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November 4, 2002

Insulin Pumps

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Question from Chicago, Illinois, USA:

I have been on an insulin pump for almost two years, but my control has not gotten any better. I eat a low carb diet and exercise six days per week. In the first two months on the pump, I gained 20 pounds, and I haven’t been able to lose any weight. I really don’t eat a lot, and I know that I am burning more calories than I am eating. What is going on?

My sugars are always on the higher side, and even after I eat veggies and protein I have to bolus. Does this mean that I am insulin resistant? I’m confused because when people have high blood sugars they usually lose weight, and that is definitely not my case! Also, I’ve noticed that I have gained a lot of my weight in the area of my stomach where my pump is connected. Does this have any relation?

I am so confused and really depressed that, after all of my hard work in the gym and paying such close attention to my diet, I am not seeing any results. What is going on? I hope you have some useful information!

Answer:

Your questions are familiar ones. I have the same feeling, that you should obtain a benefit proportional to the amount of work that goes into the process. However, it does not sound like you have the benefit you would like. There is no simple answer to your question. Rather, I would remind you of a checklist of concepts to review:

Are you having frequent hypoglycemia? This may signal that you are on too much insulin. If you are having to eat additional food, this may be a source of the weight gain. The point here is to review your results and decrease the insulin, if required.
What are you really eating in terms of calories? An inventory of your food intake is needed here. I would even go so far as to meet with a dietitian who is a diabetes educator and have a problem solving session.
Do you have lipohypertrophy at the site of the insulin infusion? This condition results from the super-high insulin concentrations in the subcutaneous space. The result is a buildup of fat tissue that does not allow for appropriate absorption of the insulin. You end up taking more than you need to get results. Have your physician or diabetes nurse look at your infusion sites.
Are you taking other medications or do you have other conditions that promote insulin resistance? Review your medications with your physician. As your physician about occult infections, whether they may involve sinuses, urinary tract, teeth and gums, etc.
Do you have a family history of type 2 diabetes? It is possible to have type 1 diabetes and inherited the genes for type 2 diabetes. Weight gain initiates the difficult feedback loop of insulin resistance followed by more insulin, followed by more weight gain, followed by higher sugars, followed by more insulin, followed by more weight gain, etc.

Hope this helps. As always, do not make any changes in your therapy until you speak with your physician.

JTL