Saturday, September 20, 2014

Weight Loss & Type 1 Diabetes

Things endocrinologists (doctors who specialize in diabetes & other hormone disorders) do: Tell you to lose weight if you're over-weight.

Things endocrinologists don't do: Bother to tell you that being a diabetic makes it really flippin' hard to lose weight!

Alright, so back when I was 77.5 kilos, every single doctor's appointment my little bitty "I lost over 45 kilograms" doctor would complain that I was overweight, that it was hurting my insulin sensitivity, and that I needed to lose weight. He would go "Do you exercise?" I would say "No...I walk to school...but other than that, no." He would say "Start running. When you come back, I hope to see that you've lost a few kilos."

Did I start running? No. Did I diet, though? Yes, yes I did. Did I lose weight? Yes, but very slowly. Did my doctor give me mad propz? Haha. Not a chance.

I first started to suspect that being a diabetic makes you gain weight/makes it difficult to lose weight when I was reading about weight loss resistance. Nearly every site I read said that having too much insulin (a hormone that diabetics actually inject into themselves multiple times per day) would make it extremely difficult to lose weight, because insulin's main function is to convert nutrients into fat. Excess insulin equals excess fat.

But since no one had told me this, I doubted the truth of my hypothesis. I kept going along feeling terrible about myself. I couldn't lose weight/couldn't lost weight very fast, my endocrinologist was constantly badgering me about being overweight, not to mention that I just wasn't that keen on looking how I did.

Then I read about a really horrifying and terrible eating disorder called "diabulimia." Only people with Insulin Dependent Diabetes (type 1 diabetes) can become diabulimics which is why it's a really obscure eating disorder. However, it is extremely dangerous. Individuals with diabulimia will reduce the amount of insulin their taking significantly/not take any insulin at all in order to lose weight. They can eat massive amounts of food and still lose weight. Thus, this eating disorder is difficult to diagnose. The individual is losing extreme amounts of weight, sleeping for multiple hours a day, and permanently damaging their health by running their blood sugars at ridiculously high levels. But their family sees them eating. They clearly aren't anorexic. And they aren't vomiting after meals so they aren't bulimic (additionally, bulimia doesn't normally cause massive weight loss). They can hide their blood sugars from their family, or claim to be taking massive amounts of insulin but are just unable to bring their blood sugar down (feign insulin resistance). So, for some people affected by diabulimia, it can take years before someone realizes what's going on. By that stage, many people have permanently damaged the nerves in their retina (putting them at high risk to develop blindness), permanently damaged their kidneys, developed osteoporosis, high cholesterol, put themselves at high risk for heat problems and damaged other nerves in the body. Erin Williams, co-founder of We Are Diabetics who previously suffered from diabulimia, damaged the nerves in her leg so severely that she broke her ankle and had no idea it was broken because she couldn't feel any pain. She went to the ER because her ankle had swelled up severely, and it was only after a doctor discovered that her ankle was broken that she had any idea it was damaged.

So, if taking little to no insulin while eating massive amounts of food makes people lose weight, does being a diabetic and taking insulin make it extremely difficult to lose weight? Yes, yes it does. This was finally confirmed for me when I started seeing a dietitian because I was struggling so severely with losing weight. Luckily for me, he had actually previously worked as a medical researcher studying diabetes, when I told him I was a type 1 diabetic, he said "Well, of course you're going to have trouble losing weight!" This was such a relief, because I finally knew that it wasn't my fault. That I wasn't being weak or doing everything wrong. But it was also extremely discouraging to know that I will always struggle more than the average person to remain at a healthy weight and to lose weight.

It's really important to make sure that you don't have any low blood sugars if you're a diabetic who is trying to lose weight. I've found that I can actually lose weight relatively easily if I eliminate most/all of my low blood sugars (because when you have a low blood sugar, your body has too much insulin). The trouble is that I am really sensitive to weight loss in terms of insulin requirements. If I lose about .5 of a kilo to 1 kilo, I need to reduce my insulin (because I become less resistant to insulin, the less I weight/the less cells I have that require insulin). Generally, I can't do it fast enough, start having lows, and gain the weight back again. But if I can manage to perfectly sync my insulin with my weight loss, everything becomes a thousand times easier than it ever was (but that is really bloody hard to do).

And finally, if by some chance you're an insulin dependent diabetic, the take home message is not to turn to diabulimia. I really get how tempting it may sound, but the damage you will do to your health is not worth it. It really isn't. Read about it. Read about how many horrible, un-reversible things you will do to yourself. Having to undergo dialysis treatments because you have ruined your kidneys is going to be a thousand times worse than being overweight and it will be a thousand times more unhealthy. Also, if by some completely insane chance, you're actually affected by diabulimia, please tell someone. It isn't worth it. People say anorexia is bad. Diabulimia is like anorexia on steroids in terms of the damage you can do to your body. Think about dialysis treatments, and going blind, and having your feet amputated. You'll look a lot worse without feet than you will if you gain a few pounds. And going blind and having dialysis treatments will be horrible. Talk to someone and start taking some insulin, please. I'm actually crying. I'm pretty sure no one with diabulimia will ever see this, but if you do, please please please take some insulin.

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