Thursday, June 17, 2010


As a person who's been overweight since childhood, I've eaten a lot of meals for reasons other than hunger, the real, physical hunger by which the body signals that there aren't enough calories on board.  Studies have shown that many obese people have lost understanding of what actual hunger even feels like: this is true of me, mostly.  I was on a program once that asked participants to rate hunger on a one-to-five scale before and after each meal.  I found this a real struggle.

When I was diagnosed with Type 2 diabetes, I was put on Metformin. From the day after the first dose, my fasting numbers dropped to within or near the target range.  For the first time in who knows how many months, my blood glucose level was normal.

But nobody had told my metabolism that.

This is my understanding of what happened next: after many months of continually elevated blood sugars, my body had grown to consider those elevated levels to be normal, what it expected, where it would work to keep me. And, when my BG dropped, my metabolism sent out the signals that the level needed to be raised.

I got hungry.

This was real hunger, physical hunger, body-in-need of nourishment hunger.  Not boredom hunger, not emotional-emptiness hunger, not boy-that-looks-good hunger.  Hunger that I had only occasionally experienced.

I may appear to exaggerate.  Obviously, this was not the hunger of starvation.  But it was brain-says-FEED-ME hunger, and I didn't handle it very well.  I ate, and ate, and the Metformin and whatever's left of my pancreas diligently worked to keep me from getting too high, and, well, let's just say I ate a lot.

As it happens, I was a Weight Watchers member at that time, and I'd been losing significant weight.  (Ironically, having changed my diet and lost some weight, I was symptom free at diagnosis.  Heaven knows what my A1c would have been if taken a month earlier.)  But within two weeks of beginning treatment, I had regained almost all the weight I had lost.  And, even though the feeling that I could clean out a buffet subsided after a few days, it was quite a while before I again felt in reasonable control of what I ate.

The reason I share this is because I know I'm not the only T2 that's experienced this when beginning treatment: perhaps some Type 1 folks experience it as well.

So, although I often forget: yes, ma'am, I do know what physical hunger feels like.

(Next-to-last paragraph edited for clarity.)


  1. Yea, T1's sometimes have a problem when they are not well controlled that when their sugars drop, they over eat to fix it, raising their levels and therefore adding pounds.

    Most folks define "control" as reducing highs, but for me, both ends of the spectrum are important

    Great post my friend, we need to get some Gates again!


  2. Since being diagnosed with T1, I have gained nearly 30-40 pounds (almost 5 years). It is difficult to lose weight for me because everytime I exercise, my blood sugar usually goes low and I have to eat or drink something with a lot of calories that I just worked off. It is frustrating, but with the right adjustments, it can be handled.

  3. Hi, Chris...

    You a pumper by chance or on MDI?

  4. Absolutely absolutely when my blood sugar rapidly drops (even if it levels out at normal range) or when I'm sitting at 70/80/90 when my average is typically about 140, i absolutely am freaking starving!!

  5. Yep, I agree with y'all 100%. It's weird how your body reacts to being lower-than-normal. It's so hard not to pack your face full when your brain is screaming "FEEEED MEEEE!" and you know you can't. The absolute hardest thing for me what having to resist that urge until my body learned to deal with the lower levels and reprogram itself to feel these as "normal".

  6. I've seen this phenomenon in a few of my patients who have lived with high glucose levels (say, 250 mg/dl) for months:

    When they get down to a "normal glucose of 100, they have symptoms of hypoglycia (hunger, weakness, dizziness, or malaise).

    It's like the months of hyperglycemia has re-set a "gluco-stat." [Think of a thermostat in a house.]

    Those folks need to work towards normal glucose levels more slowly than the average person, allowing their metabolism to adjust, and the gluco-stat to re-set.

    This issue is not well-described in the medical literature.


  7. That's very interesting, the notion that a more gradual "come down" might have been advantageous in a situation like mine. I was merely thinking that it would be helpful to warn newly diagnosed folks that it might be coming!


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T Minus Two by Bob Pedersen is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.