Does diabetes cause weight loss or gain?

In most cases, weight loss is high on the list of ways to prevent and manage diabetes. Losing weight may help improve cardiovascular health, reduce high blood pressure, regulate blood glucose levels, reverse insulin resistance, and more. Still, many individuals may experience weight changes due to diabetes. Although weight gain is commonly associated with Type 2 diabetes, weight loss is a potential symptom in cases of Type 1 or Type 2 diabetes. Fortunately, knowing how diabetes can cause weight loss, what to look for, and when to see a healthcare provider can go a long way in managing the disease and staying healthy.

Can diabetes cause weight loss? 

Yes, it can. Diabetes mellitus reduces the body’s production and/or its response to insulin. As one of your body’s essential hormones, insulin regulates blood sugar levels by helping the body transport glucose or blood sugar into the cells for energy. 

If there isn’t enough insulin or insulin is not working properly, your body may be forced to use muscle or body fat for energy instead, leading to weight loss. Most of the time, this weight loss is more likely to occur in cases of Type 1 diabetes, although Type 2 diabetes may cause unexplained weight loss too.

If you’re not diagnosed with diabetes but seeing consistent drops when standing on the scale, you may want to take note. This type of unexplained weight loss could be a sign of undiagnosed diabetes. Dramatic weight loss could also stem from other conditions, including thyroid issues, celiac disease, Crohn’s disease, and cancer. The only way to know for sure is to visit a healthcare provider.

Can diabetes cause weight gain? 

Yes, weight gain is possible with diabetes, particularly in the case of Type 2 diabetes. People with Type 2 diabetes may often experience an increased appetite due to insulin resistance, which occurs when your body’s cells are less responsive to insulin. When your body can’t use insulin properly, you might overeat and store more fat, especially around the stomach area. As a result, you might experience more weight gain over time.

Excessive weight is also one of the main risk factors for developing Type 2 diabetes in the first place. Carrying excess weight can contribute to insulin resistance and make it difficult for your body to regulate blood sugar, increasing the risk of diabetes. 

In addition, certain medications used to treat diabetes may cause weight gain. Insulin and sulfonylureas like Amaryl (glimepiride) and Glucotrol (glipizide) are examples of medications that may contribute to weight gain. These medications work by increasing insulin levels or helping your body respond better to insulin, but they can also lead to increased appetite or fat storage. 

Type 2 diabetes weight loss; how to lose weight safely

Even though people with diabetes can experience sudden, unexplained weight loss, this isn’t the most common outcome. It mainly occurs in Type 1 diabetes cases, which only comprise 5% to 10% of all diabetes cases. More often, it’s the opposite—losing weight is a struggle. 

While there’s no cure for Type 2 diabetes, sustained weight loss through dieting and physical activity may help reverse it. This doesn’t mean that diabetes is gone forever. It simply means that the disease is in remission and you’re maintaining healthy blood sugar levels, but symptoms could always return. 

The biggest question is: what’s the best, safest way to lose weight if you have diabetes? There are plenty of fad diets that aren’t healthy. Sure, consuming nothing but carrot juice for a week will probably help you lose extra weight, but it’s probably not the healthiest option in the long run. It’s often better to eat a well-rounded diet, manage portions, and exercise regularly. Here are some diabetes weight loss options that might be effective:

Low-calorie diet 

This is a time-tested weight loss approach. A calorie deficit day after day will lead to weight loss. Typically, this limits calorie intake to 1,200 to 1,600 a day for men and 1,000 to 1,200 a day for women. But it’s also about eating the right calories—a balanced diet with enough vegetables, fruits, protein, and carbohydrates. A study from the U.K. showed that 45.6% of people with Type 2 diabetes who participated in a low-calorie weight management program achieved remission within one year.

Very low-calorie diet (VLCD)

VLCDs are a relatively recent trend restricting total daily calories to less than 800. It’s difficult, but in a 2019 study, diabetes patients on a 600-calorie per day VLCD experienced a rapid improvement in blood sugar in just two weeks, and 79% achieved remission in eight to 12 weeks. 

Avoiding certain foods 

Healthcare providers and dietitians might recommend drastically reducing or cutting out processed grains, full-fat dairy products, foods high in saturated or trans fats, and foods with added sugar or sweeteners. These foods can cause spikes in blood sugar and increase caloric intake. 

That said, diabetes “can wreak havoc on one’s relationship with food,” says Moskovitz. “It is not uncommon to develop disordered eating patterns or even eating disorders after diagnosis. For that reason, a personalized, flexible, and inclusive approach that fits the individual’s needs and lifestyle is paramount for long-term success.”

She recommends “a low glycemic diet with plenty of plant-based and fiber-rich foods, lean proteins, and anti-inflammatory fats, [which] is the best treatment to regulate hemoglobin A1C, the average blood sugar over the course of three months.” She says that people with diabetes should avoid or consume alcohol and caffeine in moderation (since they can both impact blood sugar levels) and eat balanced meals or snacks consisting of fiber, protein, and fat every three to five hours throughout the day.

Portion control 

This one is pretty self-explanatory. Overeating can lead to weight gain, which is detrimental to diabetes care. Portion control might involve using smaller plates or bowls to reduce serving sizes or measuring the amount of food through various techniques. To help keep patients on track, dietitians will often create a balanced meal plan to manage sugar and overall caloric intake while teaching healthy eating habits.

Regular exercise

Regular exercise is a cornerstone in managing diabetes, often providing benefits that extend beyond just weight control. Exercise can lower blood sugar and increase insulin sensitivity for up to 24 hours after a workout. However, this depends on the workout’s intensity and duration, according to the American Diabetes Association (ADA). Healthcare providers might recommend an exercise routine with a meal plan when treating diabetes. 

For those looking to manage their blood sugar effectively, the ADA generally recommends at least 150 minutes of moderate-intensity aerobic exercise per week. That might include activities like brisk walking, swimming, or cycling. In addition to aerobic exercise, resistance training, such as weightlifting or yoga, twice a week may be beneficial. These activities can help with blood sugar control and build muscle mass, which may further improve insulin sensitivity.

Medications

While certain anti-diabetic medications, like insulin and sulfonylureas, may cause weight gain, others may cause weight loss. These medications include metformin, GLP-1 agonists such as Victoza (liraglutide) and Byetta (exenatide), and SGLT2 inhibitors like Jardiance (empagliflozin) and Farxiga (dapagliflozin) are often associated with weight loss or have a neutral effect on weight. These medications may work in different ways, such as improving insulin sensitivity, reducing hunger, or causing the kidneys to excrete more sugar from the body.

What about low-carb diets?

Low-carb and zero-carb diets have been hot for the past several years. Thousands of people have jumped on (and sometimes off) the Atkins Diet and keto diet bandwagons. Some people swear by them, even though certain studies have shown the long-term hazards of cutting out an entire macronutrient.

When it comes to diabetes, “carbohydrate counting can also make weight loss easier and more effective,” says Moskovitz. But while carb counting is often helpful, eliminating carbs isn’t always the best long-term option. It’s more about eating the right healthy carbohydrates in the right amounts. Refined, enriched carbs like white bread, baked goods, and sugars can cause quick spikes in blood glucose. Complex carbs and fibers from whole grains, fruits, and vegetables take longer to break down and don’t provide the same kind of spike. 

When to see a healthcare provider

Sometimes, body weight can fluctuate naturally, but when should someone be concerned? The general consensus is that an unintentional 5% decrease in body weight (or more) over six to 12 months is abnormal. “Sudden weight loss can be a sign of rising or uncontrolled blood glucose levels,” says Lisa Moskovitz, RD, the CEO of NY Nutrition Group. “Whether or not you’re intentionally losing weight, any loss greater than two to three pounds per week should be reported to your healthcare provider.”

On the flip side, obesity is a significant risk factor for Type 2 diabetes. People with a body mass index (BMI) of or over 25 often have a higher level of insulin resistance, potentially leading to Type 2 diabetes. Not every case of excess weight or obesity leads to diabetes, but it certainly increases the chances of developing it. On top of that, obesity may worsen diabetes symptoms for anyone who already has it. 

For this reason, healthcare providers and dietitians will often develop diets or weight loss programs for patients with diabetes or prediabetes. These programs often include meal plans and physical activity routines that help an individual achieve and maintain a healthy weight, reducing the risk or severity of Type 2 diabetes. Typically, a weight management program involves analyzing current eating or exercise habits and laying out practical lifestyle changes to help achieve personal weight loss goals.

Frequently asked questions about diabetes and weight loss

Does insulin make you gain weight?

The use of insulin may lead to weight gain. Insulin is a hormone that helps manage blood sugar by allowing it to enter cells and be used for energy. However, any excess glucose in the blood can be stored as fat while using insulin, especially when consuming more calories than burning. Some people also experience increased appetite when they start insulin therapy, which can further promote weight gain.

How to lose weight as a diabetic

Losing weight when you have diabetes involves a balanced strategy that includes dietary changes, regular exercise, and possible changes to your diabetes medication. A healthy diet rich in vegetables, lean protein, and whole grains may help control your blood sugar while allowing you to shed pounds. Exercise can help improve insulin sensitivity and help you burn calories. Always consult your doctor or healthcare provider for a personalized plan, which may include changing your medication if it’s contributing to weight gain.

How to stop diabetes weight loss

Unintended weight loss can be a concern, especially in Type 1 diabetes or severe cases of Type 2 diabetes. If you experience significant weight loss with diabetes, you may want to consult a healthcare provider about your concerns. Sometimes, you may need medication adjustments or a personalized meal plan that helps you safely maintain or gain weight. Regularly monitoring your blood sugar levels can also help you track how well your treatment plan works.

How can weight loss be beneficial for managing diabetes?

Weight loss can have multiple benefits for diabetes management. Losing a moderate amount of weight—around 5% to 10% of your body weight—may help improve blood sugar control, blood pressure, and cholesterol levels. Weight loss may also help improve the body’s ability to use insulin, which can regulate blood sugar levels and make it easier to manage diabetes.

Can losing weight prevent or delay the onset of diabetes?

Excess weight, especially around the abdomen, is a major risk factor for developing insulin resistance, which can lead to Type 2 diabetes. Therefore, weight loss can be a significant factor in preventing or delaying the onset of Type 2 diabetes. Numerous studies show that lifestyle changes, including regular exercise and modest weight loss, can reduce the risk of developing diabetes by up to 58% in high-risk individuals.

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