Ask the experts
I have a friend that is 35 and
has diabetes. For the past eight
years, his weight has always been in check and if anything he may have been
a little overweight. Just recently, he has lost a lot of weight and he told
me that he weighs less than he did in high school. I think he looks too
thin and I am concerned about his health with him being a diabetic. Should
there be a concern and what kind of advice can you give me to pass on to
We often assume weight loss is
good and healthy. A slow steady intentional weight loss using
and exercise is associated with beneficial effects on the heart,
and cholesterol levels. In addition, weight loss can reduce
“insulin resistance” and make
muscles and fat tissues more sensitive to circulating insulin levels in the blood.
What type of diabetes causes weight loss?
A reduction in insulin resistance is problematic because insulin is needed to
help glucose enter these tissues to be metabolized. If these tissues are
resistant to insulin, higher than normal levels are needed for this process
to occur. This is often the case in
Type 2 diabetes. As a result, a vicious
cycle occurs, the higher the insulin levels are, the harder it is to lose
weight (insulin is anabolic, and is a hormone that likes to store fat). On
the other hand, the heavier a person is, the more likely they are to have
higher insulin levels.
As you can see, the cycle is often hard to break.
What causes unintentional weight loss in diabetes?
While intentional weight loss in people with diabetes is usually a good
thing, unintentional weight loss is not. If blood sugars are very high,
patients with diabetes tend to urinate a lot, and this results in
dehydration as a possible cause of weight loss.
Also, muscle breakdown can
occur if sugars are too high, causing an unhealthy weight loss. Actually,
many patients with diabetes present for the first time to their doctor’s
office because of unexplained loss of weight. In addition to diabetes, there
are other concerning causes of unexpected weight loss which should be
explored such as thyroid disease and cancers.
In summary, a supervised attempt to lose weight in people who can exercise
without risk is usually of benefit. However in certain cases such as if
blood sugars are too high or too low or if heart disease is present, it can
be dangerous. This is why all exercise and weight loss programs should be
started only after discussion with a physician. Any unexplained weight loss,
in patients with or without known diabetes may be a sign of high blood
sugars or another serious illness. It is absolutely necessary to see a
physician and undergo a complete evaluation in these cases.
Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care
Fauci, Anthony S., et al. Harrison’s Principles of Internal Medicine. 17th ed. United States: McGraw-Hill Professional, 2008.
Last Editorial Review: 6/6/2017