Diabetes and Weight Loss: Finding the Right Path

There's no question about it: If you're overweight and have type 2 diabetes, dropping pounds lowers your blood sugar, improves your health, and helps you feel better.

But before you start a diabetes weight loss plan, it's important to work closely with your doctor or diabetes educator - because while you're dieting, your blood sugar, insulin, and medications need special attention.

Make no mistake -- you're on the right path. "No matter how heavy you are, you will significantly lower your blood sugar if you lose some weight," says Cathy Nonas, MS, RD, a spokeswoman for the American Dietetic Association and a professor at Mount Sinai School of Medicine in New York City.

A 2001 National Institutes of Health study found that a combination of diet and exercise cuts the risk of developing diabetes by 58%. The study involved people who were overweight (average body mass index of 34) and who had high -- but not yet diabetic -- blood sugar levels.

"We know it's true -- that if someone with diabetes loses 5% to 10% of their weight, they will significantly reduce their blood sugar," Nonas tells WebMD.

"We see it all the time: people can get off their insulin and their medication," she says. "It's wonderful. It shows you how interwoven obesity and diabetes are."

Even losing 10 or 15 pounds has health benefits, says the American Diabetes Association. It can:

• Lower blood sugar
• Reduce blood pressure
• Improve cholesterol levels
• Lighten the stress on hips, knees, ankles, and feet

Plus, you'll probably have more energy, get around easier, and breathe easier.

On a Diabetes Weight Loss Plan, Watch for Changes in Blood Sugar

Cutting back on just one meal can affect the delicate balance of blood sugar, insulin, and medication in your body. So it's important to work with an expert when you diet.

Check with your doctor before starting a diabetes weight loss plan, then consult with a diabetes educator or nutritionist, advises Larry C. Deeb, MD, a diabetes specialist in Tallahassee, Fla. and president-elect of the American Diabetes Association.

"Don't try to lose weight on your own," says Deeb. "With a doctor and a good nutritionist, it's very safe to do. This is very important if you're taking insulin or medications."

Go for the Right Balance in a Diabetes Weight Loss Plan

Christine Gerbstadt, MD, a spokeswoman for the American Dietetic Association, warns: "You don't want to run the risk of high or low blood sugar while you're dieting," she tells WebMD. "You want tight glucose control while you lose weight."

Gerbstadt suggests cutting 500 calories a day, "which is safe for someone with diabetes," she says. "Cut calories across the board -- from protein, carbohydrates, and fat -- that's the best way." She recommends that people with diabetes maintain a healthy ratio of carbs, fat, and protein. The ideal:

• 50% to 55% carbs
• 30% fat
• 10% to 15% protein

Watch the Carbs in a Diabetes Weight Loss Plan

For people with diabetes, a refresher course on carbs may also be in order, Gerbstadt says.

That's because carbs have the biggest effect on blood sugar, since they are broken down into sugar early in digestion. Eating complex carbs (whole-grain bread and vegetables, for example) is good because they are absorbed more slowly into the bloodstream, cutting the risk of blood sugar spikes, Gerbstadt explains.

"Worst case scenario is sliced white bread," she says. "Whole-wheat bread is an improvement. Adding a little peanut butter is even better."

Simply cutting lots of carbs -- a common dieting strategy -- can be dangerous, Gerbstadt says. When your body doesn't have carbs to burn for fuel, your metabolism changes into what's known as ketosis -- and fat is burned instead. You'll feel less hungry, and eat less than you usually do -- but long-term ketosis can cause health problems.

"Ketosis decreases oxygen delivery to the tissues, which puts stress on eyes, kidneys, heart, liver," Gerbstadt says. "That's why the low-carb, high-protein Atkins diet is not really safe for people with diabetes. Diabetics need to try to stick with a more balanced diet so your body can handle nutrients without going into ketosis."

Special Challenges when Following a Diabetes Weight Loss Plan

"For anyone, losing weight is challenging enough," Luigi Meneghini, MD, tells WebMD. Meneghini is director of the Kosnow Diabetes Treatment Center at the University of Miami School of Medicine. "For people who inject insulin, it's even more difficult because they have to eat when they have low blood sugar. When you have to reduce calorie intake, prevent overmedication, and eat to correct your low blood sugar, it's very challenging."