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Wednesday, December 11, 2013
Loosing Weight After Insulin Pump Use
I have been on a insulin pump for about a year. I have been a Type I diabetic for 33 years. I have put on a tremendous amount of weight with the pump. I am in the process of trying to diet and lose weight but no matter what I do the weight does not seem to come off. I have never had this much difficulty in the past trying to lose weight nor have I ever put on this much weight. I have read that insulin pumps are a factor for weight gain with diabetics. Can you suggest any ideas that might help? Thank you.
Back in the 1990's the results of a research study called the Diabetes Control and Complications Trial (DCCT) were published. One of the findings of this study compared conventional therapy (two injections a day) with intensified therapy (3 or more injections a day or insulin pump therapy). The results showed a significant improvement in HbA1c and reduction in the risk of complications for people on intensified therapy. Compared to conventional therapy, people on intensified therapy showed a higher frequency of low blood glucose levels and about 1/3 of the people gained more weight than the people on conventional therapy.
Since that time, many changes in diabetes care have had effects on the frequency of low blood glucose levels and weight gain in people on intensified therapy (multiple injecitons and pumps). For example, the switch from Regular insulin to Humalog or Novolog has helped decrease the frequency of low blood glucose levels. The changes in the mid 90's to carbohydrate counting (regardless of insulin regimen) made it easier for people to eat what they want, and therefore avoid overeating when moving to a flexible food plan with a pump.
One of the proposed reasons for weight gain for people on intensified therapy in the DCCT was thought to be from removing dietary restrictions (the transition from rigid exchanges to carbohydrate counting and flexible food plans). People who had felt deprived or limited with food for years, were now able to eat what they want when they want and as much as they want - and possibly ran amok and ate too many calories.
Several possible reasons you gained weight after starting the pump are described below. If nothing sounds true to your situation, and if you are still unsure why you have gained weight, make an appointment with a diabetes dietitian. She or he can help you make a plan that will work for you.
1) If you were on conventional therapy before the pump (2-3 shots a day with a structured food plan) - it is possible you are eating more calories than you used to eat. People that have been on a structured food plan for years do not have a normal sense of hunger - because they have had to eat whether hungry or not. So it can take a little while after moving to a flexible food plan for a person to eat more if they are hungry, and eat less if they are not hungry. It is also possible with a flexible food plan that people start skipping meals (like breakfast) that they never used to skip - the time of day that food is eaten can affect weight.
2) You may be exercising less on the pump than you were before.
3) If you were not in good glucose control before the pump, and now you are in good glucose control, you may have gained weight. When blood glucose levels run high - some of the calories that are eaten are never able to be used by the body - a lot of calories are excreted as glucose in the urine. So a person can overeat and not gain as much weight if their blood glucose levels are high. Once there is enough insulin and blood glucose levels are in a good range - a person "gets credit" for all of the calories they are eating. If the amount of calories doesn't change and the person continues to overeat, the person will gain more weight than before.
4) Take a look at your diet and exercise plan. Are you getting 20-30 minutes of exercise a day? Are you eating 5-10 servings of fruits and vegetables a day? Are you eating at least 3 times a day with insulin? Are you eating breakfast?
5) If you are treating low blood glucose levels at least once a day - it may be contributing to weight gain. If you are low at least once every day, you may need to adjust your insulin plan. Look at how much carbohdyrate and what kind of carbohydrate you are using to treat low blood glucose levels. It is best to have a system - and use fast-acting carbohydrates like glucose tablets to treat lows. Most adults only need 8-10 grams of carbohydrate to treat a low. Be careful you are not low too often, or overtreating lows with too much carbohydrate or high calorie foods.
6) Many people struggle with weight. People with Type 1 diabetes have additional stresses because of the need to estimate a portion size and count the carbohydrates in every morsel of food they eat. This emphasis on food, day in and day out, can make it harder to understand what is affecting weight gain.
You deserve to have some help! Make an appointment with a diabetes dietitian. Your diabetes care provider may have a dietitian in their practice, or they should be able to recommend one in your area. Your pump trainer may also be able to recommend a dietitian.
Nancy J Morwessel, CNP, MSN, CDE
Pediatric Nurse Practitioner
College of Medicine
University of Cincinnati