My Diabetes Is Controlled — But Why Am I Gaining Weight?

By: Marwan Hamaty, MD, MBA

Exercise, eat right and stay at a healthy weight. These goals are at the core of every type 2 diabetes treatment plan. And, for some people, that’s enough. When it’s not, insulin therapy is one of the treatment options that can help patients. But among the possible side effects is weight gain.

This can become a cycle for patients who need to control both diabetes and their weight. You may get frustrated when you feel the treatment is part of the problem ― and you might jeopardize sticking with your therapy.

With diabetes, getting your blood sugar under control is a crucial task. Insulin is used because it works when other treatments aren’t adequately effective or are contraindicated (shouldn’t be used because it could be harmful to that particular person). The cost of insulin varies. Lower-cost insulin types are associated with more weight gain.

How to break the cycle

In a way, weight gain is a sign that the insulin is working — your body is utilizing sugar, fat and protein more effectively and able to store nutrients.

Typically, your appetite is increased when your blood sugars are higher. (This is a main symptom of having diabetes). When your body is utilizing nutrients better and is able to store them, food intake should be adjusted to maintain the same weight. You’ll need to make further adjustments if you’re attempting to lose weight. If food intake (both amount and types) isn’t adjusted, then you can expect to gain weight.

Also, insulin isn’t necessarily the only factor.

When you’re managing your diabetes, your body has a better chance to rehydrate, which can also cause mild weight gain. Of course, dehydration is a greater risk if you have diabetes (frequent urination and thirst are two common signs of the condition).

Drugs you take for other conditions also sometimes cause you to gain weight.

So what are your options if weight gain and insulin are an issue? Try these three tips:

1. Up the ante on diet + exercise

The most basic (and important) answers are adjusting your diet and exercise. 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. Sometimes, your insulin dosage should be adjusted (usually lowered) when exercising.

Don’t self-adjust the dosage or timing of your insulin to accommodate eating more calories. You can end up gaining more weight. 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.

2. Take a closer look at your 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. Insulin analogs (modified human insulin) are may cause less weight gain.

Some medications for type 2 diabetes may cause weight loss, as a side benefit. You may discuss with your medical providers if using these medications is appropriate for you. And if used, how to adjust your insulin dosage.

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.

3. 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. A screening test for low thyroid hormone (a blood test called TSH) is appropriate.

You’ll also want to find out the out-of-pocket costs for each specific drug. Some are costly and you’ll need to consider whether you can easily afford these medications long-term.

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.

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