April 15, 2010

Type 2, Weight Loss and Control – Stop Dreaming, Act NOW

dream imageDo you (or a loved one) have type 2 diabetes and you’re under the impression that your blood glucose would rapidly fall into control if only you could just lose weight? Have you heard this promise from your healthcare provider (HCP)?

As a dietitian and diabetes educator nothing would please me more than to be able to say this is true. But it’s often not the case and particularly so as type 2 progresses over the years. My message to you, stop dreaming and act NOW!

The main mantra to people with type 2 diabetes, especially early on, used to be lose weight. Though losing 10 to 20 pounds can, especially early on after diagnosis, cause blood glucose to plummet and other medical problem to improve, research shows the continually pounding about weight loss that people often get from their health care provider needs to change. We know much more now about the progression of type 2. And the more we learn about the continual loss of beta cells (cells that make insulin and amylin) the more we know that weight loss alone is not going to be enough ammunition for most people to control their blood glucose. Yet countless people I counsel and know, some of them dear friends, constantly hear, “if you could just lose weight you’ll be able to control your diabetes.” Or you chastise yourself for, “not being able to just lose the weight and keep it off.”

We know much more today than even 5, 10 years, let alone 20, 30 years ago. Numerous studies, some of them older, some ongoing, have taught us a lot about the onset of this progressive disease – which looks to start down the progressive course of insulin resistance and loss of beta cells about 5 to 10 years before blood glucose gets high enough to make the diagnosis.

Newer understanding has also taught us that by the time the diagnosis of type 2 diabetes is made (unfortunately often several years after blood glucose rises too high), most people have lost 50 to 80 percent of their beta cells--and the available amount of insulin continues to dwindle. In addition, other problems have usually arisen with the hormones that help control glucose – loss of the hormone amylin (from the beta cells) and a loss of gut hormones, one group being incretins.

The set up to start down this road of type 2 diabetes is based on heredity. But that alone isn’t enough for the majority of people to develop type 2. What pulls the trigger for most people is our environment which cultivates escalating excess weight, sedentary lifestyle, and unhealthy food choices. By the time the diagnosis of type 2 diabetes is made, and especially, several years afterwards as the disease has progressed further, weight loss tends to have minimal, if any, impact on blood glucose control. (Where research shows you get the bang for your effort with weight loss is with prediabetes.)

In fact, as of 2008 the American Diabetes Association’s recommendations suggest that health care providers start you on a blood glucose lowering medication immediately at diagnosis. The most commonly used starting drug is metformin (generic Glucophage). Other medications are approved and can be used.

Then to continue to control blood glucose overtime you will need to increase and/or add blood glucose lowering medications. Who likes to be on a slew of medications? No one! But evidence shows most people will need blood glucose, blood lipid and blood pressure medicines to control these factors and stay healthy. (Controlling diabetes today is no longer just about blood glucose, it’s also about controlling blood lipids and blood pressure.)

When it comes to weight loss and healthy eating with type 2 diabetes, there’s no doubt that following a healthy eating plan can help you control your weight (help prevent further weight gain), knock off a few pounds, help control other risk factors/problems: high blood pressure, abnormal blood fats (lipids), and more. Healthy eating is always a smart move. You’ll find valuable how-to details about making lifestyle changes and eating healthy in my book Diabetes Meal Planning Made Easy.

But, and this a big but, don’t continue to dream of controlling your glucose by losing weight and waiting for a time when those pounds will drop off as you spend years with your blood glucose too high. And don’t beat yourself up for not being able to lose weight as the means to control your blood glucose (even if your HCP does)! Reality is it’s tough work and having type 2 and insulin resistance seems to make this even harder.

Start now to control your blood glucose and be aware that type 2 diabetes is a progressive disease that requires progressive management.