One of the added layers of surviving a pandemic seems to be literal: dealing with extra unwanted weight gain.
According to an American Psychological Association survey conducted in February 2021, 42 percent of Americans gained more weight than intended during the pandemic, reporting an average weight gain of 29 pounds.
For people with type 1 diabetes (T1D), losing the unintended weight and maintaining a moderate weight can be, like so many other things in life with diabetes, fraught with challenges.
Struggles range from needing to constantly adapt and adjust insulin levels as the weight comes off, to the frustration of needing to treat lows with carbs and calories, to the oft-layered emotional relationship with lab tests, numbers, and all things food. So, finding the right way to not just lose but maintain weight healthfully isn’t as easy as “just cutting back” for those with T1D.
“Our bodies are trained to think obsessively because our lives are all about numbers,” Anna Sabino, certified diabetes care and education specialist (CDCES) and director of young adult programs at the College Diabetes Network, who has lived with T1D for 33 years, told DiabetesMine. “A1C, carb ratios, blood pressure, Time in Range; so much of our lives are numbers.”
And while that sets a person with diabetes (PWD) up to better understand numbers around health, she said, it also sets them up for frustration and burnout.
Her method of maintaining a healthy, moderate weight? Approach it like she does blood sugar management.
“We plan for the worst and hope for the best,” she said. “We add a second layer of discipline.”
So, how should a PWD approach weight loss and maintaining a moderate weight?
The first thing to realize is that “quick fixes don’t work,” according to Amanda Ciprich, the registered dietitian behind T1D Nutritionist who was diagnosed with T1D at 18 years old.
Rather, Ciprich said she guides her clients — and herself — to realize what you want from any weight loss effort.
“I know it’s not weight loss in itself that you want,” she said. “You just want to feel good and manage your life well.”
In other words, for PWDs, “thinness” isn’t the end-all of “good health.”
“Society can view thinness as health; the ultimate health,” she said. “If that was true, thin people wouldn’t have diabetes, or other conditions.” But they do.
Realizing that moderate weight is nuanced and unique to each of us can help people better set up a plan that doesn’t lead to failure.
“You don’t have to focus on the numbers on the scale,” she said, but rather on things like your overall lab results, energy level, and how well you are sleeping — all factors that are signs of good health.
But to get there, you need a method.
Hope Warshaw, CDCES, dietitian and author of “Diabetes Meal Planning Made Easy,” guides many PWDs to a healthy place in the course of her work. She’s keenly aware that weight loss does have some added nuances for those living with diabetes.
“There’s no doubt when you have T1D there are precautions you should be aware of,” she said. “What is your insulin regime? Do you have the knowledge enough to be adjusting your insulin as needed?”
A big tip from her about building your plan: Make sure you are truly ready for it.
“Really do some self-reflecting and self-assessment to see if this is a good time in your life for this start,” she said.
If you don’t feel up to a major change, don’t try to make one, she said. That’s because maintaining weight is at least as important as efforts to lose weight, she said.
“People can feel overconfident, you know: I can do this! But it’s tough. So, unless you are really ready to go into this for the long-term, it’s OK to wait for the right time.”
But that doesn’t mean just giving up and doing nothing.
“Stop gaining weight. Work on just that [for now],” she advises.
Since crash diets are known to be unsustainable, Ciprich suggests that PWDs focus less on “dieting” and more on making healthy lifestyle changes.
“If you Google ‘diet and T1D’ it’s all ‘don’t, don’t, don’t,’” she said. “It can be challenging [to succeed] when all your focus is what you cannot have.”
Instead, she suggests going the opposite way of most diets by finding the things that taste great AND are good for you, and add more of those to your life.
In her own life with T1D, she does just that, she said.
“I believe in taking an ‘abundance’ approach…. I ask myself what can I add to a meal that’s better for me and my blood sugars?”
“People tend to focus on cutting carbs and trying to eat the lowest carb possible. Not me,” she adds.
For instance, if she has a Greek yogurt in the morning, she adds a generous topping of berries and nuts. This is filling and good for your health, if not totally low carb.
Gary Scheiner, a CDCES, exercise physiologist and diabetes author who runs Integrated Diabetes Services and who has had T1D since 1985, agrees.
“There are plenty of people who are healthy but weigh more,” he told DiabetesMine. “There is a difference between our weight average and our health from person to person.”
Rather than concentrating on things like BMI or the number on the scale, he suggests focusing on more practical, real-world concerns like how clothes fit and how you feel physically.
Ask just about any PWD working on weight loss and fitness and they’ll tell you they’ve had this experience:
You eat a super healthy breakfast, one with just the right carbs for weight loss, and then head out for exercise: A run, a walk, a class at the gym.
You feel proud; you’re making it happen.
And then you go low, and find yourself scarfing down fast-acting sugar like Smarties or Sour Patch Kids faster than one could imagine. Afterwards, you still feel hungry from the blood sugar low and you’re disappointed in yourself and frustrated over consuming the candy.
Warshaw said that hypoglycemia with weight loss efforts is a big challenge she often hears of.
“When I try to put myself in the position of having to eat to manage a low? It would make me crazy,” she said. “The frustration is huge.”
Her suggestion? Be prepared, be aware and take action as early as you can.
She suggests you have your go-to low treatment items within reach at all times. And try to be aware of your symptoms, particularly when exercising.
“Treat as early as you can,” she said. “This is so much easier said than done.”
Sabino, too, has felt that and worked hard over the years to improve her ability to prepare for, treat, and, when possible, avoid lows.
“When you are low you often eat 200 to 300 calories when you only need 40 or so,” she said.
She realized shortly after college, when working to lose extra pounds, a few things that made lows less challenging.
“From a hormonal standpoint, it’s much better to work out in the morning,” she said.
First, most times, people are coming off a relatively stable blood sugar range overnight. Second, she said, the dawn phenomenon that many PWDs experience is often enough to keep her blood sugars up through her workout.
She can now wake up, go to the gym at 8:30 a.m., take no insulin (because she eats post-workout) and “still be in the 80s after,” she said.
That took testing and practice, she said. Combining that with knowing exactly how much carb content she needs in reality (as opposed to what the low blood sugar brain likes to suggest), is working.
She also realized after college that aerobic activity alone wasn’t the right choice for her as a PWD. A runner, she’d often find that her blood sugar would “crash” after a workout, and in response she’d eat too much, spiking her blood sugar post-workout.
Now, by mixing anaerobic and aerobic exercise, she has moved from “every day was a different recipe for disaster,” to “more predictable blood sugars” when exercising.
Calling in your diabetes team — or working with a nutritionist with diabetes expertise — is not necessarily a must-do for weight loss.
However, Warshaw said, the challenge of weight loss isn’t the loss; it’s the maintenance.
And to build a plan to succeed long-term, it may be a good idea to have some strong coaches at your side.
“I’d love to say that people can all figure this out on their own, but experience has shown me, it’s challenging to do without support,” Scheiner said. “It helps getting coaching from experts on lifestyle changes.”
A good diabetes and nutrition team can help you figure out if you need other tools, such as the
“Those medications, used right, can level the playing field” for PWDs, he said.
Support can have different looks as well.
For Sabino, joining a workout group was a huge plus. “It made a world of difference for me,” she said.
First, there’s that feeling of needing to show up so as not to let down the team, something that works for many people when it comes to motivation.
But Sabino said at her gym and in her workout group, she’s found way more than that.
“I feel more connected to the goal and the community,” she said. “Each one of us [in the workout group] has challenges of our own. It’s not all T1D, but much of what we all find as challenges are very much the same. And we share. It’s great.”
With the advent of smarter insulin pumps and continuous glucose monitors (CGM), PWDs have more ability to micromanage and stay on top of their blood sugars, a key to better weight loss and maintenance.
Whether you are using injection therapy, a pump, or a hybrid or looped automated insulin delivery system, Warshaw said, “The more that your insulin is managed, I think the easier time you are going to have [with weight loss]. The less hypos you have, the more your system helps you manage your insulin, the better.”
Sabino, for one, said she’s found great success using diabetes technology.
“Using looping really helps,” she said.
But she also realized that in America at least, that’s a comment that comes from privilege.
“Access [to technology for all] is still an issue,” she said.
[Click here to learn about what to do if you can’t afford a CGM.]
It’s a hot button topic in the diabetes community and the world in general. Is low carb eating the magic answer?
Scheiner says no.
“I’m very leery of super low carb diets,” he said. “It’s almost impossible to follow them long-term, and the long term usually offsets the short term.”
In other words, going super low carb may help you lose weight quickly, but the bounce-back may include gaining more.
Warshaw said, “I’m an advocate for healthy, plant-focused eating for everyone.”
Rather than focus on carbs, she said, “Make healthier, nutrient-rich foods the core of what you eat.”
Plus, weight loss and long-term maintenance isn’t just about a diet, Warshaw said.
“It’s more about behavior change, and that’s something often best taken one step at a time.”