Diabetes & Gaining
or…How to Dance With the Devil and Not Lose a Leg
This is an answer to a question I get asked frequently. I thought it was long overdue I wrote a response.
Diabetes is not the end of gaining. In fact for some, diabetes marks the beginning of their serious weight gain. Many gainers I know have had diabetes for years or even decades and have continued to gain well past 400 or even 500 pounds. These people are not legless cripples; in fact, many are gainers you all know and follow on Tumblr, YouTube, or other sites. They just haven’t told you since talk of diabetes is the third-rail of gaining. (And anyway it’s really nobody’s business but theirs.) I asked a few of these diabetic gainers for help in writing this post.
Diabetes is a manageable disease. Very manageable. Easily manageable. Despite this, most people with diabetes do not manage it…
Keep reading
Just a heads up: this post is over 10 years old now and diabetic technologies have changed A LOT since then. Leaps & bounds. It’s a whole new world of management now. And it’s all for the better. It’s never been a better time to be diabetic.
Let’s have a little update for 2026.
So my partner is (pretty badly) T2 diabetic and has been for about a decade now. I’ve gotten to watch the changes over the years. I was just diagnosed mildly T2 diabetic a few months ago. His mom’s also diabetic. So I’ve been around this for a while now, with different paths for all of us.
Also note that this is the path I took and he took over the years. What you do when may be a different in 2026; they’re coming out with new drugs and different techniques (when you try what drugs) literally all the time for this.
1) At first they’re just gonna start you on a pill like Jardiance, an SGLT2 inhibitor. 1 pill a day, that’s it, real easy. The only side effect is that I have an increased risk of a UTI, so I’m supposed to drink lots of water. (I do seem to be more thirsty on it.) (That’s all I’m on. Hopefully it’ll work to lower my A1C & then that’ll be it for me!)
2) If that doesn’t work, they may start you on Metformin as well. I forget the type of med it is, but it’s incredibly common for diabetes treatment. Gives some people diarrhea and/or nausea while they get used to it, but that usually goes away anywhere from a few days to 2 weeks. My partner takes 2 pills of it, 2x a day for 4 pills total.
3) They may throw a GLP-1 agonist in there, possibly after all that, but possibly first. Yes, I know we all know them as weight loss drugs, but they started as diabetic drugs, and they are REALLY GOOD at controlling blood sugar. Really, REALLY good when you’re finally on the right one for you. You may end up trying a number of them to get the one that’s just right for you. Don’t despair; not everyone loses weight on them. My partner not only hasn’t lost any weight on any of the ones he’s been on, he’s GAINED weight on one of them! Most GLP-1 agonists are one shot a week; some are pills, and I think there’s one out there that’s 1 shot a day. The needles, you can’t even feel them unless you get unlucky and you happen to hit a nerve.
4) If all that doesn’t work, I think there’s a couple of other pills they can try (sulfonylureas?)
5) If THAT doesn’t work, THEN they try insulin.
First you try a long acting insulin that you take 2x a day. It’s probably gonna be the Lantus Solostar (if you’re in the USA. I haven’t seen any other brands.) it’s the shape and size of a marker. it’s a simple injector; you put a pen needle cap on the end, dial up the amount you’re supposed to take, stick it in you, push the button, wait 5 seconds, then take it out & discard the needle. Simple. No messing around with measuring doses from vials or large needles.
6) If that doesn’t work, at that point they switch you to a short acting insulin. In this day and age, it’s rare to be doing it by hand anymore (that is, starting out doing it by hand; folks who are long well managed doing it by hand may continue doing that.) You will be getting a CGM/pump combo with an infusion set.
The CGM, Continuous Glucose Monitor, is a little sensor that sticks on your body 24/7 and constantly reads the glucose in your fluids (NOT actually in your blood.) It usually goes on the back of your upper arm. There’s a number of brands and they last different amounts of times. My partner’s used to last a week but they literally just came out with a new model that lasts for 2 weeks. (They’re still working the kinks out of that model.) CGMs keep you from having to stick yourself up to 6 times daily to manually take your blood sugars.
Your insulin pump uses short acting insulin to deliver both a basal & a bolus. A basal is the 24/7 background drip of insulin your body needs all the time. A bolus is an extra bonus amount insulin you give yourself before you eat to make up for the carbohydrates in your food. You enter into the pump the amount of carbs you’re eating & it figures out how much insulin to give you and boluses accordingly. Your insulin pump also is the monitor that shows you what your sugar levels are according to your CGM. They also have graphs so you can see how you’re doing over time, etc. Modern CGMs work with pumps to constantly change what your basal is according to your sugar readings. (This was not the case in the mid 2010s in the USA. It hadn’t been approved yet.) The interface is quite simple and quite idiotproof, very much on purpose. They are also the most bug-free devices I’ve ever seen. Some pumps even let you give them firmware upgrades for better functionality. My partner’s went from having to test his sugars manually 1-2 times daily to only having to do it 1x when you first put your CGM in to calibrate the new sensor. The CGM talks to the pump via Bluetooth. And yes, it can talk to his phone if he wants it to.
The infusion set goes from your pump to your body. It’s a reservoir that goes into the pump, a little tube, and a part that sticks to your skin and goes into your body to deliver the insulin. My partner’s infusion set used to last 3 days before he had to change it out, but they just came out with a new model that lasts a week. He has to put a new reservoir with more insulin in roughly daily (YMMV on that.) It takes about 5 mins to fill a reservoir from the vial of insulin and then put it in the pump.
There are models that have pump, reservoir and infusion set in one unit. (It may even include the CGM?) I’ve only seen T1 and children use this, though. I don’t think it works well for T2s, esp not folks who use a lot of insulin.
Honestly, the biggest problem with diabetes, once you figure out the combo that works for you, is dealing with pharmacies & insurance. 2nd worse is your CGM or infusion set coming out of your body early (which might happen less with someone less sweaty. Also, they make all sorts of sticky tapes, adhesives, etc. for this. Including one specifically for very active diabetics called GrifGrips. Comes in like a hundred different colors, shapes, and designs.)
You really DO have to stay on top of it though and take it seriously. It’s not just hands and feet that can be damaged; my partner has internal organ damage that’s irreversible because he didn’t take it seriously enough at first and let it go too long. (And an organ that you don’t realize has nerve endings. You’d be surprised where in your body there’s nerves.)
But if you accept it right off the bat and do what needs to be done, it’s absolutely no longer a death sentence; most diabetics live long & healthy lives now with well managed blood sugars and a minimum of hassle. And most people don’t get to the point of needing a pump; it’s usually just a pill or a few a day for most diabetics.
