Weight + Diabetes Complications: What’s the Connection?

While blood sugar levels play a leading role in your risk of developing diabetes-related complications, your weight—regardless of your A1c and diabetes management—is an important factor, too.

It’s important to remember when thinking about your weight: the number on a scale can come with a great deal of judgment. Your weight does not define you or your health. Instead, just like blood sugar levels, your weight is one part of your overall health.

There are so many factors that play a role in your weight, including your genetics, food culture within your family, relationship with food, mental health, physical limitations, other health concerns, access to food, stable housing, a livable income, access to medications, diabetes supplies and general healthcare.

We encourage you to read through this piece with that context in mind; this is purely information for your health and comes without judgement. If you are looking for a community of people also living with type 2 diabetes for support, consider joining the Beyond Type 2 community online or via mobile app.

Here, we’ll look at why and how to protect yourself from potential health complications of being overweight or obese as a person with type 2 diabetes.

Does your weight increase your risk of developing diabetes complications?

“Yes, it’s all so interconnected,” says Tejaswi Kompala, MD, who juggles her role as an endocrinologist at UCSF and clinical strategy director at Teledoc. Kompala’s patient care focuses largely on caring for adults with type 1 and type 2 diabetes.

In the simplest understanding, diabetes complications are primarily related to chronically high blood sugar levels that damage the blood vessels, nerves and cells throughout different areas of your body.

“Certainly, people with type 2 diabetes who are also overweight or obese could have excellent blood sugar management and could be able to avoid/prevent complications,” explains Kompala.

“Being overweight or obese does not necessarily equate to developing complications.”

The most common complications of diabetes include:

• Neuropathy in your feet, legs and hands.
• Nephropathy—also known as diabetic kidney disease—in your kidneys.
• Retinopathy—part of diabetic eye disease—in your eyes.
• Cardiovascular disease—including heart attack, heart failure, stroke and cardiomyopathy—in your heart.
• Gastroparesis your stomach and overall digestive system.
• Dental issues throughout your teeth and gums.
• A variety of different skin conditions.
• Sexual function, including erectile dysfunction and decreased vaginal lubrication.

It’s important to note that some people can still develop diabetes-related complications regardless of blood sugar levels—due to other factors, like a genetic predisposition for retinopathy or nephropathy.

However, being overweight or obese can increase your risk of diabetes complications in three ways:

• The more weight you carry, the more likely you will struggle with insulin resistance because body fat decreases your body’s sensitivity to insulin. This can simply make it more challenging to manage blood sugar levels and stay within your goal range. Blood sugar management can be additionally challenging if you continue to gain weight, which means your level of insulin resistance may increase, too.
• The more weight you carry, the more stress your overall body is under, which means the more you are at risk for various complications related to obesity regardless of a diabetes diagnosis.

“Not all fat is created equal. Where you store extra body fat can matter, too,” reminds Kompala. “Stomach fat is the most harmful metabolically and most associated with metabolic disease, including diabetes, hypertension, high cholesterol and heart disease. Thin arms and legs, but significant belly fat, could be more detrimental than someone who carries more weight in their arms and thighs than their belly. The apple versus the pear shape.”

Where a person stores body fat is mainly genetic, and your body mass index (BMI) alone doesn’t account for fat distribution—one of the many reasons BMI is no longer a trusted method for assessing health. Talking to your healthcare team about your body composition can be a daunting but crucial step to take if you have weight-loss goals.

Obesity—without diabetes—can lead to similar and different complications.

“Obesity is obviously a major risk factor for developing type 2 diabetes, but obesity without diabetes also poses many of the same complications,” explains Kompala.

“Obesity itself increases your risk of osteoarthritis, sleep apnea and chronic kidney disease.”

Kompala is adamant that most people with obesity and/or type 2 diabetes also be screened for sleep quality and sleep apnea—especially considering its link with insulin resistance, too.

Research has found that being overweight or obese can change how well your kidneys filter waste and extra water from your blood and how well they can handle protein, explains Kompala. This means obesity (even without diabetes) and diabetes threaten your kidney function.

Kidney disease (or diabetic nephropathy in a person with diabetes) isn’t usually diagnosed until a urine sample reveals higher than normal protein levels. While there is newer testing you can do to determine your risk of kidney disease before it develops, routine bloodwork with your primary care provider is an essential part of detecting kidney disease in its earliest stages.

Losing weight (even just a bit) to reduce your risk of diabetes complications

“Even modest weight loss in those who are overweight or obese can have a large impact on blood sugar levels and hugely improve the risk or progression of complications,” says Kompala.

While some types and stages of diabetes complications are irreversible, the early stages of retinopathy and kidney disease can be stopped quickly in their tracks and remarkably improved when treated early. Hypertension and high cholesterol can be reversed altogether. Thank

Losing even just a little bit of weight can help you improve insulin sensitivity and decrease the likelihood of further complication progression.

How certain medications (with lifestyle changes) can help you lose weight and stabilize diabetes complications

“While insulin is obviously an important and effective drug for reducing blood sugar levels in people with type 2 diabetes,” explains Kompala, “inappropriately high doses can lead to weight gain.”

In her work with patients, Kompala says the first thing she looks at in a patient’s medication regimen is just how much insulin you are taking—because the gradual impact on weight gain and your ability to lose weight is significant.

In addition to fine-tuning any existing insulin regimens, Kompala says starting a glucagon-like peptide-1 (GLP-1) and/or sodium-glucose cotransporter 2 (SGLT-2) medication is critical for losing weight with diabetes. In fact, they’ve become the go-to medication for helping patients with type 2 diabetes lose weight.

“Both of these drug classes are great because they can be effective without the addition of insulin,” explains Kompala. “And if you’re already taking insulin, these drugs can help you reduce your insulin needs both immediately and long term as they help you lose weight.”

When it comes to complications, both GLP-1 and SGLT-2 drugs have proven to stabilize the progression of kidney disease and reduce your risk of cardiovascular-related events like heart attack and stroke.

“Of course, all of this needs to be combined with healthy lifestyle habits, too,” says Kompala. “But just losing 5 percent of your body weight can have a huge impact on your risk of diabetes complications. You don’t need to lose all the weight, be realistic, focus on just 10 pounds. It has benefits.”

It can be hard to get started when it comes to lifestyle changes, but Kompala has one area she recommends.

“Start by eliminating all sugary beverages, including soda, juice and coffee drinks,” she says. “You’ll be surprised at just how much weight you can lose with this simple change if you’re drinking a lot of sugar throughout the day.”

But remember that weight loss doesn’t happen overnight—it takes time.

“If weight loss was easy, we wouldn’t be talking about it,” adds Kompala. “There are so many biological mechanisms in your body that are making this hard.”

Keep your goals realistic, be patient and let your healthcare team help you.

Educational content related to weight loss is made possible through support from Lilly. ​Editorial control rests solely on Beyond Type 2.