NAVIGATING THE NEXUS: DIABETES AND THE DELICATE BALANCE OF WEIGHT MANAGEMENT

Diabetes mellitus, commonly known as diabetes, is a metabolic disease that presents as elevated blood glucose levels. There are different types of diabetes mellitus, which are all affected by many external factors, including your weight. People living with diabetes may benefit from intentional weight loss strategies if they are carrying extra weight. Maintaining a healthy weight for people living with diabetes doesn’t have to be difficult or time consuming, this article will give insight and strategies to navigate weight loss and diabetes. 

BENEFITS OF WEIGHT LOSS FOR PEOPLE LIVING WITH DIABETES? 

It is always important to understand the benefits of weight loss as it makes the implementation just a little easier. Holding extra weight, especially around your waist, results in fat build up around your organs (like your liver and pancreas).  This extra weight can result in insulin resistance. In saying that, the opposite can be true too. Losing weight can help the insulin that your body produces or the insulin you inject (if necessary) work properly. It is important to note, when you lose weight and start to increase your activity level, your diabetes “plan” might change (this might result in medication changes). Always consult your doctor, nurse and dietitian when working on a weight management plan1.

Weight loss should be intentional (you are actively working to lose weight) and not unintentional. Type 1 diabetes is based on a different mechanism of action when compared to type 2 diabetes. Even though intentional weight loss in overweight type 1 diabetics is beneficial in reducing the risk if complications, it does not have the same effects on blood glucose control as it does in people living with type 2 diabetes1.

1. Weight Loss and Blood Glucose Control: weight loss as a result of lifestyle changes is often the first point of call to assist in glucose control in people living with diabetes because of the improvements seen in blood glucose control. Even small amounts of weight loss have been shown to improve blood glucose control. People living with type 2 diabetes that lose weight have been shown to achieve their target HbA1c more than people who maintain or gain weight. Weight loss can help reduce the dose of medication2.
2. Weight Loss and Cardiovascular Events: studies show that weight loss in people living with type 2 diabetes appears to reduce the risk of cardiovascular events (stroke/ heart attack)2.
3. Weight Loss and Other Comorbidities: the development of microvascular complications (retinopathy- damage to the blood vessels in your eyes, causing blindness, nephropathy- decline in kidney function, and neuropathy- decline in brain function) are dependent on the duration of diabetes, blood pressure and blood glucose control and in turn is associated with obesity. Weight loss can potentially delay the onset of microvascular comorbidities. Weight loss has also been shown to help with improvements in mobility and physical function2

WHAT WEIGHT SHOULD I AIM FOR? 

A 5% weight loss in people living with type 2 diabetes can result in major benefits to your health1. When deciding on the desired ideal body weight, you need to look at two things. 

1. BMI: your BMI will give you an indication of what weight to aim for. It considers your weight and height. For a quick tool to work out your BMI visit: https://www.nhs.uk/health-assessment-tools/calculate-your-body-mass-index/ . You should aim to be in the normal BMI range (18.5-24.9kg.m2). This might not be realistic for all patients, so it is advised to see a dietitian for personalised advice1.   
2. Waist Circumference: a healthy waist circumference means you have less fat build up around your organs. Aim for a waist circumference of less than 80cm for women and 94cm for most men1.

TIPS FOR WEIGHT MANAGEMENT

1. Enjoy a variety of foods: different food from all food groups ensures you’re getting all the essential nutrients (carbohydrates, proteins, fats, vitamins and minerals).
2. Portion control: carbohydrates are found in fruit, vegetables, whole grains, beans, peas, legumes, and dairy products. These foods affect your blood sugar levels more than protein and fat and the amount consumed at a meal should be monitored.
3. Your plate: should consist of mostly salad and vegetables (make up at least ½ your plate), ¼ plate lean protein, and ¼ plate whole grain, high fibre carbohydrates. It could also contain 1 fruit and a low-fat dairy portion.
4. When choosing carbohydrates: select low Glycaemic Index (GI) carbohydrates. GI is a measure that ranks carbohydrate-containing foods according to how quickly and to what extent they affect your blood glucose levels. Low GI foods take longer to break down, releasing the glucose more slowing into your blood stream to help control blood glucose levels and keep you fuller for longer). Examples include grain-based foods that are whole grain and high fibre (whole wheat bread, whole what pasta and brown rice.
5. When choosing proteins: focus on lean meats with the excess fat removed, and incorporate plant proteins e.g. soy, beans, peas, lentils and chickpeas.
6. Prioritise healthy fats: such as olive oil, canola oil, sunflower oil, avocados, sugar free nut butters, nuts, seeds, soft tub margarine and fatty fish (sardines, pilchards and salmon) over saturated (animal fats) or trans fats (deep fried foods, crips and biscuits).
7. NEVER skip a meal: minimum 3 meals a day (every 4 - 6 hours), include snacks according to medication.
8. Include regular physical activity: at least 150 minutes of moderate to vigorous intensity aerobic exercise e.g. brisk walking, dancing, cycling, swimming etc. as well as two strength training sessions per week. Ensure you eat to fuel these sessions sufficiently.
9. Monitor: your blood glucose levels regularly.
10. Drink plenty of water: avoid sugar-containing beverages.

CONCLUSION

It has become evident that understanding and addressing the balance of a healthy weight, exercise and medical treatment is of utmost importance to people living with diabetes and their overall well-being.  By embracing a holistic approach, incorporating balanced nutrition, exercise, correct medication uses and mindful habits, you can help pave the way to a healthier, happier you. Weight loss can be an integral component of diabetes treatment and can play a role in managing further complications. Chat to a Registered Dietitian about an individualised plan for you. Visit www.adsa.org.za to find one in your area.

REFERENCES

1. https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/whats-your-healthy-weight/lose-weight#:~:text=Although%20getting%20type%201%20diabetes,real%20benefits%20for%20your%20health.
2. Wilding JP. The importance of weight management in type 2 diabetes mellitus. Int J Clin Pract. 2014 Jun;68(6):682-91. doi: 10.1111/ijcp.12384. Epub 2014 Feb 18. PMID: 24548654; PMCID: PMC4238418.