Need help navigating life with diabetes? You can always Ask D'Mine! Welcome again to our weekly Q&A column, hosted by veteran type 1 and diabetes author Wil Dubois. This week, Wil takes a question on the popular fat reduction therapy "coolsculpting" and how that plays with diabetes treatments.

{Got your own questions? Email us at AskDMine@diabetesmine.com }

 

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CeeCee, type 1 from North Carolina, writes:Hello all. My question is about Coolsculpting. Can a type 1 be a candidate for it? I would love to have it on my stomach, but I’m afraid it would decrease the absorption of insulin. I use a pump, and most of the time, I wear it on my stomach. I look forward to hearing from you.

Wil@Ask D’Mine answers:Cool question. No pun intended. Gosh, where to start? Well, let me start with a strange but true biological factoid: Despite their insulating effect, fat cells themselves are highly sensitive to cold. In fact, cold that’s harmless to other types of cells will flat-out kill fat cells. This anomaly of nature has created an interesting opportunity to remove unwanted fat cells without having to cut them out.

The process is technically called cyrolipolysis, but it’s more commonly known as Coolsculpting®, which is the registered trademark of Zeltiq Aesthetics, the folks that commercialized the process here in the United States. It’s basically surgery-free liposuction. The Coolsculpting device itself is sorta like a freezer and a vacuum cleaner combined. It tugs on unwanted fat bulges and puts the freeze on them. This video is a pure promo, but it nicely shows how the process works.

This all sounds, well, really cool. But how well does it work? Pretty damn well, by all reports. It’s been shown to reduce fat in targeted areas by 20%, although most of the websites touting the procedure indicate that it only works for “moderately fat persons.” Bear in mind that Coolsculpting is non-invasive cosmetic surgery. It’s a way to knock off unsightly bulges that don’t respond to the gym and the salad bar -- not a way to eliminate too many visits to the all you can eat buffet.

Coolsculpting’s reduction in fat cells is permanent. Unlike good ol’ diet and exercise, which simply deflate fat cells like wilted helium balloons after a party, Coolsculpting kills the cells. They’re dead, and in time they’re gone. OK, so speaking of that, where the hell do the dead frozen cells go? The body’s cellular garbage trucks, the macrophages, clean them out, just like they do cells that die of old age. It takes some time for them to remove the Coolsculpted dead cells, but not until hell freezes over. Only about 3-4 months.

So what parts of your body can you re-sculpt? Coolsculpting generally targets the abdomen, muffin top, thigh, bra fat, back fat, the upper arm, and—this was a new one to me—the banana roll, which I’m told is fat underneath your buttocks. Oh, and it was also recently approved for double chins.

OK. So enough about Coolsculpting. What about us PWDs (people with diabetes)? Is this safe? Is this a good idea?

Type 1s, or any other flavor of PWDs, don’t seem to be barred from Coolsculpting, which is an FDA cleared procedure. In fact, there doesn’t seem to be anyone who’s contraindicated for the procedure, which I actually find a bit disconcerting. Most medical procedures have lengthy lists of people considered to be poor candidates. So I reached out to the cool folks at Coolsculpting and asked them about that. But they didn’t respond.

How cold.

Casting a wider net, I found a number of docs, most of them posting on the cosmetic surgery portal Real Self, saying that they’d treated both T1 and T2 patients to good effect. But what about science? Well, if Coolsculpting has been specifically studied in PWDs, I can’t find a report of it. I did find that cryolipolysis has no positive effect on cholesterol levels or liver functions, but there is some suggestion that it can have a positive effect on metabolic syndrome, which itself can fuel type 2 diabetes. Although let’s be clear: This process isn’t intended to be a health procedure. This is cosmetic surgery. So don’t confuse it with the bariatric surgery that’s recommended for the health benefit of seriously obese individuals suffering numerous health issues. Still, if you’re getting cosmetic surgery, blade-free is no doubt safer. No infection risk. No long healing times.

Coolsculpting is growing in popularity, even among docs. More than 6 million procedures have been done worldwide since it was introduced. So are any of them turning out badly? Yes. But not many.

I found only one adverse event report, from a patient who found the process painful, with pain enduring for at least a week; and then, more concerning, I found one PWD at Diabetic Connect reporting exactly what you’re worried about: Her insulin absorption for her pump sites on her belly went to hell after Coolsculpting. She was worried at the time of her post, seven months ago, that it might be permanent. But she’s disappeared from the scene since, so I don’t know if that came to pass or not.

Additionally, although exceedingly rare, some people suffer paradoxical adipose hyperplasia after Coolsculpting. What on earth is that? It’s the opposite of what you paid a thousand bucks for: Runaway fat cell growth, instead of fat cell death. Freaky. But to be fair, the researchers who identified this side effect estimate its incidence at only 0.0051%. Still, if their numbers are right, about 30,000 people got fatter after Coolsculpting.

So what to make of all of this? The facts are that we don’t have the facts. To be totally safe, you should avoid it. But that said—and this is just my gut feeling based on my knowledge of biology, anatomy, and diabetes—I think that for most type 1s, it would probably be safe enough in the long run.

But it’s the short run that I’m worried about.

Consider that your pump delivers insulin into your subcutaneous fat -- the very same fat that you’re hoping to freeze into oblivion. If the procure works as it should, 20% of the fat cells on your stomach will drop dead. I foresee absorption problems, at least until the macrophages clean out all the carcasses.

But once the dead are off the battlefield, I don’t see any reason why your sites won’t work again. Even with traditional liposuction, unless there is some scaring from the cuts, most folks can still use stomach pump sites afterward, and Coolsculpting eliminates the scar risk.

So if you go forward with it, use alternate sites, or take a pump break, until you are four months beyond the last Coolsculpting session. At that point, the body has taken out the trash and I think you’ll be able to slap an infusion set back on your sexy new (20% flatter) tummy.

Very cool.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.