Why Do You Lose Weight With Diabetes? Causes, Tips and More

Losing weight in diabetes: Facts and causes

About 422 million people worldwide have diabetes, a disease defined by a high sugar or glucose levels in the bloodstream (1).

In diabetes, weight loss doesn’t just mean pursuing a slimmer figure but a healthier body. Let’s probe into the link between diabetes and losing weight. 

Weight loss and A1c: The dynamic duo 

“Hemoglobin A1c” is a blood test to assess how well your body has managed your blood sugar over the past three months (2). 

A1c measures the amount of sugar carried by your red blood cells. Red blood cells last for about three months, and the sugar they carry is attached to a protein called hemoglobin (Hb).

If there’s too much sugar attached, your A1c level will be high. If you have diabetes, it’s crucial to monitor your A1c and try to keep it low (2, 3).

Suppose you are overweight or obese and have pre-diabetes or diabetes. In that case, weight loss can help you control your blood sugars; and improve insulin sensitivity, thus bringing a positive impact on your A1c levels (4). 

In a study, when a group of overweight or obese people with type 2 diabetes lost weight, their A1c levels decreased (5).

The model-based analyses show that A1c levels fell by 0.1% for every kilogram lost. People who had higher A1c levels to start with saw more significant drops for the same amount of weight loss (5). 

A meta-analysis of weight loss interventions found people who were overweight or obese and had type 2 diabetes lost > 5% of their weight and maintained it for 12 months had a significant decrease in their A1c level. The same meta-analysis suggested that A1c levels decreased by 0.6‒1.8% after over a year, depending on the weight loss intervention (6).

How about a considerable pound-shedding? Another 3-month study observed 310 diabetic patients after a weight loss of > 10% body weight. They had a notable drop of 0.83% in hemoglobin A1c (4).

Losing weight with type 1 diabetes: Decoding the complexities 

With type 1 diabetes, our pancreas doesn’t make enough insulin. Insulin is a hormone that helps stabilize (lower) your blood glucose level after eating (3, 7).

For this type, unintentional weight loss may be a symptom and not a goal (1, 3). 

Losing weight without diet changes or exercise may sound attractive to some. Yet it can be a warning sign of diabetes.

In some Asian and African countries, 24‒66% of people with diabetes are under-to-normal weight. The percentage is considerably higher than the 10% in the US (8). 

This could be because of undernourishment in the womb and changes in gene expression due to environmental changes. Yet the main reason is insulin secretion malfunction in type 1 diabetes (3, 8).

When there is insufficient insulin, glucose (sugar) in the bloodstream can’t get into cells to be used for energy (3). The body starts burning fat and breaking down muscle for energy. Thus, you could end up losing some weight (9).

Moreover, as the body can’t get glucose from the blood, our kidneys will remove glucose through urine. As glucose leaves your body, so do calories (10). 

Why do you lose weight with diabetes?

Type 1 diabetes is usually thought to affect lean people, but it’s becoming more common in overweight ones (11). 

If you are dealing with being overweight or obese, it’ll increase your risk of getting type 2 diabetes (3). However, shedding off 5% of body weight can improve insulin sensitivity and lower the risk (6, 12).

This slight weight drop can also help improve your blood sugar. The lipid profile can also be improved, boosting good cholesterol (HDL) and reducing bad cholesterol (LDL). Thus, lower your risk of heart disease (6, 12). 

Type 1 diabetes

If unintentional weight loss is a symptom of type 1 diabetes, why do some people still try to lose weight? Because some people with type 1 diabetes are overweight or obese, obtaining a healthy weight and BMI should be their goal (11). 

When people with type 1 diabetes take insulin, a medication to treat type 1 diabetes, they start gaining weight. Besides, the stress of managing their blood sugar may also foster weight gain (13, 14, 15). 

In addition, eating disorders affect up to 40% of young adult females with type 1 diabetes. Again, insulin can cause weight gain and cause weight dissatisfaction rather than striving for a specific health benefit (14). 

Type 2 diabetes

Type 2 diabetes stops the body from using insulin properly (called insulin resistance). Hence sugar will pile up in your blood (3).

Most people with type 2 diabetes are overweight or obese (16). In the US, about 35% of new diabetic cases diagnosed between 2001‒2004 could be attributed to obesity. This number increased to 41% in 2013‒2016 (17). 

If you are not a diabetic, weight loss can help prevent developing pre-diabetes or type 2 diabetes (4). 

If you’re one of the many people with prediabetes or type 2 diabetes, keeping track of your weight should be a priority (18). 

Weight loss can be a powerful way to combat insulin resistance (19). It can enhance the sensitivity of the liver and skeletal muscle to insulin. In this way, you can control blood glucose better (6, 20). 

The American Diabetes Association (ADA) recommends that people with type 2 diabetes or pre-diabetes should try to lose 7% of their body weight. People who followed this advice had less inflammation and better kidney function (21).

Losing 10‒15 kg can make the disease disappear (16). In a one-year study, almost half (46%) of type 2 diabetics who lost 15 kilograms or more got cured of their diabetes and stopped taking medication (22, 23).

Losing weight with type 2 diabetes: Practical tips

In type 2 diabetes, the symptoms can be mild and may take many years to be noticed (7). It develops through your long-term habit, so you may need to adopt other healthy habits to reverse the condition. 

Make sure your goal is measurable, realistic, and time-bound. That way, you’ll be less likely to slip up or fall back into old habits.

The common rules

Regarding diabetes, some principles are in common to help you drop pounds. The key is to focus on those changes you can commit to.

Blood sugar monitoring

In case you have diabetes and want to lose weight, the first step is to control your blood sugar. This will ensure your best metabolic condition (24). When your blood sugar returns to normal, your weight can stop changing.

You must work with your healthcare provider on a treatment plan, as it’s a lifelong condition. This plan may involve different strategies depending on your situation.

Choose the right food

In a review of 18 studies across 21,372 newly diagnosed cases of diabetes, experts found that people who ate healthy diets had a 20% lower risk of getting type 2 diabetes (25). 

Even small changes to your diet can make a big impact. The ADA recommends the diabetes plate method—the simplest way to plan a balanced meal to control blood sugar (26).

This method requires no measuring, calculating, or counting carbohydrates. You simply need to divide a standard 9-inch plate into three sections (26):

• Fill up half of your plate with non-starchy veggies. They are a great source of fiber, which has long been a trusted ally in many weight-loss diets (27).
• Fill one-quarter with protein such as chicken, fish, tofu, and beans. Protein is a must to promote lasting fullness and keep you healthy (20, 28). 
• Fill the other quarter with carbs like starchy veggies, legumes, and fruits. Say yes to complex carbs like whole grains, as our body slowly breaks them down into glucose in your blood (29). 

For a drink, water or low-calorie drinks are the best choices. Keep yourself hydrated for good health, but avoid alcohol and sugary drinks (24). 

You don’t have to give a special space for healthy fats like monounsaturated and polyunsaturated fats from fish, nuts, avocados, and plant oil. You can add them for some flavor and a satisfying feeling.

It’s always good to cook at home to follow any specific diet, where you can freely choose the ingredients and fully control portion size (30).  

Also, it’s best to stay away from: 

• Trans fats: Some doubt that trans fat may trigger insulin resistance and, thus, diabetes. Trans fat can be found in processed snacks, baked goods, shortening, and stick margarine (31).
• Sugary foods: Soda, concentrated fruit juice, cakes, or candies are appealing. Yet their sugar content may spike your blood glucose (32).
• High-sodium foods: Consuming too much salt can worsen your blood pressure and diabetes. If you often use canned fruit or veggies, go for those that say “no salt added” (33, 34).

Plus, don’t leave your body going too hungry, which may further trigger binge eating. Try to eat slowly since it takes 20 minutes or more for your brain to know you are full (18, 20). 

Sweat for success

Not getting enough exercise and obesity are well-established risk factors for type 2 diabetes (7, 8).

The ADA also suggests aiming for 150 minutes of moderate-intensity exercise each week (21, 35). The number seems high, but you can divide it across the week. You just need to spend 30 minutes daily, five days a week.

Think about three times in your day when you could do 10 minutes of exercise. It could be:

• Walking or biking to school or work
• Going for a stroll after meals
• Taking the stairs instead of the elevator 
• Doing household chores
• Dancing or swimming with your loved ones
• Gardening and enjoying nature

A small yet powerful tip is to lay out your workout clothes before sleeping. You will wake up with more motivation!

The most effective way is to have continued support from your loved ones or general practitioner (GP). Often, the amount of weight loss is less than what people wanted. Yet staying motivated is the key to keeping your weight off (6). 

Remember that some medications can cause adverse effects when you should work out. For example, insulin and sulfonylureas could put you at a higher risk of having low blood glucose levels if you exercise (36, 24).

If you work out in the evening, that risk could be even greater. If you’re worried about low blood glucose while you sleep, it might be safer to work out in the morning or afternoon instead of the evening (35).

Diet for type 2 diabetes and losing weight

The potential of intermittent fasting 

Almost all kinds of intermittent fasting (IF) exhibited a weight-loss effect (especially belly fat) in many types of conditions, including type 2 diabetes (37, 38). 

Intermittent fasting is when you don’t eat for a while after an eating window. The most common versions are the 16/8 and 12/12, where you fast for 16 or 12 hours and eat during the remaining hours (39).

In patients with poor blood sugar control (dysglycemia), IF could lower fasting glucose, and A1c concentrations and improve insulin sensitivity. All of them will benefit type 2 diabetics (37, 38). 

Intermittent fasting is also a safe dietary therapeutic target for type 2 diabetes. Besides supporting diabetics, it also supports improved metabolism and your gut, fat tissue, and peripheral tissues (38). 

If you’re new to intermittent fasting, gradually extending your daily fast time is the best. Though coping with hunger during fasting can be challenging, staying busy and getting enough sleep can help. 

Another tip is staying hydrated with water and tea, which can directly boost your energy without adding calories.

Exploring Mediterranean and other diet

As its name implies, the Mediterranean diet is what people in the Mediterranean region eat. Researchers found that these people are healthy and hardly get sick with chronic diseases (40, 41).

This diet can reduce inflammation with its antioxidative properties and even change gut bacteria (40, 42). It can even cause a drop of 19% in diabetes risk (43).

The diet embraces fresh and whole food. The food should be as close to nature as possible. In other words, you should eat lots of veggies, whole grains, and nuts. It’s favorable to use olive oil for cooking (40, 41). 

You can have legumes, fish, and white meat for protein. If you want dairy, go for local cheese and yogurt in small amounts. Besides, try not to overeat red meat or processed foods. For dessert, you can have colorful fruit or something sweet with nuts and honey, but only on special occasions (41, 42).

Besides being nourishing, the Mediterranean diet has proven to improve the condition of type 2 diabetes, reducing A1c levels (44, 45).

However, if you’re not into Mediterranean food, going vegan or trying a low-calorie or low-carbohydrate diet can help you get those sweet A1c levels down. They will help you lose weight and reduce your BMI (16, 42).

Following a low-carb diet also means you might not need much insulin for treatment. It’s helpful, as insulin drugs can trigger weight gain (14, 46).

How to lose weight with type 1 diabetes

People with type 1 diabetes should avoid those sketchy weight loss pills and starvation diets. But some of the popular diets can help.

Let’s explore the challenges of this type and how to overcome them. 

Weight loss for type 1 diabetes: The unique challenge

Insulin control

Often, those who take insulin gain weight (14). Thus, getting leaner can be challenging for type 1 diabetics since they depend on insulin. 

In a survey of nearly 5,000 youths, women with type 1 diabetes are less likely to use other unhealthy ways to lose weight, such as vomiting or skipping meals, than those without diabetes. Yet they use another method: reducing insulin dosage (47).

If you are employing insulin restriction or under-treating your diabetes to lose weight, the results could be pretty serious. This can cause high blood sugar levels, a serious condition called diabetic ketoacidosis (3, 48). 

You can lower your insulin intake using an insulin pump. People who use this device need less insulin and experience fewer eating problems. They can even manage their blood sugar better (49, 50).

Also, some diabetes medicines may help you lose weight and lower your insulin dosage. It’s always a good idea to talk to your general physician to see if they can be a good fit for your diabetes treatment plan.

Still, spare yourself from manipulating insulin dosage unless you have advice from your doctor.

Fasting problems

In short, people with type 1 diabetes should abandon the idea of intermittent fasting. They are more at risk when fasting than type 2 diabetes because they take insulin. 

When fasting, they need to reduce the amount of insulin intake. They may have hypoglycemia (low blood sugar) if they don’t reduce it enough. Yet if they reduce it too much, they may develop hyperglycemia (high blood sugar) (48, 51). 

Some may need to fast for religious reasons; for example, Muslims will fast during Ramadan. It means they don’t eat from sunrise to sunset for a specific period. 

They can still fast for some days if they have type 1 diabetes. However, they need proper education and advanced glucose monitoring. If their condition is complex, fasting may put them at a higher risk of diabetes complications (52). 

Low-carb or low-cal diets

You may need to pay more attention to serving size and carbohydrate content to control your blood sugar for shedding pounds. Your dietitian can help you figure them out, so you can adjust the insulin dose accordingly. 

If you’re on a fixed insulin dose, it’s best to have carbs more regularly to avoid those dips in blood sugar (36).

And if you’re trying to lose weight by eating almost nothing (800 calories or less per day), that can also lower your blood sugar. You may need a multivitamin-mineral supplement (24, 53).

Best diets for losing weight with type 1 diabetes

If you want to plan an ideal diet, talking to a nutrition expert is a good idea. They’ll tell you how to measure food portions and read food labels.

The best diet should be customized for yourself, but some healthy diets can be applied to reach your weight-loss goal: 

• Mediterranean diet: Involves eating many vegetables, lean proteins, nuts, and healthy fats (40).
• DASH diet: A heart-healthy eating style with nutrients to help lower your blood pressure, but it has also been found to be beneficial in controlling blood sugar, weight loss, and improving insulin sensitivity (54, 55).
• Plant-based diet: Vegetable proteins take longer to digest due to the presence of fibers, which help control blood sugar levels and prevent spikes. Yet you may need to supplement n-3 fatty acids to reduce insulin requirements (56). 

Low-fat diet: Aim for about 30% of your calories from fat. This diet can improve your insulin sensitivity (57).

Expert’s tip: Best diet for pre-diabetes and diabetes

How to stop weight loss in diabetes: Unintentional weight loss

Dropping pounds is more of a symptom of diabetes, so don’t neglect it. A good rule of thumb is to see your doctor if you’ve lost more than 5% of your weight within 6 to 12 months (58) and take note of any other symptoms as well.

Unintentional weight loss comes from problems using insulin. Hence, the fastest way to regain your weight gain is to take insulin with the dosage prescribed by your doctor (3).

Following a healthy diabetes regimen is fruitful. Consult your doctor, nutritionist, or dietitian to ensure you get the best care possible. You may need to aim for proper nutrition and closely monitor blood sugar levels.

For a nourishing diet, try to add more nutrient-dense foods to your diet. You can also try eating smaller and more meals throughout the day (24). 

Sometimes, stress can alter your appetite. In this case, finding healthy ways to manage your stress and anxiety can improve your diet.