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On Insulin and Weight Gain

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

Does my insulin make me look fat? The answer to this question is …it might. That would make it the wrong answer because none of us want to take a medication that may cause weight gain, especially as maintaining a healthy weight is such a crucial aspect of good diabetes management. The purpose of this post is to discuss how insulin works and how it may affect your weight. I hope after reading this you’ll have fewer reservations about using insulin if it becomes necessary.

Maintaining a healthy weight is so important for general health and is particularly important for people with chronic diseases such as high blood pressure, high cholesterol, heart disease, arthritis, and diabetes. A healthy diet and weight may mean fewer daily medications or a lower dose of medications you still require. Many medications have the potential for side effects; diabetes medications are no different. Weight gain IS a possible side effect of insulin, but it may also happen with oral medications.

Let’s talk about insulin as a first step. It is, simply put, a lifesaving medication. Insulin was discovered in 1921 at the University of Toronto and has been extensively studied and improved upon since. The job of insulin is to move the glucose from the food we eat into our cells so they’re able to stay healthy and work well. It then takes the remaining glucose from the bloodstream and stores it so it can be used for energy later. People with Type 1 Diabetes are totally dependent upon this medication for survival as their pancreas does not produce insulin. People with Type 2 Diabetes can manage their disease many different ways: diet, exercise, oral medications, and insulin. Diabetes is a progressive and chronic disease that as yet does not have a cure. That is why so many people with Type 2 Diabetes will require insulin as part of their management over time.

Two common symptoms of poorly controlled diabetes are significant weight loss and excessive urination. The weight loss happens because stored fat gets broken down to provide enough fuel for bodily functions (heart and lungs, for example) to operate and maintain life. You may start to notice the numbers on the scale decrease, regardless of what you eat or drink. This is because calories consumed aren’t being properly metabolized but rather directly excreted with urination.

The treatment for extreme hyperglycemia is insulin therapy. The insulin corrects the high blood sugar, correcting the excessive weight loss in the process. The insulin is helping the body work correctly; it’s not causing new weight but rather replacing what was lost when the body was in crisis. It’s a sign the body is healing and starting to work more normally again. This is a good thing, but it can also be frustrating for people who struggle with their weight regardless of their level of glucose control. If your weight is still creeping up after your blood sugar is better controlled, there are probably other reasons for this and further investigation is needed.

Frequent episodes of hypoglycemia (low blood sugars) can cause added weight. I’ve discussed hypoglycemia in more detail in the past, but I want to review a couple of points now. Under eating, over exercising, and both oral medicines and insulin are potential causes of this frightening and potentially life threatening condition. Proper treatment is key, but it’s common for people to over treat low blood sugars because they feel so poorly and think more is faster and better. This is not the case, and the extra calories may cause added weight over time.  The strategy I encourage my patients to use is trying things like glucose tablets and gels for treatment more often than juices or regular soda because they are pre-packaged for the correct carbohydrate (15grams). It can be hard to measure out 4 oz of juice or regular soda when you are feeling so poorly and anxious during an episode of low blood sugar. I also strongly encourage all of my patients to see our RD CDE on a regular basis to review meal plans and make any adjustments as needed to assist with better weight control. It is also important to be as active as possible as any type of movement will decrease insulin resistance and improve weight and blood sugar numbers.

Insulin initiation is a daunting prospect for some. Many of my patients, especially those who are really struggling with their weight, have told me the fear of gaining weight is why they refuse insulin. I hope that my explanation helps to minimize this fear. So, this brings us back to where we started. Does my insulin make me look fat? I prefer to answer this way: It makes your body healthy so you look marvelous!!!

Health

Diabetes and the Brain

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

I’m confident that I’m not the only one who frequently goes wild because I can’t remember where I put my T-Pass, or my wallet or gloves. I know I had them, but  can’t remember where I put them. Little memory lapses like these happen to everyone no matter  how old you are, and it’s  a pretty normal occurrence.  However, there is potentially another side that worries all of us:  When are these common lapses more than just that? When is it a signal that something is seriously wrong, like the beginning of dementia or Alzheimer’s disease?

Let me start by defining these two illnesses. Dementia is a syndrome caused by a group of brain disorders, Alzheimer’s disease being the most common cause. There is a loss of memory, language, and judgment which interferes with activities of daily living. Alzheimer’s is a fatal disease characterized by progressive worsening of these symptoms thought to be due to abnormal clumps of protein in the brain.

There have been studies conducted showing people with  Type 2 Diabetes have a higher risk of developing Alzheimer’s disease and  other types of dementia later in life, though the exact connection between these conditions isn’t well understood and is still being studied. (It still isn’t clear if people with Type 1 Diabetes have the same increased risk.) There are a few possibilities to consider, however. Type 2 Diabetes is a condition that means there is insulin resistance and insulin deficiency. Inadequate insulin means glucose can’t get from the bloodstream to the cells of the body that keep it healthy and working well. This can lead to damage of the blood vessels anywhere in the body, including the brain.  This damage may go on to cause a decrease in blood flow and even blockages of the vessels. This series of events can lead to vascular dementia.

Hypoglycemia (low blood sugar) has also been indicated as a possible cause of decreased mental functioning. Glucose is the main source of energy for the brain. When you have a low blood sugar, there isn’t enough available to fuel the brain which causes decreased brain function. There is also the possibility that frequent and prolonged hypoglycemia may cause some brain damage to the cerebral cortex (the outermost covering of the brain) and the hippocampus (area responsible for memory).

There is continuous medical investigation underway to better understand the disease process of both diabetes and dementia, and achieve cures for these diseases.  What I hope you will take away with this information is an understanding that there are steps that you can take to help stay as healthy with diabetes as is possible.  Good blood sugar control is the key.  Discuss your self-monitoring goals and HbA1C range with your health care provider at your next visit as these are different for every person.  Taking care of your health is the best holiday gift you can give to yourself and your loved ones.

Health

So, what’s the Deal with All the “Sweeteners”?

By Suzanne Russell-Curtis, RD, CDE
Bulfinch Medical Group

Artificial sweeteners, sugar alcohols, natural sweeteners and plain old sugar — we hear about them all the time.  Natural is better than artificial. High fructose corn syrup is the cause of obesity. Sweeteners will save us all from weight gain, heart disease and diabetes. The list goes on and on. Well, here is the breakdown on the types of sweeteners and what you need to know about each.

Artificial Sweeteners: Sucralose (Splenda®), Aspartame (Equal®, Nutrasweet®),   Saccharine (Sweet n’ Low®).

  1. Do not affect blood sugar
  2. Zero calories
  3. Can be used in baking (not a direct substitution for sugar. Artificial sweeteners are much sweeter than regular sugar and they do not add bulk or volume to recipes. Read substitution suggestions carefully)

Sugar alcohols: Mannitol, Sorbitol, Xylitol

  1. Will increase blood sugars, however not to the extent of regular sugar
  2. Provide a small amount of calories
  3. Better alternative for baking, however not readily available to the general public.  Typically found in commercial baked goods, mouthwash, toothpaste and drinks
  4. Although named sugar “alcohols” they do not contain alcohol

Natural Sweeteners: Agave nectar, fruit juice concentrate, honey, maple syrup, and molasses

  1. Will increase blood sugar the same as sugar
  2. Will provide calories
  3. Widely used in baking. Each natural sweetener provides its own unique taste

Other Sweeteners: Stevia (Truvia®, Pure Via®)

  1. These sweeteners are combined with either sugar alcohols or forms of natural sugar. Do not assume your blood sugars will not rise when using these types of sweeteners. Depending on the serving size and product there may be a slight effect on blood sugars or none at all
  2. Zero Calories
  3. FDA labeled purified Stevia as “Generally Recognized as Safe” but has not approved crude Stevia or whole leaf Stevia as there are some health concerns

High fructose corn syrup:

  1. Will increase blood sugars the same as sugar                                                          **The make up of HFCS is the same as regular sugar (fructose and glucose). The only difference is cornstarch is highly processed to make the syrup. At this time there is no known difference on how the body reacts to HFCS.  More research is needed
  2. Will provide calories
  3. Widely added as a sweetener to any type of food

So those are the facts on sugar substitutes. It’s up to you if you want to use any of them, but please remember to use caution when choosing a food that is labeled “no sugar added” as these products may contain carbohydrates. An example would be “no sugar added” ice cream. Ice cream is made from milk –> milk is a carbohydrate –> carbohydrate turns into sugar –> blood sugar levels will rise.  The best way to determine the effects on your blood sugar is to read the food label!

Diabetes ABCs

Diabetes ABCs: P

Pre-diabetes
By Paula Cerqueira, Dietetic Intern

P

Pre-diabetes is a condition in which a person’s blood sugar levels are higher than what is considered to be normal, but not quite high as to denote diabetes.  According to the CDC, about 1 in 3 American adults have pre-diabetes.  Of those with pre-diabetes, 1/3 to 1/2 will develop diabetes within 5-10 years without intervention.

When people are in a pre-diabetic state, they may begin to develop significant cardiovascular and nerve damage.  However, diabetes is not an inevitable diagnosis.  Pre-diabetes can serve as an opportunity to develop healthy habits to prevent the progression to Type 2 Diabetes.  With such lifestyle changes as following a healthy diet, weight loss of 5% to 10% of body weight, at least 150 minutes per week of exercise, and not smoking you may be able to bring your blood sugar level back to normal.

Reviewed by Debra Powers, MS, RD, CDE, LDN, Senior Clinical Nutritionist

Pancreas

The pancreas is a small organ located behind the stomach.  Its main function is to produce enzymes used to digest food.  The pancreas also produces insulin, a hormone the body uses to move glucose out of the blood stream and into cells for energy.  For people with diabetes, the pancreas either does not produce enough insulin (or none at all) or the body is unable to use the insulin it produces properly.

(Reviewed by MGH Diabetes Center)
Diabetes ABCs

Diabetes ABCs: L

Lantus
By Eileen B. Wyner, NP
Bulfinch Medical Group

L

Lantus (also called Glargine) is a long acting, man-made version of human insulin that is meant to be taken daily to regulate both Type 1 and Type 2 Diabetes. It’s available by prescription and should be taken at about the same time daily to keep the blood sugar stable. It works like a time release capsule, slowly releasing insulin into the blood stream to control blood sugar. The dose can be adjusted as needed to ensure good diabetes control. It should never be mixed with other insulins.

Diabetes ABCs

Diabetes ABCs: F

Fasting Blood Sugar
By Eileen B. Wyner NP
Bulfinch Medical Group

F

Fasting blood sugar is a test to determine how much glucose (sugar) is in a blood sample after an overnight fast. Typically, this test is done after 12 hours without any food or liquids except water. The fasting blood glucose test is commonly used to detect diabetes mellitus and may be done as part of a routine medical exam. A result less than 99 mg/dL is normal.

Diabetes ABCs

Diabetes ABCs: E

Exercise
By Paula Cerqueira, Dietetic Intern 

E

Exercise is an integral part of diabetes management. It helps improve blood glucose control in the long run; reduces insulin resistance; increases insulin sensitivity for up to 72 hours after an activity session; promotes modest weight loss and weight maintenance; lowers blood pressure, LDL (bad) cholesterol and triglycerides; decreases risk of heart disease and stroke; and reduces stress, anxiety and depression.

In order to get the greatest benefits from your workouts, it’s recommended that you participate in 150 minutes per week of moderately intense physical activity, such as: walking at a brisk pace, jogging, swimming, bicycling, playing tennis or using an elliptical.

While exercise is an important part of any diabetes treatment plan, it needs to be started carefully.  Check in with your healthcare provider before starting an exercise program. For those who take insulin or medication that stimulates insulin production, it’s critical to check your blood sugar levels before, after, and during your workout to avoid dangerous blood sugar fluctuations.

Prior to exercise, if your blood sugar is below 80 mg/dL, it may be too low to safely do moderate physical activity.  Eat a small carbohydrate-containing snack, such as a medium piece of fruit or a slice of toast, before you begin your workout.  If your blood sugar levels are greater than 250 mg/dL, you should test your urine for ketones (a byproduct of fat metabolism). Hormones associated with exercise can further raise blood ketones and cause a drop in your blood pH.  Wait to exercise until urine ketones are at a low level. Contact your healthcare provider with any questions regarding exercise and/or your diabetes care plan.

(Reviewed by Debra Powers, MS, RD, CDE, LDN, Senior Clinical Nutritionist)