I am 31 years old, extremely obese, have type 1 diabetes, and I know that a lot of my weight comes from overuse of Regular insulin. For example, I would get up in the mornings, take my shot and then my shower, do hair and make up and not have time to eat. (My thought was always I could grab something at school or wherever.) By the time I could finally eat, I was very low and ate way too much and then had to take more Regular insulin to cover the meal. Of course, I would then drop again, and it basically became a “vicious cycle” for me. My hemoglobin A1c looks pretty great for someone who’s had as little guidance as I have, but that’s only because the constant highs and lows are balancing each other out.

About two years ago, I asked my previous endocrinologist about the pump and his reply was that I am too fat. (Yes, that was all the answer I was given.) I’ve recently found a wonderful endocrinologist, and I asked him about the pump. He did explain that weight gain is one of the major concerns with use, but now, my thought is that if I use the pump, then I can bolus (just before i sit down to eat) if I need to, and skip it until I’m ready to eat if I don’t. I think this will help to reduce my cycle of highs and lows and help with weight reduction. Can a pump actually aid in weight loss if used properly? Does using one guarantee any weight gain? Is the weight gain because people feel they have a new freedom and perhaps start to consume more?

It is not likely that the insulin pump would help you lose weight. With improved day to day control, the extra calories you take would then be stored as more fat instead of as hyperglycemia — then glycosuria and lost in the urine.

You may want to have several sessions with your new diabetes team and problem-solve with them about not only your weight but also desired blood glucose goals, what to do about your dietary inconsistencies re: timing as well as portion control. Have you ever done carbohydrate counting seriously? Weight Watchers uses something very similar but called points. Writing things down would also help, I suspect. Once your goals are better defined, then perhaps a pump would help you meet these goals. If you combine better glucose control with lower caloric intake, then no weight gain takes place. If you improve glucose control without changing calories or activity each day, then you must gain weight. these are basic physiologic rules of living organisms.

SB

[Editor’s comment: In my experience, many, but not all patients starting on pumps gain weight — and I’d suspect that most of those who did gain weight were enjoying their new-found freedom a bit too much! I agree with Dr. Brink, that your first priority should be to find a weight loss program that you can stick with. Then, whether you choose to use a basal/bolus insulin program with a combination of a short-acting insulin before meals with long-acting insulin like Ultralente or Lantus (insulin glargine), or a pump, is your option once you’ve got your weight-loss program underway.

WWQ]