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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Friday, February 10, 2012
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Friday, February 10, 2012
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Diabetes |
Weight control on an insulin pump03/09/2000 |
My daughter is 14 and on an insulin pump. She is having a lot of trouble controling her weight. Is it possible she`s getting too much insulin or is insulin resistant?
There are several parts to your question:1. Does the dose of insulin affect weight control?
2. Does insulin resistance affect weight control?
3. Does insulin pump therapy affect weight control?
4. What are the risks for teens who are concerned about their weight?
Insulin can stimulate the body`s ability to store nutrients as fat. Weight gain occurs commonly in people with type 2 diabetes when their blood sugars are controlled without adequate calorie reduction. Total daily dose of insulin can also affect weight in people with Type 1 diabetes which would be the diagnosis in most people on insulin pumps.
Insulin resistance is a problem with how a person’s tissues responds to insulin - there is a "barrier" between the insulin and the insulin receptor. Insulin resistance is a prominent factor in Type 2 diabetes It is not a common feature of Type 1 diabetes but it can occur there, especially in those that are overweight and those going through the physical changes associated with becoming a teenager. The relationship between weight control and insulin resistance seems to start with obesity: people who are obese are more likely to be insulin resistant.
Weight gain was identified as a risk of intensified insulin therapy (multiple injections or an insulin pump) in the findings from the Diabetes Control and Complications Trial (DCCT), first published in 1993. It didn’t matter which form of insulin delivery was used. Part of the challenge is getting just the right amount of calories and using just enough insulin to get to tight blood sugar control without causing too much weight gain directly and without making blood sugar too low, making people eat more as a precaution. The use of frequent blood sugar tests can help with that.
Total calories eaten each day is the major issue in a person`s ability to maintain weight. We commonly use carbohydrate counting as the foundation for diabetes meal planning, and so many people with diabetes don`t think about the effect of fats and proteins on body weight. Fats and proteins have a minimal effect on blood sugar in teens with diabetes, but high fat and high protein diets can add a lot of calories and therefore increase weight, regardless of whether the person has diabetes. People on an insulin pump are so happy to "eat what they want, when they want" that sometimes they don`t think about whether they are eating healthy amounts of all food types, not just carbohydrates.
The carbohydrates taken to treat hypoglycemia or low blood sugar can contribute to weight gain in several ways:
1. If blood sugar levels swing from high to low to high again, a person with diabetes may gain weight from the extra calories used to treat hypoglycemia. Day after day, the extra carbohydrate can contribute to weight gain.
2) Some people with diabetes are very fearful of hypoglycemia. This fear can cause over-treatment, either by eating too many grams of carbohydrate or by identifying a normal blood sugar as a "low" blood sugar and treating it. Eating excess carbohydrates can result in weight gain.
3) Since one of the symptoms of hypoglycemia can be intense hunger, some people with diabetes respond to a low blood sugar level by eating 30, 45, 60, or more grams of carbohydrate in a short period of time. If you overeat while your blood sugar is low, you may need additional insulin to prevent a high blood sugar afterwards (it ended up being a snack, not just a treatment for low blood sugar!). Remember, all of the calories eaten affect weight.
4) Many people see hypoglycemia as a good time to "binge" on candy, cookies, and other high calorie, high fat foods. Avoid using "treats" for fixing low blood sugar levels - these foods don`t work well as treatment for hypoglycemia. They turn into sugar more slowly than juice or other fast-acting carbohydrates, and can result in prolonged hypoglycemia until the food finally gets broken down to simple sugars. In addition, the extra calories in these foods can contribute to weight gain.
Keep in mind that teenagers are often overly concerned about their weight. There is a tremendous pressure for thinness, and eating disorders are present in teens with diabetes just as in teens without diabetes. In fact, some studies suggest that teens with diabetes are more prone to eating disorders because of the extra emphasis placed on food. Teens with an eating disorder can be thin, normal weight, or overweight. If you have concerns about your teen`s weight, talk with your diabetes care provider or your primary care provider.
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Nancy J Morwessel, CNP, MSN, CDE Pediatric Nurse Practitioner Diabetes Center College of Medicine University of Cincinnati |
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