Insulin and Weight Gain

This blog about insulin and weight gain is one of the better blogs on the topic I have read. It is written by a certified diabetes educator (CDE), so I will need to be cautious. I do have a greater understanding of the difficulty of losing weight as a person on insulin. Would I go back to oral medications if I could – no way – the management of my diabetes as a person with type 2 diabetes is so much easier and more effective than any oral medications.

Have I had hypoglycemia from taking insulin? Yes, but very rarely. In the almost 13 full years of being on insulin, I can still count the number of episodes on ten fingers and have a couple to spare. Is my carb counting that exact – I doubt it, but I don't inject all the insulin at once and generally test to see if I might need more and how much more. In general this means keeping my blood glucose levels under 150 and closer to 120 two hours after eating. For the few times I get above 150, I immediately add the extra insulin to assure myself of bringing it back down to approximately 90 at four hours.

In a few of the author identified blogs, Nora Saul at the Joslin Diabetes Center, does an excellent job of explaining why people have such a large problem with weight gain and lays the blame squarely where it belongs, on both the patient and doctor. The patient for not wanting insulin and the doctor who encourages patients to stay on oral medications. It is this treatment of last resort that makes for problems of weight gain. It is also the myths about insulin and the fear of the patient and doctor about hypoglycemia that prevents using it early on when it would be more beneficial.

Both the patient and doctor need education in the use of insulin to make it an efficient treatment without the fear of hypoglycemia. Plus what many people forget, by starting insulin use early, this allows the pancreas some rest instead of complete burn out and not requiring the quantity of insulin when the pancreas is all but done and insulin is used as the treatment of last resort.

Also important is the consideration of nutrition and exercise, which is often easier before the weight gain. Quoting Nora Saul, “one reason people with type 2 diabetes often see the pounds pile on after they begin taking insulin is that they've waited too long to start.” I have written about this before and do believe this to be very true.

Please read the full blog by Nora Saul for her full explanation of what happens when you as the patient and your doctor avoid the use of insulin until it is absolutely necessary. You are not doing yourself any favors and only damaging your body by letting your blood glucose get too high and thereby undermining the normal metabolism of carbohydrates and fat. I have several Type 2 friends that can agree that waiting too long to start insulin is not a good idea. They will tell you it is better to start early.

Many people are not educated in counting carbs correctly and then enter the vicious cycle of hypoglycemia and eating to correct it. They often eat too many carbs for correction and then develop hyperglycemia – too high a blood glucose level. Another problem is the injected insulin (the short acting) stays in your body about twice as long than your own insulin ever did and as a result, you end up feeling hungry. This is when you need to learn that you don't need food, and must force yourself to avoid food.

Eating at regular times becomes more important to know how to gain the advantage of ignoring the hunger as too many people feed the hunger and the management of diabetes goes out the window. It does take some discipline at the start, but with time the hunger pangs will subside and become easier to manage.

She does recommend seeing a CDE for education, but I would urge you to see a good dietitian or nutritionist, specializing in diabetes, that may not push the old American Diabetes Association way (unless you are a patient at Joslin Diabetes Center), but will use the new guidelines of individual needs and desires being more important. The key here is balancing the nutritional aspects of the food you eat and learning that the old ADA way often has too many carbs which will (I mean will) help increase your weight and keep you on an upward trend. You will need to adapt to the number of carbs that works for you and does not increase your weight.

When you take insulin, glucose is able to enter your cells, and glucose levels in your blood drop. This is the desired therapeutic goal. But, if you take in more carbohydrates than you need to maintain a healthy weight — given your level of activity — your cells will get more glucose than they need. Glucose that your cells don't use accumulates as fat, hence the weight gain. Therefore to prevent weight gain, be prepared to reduce the number of carbohydrates you consume on a daily basis.

Some Diabetes Drugs Cause Weight Gain

This is something you need to be aware of and lower the amount of carbohydrates you consume when you receive your diagnosis of diabetes. Weight gain is a complaint about many diabetes medications, both oral and insulin. Sulfonylureas, thiazolidinediones, and insulin do cause weight gain because they help the body absorb nutrients and move glucose into the cells for use and storage, which causes the initial weight gain.

Metformin and incretin mimetics usually don't cause weight gain and may even cause a little weight loss and they are considered weight neutral. Many people say they don't want to start insulin therapy because it causes weight gain. Most people keep eating the same foods they have been eating and do not reduce the amount of carbohydrates they consume and this is the main cause of weight gain.

What many people do not realize, if your blood glucose levels are consistently high over a period of time, and your medication is not controlling your blood glucose levels, your body tries to get rid of the excess glucose through the kidneys. If this continues for long enough, you will have kidney damage or one of the diabetes complications. Dialysis can result and this is not favorable for your health. This is the reason for lowering the carbohydrates you consume.

Hypoglycemia can also cause weight gain. If you've ever had low blood sugar, you know that feeling of anxiety you get that makes you overeat to get your blood sugar back up. Some pre-mixed or intermediate acting insulins require that you eat on a schedule. If the dose is too high, you may need to eat extra snacks to avoid low blood glucose, which then leads to weight gain. If this happens, work with your doctor or diabetes educator for assistance.

If you overeat, you gain weight. Just because you can "take insulin to cover it" doesn't give you free reign to overindulge. This is what many people unfortunately continue to do and this is not good. This is when people blame the insulin and forget that it was what they did that caused the weight gain. If they would have reduced the amount of carbohydrates they consumed, the extra insulin would not have been necessary and the weight gain would have stopped before it became a problem.

What can you do to prevent or minimize weight gain? Here are a few tips:

• Exercise and maintain a healthy food plan.
• Use glucose products to treat low blood glucose instead of eating junk food.
• Get help from your doctor or diabetes educator if you find you're eating to keep your blood sugar up. You may need a medication change or insulin dose adjustment.
• If weight gain is a concern, ask your doctor for other medication options. However, realize that reducing the amount of carbohydrates will stop weight gain.

Many Psychiatric Drugs Cause Weight Gain

I have been fortunate in my life to have never needed any psychiatric drugs. While I have had two periods of minor depression during my battle with diabetes, and a few weeks after my first wife passed from cancer, I was fortunate that I had some people around me that pushed me into a positive attitude after my wife passed and told me to find the positive in her passing.

Now that I know what the drugs do to people taking them, I will need to refuse them if a doctor attempts to prescribe them for me in the future. In the medical community, antipsychotics are well known to cause significant weight gain. Gains of 20 to 35 pounds or more over the course of a year or two are not unusual. Doctors seldom warn patients about this side effect. The situation is not uncommon, according to psychiatrist Matthew Rudorfer, chief of the somatic treatments program at the National Institute of Mental Health, who points out that although the U.S. Food and Drug Administration carefully tracks acute side effects such as seizures, it pays less attention to longer-term complications such as weight change. Perhaps taking their cue from the FDA, doctors tend to downplay weight-related risks that accompany many psychiatric drugs, Rudorfer says. For many, the weight gain is not trivial.

Antipsychotics

According to a 2014 review of eight studies, as many as 55 percent of patients who take modern antipsychotics experienced weight gain. This is a side effect that appears to be caused by a disruption of the chemical signals controlling appetite. Olanzapine (Zyprexa) and clozapine (Clozaril) are the top two offenders, as studies have shown that on average these drugs cause patients to gain more than eight pounds in just 10 weeks. These two drugs also bear the highest risk of metabolic syndrome, which encompasses weight gain and other related disorders, including type 2 diabetes, according to a 2011 study of 90 people with schizophrenia.

Antidepressants

A 2014 study of 22,610 people revealed that antidepressants generally cause more modest weight gain than antipsychotics, although the outcome varies greatly from one drug to the next. Of the 11 antidepressants analyzed, mirtazapine (Remeron) caused the greatest weight gain, followed by paroxetine (Paxil). A quarter of those who took mirtazapine for a year gained more than 7 percent of their initial weight. Only one antidepressant, bupropion (Wellbutrin and other brands), was associated with a small degree of weight loss.

Depression itself, however, is linked with an increased risk of becoming obese, according to a 2010 analysis that included more than 58,000 people. The reverse holds true as well, the study found; obese people are more likely to suffer from depression. As a result, “it is easy to misattribute the weight gain to a medicine when, in fact, it may largely be related to the illness being treated,” cautions Richard Shelton, a professor of psychiatry at the University of Alabama at Birmingham.

Stimulants

Typically used to treat attention-deficit disorders, stimulants such as Ritalin are consistently associated with weight loss. Many stimulants are specifically marketed as antiobesity drugs, including phentermine and lisdexamfetamine dimesylate (Vyvanse), which earlier this year became the first drug approved for the treatment of binge-eating disorder. Although the evidence is limited, early studies have shown that some young adults abuse prescription stimulants for weight-loss purposes. About 12 percent of the 705 undergraduate participants in a 2013 study reported that they had attempted to lose weight by taking a stimulant without a doctor's prescription.