This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!
When it comes to blood sugar management for those who have Type 2 Diabetes (T2D), medical weight stigma often puts fat* people at a serious disadvantage. Whereas treatment for thin people focuses on blood sugar management, often for fat patients the focus of their healthcare providers (HCPs) is their weight/weight loss. I hear from so many fat people who have been diagnosed with T2D who have been misinformed that the only options for managing their blood sugar are weight loss and extreme carb restriction (which can harm people of all sizes, especially those dealing with disordered eating/eating disorders.) This is absolutely not true.
Today we’re going to talk about weight-neutral, non-restrictive options for managing blood sugar, so I asked Dr. Gregory Dodell, a weight-neutral endocrinologist who you may remember from his interview here, to review it. I’ve incorporated his feedback into the final version with permission and deep gratitude.
If talking works better than reading for you, or if you’d like further support, I have a video workshop of this talk available here, including a pay-what-you-can-afford option.
Before we get to the options, there are a few things to know.
To start, developing T2D is not anyone’s “fault.” Two people can have the exact same eating/exercise habits and one will develop T2D and one won’t. The way in which the focus tends to be on blaming fat people with T2D shows the ways that this is very often driven by weight bias, and the desire to use healthism as a justification for fatphobia. The bottom line is that, regardless of a healthcare provider’s beliefs about fat people (or about developing T2D (for people of any size,) the only ethical way to treat those who have been diagnosed with T2D is blame-free, shame-free, future-oriented, and evidence-based.
In addition to the fact that we know that significant, long-term weight loss almost never succeeds (at producing thinness or managing T2D,) it can actually exacerbate blood sugar issues. This can happen through dieting behaviors (for example, low fat dieting can lead to blood sugar spikes if carbohydrates are not balanced with fat and/or protein. I can’t help but notice that the increase in T2D diagnoses was preceded by the low-fat dieting fad (*cough* Snackwells *cough*) but that’s a subject for another post.) Weight cycling, or yo-yo dieting, the most common outcome of more than one weight loss attempt, can also lead to blood sugar issues.
One of the major problems with weight loss as a “treatment” for T2D is that the food strategies that can help manage blood sugar often fly in the face of what is considered “best for weight loss.” Fat patients are often at a disadvantage in terms of medical management because the focus is on changing their body size, rather than managing blood sugar - so everything from behaviors to pharmaceuticals are recommended based on how they are perceived to impact weight, rather than how they will impact blood sugar. In this way blood sugar management often becomes a textbook example of the harm that happens when diet culture is allowed to be conflated with healthcare. Dr. Dodell pointed out that sometimes providers are hesitant to start or increase insulin for fat patients because it could cause weight gain, while on the other hand many of the new medications (such as GLP1 agonists / SGLT2 inhibitors) are being highlighted because they may lead to some weight loss (at least short-term). He says “I often have to clarify to patients that I am not using them for weight loss (which may happen) but because they improve insulin resistance.
In truth there are many options that can help manage blood sugar that are weight-neutral and non-restrictive. This is not an exhaustive list so please feel free to add other ideas in the comments.
A couple final notes. First of all, nobody is obligated to use any of the below options, and I want to acknowledge that privilege, oppression, and access may impact people’s ability to utilize these options in various ways. Second, people’s bodies react to things very differently – what can cause a big blood sugar spike for one person will barely be a bump for someone else. To the extent that it is possible for your situation, test as much as you can to learn about your body’s reactions. Finally, this is not intended to be medical advice – check with your weight-neutral healthcare provider about these.
Many medications exist for the management of T2D and there is no shame in taking them, including and especially if other options for management trigger disordered eating/eating disorders.
Your HCP should give you the options with the pros and cons of each (none of which should be tied to possible weight changes.)
Stress hormones (including cortisol and adrenaline) can impact blood sugar, so having a stress management toolbox (everything from meditating to hitting a pillow with a tennis racquet etc.) can be helpful. (This is also one of the ways that the stress of weight stigma can harm fat people.)
Diabetes can make you more prone to periodontal disease, and periodontal disease can raise your blood sugar levels, so taking care of your gums can help control blood sugar levels.
Lack of sleep and/or poor sleep quality can increase blood sugar so, if possible, get enough sleep and treat any sleep issues like sleep apnea.
Note: The research on supplements is mixed, if you have any questions about medicine interactions or amounts definitely talk to a qualified, HAES-based healthcare practitioner.
Fiber – This can take the form of psyllium fiber supplements or high fiber foods consumed before a meal, and/or increasing the fiber contained in meals.
Turmeric - Whether in supplements and/or eating foods with turmeric, it has been linked to supporting blood sugar and preventing some of the complications of T2D.
Cinnamon – This can be taken as a supplement and/or consumed in food or drinks.
Vinegar – Some research suggests that eating vinegar prior to/during a meal and/or just before bedtime can help regulate blood sugar. This might take the form of a vinegar-based salad dressing, or red wine vinegar dissolved in water.
Almonds – Research shows that consumption of almonds before, during, after meals and/or as a snack can positively impact blood sugar (this is also a good example of diet culture negatively impacting recommendations as concern over the caloric value of almonds leads to situations where a study finds that 2oz of almonds impacts blood sugar, but the recommendation is to eat half that because of calories.)
Dark chocolate – research shows that consuming dark chocolate may help regulate blood sugar, as well as mitigating some of the possible complications of T2D
Cook and Chill – Cooking rice, pasta, and potatoes and then chilling and re-heating them can significantly decrease their impact on blood sugar. I told a friend about this and she recently texted me to say that she is now enjoying potatoes again without the ensuing blood sugar spike.
Food combining – carbs, when eaten alone, can cause a significant blood sugar spike. If you pair those same carbs with fat and/or protein (like cheese and crackers instead of just crackers) it can create a much smaller blood sugar reaction. Here again, often diet culture gets in the way of blood sugar management as hand-wringing about calories takes precedence over blood sugar management – like the idea that butter or sour cream “ruin” a baked potato, when in fact you still get the nutritional value of the potato, plus likely better blood sugar, and deliciousness!)
Food order – giving your digestive system some fat/protein/fiber to process before the carbs hit can help even out the ensuing glucose spike, so you can “pre-game” your meal with these foods and/or eat the proteins/veggies/fats first in your meal.
Movement in general has been shown to help manage blood sugar in various ways. As we’ve talked about before in this newsletter, you can engage in movement (or not) entirely on your own terms. If you choose to use movement as a blood sugar management strategy, it can include engaging in movement when it makes sense for you, or using movement strategically.
Strength Training – in general, having more muscle mass can help with blood sugar management. The act of strength training can also increase insulin sensitivity immediately and for hours afterward.
Cardio – any movement that moderately raises heart rate can help to control blood sugar, and the impact can last up to 24 hours. Moderate intensity movement immediately prior to and/or following a meal (even 5 minutes of movement) can help to mitigate any blood sugar spike.
So, for example, if you know that you are going to have a high carb meal you could pre-game the meal with some light strength-training and then do some moderate cardio after.
Important notes about movement:
Intense movement, including strength training and cardio, can increase blood sugar short-term. So, for example, if your blood sugar is high and you want to use movement to try to bring it down, it would be best to choose low to moderate intensity movement rather than high intensity and/or strength training. Ask your weight-neutral HCP how high is too high to safely use movement to bring down blood sugar.
Make sure to stay hydrated as dehydration can increase blood sugar, and remember that movement can also cause blood sugar lows so always have easy access to quickly digested sugar, and consider testing often.
Unfortunately diet culture has heavily infiltrated the world of blood sugar management, but we don’t have to buy into it. For more info about this, check out the Type 2 Diabetes sheet at https://haeshealthsheets.com/type-2-diabetes/
One more time…as with everything health related, your mileage may vary so if you can, talk to a weight-neutral healthcare provider to see what’s best for you!
If you’d like more support around this, I have a video workshop about weight neutral blood sugar management (there is a pay-what-you-can option so that money isn’t a barrier) that you can check out here!
Did you find this post helpful? You can get a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits including our Friday Conversations, or subscribe for free to get future posts delivered direct to your inbox! Click the Subscribe button below for details:
More research and resources:
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Thank you for this, Ragen!
I've been struggling with Type 2 diabetes for years. Every doctor I've been to has told me to lose weight! Next time I see my endo, I will bring this article along with me.
For some reason, I can eat potatoes till the cows come home and they don't have any serious impact on my blood sugar. Bread isn't that bad either. I measure out insulin corresponding to the amount of carbs in potatoes, pasta, or bread and all is fine and dandy. Rice, on the other hand, spikes my blood sugar. I have to use twice as much insulin than would seem necessary for the amount of carbs.