled plans.  True, low-carbohydrate (40 grams of carbohydrate or less per day) that induce ketosis are somewhat controversial as to their long-term health risks and benefits.  But many who are metabolically challenged and unable to lose weight on other plans find they can control their weight by more drastic carbohydrate reduction.

Sudden weight gain from fluid retention may indicate a serious underlying medical problem including heart disease, kidney disease, high blood pressure, a negative side effect to an oral antidiabetes medication, or even a condition such as irritable bowel syndrome or celiac disease.  Be sure to discuss any sudden, unexplained, or significant weight loss with your physician.

 


Weight Loss

Weight loss may be part of a healthy approach to managing diabetes, especially for those with type 2 diabetes.  But when weight loss is either unintentional, or more than healthy, it could be part of an underlying medical condition or possibly due to an eating disorder.

Weight loss can occur in diabetes due to insufficient insulin present, from a wasting disease such as cystic fibrosis (CF), or from eating disorders, or difficulty in digestion food such as is the case with celiac sprue and irritable bowel syndrome.

Weight loss can occur when blood glucose levels are too high because not enough insulin is being taken in order to cover food eaten.  One of the symptoms of type 1 diabetes prior to diagnosis is weight loss because when not enough insulin is present to properly metabolize and make use of food energy glucose (sugars) will build up in the blood stream.

To understand why weight loss occurs when not enough insulin is present it may help to think of insulin as a key that "unlocks" cells and allows glucose (from food energy) to enter into cells and nourish the body.  Without sufficient insulin the body's cells, tissues, organs, and even the brain begin to starve.  As a defense, the body turns to fat stores in an effort to find useable energy.  When this happens, in addition to a buildup of glucose in the bloodstream, ketones (a byproduct of fat burning) may also build up in the body.  This can lead to a serious, potentially life-threatening condition called diabetic ketoacidosis (DKA) and may require hospitalization.

You should always discuss unexpected weight loss, or moderate-high levels of urine ketones to your physician.

 

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Page Updated 03/23/2006