Type 1 diabetic insulin pump wearer needing to lose more weight!
Hi all, I am a type 1 diabetic (for 13 years this year) with an insulin pump and I'm 5 years out of RNY surgery and I've put on some weight (not a ton but you know) and I was wondering if any other diabetics out there have had any issues with keeping weight off some years after having weight loss surgery and if so what did you do to lose it again?
I'm also wondering if the amount of insulin I'm having to take could be the culprit behind my weight gain....
Thanks a lot!
Lance
Hi Lance:
I'm also type 1, 15 months out from RNY and getting ready to transition onto a pump. I've been diabetic for 26 years.
I'm still losing a little, but have the exact concerns you described about possible weight gain from insulin use. I gained about 100 pounds after I went onto insulin 25 years ago, so I have always been worried about regain.
I've tried to stay fairly low carb since the surgery, as that also keeps my insulin needs down. Don't know if you count carbs, but perhaps doing that will help both your weight and your insulin needs.
Have you talked with a RD or diabetic educator about your current regime? Maybe it's time to re-evaluate? I have a terrific diabetic educator who does consultations via Skype and phone - Gary at Integrated Diabetes - http://www.integrateddiabetes.com/index.shtml. I've been working with them recently and it's been very helpful. I thought I knew everything about managing my diabetes, but I've gotten some very interesting tips and techniques. Even their website has some good info.
How much insulin do you use daily? Do you exercise? I find that so tricky on insulin and am hoping the pump makes that easier.
Hi thanks for responding! I probably use about 50 units a day of the basal rate and another 20 or 30 units of bolus. I love the pump but I'm just worried that it's causing me to retain weight and not get it off. I'll check out the website definitely! And I try to exercise when the weather is nice but here in the south we are having our nasty winter weather (it's been raining for like 2 weeks almost and been cloudy a lot) so whenever I get the chance I go walking.
The insulin pump does make it easier to keep your blood sugars more stable but I think I use more insulin sometimes on the pump than when I was just doing injections so I don't know. I may eventually get off the pump for a while and just see if there's a difference in my weight.
That's been one of my concerns about the pump. I use multiple daily injections now, and I find that it keeps me very structured around 3 meals a day, no snacks unless hypoglycemic, and counting carbs. I don't want flexibility around some of this - I find the structure is very helpful to me. However, my control is less than ideal and I know that has to be addressed.
I was told that pumpers generally use less insulin per day than if you are doing multiple daily injections. I don't know how long you have been on the pump, so I don't know if this is true for you. But it's something that I will be watching quite carefully.
May I ask what brand of pump you use? What do you think of it? I am leaning heavily toward the Omnipod as I really don't want the external tubing.
The other thing I might suggest to you is something I see others discuss a lot, and that is get back to basics. Track your food and protein intake for a while. Count your carbs. Do something that takes you back to the early days after surgery, so that you get a sense of where you can improve. I like My Fitness Pal as an app on my iPhone - that helps me sometimes when I get a little off track.
I have the Medtronic Revel pump it's relatively new and it has tubing and such but I have minimal issues with it. I'm sure I use less than I used to but I would like to use even less if I could so I will probably get back to basics like you suggested and see if that helps me lower my insulin use. I would only suggest the OmniPod system if you are very active and are worried about losing and or damaging the pump itself because with the Omnipod it is not renewable like you can't just put insulin in it and go back to work you have to change out the entire pod (at least that's what I've read anyway) so I always tell people to get one of the actual pumps that you have reservoirs for and can change the insulin and tubing and stuff if it gets clogged or anything. But if you and your doctor feel the Omnipod is right for you then by all means don't just take my advice!
Glad to see other type I and pumpers here. I've been type I for 42 years, and on a pump for 14 years. I had lap band in 2008, revised to RNY about 4 months ago. I was terrified to have the RNY because of worries about trying to treat hypoglycemia and possible dumping. Fortunately, that hasn't been a problem.
For many years I did multiple injections before going on the pump. My insulin needs dropped significantly when I went on the pump. I think my body was able to use the insulin more efficiently, and my control greatly improved.
That being said, my body loves it when I eat no carbs (or very little) and need very little bolus insulin. My weight loss and blood sugar management is best then. Insulin definitely plays a part in gaining weight. So, you may want to try really limiting carbs, particularly refined carbs and see if as your insulin requirements go down, the weight loss follows.
I get it. I'm afraid I'm a Christmas-cookie-aholic. Not good.
One other pump benefit I've found is with hypoglycemia....if it's a gradual blood sugar drop, I can treat by using a temporary basal rate of 0% (turning pump off) for an hour to let my glucose come up on its own rather than having to eat something. I've saved countless calories that way, and avoided triggering some overeating/overtreating episodes. When I was taking multiple injections, the insulin was already "on board" and there was nothing I could do but treat low blood sugar by eating something.
thanks so much for these tips! I have been a carb counter for many years, and especially since the RNY 16 months ago. All of my mealtime insulin is driven by a different carb/unit of insulin dose, so it keeps me honest on carbs. My diabetic body also likes it best when I keep them at a minimum. And I know the more carbs I eat, the more insulin I will need and insulin will promote regain. I have to keep that top of mind because it's so easy to think differently about it. It's the "this is what my body needs and I don't metabolize normally because I've had surgery and diabetes" vs. "I want that, I like it, I deserve, just a little will be fine" kind of thinking that I am sure you all know about.
I loved what you said about treating the lows and it's good to know a new way to do it with the pump. It feels so self-defeating to eat carbs to deal with the low, knowing full well that a rebound is in the future too. I have my pump training on 1/28, so I'm sure I'll learn more about how to adjust all that on the OmniPod. One of my long-term frustrations has been exercise. I really don't mind exercising at all, but adjusting for it is a whole other thing! I'm not always able to plan things out to the level you need to if using multiple daily injections. So, I wind up having to either eat before/during exercise to compensate for IOB or not exercise at all. I don't like either of those choices, so I'm glad to know that I have some other ones with the pump too. I'm very exercise sensitive and can plummet 120-200 points when I do. So there's this weird dynamic of having to push my sugar up to exercise. Again, it feels quite self-defeating.
Weaver, I was concerned about RNY for the exact thing you said - dumping and how to treat hypoglycemia in the early days. That's what led me to this board - I was looking for info on that and couldn't find it at all. Fortunately, like you, that has not been a concern. We Type 1 bariatric surgery people are not easy to find. I am a LADA (type 1.5) and they are even harder to find!! Glad to have some other people to share experiences with - it's lonely out here sometimes. 
Good luck with your pump training. I'm not familiar with the Omnipod. I have always used a Medtronic pump. However, I'm thinking the Omnipod should have options for temporary basal rates. When I exercise I drop too. I've worked with my diabetes educator to find what works best. Usually a 50% basal rate for 1/2 hr before exercising, and 0-50% during exercise to keep from crashing. It would make me sooooooo mad to have to treat a low blood sugar and eat all the calories (and more) that I had just burned by exercising! Given the challenges in managing blood sugar after WLS, maybe your insurance will cover continuous glucose monitoring (CGM) also. I use the Medtronic Revel. It's not the most accurate sensor out there and I'll probably change to a different brand when my warranty is up. However, it is invaluable for sensing the trends and looking at the patterns to make adjustments.
