How Diabetes and Weight Gain Are Related
This month’s blog is focused on diabetes awareness so I will be addressing this condition and how it relates to weight gain. I will be primarily focusing on Type 2 diabetes as it relates to weight gain much more so than Type 1. So when I use the term “diabetes,” I am referring to Type 2 and not Type 1.
Type 2 diabetes simply means insulin resistance. What does insulin do? Insulin is a hormone secreted by the beta cells of our pancreas in response to eating food. Most food, when absorbed, gets converted into various forms of simplified, broken-down sugars. These sugars are meant to be used as an energy source for muscles, liver, brain, etc. Insulin is the hormone that gets the blood sugar into these organs’ cells.
Diabetes occurs when there is dysfunction in the hormone receptors on the cells of our organs making it difficult for the body to maintain a healthy level of blood sugar. The body responds to this by secreting more insulin to get the job done which ultimately perpetuates the problem. I equate it to hitting your car brakes harder and harder to make them work until they just simply don’t which is disastrous. Once your body has trouble balancing your blood sugar levels, an autoimmune reaction occurs because of this accumulation.
These autoimmune chemicals then react with various parts of your body leading to nerve damage in your extremities, eyes, heart, stomach, brain and more central nerves that control your balance. These also damage the vascular walls throughout your body putting you at risk for heart disease, perivascular disease, and stroke. The longer and more severe diabetes is, the worse the risk is.
What does weight gain have to do with Type 2 diabetes? Well there is no simple answer to this as we are still investigating the exact mechanisms but I will do my best to relay what we think we know. There is a certain time when, as you gain weight, that your fat cells become dysfunctional themselves. Dysfunction breeds an inflammatory response. Specifically, these dysfunctional fat cells promote pro-inflammatory macrophages in response to fat cell death, low oxygen levels inside the fat cells, and other dysfunctional processes.
The cells then secrete pro-inflammatory chemicals lead to a decrease in insulin receptors on cells along with other similar receptors that regulate blood sugar levels as well as promote dysfunction of current insulin and other blood sugar receptors. That is the basic concept with no need for further in-depth discussion as the point of knowing this to help you understand that as a person gains weight, so too does one’s chance of developing diabetes.
Thankfully we now have options to reverse this course and return you back to your normal state! Of course, the first and most obvious answer to this problem is a good healthy balanced diet. Specifically, when it comes to lowering your diabetes risk or simply treating diabetes, you must consume foods that are of low glycemic index. These are foods that do not spike up your blood sugar after eating them. This consists of healthy options with natural sugars that are complex as well as in general low-carb food options. The healthy higher-carb food items contain more complex natural sugars that are harder to break down by the body’s digestive tract so less gets absorbed over that time. Versus those sweets and snacks we like contain added sugars which are simple already-broken-down sugars which are all readily absorbed leading to a greater spike in your body’s blood sugar levels which then demand a higher amount of insulin secretion ultimately leading to weight gain and insulin resistance.
If one is seeking medication to help cure them of diabetes, consider the GLP-1 agonists class. Examples of these include Ozempic, Mounjaro, Wegovy, Saxenda, Trulicity. These work by countering your “hunger-hormones” and promote increased insulin sensitivity. These combined with another class of medication called the SGLT-2 inhibitors are very good at not only getting your blood sugars under control but also help you to lose weight in the process. The idea behind these medications is to not only fix the current diabetes problem but to hopefully help one in negating one of the main causes behind diabetes which is weight gain. For those on insulin therapy, these medications will not only help much more than insulin but it is always my goal for my patients to wean off their insulin to promote further weight loss. Insulin, as a medicine you give yourself, leads to weight gain as well. This is because the levels of this hormone are not as carefully regulated since you are giving insulin on top of your natural production. Weaning off helps the weight loss process. The ultimate idea of these medicines is to be on them as long as the increased weight continues to put you at risk. Once your weight is at a healthy level, then we can start to wean off these medicines themselves as the hope is now you can control everything with diet and exercise alone.
I hope that this blog has been good in helping you to understand diabetes and how it relates to weight gain. There are of course other causes behind Type 2 diabetes and not just weight alone but this is an area that we can control ourselves by making the necessary lifestyle changes we know we all need to make. Remember that even a mild weight gain can increase your risk of diabetes so do take care in managing your appetites and attachments to certain foods you know are not good for you. If you’re ready to take the next step in attaining greater wellness, schedule a weight loss appointment with me, I’d love to accompany you on this journey, and so would our Health Coach Kala.
Stephen Hoelscher, MD, Board Certified in Internal Medicine, Obesity, and Weight Loss