I am a 38 year old female who has had type�1 diabetes for 28 years. I have been on an insulin pump for five months, and even though my blood sugars have improved, I continue to gain one to three pounds per week (40 pounds total). I exercise daily (aerobics, weightlifting, walking, etc.), follow a 1200 calorie diet along with carbohydrate counting, and meet with a dietitian regularly. My basal rate is below 25 Units of Humalog daily, and boluses are always under three Units per meal.

Due to this rapid weight gain, my endocrinologist has tried me on prescription weight loss medications with no success! I have tried every diet out there, low carb, no fat, high protein and every herbal weight loss product that I can take with no luck! I have even tried fasting with no avail. The only way for me to lose weight and keep it off is with high blood sugars. Before I started on the pump, my blood sugars were always high, but my weight was okay. Both my endocrinologist and dietitian don’t know what to do.

It is a Catch-22! People with diabetes need to watch their weight, but at the same time we’re gaining weight. I am more depressed than ever before! 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 (overeating, not exercising, etc.), then it would be my fault, but I am so aware of every thing I do.

I feel badly about your struggle. The amount of weight gain is more than expected. Make sure you are using as little insulin as possible to maintain your blood sugar goals. This does not mean run high sugars. I would make sure you are writing down everything you are eating and get feedback from your physician and dietitian. I would get feedback from an exercise physiologist about the type of exercise you are performing. Medications are not bad ideas if they work. Your physician may also want to consider using an insulin sensitizer like metformin, which will improve the action of the insulin without weight gain and will hopefully decrease insulin requirements.

JTL
Additional comments from Betty Brackenridge, diabetes dietitian:

I’m so sorry you’re having such a rough time. Weight and body image are such big issues in our society that worries about gaining weight can take on tremendous power.

I have a couple of thoughts to add. First, I urge you to forget all the silly, extreme diets. They just don’t work. Over 95% of people on these extreme plans regain every pound after an initial weight loss. They are not a road to permanent health and fitness. Second, you don’t mention hypoglycemia. Even though your total pump insulin dose looks fairly low, its important that the dose be exactly right for you — getting rid of highs is only half of the glucose control equation. If you are having much hypoglycemia and feeding the reactions, that may be a factor. Finally, you don’t mention how tall you are, what your current weight is, nor how your weight compares to others in your family. Weight is, to a greater degree than most people appreciate, influenced by genetics. In other words, your “natural” body type may be not the slim person you were when your blood sugars were out of control, but a stockier one. Getting blood sugars into the target range reestablishes a normal metabolic state and that may just be allowing your body to seek its normal level (at a higher point than you maintained before or that you apparently want).

Food is such an integral and important part of every day that being locked in mortal combat over every bite is a huge burden. I urge you to keep working with your doctor to make sure you are on the right types and doses of medications for you, try to pat yourself on the back for all you’re doing and keep up the physical activity, consider how your new weight compares to others in your family, and make sure you are not treating excessive low blood sugar reactions.

BB