Weight Management in Type 1 Diabetes: Expert Insights from Sarah Hormachea, RDN, CDCES

Managing weight with type 1 diabetes (T1D) isn’t as simple as “eat less, move more.” In fact, that approach can backfire — especially when insulin, blood sugar fluctuations, and hormone changes are part of the equation.

In a recent episode of the Direct Diabetes video podcast, registered dietitian nutritionist and certified diabetes care and education specialist Sarah Hormachea, RDN, CDCES, breaks down what safe, evidence-based weight management really looks like for people living with T1D .

If you live with type 1 diabetes — or treat patients who do — this is a conversation worth understanding.

🎥 Watch on YouTube: https://www.youtube.com/

🎧 Listen on Spotify: https://open.spotify.com/

Why Weight Loss Is More Complex in Type 1 Diabetes

Many people with T1D approach weight loss the same way as someone with type 2 diabetes or no diabetes at all. But physiologically, the body functions differently.

According to Hormachea, type 1 diabetes involves more than just insulin deficiency. When pancreatic beta cells are lost, other key metabolic hormones are also affected .

These include:

• GLP-1 and GIP (incretin hormones)

• Glucagon

• Fat storage regulation mechanisms

• Insulin sensitivity pathways

On top of that, low blood sugars require treatment — which means eating. That reality alone makes aggressive calorie restriction risky and often unsustainable.

Key takeaway: Weight management in T1D requires a tailored approach, not a copy-paste plan from type 2 diabetes care.

Common Mistakes in T1D Weight Loss

Hormachea strongly cautions against:

❌ Very low-calorie diets

❌ Extremely low-carb or ketogenic plans

❌ “Eating to match insulin” instead of adjusting insulin to match needs

Cutting carbohydrates drastically without adjusting insulin can lead to dangerous lows or unpredictable blood sugar swings .

Instead, insulin titration should evolve alongside dietary changes. As weight decreases and insulin sensitivity improves, medication adjustments are often necessary.

Insulin Resistance in Type 1 Diabetes: A Growing Reality

Many people are surprised to learn that insulin resistance can occur in type 1 diabetes.

Hormachea explains that more than half of new-onset T1D cases now occur in adults — many of whom may already be living with overweight, obesity, or metabolic syndrome.

Other contributors include:

• Perimenopause and menopause (declining estrogen increases insulin resistance)

• Chronic stress and elevated cortisol

• Age-related metabolic shifts

This dual reality — autoimmune diabetes plus insulin resistance — complicates treatment decisions and narrows the available medication toolbox.

GLP-1 Medications in Type 1 Diabetes: What Patients Should Know

GLP-1 and GIP medications (like semaglutide-based therapies) are not FDA-approved for type 1 diabetes. However, they are increasingly discussed and sometimes used off-label .

Hormachea notes:

• Some providers prescribe based on coexisting insulin resistance or obesity.

• Clinical trials are underway at major institutions.

• Conversations about safety and monitoring are essential.

She emphasizes working with reputable providers and avoiding unsafe sourcing methods .

What Is GLP-1 “Microdosing”?

“Microdosing” refers to using smaller-than-standard therapeutic doses of GLP-1 medications.

In the T1D community, some individuals use low doses to:

• Improve insulin sensitivity

• Reduce insulin requirements

• Minimize post-meal glucose spikes

• Support modest weight loss without dramatic appetite suppression

While still emerging and not standardized, this approach highlights how personalized diabetes management continues to evolve.

Clinical Bias Around Weight and Type 1 Diabetes

Hormachea also addresses a critical issue: weight bias in diabetes care.

Historically:

• T1D was associated with children and thin bodies.

• T2D was associated with adults and larger bodies.

This oversimplification can lead to:

• Delayed diagnosis

• Incorrect classification

• Missed treatment opportunities

• Inadequate screening for metabolic risk

Her message is clear: Treat the individual, not the label.

What Safe, Evidence-Based Weight Management Looks Like in T1D

For people living with type 1 diabetes:

✔ Focus on overall dietary patterns, not extreme restriction

✔ Maintain moderate carbohydrate intake

✔ Adjust insulin alongside nutrition changes

✔ Monitor fasting vs post-meal glucose trends

✔ Address sleep, stress, and hormonal shifts

✔ Watch for signs of disordered eating

For clinicians:

✔ Avoid overly restrictive diet prescriptions

✔ Recognize insulin resistance in T1D

✔ Stay open to emerging therapies

✔ Personalize treatment plans

Hormachea summarizes that T1D weight management must be holistic and individualized .

Why This Matters

Living with type 1 diabetes already requires constant decision-making. Adding weight loss goals without proper support can increase burnout, frustration, and risk.

The encouraging part? Research, technology, and therapeutic options are expanding. The conversation is evolving — and so is care.

Learn More

🎥 Watch the full episode on YouTube: https://www.youtube.com/

🎧 Listen on Spotify: https://open.spotify.com/

🍎 Apple Podcasts: https://podcasts.apple.com/

Follow along:

👉 Host Madi Cheever: @type.one.type.fun | TypeOneTypeFun.com

👉 Guest: @Sarah.Hormachea, RDN, CDCES | SarahHormachea.com

👉 Presented by: @DirectDiabetes | DirectDiabetes.com - Helping people with diabetes get CGMs, insulin pump supplies & testing supplies delivered to their front door without insurance headaches & pharmacy hassles

Because personalized care isn’t optional—it’s essential.

This content is for informational purposes only and should not be taken as medical advice. Always consult a qualified healthcare provider about any questions or concerns regarding your health or treatment options.