My 14 daughter has been on a insulin pump for two and a half years, and her doctor is concerned that her basal rates are too high relative to the amount she is bolusing for each meal (i.e., her bolus ratio). Overall her control is quite good. However, she is frequently hungry and not thin despite the fact she watches what she eats and exercises. Is there a problem with having relatively high basal rates? Do people with higher basal rates tend to gain and retain weight? What do you recommend?

There are huge variations in need for insulin, but, if weight is an issue, then excess insulin may be subtly contributing to overeating and excess weight gain. You should work closely with the diabetes team helping to manage your daughter’s diabetes to see about increasing daily exercise, decreasing daily caloric intake and adjusting insulin downward appropriately according to lots of blood glucose readings. Making sure that you are checking lots of pre- and postprandial blood glucose readings would also be helpful to readjust insulin doses.

Virtually all people who need to lose weight can do so successfully, even if they have diabetes, if they increase daily exercise and decrease daily calories even if there are different metabolic susceptibilities to weight gain.

SB