How To Manage Your Weight When You Take Insulin

The three goals at the core of every diabetes management plan are the same: exercise, eat well and stay at a healthy weight. And for some people, there’s also insulin.

If you have Type 1 diabetes, insulin therapy has been a part of your treatment from day one. And if you have Type 2 diabetes, insulin could be the missing piece of the treatment puzzle that can help manage your condition.

But one of the possible side effects of insulin is weight gain.

“This can become a cycle for people who need to manage both diabetes and their weight,” says Marwan Hamaty, MD, an endocrinologist who specializes in diabetes and metabolism. “You may get frustrated when you feel that the treatment of one condition is part of another problem ― and that might jeopardize sticking with your therapy.”

Dr. Hamaty explains the connection between diabetes, insulin and possible weight gain so you can better understand your condition and how to manage it.

Why insulin can cause weight gain

To manage diabetes, stabilizing your blood sugar numbers is crucial. When other treatments aren’t effective (or when there’s some reason why you can’t use them), synthetic insulin can help directly lower your blood sugar levels.

But it can also lead to weight gain.

“In a way, weight gain is a sign that your insulin therapy is working,” Dr. Hamaty explains. “It means your body is utilizing sugar, fat and protein more effectively and that it’s able to store nutrients.”

Wait, whaaat? Let’s back up.

High blood sugar increases your appetite. But when you first develop diabetes, you may actually lose weight in the beginning.

“Because you’re not able to use sugars, you’re losing a lot of sugar through your urine and your body is using fat as a source of protein instead,” he adds. “These can lead to weight loss, and you may become hungrier to overcome that weight loss.”

Insulin-related weight gain, then, is a sign that the insulin is doing what it’s supposed to — helping your body utilize and store nutrients better.

Other factors that may contribute to insulin weight gain

The relationship between diabetes and weight is a complex one. Many people who develop Type 2 diabetes are already living with obesity or overweight. In fact, it’s the No. 1 risk factor for developing this condition.

But once your blood sugar is managed, you may find that you’re still gaining weight.

When your body gets better at using and storing nutrients, you’ll need to adjust your food intake to maintain the same weight. And if you’re trying to lose weight, you’ll need to make further adjustments to your diet.

“If your food intake isn’t adjusted — both in terms of what you eat and how much you eat — then, you can expect to gain weight,” Dr. Hamaty says. “Healthy food choices can help you manage your appetite. And remember that your appetite was higher to start with when you had higher blood sugar levels, so you’ll need help curbing your appetite.”

Other factors that can contribute to weight gain include:

• The type of insulin you’re on. The cost of insulin varies, and lower-cost insulin types are associated with more weight gain. “Nowadays, because there is a cap on your out-of-pocket cost of insulin, you should be able to use insulin types (insulin analogs) that cause less weight gain,” Dr. Hamaty shares.
• Better hydration. Diabetes raises your risk for dehydration (which is why thirst and frequent urination are two common signs of the condition). “When you’re managing your diabetes with insulin, though, your body has a better chance to rehydrate,” Dr. Hamaty points out, “which can cause mild weight gain.”
• Other medications. Sometimes, it’s not about diabetes. Are you taking medications for any other health conditions? Ask your healthcare provider if these could be causing weight gain.

Tips to avoid weight gain on insulin

When it comes to weight gain and insulin, what are your options?

“If you can make effective lifestyle changes, you can minimize your need for medication,” Dr. Hamaty states. “In the long run, this means better health, fewer side effects and an overall feeling of well-being.

He shares four important tips that can help you manage your diabetes, while also managing your weight.

1. Change your diet

The most basic answer often lies in adjusting what you eat. You may already have changed your diet when you were first diagnosed with diabetes — but it could need further tweaks.

“Talk to your doctor and a nutrition specialist about a food plan that accounts for the effects of insulin,” Dr. Hamaty advises. They’ll help with a diabetes-friendly diet that can help you maintain or lose weight even while on insulin.

2. Up the ante on exercise

A healthy diet isn’t the only key piece of a diabetes management plan. It goes hand-in-hand with exercise. It’s so important that the American Diabetes Association urges people with diabetes not to go more than two days in a row without it.

“Try to work a bit more activity or exercise into each day,” Dr. Hamaty recommends. Some of the best exercises for diabetes are simple but powerful. Aerobic exercise, for example, can lower your blood sugar level and may even reduce your insulin requirements, so look into activities like walking, yoga and swimming.

3. Ask about insulin adjustments

Dr. Hamaty warns not to try to self-adjust the dosage or timing of your insulin, like to accommodate eating more calories. “You could end up gaining more weight,” he warns. “Plus, sometimes, your insulin dosage should be adjusted (usually lowered) when you’re exercising and/or consuming fewer calories.”

Instead of DIYing it, keep your diabetes healthcare provider in the loop about any changes in your diet and exercise. They can help fine-tune your insulin dosage, timing and even type, if needed.

4. Take a look at other medications

Losing weight can lower your insulin resistance and stabilize your blood sugar, so it’s important to pursue all of the possible factors that could be affecting your weight.

If you’re taking other diabetes medications, like sulfonylureas, mild weight gain could be a side effect. Other medications, like pioglitazone, could cause more weight gain, especially when they’re used along with insulin.

But the reverse is true, too: Some medications for Type 2 diabetes cause weight loss.

Either way, talk to your healthcare provider about other medications you take and whether might be affecting your ability to lose weight.

“Your doctor can help determine whether another medication might be appropriate for you,” Dr. Hamaty explains, “along with whether they need to adjust your insulin dosage or simplify your insulin regimen.”

5. Check your thyroid health

Ask your healthcare provider if another aspect of your health, like hypothyroidism, could be affecting your weight. Dr. Hamaty says a screening test for low thyroid hormone (a blood test called TSH) may be appropriate.

A final word insulin and weight management

Managing Type 2 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 diabetes management plan is working well.

“Make sure you understand all the reasons you might be gaining weight, including medications you’re taking that have that side effect and the alternatives that may be available,” Dr. Hamaty reiterates. “As a patient, the best thing you can do is ask questions.”