It’s official: I’m fat.
I came to this (not so startling) conclusion the other night as I refastened a button on one of my dress shirts for the third time in under an hour. My burgeoning belly had caused the recurring wardrobe malfunction—and sent me to a scale, where I confirmed my diagnosis: 200 pounds on this 5′7" frame.
Somewhere a statistician with a body mass index is tallying another obese American.
Seeing myself as overweight has never been something I’ve struggled with, even in college when I tipped the scales at 220. You see I was lifting weights and playing rugby, and on the field I was fast: Even though I played second line, I could have been a wing. I certainly wasn’t “fat.”
By the end of high school I weighed only 170 pounds, fit from two seasons of varsity soccer. Even just two years ago, at age 32, I was a thick-but-comfortable 175. Then I began taking insulin to manage my type 2 diabetes.
Research shows that type 2 diabetics who start insulin therapy typically gain weight, with most of the gain coming within the first three years. Now that I’ve admitted I’m fat, I would like to blame insulin too.
Of course, that’s the easy way out. The reality is more complicated. A 2001 study by French physicians suggested that insulin therapy alone does not cause weight gain. And it looked like common weight increase came from something similar to a yo-yo dieting effect.
Insulin is typically prescribed when other therapies (oral medications, diet, and exercise) are failing to control blood sugar. Such patients have often lost weight—a side effect of high blood sugar—during the period leading up to the insulin prescription. They gain it back (roughly 17 pounds on average in the study) in the first two years of insulin therapy.
While I understand the theory, it only explains part of my weight gain. True, my blood sugars had increased in the years leading up to my insulin prescription. But other factors had played a role in my waist size.
I worked out, often four times a week. I ran, lifted weights, and swam. I even tried pilates (a fact hard to explain to my rugby friends). My weight hovered consistently between 175 and 180.
Then a couple of things changed at around the time I began taking insulin: I started a new job and we had another child. The first put an end to my long lunchtime workouts; the second took away any other free time I had for exercise.
Managing diabetes requires constant coordination of therapy, diet, and exercise. If your meds aren’t working properly, your blood sugar rises. If you’re not eating right, your blood sugar rises. If you don’t have time to exercise, your blood sugar rises. Any change in one factor requires an adjustment in others.
I wish I could blame insulin, but it has been really helpful in keeping my blood sugar under control. Of the 25 pounds I’ve gained, insulin is probably to blame for only a couple. My inability to integrate exercise back into my life—or to compensate by reducing caloric consumption—has made up the rest.
The French study did include some good news: By the third year of drug therapy, weight gain usually levels out. And though I don’t attribute much of my increased mass to the drug, I am hopeful that this coming year—my third on insulin—I can regain some of the balance, and the healthy habits, I had before my diagnosis.
Vital Statistics:
Managing diabetes is all about the numbers: blood sugar (normal approximately 70 to 120), caloric intake, calories burned, etc. Here are some of this week’s highlights.
My average blood sugar: 150
This week’s high: 300
This week’s low: 90
Insulin (Lantus) intake for one week: 280 units (2.8 milliliters)
Co-pay for a one-month supply: $50
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