Why do patients gain a significant amount of weight when on insulin therapy? Several proposed theories include decreased glycosuria due to improved glycemic control, the anabolic effects of insulin itself, decreased metabolic rate, aggressive treatment of hypoglycemia, and defensive eating to prevent hypoglycemia or deal with the fear of hypoglycemia.As observed majority of patients with Type 2 Diabetes Mellitus (T2DM) are already overweight, the weight gain associated with insulin therapy may delay insulin initiation. Weight gain may also increase low-density lipoprotein (LDL) cholesterol, worsen hypertension, and lower high-density lipoprotein (HDL) cholesterol, all of which are independent risk factors for atherosclerosis. Therefore, intervention to help minimize the weight gain associated with insulin therapy has to be closely monitored.How to Avoid Weight Gain?Avoid any foods that are high in fat content and sugars: Increase intake of fruits, vegetables and whole grains. Some examples of sweets that would be considered low cholesterol food include: Angel food cake topped with fruit puree or fresh fruit slices, fat-free or low-fat brownies, cakes, cheesecake, cupcakes, and pastries, gelatin desserts (watch the whipped cream!), Graham crackers, fat-free or low-fat cookies, like animal crackers, devil's food cookies, fig and other fruit bars, ginger snaps, and vanilla or lemon wafers, frozen low-fat or nonfat yogurt, fruit ices, ice milk, sherbet, and sorbet, puddings made with 1 percent or fat-free milk. Plan for every meal to have the right mix of starches, fruits and vegetables, proteins, and fats. Make sure you eat enough to prevent low blood glucose reaction.A consistent and structured exercise regimen: During physical activity, your muscles take up blood glucose and use it as a fuel without insulin and then following exercise, your insulin action is heightened for a few hours and as long as 72 hours -- meaning that you will need smaller doses of insulin to have the same glucose-lowering effect. A minimum of 150 minutes a week of moderately intense aerobic activity - such as walking, bicycling, water aerobics, dancing or gardening - plus strength exercises at least two times a week.Try to keep your insulin dose as low as possible because the more insulin you take, the greater your potential for weight gain is.Type of Medication: Take a look at the type of insulin(s) that you are using. For example, in overweight type 2 diabetic subjects, use of once-daily Levemir (detemir) caused less weight gain and less frequent hypoglycemia than use of NPH, even combined with use of rapid-acting injections of a separate insulin for meals (and the same is likely true when using Lantus, or insulin glargine). Anyone taking basal insulin alone (once or twice daily) or following a basal-bolus regimen can benefit by making sure that insulin doses are regulated effectively to prevent blood sugar lows and highs -- while using as little insulin as absolutely necessary to get the desired glycemic effect. (source: http://www.diabetesincontrol.com/ ).Avoid Skipping Meals: Missing out on meals can causes large fluctuations in blood sugar levels. Three modest meals a day with healthy snacks in between can result in better control of weight and blood glucose levels.Skip second helping of meals.Drink 7-8 glasses of water daily.Addressing insulin-related weight gain is highly relevant to the prevention of metabolic and cardiovascular consequences in this high-risk population with type 2 diabetes. In addition to lifestyle changes (eg, diet and exercise) and available medical interventions to minimize the risk of weight gain with insulin treatment, familiarity with the weight gain patterns of different insulins may help deal with this problem. The use of basal insulin analogs may offer advantages over conventional human insulin preparations in terms of more physiologic time-action profiles, reduced risk of hypoglycemia, and reduced weight gain. (source: http://www.ncbi.nlm.nih.gov/)

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