I have had many of my pump patients tells me that they thought when they went on an insulin pump, they could eat what they wanted and bolus insulin accordingly. Does this work? A BIG NO. It doesn’t work with injections and it doesn’t work 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, 30g of carbs from broccoli will act completely differently in the body than 30g of carbs from cake. But 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 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 grains) as well as even “real food” that is high glycemic (starches and most fruit) will stabilize blood glucose.
To me, the goal of using technology in managing diabetes is to learn how to PREVENT high blood glucose, rather than always just TREATING it. Let’s take an illustration. Say you were on a dark, dangerous, steep, curvy mountain road. What would you rather have: warning signs and a guard rail at the top to PREVENT you from going over the side? Or would you rather have nothing at the top, but a rescue team waiting for you at the bottom after you’ve driven off the cliff? (Best wishes with that Thelma and Louise.) This is how our current model of healthcare works. No thanks, I’ll take prevention. So this is an area where technology is helpful, pumps, and particularly when used with a CGM that is giving you real time feedback on how your diet, activity and lifestyle is affecting you. Then use that technology to fix those issues* and live a life of prevention.
Bottom line, an insulin pump is a delivery device. While they 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 lifestyle with frequent BG monitoring and adjusting as needed will help you get the most from your insulin pump.
*Some BG 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. This is not what this article is referring to.