Expert tips to off-set insulin-related weight gain in patients with type 2 diabetes

Marwan Hamaty, MD, MBA

Maintaining a healthy weight is important for controlling type 2 diabetes, but for patients who are taking insulin, this can be more challenging, says an expert from global health system Cleveland Clinic.

Exercising, eating correctly and staying at a healthy weight are at the core of every type 2 diabetes treatment plan, says endocrinologist Marwan Hamaty, MD, MBA, adding that for some people, these steps are sufficient to control their condition. However, in some cases, insulin therapy is among additional treatment options. Its potential side effects include weight gain.

“This can become a cycle for patients who need to control both diabetes and their weight. They may get frustrated when they feel the treatment is part of the problem ― and this might jeopardize their willingness sticking with the treatment program,” says Dr. Hamaty.

Insulin is used when other treatments are contraindicated or are not adequately effective at controlling blood sugar, which is crucial, says Dr. Hamaty. He adds that there are different types of insulin, and certain types are associated with more weight gain.

“In a way, weight gain is a sign that the insulin is working,” says Dr. Hamaty. “Your body is utilizing sugar, fat and protein more effectively and is now able to store nutrients. For this reason, you need to adjust the amount and type of food you are eating to avoid gaining weight, or to start losing weight.”

However, insulin is not necessarily the only factor in weight gain, says Dr. Hamaty. “Frequent urination and thirst are two common signs of diabetes and, left uncontrolled, diabetes can lead to dehydration. When you’re managing your diabetes well, your body has a better chance to rehydrate, which can show as a moderate increase in weight on your scale.”

Medications taken for other related conditions can sometimes cause a person to gain weight.

Dr. Hamaty recommends three strategies to help individuals manage their weight while taking insulin:

  1. Up the ante on diet and exercise

The most basic, and important, strategy is for individuals to adjust their diet and to exercise, says Dr. Hamaty. “Talk to your doctor and to a nutrition specialist about a food plan that takes the insulin effects into account. Work a bit more activity or exercise into each day and remember that, sometimes, your insulin dosage should be adjusted — usually lowered — when exercising.”

Dr. Hamaty cautions against self-adjusting the dosage or timing of insulin to accommodate eating more calories. You can end up gaining more weight,” he says.

“However, it’s good to self-adjust insulin for the purpose of fine-tuning the dosage. Of course, you want to keep your doctor informed and continually work on good diet and exercise habits,” he adds.

  1. Review all medications

“If you aren’t able to offset weight gain by reducing calorie intake and adding more activities, try evaluating what type of insulin you’re taking,” advises Dr. Hamaty, adding that insulin analogs, or modified human insulin, may cause less weight gain.

Dr. Hamaty points out that some medications for type 2 diabetes may cause weight loss, as a side benefit. “You could discuss with your medical providers whether using any of these medications is appropriate for you. And if used, how to adjust your insulin dosage,” he says. “The reverse is true as well. If you’re taking other diabetes medications with your insulin, find out if weight gain is a side effect of those medications too. Ask your doctor if another medication might be appropriate for you.”

  1. Work out the details with your doctor

“The best thing a patient can do is ask questions. Make sure you understand all the reasons you might be gaining weight, what medications you’re taking that have that side effect and what alternatives are available, as well as their associated costs,” says Dr. Hamaty.

He adds that a screening test for low thyroid hormone (a blood test called TSH) would be appropriate. Typically, it is a part of the routine labs for patients with diabetes.

“Managing diabetes is a challenge, and your treatment plan has to work for you. Talk to your doctor and other healthcare providers and make adjustments until your plan is working well,” concludes Dr. Hamaty.

“If you can effectively make the right lifestyle choices, you can minimize your need for medication. This means lower cost, fewer side effects and an overall feeling of well-being,” he concludes.