Weight loss with type 1 diabetes

Question
QUESTION: Hi Crystal-

I'm 29-years old and weigh 130-lbs.  Two years ago I was diagnosed with type 1 diabetes, which meant I had to start using synthetic insulin.  Never before in my life did I have a weight problem.  In fact, when I joined the Air Force at age 20, I actually had to GAIN 3 pounds before they would let me in.  Friends and family always joked that I was too thin.

Now I know that a person's metabolism slows down as they age and that synthetic insulin - like other various meds - can cause some weight gain.  But I have been exercising and dieting for over a year and I've only lost 5 pounds (started at 135-lbs).  And I think that 5 pounds was water weight, due to the fact that I started taking fiber tablets a few weeks ago.

I try to take my diet very seriously, so I attempt to eat balanced meals and read the nutrition labels on everything I consume.  I admit I have a sweet tooth, but I only allow myself one small dessert per day, as I think moderation is the key to life, essentially (not to mention the fact that I have to watch the carbs, thanks to the diabetes).  Also, I found several BMR calculators online, and the median I got was 2000 calories per day to maintain my weight.  That sounds awfully high to me.  Am I wrong?  Even subtracting 500 cals per day, with a goal of losing one pound per week, still sounds like a lot of calories to consume.  So I went to a nutritionist here in Austin to talk about those numbers.  She did her own BMR calculation and got 1900 cals per day to maintain.  So she told me to consume 1400 calories per day.  Thing is, she never mentioned exercise or what to eat, which I found a little strange.  She all but said, Consume only 1400 calories per day, and do nothing else, and you will lose a pound every week.  I tried the 1400-calorie per day diet for a month, with exercise, but I saw no results.  So I scaled back the calories to 1300 per day.  Still no results, except for the water weight I lost from the fiber pills.

As far as working out, I exercise 3-5 days per week (usually 5) by doing 30 minutes on my elliptical trainer at a moderate pace; lunges with hand weights (20 reps each leg); and 20-30 crunches, each work-out session.

Should I be eating 1200 calories per day?  I don't want to eat so little that my body goes into starvation mode.  I feel like all I do is exercise, but I just can't get anywhere.  I know losing weight is hard, but should I basically have to kill myself to lose 20 stinking pounds?  

Please help shed some light on this, if you can.  Thank you very much!

ANSWER: Hi Catherine,
Thank you for writing to me about your dilemma.   I am very sorry that your nutritionist did not mention exercise--you did not get very good advice.  You didn't mention your height, but I'm assuming you must be around 5'4 or so if your caloric intake was listed at 1900-2000 for weight maintenance.  
I will tell you right now that 1400 calories is a bit low, and a much more effective plan would be to consume 1800-2000 calories, and change your workouts.   Try increasing the cardio to 40-45 minutes at a more intense pace---challenge yourself!   The whole workout doesn't have to be super intense, but try a few intervals for a minute or so at a higher level, and when you get breathless, ease back to your normal level, catch your breath, and then increase again.    After a few times of doing this, your cardiovascular fitness will improve significantly, and you will burn a lot more fat!   As far as the rest of your workouts, a few lunges and crunches is not going to help you lose weight--you need to do a total body workout with weights!   The key to weight loss is to increase your body's amt of lean tissue/muscle, which means you will be one lean, mean, fat-burning machine!   The only way to do this is with resistance training, and you need to do this with your whole body!   You can either hire a personal trainer for a few sessions to show you how to work out your whole body, or go to www.oxygenmag.com to design your own workout (or look at some sample workouts of other fitness girls).   You will see huge results in as little as 4 weeks, and after 2-3 months, you should have lost a few pant sizes.  The only thing you are accomplishing by lowering your calories to 1400 or less is slowing down your metabolism, making it even harder to lose fat!      So keep those calories in the 1800-2000 range, and instead focus on more effective and intense regular workouts!   I don't think this will be very hard for you, since you are already going to the gym 5 days a week, so just stepping it up a bit will be a piece of cake (no pun intended!)
One word of caution though--make sure that you do consume a mini-meal 30 min before you work out (a small protein shake), and always have food on hand while you work out, and make sure to have a protein shake right after your workouts.   You will also find that you will have to adjust your insulin dosages from this type of workout.  You will probably have to use less, especially before your workouts.   Intense weights and cardio use a great deal of glucose from the bloodstream, and if you continue using your usual amt of insulin, you could suffer from hypoglycemic shock, so please monitor your dosages and symptoms of impending hypoglyemia.   That is why I suggest always having some type of juice with you, or candy bar in your gym bag, so that you can take a few bites when you start to feel any weakness coming on.
Good luck!

---------- FOLLOW-UP ----------

QUESTION: Hey again-

Is it okay to split up my session on the elliptical trainer so I don't get bored?  As it is doing 30 minutes at a time, I get super bored on that machine, even with the tv on, so moving up to a 40-45 minute session will definitely be very boring.  Is it okay to do, say, one 20-minute session, and then some other type of exercise, and then do another 20-minute session on the elliptical trainer?  I think that way I'd even be inclined to do 3 or 4 20-minute sessions!

Answer
Hi Catherine!
Glad that you took well to my suggestions.   And as far as splitting up the cardio, go for it!   I would rather have you do 2 really intense 20 minute sessions at a higher, more challenging level, than one long boring 40 min session that you probably will procrastinate doing, and begin hating it.     When you do your sessions, make sure that for the first 3-4 minutes you start off at a reasonable rate to get your heart rate up a bit, and then after a full 5 minutes, let it rip!    Start by increasing the intensity 2 levels above your normal level.   Try sustaining that for at least 1 minute.   After 2 minutes, adjust the level down to your normal training levels.....stay here for 2 minutes, then increase by 2 levels again for 1-2 minutes.   If you can go longer than 2 minutes, then you need to increase the level even more (3 levels or more).   Your goal is to try to increase the high spurts and reduce the rest (baseline level).   As your fitness level increases, you will be able to do 2 or 3 minutes at a high intensity, as much as 4-5 levels over your normal level, and then baseline for 1 minute.   However, you will see near the end of your workout that you will need to take longer baseline intervals.    This is called HIIT training, High Intensity Interval Training.   It is highly effective for fat burning and challenging your cardiovascular health.  If you do 2 of these per day 20 minutes each, you will see a big difference in about 3-4 weeks....guaranteed!   Just make sure your diet is clean---yes, 1900 calories, but make sure that the food is all clean & healthy!!!   
Good luck and please do write me in 1 month for an update!  

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