March 17, 2016
An Insulin Pump Cannot Help a Bad Diet
I have had many arguments with people with type 1 diabetes with insulin pumps when they say they could eat what they wanted and bolus insulin accordingly. Does this work? I don't believe so. It doesn’t work with injections and I don't believe it works with pumps either. Matching insulin to carbs is nowhere near an exact science. This is true whether taking injections or pumping. There is huge margin for error. The error can come from inaccurate food labeling. It can come from “estimating” our carb intake. It can come from how our body is absorbing the insulin itself (what degree of resistance we have).
Not to mention that a carb is not a carb. Pumps take into consideration carb quantity, not carb quality. For instance, 30 grams of carbs from broccoli will act completely differently in the body than 30 grams of carbs from cake. However, in your pump, these will both receive the same insulin coverage.
Next, eating whatever we want and taking insulin to cover it will cause weight gain and increased insulin resistance, whether we are on injections or a pump. Also, most insulin users are unaware that a portion of the protein we eat turns into glucose as well, particularly if you are an adult and sedentary and are eating more protein than you need.
Therefore, a low carb high fat approach is really necessary to avoid complications with pump use. Eating less carbs, thereby using less insulin, will reduce the margin for errors. See Dr. Bernstein’s law of small numbers here. Choosing better quality carbohydrates like non-starchy vegetables and eliminating processed and refined carbs like sugar and all grains as well as even “real food” that is high glycemic, like starches and most fruit, will stabilize blood glucose levels.
Just remember, an insulin pump is a delivery device. While pumps are wonderfully convenient and can even decrease insulin usage, as well as reduce the number of needle sticks, they can’t work miracles. They can only do their best with what you give them to work with. Eating a healthy, whole food, low carb high fat way of eating with frequent blood glucose monitoring and adjusting as needed will help you get the most from your insulin pump.
Some blood glucose fluctuations are not caused by factors that can be prevented, like elevations during “growth spurts” in children, hormonal changes or other physiologic processes that cannot necessarily be prevented. Add to these stress, lack of sleep, infections, and other causes.
Yet with all this, most of the type 1 people I have met recently are convinced they can eat what they want and cover with insulin. They have refused to consider any other way even though several are gaining weight and a couple are way overweight.
Our honorary type 1 member knows how important this is and has been forced to keep quiet because other type 1's don't believe her and even ridicule her for the way she eats. When she was in high school and active in sports, she did eat more, but still tried to eat low carb high fat with extra protein. Now that she is in college and not active in sports, she has been more careful in her way of eating.