From Montreal, Quebec, Canada:
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:
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.
- 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.
Original posting 6 Apr 2001
Posted to Daily Care
Last Updated: Tuesday April 06, 2010 15:09:20
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