So there I was, at the endocrinologist’s office, having been told I definitely had Type 1 diabetes (not that I believed it) and that I possibly also had Type 2 diabetes. Thinking, basically, it couldn’t get any worse.
And then I heard the four words that every overweight person fears most.
“Let’s check your weight,” she said.
Did you know that when doctors weigh you, believe it or not, their goal is not actually to humiliate you? As an overweight person, I figured every time I was weighed at the doctor’s office was simply my doctor taking another opportunity to remind me that, in the “weight department”, I had failed. Utterly.
In fact, I have since learned that the primary reason doctors weigh you is to detect sudden (sudden) extreme (extreme) changes in your weight that could indicate something malicious is going on in your body. Say, DKA. To a certain extent, your actual weight is secondary to the pattern in your weight your doctor is trying to observe. In many cases, they are primarily looking at the trends – have you lost, say, 29 pounds in a few short weeks? PERHAPS YOU ARE IN DKA.
When I was admitted to the hospital, my weight was an astounding (for me) 182.
Less than a week later, in Dr. M’s office, I weighed in at 187.
Here we go again: that wave of self-loathing. I had only been a diabetic for six days and already I was failing, I was fucking failing, about as tremendously as a person could fail. Where did those 5 pounds even come from? I had been eating diligently, so diligently! In an attempt to obtain a reasonable blood sugar number, I had avoided almost everything that my diet-obsessed brain knew to be “bad”. My “diet” had gotten pretty damn clean, pretty sparse. I just wanted to see a blood sugar number that started with a 1 instead of a 2. And if avoiding pizza meant that could happen faster, that was a fair trade off for me.
That weekend, eating had stopped being pleasure, fun at all. It was a means to an end. So to have, on top of all this bullshit, gained five pounds from my new, joyless diet, was abominable. And now, like every time I weighed in at a doctor’s office and showed a “bad” number, I was going to have to explain myself, to come up with some excuse as to how this could have happened.
“How much did you weigh when you were admitted to the hospital?” she asked.
“182,” I answered, wanting to cry, just wanting to cry.
She looked at the 187. “Oh,” she said. “Good.”
I’m sorry, ‘good’? Dr. M, I am obese. How is gaining 5 pounds in 5 days “good”?
How patient she was with me, in those first few weeks, few months (still is, in fact). Calmly and thoroughly, she began explaining that I was recovering from major bodily trauma (DKA). As I had come to know, weight loss was a frightening side effect of DKA, and the fact that it had stopped was a reason to rejoice. My body was, quite literally, behaving like a body again. It was working. She went on to explain that much of the weight loss I had seen, especially towards then end when things were really bad, was no more than “tissue shrinkage”; to have gained weight, at this point, meant my “tissues” were recovering. It was cause for celebration. It meant I was getting healthier.
What was this strange new world, where I had type 1 diabetes, where weight gain was good? It seemed like everything I knew was being challenged.
I wish I could tell you that this moment marked a sudden shift in my beliefs and convictions – that, with this “weight gain good” revelation, 26 years of hard wired understanding of obesity and self worth were erased. But of course, nothing is ever that easy or simple.
In fact, learning that I was probably going to gain back all the weight, every single pound, that I had lost in DKA, felt like the ultimate violation, the ultimate “fuck you” from this awful disease that had suddenly taken a hold of me. If I had to be a diabetic, I at least wanted to get something out of it. 29 pounds, frankly, seemed the least that diabetes could do for me.
Plus, there was my absolute petrification when it came to insulin. I had already googled “side effects” of insulin, and read horror – absolute horror – stories about weight gain on insulin. Go ahead: do it now. Google “Insulin and weight gain.” I just did, and came up with approximately ten million, four hundred thousand results.
In the first few days after discharge, with nothing to do but fret and freak, I had lost myself in the rabbit hole of internet research about going on insulin and gaining weight. Here’s my favorite phrase, from the mayo clinic website: “Insulin and weight gain go hand in hand.” Cute. Fuck you, Mayo Clinic.
Here’s another one, from a scientific paper published in 2007: “Insulin therapy or intensification of insulin therapy commonly results in weight gain in both type 1 and type 2 diabetes. This weight gain can be excessive, adversely affecting cardiovascular risk profile.”
As I’ve mentioned before, many people who get diagnosed with Type 2 diabetes don’t have to go on insulin right away. Often, other meds (like metformin – a side of which can actually be weight loss) can do the trick, for a while at least. The typical Type 2 diabetic heavily resists going on insulin – often because they have heard horror stories about weight gain, and sometimes also because of the stigma associated with going on insulin as implying you’ve “failed” at diabetes.
Type 1 diabetics, of course, have no choice. It’s insulin or death.
Here’s a few delightful postings from message boards that I discovered about weight gain on insulin.
“Insulin has definitely caused me to gain weight since I started taking it a few years ago!”
“I gained 10 pounds in a week on insulin”
“When I started on insulin I gained over 30 lbs… I switched insulins and gained another 30 lbs”
“Frustrated beyond belief. 374 pounds, eating 1400 calories a day, exercising daily and have GAINED 20 pounds in the last 45 days since starting on insulin”
“Gained 100 pounds in 10 years on insulin”
“I gained 20 pounds within 10 days of starting Lantus and Novolog!”
“CRAZY weight gain after starting insulin. HELP!!!!”
It looked pretty bleak. So, why does this phenomenon occur??
DIABETES 104: INSULIN AND WEIGHT GAIN
There’s a few theories. One is that most people who need to go on insulin, like me, have spent the weeks leading up to it losing weight, and the weight gain is just a result of their bodies adjusting to having better glycemic control. Essentially, you’re no longer peeing out all the calories you eat.
Another theory is that man-made insulin is actually a bit more powerful than the insulin our (well, your) bodies make. It is more efficient at processing calories. Essentially, you use them (calories) so efficiently when on insulin that you actually don’t need as many anymore. But you don’t know that, so if you keep eating “normally” you’re suddenly overeating for your body without realizing it.
Another thought has to do with hypoglycemia. I’ll get into that later, but hypoglycemia is, essentially, low blood sugar – when a diabetics’ blood sugar drops below the coveted 70, which can happen if you take too much insulin. There is only one way to “get out of” hypoglycemia – eating glucose. That is, carbohydrates. Since hypoglycemia is bad, you want to get out of it fast – with fast acting carbs. Like juice, simple sugars. So if you have a lot of low blood sugar episodes, you’ll have to take in a lot of extra calories to “treat” that low blood sugar – so you start gaining weight from all the “treatment” calories you have to eat.
(Never seemed to have happened to stupid Stacey from the Babysitter’s Club. Of course, she was, you know, fictional….)
My research from the first weekend had proved to me that weight gain and insulin was very real, and very terrifying. And I literally had no choice in the matter: it was insulin or death. No matter how I tried to spin it in my head, the research was depressing – depressing as fuck. It seemed that, now that I was on insulin, I could look forward to the threat of weight gain for the rest of my life. AND I WAS NOT EXACTLY A PERSON WHO HAD BEEN ABLE TO AVOID WEIGHT GAIN SO FAR.
Being a young overweight woman sucks. It sucks for a lot of reasons, but for me, a major one was hearing about how much *harder* weight loss was going to get as life progressed.
“The older you get,” they’d say, “the harder weight loss is!”
“Try losing weight once you have kids!”
“Or how about losing weight after menopause??!”
Well shit, I’d think. I’m young. I probably have the “fastest” metabolism I’ll ever have in my life. I don’t have kids or menopause impeding my weight loss efforts and yet IM STILL FAT. If I couldn’t manage to lose weight when I was most metabolically disposed to do it, God knows what I was going to look like 20, 30, 50 years from now.
I must really, really suck at this.
What was going to happen when one of those fabled weight loss impeders – age, menopause, kids – got in the way?
And now I had to go on insulin. Which, according to the internet, made age/menopause/kids look like child’s play. It was paralyzing.
And on top of all that, I was now being told that every single one of the 29 pounds I lost while in DKA would probably be reversed. And quickly. And somehow, this would be “a good thing.”
It was the ultimate insult to injury.
I didn’t even get to keep any of the 29 pounds I’d lost?? Are you fucking kidding me?? It seemed the decks were stacked against me: I would gain all the DKA weight back, then, I’d be on insulin, so I’d keep gaining, and then I’d be type “Both” for sure, and I’d be like a zillion pounds and absolutely, entirely fucked.
So no, the revelation that weight gain was good did not suddenly and dramatically change everything I ever knew and thought about weight and body image. As much as that would have made for good reading, the primary emotions that I felt at that moment were horror and indignation.
But I had heard her. The words had sunk in, whether or not their message had. This whole “weigh less be skinny feel better” model that I had been aspiring to for 26 years hadn’t crumbled – by no means had it crumbled – but it was slowly being challenged by other models – ones which involved health, not appearance, taking centerstage. In the long run, it probably would be better for me to weigh 182 pounds and be a diabetic than weigh 187 pounds and be a diabetic, but in that moment, 187 was a hell of a lot safer and healthier of a weight to be.
I walked out of Dr. M’s office, still pissed, still scared, but with a whole lot more knowledge on my side than I’d walked in with. Two days later, I turned 27, and got to face an age where all I’d ever been was a diabetic. Not to end on the ultimate cliché, but it was a brand new world, one in which I was, slowly, ever so slowly, being reeducated.