Since I am a diabetes educator who also specializes in obesity medicine, I see a lot of different responses to travel. For all, I see both weight loss and weight gain after travel.
The interesting thing is for people with obesity, I see both. What I also find interesting is a lot of my patients who go to Europe tell me they eat pasta, more bread and other carbs, but when they lose weight, glucose levels improve. Why? Usually because they also tell me they are more active.
A woman—72 years of age who is Asian, insulin dependent, and no excess weight—recently went to the Philippines. She admitted to eating more carbs and not taking care of her diabetes as she does when she is home. Upon her return, she had lost weight and her A1C was elevated. She was surprised that with eating all she did, she lost weight. She does not regularly check her glucose and was feeling fine. but her random glucose was 198. My concern was the fact she had lost weight with the elevated A1C and random glucose. She was not concerned about her weight loss other than she didn’t think she looked good. I recommended she wear a CGM for the week and keep a food log.
She returned to our office today with her CGM. We went over the results together with her food log: Her average glucose was 128mg/DL. Her random glucose was 122mg/dL. Although she did not gain any weight in the one week, she did not lose any more weight since our visit. In fact, she had gained a few pounds since her return from her trip.
I made it clear that weight loss is not always a good thing, especially when someone has diabetes. I wanted to differentiate if the weight loss was due to unmanaged glucose, high glucose levels during her trip, or now was an ongoing issue we would need to address and change her therapy. It seems now it was related to her trip—going back to old habits that play havoc with glucose levels and can affect other parts of her body.
Now she is seeing the numbers and understanding what getting “off track” means, which can include weight loss. She’s now back on track. The patient does want to regain some weight but now understands how to do it without raising her glucose.
- In this world—for many—some people get the message that weight loss is good…always. Teach patients that weight loss can be a symptom of high glucose levels.
- For all of our patients, we need to look at the whole picture before congratulating our patients for losing weight.
Joy Pape, FNP-C CDE
Medical Editor, DIabetesInControl
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Joy Pape, FNP-C, CDE
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