Weight loss, diabetes and me
August 13, 2023
This morning I got on the scales and they registered at 199.8lbs – meaning I’ve lost roughly 50lbs this year. There’s going to be a lot of personal information in this, but I believe that we only understand what other people are going through by sharing. I don’t tell this for sympathy, pity, or anything self-serving. It’s just sharing one person’s journey.
Almost years ago I was 235lbs and I was diagnosed with PCOS. Poly Cystic Ovarian Syndrome. The gynecologist told me the best way to get it under control was to lose weight. I went on a low carb diet as this is best suited to weight loss for those with PCOS, and I went to Curves, a gym, 4 or 5 times a week. 70lbs of weight loss later my PCOS was under control, but coincidentally or not I had the Big Bang of MS – from no symptoms to never walking fully again in 4 days.
No more exercise, no more low carb diet, no lunch (because I go to bed at noon every day) and the weight went back to 235lbs again. Over the years since then it has fluctuated up and down plus or minus 5 or 10 pounds, but not necessarily much more than that. Late last year my clothes felt a little tight, so I got on the scales – 248lbs! Time to cut back on the biscuits!
At the start of this year I felt terrible. Anything I worked on was a real struggle. My brain was in a permanent fog, and working on my PhD was almost impossible – at one point I considered not being able to continue. I thought that my MS was marching on. I was losing weight quickly, even though I wasn’t trying to at all. This time my clothes felt loose so I weighed myself. I had lost 20 lbs in just over two months. A blood test in March showed that I had type 2 diabetes. I had skipped right over the pre-diabetes phase as previous blood tests had not shown any indications, but the A1C, a test that shows your average blood sugar for 3 months, showed that my blood sugar had been really high for that whole period I had been feeling ill. I rushed out to get a glucometer, the blood sugar test, and my blood sugar was 25 – and normal is between 4 and 7. I saw a doctor next day who confirmed I had diabetes, and said that the weight loss was because my body was literally eating itself.
People’s reaction to this news was odd. Close family were worried, particularly given my MS and the immunosuppressant drug that I take. I’m well known for my love of chocolate, and there were a number of reactions that hinted that I had “done this to myself”, and that because I was overweight I only had myself to blame. Not only was this very hard to hear but it was entirely inaccurate.
Back to PCOS. It means I have weight gain that’s not from overeating. And, it’s genetic. Most of the women in my family probably have it. There’s also a family history of type 2 diabetes in the women in my family.
Let me introduce you to Nelly Deeley, my great grandmother. Nelly was born in Kilfenora, Ireland, and emigrated to England, to Liverpool, where she married my great grandfather and gave birth to my grandma. Nelly had type 2 diabetes. On a trip back to Ireland to see family she ran out of insulin and died. I’m grateful that medical advances and access to medication mean that that will never happen to me.
So, diabetes was a time bomb waiting to go off for me. It’s probably no coincidence that I have an auto-immune disease that fairly advanced and that I also didn’t do a pre “warm-up” phase for – no messing around for me. Straight into MS and diabetes. Do not pass go, do not collect $200, go straight to collecting diagnoses.
My diabetes is now well managed. I have changed my diet, and I’m on two medications, Metformin and Ozempic. And this is where the story takes a somewhat bizarre turn.
I’ve changed my diet completely to be diabetic friendly, which actually means I’m eating more than I used to eat – lunch is back on the menu. My weight loss has continued at a much slower pace – another 30 lbs or so over 3 to 4 months. I do not take Ozempic for weight loss – I don’t take enough of it to make that much difference. What about chocolate, though? Surely you’re not eating chocolate anymore, Michelle? Well I am. And very successfully. Dark chocolate, over 80% cocoa solids, is an effective part of a diabetic diet. And for me I have half a bar, 40 grams, every night at around 10pm – because it stops my blood sugar from increasing too much overnight and waking up with higher blood sugar to start the day because I haven’t eaten anything.
You don’t have to read much of the news to see a story about Ozempic – but not necessarily a story about diabetes. Ozempic is the weight loss drug of the moment, sometimes also known as Wegovy, the same drug with a different brand name. They’re both a drug called semaglutide. For people with diabetes, it increases insulin secretion, increases blood sugar disposal and improves glycemic control. It’s an injection you give yourself once a week, and for me, it works together with Metformin which is a tablet daily taken a couple of times a day. I see one working as a steady constant in the background while the other I can alter daily based on changes I see. I think it’s a great combination.
It also makes you feel full faster, slows down your digestive processes, and that leads to weight loss, which is leading to some bizarre situations.
My province, BC, had to act to safeguard the supply of Ozempic for diabetics. It’s not straightforward to get – you have to go through something called Special Authority. However, as this story details, in the first two months of the year 15% of all prescriptions filled were going to the US, because it’s so much cheaper to buy here. The prescriptions were written by a doctor in Nova Scotia – the other side of the country – and filled through two pharmacies in Vancouver. By comparison, less than 0.5% of other drugs prescribed in BC were going to non-residents. A massive, massive difference.
Ozempic shaming is now a thing, it seems. Amy Schumer called out those taking it for weight loss and not admitting it. Even Boris Johnson is getting in on the act, with his new column in the Daily Mail, the column he failed to declare he was being paid for given that he is still an MP. Both articles focus on weight loss, with all kinds of fat shaming going on, and little to no mention of diabetes. In fact the wonderful reporting of the Daily Mail is a treasure trove of weight loss stories linked to Ozempic – and some truly awful stories related to its side effects, with this particularly dangerous one that focused on it causing depression. The story does not headline that the taker was doing so by sidestepping her regular doctor who would have probably caught that the drug was contra-indicated for other medication she takes – and it was that interaction that was causing her side effects.
However, as this article in the Guardian shows, any gains that were made in accepting all shapes and sizes of bodies are being swept away, because roll up roll up just take this jab and be slim! Never mind the consequences, the side effects, and that when you stop taking it the weight goes back on! Step right up because we should all be skinny! Being fat is being lazy – take the jab and be skinny, healthy and wealthy!
But what about those of us with diabetes? I find that people are congratulating me for my weight loss – but the first 20 lbs of weight loss happened because my body was eating itself. What should my response be? Thank you? The side effects of the first drug I tried – metformin, a wonderful, cheap easy to take pill – were so massive for me at a pretty regular dose, that I’ve added in the lowest dose of Ozempic that makes a medical difference. So far two drugs on a low dose seem to be keeping the side effects at bay while still keeping the diabetes in check. The idea of stopping taking it doesn’t exist for those of us with diabetes unless it gets replaced with another drug. Diabetes – life long disease.
Our relationship with body shapes and sizes is seriously out of whack. We continue to prize an unhealthy skinniness as the ideal in our society to the extent that the desire has driven people to buy Ozempic, Wegovy and similar drugs in ways that put their own health at risk, and risk the availability of the drug for those of us that need it.
It’s taken me a long time to write this post. I’ve been picking away at it over the last couple of months. I keep asking myself what the purpose of it is, as it meanders through my health history, diabetes, fat shaming and a number of other things along the way. I guess the purpose is to put it all out there to show that the situation is complicated, and the pressure that we put each other under does not help at all.