Dangerous Weight Loss Programs for Diabetics

A few days ago I was concluding a visit with a patient with thyroid disease, while her diabetic
husband, also my patient, looked on. They are a pleasant older couple I have known for
years, who are devotedly helping each other stay healthy. As they were leaving the exam room the
wife apologetically turned the subject to her husband mentioning he was having almost
daily “episodes” of weakness and confusion. “I hadn’t changed his diabetic medication recently
so why should his blood sugar be an problem now”, I thought. A number of other unpleasant
possibilities immediately occurred to me. I inquired about signs of a possible stroke or heart
condition. If these other angles were unproductive I faced the choice of sending him to the
hospital for an evaluation. We quickly ran through a routine systems review. He had lost 10
lbs in the past month, the wife mentioned. “Oh, no, cancer” , was my first thought. His wife
explained that as a New Year’s resolution he enrolled in a commercial weight loss program for
diabetics. With relief, I knew we had the explanation of his disturbing new symptoms.

Most of my diabetic patients are on medication since they are unable to maintain good glucose
control with diet and exercise only. If they succeed however, in achieving weight loss then the
diabetes medication must be reduced to prevent undesirable hypoglycemia (low blood sugar).
Hypoglycemia is potentially dangerous because the brain cannot function properly resulting in
abnormal behavior, loss of muscle control and even unconsciousness. Imagine this occurring
while behind the wheel? Down here in Florida this is all too common.

Many commercial weight loss programs have started targeting Type 2 diabetics (adult onset)
with their TV ads. These programs are generally administered by people without any medical
background. They cannot advise medication changes (not that you would want them to) without
breaking the law by practicing medicine without a license. The result, as with my patient, is the
development of potentially serious complications of hypoglycemia.

In a previous blog http://www.metabolism.com/2010/10/17/injured-diabetic-diet , I worried that this type of problem could develop with commercial weight loss programs. I didn’t expect to see evidence of it so soon and in my own exam room. If my patient’s wife didn’t stop and mention his new symptoms at the last moment
that day, I imagine a far worse outcome for her husband was possible.

Gary Pepper, M.D.
Editor-in-Chief, metabolism.com

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  • Tae Moon

    Hello. I have no doubt that diabetics who are exercising and who do not check their blood sugar levels often will get into trouble because the exercise will lower the sugar in their blood, this is obvious. This is a lack of sugar management, to criticize people from exercising or trying a diet should not itself be looked down upon, especially from a doctor of medicine. Since diabetes medication itself does not cure and only manages, do you not want those that want to “get off” the medication a way to go about doing so? Why do you want to want patients to constantly take management pills instead of trying to cure the underlying problem, obesity and poor food habits by eating correctly and exercise? Why not also teach diabetics how to manage blood sugar and utilize the doctor instead of “see you in three months?” type of “standard” office visit. This to me is more the crime these days. Doctors do not expect diabetics to take control of their lives and this is not acceptable. Prevention is key and to wait for people to get sick or ill is simply lazy.

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    I think lemonade diet is also not suitable for diabetics. you need to consult an expert before starting any weight loss program