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Ask Dr. Gourmet

How can an underweight diabetic gain weight?

My father-in-law is about 5ft. 10", weighs 126 pounds, and cannot seem to gain weight but shows fasting blood glucose levels of 150 to 190 with 1.25mg of Micronase taken daily.

Most information on diabetic diets addresses the problem of being overweight and how to lose weight. He has the opposite problem. Could you direct us to information on how to address this problem and understand the possible mechanisms involved? His fasting blood glucose levels for the past several years were steadily at 129. Now that he's being more aggressive in treatment, it seems his fasting blood glucose levels have increased.

Dr. Gourmet Says...

An elderly couple sitting in a swing on their front porch, both looking at a laptop computer

We do see this problem fairly often. Many times as folks age they will lose weight, but there is also the factor that when a patient's diabetes is not well controlled it can lead to weight loss as well.

This is a case where you and your father-in-law should speak with his physician about seeing a dietitian. Liberalizing his diet by adding in the right balance of carbs and protein for his case is best handled by those who are close to him. The dietitians do a fantastic job of coordinating with patient's doctors to make sure that as he gets more calories, his medication is increased so that he can regulate his blood sugars carefully. Weight gain is about making sure that one is getting more calories than are being burned (just the opposite of weight loss). That said, it can be a struggle for diabetics to eat more and at the same time watch their blood sugar carefully.

There's good research showing that sometimes folks who are older just don't eat enough calories. A food diary can help a lot in assessing this and taking that with you to the dietitian can make his visits more productive.

Lastly, if there's been a substantial weight loss, checking for other conditions is important. Such things as thyroid disease and stomach issues can limit folks' ability to gain weight. Check with his doctor on these.

Thanks for writing,

Timothy S. Harlan, MD, FACP, CCMS
Dr. Gourmet