Diabetes And Weight

Type 2 diabetes is a common condition that is characterised by high levels of glucose (sugar) in the blood. Having high blood glucose levels over a long period of time can cause a variety of health problems to include eye, kidney and nerve issues in addition to increasing risk of conditions like heart disease. Risk factors for having this condition include carrying excess weight, particularly weight around the middle, being over the age of 40 and having a family history of Type 2 Diabetes. 

Insulin is the hormone which is responsible for controlling our blood sugar levels. Many people living with Type 2 diabetes are resistant to the hormone insulin, when this happens blood sugar levels become too high as the body does not respond to the insulin being produced. Being insulin resistant and having high blood sugar levels increases the risk of further health problems such as heart disease. 

Treatment for Type 2 Diabetes aims to control blood sugar levels, many of the commonly used medications to treat this condition aim to help insulin work better, help the body to make more insulin or to help the body become more sensitive to insulin, which can ultimately help control blood sugar levels. 

For individuals who live with overweight or obesity, one of the core management strategies is weight management. Not all people with Type 2 Diabetes are overweight, some people with Type 2 Diabetes just do not produce enough insulin. In these circumstances controlling carbohydrate intake can help to control blood sugar levels.   

Excess weight and diabetes

Type 2 diabetes is strongly related to excess weight, in particular weight gain around the middle and the accumulation of fat around our organs, in particular the liver and pancreas. Central weight gain is associated with increased inflammation, oxidative stress and resistance to the hormone insulin. 

Being overweight or obese, having a diet high in calories, sugar and carbohydrate and having a sedentary lifestyle can all increase risk of developing Type 2 diabetes. 

As well as the medications available, diet and lifestyle changes are important pillars for helping people with Type 2 Diabetes manage their condition. Weight loss in particular can help to improve insulin sensitivity. Recent research has found that losing a significant amount of weight in the range of 10-15 kg, can reduce or even abolish the need for medication or in some cases put diabetes into remission; remission is more common in those who have been more recently diagnosed (1). As well as losing a significant amount of weight, long term maintenance of this weight loss is crucial to keep diabetes in remission. 

Weight loss for diabetes management 

Weight loss in the range of 2-6 kg offers benefits such as improving blood sugar control as well as reducing the risk of disease progression and related complications. 

A weight reduction of 10-15 kg is generally required for remission of Type 2 Diabetes although even smaller losses can result in diabetes remission in some people. Losing a significant amount of weight can however be challenging. in the past, bariatric surgery, has been suggested as the most effective weight loss strategy for people with Type 2 Diabetes however, this option can come with a huge financial cost, risk of surgery, risk of long term complications, risk of nutritional deficiencies and in some cases restrictions on food intake for life (2).

To lose weight, we need to be in a calorie deficit and this can be done by a variety of means. It could be as simple as reducing portion sizes and eating less snacks and treats, increasing activity levels, reducing carbohydrate, intermittent fasting or using meal replacement products. We are more commonly seeing total diet replacements being used to drive significant weight losses in adults with type 2 diabetes. It has shown to be a very effective intervention but long-term weight loss maintenance is important to ensure long-term diabetes control(3).

It is important to note that there are additional risks that should be considered if trying to lose weight if you live with type 2 diabetes, particularly if you are taking medications that can induce hypos or hypoglycaemia (low blood glucose levels). Therefore if you do have type 2 diabetes and want to follow a certain diet, you should consult with your doctor first to see whether the diet is suitable for you, and whether any of your medications need altering. It can be useful to monitor your blood glucose levels too to ensure that your blood glucose levels remain to be in range.

You should also ensure you know how to correctly treat a hypo to bring your blood glucose levels back up, in case this were to occur, so speak to your healthcare professional about this.  

Long term weight loss 

For a diet to truly be a success, we want to ensure that your weight loss is maintained in the long-term

Some strategies that can help maintain weight loss include: 

• Consuming a Mediterranean style diet  (4), high in fruits and vegetables, whole grains, legumes, nuts and dairy, can help to control weight, can help with blood glucose control and reduce the need for diabetes medications (5). 
• Exercising portion control can help to reduce overall food intake. 
• Diets with a high glycaemic index are associated with increased risk of Type 2 diabetes (6). Swapping refined grains for whole grains and avoiding added sugars can help to increase satiety, reduce calorie intake and help control blood sugar levels
• Reducing carbohydrate intake can also be an effective way to improve diabetes control and lowering carbohydrate intake can help to maintain weight loss  (7)
• Maintaining adequate activity levels 
• Behaviour change methods such as cognitive behavioural therapy can be used to support lifestyle changes (8)

There is not a one size fits all approach when it comes to managing Type 2 Diabetes however, changes to diet and lifestyle as well as losing weight can be beneficial for most people. Achieving and sustaining weight loss can reduce medications, improve quality of life, reduce risk of other health conditions, improve diabetes control and in some cases put diabetes into remission. If you would like to make improvements within your diabetes management, please speak to your GP or diabetes team in the first instance.  

References 

1. Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018 Feb 10;391(10120):541–51. 
2. Sjöström L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden Å, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA – J Am Med Assoc [Internet]. 2014 Jun 11 [cited 2021 May 27];311(22):2297–304. Available from: https://pubmed.ncbi.nlm.nih.gov/24915261/
3. Brown A, Dornhorst A, McGowan B, Omar O, Leeds AR, Taheri S, et al. Low-energy total diet replacement intervention in patients with type 2 diabetes mellitus and obesity treated with insulin: A randomized trial. BMJ Open Diabetes Res Care [Internet]. 2020 Jan 28 [cited 2021 May 27];8(1):1012. Available from: http://drc.bmj.com/
4. Esposito K, Maiorino MI, Bellastella G, Chiodini P, Panagiotakos D, Giugliano D. A journey into a Mediterranean diet and type 2 diabetes: A systematic review with meta-analyses. Vol. 5, BMJ Open. BMJ Publishing Group; 2015. p. e008222. 
5. Javier Basterra-Gortari F, Ruiz-Canela M, Martínez-González MA, Babio N, Sorlí J V., Fito M, et al. Effects of a Mediterranean eating plan on the need for glucose-lowering medications in participants with type 2 diabetes: A subgroup analysis of the PREDIMED trial. Diabetes Care [Internet]. 2019 Aug 1 [cited 2021 May 28];42(8):1390–7. Available from: https://doi.org/10.2337/dc18-2475
6. Willett W, Manson J, Liu S. Glycemic index, glycemic load, and risk of type 2 diabetes. In: American Journal of Clinical Nutrition [Internet]. American Society for Nutrition; 2002 [cited 2021 May 28]. p. 274S-280S. Available from: https://academic.oup.com/ajcn/article/76/1/274S/4824162
7. Goldenberg JZ, Johnston BC. Low and very low carbohydrate diets for diabetes remission Definition of low or very low carbohydrate diets. [cited 2021 May 27]; Available from: http://dx.doi.org/10.1136/bmj.n262
8. Madjd A, Taylor MA, Delavari A, Malekzadeh R, Macdonald IA, Farshchi HR. Effects of cognitive behavioral therapy on weight maintenance after successful weight loss in women; a randomized clinical trial. Eur J Clin Nutr [Internet]. 2020 Mar 1 [cited 2021 May 28];74(3):436–44. Available from: https://pubmed.ncbi.nlm.nih.gov/31462695/

Now you are up to speed about how diabetes and weight go hand in hand, Whether you are type 2 Diabetic, Pre-Diabetic or worried about getting Diabetes take action now and make a change!