If you have type 2 diabetes and are overweight, treating the excess weight is a key part of your comprehensive diabetes management.
If a person with type 2 diabetes is overweight, the management of it is an essential part of the diabetes therapy as a whole. The objective of obesity treatment is to find a good way to eat and exercise that suits your lifestyle and helps with sustainable weight control. Your reserves of mental strength and a life situation which enables you to make changes must also be taken into consideration.
You should think about your weight history and previous experiences of attempting to lose weight. Together, you can draw up a realistic target weight and schedule for achieving it. It is also important to plan a way to avoid regaining weight after losing it.
Normalising blood sugar, i.e. remission
A person who has been recently diagnosed with type 2 diabetes should strive to normalise their blood sugar levels, i.e. diabetes remission, through efficient lifestyle management. Recent studies have shown that nearly half of the people with type 2 diabetes for less than 5 years who reduced their weight by approximately 10% were able to maintain a normal blood sugar level without drug therapy over a two-year monitoring period.
A very low-energy diet or VLED is an effective way to lose weight and correct your blood sugar level in type 2 diabetes, if lifestyle management alone is not enough. The diet can be implemented using diet products or, with the guidance of a nutritional therapist, by eating normally.
As it is easy to regain weight after the VLED period, permanent lifestyle changes are crucial. Correctly implemented and overseen by a doctor, the VLED diet is safe for type 2 diabetes. Your doctor can instruct you on when to reduce or pause the medication during the VLED period.
If the BMI of the person with type 2 diabetes is ≥ 27 kg/m2, an obesity drug can be used in parallel with lifestyle management. The medications available for obesity drug therapy include orlistat as well as the prescription products naltrexone-bupropion and liraglutide injections. The goal of drug therapy is a significant weight loss of at least 5% over a 3-month period.
Bariatric surgery may be considered on a case-by-case basis for a person with type 2 diabetes under the age of 65 whose BMI is ≥ 35 kg/m2, or if it has not been otherwise possible to correct the sugar balance and the BMI is ≥ 30 kg/m2. Following the surgery, the diabetes medication will be reduced or stopped entirely. The need for blood pressure medication is also often reduced.
The medication for type 2 diabetes is selected from the viewpoint of supporting weight control. Current pharmaceutical products in themselves do not drop blood sugar too low, which means that the quantity of food does not need to be increased after the start of drug therapy. Rather, the quantity of food should be reduced after the start of medication to enable weight control once the secretion of sugar to urine has been remedied. SGLT2 inhibitors increase urinary glucose excretion, as a result of which you may initially lose several kg at the start of medication.
If lifestyle management or tablet medication are not successful in lowering the blood pressure to the target level, injection therapy may be considered. For an overweight person who does not have insulin-deficiency, the primary injection therapy includes the GLP-1 intestinal hormone products. They slow down the evacuation of the stomach, reduce appetite and increase weight loss.
Correctly dosed insulin in itself does not make you fat. At the start of insulin therapy and when the blood sugar level is corrected, weight can easily go up to correct the loss of glucose and energy into urine. This is why person needs to eat less when starting insulin therapy. The basal insulin dose is adjusted in such a way that it does not result in low blood sugar or force to snack. For many, a combination of basal insulin therapy and GLP-1 products works well.
Large insulin doses make it hard to control weight because they may increase appetite and lead to blood sugar dropping too low.
