Insulin Resistance and weight gain

One of the side effects of insulin is weight gain. I've finally started losing weight after going from BMI 19 to 24. I've had to increase my exercise and reduce my calories, and intermittent fast. I eat keto also, which means I need less insulin. There have been no shortcuts. I wish it were easy, but it hasn't been. Good luck.

In Response said:

My understanding is that one of the side effects of excess insulin is weight gain.
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Actually, it's a general side effect. I don't have insulin resistance nor take excess insulin but still increased my weight from 63 kg to 81 kg without eating very much. Here is the Mayo Clinic reference:

https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/insulin-and-weight-gain/art-20047836#:~:text=Weight gain is a common,your overall diabetes management plan.

Well done @In Response for not gaining weight, but neither myself nor @Emck can relate to this.

As you can see, my lastest HbA1c was 5.3% so I'm all for tight BS control, but the more carbs I eat, the more insulin I needed to cover them, and if I'm insulin resistant (or even without insulin resistance), that becomes a problem.

In Response said:

@ert, the article you referenced says
“But if you take in more calories 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.”
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It is true that if you have more calories than you need, then you gain weight. But on insulin it would appear that I only need 1000 calories to maintain weight and 800 or less to lose, which is tough going.
Of course, we are all different, but still, in general, using insulin one does find it easier to gain weight, and I can eat a lot fewer calories as a result of it, once eating 1800 calories at 63 kg with the same exercise regime, but no insulin.
Again, I've never skipped insulin and had my blood sugars rise with a HbA1c of 5.3% that's not an issue, which you've raised again. Eating fewer carbohydrates means less insulin, but with propper dosing to maintain BS's.

The starting point is that as much insulin as is required to keep blood glucose in the target range should be used. I think we all know this, even newly diagnosed T1s. If this results in weight gain, calories need to be reduced and insulin adjusted accordingly. It doesn't really matter where the calories come from - carbohydrate, fat or protein. Newly diagnosed T1s often gain weight after insulin therapy starts because they now metabolise all the food they eat. Especially the carbohydrates. Before diagnosis there may have been a calorie deficit and after insulin treatment starts there is a calorie surplus, without changing the amount of food eaten.

Achieving stable weight is part of the the process starting insulin treatment involves. For some it is more difficult than others. After 43 years of T1, I still manage my weight actively. I weigh myself 3 times a week and make incremental changes to diet /insulin to ensure that my weight stays on track.

Hiya, it’s so disheartening when our diabetes keeps evolving and making life more difficult - I do sympathise. I’ve had T1 for about 40 years and my diabetes has been described as ‘brittle’. Your HbA1c is enviable- well done! - but you don’t mention your testing. I’ve found the Freestyle Libre very useful - it shows how volatile my wild fluctuations in my blood glucose levels are; so my own (HbA1c of 6.7 or thereabouts most years) turned out to be an average of 1.2 and 20-odd! It’s very difficult to plot blood sugar fluctuations if you’re rationed to 5 or fewer blood test strips per day. Santa got me a FitBit too. Normally I’d hate all these gadgets, but they’ve helped me to get a much better picture of what’s affecting my blood sugar most. I’m still exploring changes I can make to pull in my blood-sugar fluctuations. I’ve cut right down on high GI carbs after seeing the incredible blood sugar spikes after meals (I’m talking cutting down on wholemeal pasta or granary bread - I never did eat much white flour - even wholegrain foods give me a humongous blood sugar spike - not the gradual spike I’d expected) and I managed to lose half a stone since moving to Medtronic’s CGM system. I try to keep my bmi below 22 as I have a small build, but I have to work very hard to keep my weight down by exercise and very careful low-carb dieting. I’ve found some of Dr Michael Moseley’s books very interesting, especially the Clever Guts Diet book (I think that’s the title), which sheds some light on the relationship between types of food and weight gain, without focusing on calories! If you’re getting desperate, it might be worth a read - a few diet tweaks without anything daft or extreme might help (high fibre, low in refined carbs and cutting out processed foods as much as you can manage). Good luck and try not to beat yourself up about your diabetes-management - your HbA1c is great!

Emck said:

... It does just feel very hard to work out regularly, eat a healthy diet and achieve minimal progress. I feel like insulin does work against me in that regard. Given that my basal is so high, the diet that I eat is only a small part of this.

Has anyone had success with any treatments for insulin resistance, other than metformin?

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Insulin resistance is not well understood, but diet and exercise are major factors. They are also controllable variables. Eating ketogenically has been the the strongest driver of insulin sensitivity for me. It means getting almost all calories from fat and protein. The body is retrained to to use fat instead of glucose for energy. Insulin is no longer required for metabolising carbohydrate. In my case insulin requirements, both bolus and basal, were reduced substantially.

I use half as much insulin as I needed before. Managing weight has also become much easier. Regular exercise (30 minutes a day) is an important part of the therapy. The hard part is sticking to the discipline. Eating even small amounts of carbohydrate throws the body out of dietary ketosis and benefits of it are lost.

Emck said:

Thanks for the responses all!

I think I've sparked a bit of a heated discusssion, which wasn't my intention. I would never suggest that anyone should skip their insulin in order to reduce weight gain.

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Hi,

Rest assured you haven't.

Regaining insulin sensitivity is an individual journey.

& you have my best wishes on your path.

For anyone who is interested here is Dr Ian Lake on Double Diabetes (insulin resistance in type 1s)

NicoleC1971 said:

For anyone who is interested here is Dr Ian Lake on Double Diabetes (insulin resistance in type 1s)

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Interesting presentation. I am very aware of the insulin sensitivity issue. Eating very low carb has certainly reduced the effect and smoothed blood glucose out. I suspect T1s are more vulnerable to declining insulin sensitivity than many of them ealise.

NicoleC1971 said:

For anyone who is interested here is Dr Ian Lake on Double Diabetes (insulin resistance in type 1s)

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Interesting that it's stated that having type 1 doesn't prevent you from developing type 2 if your IR increases over time. Also, injecting 20 to 40 Units a day is equivalent to a normal person's insulin load without diabetes. Above this, is the road to IR over time.

ert said:

Interesting that it's stated that having type 1 doesn't prevent you from developing type 2 if your IR increases over time. Also, injecting 20 to 40 Units a day is equivalent to a normal person's insulin load without diabetes. Above this, is the road to IR over time.

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Now that is interesting. I have always wondered how much (on average I guess) a non diabetic's insulin output would be. I know it would depend on what is eaten and many other variables but it's still interesting. I use around 6 units of novarapid throughout the day and 8 units of Lantus once a day, so 14 units a day. I eat around 130 carbs on an average day so nothing too extreme either way and I exercise at least 3/4 times a week. So I wonder why my overall insulin amount is so much lower than a 'normal' person then? I guess it could be that I am still producing some of my own insulin that adds to the 14 units? Who knows but fascinating stuff.

KK123 said:

... I use around 6 units of novarapid throughout the day and 8 units of Lantus once a day, so 14 units a day. I eat around 130 carbs on an average day so nothing too extreme either way and I exercise at least 3/4 times a week. So I wonder why my overall insulin amount is so much lower than a 'normal' person then? I guess it could be that I am still producing some of my own insulin that adds to the 14 units? Who knows but fascinating stuff.

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Insulin requirement of an insulin sensitive person is about 0.5 units per Kg of body weight per day. That works out to 35 units for a 70 Kg person per day. It is lower with low carb so it looks like you are making a fair amount of your insulin. I eat low carb, I weigh 73 Kg and I use about 30 units of insulin a day. People with insulin resistance and who are fully dependent on injected insulin use over 1 unit/Kg daily.

I am 47, had type 1 for 30 years. I am insulin resistant and brittle diabetes. I'm on the pump, libre and metformin.
I've tried alsorts if ways to lose weight but just continued to gain.
Started slim pod this year, the 16:8 IF. Now finally I'm losing some weight. Almost a stone at the moment but strangely my body measurements have remained the same! Yes I drink plenty of water.
I've done low carb no carb so many times over the years. But still have to take similar amount of insulin for a green salad as a sandwich!!
For years my team had no explanation on this then last year they said ketogenesus where my body gives me the missing sugars so of course low to no carbs won't work on me !
Frustrating as this is something I've heard a lot over the years

The things that I do know for sure is that due to M.E., and the hyper vigilant function being permanently switched on, my body reacts with a stress response to so many things.
A noise makes me jump
I've to organise my banking
Pay a bill
Do a chore
Go to the shops
Etc etc
In goes the adrenaline and up goes my blood sugars!
Then I spend ages trying to get my bloods down which can take a lot of insulin and a whole day or more

My fitbit has really helped stop my weight creeping up. My BG doesn't really respond to carb counting which is odd - it more seems to require a certain number of units around the same time each day.

megan said:

... For years my team had no explanation on this then last year they said ketogenesus where my body gives me the missing sugars so of course low to no carbs won't work on me ! ...

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This doesn't make much sense. These things can be easily misunderstood. Ketogenesis is the process whereby stored fat is used for energy. It is exactly what the body needs to do to lose weight. The body only does this if adequate glucose is not available, which is why eating low very low carb (ketogenically) is an important part of the process.

For a ketogenic diet to work, it has to be done properly and becoming fat adapted takes up to 6 months. For there to be weight loss, calories from other sources (protein and fat) may also need to be restricted. Exercise improves insulin sensitivity, which helps especially when there is insulin resistance.

Sounds like too much liver glucose is a problem. Have you tried using Metformin to help deal with it?

Note also that, apples to apples, a type 1 diabetic needs more circulating insulin than someone whose pancreas delivers it directly to the liver through the portal vein. In theory this might actually make it easier for a type 1 to become hyperinsulinemic (resistant). Albeit with exogenous dosing.

Hi all. So I’ve been T1 diabetic for 23 years and up until 10 years ago, weighed 50kg (I’m a female 5 foot 3). I’m now 72kg and put on weight after having kids aka being a house mum. Past 4 weeks I’ve been walking and running 5k, each time getting faster and yet... no weight has come off. My diet is clean and I’m taking less insulin. Doctor put me on metformin with no change except for upset stomach. So I’m interested in the keto diet and changing my body to use fat for energy. Can someone with experience guide me what this entails? What kind of breakfast and lunch/dinners do you have... what snacks can you have? I take tresiba at night of 21 units and take about 17 units of novorapid during the day (I’ve dine dafne) but that’s my average. I have lean legs but my upper body is large... just can’t seem to budge a single pound despite being in 600 calorie deficit everyday. I wear a Fitbit and always weigh myself on same scale, same place and same time if day.

T1losingTheChub said:

Hi all. So I’ve been T1 diabetic for 23 years and up until 10 years ago, weighed 50kg (I’m a female 5 foot 3). I’m now 72kg and put on weight after having kids ....

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What has happened to you happens to lots of non-diabetics too. It seems hormones have a lot to do with it. Doing a keto diet is certainly worth a try. I simply removed all carbohydrate from my meals. If you do this, be sure to adjust insulin dosages accordingly. Basal may also have to come down as the body uses more fat for energy.

For breakfast I have an egg dish made in the microwave - 3 eggs and 50 grams of cheese, to which I add some combination of mushroom, onion, broccoli and cauliflower. Only the onion has some carb in it. For lunch I have a chicken, tuna or salmon salad, at this time of year with avocado. Also add some combination of capsicum, tomato, cucumber and riced broccoli/cauliflower. For supper I have a portion of frozen protein food, done in the slow cooker and stored in portion sized containers, together with cooked vegetables.

For me the biggest challenge is avoiding use of carbo to treat low blood glucose. It can take a while for insulin doses to be adjusted suitably and unexpected exercise, stress or eating out messes up the process. Eating carbohydrate stops ketosis, which is required for fat to be used for energy. This may stall weight loss, but don't let it get you down. Also be aware that it can take months of being in ketosis to become fully fat adapted. Retraining the metabolism is not an easy process.