Diabetes Self-Management Articles

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Why Can’t I Lose Weight?
Finding Your Trouble Spots

by Jacquie Craig, MS, RD, LD, CDE

If you’re not sure what’s keeping you awake, it may help to keep a sleep diary, in which you record when you went to bed, when you fell asleep, what disrupted your sleep, etc. Sleep diary forms are available online; one example can be found at http://www.sleep.buffalo.edu/sleepdiary.pdf.

Diabetes medicines
Some diabetes medicines are associated with weight gain, and some are not.

Taking the correct dose of injected insulin does not cause weight gain, but taking more than you need, or overeating and taking larger doses of insulin to “cover” the food, can contribute to weight gain.

Insulin not only allows glucose in the blood to enter the cells of the body, but it also helps the body store excess glucose as fat. If your body doesn’t have enough insulin, two things happen: Glucose in the bloodstream is not absorbed and instead leaves the body in the urine, and the body begins to burn more fat than normal for energy. Both of these contribute to weight loss. Once insulin therapy is initiated, the body can once again burn glucose as its preferred source of energy and store any extra calories as fat, so any lost weight is usually gained back. Avoiding weight gain with insulin therapy generally requires eating fewer calories, learning to prevent hypoglycemia by matching insulin doses to the body’s needs, and getting regular exercise.

Oral diabetes drugs that cause the pancreas to release more insulin can also contribute to weight gain in the same way as injected insulin can. Among those that have this effect are drugs in the sulfonylurea class, such as glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (DiaBeta, Glynase, and Micronase), as well as combination pills that contain these drugs.

Two other oral diabetes drugs that tend to cause weight gain are pioglitazone (Actos) and rosiglitazone (Avandia). These medicines work by reducing insulin resistance; reduced insulin resistance means that insulin is more efficient at moving blood glucose into cells, where it is stored as energy. The weight gain caused by pioglitazone and rosiglitazone is usually the result of both fluid retention and increased fat storage.

An oral diabetes drug that typically does not cause weight gain and in some cases contributes to weight loss is metformin (Glucophage and other brands). Metformin works by preventing the liver from releasing glucose into the bloodstream when it’s not needed and by reducing insulin resistance.

Sitagliptin (Januvia), also an oral drug for Type 2 diabetes, is associated with neither weight gain nor weight loss.

Exenatide (Byetta), a newer medicine that is approved for treatment of Type 2 diabetes and is given by injection twice a day, also does not tend to cause weight gain. Exenatide signals the pancreas to produce the right amount of insulin when you need it, stops the liver from releasing glucose into the bloodstream when it’s not needed, slows stomach emptying, and may reduce appetite, possibly leading to eating less and to weight loss.

Another newer medicine that is not associated with weight gain is pramlintide (Symlin). Pramlintide is an injectable drug that is taken along with insulin before meals. It is approved for people with either Type 1 or Type 2 diabetes who take insulin before meals. Pramlintide stops the liver from releasing glucose into the bloodstream when it’s not needed, slows stomach emptying, and may decrease appetite.

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