Unexplained weight loss is a common problem for people with diabetes. When you have diabetes, your body cannot properly use and store glucose, which can cause weight fluctuations. Weight loss occurs when your body breaks down fat and muscle for energy, because it cannot get enough energy from the food you eat. While some weight loss may be normal, losing a significant amount of weight without trying can be a sign of uncontrolled diabetes or an underlying health condition. The good news is that there are steps you can take to maintain and gain back a healthy weight if you have diabetes.
Why do diabetics lose weight?
There are a few reasons why uncontrolled diabetes can lead to weight loss:
Your body breaks down fat and muscle
Without enough insulin, your cells cannot access blood sugar for energy. So your body starts breaking down fat stores and muscle tissue instead. This causes weight loss, but it’s not healthy or sustainable long-term.
Excess glucose is excreted
When you have more glucose in your blood than your cells can use, the excess sugar gets excreted through your urine. This causes calories to be lost from your body.
Dehydration
Frequent urination due to high blood sugar levels can lead to dehydration. This fluid loss shows up on the scale as weight loss.
Loss of appetite
Over time, poorly controlled diabetes may reduce your appetite as your body struggles to use energy properly. Eating less food means you take in fewer calories, leading to weight loss.
When is weight loss a concern?
Mild weight fluctuations are normal, but losing a significant amount of weight without trying is a red flag. Contact your doctor if you lose:
- 5% of your body weight in 1 month
- 10% of your body weight in 6 months
This much weight loss, especially without dietary changes or increased exercise, could signify uncontrolled diabetes or another medical issue.
Medical causes of weight loss
In some cases, diabetes-related weight loss is a symptom of another health problem. Medical causes can include:
Diabetic ketoacidosis (DKA)
DKA is a serious complication of diabetes caused by severely high blood sugar. It occurs when your body starts breaking down fat rapidly for fuel, causing a buildup of acids called ketones. Ketoacidosis can cause nausea, vomiting, fatigue and weight loss.
Gastroparesis
This nerve damage in the stomach delays digestion, causing nausea, appetite loss and weight loss. It’s more common in those with type 1 diabetes.
Celiac disease
An inability to absorb nutrients from food can lead to malnutrition and weight loss. People with type 1 diabetes have a higher risk of this digestive disorder.
Cancer
Unexplained weight loss can sometimes be an early sign of cancers like pancreatic, stomach or lung cancer. But there are many other possible causes besides cancer.
Hyperthyroidism
An overactive thyroid gland speeds up metabolism and can cause muscle wasting and weight loss. Hyperthyroidism is more common in people with type 1 diabetes.
Chronic infections
Ongoing infections that your body is fighting, especially in people with high blood sugar, can increase metabolism and cause weight loss.
When to see a doctor
Contact your doctor if you notice you are losing weight without trying. Especially seek medical care if you are experiencing:
- Fatigue
- Excessive thirst or urination
- Nausea, vomiting or abdominal pain
- Labored breathing
- Chest pain
- Confusion
These may be signs of uncontrolled diabetes or a serious condition like diabetic ketoacidosis. Early treatment can help prevent complications.
Your doctor will try to determine if your weight loss is due to your diabetes treatment plan or another medical cause. They may order blood tests or other diagnostic tests to check your overall health.
How to stop losing weight with diabetes
Once any underlying condition is treated, focus on diabetes management strategies to help gain back a healthy weight:
Improve blood sugar control
Work with your doctor to keep your blood sugar levels as close to normal as possible with medications, meal planning and physical activity. This helps ensure your body can use glucose properly for energy.
Eat more nutrient-dense calories
Choose high-protein foods like eggs, dairy, beans and meat to help you gain muscle. Add healthy fats like nuts, seeds, avocados and olive oil to stop body fat breakdown. Complex carbs such as whole grains can also help.
Eat smaller meals more frequently
Eating smaller meals every 3-4 hours can keep your blood sugar steady. This helps control hunger and prevents overeating at main meals.
| Time | Meal/Snack |
|---|---|
| 7 AM | Egg & veggie scramble |
| 10 AM | Cottage cheese and fruit |
| 1 PM | Tuna salad sandwich |
| 4 PM | Hummus & veggie sticks |
| 7 PM | Chicken stir fry |
Stay hydrated
Drink water and other fluids to replace losses from increased urination. Dehydration can suppress appetite further.
Lower your blood sugar before meals
Check your blood sugar before eating, especially if taking insulin at mealtimes. Correct high blood sugar with an extra dose of medication so your body can utilize food properly.
Exercise regularly
Aerobic activity and strength training helps stabilize blood sugar and build muscle mass. But check with your doctor first to ensure activity is safe for you.
Consider insulin therapy
Some people with type 2 diabetes require insulin to keep blood sugar levels under control, allowing for proper nutrient absorption.
Treat digestive issues
See a gastroenterologist to treat conditions like celiac disease or gastroparesis that affect nutrition.
Try nutritional supplements
Ask your doctor about supplements to support weight gain if food intake is inadequate, such as high-calorie shakes or whey protein.
Consider appetite stimulants
Medications like megestrol can improve appetite in some cases, but have side effects. Discuss the pros and cons with your doctor.
Treat infections
Promptly seek treatment for any infections or illnesses, as fighting infections can lead to weight loss.
Consider therapy
Depression and food anxiety are common in people with diabetes. Therapy may help improve your relationship with food.
Set a goal weight and make a plan
Work with a dietitian or diabetes educator to:
- Determine a healthy weight goal for your age, sex and height
- Create meal and snack plans to meet your nutrition needs
- Make appropriate adjustments to your diabetes medications
- Incorporate regular physical activity
They can also help monitor your progress through follow-up appointments. Aim to lose no more than 1-2 pounds per week on a weight gain plan to avoid excess body fat.
When weight gain stalls
Plateaus are normal during weight gain. If progress stalls for a few weeks, reassess your plan with your healthcare team. Some strategies to boost weight gain include:
- Increasing calorie intake by 100 per day
- Adding nut butters, avocado and olive oil to meals
- Drinking more milk, smoothies or shakes
- Starting each meal with a protein like eggs or Greek yogurt
- Strength training to build muscle
Keep focusing on consistency with your eating plan and diabetes management. Avoid cutting calories or increasing activity without medical guidance.
Prevent future unintended weight loss
Once you regain a healthy weight, be vigilant about preventing additional weight loss by:
- Checking your blood sugar regularly
- Taking diabetes medications as prescribed
- Monitoring for signs of infection or illness
- Communicating with your healthcare team
- Continuing healthy eating and exercise habits
Consistent diabetes self-care can help you maintain your weight long-term.
When to seek medical advice
Check with your doctor if:
- You lose 5-10% of your body weight in a month or less
- You lose your appetite or start feeling full quickly
- You experience nausea, vomiting or diarrhea frequently
- Your blood sugar is often over 300 mg/dL
- You feel fatigued, confused or ill
Unexplained weight loss with diabetes can signify an underlying health issue, so don’t hesitate to seek medical advice. Ongoing care from your diabetes healthcare team is key to staying healthy.
The takeaway
Left unchecked, diabetes can cause weight loss due to your body breaking down fat and muscle for energy. But you can take steps to maintain and restore a healthy weight by improving blood sugar control, adjusting your diet, staying active and addressing any underlying issues. Work closely with your medical team and be consistent with your diabetes management plan. With the right changes, it is possible to stabilize your weight, prevent complications and feel your best.