Sunday, June 18, 2006

The Weighty Problem

Does anyone else out there feel like weight loss is really a secondary concern when maintaining tight blood sugars?

Turns out that while my A1Cs rock, I've also put on seven pounds since September, when I first started correcting my sugars to keep them as close to 70-160 as possible. This is definitely because of the small hits of insulin I'm taking all day long, particularly after meals.

My endo said she wasn't sure why, if I'm not eating more than usual, why I shouldn't be able to maintain or even lose weight and still take the right amount of insulin. Personally, I just don't feel like I have the energy to try to lose weight. I'm spending all my time checking blood sugars and if I'm low (which happens), treating them with my new favorite phrase, "unfortunate eating incidents," (a twist from Art-Sweet's post), because honestly, most of the time when I'm low, I just feel low and I don't particularly want to eat something that'll just become extra calories I don't want. (Is there a way somehow to treat a reaction and not ingest calories? Seems like a zero-sum game.)

I've usually used Life Savers to treat reactions, since they're very portable and available everywhere. But it irks me when I have to eat a whole pack because my sugar doesn't come up with just three or four of them. (There are about 11 in a regular-sized pack).

I also have inbred the years of being diagnosed as a child in the late 1970s, when exchange diets were strict and there was no such thing as really fast-acting insulin or pumps. I ate what my mother said I could, and really no more under her watch. It's therefore no surprise that whenever I went to a friend's birthday party where candy was plentiful, I'd eat whatever I could. Years later, when I lived alone, I definitely played fast and loose with food (a box of chocolate chip cookies for dinner, eating several bagels with cream cheese all day as my Sunday meals, etc.) Often, it was because I'd been told for years, "you can't eat that," that I rebelled and did just that. (And even though by then I was able to test my blood sugars and take extra insulin through my pump, that still didn't mean I wasn't carrying extra weight, or dealing with the initial high of a blood sugar immediately after eating all that white simple carb, even if the sugar went down a few hours later).

The irony is that today I'm eating as healthily as I can (I now worry that eating non-organic fruit might be damaging me somehow, and actually love most vegetables and try to eat them as often as I can), but figure that eating a roll at dinner (or in my case last night, two pieces of cornbread along with my grilled bluefish), *still* causes me to go high immediately after a meal, even though in two or four hours I'll be where I want to be.

I wish I could try Symilin, but my doc won't prescribe it because it hasn't been tested in women trying to get, or those who already are, pregnant.

I also feel like, on one hand, if I'd stuck with Weight Watchers back in December, I'd be thirty pounds lighter today and wouldn't have to buy larger shorts. But on the other hand, I could be pregnant right now, which means a plan like Weight Watchers is forbidden, so I'm only going to gain weight for the next possible nine months anyway, so don't worry about the size of the fabric stretching across my ass. (Then again, this bigger size is so comfortable that I almost don't care how big it is.... until I see clothes from two summers ago in my closet that I wish I could wear comfortably.)

And the flip side is that I try to exercise every day, and walk a good 30 minutes during the workday just to get to my office from the train station. But I then have a solid commute each way that takes up good time where I'd rather be at the gym. And on days I get home late, I'm often too tired for the gym. And now I'm reading that some docs think vigorous exercise might hinder getting pregnant (although truly, being underweight is NOT my problem and I wonder if the docs who suggest cutting down exercise when trying to conceive are talking to the super skinny types who are prone to amenorrhea), I wonder if going to my gym isn't a good thing until I know whether I'm pregnant or not.

And so that leaves walking, which I try to do. But is walking, as I did on Friday, a good 45 minutes to a store somewhat near my office to buy a Father's Day gift for my dad, really a workout? I wore comfy sandals and walked comfortably, but I wasn't sweating and huffing and puffing. I'd like to think I wasn't just strolling, either. Did that really do anything for me? I even took less insulin at lunch, which I ate just before my walk, but when I got back to the office, I was still 190, so I took more insulin and several hours later had to eat a pack of Life Savers because I was low before dinner.

What also irks me is having a reaction, say, an hour before dinner, but knowing that I was planning to eat a lot at dinner anyway. So again, the calories ingested just an hour before my big meal are just excess. And fuck if I'm going to eat less at that meal simply because I had to treat a reaction an hour before. Is it this sort of defiance that just keeps me gaining weight? I mean, it's not like I *wanted* to treat a reaction at the time I had to.

Some days I figure I'm just destined to be the size I am with the diabetes I have. And other days I think that I've gained two pounds a year for the past ten years and I'd like to reverse the trend. I read about people training for marathons or being athletes and I think, "that sounds like something I'd like to do." But then I think, "well, I'm trying to get pregnant and I can't start a big exercise push at this time."

Where does this leave me? Anyone got any insight? If I got a pump with an insulin on board feature, would it help me keep the weight down (I'm still using a Minimed 508, though it's out of warranty, because I like it and love the clip it has. Is this just being silly? I figure if it breaks I'll order a new pump and just use Lantus for the days I wait for the new pump to arrive.)?


Rachel said...

I don't have much to say, other than I know it was easier for my husband to gain weight (and harder to try to lose it) with lower A1C's. This was when he was consistently 6.4 - 6.8 over the course of several years, but like you said about yourself, he probably overcorrected for lows too often.

Brad said...
This comment has been removed by a blog administrator.
Scott K. Johnson said...

Great post.

Trying to lose weight and keep BG's under control can really be a challenge. The body is such a finely tuned machine (most of the time), it's tough when we have to do part of it manually. Usually doesn't work as well.

The IOB (insulin on board) features of the newer pumps may really help get rid of some of those lows, if they tend to be related to stacking of boluses.

Kelsey said...

My doctor (who has type 1 himself) told me years ago that tighter control would hinder my attempts to loose weight. All the stuff you've mentioned is true and it sucks!

I gained a fair amount of weight during high school due to diabetes. Now, as an adult I've pin-pointed a few reasons why. When I'd have a low at say, 5 am, I'd eat to correct it and then have my regular breakfast before school. Now,if I'm low in the early morning, I'll eat some cereal and consider it breakfast. Then, maybe I'll have an earlier lunch, or I'll just be a little hungry that day!

Anonymous said...

Yup, it's really tough to lose weight when you're in tight control. Exercising is difficult because of the having to eat before, during, and after thing. I know a T1 friend of mine went on Weight Watchers and had to count the juice boxes and glucose tabs as part of her points. She looks great. You can't lose weight with all the extra juice going in unless you count it as part of your daily intake.

Jane said...

No great insight only empathy. My endo told me years ago that the tighter the control the harder it would be to lose weight, and that any other autoimmune diseases like PCOS would make it doubly harder. I had Graves Disease as well as Type I and everyone else I met with that combination weighed about 100lbs and ate all the time. I, on the other hand, put on 20lbs before the thyroid was brought under control!
The only thing that works for me exercise-wise is weight training (ha ironic ha) but it also makes me really hypo a few hours later so I have to eat more/drink fruit juice.
A viscious circle. The only other way is severe calorie reduction -no fun. I'm pinning my hopes on a miracle drug!

caren said...

Oh sister friend, I hear ya! I have to recommend maybe thinking of upgrading your pump. I live by my IOB feature when trying to adjust and correct for mis-counted carbs. It always surprises me to see what is still floating around in me that in the past I would have never accounted for. It may be worth looking into...
Good luck.

art-sweet said...

Oh I feel ya, I really do.

One suggestion that works for me (sometimes) is to exercise after a meal. That way you up your metabolism, and you can just reduce your bolus to give you some carbs to cover the exercise.

FWIW, I'm loving the insulin on board and temporary basal rates on my 722.

J said...

my doc told me that once I stable out with my sugars the body has nothing to feed off of so then the weight stays on.. I had insulin toxidity (sp) I am overweight was using so much insulin to keep my weight down it was making me bloat.. but in order to change that I need to loose weight ..,once I got to joslin and the cut my basil down and increased my ration I lost 20 lbs in3 months it has since stoped but I think it is just not having stable sugars again.


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