Like many people, losing weight might have been at the top of your New Year’s resolution list year after year. Yet every single year, nothing seems to change. 

Losing weight with type 1 diabetes (T1D) can become this big, scary monster that feels intimidating, and sometimes nearly impossible to achieve. 

Losing weight with T1D isn’t easy 

A common experience: maybe you start a weight loss effort, and two days in, it feels like you just bought yourself a first-class, one-way ticket to the blood sugar rollercoaster. It crushes your motivation and makes you wonder why you wanted this so badly in the first place. 

I’m here to tell you that it is possible to lose weight with diabetes, and to do so in a way that is sustainable, fits with your lifestyle, and doesn’t feel like such a chore. 

I’m going to break down the top factors that have helped hundreds of our clients successfully lose weight living with diabetes! 

In part 1, we will dive into the first four things for a successful weight loss journey: 

1. Blood sugar management and time-in-range matters over everything else

Quite honestly, if you lose weight but your blood sugars are all over the place, you are setting yourself up for an increased risk of potential diabetes-related complications (like retinopathy, neuropathy, etc.) in the short and long term. 

Blood sugar management is paramount to successful weight loss.  

2. Does insulin cause weight gain? 

If you’ve had diabetes for longer than two days, you have likely heard that ‘insulin causes weight gain,” which can be concerning for someone living with type 1 diabetes who wants to lose weight. 

Many people gain a considerable amount of weight in the first few years after diagnosis and starting insulin therapy. 

Remember, insulin’s goal is to shuttle glucose into the cells to be used as energy. In the weeks or months prior to your diagnosis, your body had very little insulin available for that job, so the glucose is just sitting in the bloodstream. Blood sugar levels were super high, and the excess glucose is peed out. 

This means you weren’t using the majority of the energy you were consuming, so your body is in a catabolic state — state of breakdown.  

Then you start taking life-saving insulin and your body isn’t starving anymore. That excess glucose is being used for energy or stored as body fat. Even more complex, there are actually five other hormones your body doesn’t produce properly that make weight management even harder. If managing your weight as a person with T1D feels frustrating and exhausting, you are not alone.  

3. Let’s agree on reasonable expectations

It’s 2023. You can go online and order something, only for it to show up in two days (or in some places, two hours). As a result, there’s a lack of patience, and you may get fed up if you aren’t seeing results from the first moment you start this weight loss journey. 

I want you to ask yourself, “Did it take more than a week or two (or several months) to gain the weight that I am looking to lose?” 

If you can answer ‘yes,’ then don’t expect to lose all the weight instantly — in fact, losing weight quickly is the opposite of what you want!  

Your biggest ingredients to success here are time, directed effort, happy blood sugars, and consistency. A reasonable (and sustainable) goal is to lose no more than one to three pounds per week. 

Most of the methods of rapid weight loss are not sustainable and can lead to rapidly regaining the weight you lose!  

Slow and steady wins the race. 

4. You will need to manage your calorie consumption 

This is all about creating a “calorie deficit” which simply means eating fewer calories than your body burns in a day. If you’ve looked up weight loss before, I’m sure this concept comes as no surprise. The trickier part for people with T1D is juggling the low blood sugars that can come with that calorie deficit. 

To lose weight, your body must be in a calorie deficit, described here: 

  • Calories consumed < calories burned = weight loss 

Theoretically, if this is done, weight should trend downward — however, no system is perfect and there are easy ways to do this wrong. 

Many people take an extreme approach and end up reducing calories too drastically (i.e. any of the ‘fad’ diets you see online), leading to unsustainable weight loss that gain back easily and quickly. 

And then you’ve gotta manage your blood sugar and prevent lows. 

To prevent frequent low blood sugars while trying to lose weight means you’ll likely (and quickly) need to reduce your basal and mealtime insulin doses. This is important for two reasons: 

  • You don’t want to keep eating all the calories you’re trying to reduce every time you treat a low blood sugar.  
  • A big part of weight loss comes with reducing insulin doses because excess glucose is stored by insulin as body fat. Reducing insulin doses by decreasing your body’s insulin needs can lead to weight loss. 

I’ve seen these low blood sugars alone wreak havoc on our clients’ weight loss journeys, and until you address the lows, weight loss remains fairly stagnant. It normally takes somewhere between one to three weeks to adjust fully to the calorie deficit. Once you get your insulin doses fine-tuned, you’ll likely start seeing more successful results. (But remember, the more weight you lose, the more likely you’ll need to adjust your insulin doses again because weight loss increases your sensitivity to insulin which means you need less to do the same job!) 

Okay, we’re just getting started! Stay tuned for Part 2 on losing weight with type 1 diabetes!  

In the meantime, make sure to join the T1D Exchange Online Community, where you’ll be connected with tons of other people living with diabetes and plugged into the newest knowledge and research coming out!