I hear this question all the time from my patients. Unfortunately, the answer is not straightforward. I'm going to walk you through some factors that make the challenge of weight loss different for folks with type 1.
The calories used to treat lows (or additional snack calories for preventing lows) need to be considered. For example, if you need to consume ~1400 calories per day to lose weight, and you are consuming 400 calories in extra food for preventing lows, treating lows, and/or over treating lows, you're only left with 1000 calories to "spend" on your food for the day, and that's not much!
Tips: 1. Use as few calories as needed to treat lows. Juice, glucose tablets, glucose gel and other forms of pure sugar will be the fastest (and least caloric) way to treat a low. Candy bars, cookies, and crackers with peanut butter are risky methods for treating a low because they work too slowly (and of course they are very caloric as well).
2. Identify the cause of lows and work with your provider if needed on insulin adjustments to help prevent lows. This can be tricky and having an endocrinologist and/or CDE with a strong exercise physiology background or experience working with athletes can be helpful. Most of my patients go into exercise with too much insulin on board and don't adjust insulin later in the day to account for the fact that they are more sensitive to insulin. This of course can increase the frequency of hypoglycemia.
Insulin is an anabolic hormone. When someone with diabetes is overweight or obese, sedentary, or has a condition called Polycystic Ovarian Syndrome (PCOS), they will be more insulin resistant. This means that they will require more insulin. So having one of these factors in addition to type 1 would theoretically make weight loss even more challenging. Therefore we need to focus of factors that will help improve insulin sensitivity and lower insulin requirements.
Tips: 1. Exercise often. Insulin sensitivity decreases the further out you are from exercise, so try to exercise daily (or even twice a day).
2. Consider beverages you consume that cause your blood sugar to go up and increase your insulin requirement. For example, do you have to bolus for coffee or diet soda (or notice hyperglycemia after consuming those items)?
3. Choose lower fat meals. High fat, high carbohydrate meals typically require more insulin and administration over a longer period of time (dual wave, combo bolus). By choosing lower fat meals you may be able to reduce the amount of insulin you take.
4. Don't go overboard on carbs. I'm not a fan of low carb diets, and i'm not a fan of high carb diets, except maybe for Lance Armstrong. Moderation is key. If you're not sure how many carbs to aim for in a day, consider 40% of your calories coming from carbs if you have type 1 diabetes, want to follow a moderate carb diet, and are trying to lose weight.If you are looking for structure to help you keep your carbs in check, check out our fully customized meal planning service.
5. Work on stress reduction. Stress can cause hyperglycemia, which will lead you to increase your insulin if you are trying to keep glucose levels within target range. Activities like yoga, meditation, writing in a journal, exercise, and deep breathing are just a few things you can try to reduce stress.
So is it harder to lose weight with type 1 diabetes? I would argue, yes. However, it's do-able and hopefully this article helped to shed some light on the additional difficulties of losing weight with type 1.