The immune system destroys more and more insulin-producing beta cells in the pancreas over time, until the diagnosis of type 1 diabetes is made. Type 1 diabetes is seen most often in children and young adults, although the disease can occur at any age.
People with Type 1 disease are often thin to normal weight and often lose weight prior to diagnosis. The goal of type 1 diabetes management is to keep your blood sugars as close to normal as possible.
The primary treatment for type 1 diabetes is insulin injections, since the body is not making enough insulin to keep cells functioning normally. Components of diabetes care include:. Once a person starts insulin injections, sugar production is turned off in the liver and some insulin is still being made in the remaining beta cells of the pancreas. The need for insulin decreases and blood sugars return to almost normal levels. Instead, it builds up in your blood.
It creates energy by burning fat and muscle at a rapid pace. This causes unexplained weight loss. Your kidneys also begin working overtime to eliminate the excess sugars in the blood. This uses additional energy and can cause damage to the kidneys. Type 1 diabetes has a similar pattern, but instead of being unable to use insulin, your body stops producing it altogether. In fact, unexplained weight loss could be a sign of diabetes.
Diabetes is a common metabolic condition that affects the way your body uses sugar from the foods you eat. Diabetes is a chronic condition, and it can cause numerous health problems — from nerve damage to vision changes — if left untreated.
Insulin is a hormone the body produces to absorb sugar, or glucose, from the foods you eat. Insulin converts sugar into energy that fuels your brain, muscles, and the rest of your body. As a result, the sugar stays in your bloodstream instead of being converted into energy, and your blood sugar rises.
As a result, it begins burning fat and muscle for energy, which can result in unexplained weight loss. The most common types of diabetes are Type 1 and Type 2 diabetes. With Type 1 diabetes, the body produces little or no insulin because the immune system attacks insulin-producing cells.
Type 1 diabetes often develops in early childhood. Although these dietary plans, with different macronutrient compositions, have been shown to induce significant weight loss, the American Diabetes Association has determined in its position statement that there is no ideal macronutrient composition for meal plans. Regardless of macronutrient breakdown, total energy intake must be appropriate to the weight management goal [ 24 ].
For carbohydrate consumption, intake of dietary fiber has been inversely associated with all-cause mortality in diabetes, while high glycemic load and sugar intake were associated with increased mortality [ 32 ]. For protein consumption, diets containing leaner sources of protein such as chicken and soy result in more favorable lipid profiles than diets containing red meat [ 34 ].
For fat consumption, type and source of fat are more important than the percentage or total amount of fat [ 35 ].
Diets containing foods high in monounsaturated fatty acids, such as extra-virgin olive oil and nuts, decreased CVD risk [ 36 ] and should therefore replace saturated and trans fatty acids [ 35 ]. Although weight loss can be achieved with only restriction of energy intake, increasing physical activity and incorporating exercise training into a weight loss plan lead to greater loss of fat mass and preservation of lean muscle mass compared to energy restriction alone [ 37 , 38 ].
Additionally, there are metabolic benefits to partaking in physical activity for weight loss [ 37 ]. In patients with T1D, physical activity has been shown to decrease cardiovascular risk and mortality [ 39 ], in addition to improving lipid profile and endothelial function [ 40 ].
In patients with T2D, physical activity improves insulin sensitivity [ 39 , 41 ]. As explained earlier, IR is not unique to those with T2D, as patients with T1D tend to be more insulin resistant than their counterparts without diabetes [ 39 ].
Therefore, the benefits of exercise on insulin sensitivity are pertinent to this population, especially in those who are overweight or obese. Highly variable data exists as to what type of physical activity is best suited for weight reduction.
Resistance training alone is associated with fat loss but has minimal effect on overall weight loss [ 42 ]. Even when resistance therapy is combined with aerobic training, this seems to lead to a similar amount of weight loss as aerobic training alone [ 37 , 42 ]. One study showed that aerobic exercise was shown to lower visceral adipose tissue to a greater extent than progressive resistance training when compared to control groups [ 43 ].
However, the major benefit of resistance exercise is to preserve lean muscle mass during weight loss [ 44 ]. This is especially important since patients with diabetes have progressive lean muscle loss as they age [ 45 ].
In terms of exercise intensity, some studies have shown that high intensity interval training HIIT , consisting of repeated bursts of rigorous exercise immediately followed by low intensity recovery, can lead to significant reductions in abdominal fat [ 46 — 48 ].
However, other evidence showed that while this approach is time efficient, it is no more effective than continuous moderate aerobic exercise in promoting fat loss [ 49 ]. This supports the observation that rigorous and moderate intensity aerobic training results in similar amounts of weight loss when intensities of physical activity are matched in energy expenditure [ 42 ].
Patients can partake in the type of physical activity they find most suitable as long as their energy expenditure is in line with their weight loss goals. Risk of hypoglycemia during or after exercise can be minimized if blood glucose is closely monitored before, during, and after exercise, and individual adjustments in insulin or food intake are made [ 50 ].
Adjustment of insulin treatment to facilitate weight reduction has been suggested [ 52 ]. Long-acting insulin creates a pattern of h hyperinsulinemia, which stimulates lipogenesis and inhibits lipolysis [ 52 ]. If long-acting insulin is indicated, insulin detemir, insulin degludec, and insulin glargine U are preferred as they cause less weight gain compared to NPH or insulin glargine U [ 54 — 57 ]. To minimize the hypoglycemic risk and the unnecessary consumption of extra-calories, it is better to administer short-acting insulin immediately after meals or within 20 min from the start of the meal [ 58 ].
This gives patients the ability to calculate the short-acting insulin dosage based on the food that they actually consumed and not on what they presumed to eat. In patients with T1D, insulin glulisine is preferred in such scenarios due to its faster onset of action [ 58 ]. Metformin is a potent anti-hyperglycemic agent used to treat T2D; however, several studies used metformin alongside intensive insulin therapy to treat patients with T1D and obesity [ 59 , 60 ].
GLP-1 is an incretin hormone that is involved in both peripheral and central pathways mediating satiation [ 62 ]. GLP-1 analogs are currently used to treat T2D and obesity. They reduce appetite and slow gastric emptying and thus reduce body weight and body fat by lowering energy intake [ 63 ]. Liraglutide, a GLP-1 analog, in conjunction with insulin has been shown to improve glycemic control and induce weight loss in patients with T1D [ 65 , 66 ]. It was also found to reduce insulin dose [ 67 ].
While it is not approved for patients with T1D, its higher doses 2. In a crossover study, exenatide treatment reduced postprandial plasma glucose but did not change HbA1c in patients with T1D [ 66 , 68 ].
Another study showed that adding once weekly exenatide to insulin therapy significantly improved HbA1c, body weight, BMI, and reduced insulin doses [ 69 , 70 ]. Pramlintide is an injectable, synthetic form of human amylin [ 71 ]. This new class of medications reduces blood glucose by inhibiting glucose reabsorption in the proximal convoluted tubules of the nephrons [ 73 ].
Excretion of glucose in urine reduces body weight in addition to reducing HbA1c [ 74 ]. Recent studies showed cardiovascular benefits of two medications from this class; empagliflozin and canagliflozin [ 75 , 76 ]. Several studies were done in patients with T1D showing reduction in plasma glucose and body weight but with increased incidence of ketoacidosis [ 77 , 78 ].
All of them plus the older medications like Orlistat and Phentermine are effective for weight loss with variable efficacy and side event profiles [ 80 ]. No studies using these medications were specifically conducted in patients with T1D.
However, these medications showed reduction in HbA1c and number or doses of diabetes medications in patients with T2D [ 81 — 83 ]. It is not clear if this effect is related to weight loss or it is specific to the mechanisms of action of these medications. There are several surgical options to reduce body weight that are constantly suggested for patients with T2D [ 84 ]. All of these methods were shown to significantly reduce body weight with variable duration [ 89 — 91 ] and improve glycemic control and may induce partial or complete remission from T2D, especially when they are done early in the course of the disease [ 92 ].
This procedure reduces stomach size by creating a small 15—mL gastric pouch [ 94 ]. While the mechanisms by which it improves blood glucose are only partially understood, there is good understanding of how it enables weight loss [ 94 ]. This surgery alters different gut hormone responses including GLP-1 and ghrelin, a potent hunger hormone [ 94 ]. After gastric bypass operations, GLP-1 secretion in response is significantly increased and this is presumed to contribute to the observed improvement in glycemic control [ 95 — 98 ].
It has been suggested that this surgery does not have a similar benefit on glycemic control if residual beta cell function is absent [ 99 , ]. A study comparing different types of bariatric surgeries found that complications are more likely to occur with RYGB than with sleeve gastrectomy [ ].
Another study suggests that many patients who initially have remission from T2D relapse at some point after these procedures, particularly with RYGB and biliopancreatic diversion [ 87 ]. There is also a recognized risk of postprandial hypoglycemia [ ] and weight regain after this procedure [ ].
Sleeve gastrectomy restricts stomach size by removing stomach fundus that contains cells that secrete ghrelin hormone. This results in a significant reduction in food intake and suppression of appetite [ , ].
Now, it is the most commonly prescribed bariatric surgery due to its efficacy and durability in treating obesity and associated comorbidities [ ]. Sleeve gastrectomy is associated with similar rates of complications as gastric RYGB [ ]. A study that compared the effects of bariatric surgery in patients with T2D and T1D diabetes found that surgery could benefit T1D patients in terms of weight loss and improved glycemic control [ ]. It was noted that after 1 year, the decrease in median HbA1c in patients with T1D was much less than in those with T2D [ ].
In contrast, a few studies suggest that improved glycemic control may not be a probable outcome of bariatric surgery [ , ]. Prevalence of obesity has increased at faster rate in patients with T1D than in the general population. While intensive insulin therapy, lack of physical activity, and development of double diabetes explain some of the mechanisms for weight gain in patients with T1D, little is studied about effective interventions for weight management in this population who were portrayed for long as being lean.
Dietary intervention, increased physical activity and exercise, adjustment of insulin therapy, adding other diabetes medications that positively impact body weight, or adding anti-obesity medications are suggested. If medical weight management fails, bariatric surgeries are valid methods for weight management in patients with T1D.
Mar, Taha Elseaidy, and Sahar Ashrafzadeh declare that they have no conflict of interest. This article does not contain any studies with human or animal subjects performed by any of the authors. This article is part of the Topical Collection on Obesity.
Adham Mottalib, Email: ude. Megan Kasetty, Email: moc. Jessica Y. Mar, Email: moc. Taha Elseaidy, Email: ude. Sahar Ashrafzadeh, Email: ude. Osama Hamdy, Email: ude. National Center for Biotechnology Information , U.
Current Diabetes Reports. Curr Diab Rep. Published online Aug Author information Copyright and License information Disclaimer. Corresponding author. This article has been cited by other articles in PMC.
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