Medical Barriers: Endocrine Disorders I

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.

Diabetes Mellitus

Weight loss is particularly difficult for individuals with diabetes.

Individuals with type 1 diabetes are dependent on the exogenous administration of insulin, which may lead to weight gain or difficulty with weight loss.

Individuals with type 2 diabetes struggle with weight management for many reasons. Some, like those with type 1 diabetes, require exogenous insulin which can lead to weight gain. Others are treated with sulphonylureas or thiazolidinediones, both of which may also contribute iatrogenically to weight gain or impede weight loss. Patients with early stage 2 diabetes may be hyperinsulinemic, which can also impede weight-loss efforts. Insulin resistance is present in lean tissue but not in adipose tissue. The adipose tissue of someone with type 2 diabetes may therefore be exposed to very large amounts of daily insulin and, as a result, become more efficient at energy storage.

The drug of choice for those with type 2 diabetes who need to lose weight is the biguanide metformin, which does not contribute to weight gain and actually promotes weight loss. A possible explanation is that metformin decreases circulating insulin by increasing the body’s insulin sensitivity and decreasing both hepatic gluconeogenesis and the gastrointestinal tract’s absorption of glucose.

For type 2 diabetes patients who require insulin, only detemir insulin has been shown to be weight neutral.

In this group, glycemic control takes priority over weight management. Discontinuation of weight-contributing medications should not be part of a patient’s management plan unless their glucose levels are under control.

Lifestyle measures can help achieve glycemic control. Patients should be advised to eat many small meals and snacks throughout the day, minimize their intake of refined carbohydrates, increase their intake of whole grains and protein, and undertake short bouts of exercise several times a day.

Weight loss and fitness independently improve glycemic control and decrease insulin resistance. In some cases, they can be sufficient to control type 2 diabetes.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

Members of the Canadian Obesity Network can download Best Weight for free.

Best Weight is also available at Amazon and Barnes & Nobles (part of the proceeds from all sales go to support the Canadian Obesity Network)

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