I am a 26 year old female who has type 1 diabetes and has been on an insulin pump for three and a half years. Over the past year, I have gained 25 pounds even though I watch what I eat and exercise regularly. I have tried many diets with no luck. I do everything to watch my weight, but I’m gaining some. I want to lose this weight, it is all I think about 24 hours a day 7 days a week, and it is consuming me. I think if I weren’t doing my part, then it would be my fault, but I am so aware of every thing I do.

I have maintained good control until this past summer, but now, no matter what I do, my blood sugar is up to 300 mg/dl [16.7 mmol/L] at least once a day. I have been testing my blood sugar all the time, so it’s never high for more than a few hours at a time.

I do what endocrinologist said, but nothing has changed. I am always tired, and I have slanted vision. The last time that I saw my doctor, she said that I have an insulin resistance and an enlarged thyroid gland, but she didn’t gave me anything to correct those troubles. She just suggested that I wake up twice during the night to check my blood sugar. Is it normal? What should I do?

Your concerns are frequently expressed by a number of patients who have type 1 diabetes. Weight gain is associated with initiation of an intensive insulin regimen. If you put insulin resistance on top of this, because of a genetic predisposition, it becomes difficult to control your sugars. I have several suggestions that represent a process rather than a solution:

Make sure the calorie content of your diet is not excessive. Consult with a dietitian who can review menus with you.
Make sure you are not receiving excessive amounts of insulin. For instance, are you getting hypoglycemic? Have you recently changed your basal rates?
If you are truly requiring a lot more insulin, consider using an insulin sensitizer like Glucophage [metformin] to improve tissue response to insulin.
Look for other treatable causes of insulin resistance. This might include your thyroid condition. However, not all thyroid abnormalities are associated with marked insulin resistance.
Consider counseling to help you readdress your attitude about food and body image if this continues to make you unhappy.
In selected patients, it is reasonable to consider one of the two medications available for long-term weight loss.

It is very important to discuss these issues with your physician. It is not meant as a solution, but is a process which needs to be discussed.

JTL