Metabolism, Thyroid Could Be To Blame

Q. A few years ago, I was diagnosed as a diabetic and placed on Glucotrol. Even though I try to watch my weight, I seem to be losing the battle. I’ve heard that medication for diabetes causes people to gain weight. Is that true? That seemed to happen to me. -D.D., Boston

A. It sure is easy to gain weight, and it sure is tough to lose it! Yes, those drugs we use to treat diabetes do have a tendency to cause weight gain. But let’s not forget that there are other reasons why we can gain weight.

As we get older, our metabolisms slow down so we don’t burn out at a tender age. A gradual slowing of the metabolism means that we don’t burn calories from food we ingest nearly as rapidly as in years past. Excess calories get stored as fat. That means that we need to cut back on the overall calories we eat each day. And those desserts and extra helpings sure are tempting.

Exercise, the aerobic kind that gets our heart rate up, can help cause temporary and brief increases in the metabolism to burn those excess calories. Of course, exercising several times a week takes time, and some people are either too busy from work and home demands, physically unable or just plain unmotivated to exercise.

Some folks may do everything right and still find it impossible to lose weight. Those folks likely inherited a genetic tendency towards obesity.

While medication treatment for diabetes makes it difficult to lose weight, let’s make sure that there’s not a sluggish underactive thyroid condition. A TSH blood test can check one’s thyroid function.

The weight gain from using Glucotrol is due to the fact that Glucotrol lowers blood sugar by pushing the pancreas to squeeze out even more insulin into the circulation.

You see, the insulin molecule is the culprit in the diabetic weight gain mystery. The insulin molecule does more than just lower blood sugar. It encourages the formation and storage of fat in the body; it encourages the storage of protein in the body derived from foods we eat; it inhibits the breakdown of fats and proteins for energy; and it works to enhance the activity of growth hormone.

So taking insulin shots will likely cause weight gain, but so does any diabetic pill that works by pushing the pancreas to make more insulin.

The new approach in “adult-onset” diabetes has therefore been to try to increase the body’s sensitivity to insulin. Instead of putting more insulin into the circulation, why not get the body to become more sensitive to all that insulin that’s already out there?

The first step in that effort is weight loss through diet and exercise. As little as 5-10 pounds of weight loss can make the body a whole lot more sensitive to all the insulin that’s floating around. That’ll lower blood sugar.

If drugs are needed, it may be first worth trying a drug such as Glucophage. It works by getting the body to use the insulin that it already has rather than getting the body to make more. Avandia and Actos also work in a similar way, but they do cause a slight degree of weight gain. Drugs like Glucotrol or Micronase do a great job of lowering blood sugar, but be prepared to gain a few pounds as a result of their mechanism of action.

Using Glucotrol or Micronase as first-line drugs, or waiting until Glucophage and Avandia/Actos have been tried and are doing all they can do to lower blood sugar, is a decision your doctor will make. But at least you’ll now know that weight gain with diabetic treatment isn’t just a coincidence.