Effects of Insulin on Weight Gain Paper

The issues of human health are farfetched. It can never be possible for one to fully exhaust the whole aspect of human health. This is because it may never be easy to identify some of the human habits that we so much cling on as either healthy or unhealthy. Most of the things that we do on a daily basis may seem less dangerous as far as the health of an individual is concerned. However when given a deeper thought and approach, one might well realize that some of these activities pose as great threats to our health (Melloul 2002). A number of conflicting ideas have been put forward concerning the contributions of insulin to weight gain. This discussion shall therefore seek to explore the validity of the above statement. Insulin gets released in the body even when one thinks about food. We therefore ought to explore the truth behind the idea that insulin can end up causing the body to store up energy instead of using it.Effects of Insulin on Weight Gain Paper

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To begin with, insulin can be described as a hormone which is central to the regulating carbohydrate as well as the metabolism of fats in the body. This hormone cause cells in the muscles, liver as well as the fat tissues to absorb glucose from the blood. The glucose is then stored as glycogen both in the muscles and in the liver. The glycogen in these organs is usually stored in large amounts hence the need to use them on a continuous basis. However, when the body system to effectively harness the glycogen it may lead to the under use of energy (Benedict 1997). This is because most of this energy is stored in the raw form and cannot be converted. This may be a factor which can account for a gain in the weight of an individual.Effects of Insulin on Weight Gain Paper

According to the results obtained from a series of studies carried out on different animals, it can be confirmed that a sweet taste can cause an insulin response. This can be explained using the release and storage of sugar in the body. The release of insulin in the body leads to the storage of blood sugar in the tissues. This also includes fats. As a result of that, there is the possibility of an increased food intake the next time an individual eats. This is because when the body responds to an artificial sweetener by producing insulin, there can be increased hyperglycemia due to the fact that blood sugar does not increase. Increased food intake is one obvious factor which can lead to an individual gaining weight so easily. This happens when the fat in the food is not converted to give energy but is instead stored in the tissues.

In line with the above discussion, it is therefore possible to confirm the fact that sweeteners can actually lead to production of more insulin. This happens in the following chain, the sweeteners through the production of more insulin in the body get to trigger an increase in calorie intake. This in turn leads to increased adipose which is actually the accumulation of more fat in the adipose layer (Benedict 1997) . As a result of increased adiposity there comes a gain in weight. According to a research in The University of Texas in the Health Science Center, obesity as well as increase in weight was associated with increased use of diet soda. The study was population based and the results actually revealed that diet sugar which is a substance that greatly leads to the production of insulin caused weight gain and /or obesity to the users Effects of Insulin on Weight Gain Paper

It is therefore clear that weight gain is a possible side effect which may result from the use of insulin by the body. This use varies from one individual to the other. For instance, in some cases, some people produce so much insulin that the body is unable to absorb it all. The inability of the body to balance the production and absorption of insulin can also lead to weight gain (Jorgensen 2004). This is because most of the fat will be deposited under the skin and in the muscles yet only a small portion of it will actually be converted to give energy.

In a nut shell, insulin can cause people to gain weight in so many ways. Insulin may reduce the rate in which glucose is removed from the body. The excess glucose stored as fat may then result in the weight gain.  Secondly, insulin can lead to a condition in the body comprising low blood sugar levels. This may cause an individual to overeat in a bid to correct the low blood sugar levels. When such a habit is not controlled then the body might end up receiving more than it necessarily needs. Consequently, the overeating can lead to the gain in weight.  Furthermore, some individuals think that so long as they take insulin then they are able to eat anything they want. This is a misconception that can easily lead to individuals taking too much for the body without even realizing it. The consequences are therefore manifested only when the side effects of careless consumption begin to cause weight gain.Effects of Insulin on Weight Gain Paper

From the above discussion, it can well be possible to conclude that insulin can be linked to weight gain in a number of ways.  Individuals should therefore monitor their intake of food and of substances that may lead to excessive production of insulin. The production and use of insulin should therefore be maintained at a balanced level. This alone can be the surest way of enhancing the security of a person’s health.

Insulin therapy or intensification of insulin therapy commonly results in weight gain in both type 1 and type 2 diabetes. This weight gain can be excessive, adversely affecting cardiovascular risk profile. The specter of weight gain can increase diabetic morbidity and mortality when it acts as a psychological barrier to the initiation or intensification of insulin, or affects adherence with prescribed regimens. Insulin-associated weight gain may result from a reduction of blood glucose to levels below the renal threshold without a compensatory reduction in calorie intake, a defensive or unconscious increase in calorie intake caused by the fear or experience of hypoglycaemia, or the ‘physiological pharmacokinetic and metabolic profiles that follow subcutaneous administration. There is, however, scope for limiting insulin-associated weight gain. Strategies include limiting dose by increasing insulin sensitivity through diet and exercise or by using adjunctive anorectic or insulin-sparing pharmacotherapy such as pramlintide or metformin. Insulin replacement regimens that attempt to mimic physiological norms should also enable insulin to be dosed with maximum efficiency. The novel acylated analogue, insulin detemir, appears to lack the usual propensity for causing weight gain. Elucidation of the pharmacological mechanisms underlying this property might help clarify the mechanisms linking insulin with weight regulation.Effects of Insulin on Weight Gain Paper

There are several factors at work to lead you to believe that insulin is “to blame” for your weight gain.

People who have poorly controlled diabetes also sometimes experience weight loss because their bodies are unable to properly convert food into energy. This is because they either are not producing enough insulin or their bodies are unable to use the insulin they produce properly. This food winds up as excess glucose circulating in the blood (resulting in high blood glucose!). Ultimately the body can’t use all that extra glucose circulating in the blood and so it is eliminated in the urine.

When your blood glucose runs high, you can become dehydrated as your body works to clear itself of all that excess glucose — which makes you think you’ve lost weight, but you’ve only lost water. Then, when you start taking insulin and get your blood glucose under better control, you start over-retaining fluids initially to make up for your dehydration, which makes you think you’ve rapidly gained a lot of weight. You associate it with taking insulin, but really what is happening is taking your insulin properly is just enabling your body to better use food and maintain a proper water balance.Effects of Insulin on Weight Gain Paper

Also, once you start taking insulin injections and start getting your blood glucose under control, you now have enough insulin circulating in your blood to help the glucose get into the body’s cells where it can be used as energy. So the glucose produced by the food you eat is no longer spending time in your bloodstream and being excreted out as urine. You gain weight.

Your high blood glucose may have also made you feel more hungry because not all the food you were eating was able to get into the cells as energy to nourish the cells. Then, you started taking insulin — and continued to eat the same amount of food. Only this time, because your body has enough insulin to process the food you’re eating, you gain weight. Before, you were getting away with eating more food because your body couldn’t use it properly. But once your blood glucose are in a more normal range, you’re just using the food properly — and you gain weight.

Some people quickly come to associate taking insulin with weight gain. They will sometimes cut back on their insulin and let their blood glucose run high once they discover they can lose a few pounds in a few days times by doing so. Unfortunately, when they go back to using the right amount of insulin to maintain good control, they are dismayed to discover that they gain the weight back — and perhaps more — in equally rapid fashion. Manipulating insulin to lose weight is an unhealthy pattern to get into. Letting your blood glucose run high can lead to long-term complications — and up and down weight problems when you try to bring your blood glucose back to a normal range.Effects of Insulin on Weight Gain Paper

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When you begin taking insulin, discuss with your health team how to address your weight concerns. It may mean making adjustments in how much you eat. You will need to eat enough to make sure you don’t have a low blood glucose reaction, but perhaps not as much as you have been eating to offset the problems caused by having had high blood glucose for a while.

Insulin resistance is when cells in your muscles, body fat and liver start resisting or ignoring the signal that the hormone insulin is trying to send out—which is to grab glucose out of the bloodstream and put it into our cells. Glucose, also known as blood sugar, is the body’s main source of fuel. We get glucose from grains, fruit, vegetables, dairy products, and drinks that bring break down into carbohydrates.

How Insulin Resistance Develops

While genetics, aging and ethnicity play roles in developing insulin sensitivity, the driving forces behind insulin resistance include excess body weight, too much belly fat, a lack of exercise, smoking, and even skimping on sleep.4

As insulin resistance develops, your body fights back by producing more insulin. Over months and years, the beta cells in your pancreas that are working so hard to make insulin get worn out and can no longer keep pace with the demand for more and more insulin. Then – years after insulin resistance silently began – your blood sugar may begin to rise and you may develop prediabetes or type 2 diabetes. You may also develop non-alcoholic fatty liver disease (NAFLD), a growing problem associated with insulin resistance that boosts your risk for liver damage and heart disease. 5Effects of Insulin on Weight Gain Paper

Signs and Symptoms of Insulin Resistance

Insulin resistance is usually triggered by a combination of factors linked to weight, age, genetics, being sedentary and smoking.

– A large waist. Experts say the best way to tell whether you’re at risk for insulin resistance involves a tape measure and moment of truth in front of the bathroom mirror. A waist that measures 35 inches or more for women, 40 or more for men (31.5 inches for women and 35.5 inches for men if you’re of Southeast Asian, Chinese or Japanese descent)6 increases the odds of insulin resistance and metabolic syndrome, which is also linked to insulin resistance.

– You have additional signs of metabolic syndrome. According to the National Institutes of Health,7 in addition to a large waist, if you have three or more of the following, you likely have metabolic syndrome, which creates insulin resistance.

High triglycerides. Levels of 150 or higher, or taking medication to treat high levels of these blood fats.
Low HDLs. Low-density lipoprotein levels below 50 for women and 40 for men – or taking medication to raise low high-density lipoprotein (HDL) levels.
High blood pressure. Readings of 130/85 mmHg or higher, or taking medication to control high blood pressure
High blood sugar. Levels of 100-125 mg/dl (the prediabetes range) or over 125 (diabetes).
High fasting blood sugar (or you’re on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.Effects of Insulin on Weight Gain Paper

– You develop dark skin patches. If insulin resistance is severe, you may have visible skin changes. These include patches of darkened skin on the back of your neck or on your elbows, knees, knuckles or armpits. This discoloration is called acanthosis nigricans.8

Health Conditions Related to Insulin Resistance

An estimated 87 million American adults have prediabetes; 30-50% will go on to develop full-blown type 2 diabetes. In addition, up to 80% of people with type 2 diabetes have NAFLD.9 But those aren’t the only threats posed by insulin resistance.

Thanks to years of high insulin levels followed by an onslaught of cell-damaging high blood sugar, people with insulin resistance, prediabetes and type 2 diabetes are at high risk for cardiovascular disease. Insulin resistance doubles your risk for heart attack and stroke – and triples the odds that your heart attack or ‘brain attack’ will be deadly, according to the International Diabetes Federation.10

Meanwhile, insulin resistance and metabolic syndrome are also linked with higher risk for cancers of the bladder, breast, colon, cervix, pancreas, prostate and uterus.11, 12  The connection: High insulin levels early in insulin resistance seem to fuel the growth of tumors and to suppress the body’s ability to protect itself by killing off malignant cells. 13

Research has also found a strong association between insulin resistance and memory function decline, increasing the risk for Alzheimer’s disease.Effects of Insulin on Weight Gain Paper

How You Can Prevent or Reverse Insulin Resistance

Losing weight, getting regular exercise and not skimping on sleep can all help improve your insulin sensitivity. Don’t rely on dieting or exercise alone: in one fascinating University of New Mexico School of Medicine study, published in the International Journal of Obesity, overweight people who lost 10% of their weight through diet plus exercise saw insulin sensitivity improve by an impressive 80%. Those who lost the same amount of weight through diet alone got a 38% increase. And those who simply got more exercise, but didn’t lose much weight, saw almost no shift in their level of insulin resistance.14 

Turn in on time, too. In a study presented at the 2015 meeting of the Obesity Society, researchers found that just one night of sleep deprivation boosted insulin resistance as much as eating high-fat foods for six months.15

Over the years Americans have been getting higher fasting insulin and hemoglobin A1c blood levels. A study from Life Extension Magazine showed 66% higher than desired fasting insulin. Twenty-Two percent had hemoglobin A1c levels that placed them in a pre-diabetic state.

Hemoglobin A1c measures the percentage of glycated hemoglobin in one’s blood. Hemoglobin A1c levels should be below 5.6% yet more than one in five people test over 6%.Effects of Insulin on Weight Gain Paper

Gaining access to this kind of information can prevent severe diabetic related illness. Insulin is a hormone that regulates carbohydrate and fat metabolism. Insulin enables liver and muscle cells to take up blood sugar (glucose) for energy production or storage. Insulin also helps to pack glucose into the fat cells as triglycerides.

Once a burst of insulin is released in response to food ingestion, insulin levels should drop below 5 uIU/ml and only a small amount of insulin should be needed to maintain balance.Effects of Insulin on Weight Gain Paper

When the fasting insulin levels are above 5 uIU/ml, this indicates a pre-diabetic state that increases the risk of degenerative disease. In people with metabolic disorders or obesity insulin levels remain elevated. While this creates cellular damage it also prevents weight loss by forcing glucose into the fat cells as storage.

In a condition called hyperinsulinemia the pancreas stimulates the uptake of glucose from blood into the body’s cells. The inability of the body’s cells to utilize the insulin is called insulin resistance.

In hyperinsulinemia the pancreas produces more insulin than normal so there are higher levels of insulin circulating in the blood stream. Normally to process 10mg of sugar a person would have to produce one unit of insulin, but in a person with hyperinsulinemia, ten units of insulin may be needed to balance that same 10 mg of glucose. Hyperinsulinemia also called insulin resistance create many health problems including high triglycerides, low HDL and type II diabetes along with obesity. If you haven’t tested your lipid levels you should consider having an Advanced Diagnostic Lipid Panel  done this test gives you more than just a basic lipid panel, it also tells you the particle size of cholesterol. This provides a great deal of information about early stage heart health and if reactive insulin is causing your lipids to be abnormal.

Unfortunately, despite the numerous peer-reviewed studies mainstream medicine has not made a priority in measuring these levels and doing what is needed to prevent chronic illness with early intervention.Effects of Insulin on Weight Gain Paper

High insulin levels promote hypertension by impairing the proper release of sodium. High insulin harms the kidneys and prolongs exposure to high insulin damages the vascular system. It can also increase the risk of certain cancers. High insulin can also promote formation of beta-amyloid brain cells, which may contribute to the development of Alzheimer’s disease. Over production of insulin also contributes to prostate enlargement by promoting the overgrowth of prostate cells. High insulin is also associated with abdominal obesity, which contributes to atherosclerosis and impotence.

The excess elevation of blood sugar after eating meals can create as many complications as having a high fasting insulin level. High postprandial (after meals) blood sugar, accompanies an insulin surge, are significant to the development of age-related disease, along with microvasculature (small blood vessel within eye, kidney’s, and nerve supply). Studies show that men with the highest levels of post-load glucose, insulin and measurements of glycemic imbalance had the greatest number of blocked coronary arteries. Studies like this prove that blocking that surge in after meal blood sugar and insulin is an important goal for optimal longevity.

You can now request your own metabolic profile, fasting insulin, blood glucoseand hemoglobin A1c on your own. You may want to add it to a Female and Male weight loss profile. These test results can assist in measuring what type of risk factors you may be dealing with and more importantly will let you know what type of lifestyle changes are necessary.Effects of Insulin on Weight Gain Paper

There is a form of liver disease caused by hyperinsulinemia also known as non-alcoholic fatty liver disease. It is noted by an infiltration of fat into the liver, which impairs the livers function. A 2013 study reviewed patients affected with primary liver cancer and found a high prevalence of liver cancer in type II diabetics.

A 2012 study looking at college students found 8 out of 22 subjects had hyperinsulin with fasting insulin levels greater than 19 uIU/ml. Studies of older people with this conditions reveals damaging processes occurring early in life.

A 2013 study showed over a ten-year period of time that type II diabetics treated with insulin augmenting drugs had an 80% increased risk of experiencing cancer, an adverse cardiac event or death from patients who only received the drug metformin, which lowers insulin levels. A drug class known as sulfonylureas stimulates pancreatic insulin secretion and temporarily reduces glucose. By giving type II diabetics insulin-augmenting therapies instead of lifestyle changes, nutrients, and metformin the medical community has creates higher risks of weight gain, neuropathy, renal failure and atherosclerosis and cancer.

Once a person is diagnosed with cancer, it is essential to suppress excess insulin secretion. This is because insulin not only initiates cancer it stimulates the proliferation of malignant cells.

Alzheimer’s disease is the fastest growing threat to the United States, according to a 2013 team of researchers from University of Washington in Seattle.

Known causes of Alzheimer’s include mitochondrial dysfunction, oxidative stress, and chronic inflammation. A 2012 described how insulin is involved in the metabolism of beta-amyloid and concluded that insulin resistance is involved in the pathogenesis of neurodegenerative diseases including Alzheimer’s.

This information could be devastating if we did not have lifestyle changes and ways to adjust these high insulin levels. Most people do not realize that starches are broken down in the intestines and produce rapid elevation of after-meal glucose and insulin blood levels. Even if your fasting blood levels are normal but you have spikes in blood sugar/insulin after meals too high or too fast there will be increased risks of cardiovascular disease.Effects of Insulin on Weight Gain Paper

A natural enzyme has been discovered to reduce after meal blood sugar and insulin spikes in a unique meal. This enzyme converts rapidly digestible starch in the intestines into a fiber that is not readily absorbed as glucose. Wide spread use of this enzyme before starch containing meals could help reduce the epidemic of glucose intolerance and hyperinsulinemia that plagues the modern world.

The first step to creating an environment that prevents the rise in blood glucose and insulin is to restrict starch consumption that is all starches (breads, pastry, pasta, and flour based products). Begin doing daily activity, move your body! Begin doing activities like Yoga, walking, biking or your favorite physical activity. Begin using nutritional support that helps to break down starch, enzymes that promote good digestion, carnitine that helps promote weight loss these are just a few items that can help weight management.

If you’re a woman with diabetes, have you ever cut back on your insulin — perhaps just a little — because you’ve discovered that you can lose a few pounds in a few days by doing so? And then, when you go back to using your normal amount of insulin, are you dismayed to discover that you gain the weight back — and perhaps more — in equally rapid fashion? Over time, have you come to blame the insulin for your weight gain problems, so you take less insulin than you should — even though you’re blood glucose runs higher as a result?

Over 40 women with diabetes, many of whom admitted to having let this familiar thought process influence their diabetes program, came together at Joslin’s second Women and Diabetes symposium recently. The day-long symposium attracted nearly 100 women with diabetes who heard talks on topics ranging from the interrelationship of diabetes, menopause, and heart disease, to a session on having a healthy pregnancy if you have diabetes. One of the most popular sessions, however, was entitled “Living on the Edge.” Presented by Joslin dietitian Karen Chalmers, M.S., R.D., C.D.E., who is the Director of Nutrition Services at Joslin, the session examined the balancing act women with diabetes encounter as they try to keep blood glucose in a safe range — and their weight down too.Effects of Insulin on Weight Gain Paper

“Most of the women at the session on insulin and weight gain were between 20 and 55 years old or so,” notes Chalmers in an interview after the symposium. “Some were on intensive insulin therapy, but others were doing insulin manipulation to lose weight. This is a fairly common kind of problem in women with diabetes. Weight loss is a big challenge — nearly an obsession — with many women in this day and age. Our society is so hung up on being thin, and these women begin to feel that taking the right amount of insulin is causing them to gain weight, so they start cutting back, letting their blood glucose run high to stay thin.”

The “Weight Watchers” generation

The baby boomer generation is the first generation to be raised by mothers who were highly weight conscious, Chalmers believes. “Baby boomers have been called the children of the Weight Watchers generation,” says Chalmers. “As a result, we have more of a dieter’s mentality.Effects of Insulin on Weight Gain Paper

“When I asked the group at the seminar ‘How many people have ever been on a diet?’ every hand went up. ‘Five diets?’ Still every hand went up. About half the people in the seminar had been on 10 diets or more. I had a woman in my office recently who had spent over $10,000 on diets in the past seven years, and she’s now the heaviest she’s ever been in her life.”

People attending the seminar were comfortable enough in the hour-long session to admit in front of others that they manipulate their insulin dosages to lose weight. But as Chalmers explained to them, it’s not their insulin alone that is causing them to gain weight or preventing them from losing weight. And while taking less than the correct amount of insulin will lead to rapid weight loss, the weight lost will be mostly water and muscle being broken down, and not all fat. “And losing weight that quickly is unhealthy — not to mention the fact that keeping your blood glucose high makes you increasingly prone to long-term diabetes complications,” she says.

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High sugars equal weight loss

But how do so many women come to believe that insulin is a root cause of their weight loss battle?Effects of Insulin on Weight Gain Paper

“When you don’t take the right amount of insulin and your blood glucose run high, you can become dehydrated — which makes you think you’ve lost weight, but you’ve only lost water,” Chalmers says. “Then, when you start taking your insulin in the appropriate amounts again, you start over-retaining fluids initially to make up for your dehydration, which makes you think you’ve rapidly gained a lot of weight. You associate it with taking insulin, but really what is happening is taking your insulin properly is just enabling your body to better use food and maintain a proper water balance.

“Or, maybe you are using less insulin and as a result your blood glucose will run high. High blood glucose can make you feel more hungry because not all the food you are eating is able to get into the cells as energy to nourish the cells. Then, when you’ve lost the weight you wanted to lose, you start taking the right amount of insulin again — and continue to eat the same amount of food. Only this time, because your body has enough insulin to process the food you’re eating, you gain weight. Before, you were getting away with eating more food because your body couldn’t use it properly. But once your blood glucose is in a more normal range, you’re just using the food properly — and you gain weight.”

Others who are using intensive insulin therapy may find they are gaining weight simply because they are over-treating low blood sugar reactions with too many calories, she says.

Some of the women on intensive therapy noted that the results of the DCCT showed that people on intensive therapy are prone to modest weight gain. “So they ask me, ‘How do you expect me to lose weight when I’m on intensive insulin therapy? Doesn’t insulin prompt you to cause your body to store weight as fat?’ But that isn’t what’s happening at all. It’s these other metabolic processes that are causing the weight loss, and the weight gain.”Effects of Insulin on Weight Gain Paper

Weight gain principles — women are different

Women are more prone to weight gain — whether they have diabetes or not — for a variety of biological and lifestyle reasons. For example, women store fat more easily than men because female hormones tend to promote the formation of fat. Before puberty, boys and girls have about the same amount of body fat. Then after puberty (by around age 20), girls have 22 percent body fat, and active boys only have about 10 percent.

“In a nutshell, male hormones keep muscle mass high and fat levels low. Female hormones do just the opposite,” says Chalmers.

The specific way men and women gain weight is different too. Women deposit fat from the bottom up — they gain weight in the thighs and buttocks first, then the stomach, and then finally on the upper body, arms, etc. Men gain weight first in the stomach — “the classic big beer belly.” Whatever fat is gained first is the last to be shed — which is why it is so hard for women to lose weight on their thighs and rear end, and why weight loss seems to happen first in the face, neck and upper body.

Why skipping meals promotes weight gain

There are a host of lifestyle reasons that lead to weight gain, too. Skipping meals actually causes your body to gain weight over the long haul, because when you skip meals, your body slows down its metabolism and becomes very efficient at conserving calories (instead of burning calories). “Your body does this to protect you, because your body doesn’t know when you’ll feed it again — it stores more calories as fat so you’ll have reserves on hand for the next time you skip a meal.

“So if you eat little or nothing during the day and only eat at night, you’re promoting higher weight — even if you aren’t eating more total calories than you might have eaten if you ate three square meals a day — because your body is going to conserve more of those calories as fat.Effects of Insulin on Weight Gain Paper

The same thing happens to those who go on super low calorie diets. “If you are on too low a calorie amount, your metabolism is going to slow down and your body will adapt to being starved. So, super low calorie diets do not work long-term,” she says.

The key to weight loss is not fooling with your insulin, or skipping meals or following the fad low-calorie diet of the week, says Chalmers.

The weight loss key — keep metabolism up

The best way to lose weight is by keeping your metabolism sped up by spreading calories over the day, regular physical activity, and not skipping meals or following a diet too low in calories. If you are on a 1500 calorie a day diet, be sure you spread those calories over three meals and one to two snacks throughout the day. By doing that, fewer of the calories will be stored as fat than if you ate all the calories at one time. This will help keep your metabolism steady.

Chalmers also encourages people to move beyond the diet mentality and to learn more about the “set-point theory.” “If you ask most people, they’ll tell you that no matter how many diets they go on, their weight tends to go back to a certain weight — their ‘set-point’ — within a few weeks or months. Our set point tends to rise with age.”Effects of Insulin on Weight Gain Paper

You can help reset or lower your set point, so the theory goes, by:
Drastically reducing the fat in your diet
Regular physical activity

“I tell people to focus on the quality, not just the quantity, of food they eat when they are trying to lose weight or reset their set point,” says Chalmers. “If you can change the quality, you most likely will lower the set point. So once you lower the set point, you can eat a normal low-fat meal and maintain the set point weight.”

You have to be patient, she points out. “We’ve got to help people — especially women — get off this diet merry-go-round. Stop looking for the perfect diet. There isn’t one. Why are there so many diets out there? Because none of them work. If one did, everyone would use it.

“There are people — many of us — who define food as good or bad. Their whole day revolves around food. They take their failure to lose weight as a personal failure. They lose a lot of their self-esteem, when the real truth is that diets just don’t work unless they are individualized and relevant to one’s lifestyle and food preferences.

“People with diabetes may let their sugars run high to lose weight,” Chalmers says. “Imagine. You’re risking your long-term health to lose weight.”Effects of Insulin on Weight Gain Paper

There are programs to help people lose weight sensibly. Joslin’s Fit and Healthy Program, for example, is a 14-week program that offers people with diabetes the opportunity to learn new patterns of eating and activity that will enable them to take weight off and keep it off.

For those whose problem isn’t just weight, but an obsession with food, thinness, and losing weight, there are also people and programs who can help. The test will help you determine whether you may be too concerned about food and your weight and need some additional help because you have an eating disorder.

Weight gain can be a common side effect for people who take insulin. However, controlling weight is not only possible, but also an important part of overall diabetes self-management. So many people with diabetes are unclear as to why weight gain happens when insulin is initiated, so in order to understand how to lose weight, it is important to gain a better understanding of how high blood glucose starts the whole process.

First, dehydration occurs as the body works to clear itself of the excess glucose, which makes most think they have lost weight, but it is only lost water. Second, because the body is unable to properly convert food into energy due to the improper insulin secretion or insulin resistance, the food (and most specifically carbohydrates) turns into excess glucose circulating in the blood, resulting in high blood glucose. Ultimately, the body cannot use all the extra glucose circulating in the blood, so it is eliminated in the urine. High blood glucose may also cause increased hunger since all the carbohydrates consumed are unable to get into the cells as energy.Effects of Insulin on Weight Gain Paper

When insulin is added:

• Fluid retention occurs to counteract the dehydration that was present prior to insulin initiation. This weight gain only lasts a short period of time.

• The glucose in the bloodstream from carbohydrates consumed can be absorbed by the cells, where it’s used and stored for energy instead of being excreted by the kidneys, leading to better blood glucose but all the calories consumed are not being lost.

• Hunger is reduced due to increased energy to the cells. However, if one continues to consume the extra calories they are used to consuming when the glucose levels were elevated, the body will store it as fat, leading to weight gain.

When initiating insulin, it is important to understand that some changes may need to be made to meal planning to aid in weight maintenance or weight loss. Being aware of the amount and types of food eaten and being physically active most days can help prevent unwanted weight gain.Effects of Insulin on Weight Gain Paper

Here are a few tips to help with weight loss:

• Count calories and know what is a serving size: Eating and drinking fewer calories helps prevent weight gain. Following the rules of My Plate is a good way to choose healthier food options from all the food groups. It is still advised to consume at least 2 servings of fruit per day, at least 3 servings of vegetables – and make this half of the plate. Since carbohydrate is the main type of energy that breaks down into glucose, it is important to maintain some consistency in the amount consumed to reduce the risk of the blood glucose levels rising or falling. This may be a gross over-exaggeration of portion control, but a good mantra to have is “It is not the What, but the How Much.”  Learning what a serving size is and how much one should have as a portion is crucial to weight loss AND better blood glucose control.

One of the easiest ways to reduce the amount of carbohydrate (and calories) at any meal is to eliminate caloric beverages, especially juices, sports drinks, regular soft drinks and powder mixes made with sugar. As meal planning is so individualized, it is really important to meet with a registered dietitian nutritionist to help create a plan and goals for the individual.Effects of Insulin on Weight Gain Paper

• Do not skip meals or eliminate carbohydrates: Skipping a meal causes the body to use energy less efficiently.  Essentially, the body thinks it is starving, so instead of burning calories, it grabs onto all the energy given and will not let it go, leading to weight gain.  Also, when someone skips a meal, it tends to lead to increased hunger at the next meal (or before), making it more likely to consume less healthy food choices. Skipping meals can also cause low blood sugar levels, depending on the type of insulin being used.

• Move more every day: All physical activity helps to burn calories. It is recommended to get at least 150 minutes a week of aerobic activity—such as walking, bicycling, water aerobics, dancing or gardening—plus muscle-strengthening exercises at least two times a week. However, if someone is not used to doing any activity at all, it is important to start slow (5-10 minutes at a time) and build up to a goal of at least 30 minutes most days of the week. During any physical activity, the muscles utilize glucose as fuel and any insulin that is injected works more efficiently for up to several hours after finishing activity.  This means that insulin doses will most need to be reduced surrounding activity. If doses are not reduced, hypoglycemia is more likely to occur, leading to increase food intake to increase the blood glucose level.

• Take insulin doses as directed BUT have a plan for reducing insulin for eating less and adding physical activity. It is important to take all insulin doses as prescribed, but in order to reduce the risk of hypoglycemia with activity, it is crucial to have a plan to adjust insulin doses on days with more activity to reduce hypoglycemia.

Insulin still is the best medication to help improve blood glucose control and reduce long term complications.  But, to lose weight without hypoglycemia, it pays to have a plan and continually update it based on life changes.Effects of Insulin on Weight Gain Paper

It’s possible to gain weight from treating too many bouts of hypoglycemia. I addressed this topic over a decade ago, but it remains relevant and worth revisiting, along with addressing some new insights on weight gain in general with insulin use.

Weight Gain from Treating Lows

Although you can’t avoid treating a low, everything you use contains calories (at least until mini and nasal doses of glucagon are available) and those extra (albeit medically necessary) calories can still end up as excess body fat. Some heavily training athletes have reported gaining fat rather than getting leaner from all their workouts due to chasing a lot of exercise lows. Avoid gaining extra body fat by treating each low precisely to limit calories. Don’t just grab the nearest candy bar when it may take just one glucose tablet to bring your blood glucose back to normal if you have a minimal amount of insulin on board.

The best advice is to start with 4 to 15 grams of a rapid-acting sugar (preferably glucose), and only take in more glucose or follow it with a balanced food or drink if your low doesn’t resolve itself within 10 to 15 minutes or if you anticipate needing protein or fat in your system to prevent later lows, such as after a long workout or if you took too much insulin. Over treating your lows just leads to rebound hyperglycemia, more insulin to bring it back down, and potentially another low later — followed by more calories and potential weight gain.Effects of Insulin on Weight Gain Paper

Weight Gain from Insulin Use

In addition to lowering blood glucose, the hormone insulin promotes fat storage, and if you often end up taking too much, it can make you gain extra fat weight. You can adopt some strategies to keep weight gain from happening from insulin or other diabetes medications, regardless of what type of diabetes you have.

Why is using insulin often associated with weight gain? When you use it, your blood glucose is (usually) in a tighter range, and you stop losing some calories as glucose in your urine like you do when your blood glucose is running on the high side. Also, as mentioned, you can gain weight from having to eat extra to treat any lows caused by insulin or other medications. (Remember, even if you have no other choice than to treat hypoglycemia, calories are still calories.) You may find that cutting back on refined carbohydrates that require more insulin to cover them, exercising regularly, and checking your blood glucose to avoid taking too much of any weight-inducing medications will help you avoid gaining fat weight.

Most people diagnosed with type 1 diabetes gain some weight as soon as they start using insulin. Many of them lost weight before diagnosis — some of it muscle — so not all the weight regain is necessarily bad (some is from muscle mass). However, you can gain excess weight from taking too much daily insulin and treating lows or even from taking the right amount of insulin but eating too many calories.

It’s advisable to not give up exercise, but you should still avoid gaining extra fat if you can because it is often associated with being more insulin resistant and may require you to take even larger doses of insulin. You can lower your insulin needs by staying regularly active. Readjusting your ratio of basal to bolus insulin — specifically, lowering your basal doses and raising your per-meal insulin — without increasing your total daily insulin dose may also prevent weight gain with type 1 diabetes.

Also, try to keep your insulin needs as low as possible because the more you take, the greater your potential for causing lows that lead to weight gain. During any physical activity, your muscles can take up blood glucose and use it as a fuel without insulin. Following exercise, your insulin action is heightened for a few hours up to 72 hours. During that time, you need smaller doses of insulin to have the same effect. With that in mind, adjust your insulin doses downward to prevent lows after exercise that cause you to take in extra calories to treat them.Effects of Insulin on Weight Gain Paper

Finally, you may be able to avoid weight gain from insulin use by looking at the type of insulin you’re using. For example, once-daily Lev emir used by people with type 2 diabetes causes less weight gain and less frequent hypoglycemia than NPH insulin, even combined with use of rapid-acting injections of meal insulin. The same is likely true when using Lantus, Basaglar, Toujeo, and Tresiba. In type 1 diabetes, individuals end up eating less when using Levemir compared to Lantus, leading them to gain less weight. It also helps to dose with fast-acting insulins for the amount of food you actually eat rather than eating to match your pre-meal insulin doses.

We left off last week with the question, “What prevents fat from leaving the fat cell?” If you missed out on it, you may want to read The Futility of Low-Calorie Diets.

To quickly recap, we talked about the fact that your body has two main fuels: glucose (sugar) or fat. The preferred source of fuel is fat, but under certain circumstances, we can shift the body to using more sugar rather than fat. At times, such as being chased by a rabid dog, this is a good thing. However, it’s not a good thing if sugar remains the main fuel for most of the day. Relying on sugar means you’re not burning fat.

Many people make lifestyle choices and nutrition decisions that have basically locked up their extra stored fat in their fat cells, making it useless for energy. The only way you can lose fat is if you use fat. You’ll be unsuccessful at losing fat if you don’t burn fat, even if you eat fewer calories and burn more through exercise. You can lose weight, but most of the loss will come from lean body mass, or muscle tissue, not fat.Effects of Insulin on Weight Gain Paper

Fat Storage and Insulin

The most significant factor in fat storage is the level of insulin in the blood. Insulin has many effects on the body. With respect to fat storage, insulin increases the storage of fat in fat cells and prevents fat cells from releasing fat for energy. This is such a key point for people to understand that I’ll repeat it: Insulin increases the storage of fat in fat cells and prevents the cells from releasing it for energy.

Eight hormones stimulate fat utilization: epinephrine, norepinephrine, adrenocorticotrophic hormone (ACTH), glucagon, thyroid-stimulating hormone, melanocyte-stimulating hormone, vasopressin and growth hormone.

One hormone prevents fat utilization: insulin.

The pancreas releases insulin when blood sugar levels rise above normal. Optimal fasting blood sugar should be between 70 and 90 mg/dL. Following a meal, blood sugars rise in relation to the amount and type of carbohydrates consumed. Processed carbohydrates are absorbed faster, and tend to cause faster and greater rises in blood sugar. The pancreas releases insulin, which tells the muscle, liver and fat cells to take up the blood sugar (and fat if it’s available) and remove it from the blood. This is a normal process because elevated blood sugar is toxic for the body.

With a moderate amount of carbohydrates consumed each day, the pancreas can gently say to the muscles, liver and fat cells, “Please grab that sugar.” The pancreas is happy because it doesn’t have to work too hard to get its message across. The muscle cells, liver cells and fat cells are happy because they’ve got room to store the moderate amount of sugar. The individual is happy because energy levels throughout the day stay pretty consistent and he or she stays relatively lean.Effects of Insulin on Weight Gain Paper

Over time, when individuals eat excessive amounts of carbohydrates, especially processed carbohydrates, on a daily basis, the muscle and fat stop listening to the pancreas’ release of insulin, which is called insulin resistance. The liver and muscle cells have a limited capacity to store glucose. Once they’re full, they shut the door and it all gets sent to the fat cells.

Since blood sugar levels are not brought down to the level they should be, the pancreas “talks louder.” It releases more insulin than it should have to. It’s like when Mom and Dad need to raise their voices because their child hasn’t done what was asked the first time. With more insulin released, glucose levels can be brought down to a safe level again, at least for a while. Over time, fasting blood sugar levels start to creep up. Fasting blood sugar levels that start trending over 90 mg/dL can be a sign of early insulin resistance. Once they get above 100 mg/dL, most physicians will tell their patients they have insulin resistance.

As the years go by and excessive carbohydrate consumption continues, blood sugar levels get higher and higher. The pancreas has to yell at the fat cells by secreting even higher levels of insulin. Eventually the cells with receptors for insulin stop listening and/or the pancreas stops secreting insulin. Blood sugar levels rise, and when they get above 125 mg/dL, type 2 diabetes is usually diagnosed. Unfortunately, people don’t get enough support during the time they’re heading toward diabetes; it’s only after their blood sugar hits disease-state levels that they get attention, often in the form of drug therapy.

For someone with insulin resistance or diabetes, he or she will have an exaggerated insulin response. Eating a small amount of carbohydrate will cause the pancreas to release a large amount of insulin. Those who are insulin resistant will have elevated insulin levels throughout the day, which means their fat cells won’t be able to release fat for fuel.

Blood sugar problems often show up long before other symptoms, or even weight gain, so it’s wise to regularly check your blood sugar, and even insulin levels with a lab package like the Energy & Metabolism test.Effects of Insulin on Weight Gain Paper

Insulin locks fat in the fat cell. Excessive carbohydrate consumption causes elevated insulin levels. Remember that the next time you start to take a bite of a low-fat bagel.

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Less Insulin, More Energy

If carbohydrates raise insulin levels and insulin increases fat storage and decreases fat burning, is a low-carb diet the answer to fat loss?

For many people, simply decreasing their carbohydrate consumption results in a decreased appetite, lowered insulin levels, improved lipid profiles and almost effortless weight loss. Once insulin levels are brought under control, fat cells are allowed to let go of their stored fatty acids. They still need to be burned somewhere, though.

Think of the lazy river at your favorite water park. The water moves freely, but it doesn’t really go anywhere. It just goes in circles. If you were to route the water somewhere else and use it in another pool, the water level in the lazy river would get lower.

If you open up the gates in the fat cells by lowering insulin levels, you now have an almost endless supply of energy available. It still needs to be used, though. Interestingly, many people proclaim how much more energy they have when they commit to a lower-carbohydrate diet. It’s especially common for those who are overweight. It makes a lot of sense, though.

When insulin levels are brought under control, it’s like getting a surprise inheritance of money after living paycheck to paycheck for years. After scraping by and keeping costs controlled from living off a meager salary, imagine how free one would feel being given a small fortune.Effects of Insulin on Weight Gain Paper

In Gary Taubes’ book Good Calories, Bad Calories, he explains that people become sedentary because they are gaining fat, they don’t gain fat because they are sedentary. The opposite way to look at this is once people control their insulin levels, they have the energy to become much more active. They don’t get active and energetic and then lose body fat.

There are less significant factors that affect one’s ability to access fat. That’s why we stress the importance of comprehensive lab testing to ensure one has a healthy, functional metabolism. However, controlling insulin seems to be the most impactful thing one can do to open up the fat gates and give the body access to the fuel stored behind them. Fortunately, you have a significant amount of control over your insulin levels by what you put in your mouth every day. If you base your diet on vegetables and protein, like in our Healthy Way of Life Food Pyramid, you won’t have to worry about rising insulin levels, and you will be able to burn fat the way your body was designed to.

In case you haven’t realized it already, none of what is mentioned above requires calorie counting; only the wisdom to make the right choices about the foods you eat.

Insulin is one of the most misunderstood hormones. Too much of it can turn your body into a fat-building machine. Too little of it and you will go into a coma and possibly die.

A full understanding of insulin will help you counteract its fat-building effects. Insulin is produced and stored in the pancreas.  When you eat starches, sugars and other carbohydrates, they are broken down (digested) to simple sugars in the intestine. The pancreas senses this sugar in the gut, and releases insulin into the bloodstream. The job of insulin is to signal muscle and other body cells (including our fat cells) to absorb the sugar. Under the best of cases, you eat just enough carbohydrates to meet your needs at the moment. If you use up the sugar as you eat it, you won’t have excess sugar to send into storage.Effects of Insulin on Weight Gain Paper

If you eat too many carbohydrates, your pancreas releases loads of insulin, which tells your cells that large amounts of sugars are on the way. The sugars that are not immediately burned are diverted into storage: the building of fat. Simply put, eating too many sugars and other carbohydrates causes the production of fat in fat cells.

Over time, with repeated overeating of carbohydrates (sugar) your cells start to partially ignore the effects of insulin, and your body will have to release even more insulin to have the same effect. This is called insulin resistance, and eventually Type 2 Diabetes. The persistent blood sugar elevation in diabetes causes blood vessels to clog, leading to strokes, heart attacks, blindness and kidney failure.

So what does this have to do with losing weight? The key to weight loss success is to control your insulin, specifically, keeping insulin as low as possible. Here are the key points:Effects of Insulin on Weight Gain Paper

Keep carbohydrates to a minimum. This will cause your body to make and release less insulin, and therefore reduce the building of fat. When looking at a food label, we believe anything over 25 grams of carbohydrates per serving is generally considered too high.
Get at least 7 hours of sleep. Sleep deprivation causes increased blood sugar and results in more insulin secretion.
Regular cardiovascular exercise (walking, running, biking, etc.) causes your body to use sugars immediately, this bypasses and suppresses insulin and reduces fat storage.  Sitting a lot and lack of activity causes the opposite.
Eating just prior to bedtime, especially carbs, causes you to store fat while sleeping. In general, we burn most of our fat while sleeping, unless we overwhelm or body with sugars.  You’ll lose an important opportunity to burn fat.

We are now learning from science that the calorie model for weight loss is not the answer for long term success. Dieters have been finding out for decades that just because they eat less and burn more, it doesn’t always equate to pounds off, especially in the long run. The majority of people gain the weight back that they have worked so hard to lose.

If monitoring calories isn’t the answer for weight loss, then what is? While calories do matter to some degree, hormones matter more.

Why Hormones, Not Calories

To provide just one example about why hormones – not calories – are the key players in weight loss, let’s briefly look at insulin. When you eat sugar of any kind, your pancreas produces this master metabolism hormone.Effects of Insulin on Weight Gain Paper

Insulin’s job is to help sugar get into your cells. Once sugar is in the cells, it can be turned into energy by your mitochondria (the energy-burning factories in your cells). So insulin is designed to help you use the sugar you eat, or, if you eat more than you need, store it for later use.

At its best, the interaction between your insulin level and the sugar in your blood is a finely tuned machine. You eat some sugar, and your body produces just enough insulin to metabolize it. Later you eat a little more sugar, and the same thing happens again. It is a smooth, harmonious cycle that the healthy body carries out every day without your slightest awareness.

Insulin Resistance and It’s Effects

However, problems can occur when there is too much sugar in your diet. When you regularly eat a lot of sugar, especially sugars that are quickly absorbed, the insulin levels in your blood become elevated. Over time, you can become resistant to the effects of insulin and thus need more and more of it to do the same job. This insulin resistance has some very serious health implications as well as a direct impact on your appetite.

Insulin resistance is very much like a drug addiction. When you are addicted to a drug, you develop a tolerance to it and hence need more and more of it to produce the same effect. When you consistently have a high level of insulin in your blood, you develop a tolerance to it. As a consequence, your body’s tissues no longer respond normally to the hormone. Hence, your pancreas produces more of it, elevating your insulin levels even more in your body’s attempt to overcome this resistance.Effects of Insulin on Weight Gain Paper

This turns into a vicious cycle very quickly. When you have more insulin in your blood than you do sugar, your body tells you to eat some sugar to even out the balance. But every time you eat the sugar you cause your insulin levels to go up even more, causing you to want more sugar, and on and on the cycle goes.

In the meantime, you are storing all the excess sugar as fat, slowing down your metabolism, and promoting heart disease, dementia, and cancer. This is a condition known as pre-diabetes. It is also called metabolic syndrome, insulin resistance, and syndrome X.

Focus On Foods That Normalize Blood Sugar

The key to weight loss, then, becomes focusing on foods that normalize blood sugar and lower insulin levels. If you eat the same amount of calories from broccoli rather than cookies, you will lose weight.

Food is information that controls your gene expression, hormones, and metabolism. The source of the calories (and the information carried along with the calories) makes a gigantic difference in how your genes, hormones, enzymes, and metabolism respond.

If you eat food that spikes your insulin level, you will gain weight. If you eat food that reduces your insulin level, you will lose weight. This is true even if the food contains exactly the same number of calories or grams of protein, fat, carbohydrates, and fiber.Effects of Insulin on Weight Gain Paper

The Only Diet That Science Shows Works

Low-glycemic-load diets are the only diets that have been proven to work— these diets don’t spike blood sugar and insulin.

In a landmark large-scale study, only one diet showed the capacity for maintaining the most weight loss over time. The study, published in the New England Journal of Medicine, found that the easiest diet to maintain, and the one that had the biggest impact on preventing weight gain after people had lost weight, was the low-glycemic-load, higher-protein diet.

When you focus on real, whole, unprocessed foods, you will automatically create a meal that has a low glycemic load. The glycemic load of a meal tells us how much of and how quickly a fixed quantity of a specific food will raise your blood sugar and insulin levels. The slower these levels rise, and the lower they are, the better.Effects of Insulin on Weight Gain Paper

Controlling the glycemic load of your meals isn’t very hard.You need to combine protein, fats, and whole-food, fiber-rich, low-starch carbohydrates from vegetables, legumes, nuts, seeds, and a limited amount of whole grains and low-sugar fruit.

Eating Disorders with Insulin Manipulation for Weight Loss
Nutrition and Wellness Resources

People with type 1 diabetes face many challenges. These challenges can include how to fit in physical activity, figuring out how many carbohydrates are in a meal, knowing how much insulin to bolus at a meal, and recognizing symptoms of high and low blood sugars. A challenge that may get overlooked for patients with type 1 diabetes is finding a healthy weight and maintaining that weight. Many providers are understandably concerned and focused on the patient’s A1C value, cholesterol numbers, or symptoms of retinopathy or neuropathy. Providers can forget to ask a patient how he or she feels about their weight and what steps a patient may be taking to lower their weight in a healthy manner. It is extremely important to ask these questions and help patients problem solve in order to prevent the use of insulin manipulation for weight loss.

What is Insulin Manipulation?

Insulin manipulation is a form of purging calories from the body. When a person skips their insulin dose or does not take enough insulin to lower their blood sugar, blood sugar rises and calories are released through the urine. This can lead to weight loss. Without the correct amount of insulin, a person can become dehydrated, thinking they have lost body fat when in actuality, mostly water has been lost. This practice can have negative short and long term consequences for a person with type 1 diabetes.What is the Prevalence of Eating Disorders in Type 1 Diabetes?

In Western countries, it has been reported that anorexia affects between 0.1-5.7% of all females and bulimia affects 0.3-7.3% of all females.1 How does this compare to the prevalence of eating disorders in females with type 1 diabetes?The research is limited and varying. However, one of the most recent studies suggests eating disorders are more prevalent in females with type 1 diabetes (10%) than in age matched non-diabetic controls (4%). It is thought that females with type 1 diabetes are more at risk for eating disorders because:2Effects of Insulin on Weight Gain Paper

Women with diabetes tend to have a higher body mass index.
There is a cycle of weight loss at disease onset and the subsequent weight gain with treatment.
Dietary restraint is required for diabetes management.
The availability of insulin for deliberate insulin manipulation for weight loss.

What Are the Consequences of Insulin Manipulation in Type 1 Diabetes?

The process of insulin manipulation puts patients at risk for severe hyperglycemia, diabetic ketoacidosis, and long-term complications of diabetes.3 In one study of women ages 16-40, the women who manipulated insulin were found to have worse glycemic control, more negative attitudes towards diabetes management, and were more likely to report symptoms of anorexia and bulimia than non-manipulators. In addition, the insulin manipulators were more likely to lie to their physicians regarding their diabetes management.4 Another study reports that women who omit or under dose insulin have significantly higher hemoglobin A1C values when compared to women who do not manipulate insulin. The women in the insulin manipulation group had an average hemoglobin A1C of 11.1 and the non-disordered eating group had an average hemoglobin A1C of 8.7. This same study showed that 86% of women with disordered eating and insulin manipulation developed retinopathy within four years.5Prevention of Eating Disorders in Patients With Type 1 Diabetes

Help patients understand the importance of managing their diabetes and the roles healthy eating and exercise play in that management.
Promote regulated eating by helping patients understand when they are hungry and when they are full.
Avoid putting foods into categories such as good, bad, fattening, or unsafe.
Encourage a balance of nutritious foods for meals and snacks plus outline the dangers of dieting.
Teach patients about healthy body image.
Encourage patients to talk positively regarding what their bodies do for them.
Talk about eating and diabetes management in terms of health, pleasure, and satisfaction, not always with regard to weight.
Encourage regular physical activity for strength, energy, and good health.
Discuss the ways genetics can determine body shapes.
Teach patients to recognize a healthy body image verses the unrealistic/unattainable body image represented in the media.

Society puts a lot of pressure on people to be thin. This pressure can be overwhelming for a person with type 1 diabetes. Pressure to be at a lower weight on top of trying to achieve good blood sugar control, correct insulin dosing, healthy cholesterol numbers, and blood pressure can be too much. Insulin manipulation can appear to be the answer for some people. It is extremely important to educate patients on healthy weight control practices and to make patients aware of the harmful, long-term effects of insulin manipulation.Effects of Insulin on Weight Gain Paper

What is insulin?

A person with diabetes being injected with insulin to regulate their blood sugar levels.

Insulin is a hormone made by an organ located behind the stomach called the pancreas. There are specialized areas within the pancreas called islets of Langerhans (the term insulin comes from the Latin insula that means island). The islets of Langerhans are made up of different type of cells that make hormones, the commonest ones are the beta cells, which produce insulin.

Insulin is then released from the pancreas into the bloodstream so that it can reach different parts of the body. Insulin has many effects but mainly it controls how the body uses carbohydrates found in certain types of food. Carbohydrates  are broken down by the human body to produce a type of sugar called glucose. Glucose is the main energy source used by cells. Insulin allows cells in the muscles, liver and fat (adipose tissue) to take up this glucose and use it as a source of energy so they can function properly. Without insulin, cells are unable to use glucose as fuel and they will start malfunctioning. Extra glucose that is not used by the cells will be converted and stored as fat so it can be used to provide energy when glucose levels are too low. In addition, insulin has several other metabolic effects (such as stopping the breakdown of protein and fat).Effects of Insulin on Weight Gain Paper

How is insulin controlled?

The main actions that insulin has are to allow glucose to enter cells to be used as energy and to maintain the amount of glucose found in the bloodstream within normal levels. The release of insulin is tightly regulated in healthy people in order to balance food intake and the metabolic needs of the body. This is a complex process and other hormones found in the gut and pancreas also contribute to this blood glucose regulation. When we eat food, glucose is absorbed from our gut into the bloodstream, raising blood glucose levels. This rise in blood glucose causes insulin to be released from the pancreas so glucose can move inside the cells and be used. As glucose moves inside the cells, the amount of glucose in the bloodstream returns to normal and insulin release slows down. Proteins in food and other hormones produced by the gut in response to food also stimulate insulin release. Hormones released in times of acute stress, such as adrenaline, stop the release of insulin, leading to higher blood glucose levels to help cope with the stressful event.

Insulin works in tandem with glucagon, another hormone produced by the pancreas. While insulin’s role is to lower blood sugar levels if needed, glucagon’s role is to raise blood sugar levels if they fall too low. Using this system, the body ensures that the blood glucose levels remain within set limits, which allows the body to function properly.Effects of Insulin on Weight Gain Paper

What happens if I have too much insulin?

If a person accidentally injects more insulin than required, e.g. because they expend more energy or eat less food than they anticipated, cells will take in too much glucose from the blood. This leads to abnormally low blood glucose levels (called hypoglycaemia). The body reacts to hypoglycaemia by releasing stored glucose from the liver in an attempt to bring the levels back to normal. Low glucose levels in the blood can make a person feel ill.

The body mounts an initial ‘fight back’ response to hypoglycaemia through a specialised set of of nerves called the sympathetic nervous system. This causes palpitations, sweating, hunger, anxiety, tremor and pale complexion that usually warn the person about the low blood glucose level so this can be treated. However, if the initial blood glucose level is too low or if it is not treated promptly and continues to drop, the brain will be affected too because it depends almost entirely on glucose as a source of energy to function properly. This can cause dizziness, confusion, fits and even coma in severe cases.

Some drugs used for people with type 2 diabetes, including sulphonylureas (e.g. gliclazide) and meglitinides (e.g. repaglinide), can also stimulate insulin production within the body and can also cause hypoglycaemia. The body responds in the same way as if excess insulin has been given by injection.

Furthermore, there is a rare tumour called an insulinoma that occurs with an incidence of 1-4 per million population. It is a tumour of the beta cells in the pancreas. Patients with this type of tumour present with symptoms of hypoglycaemia.Effects of Insulin on Weight Gain Paper

What happens if I have too little insulin?

People with diabetes have problems either making insulin, how that insulin works or both. The main two types of diabetes are type 1 and type 2 diabetes, although there are other more uncommon types.

People with type 1 diabetes produce very little or no insulin at all. This condition is caused when the beta cells that make insulin have been destroyed by antibodies (these are usually substances released by the body to fight against infections), hence they are unable to produce insulin. With too little insulin, the body can no longer move glucose from the blood into the cells, causing high blood glucose levels. If the glucose level is high enough, excess glucose spills into the urine. This drags extra water into the urine causing more frequent urination and thirst. This leads to dehydration, which can cause confusion. In addition, with too little insulin, the cells cannot take in glucose for energy and other sources of energy (such as fat and muscle) are needed to provide this energy. This makes the body tired and can cause weight loss. If this continues, patients can become very ill. This is because the body attempts to make new energy from fat and causes acids to be produced as waste products. Ultimately, this can lead to coma and death if medical attention is not sought. People with type 1 diabetes will need to inject insulin in order to survive.

Type 2 diabetes can be caused by two main factors and its severity will depend on how advanced it is. Firstly, the patient’s beta cells may have problems manufacturing insulin, so although some insulin is produced, it is not enough for the body’s needs. Secondly, the available insulin doesn’t work properly because the areas in the cell where insulin acts, called insulin receptors, become insensitive and stop responding to the insulin in the bloodstream. These receptors appear to malfunction more in people who carry excessive amount of  weight. Some people with type 2 diabetes might initially experience very few symptoms and the raised blood glucose is only picked up when a routine blood test is arranged for another reason; other people might experience symptoms similar to those seen in patients with type 1 diabetes (thirst, frequent urination, dehydration, hunger, fatigue and weight loss). Some patients with type 2 diabetes can control their symptoms by improving their diet and/or losing weight, some will need tablets, and others will need to inject insulin to improve blood glucose levels. See the article on diabetes mellitus for more information.

Insulin is an anabolic storage hormone produced by the beta cells in both a basal and a pulsatile fashion in response to food intake. Insulin is fundamental in allowing cells to uptake and use glucose. Insulin also regulates gluconeogenesis along with processes, such as protein synthesis and lipogenesis.Effects of Insulin on Weight Gain Paper

When we were evolving, the theory is that insulin was necessary because we lived a life of feast and famine. Those who could store calories had a survival benefit, thus insulin had a significant evolutionary role. So, where and when did insulin become a bad thing? Likely, at the same time our evolutionary environment took a bit of a turn. These days, it is usual to go three hours without eating, and certainly not three days! Thus, what was once adaptive is now maladaptive as we continue to store as our ancestors did. Our environment has changed faster than our genetics.

Insulin resistance is an impaired response to endogenous or exogenous insulin in cells, tissues (especially skeletal muscle and adipose tissue), the liver, or the whole body.[1,2] Many investigators believe that insulin resistance is an important factor in the development of the metabolic syndrome.Effects of Insulin on Weight Gain Paper

Insulin resistance affects several organ systems and predisposes patients to several metabolic disorders. Connections between insulin resistance and other aspects of the metabolic syndrome, such as dyslipidemia, hypertension, prothrombotic state, and glucose intolerance, are complex. Insulin resistance may contribute directly or indirectly to these conditions.[3]

It is important to note that insulin resistance predates diabetes by years. Assuming the metabolic effects of insulin resistance are in play years before a numeric diagnosis of diabetes, it is easy to see how the physiologic insults can occur prior to any awareness of the metabolic disarray.

Treating Insulin Resistance
There are many ways to treat insulin resistance. A large-scale study called the Diabetes Prevention Program (DPP) trial took 3,200 patients with impaired glucose tolerance and randomized them to placebo lifestyle or metformin.[4] The authors of this landmark study noted the following:Effects of Insulin on Weight Gain Paper
1.    Intensive lifestyle intervention reduced the development of diabetes by 58 percent
2.    Metformin reduced the development of diabetes by 31 percent
3.    Lifestyle (not to be forgotten or outdone) was more effective than metformin alone in preventing the development of diabetes

Metformin and Insulin resistance
A number of investigators have looked at metformin as a treatment for weight loss, particularly in the presence of insulin resistance.

Metformin is a biguanide, an oral diabetic agent used often as first line treatment of diabetes.[5] It improves hyperglycemia primarily through its suppression of hepatic glucose production (hepatic gluconeogenesis) via activation of AMP-activated protein kinase (AMPK), a liver enzyme that plays an important role in insulin signaling, whole body energy balance, and the metabolism of glucose and fats.[6]

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In addition to suppressing hepatic glucose production, metformin increases insulin sensitivity, enhances peripheral glucose uptake, increases fatty acid oxidation,[7] and decreases absorption of glucose from the gastrointestinal tract. Increased peripheral utilization of glucose may be due to improved insulin binding to insulin receptors. AMPK most likely also plays a role as metformin administration increases AMPK activity in skeletal muscle. AMPK is known to cause glucose transporter GLUT4 deployment to the plasma membrane, resulting in insulin-independent glucose uptake.Effects of Insulin on Weight Gain Paper

Metformin and Body Weight in Type 2 Diabetes
Table 1 is a list of randomized, controlled trials that examined the body weight of subjects with type 2 diabetes suboptimally controlled on diet. The trials in this table are all greater than six-months duration. The landmark UKPDS study[8] seems to indicate that metformin exerts benefit in not gaining weight rather than in losing weight. Table 2 is the Diabetes Progression and Outcomes trial.[9] As is evident, while there is a significant weight gain with rosiglitazone, the effect of metformin on weight is negligible. Overall, there is no indication of metformin-induced weight gain. However, there is also little to indicate a marked or significant weight loss in the groups receiving metformin relative to placebo.

What can we conclude about metformin for weight control in a diabetic population? As an adjunct to other therapies in diabetes metformin may mitigate weight gain seen with thiazolidinediones (TZDs) and sulfonylureas. We can also conclude that as an adjunct to insulin, metformin may ameliorate weight gain associated with insulin use (perhaps in part by lowering insulin dosing by improving sensitivity).

Metformin and Body Weight in Individuals without Diabetes
What is the role of metformin in controlling body weight in individuals without diabetes? Table 2 lists a few of the larger studies that reviewed this issue in subjects with obesity over a study period of greater than six months. The first trial is the Biguanides and Prevention of Risks in Obesity Study.[10] This study enrolled 324 patients with waist-to-hip ratios of >0.95 in men and >0.80 in women  as a surrogate for insulin resistance.  Subjects were randomized to low-dose metformin 850mg daily or to placebo for one year. Data showed a trend toward benefit in the metformin group.

The second trial in Table 2 looked at 150 women with body mass index (BMI)>30mg/m2 and the third trial looked at men and women with morbid obesity.[11,12] These trials were short and small in number but demonstrated a decrease in body weight with metformin.Effects of Insulin on Weight Gain Paper

Table 3 lists subjects without diabetes with impaired glucose tolerance (IGT). The DPP trial enrolled a population of over 3,000 subjects with IGT and a mean BMI of 34kg/m2 with benefits as noted.[4] No effect was observed in a three-year Chinese study.[13] The final study listed in Table 3 is a Swedish study that showed metformin demonstrated some benefit in weight loss, but this was not statistically significant.[14]

A Caveat: Metformin and Weight in Women with Polycystic Ovary Syndrome
In the subgroup of women with polycystic ovary syndrome (PCOS), some trials showed benefit of up to six percent in weight reduction over placebo;[15] however, when a systematic review of the literature was performed, of the 13 randomized, controlled trials in women with PCOS, none showed an overall beneficial effect of metformin on weight loss.[16] Regardless, it appears benefit is greater if more than 1500mg daily of metformin is used and if the duration of treatment is greater than eight weeks. Thus, in a subgroup of women with PCOS, those who with obesity who are taking high doses of metformin for greater than two months, may show a weight loss benefit. This remains to be proven in larger studies as the subgroup analysis is too small to say definitively Effects of Insulin on Weight Gain Paper

What can we conclude about metformin for weight control in a nondiabetic population? While there are benefits to using metformin in nondiabetic populations (e.g., for the prevention type 2 diabetes), there is no compelling evidence to use metfomin to control body weight in nondiabetic populations. A caveat may be found in women with obesity and PCOS on long-term therapy.

Summary
Metformin is a widely used drug for the treatment of diabetes and the off-label treatment of prediabetes, metabolic syndrome, and insulin resistance. While prevention of diabetes in a high-risk population is seen with the use of metformin, the old standard of lifestyle modification appears to be more efficacious.

Metformin does remain a cornerstone of therapy for diabetes and is often used as first-line therapy. Overall, metformin appears to be a relatively weight-neutral drug, with some evidence of modest weight loss effect. Metformin appears to mitigate the weight gain seen by other agents used for the treatment of diabetes. At this time, using metformin as a primary weight loss agent in the nondiabetic population appears to be unwarranted in the majority of subpopulations. An exception to this may be women with PCOS.Effects of Insulin on Weight Gain Paper