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Almost every type 2 diabetic is told to lose weight. If you can just shed that belly fat, the doctor says, your blood sugars will normalize and you might not even need your medications.
The Diabetic Weight Loss Dilemma
It is also true that almost every type 2 diabetic struggles to lose weight. That's because insulin does more than just move sugar out of the bloodstream. It also locks fatty acids inside fat cells. Interventions to lower diabetic blood sugar levels usually involve increasing insulin levels, and when insulin levels are high, the activity of an enzyme called hormone-sensitive lipase is low. Without the hormone, fat in the form of triglycerides cannot be broken down into the diglycerides and free fatty acids that can escape the fat cell, circulate through the bloodstream, and feed the muscles that burn them during prolonged physical activity. With the higher insulin levels needed to lower sugars, physical activity drives the appetite for more sugar, leaving fat stores untouched but setting up the hard working diabetic for blame despite his or her best efforts.
What Metformin Does for Fat Burning in Muscle (or Doesn't)
For diabetics to lose weight, they need to burn fat. Unfortunately, to burn fat they need lower insulin levels, which would lead to higher blood sugar levels. Metformin is not the complete answer to this dilemma, although it goes a long way toward resolving it.
Some muscles mostly burn fatty acids. Other muscles burn a more balanced mixture of sugar and fatty acids. Studies of muscle cells show that metformin doesn't really have a big effect on the way the slow-moving, predominantly fat-burning muscles burn fat for fuel. However, it greatly increases the rate at which faster-twitching muscles burn fat during exercise even when insulin levels are high. This means that exercise begins to result in actual fat burning with this small change in the way muscles make energy. The skeletal muscles diabetics use during exercise do more fat burning when metformin is part of the treatment plan.
This doesn't mean that metformin does all the work. It's still necessary to adhere to diet so the body does not release as much insulin (if you have type 2 diabetes) or you don't need as much injected insulin (if you have type 1 diabetes, LADA, or you are in the later stages of type 2 diabetes). This allows hormone-sensitive lipase to work inside fat cells to release fatty acids into the bloodstream to circulate to your muscles where they are burned. You also have actually to exercise so your muscles need the fatty acids that your adherence to portion control allows your fat cells finally to release.
You won't just work out only to have increased appetite and wind up gaining more weight when you exercise regularly, as millions of diabetics do.