The goal for most patients with double diabetes is to lose weight while controlling their type 1 diabetes. The physician will recommend a healthy weight range and may be able to give advice regarding the safest and most effective way to achieve a target weight. Generally this will involve a combination of diet and exercise.

A few exercise precautions are in order for people with type 1 diabetes, especially those with hypoglycemia unawareness (difficulty sensing low glucose).

• Adequate intake of water, lean protein, “good” fats (monounsaturated and omega-3) and high-fiber, nutrient-rich complex carbohydrates
  

  

• Restrictions on alcohol, avoidance of artificial trans fats, and reduced intake of sugar, starches, processed foods, fast food and saturated fats
  
  
• An adequate breakfast and several small meals and nutritious snacks during the day, rather than two or three large meals

The coexistence of type 1 diabetes and insulin resistance may complicate the long-term treatment of patients with double diabetes. Patients with type 1 diabetes require regular insulin therapy. However, insulin promotes weight gain, and patients with double diabetes may not be able to use all the insulin that is supplied to the body. This means that patients may require more insulin to control their glucose (blood sugar) and may face the consequences of hyperinsulinemia.

The U.S. Food and Drug Administration (FDA) has approved oral antidiabetic agents only to treat type 2 diabetes. They cannot address the autoimmune dysfunction of type 1 diabetes, but they are sometimes prescribed off-label (in a manner other than that for which they were intended) for insulin resistance.

In some cases, a physician may recommend diet pills to promote weight loss. Patients who have developed high blood pressure or an unhealthy lipid profile may be prescribed antihypertensives or cholesterol drugs. For severe cases of obesity that noninvasive treatments cannot resolve, bariatric surgery is sometimes recommended.