Insulin and Weight Gain

Hi, Back in March, I was diagnosed with Type 2 that is very difficult to control – Highs 400-500 and Lows 40-50. I am on 80 units U100 Tresiba/day and ~50 units U200 Humalog per meal/snack. I have gained a profound amount of weight and fat around my middle. I’m on a low carb diet, but I’m still gaining weight. My Endocrinologist plans to increase the Humalog dosage, and I’m afraid I’ll gain even more weight. My C-Peptide is very high. I would love to hear from someone as to how I can control this weight gain. Thanks in Advance.

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Hi Deb:

Welcome aboard. A lot depends on how motivated you are to get your numbers in line and how disciplined you can be to get there on your own with your endocrinologist. Since you have a long way to go, you may want to try a service such as

to work with you and help you make relatively quick, sustainable progress. On this board we can tell you what has worked for us but then it is up to you to try what you think might work best for you. The trial and error period is going to take quite a bit longer than using a service that knows what they are doing, follows you closely and gives you help and encouragement along the way.

This is just one thought and many others should soon chime in. Either way we will be here to support you in any way we can. Thanks for joining our group. We all learn from each other here.

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I agree with @CJ114’s recommendation on Virta Health. Their comprehensive program includes coaching that doesn’t leave you on your own. If you research their program, you will find them highly successful in helping their clients to sustain their efforts to rein in blood sugar and also lose significant weight.

Don’t get me wrong. Motivated people can do this on their own but doing it as part of a fully supported program will give you a greater likelihood of sustained success. Welcome to the community!

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@DebraJ I have no experience with the “Virta Health" program. Gleaning facts from your post, Debra, i sounds like you are extremely insulin resistant. That is a lot of bolus insulin, 50u of U200 would be 100u of U100. I base my opinion on you having a high C-Peptide, indicating you are secreting a lot of insulin on your own and the large amount of basal/bolus insulin.

As @CJ114 said, we can only share what has worked for us. Part of the problem is there is no really cookie cutter therapy that works for everyone.

I find I get the best results for increasing insulin sensitivity is 80% long steady aerobic type exercises with 20% strength type exercises to prevent muscle loss and perhaps increase some muscle.

The largest skeletal muscles in the human body or in our legs. Skeletal muscles can use a lot of glucose and store it in the form of glycogen. Muscle glycogen is really only for the use of the muscles, unlike liver glycogen which is converted to glucose and released into the bloodstream.

Brisk walking, hiking, cycling, swimming, rowing, skating and skiing will cause the muscles to use up their stores of glycogen which then needs to be replenished by glucose from the blood.

You don’t mention that your endo is prescribing anything except insulin. There are three oral drugs that increase insulin sensitivity, Metformin, Actos and Avandia. I can attest to Metformin increasing insulin sensitivity. I am type 2 DM on multi daily injections. After 6 months on MDI I spoke to my doctor about decreasing the max dose of Metformin I have been taking for years by half. (2000mg per day to 1000mg).

To keep my time in range in line I have increased my bolus dose by 1/2 units. Not a large amount and my weight is holding steady.

I have concerns about the other two drugs, Actos and Avandia, considering the side effects of Metformin, while annoying, is less dangerous.

One thing I’ve learned in the past 30 years with type 2 DM is the need for proper diet, daily exercise and stress relief. These 3 are a must do, drugs and insulin may be needed in addition, but don’t work well without diet, exercise and stress relief.

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What are you calling low carb?
under 50g a day is what I would be looking at. Everything is free on the net, but if you need help to get it in place, Depending on the cost, Virta has credibility.

Avandia made my feet swell and darken. I gained 20pds on Avandia,

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I didn’t know about those side effects. I found this interesting -

Always good to learn new stuff.

It’s my understanding that concentrated insulin doses measured in units of insulin are equal to all other concentration formulas. Ten units of U100 insulin = ten units of U200 insulin = ten units of U500 insulin.

The difference between these formulations is the volume of the dose. For the exact same dose in units, U200 insulin is one half the same volume as a U100 dose. U500 insulin is one fifth the volume of the exact same number of units as the U100 dose.

U100 means that there are 100 units of insulin per mL. The number of units in a 10 mL vial of U100 insulin is 1000. In a 10 mL vial of U200, the total number of units is 2000. And in a 10 mL vial of U500, it’s 5000 units.

This distinction of concentrated insulin can cause confusion. The important thing to remember, for safety, is that in order to dose the correct number of units, the syringe or pen calibration and markings needs to be matched to the insulin concentration being used. Using a pen ensures this match. If using a syringe and vial, care must be taken to use a syringe that is calibrated for that insulin concentration.

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@Terry4 I guess I can’t reply to your reply. I just wanted to thank you for that. I was just assuming I understood the various concentrations of insulin. Silly me, I know there are syringes for U100, U200 and so forth. I just never put the two things together.

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@Luis3 – This is a common misconception about insulin concentrations, Luis, one that I shared not too long ago. I had forgotten what I was taught early in my diabetes career.

When I was first diagnosed back in the '80s, medical people made sure to emphasize that I always used a U100 syringe to inject my U100 insulin. U40 and U60 insulin was in common use not too many years before my diagnosis in 1984. I guess that many serious dosing mistakes were made due to mismatching various insulin concentrations with their corresponding syringes.

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Welcome, @DebraJ !

Depending on your and your endocrinologist’s attitude to drug cocktails, you might want to add Ozempic to your list, even on top of metformin. (IMHO, Victoza is similar to Ozempic, but I greatly prefer two injections a week to two injections a day. Most people get one or one, not two, I think.) Some people find the side effects of Ozempic very unpleasant, but I don’t find it as bad as metformin.

Advice I got from a pharmacist: Try to use more long-acting insulin instead of boluses of short-acting. He claimed that there is research to back this up, but I haven’t checked.

Advice I got from a dietician-DE: Never let yourself get the feeling that you can cheat on carbohydrates, especially on sweets, and repair the damage with extra insulin. That’s the path to weight gain.

Good luck.
M.

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Hi, I’d like to thank you all for your responses to my posts. I have extreme insulin resistance, as evidenced by the somewhat large amount of insulin I’m taking. My Endocrinologist has told me that my type 2 “presents” like type 1 and is “brittle” as well. Starting today, I’ll be going up another 5 units of the Humalog. I must inject 55 units (U200) per meal, and if I eat even a small snack, I must inject another 15-20 units. It seems like a lot of insulin to me, but it’s controlling the really high highs that I was getting. (At least I’m not going to the emergency room as often.)

My last C-Peptide was 7.1 and my last A1c was 10.2 I’m watching my complex carbs very carefully and I’ve cut out simple carbs all together. I can’t exercise much as I’m disabled and wheelchair bound. You guys are probably thinking “too much information” at this point.

I’m kind of hoping that someone who reads this is in the same boat as me.

Thanks again for all the suggestions, information and kind thoughts.

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I’d like to add that I am definitely using the Humalog U200, not the U100. Also, I’m using 80 units of long acting Tresiba U100. Next week, my Endocrinologist will be prescribing an oral medication as well. I was on the long acting alone and my fasting glucose was 350+.

You need to count the carbs. They all raise BG. I lost 20lb and got my A1c to 6, sitting on the lounge

This is 20g and a good place to start, You may need to reduce your insulin by 50% so you don’t hypo

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Chair exercises will help with insulin insensitivity.

Unfortunately weight gain is common with insulin, especially when you first start using it. One of the possible problems is it looks like you are on a set dose per meal.

I was misdiagnosed for over 8 years and given hardly any guidance. They had told me 1 unit per 3 carbs and then they had me just take 25 units per meal etc. The problem and I think you are having it, is you then eat extra when you crash because you are eating to your insulin dose. It is important with insulin to dose to what you actually eat otherwise you eat extra and will gain more weight.

So honestly, you need to carb count and find the right dose per carb to take. And a lot of people have to take a much smaller amount of insulin for proteins and fats too, But when you are taking more insulin than you need you are just going to make yourself gain more weight and make yourself more insulin resistant. You need to take the dose you actually need so you are not eating extra. This also follows for your basal insulin. I am not a type 2 or low carb so I can’t help you much with proper timing.

The only reason I am talking about the carb counting thing is you talk about highs in the 400-500’s, but then you are crashing to the 40’s and 50’s. I know you have also said that the higher dosing has kept you out of the emergency room as much too. But if you are crashing that indicates too much insulin was used. It’s possible it’s a timing issue.

But I have run across some people on some blogs that need huge amounts of insulin, way more than you are even taking. It happens. I am just worried about the crashes that you have talked about in the 40’s and 50’s.

I really second individualized help from someone. I am not familiar with the program listed but I think you could use the hands on input from a program like that.

Exercise of any kind is critical. It forces the cells to use and to take in insulin better. The wheel chair throws in a huge problem obviously. I am wondering about one of the machines you spin with your arms like you do with your legs when biking? Also maybe depending if you can do some exercises or minor weight lifting exercises ( 2 or 5 pounds?) with your arms to help?

I am on Humalog U-200. Originally it was prescribed because they wanted to make sure that I could keep an Omnipod pod on for 3 days. It turns out I didn’t need it as my insulin usage dropped significantly with a insulin pump. I would take enough insulin to cover a meal, and a snack, Then I would have to make sure I ate that meal amount and snack. With a pump I could give myself what I actually needed and I dropped my insulin dose over half of what I used to use and stopped the weight gain. I stayed with it as I liked it. But again I am a type 1…

Humalog U-200 pens are easy. 1 unit is one unit, just half the volume, so the pen holds double. That is probably why they won’t ever come out with a vial, too much danger in messing up the volume/dosing thing.

I hope at least some of this can help, it can be very frustrating to not know how to fix something you want to fix. Diabetes is a learning curve that you do get better at.

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insulin doesnt really cause weight gain. The issue is that the glucose that you were peeing out into the toilet is now being kept and used as energy. When you have too much it turns into fat.

It kinda sticks that better control means you will gain weight, but its better than neuropathy kidney disease and blindness.

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You need to allow for the effect of insulin resistance. so insulin, the storing hormone works differently for T2. In IR T2 cases it makes IR worse and there is a cycle of weight gain and more insulin. IR T2 is having too much insulin in the first place. Adding more doesn’t help. Other than to get glucose out of the blood and store it. IR T2 is primarily treated with diet.

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Hi Jack16, Thanks for the information. I wish it were that simple. I’m extremely insulin resistance. For 3 years I was on long acting insulin and an oral medication and a low carb diet. That helped for quite a while. Then, quite suddenly, without changing my diet, my fasting glucose jumped up from 90-110 to 350-425. My non-fasting averaged 450-600. (It used to be 115-120.) That’s why short acting insulin was added. Plus, I had some pretty serious problems due to the insulinemia. Last Fall, I suffered a severe illness that damaged my liver and pancreas. The doctors believe this could have caused my diabetes to become a serious problem. Who knows? My blood glucose levels are much better, but still not totally under control.

Believe me when I say that I’m on a low carb diet, i.e. less than 55 carbs per day. I have been on this diet for quite a while. Also, my weight has remained essentially the same for the past 20 years. Since March, I have gained ~40 lbs, centered around my middle, despite a low carb, low calorie diet. Although I have concerns regarding gaining so much so quickly, I’m dedicated to doing exactly what my Endocrinologist, at Duke University, advises. (I understand the mechanisms/morbidity of diabetes quite well, so I know the risks of non-compliance.)

I made my post primarily to find out if there’s anything one could suggest to slow or stop the weight gain. Other than starving myself, that is. (My Endocrinologist has strongly advised against this.  ) Anyhow, thanks again for the information and for responding to my post. Take care.

If I were you, I would consult with Dr. Eric Westman, a primary care doc, internal medicine, and medical weight management specialist at Duke Health.

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