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Ask a Dietitian

Ivan Chan

We’re excited to have launched a brand-new section in Membership Matters: Ask a Dietitian! 

Each month, we’re answering a common nutrition question from our community. This month, we’re exploring a popular one: “Since being put on insulin 6 months ago, I have put on a lot of weight. Is it normal for this to happen when using insulin? I am a type 2 diabetic.”

Since being put on insulin 6 months ago, I have put on a lot of weight. Is it normal for this to happen when using insulin? I am a type 2 diabetic

There may be two possible reasons for this:

  1. You may be having too much insulin, resulting in you having to eat to keep your blood glucose levels from going too low
  2. Some people lose weight (without trying) before starting insulin (less common in type 2 diabetes). This happens because blood glucose levels have been too high, and the body is removing glucose through the kidneys in urine, leading to weight loss. Starting insulin may reverse this weight loss, hence appearing to gain weight.

Let’s first look at how insulin production changes over time in type 2 diabetes. Over time, the insulin-producing cells (called beta cells) in the pancreas can’t keep up with the body’s needs, so people produce less of their own insulin. Starting insulin injections to manage type 2 diabetes is a common and often necessary part of treatment. This insulin tops up the body’s own insulin supply and helps the body absorb glucose again, a form of energy or fuel for the body.

It is common to gain around 2kg in the first year of starting insulin, before stabilising.

As a growth hormone, insulin works in three ways:

  1. Insulin helps glucose in the blood enter muscles and other cells so you can use it for energy
  2. Once your cells have enough glucose, insulin helps store excess glucose as glycogen in the liver and in muscle cells
  3. When your liver stores are full, the remaining glucose converts to fat as a secondary energy source.

So, if you eat more carbohydrate than you use up, you will store the excess glucose first as glycogen, and then as fat. This can result in weight gain.

Having too much insulin can lower your blood glucose levels too much. This can cause a “hypo”, or hypoglycaemia, which is where blood glucose levels are too low (glucose levels under 4mmol/L). You would then need to treat the hypo by having more carbohydrate, e.g., 6-7 jelly beans, 150mL sugary drink to rapidly increase your blood glucose level. Do re-check your blood glucose again after 15 minutes to make sure the level is back in your target range. If you need carbohydrate to treat hypos, it means that you are eating or drinking more energy (kilojoules) than you were before.

If you have frequent hypos, or if you find that you “need to eat” to keep your blood glucose levels steady, then you may be taking too much insulin. The best way to safely reduce your insulin dose is to ask for help from your doctor or diabetes nurse educator

Author: Ivan Chan (Accredited Practising Dietitian at Diabetes Victoria) 

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