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(5) Overweight

Overweight

I have just been told that I have diabetes. Is it true that if I lose weight I will probably not need insulin injections?

Possibly not, if you were overweight at the time of diagnosis, but as with many questions we have to qualify this by saying that it all depends on a number of factors.

Most of the people in the UK and other European countries who have diabetes do not need insulin, especially those who are over 40 years old at the time of diagnosis and who are overweight.

People who are of normal weight at the time of diagnosis are more likely to need treatment with insulin or with diet and tablets rather than just with diet alone. If you are overweight, it is impossible to predict how much weight you will need to lose in order to control your diabetes. In some people the loss of 3 kg (half a stone) is enough to restore the blood glucose to normal, while in other people the blood glucose remains high even after they lose many kilograms in weight.

These people may then need tablets or insulin but, provided that they do not become too thin, they will still be better off for shedding the excess weight.

Diabetes is, however, a progressive condition so, even if you can control it by diet alone initially, over time you will probably need tablet treatment and eventually insulin.

I am trying to lose weight. How much should I lose a week?

It depends on how much you weigh, how active you are, and what you were eating before you decided to tackle your weight problem.

As a general rule people should be quite happy with a weight loss of anything between 1⁄2–1 kg (1–2 lbs) a week.

This doesn’t sound very much, especially when you can read about diets that claim to offer you a rapid weight loss of several kilograms a week.

Losing weight slowly and steadily is healthier than losing weight very fast, which makes you lose muscle as well as fat. It is a common observation that people who lose weight too quickly tend to regain their previous weight and more within a few years.

Most people can lose weight by modifying the quantities and types of food they eat, particularly by cutting down the amounts of fat, sugar and alcohol. By ‘saving’ about 500 calories a day, they will lose about 1 lb (1⁄2 kg) a week. Increased exercise will also help to reduce weight. Even a small amount of weight loss will help to control your diabetes.

I have been dieting on and off since I had my last child 15 years ago. The diabetes that I developed in that pregnancy has now returned despite the fact that I don’t take sugar in my drinks. What more can I do?

The answer probably lies in your dieting ‘on and off’. If you are still overweight, you should try to reduce your energy (calorie) intake until you lose the excess weight. Once you have lost the weight, you will then need to follow a sensible eating plan that balances the amount of energy you take in with the amount you use up in your daily activities, and you will then be able to keep your weight steady.

To lose weight, try to concentrate on reducing the amount of fat that you eat, and cut down on foods that contain both fat and sugar, especially biscuits and confectionery. If this does not work, seek help from a dietitian who will take a dietary history and work out where else you can save calories. Finally, increasing the amount of regular exercise that you take can help.

Why are both my dietitian and diabetes specialist nurse so against my family buying me diabetic foods? I find my diet very hard to keep to and never lose weight anyway. So why can’t I have diabetic foods as a treat?

In all probability the reason why you are not losing weight is that you are eating these ‘diabetic foods’ on top of your diet. Unfortunately foods labelled as ‘diabetic’ are often just as high in calories as standard versions. ‘Diabetic’ chocolate and biscuits contain just as many calories and just as much fat as the ordinary varieties so there is no real benefit.

I am very overweight and trying hard to lose about 20 kg (3 stone). I love ice cream and most of the cheaper varieties in the supermarket contain non-milk fat. Will this be suitable for me?

It would be acceptable to have a small bowl (1–2 scoops) of ice cream now and again, as part of your diet plan.

Non-milk fat means that the manufacturers have used cheaper vegetable fats, which have just as many calories as milk fat.

Most ice cream contains about 7–10% fat and around 80–100 calories per scoop – more in Cornish ice cream.

You can buy reduced calorie ice cream but it is more expensive and the saving in calories does not really justify it for occasional use. Remember, ice cream is not an everyday food, anyway.

I have heard that there is a new appetite suppressant on the market but is it suitable for people with diabetes?

There is a new appetite suppressant which has been approved by a government body for use in diabetes. It goes by the name of sibutramine (Reductil) and may be given to people with diabetes, who are above a certain weight. Sibutramine is not suitable for everyone and should not be used in people with heart disease.

You can continue to use the drug only if it leads to weight reduction of at least 2 kg (4 lbs) per month, and should not be considered as a long-term treatment.

I have the greatest difficulty losing weight and a friend has suggested that I should try joining ‘Weight Watchers’. Will they accept people with diabetes?

‘Weight Watchers’ and similar slimming clubs can be very helpful to people who are having trouble losing weight, and that includes people with diabetes. They may ask for a letter from your doctor confirming that they have no objection. We frequently encourage people to join a slimming club, as they are often very successful in helping with weight loss where other efforts have failed and support you after you have reached your target weight and need to maintain your weight loss. Some people respond better to group therapy.

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