I am a 27 year old type 1 diabetic (diagnosed two and a half years ago), currently using the Un-tethered Regimen, Lantus and an insulin pump. My control is adequate at the moment (last A1c 6.6), but I am always trying to improve it.

Anyway, my question is in regards to weight loss. I am 5 feet, 7 inches and weigh 169 pounds, which I feel is too much for my height and also, according to BMI, is considered overweight. I work out in the gym everyday between 45 and 60 minutes, mostly cardiovascular exercises. I also try to watch what I eat and I am even a member at a diet web site. I log what I eat and it counts the calories and other nutrition information. I have been eating the amount of calories recommended to me by the web site, if not less (but not under 1200) with no success. In fact, I have gained a pound and a half! It’s very frustrating.

I have discussed this numerous times with my dietitian and doctor and nothing has helped I am at my wit’s end. I need some concrete advice on what to do, because I feel like my weight is on an upwards track and I think it is taking a toll on my own self-esteem and, more importantly, my health. Please advise me on what I should do, like I have mentioned I have talked to my nutritionist, doctor, and this diet web site and nothing has improved.

You are already a sophisticated consumer, in terms of your meal planning, exercise, and anticipated results. It is not uncommon to discuss this problem with people who have diabetes and also maintain tight metabolic control. On the one hand, you have an aggressive insulin therapy that prevents the breakdown of fat and, the other, you are trying to minimize your calorie intake and increase calorie utilization. There are no easy answers. I have a few recommendations on where to look.

Make sure you are not having recurrent hypoglycemia anywhere. This might allow you to decrease your insulin to some degree. You do not want to take excessive amounts of insulin if you do not have to.
Review your diet with another dietician. Look for hidden calories.
Try to quantitate your exercise. To do this, talk with an exercise physiologist. This will allow you to make reasonable estimates of your exercise output.
Consider other medications and their effect on weight.
The best exercise combination is one with some cardiovascular and some resistance exercise. Examples of resistance exercise include weights. It doesn’t have to be heavy amounts of weight. Check with your physician about how much of this you could/should do.

Your short-term goal is to stabilize your weight. Keep in mind some things may be a trade-off. Don’t let your metabolic control be the thing that you let slide.

JTL