ItalianoInsulin remains a cornerstone in the management of both type 1 and type 2 diabetes. However, one of its most frequently reported side effects is weight gain. This can be a point of concern for many patients—whether for cosmetic reasons or due to health implications. In fact, research published in Diabetes Obesity and Metabolism back in 2007 warns that the weight gain linked with insulin therapy can be substantial and may negatively impact cardiovascular health.
For individuals undergoing insulin treatment, unintentional weight gain can lead to dissatisfaction with their therapeutic regimen. Some may even hesitate to begin insulin due to fears rooted in personal accounts or misunderstandings about its side effects. It is essential, therefore, to explore this link more deeply and provide clear, supportive communication with patients regarding this issue.
Why Insulin May Lead to Weight Gain
Administering insulin externally, particularly in individuals with type 2 diabetes who already exhibit insulin resistance, can intensify an already high level of circulating insulin (a condition known as hyperinsulinemia). In such cases, the body struggles to store glucose effectively as glycogen. Instead, much of the glucose is converted into fat through a process called de novo lipogenesis. This metabolic shift contributes to increased fat storage and subsequent weight gain.
Another factor is hypoglycemia, which often stimulates hunger, leading to increased calorie consumption—a well-documented response to insulin use (MacKay et al. 1940; Lotter & Woods 1977). Patients frequently eat to counteract low blood sugar, even before it occurs, a behavior known as “defensive snacking.”
In some cases, the use of insulin may inadvertently grant patients a perceived freedom to relax dietary restrictions. Others may simply regain the weight they had lost prior to diagnosis. Genetic predispositions may also influence how much weight is gained during insulin therapy. Nutritional support and structured eating guidance can help mitigate these tendencies.
Extent of Weight Gain on Insulin
The degree to which insulin contributes to weight gain varies widely among individuals. One particular study monitored 2,179 adults over a 12-month period to track changes in body weight and associated factors. The results, published in Diabetes Care, showed that on average, participants gained 1.78 kilograms, with nearly a quarter gaining over 5 kilograms. Greater weight gain was notably associated with higher initial A1C values, larger insulin doses, and lower starting BMI levels.
Similarly, an article in Diabetes Obesity and Metabolism reported that insulin therapy in type 2 diabetes patients often results in a weight increase between 3 to 9 kilograms within the first year—primarily due to increased fat mass.
Variations in Weight Gain by Insulin Type
The kind of insulin a patient uses can affect the likelihood and degree of weight gain. Basal insulin analogs appear to present a lower risk of weight gain compared to older human insulin options. These newer analogs maintain a more stable release pattern and carry less risk of causing low blood sugar during the night.
Among basal insulins, some studies suggest that insulin detemir (Levemir) results in less weight gain than insulin glargine (Lantus Solostar, Basaglar KwikPen, Toujeo SoloStar).
Strategies to Address Insulin-Associated Weight Gain
When initiating or continuing insulin therapy, it’s crucial to actively monitor and manage changes in a patient’s body weight. A multi-pronged approach can enhance the patient’s overall treatment outcome.
Prepare Patients for What to Expect
It’s important to have honest conversations with patients about potential weight gain, explaining why it might happen. Understanding their worries and showing empathy goes a long way in building trust and cooperation.
Promote Healthy Eating and Physical Activity
Educating patients on how their food choices and physical activity levels affect their condition is key. Offering specific advice about what to eat and when to eat can be highly beneficial. Regarding physical activity, the American Diabetes Association recommends integrating both cardiovascular and resistance training exercises into the routine.
Emphasize Adherence to the Prescribed Plan
Sticking to the prescribed insulin regimen is crucial. Patients must be cautioned never to reduce or discontinue insulin without medical advice, even if they are concerned about weight gain.
Consider Additional Medications When Suitable
Combining insulin with other drugs is common. For instance, metformin is typically well-tolerated and may assist in reducing body weight. GLP-1 receptor agonists are another option that may help. Any adjustments or additions to the patient’s medication plan should be closely supervised, especially because they can influence insulin dosage requirements.
FAQs on Insulin and Weight Gain
Why does insulin make weight loss difficult?
Starting insulin can complicate efforts to manage weight, particularly if patients don’t adjust their diet and activity levels accordingly. A diet rich in simple carbs but lacking in fiber can spike insulin and glucose levels, triggering hunger. This, combined with defensive eating to avoid low blood sugar, can lead to overeating.
How do blood sugar levels affect body weight in diabetics?
Fluctuating glucose levels are closely tied to body weight. High blood sugar often correlates with weight gain, especially in individuals prone to insulin resistance. Managing blood sugar through smart dietary decisions helps stabilize energy levels and caloric intake, ultimately supporting both weight control and glucose regulation.
Can GLP-1 agonists be used alongside insulin?
Yes, though there are some considerations. Medications like Wegovy and Ozempic may heighten the risk of hypoglycemia when used with insulin. Nevertheless, co-administration is possible. According to the journal Drugs, when adding a GLP-1 receptor agonist, insulin dosage should be reduced—typically by around 20%—particularly if the patient’s HbA1c is already at or below 8%.