Female, 28 years of age, diagnosed with type 1 diabetes at age 25. She was taught to manage her diabetes with a basal/bolus insulin regimen and meal plan prescribed by health care team. She was taught she could eat anything she wanted as long as she covered her carbs with rapid-acting insulin. Her glucose was in control, but she gained 50 pounds over the first year. She then attributed her weight gain to taking insulin, so she would not take enough insulin to cover her glucose levels. I met her when she was admitted to the hospital in DKA. When we reviewed what she was eating, and the amount of insulin she was taking when her glucose was in better control, it was clear to me she was eating about 250 to 300 grams of carbohydrate/day. I offered her hope, letting her know she could lose weight in a healthy way. Provided education re: how to safely decrease her carbs, keep her satisfied, and changed her insulin to better match her needs. She started losing weight and had no further issues of holding her insulin or DKA.
- Individualize meal plan. No one plan fits all.
- When teaching carbohydrate counting, teach the impact of different foods on glucose levels.
- Teach the impact of insulin on glucose levels. First teach the importance of taking insulin, the effects and side effects, including weight gain.
- If the patient has lost weight before diagnosis, teach gaining some weight is to be expected as glucose levels improve.
- Teach once glucose and weight is managed, if patient is gaining too much weight, one way to manage weight is to lower carbohydrates. In doing so, this usually includes lowering insulin needs.
- Assess patients current meal plan and insulin requirements.
- Dietary carbohydrate needs can and should be individualized.
- Teach patients who are gaining weight how to safely lower their carbohydrate intake and insulin requirements to match the lowered amount of carbohydrate to avoid hypoglycemia.
- Safely lowering carbs and the amount of insulin can help some people who have type 1 diabetes lose weight.
- If you are not experienced in nutritional counseling including lowering carbs and insulin, refer to a health care professional who is.
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