It surprises me that a two year long “study” was deemed necessary and its results published proving the long –known fact that improvement in hemoglobin A1C causes weight gain. It amazes me that Tulane researchers took two years and spent the money “rediscovering” a solid fact and even looked at a series of independent factors such as age, gender, race, BMI, waist circumference in regard to this matter. There is and always has been one factor that causes weight gain when blood sugar markedly improves; blood sugar must leave the blood stream via transference to muscle cells (to be burned as fuel) or to fat cells (to be stored as fat). It is not a mystery and never has been. Medications that cause an increased amount of available insulin facilitate the process (insulin and TZD’s are among these medications).
Either Tulane doesn’t have an understanding of the dynamics of significantly improved glycemic control, or they simply wanted to publish a study. (I have seen more and more studies for the sake of publishing in recent years.)
I think it would behoove the research team at Tulane University as well as the editors of Diabetes Care (who saw fit to publish the “results” of this study) to read the following explanation of weight gain due to A1C improvement. For everyone else reading along…the following is interesting and will explain a long known fact of blood sugar control. It will show you that you are not “lazy or crazy” when you tell your MD that since you started on medication or insulin, you are gaining weight. It’s a fact and it’s not your fault. Best of all, I will provide a remedy for this fat gain and show everyone a fool proof program that will enable FAT LOSS as hemoglobin A1C improves.
Hemoglobin A1C is a blood test. It need not be drawn in the fasting mode. It shows the patient’s average blood sugar 24/7 (around the clock) for approximately three months prior to the lab test. Yes, it looks backwards in time. It provides an average blood sugar reading indicating long term blood sugar control. Normal A1C is 5.6 and under. Pre diabetes is 5.7 to 6.4 and Diabetes is 6.5 and higher. The A1C numbers translate directly to blood sugar readings. See this table to convert your A1C number to a blood sugar reading you may be more familiar with: http://www.diabeteschart.org/bloodsugarchart.html
When a person is diagnosed with diabetes, and on subsequent lab tests, the physician will typically order a fasting blood glucose and A1C test to assess blood sugar control.
The fasting blood glucose only shows blood sugar at that one moment in time. The A1C reading shows long term control, going backwards in time for about 3 months.
So….an elevated A1C shows elevated around the clock blood sugars for up to 12 weeks before the test. Let’s say the reading comes back at 9.6. A 9.6 A1C means this person’s average blood sugar was 228mg/dL. Normal A1C is under 6.5. So, this person is 3 A1C points above normal.
High blood sugar can cause long term complications including permanent damage to the kidneys, blood vessels, nerves, retina of the eye, brain, etc. It would be extremely unhealthy to leave an A1C at 9.6. The physician and patient would need to agree on a plan to get the average blood sugar down to normal as quickly as possible and remain there.
Unfortunately, in today’s medical environment, the first line in bringing blood sugar down is with medication. Sulfonylureas and TZD’s are two classes of medications that make the pancreas release more insulin. Injecting insulin can also lower blood sugar.
How do these medications work? The oral medications cause the pancreas to make more insulin and the injected or infused insulin simply adds more insulin to the bloodstream. In either case, TZD’s and insulin increase circulating insulin in the blood.
Insulin enters the blood stream like “keys”. These keys attach to keyholes on fat cells/muscle cells to enable blood sugar circulating in the blood to leave the blood stream (where excesses will do damage) and enter the muscles or fat. Once muscles are capped off and can store no more sugar, the remainder of excess sugar goes to fat cells. As fat cells are pumped full of more and more sugar, the person gets fatter and gains weight.
So….Recapping: blood sugar is measured. If it is proven to be too high, medications are prescribed to open the fat cells to store up this excess sugar. This leaves the sugar in the blood at a lower level, but the fat cells “over fed.” And weight is gained.
The more elevated A1C is, the more medication it will take to open enough cells to deposit the sugar into and the fatter the person will become.
In fact, in my practice I have found that for every 1 point hemoglobin A1C improves, 5 pounds of fat are gained. If a person brings his A1C from 10.6 to 5.6, he will gain 25 pounds of fat!
It seems like a catch-22. The higher your blood sugar, the sicker you are. When you improve that blood sugar with medications that make more insulin, you open more fat cells and become fatter. Increased fat increases insulin resistance and that causes the need for even MORE insulin. The need for more insulin makes your pancreas work harder, fatigues the pancreas, requires greater doses and types of medications, and makes you even fatter. What a mess!
So….Tulane…that’s why people with higher blood sugar readings and higher A1C’s who reach normal blood sugar gain weight. We’ve known this “forever.”
The news….comes from me.
There is a program that works with or without medication to reduce A1C and actually simultaneously burns fat stores as they develop. The Metabolism Miracle and The Diabetes Miracle are the only lifestyle programs specifically designed to drop A1C (at a faster rate than any medications) and simultaneously burn the resultant fat gain .
I ask my patients to begin the program with a scale weight, set of body measurements, and fasting labwork including metabolic profile, lipid panel, hemoglobin A1C, CRP, Vitamin D, and blood pressure reading. After just 8 weeks of the program they are asked to repeat the scale weight, measurements, and labwork. The program will provide the expected FAT LOSS, inch loss, and all labs will be significantly improved. If after 8 weeks it is determined that medication is needed….the dose will be far less than if they were begun on medication at the outset. And…they will have lost fat, not gained fat.
So, physicians and their patients.
1.First line of treatment for type 2 diabetes:The Metabolism Miracle or The Diabetes Miracle.
2.If necessary, The Metabolism Miracle or The Diabetes Miracle with the least amount of medication that will provide normal blood sugar.
Read about it at http://www.themetabolismmiracle.com
Tulane researchers and Diabetes Care….you should go to the website, too.