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July 17, 2008

Daily Care, Weight and Weight Loss

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Question from Washington, DC, USA:

I have been working out regularly, four to seven days a week, for more than three years. While initially I hoped to lose weight, I have only gained weight since beginning the exercise plan. I eat well—count calories, minimum amount of carbohydrates, no sugar—and am told I do everything right. I know insulin may play a factor in my inability to lose weight and I’m wondering what an average daily dose of insulin is for a mid-20s female with type 1. I’m taking around 50 to 55 (sometimes more than 60, sometimes as little as 40 depending on what my blood is doing on a particular day) units per day through an insulin pump. This seems like a lot to me. Even with exercise, I have not been able to lower my doses. Any recommendations for weight loss, besides diet and exercise I’m already doing, and lowering doses? My last A1c was 6.5, but I’ve had trouble keeping my blood sugar down recently (which means more insulin) and expect my next A1c to be higher.

Answer:

From: DTeam Staff

Don’t be discouraged. You are doing the right thing. There are many other benefits from exercise than seeing the number go down on the scale. Your total number of units of insulin per day is not huge. It is true that you can sometimes drop your dose of insulin with more weight loss. However, if you exercise a lot and increase your muscle relative to your fat, you can actually gain weight. I would look into following your progress using more than just weight. I would consider using waist circumference, as well. Make sure you have someone show you how to make the measurement accurately. This will help you keep track of how much of the central weight you can lose. This is the fat mass most related to insulin resistance. In addition, I would make sure you are following with a dietitian who can troubleshoot your diet. You can also check with your doctor about how much exercise you are doing. If you are not an exerciser, starting slowly and working your way up is a good strategy. However, you have to continue to work your way up. Thirty minutes every day is recommended. Your intensity of exercise has to be evaluated as well. Finally, make sure to check with your doctor so you can receive feedback about exercising safely and whether you need to have a screening heart stress test.

JTL