By Marie L. Veselsky, RD, LD, CDE, BC-ADM

For many people with Type 2 diabetes, their inability to clear their sugars is closely related to their high body fat percentage.

Thus, it would stand to reason, that once they lose significant body fat over time, they would also improve their ability to clear their sugars.

One thing that can be said for sure, is that significant weight loss and improved diabetes symptoms go hand in hand.

Most of us have heard the stories of people seeming to get rid of their type 2 diabetes “overnight” when the person gets weight loss surgery. You don’t necessarily have to get surgery to get rid of the body fat, and thus improve your blood sugars, but it is not going to happen overnight. There are people with Type 2 diabetes who have been able to reduce or stop their diabetes medications, even insulin, that have lost significant body fat over the course of years and kept it off.  

One example is “Burnt-out Type 2 Diabetes.”

“Burnt-out Type 2 Diabetes” is a phenomenon that I ran across from being a consultant at a dialysis center.  It is well known by health care providers that individuals that have diabetes can have damage to their kidneys over time. The current guidelines are to help prevent progression of diabetes by prescribing diabetes medications, blood pressure medicines and cholesterol lowering statins as appropriate.

What I have noticed in those guidelines is that not enough attention is paid to getting to the root of the problem. The root of the problem for many is the fact they have a high body fat percentage and are significantly overweight for height.

The “Burnt-out Type 2 Diabetes” phenomenon with people on dialysis has been studied. It is believed that a third of all dialysis patients with Type 2 diabetes can get off all their diabetes meds, including insulin, over time. Why is this? They do have decreased renal and hepatic insulin clearance, but it appears to be more than that. What most of them have in common is they tend to eat poorly and have protein-calorie malnutrition and thus they lose significant body fat over time.

One older female dialysis patient I worked with had Type 2 diabetes and no longer needed to take her diabetes medication or her insulin. She basically had only one issue 20 years earlier when she weighed 175 pounds and was only about 5-foot, 1-inch tall. She was on no medications of any kind back then, but she was significantly overweight for her height and was considered obese.  

One year, when she went to see her doctor, she had elevated blood sugars and the doctor put her on the diabetes medication glipizide to help control her blood sugars. Back then health-care providers did not have as many medication choices as they do today. Glipizide has long been known to cause weight gain. This put this patient in a “Catch 22” situation because this medication could make it harder for her to lose weight.

As the years went by more medications were added. Reviewing her extensive chart going back many years, I saw that there was no weight loss, instead she gained weight. At some point, insulin (which can also cause weight gain) was added along with the glipizide, as well as more blood pressure medications.

Despite all these preventative medications, she still lost function of her kidneys.  By the time she ended up on dialysis she was on 10 medications.

This lady went close to 20 years on preventative medications, but what she didn’t do was to get to the root of the problem and have the weight loss she needed.

A Stitch in Time Saves Nine. I truly feel that if this patient had started to work on losing some weight slowly over time, in addition to taking any needed medications, she may have had a better outcome.

The root of the problem was to lose weight and it did not have to be overnight. This was evidenced by the fact that in the end she was able to get off her diabetes medication and insulin.

Over the course of the two to three years after she had to go on dialysis, she went down to 120 pounds and kept the weight off.  

She experienced “Burnt-out Type 2 Diabetes.”

The cornerstone of all treatment for pre-diabetes and diabetes is lifestyle modifications. One should always use diet, exercise and weight loss first or, in addition to, any medication that is prescribed.  

If you have been diagnosed with pre-diabetes or type 2 diabetes and are significantly overweight it is time to make 2020 the year to get to the root of the problem.  A stitch in time, no matter how slow, saves nine!

Marie L. Veselsky RD, LD, CDE, BC-ADM, is the owner of Integrated Optimal Healthand the Choice Center for Diabetes & Weight Loss (DSME), Choice Center for Medical Nutrition Therapy and Choice Center for Movement, at 45 Washington St., in Conway. The focus of Veselsky’s programs is to get back to the basics through a combination of education on an individualized diet, individualized exercise, accountability, support and other lifestyle change programs to help people reach their “optimal health.” For more information, go to integratedoptimalhealth.com or choicecenterfordiabetes.com, or call (603) 770-4856.

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