Is weight gain an inevitable result of using insulin to treat type 2?

Dear Diabetics

I have named insulin the make fat drug. Is this a fair label? What strategies should we employ to minimize this nasty effect? Of course the fundamental law input-output=accumulation is very true. Reducing input is hard when you are constantly starving, any thoughts? Increasing output is a good idea, but after 1 hour of exercise per day I am wiped out, gone are the days of 40 mile bike trips, any thoughts? Very low carb diet, does it increase depression ? Have any of you been trapped in the ballooning spiral of hunger, more eating, more insulin, more hunger, more eating, …? And of course any comments from type 1 diabetics would also be very welcome.

I’m undiagnosed as to Type at the moment, so I’m sure my experience wouldn’t hold for everyone. I started on insulin in April. I keep my meals to 30 grams of carbs and hardly ever snack - or if I do, it’s on low fat popcorn or small amounts of nuts etc. I’ve kept my BS in really good range, and lost 20 kilograms (35 pounds) during this time. I’ve found that reducing my carb intake has helped a great deal with the depression - I haven’t felt this good for a long time. My mood it much more stable and I feel less hungry.

When I first started counting carbs and reducing them it was a major shock to my system. I had been so used to eating huge amounts of carbs that I didn’t realise I was eating far too much. Now that I’ve reduced them, I don’t really miss them as much as I thought I would.

type 1 here. I don’t think insulin causes inevitable weight gain, although I gained a bit weight myself after diagnosis. But it is extremely important to figure out your correct dosages to avoid wild blood sugar swings, so you don’t have to feed the insulin. Anytime I feel hungry right after a meal, I know I’m on my way to a low, because I bolused too much.
What insulin do you use?

Dear Kat.

About 40 units of Lantus(basal) and about 30 units of Novorapid (a fast insulin, action within 15 minutes and action over in 4 hours) . Does any one have any thoughts on the split of the basal versus bolus insulin? I know they are interchangeable and if you inject every hour or pump you can live only on the fast acting one.

This is not a tremedious amount given that I unfortunately weight at 250 lb. Body weight is a very constant 250 lb (@ 6ft, 1 in gives a horrible BMI of more than 30) with little fluctuation. I am a bit puzzled by this it is like driving a car perfectly parallel to the road but 1/4 mile into the fields.

Blood sugar are also quite stable but a bit high. 7 day average is 150 which includes fasting and after meal results. The 30 day average is 170. I have been trying to eat a low carb diet in the last 2 weeks and it does show in the improved BG.

I was also trying to do 1 hour of exercise every day but the temperature today here minus 30 so my wife pronounced it too cold to go the the gym.

Dear Megan.

Thanks for your input. It is certainly probably that getting used to a low carb diet takes some time and maybe like most addictions the withdrawl symptons are not easy. It is good news to hear that reducting the carbs helped improve your mood.

As far as I know there are no definite rules regarding the amount of basal and bolus, because everyone is very different. You don’t need Lantus with the pump because it constantly dispenses small amounts of fast acting that has the same effect of keeping your blood sugars stable between meals and during the night and I suppose you could inject fast acting every our to avoid Lantus without a pump but who would want to be a full time diabetic like that?.

Regarding the low carb diet, I would start small and reduce carbs slowly (you could set weekly goals) and never to the point where you can’t have a tomato on your salad because it has half a gram of carbs too many. You won’t experience any immediate weight loss that way, but it might be easier to get used to low carb and maintain that diet for a long time. Additionally I recommend switching to whole wheat products, they are usually more filling, because they take longer to digest.

And last but not least, the whole BMI concept is seriously flawed. Just look at the people here:
According to their BMI most of them are obese and thats just ridiculous. They look perfectly normal. So I wouldn’t worry about your BMI and instead concentrate on a healthy diet with regular exercise (even if you can’t go to the gym every day) to loose weight until you feel comfortable with yourself even if that leaves you a few lb too heavy according to some stupid chart :wink: Good BG is far more important. At least that’s my opinion.


I have both lost weight and gained weight while using insulin. It really depends on what you eat, especially the carbs.

If you have your doses set up right, you should not be hungry. If you use basal insulin (Lantus, for example) It won’t cover meals. Raise Lantus doses high enough to cover meals and you may be hungry the rest of the time because you will have much too much insulin working.

Using fast acting at meals, matching the dose to the carb intake should prevent hunger. Just like a normal person, if you eat a lot of carbs, they will turn into body fat.

Using basal insulin and a low carb diet is very compatible with weight loss.

Low carb eating flattens out blood sugar swings and those swings make a lot of us feel rotten. Just remember it takes about 2 weeks to adapt to a lower carb diet, so don’t make any judgments until the two weeks are over.

It definitely makes it hard to keep type 2s from gaining weight, especially if you use only insulin for blood glucose control but keep following a low-fat but high-carb diet and therefore increase your need for insulin. If your liver makes fat from any excess carbs, that fat usually goes to your fat cells. If you eat fat instead, that fat tends to be used to give your body more energy as long as you don’t eat too much of it.……

Also, the hunger resulting from a low-carb diet is likely to go away after a few weeks; this tends not to happen for low-fat diets.

Could the weight loss be because his doctor told him to lose weight and he’s doing it, despite the difficulty caused by the high insulin?

Dear Kat.

Thanks for the moral boost. It is true that the BMI is not perfect but by any other measure I am extremely obese. The waist circumference is over 45 inches and my wedding pants do not close by about 9 inches. Most of the weight is in the tummy where it is the most damaging. As my fried Dr. Cox explained the grease in the male is intimately mixed with the organs and is biologically active contributing to inflammation and insulin resistance. This is not as less harmful reserves in the female. Even then the mechanical aspects like wearing out the knees will occur. Image have a money belt with 50 pounds of coins tied to your tummy day and night.

Dear Jenny. Thanks for the insights, I will persist in a low carb diet. When I asked my Endo he said that his patients that have adapted one have lost weight. This goes against the food doctrine preached by the ADA and that is parroted by its Canadian counterpart.

Dear Renee.

If one knew what is causing America to become massively overweight and had some solution not involving effort then they could become a billionaire without using a Ponzi scheme.

When I was Erez age I don’t remember any of the boys being significantly overweight. My friend Ben knew one. He went to Israel and either “volunteered” or was drafted. Well the Army put a 50 lb pack on him and marched him 20 miles a day in the desert for as long as it took. Surprisingly He did not die then and there and was normal weight for at least 10 years after.

This may be a simplistic view that the lack of physical exercise is the main cause of the problem. When I first became obese I was doing a lot of physical work. Insulin resistance and obesity I think are a chicken and the egg problem. I don’t think it is a simple as one directional flow: get obese and then get diabetes.

I am wondering if the millions of chemicals we have produced since the last war have any input into this problem. Also Edison may have destroyed the possibility of getting enough sleep which is a major contributor to the weight problem as is any other stress.

The main problem is that America is toxic when it comes to lifestyle: physical inactivity and constant abundance and advertising of food… I was told that I was undermining the economy because I took my bicycle to buy a gallon of milk instead of driving. My son sits all day at work in front of a computer agonizing over the software needed to account for the flow in the Alaska pipeline giving him both stress and physical inactivity. He comes home and sits in front of the computer killing aliens. He used to play basketball once a week but a serious car accident put a stop to this. By miracle now he goes to the gym a couple times a week with his Polish friends. The only thing that saves the day so far is that he could not be bothered to eat, so in spite of being 6’ 4 "and 190 lb he eats very little.

Well whatever the underlying philosophy Erez is on the right track by loosing weight. I was able to control my diabetes in the begining by loosing from 265 lb down to 185 lb by a 1500 calories per day diet and a lot of exercise. I don’t know how much was will power or how much was physiological. Lately I went to a discussion of a draft PhD thesis on the methods used by people with diabetes to loose weight. There were 2 obese males, one obese female and one slim male. Wow, I asked the slim male was it superior will power? No he said, it was metformin. In this case reducing the insulin resistance reduced the weight. It may be as Frederich the Great said: Everyone should be allowed to go to heaven in his own way.

Dear Robert.

Thanks a lot for your comments and attachments. These are radical ideas and I will give them a prolonged read before commenting in detail. My gut feeling that a lot of this or all of it is true and that we may have been grossly mislead. Well being brought up in the cold war and taking as God’s truth that we had to spend trillions to destroy Communism. Now we are told we have to spend trillions to bail out the banks, the auto, forest products, steel, farming, … etc. Communism? It is hard as an old Dog to learn new tricks.