Putting on weight with insulin - what to do?

HI there,
It is a very frustrating position to be in and sometimes insulin is treated as the be all and end all and nothing else is important.

I would certainly encourage you to stay on insulin as managing blood glucose levels well is important to minimise complications.
When people start insulin there is generally weight gain as insulin is a growth hormone.

Having said that, it is possible to increase exercise and decrease your food intake and hopefully this will decrease your insulin needs and help with weight loss.

The mixed insulins give you less flexibility so it may be useful to see an endocrinologist about taking the quick and long acting insulins separately- it means more injections but if you are interested in exercising more and eating a bit less- this is necessary for weight loss- it increases flexibility and decreases your risk of hypos and the need to eat more to prevent hypos.

Don't give up perhaps you just haven't found the right diabetes team to manage all your requirements yet.

All the best.

Unfortunately there is no easy solution but that doesn't mean that it's hopeless. You are not alone feeling depressed about your weight but it is also important to know that you can lose weight without exercise.
A lot of people get stuck in a diet mentality and that often leads to a vicious cycle of deprivation, guilt and depression- there definitely is another way which may have more moderate weight loss results but what you lose is sustainable weight loss.
If you are interested, I have written a book on this sort of stuff- it's called Body Warfare and you could check out the first chapter on my website www.bodywarfare.com.au - it may help get your head in a different space for weight loss.
Good Luck!
Lisa

Starting Insulin often means you can gain weight because now the food ( energy) you are eating is now being absorbed better by the body and used as energy better and if it is too much converted to fat and cause weight gain.

It is important to keep taking your insulin even though you are frustrated with your weight gain and  get the help you need.

You are in a very difficult situation not being very mobile and active because of your back pain and arthritis so it is going to be hard for you to maintain a healthy body weight. But you can do it but it requires a lot of effort and dedication from your part.

The amount of insulin you need is worked out roughly on the amount of food you eat. Other factors do play a role like how well your body uses insulin , hormones, how much insulin you body is producing and activity. Some you are unable to control but some you can,  being your food intake and exercise.

I would strongly recommend you see a Physiotherapist who is experienced in your arthritis and back pain who is able to recommend an exercise  program that you are able to do without causing you any harm. They may be able to link you in with a community exercise programs (e.g. community care ) available for you. This exercise will help you use the insulin you are giving yourself better so you will not have to take more than you need. It will also help you maintain your weight as this will be your first goal and to stop the weight increase. It will be very difficult but with the right guidance and support is very important and will help you achieve your goal.

With you food because you are not very active you do not need so much. So the challenge is getting enough nutrients from your food for your health and wellness without eating too much to put on weight. Also if you are experiencing hypoglycaemia with your insulin you can tend to eat more which is adding extra energy which can go on as fat. It is very important to treat Hypos but more important to prevent them and keeping these to a minimum helps weight maintenance.

Your weight gain indicates you are needing help. I would encourage you to see a multidisciplinary team with diabetes specialist, Dietitian and physiotherapist which may be part of a Community Health Service in your area so you can get the help you need.

Lisa & Elizabeth have given us very good answers thank you. I agree wholeheartedly that it is important to always revisit lifestyle factors, every step of the way in T2D management.

Especially when there is weight gain in T2D, it is thought to be linked with poorer glycemic control and less likely to attain a wide range of metabolic targets.

The latest international guideline on obesity management have suggested that there are certain types of insulin regimen that should be preferable initiated to prevent weight gain (1).

Without going into the details of the regimens, as that would be beyond the scope of this forum, it is advisable that you seek review with your GP, consider seeing a diabetes educator, dietian, exercise physiologist if you haven't already seen.

Best wishes,
Dr Kevin Lee

Consultant Physician Endocrinlogist.

https://www.facebook.com/kevinleeFRACP
 

1.    Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al. Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015 Jan 15;:jc20143415. 

Lap banding is an alternative, have you considered this? 

There are several factors at work to lead you to believe that insulin is "to blame" for your weight gain.  People who have poorly controlled diabetes also sometimes experience weight loss because their bodies are unable to properly convert food into energy. This is because they either are not producing enough insulin or their bodies are unable to use the insulin they produce properly. This food winds up as excess glucose circulating in the blood (resulting in high blood glucose!). Ultimately the body can't use all that extra glucose circulating in the blood and so it is eliminated in the urine.

When your blood glucose runs high, you can become dehydrated as your body works to clear itself of all that excess glucose — which makes you think you've lost weight, but you've only lost water. Then, when you start taking insulin and get your blood glucose under better control, you start over-retaining fluids initially to make up for your dehydration, which makes you think you've rapidly gained a lot of weight. You associate it with taking insulin, but really what is happening is taking your insulin properly is just enabling your body to better use food and maintain a proper water balance.

Also, once you start taking insulin injections and start getting your blood glucose under control, you now have enough insulin circulating in your blood to help the glucose get into the body's cells where it can be used as energy. So the glucose produced by the food you eat is no longer spending time in your bloodstream and being excreted out as urine. You gain weight.

Your high blood glucose may have also made you feel more hungry because not all the food you were eating was able to get into the cells as energy to nourish the cells. Then, you started taking insulin — and continued to eat the same amount of food. Only this time, because your body has enough insulin to process the food you're eating, you gain weight. Before, you were getting away with eating more food because your body couldn't use it properly. But once your blood glucose are in a more normal range, you're just using the food properly — and you gain weight.

Some people quickly come to associate taking insulin with weight gain. They will sometimes cut back on their insulin and let their blood glucose run high once they discover they can lose a few pounds in a few days times by doing so. Unfortunately, when they go back to using the right amount of insulin to maintain good control, they are dismayed to discover that they gain the weight back — and perhaps more — in equally rapid fashion. Manipulating insulin to lose weight is an unhealthy pattern to get into. Letting your blood glucose run high can lead to long-term complications — and up and down weight problems when you try to bring your blood glucose back to a normal range.

When you begin taking insulin, discuss with your health team how to address your weight concerns. It may mean making adjustments in how much you eat. You will need to eat enough to make sure you don't have a low blood glucose reaction, but perhaps not as much as you have been eating to offset the problems caused by having had high blood glucose for a while. Commencing a regular exercise regime should help with weight loss. Reducing your food intake will allow you to reduce your insulin injections together with the exercise should result in both better blood sugar control and you dropping a few kilos.