I’ve had type 1 diabetes for 22 years, have been trying to get on an insulin pump for a long time, and several years ago, an endocrinologist told me that was too fat to use it. I finally found a doctor who would let use a pump, but since I started it (about eight months ago), I have not been able to regain control of my blood sugars (even when I was sticking faithfully to the prescribed diet and insulin to carb ratio).

I am currently on a single basal rate, my doctor did change my insulin to carb ratio during a recent infection, and I for which i did not back after the infection was gone. I am 5 feet, five inches tall and weigh almost 300 pounds. I was above that weight when I first started the pump, but of course the blood sugars have been high enough to cause some weight loss (which is part of why I haven’t been pushing to get it all sorted out). Should I push for more basal rates? Was that first endocrinologist correct when he said I am too fat to use a pump?

You did not mention hemoglobin A1c values which would be important information. If you are not in good control based upon blood glucose readings, either your basal rates are incorrect or your insulin/carb ratios are incorrect or some combination.

You need to problem-solve based upon before and two-hour postprandial blood glucose values and then decide if you need more of one or another type of insulin at any given time. It is impossible to answer this type of question in any more specific but you should go back to your diabetes team and work with them. In general, the more overweight you are, the more insulin resistance you will have and the higher doses you will need at that weight.

SB

[Editor’s comment: I agree with Dr Brink in that you should do extensive blood glucose monitoring to determine how your insulin needs to be adjusted. Your situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. See The Continuous Glucose Monitoring System and ask your doctor about using it. You might also wish to review insulin sensitizer as an adjunct to your pump therapy. Please set up an appointment with your diabetes team to discuss all these options.

SS]