How does your weight play a role in type 1 diabetes? Health experts used to think that people with type 1 diabetes were generally thinner — however, new research shows that higher body weights may be more common than previously thought among people with type 1 diabetes.

In this article, we’ll cover how obesity is defined and explore how it’s connected to type 1 diabetes. To learn more, talk to your doctor or your child’s pediatrician.

What Is Obesity?

Doctors use a scale called the body mass index (BMI) to diagnose people with obesity. BMI takes into consideration your height (in square meters) and weight (in kilograms). A BMI score is considered healthy if it falls between 18.5 and 24.9 kilograms per square meter. A person is diagnosed with obesity if their BMI score is 30 kilograms per square meter or higher.

Having a BMI score in the obese range has been associated with an increased risk of many health conditions, including:

• Type 2 diabetes
• Hypertension (high blood pressure) and high cholesterol
• Bone health problems
• Certain cancers, like breast, colon, and liver cancers
• Lung problems, including asthma

What Causes Obesity?

In many cases, a person’s body weight is influenced by multiple causes. Many people think personal lifestyle choices are obesity’s root cause. These choices can include eating a diet with too many added sugars and processed foods and not enough whole grains, vegetables, and fruits. A lack of exercise can also contribute to body weight.

However, many other factors can influence a person’s body size:

• Genetics, especially if higher body weights run in your family
• Certain medications that cause weight gain
• Health conditions that lead to weight gain or make physical activity difficult
• Long-term stress, which affects hormones and appetite
• A lack of good sleep, which also impacts hormones and appetite
• No access to healthy foods or ways to cook them
• A home environment without safe, walkable areas to exercise or play

Is There a Connection Between Obesity and Type 1 Diabetes?

New research shows there’s more of a connection between obesity and type 1 diabetes than previously thought. One study of 4,060 people with type 1 diabetes found that obesity rates among people with the condition have increased in recent years. The authors noted that 32.6 percent of study participants with type 1 diabetes had obesity in 2004 — this number increased to 36.8 percent in 2018.

Type 1 Diabetes Treatments May Contribute to Weight Gain

People with type 1 diabetes need insulin therapy to control their blood glucose (sugar) levels. Insulin helps move sugar from your blood to your cells for fuel. People with type 1 diabetes do not have enough insulin, and this means the food they eat cannot be easily used for energy. This will cause the breakdown of body fat, which is why some people have lower body weights when they are first diagnosed with type 1 diabetes.

Starting insulin therapy, which helps the body begin to use food for energy, may cause some weight gain.

Type 1 diabetes can also cause hypoglycemia (extremely low blood glucose levels). When your blood sugar drops, your body tells your brain to eat more food. It especially craves carbohydrates with plenty of glucose. If your blood sugar levels drop regularly, you may be eating more carb-heavy snacks. This can contribute to weight gain over time.

Researchers Are Still Learning Whether Obesity Raises the Risk of Type 1 Diabetes

Researchers aren’t sure whether having a BMI score in the obese range raises the risk of developing type 1 diabetes. Type 1 diabetes is an autoimmune disease — meaning the immune system attacks the pancreas. A damaged pancreas can’t make enough insulin, a hormone needed to control blood glucose levels.

Some studies suggest that having more body fat affects how the immune system functions. Obesity is associated with low-grade inflammation that may affect immune cells. Another theory is that diets high in carbohydrates, salt, and fat can negatively affect beta cells. These cells are found in the pancreas which are responsible for making insulin.

At this time, scientists still don’t fully understand whether obesity plays a role in type 1 diabetes development. More studies are needed.

Obesity Can Affect Insulin Sensitivity With Type 1 Diabetes

Some people with an obesity diagnosis also have insulin resistance. This condition occurs when the body’s cells can’t use insulin as well as they used to. Since glucose can’t enter cells without insulin, blood sugar levels start to rise.

If you have been diagnosed with obesity and type 1 diabetes, you may need to use more insulin to lower your blood sugar levels. Research shows that using more insulin leads to more weight gain, creating a cycle. This could make it harder for you to manage your disease.

How Can You Best Manage Type 1 Diabetes With Obesity?

If you have been diagnosed with type 1 diabetes and obesity, your doctor and your endocrinologist (hormone specialist) will help create your treatment plan.

Be sure to stick with your insulin treatment to properly control your diabetes. You can also work closely with your health care team to find healthy weight management strategies and lifestyle changes.

Recommendations your doctor may make include:

• Making dietary changes to support diabetes health
• Monitoring your carbohydrates to better balance your insulin therapy
• Increasing physical activity
• Considering medication or other therapies for weight loss

• Taking certain medications to control your blood sugar levels, such as pramlintide

Many people with type 1 diabetes worry about experiencing hypoglycemia, or periods of low blood sugar, when they exercise. This fear can make it harder to maintain a balanced body weight — especially if you need more physical activity. If you’re concerned about this, talk to your doctor. They can offer tips and tricks to avoid low blood sugar episodes.

Hypoglycemia doesn’t only happen if you exercise. It can also occur if you aren’t eating enough carbohydrates, if you inject too much insulin, or when you’re first learning to balance the dose of a new treatment. These low blood sugar episodes can cause you to feel very hungry and overeat as a result. It’s best to check your blood sugar levels closely or wear a sensor.

Can Obesity Affect Your Health Outlook With Type 1 Diabetes?

Being diagnosed with obesity is associated with a higher likelihood of having certain other physical and mental health issues. Other health conditions can also impact your prognosis (outlook) with diabetes. For example, having depression may make it harder to exercise or keep close track of your diabetes care. It’s important to let your entire care team know about all the health conditions you may have.

High blood sugar levels sometimes present with type 1 diabetes can harm different parts of your body — including your kidneys, eyes, and nerves. Researchers have found that people diagnosed with obesity and type 1 diabetes have a 50 percent higher chance of having kidney problems. Specifically, obesity negatively affects how well your kidneys filter toxins out of your blood.

Obesity and type 1 diabetes together can also raise your risk of high blood pressure, high cholesterol, and cardiovascular disease. In the United States, heart disease is the leading cause of death.

Mortality From Obesity and Type 1 Diabetes

Other studies have looked at whether having a BMI in the obese range and type 1 diabetes increases the risk of death. One report of more than 25,000 people found that male study participants with both obesity and type 1 diabetes had a “minor increase” in the likelihood of death from all causes compared to those with type 1 diabetes and a healthy BMI. The study found no association between BMI and a higher risk of death for women.

When living with type 1 diabetes, it’s important to control your blood sugar and maintain a healthy diet to avoid other complications. If you need help choosing the best foods for your needs, ask for a referral to a dietitian, who can help you create a healthy eating plan customized for people with type 1 diabetes.

Find Your Team

On myT1Dteam, the social network for people with type 1 diabetes and their loved ones, more than 3,400 members come together to ask questions, give advice, and share their stories with others who understand life with type 1 diabetes.

Are you or your child living with type 1 diabetes? Has body weight affected your diabetes treatment plan? Share your experiences in the comments below, or start a conversation by posting on your Activities page.