Question: Is it harder for someone who has Type II diabetes to lose the weight they gained during Cushing’s?

Answer: Weight loss is difficult in general and depends on many factors, e.g. caloric intake, activity level, and basal metabolic rate. Weight loss may be more difficult in individuals with Type II diabetes. However, as pointed out in most advertisements for weight loss products and programs, albeit in small print, “individual results may vary.” Both diabetes and obesity tend to be progressive disorders. In addition, the interactions between Cushing’s syndrome, diabetes, and obesity are complex. The high cortisol levels of Cushing’s syndrome cause insulin resistance, which in turn results in increased pancreatic secretion of insulin. High levels of insulin (hyperinsulinemia) promote fat deposition. If the insulin resistance is severe enough, especially in susceptible individuals, diabetes results. Obesity itself is associated with insulin resistance. Thus, hyperinsulinemia works against weight loss by perpetuating fat deposition and, correspondingly, continued insulin resistance and more hyperinsulinemia. Treatment of Cushing’s syndrome with the reduction of cortisol levels usually leads to weight reduction, if not resolution of diabetes. However, there is a great deal of variation from individual to individual.

By Dr. David Aron MD (Winter, 2001)