- Article
- Source: Campus Sanofi
- 9 Oct 2025
Help Managing Insulin-Related Weight Gain in Type 2 Diabetes: Practical Guidance
Table of Contents
Introduction to Insulin Therapy and Associated Weight Gain Concerns
Managing Type 2 diabetes (T2D) presents as a challenge, with many individuals eventually needing insulin therapy to maintain adequate glycaemic control.1 People with T2D often feel apprehensive about initiating insulin therapy due to various psychosocial concerns, including fear of insulin-related potential weight gain.1,2 Hence, it is essential to help address related concerns carefully before introducing insulin therapy.
Achieving an optimal equilibrium between blood glucose management and weight considerations plays a key role in enhancing adherence to insulin therapy.1 This is in line with recommendations from the 2022 American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) consensus report which emphasises the importance of weight management as a core component of holistic, and person-centric approach to T2D management.3
This article examines evidence-based strategies for mitigating insulin-associated weight gain while optimising glycaemic parameters. Particular attention is given to insulin selection, structured titration protocols, and comprehensive management approaches that can be effectively implemented in clinical practice to help address this challenge.
Understanding the Link Between Insulin and Weight Gain
Potential weight gain while on insulin therapy can result from a combination of physiological and psychological factors, including:
| Anabolic effects: Insulin, an anabolic hormone, promotes the storage of fat and inhibits the breakdown of protein, contributing to increased body mass.4 |
| Defensive snacking: Previous studies have shown that individuals on insulin therapy tend to consume additional calories to prevent or manage hypoglycaemia. This defensive eating behaviour may eventually contribute to weight gain.4,5 |
| Reduced energy expenditure: People with T2D sometimes follow a lifestyle with reduced physical activity due to fear of hypoglycaemia. This may contribute to weight gain.6 |
Hence proactively addressing these factors is essential both when starting and continuing insulin therapy.
Practical Strategies to Help Address Insulin-Related Weight Gain Concerns
With an appreciation of factors that might influence weight during insulin therapy, several approaches could be considered to help address these concerns while supporting glycaemic management. A comprehensive, multi-faceted approach that addresses insulin selection, education, technology utilisation, physical activity, and nutrition may offer the best opportunity for successful outcomes.3
When considering insulin options, it has been observed that modern insulin formulations with similar glycaemic benefits may have varying effects on weight among people with T2D.
- Patient-level meta-analysis of the EDITION studies showed that insulin glargine U300 had glycaemic control effects similar to glargine U100 but was associated with 0.28 kg less weight gain (p<0.05) over 6 months.7
- Similarly, results from multiple treat-to-target trials have shown that insulin detemir was associated with a favourable weight profile compared with NPH insulin and insulin glargine U100, while achieving similar glycaemic targets.8,9
Evidence-based educational interventions are effective components of insulin initiation protocols to help address weight management concerns.
When discussing weight concerns with people on insulin therapy, consider these evidence-based approaches that can be integrated into personalised care plans:
Digital Health Tools: Meta-analyses indicate mobile app integration was associated with body weight reduction (-0.84 kg) in people with T2D, with more pronounced reduction in people with obesity (BMI >30 kg/m2) or when combined with behavioural support components. Applications incorporating Technology-Enabled Self-Management (TES) Feedback Loop showed promising outcomes through technology-driven communication between patients and healthcare teams and analysis of patient-generated health data.13,14
Physical Activity Recommendations: The ADA and EASD recommend approximately 150 minutes weekly of moderate-to-vigorous aerobic activity, breaking up sedentary time with brief activity breaks, maximising glycaemic effects with ≥45-minute post-meal activity, and implementing a small steps approach, where adding ~500 steps daily has been associated with 2-9% reduced risk of cardiovascular morbidity and all-cause mortality.3
Nutritional Approaches: European and American clinical guidelines support personalised carbohydrate monitoring for optimising meal timing and food choices. Lower glycaemic load meals and increased soluble fibre intake may offer benefits within dietary approaches. Protein intake around 1.2-1.6 g/kg/day may influence satiety hormones like GLP-1 and PYY, offering additional weight management considerations.15-17
Balancing Glycaemic Control and Weight Management: A Way Forward
By addressing weight gain concerns associated with insulin therapy directly and providing evidence-based strategies, you may help patients overcome their hesitation about starting on insulin.3
Key takeaways
- Educating patients on the realities of insulin therapy may help them accept insulins and mitigate potential weight gain.
- You can support your patients by providing them with tangible actions that are easily implementable to help them with their diabetes treatment and weight concerns.
Explore other resources to aid in patient conversations on Campus
- McFarlane SI. Insulin therapy and type 2 diabetes: management of weight gain. J Clin Hypertens (Greenwich). 2009;11(10):601-607. doi:10.1111/j.1559-4572.2009.00063.x
- Home P, Riddle M, Cefalu WT, et al. Insulin therapy in people with type 2 diabetes: opportunities and challenges?. Diabetes Care. 2014;37(6):1499-1508. doi:10.2337/dc13-2743
- Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45(11):2753-2786. doi:10.2337/dci22-0034
- Russell-Jones D, Khan R. Insulin-associated weight gain in diabetes—causes, effects and coping strategies. Diabetes Obes Metab. 2007;9(6):799-812. doi:10.1111/j.1463-1326.2006.00686.x
- Ramachandran A, Venkatraman S, Moses A, Vijayakumar G. Hyp-O-besity: Unmet Challenge in Management of Type 2 Diabetes Mellitus and Cardiovascular Risk. J Diabetes Metab. 2015;6(4):520. DOI: 10.4172/2155-6156.1000520
- Zaharieva DP, Riddell MC. Insulin Management Strategies for Exercise in Diabetes. Can J Diabetes. 2017;41(5):507-516. doi:10.1016/j.jcjd.2017.07.004
- Ritzel R, Roussel R, Bolli GB, et al. Patient-level meta-analysis of the EDITION 1, 2 and 3 studies: glycaemic control and hypoglycaemia with new insulin glargine 300 U/ml versus glargine 100 U/ml in people with type 2 diabetes. Diabetes Obes Metab. 2015;17(9):859-867. doi:10.1111/dom.12485
- Hermansen K, Davies M, Derezinski T, Martinez Ravn G, Clauson P, Home P. A 26-week, randomized, parallel, treat-to-target trial comparing insulin detemir with NPH insulin as add-on therapy to oral glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetes Care. 2006;29(6):1269-1274. doi:10.2337/dc05-1365
- Rosenstock J, Davies M, Home PD, Larsen J, Koenen C, Schernthaner G. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia. 2008;51(3):408-416. doi:10.1007/s00125-007-0911-x
- Kuritzky L, Reid TS, Wysham CH. Practical Guidance on Effective Basal Insulin Titration for Primary Care Providers. Clin Diabetes. 2019;37(4):368-376. doi:10.2337/cd18-0091
- Blonde L, Merilainen M, Karwe V, Raskin P; TITRATE Study Group. Patient-directed titration for achieving glycaemic goals using a once-daily basal insulin analogue: an assessment of two different fasting plasma glucose targets - the TITRATE study. Diabetes Obes Metab. 2009;11(6):623-631. doi:10.1111/j.1463-1326.2009.01060.x
- Meneghini L, Koenen C, Weng W, Selam JL. The usage of a simplified self-titration dosing guideline (303 Algorithm) for insulin detemir in patients with type 2 diabetes-results of the randomized, controlled PREDICTIVE 303 study. Diabetes Obes Metab. 2007;9(6):902-913. doi:10.1111/j.1463-1326.2007.00804.x
- Cai X, Qiu S, Luo D, Wang L, Lu Y, Li M. Mobile Application Interventions and Weight Loss in Type 2 Diabetes: A Meta-Analysis. Obesity (Silver Spring). 2020;28(3):502-509. doi:10.1002/oby.22715
- Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A Systematic Review of Reviews Evaluating Technology-Enabled Diabetes Self-Management Education and Support. J Diabetes Sci Technol. 2017;11(5):1015-1027. doi:10.1177/1932296817713506
- Ibrahim SMH, Shahat EA, Amer LA, Aljohani AK. The Impact of Using Carbohydrate Counting on Managing Diabetic Patients: A Review. Cureus. 2023;15(11):e48998. Published 2023 Nov 18. doi:10.7759/cureus.48998
- Vlachos D, Malisova S, Lindberg FA, Karaniki G. Glycemic Index (GI) or Glycemic Load (GL) and Dietary Interventions for Optimizing Postprandial Hyperglycemia in Patients with T2 Diabetes: A Review. Nutrients. 2020;12(6):1561. Published 2020 May 27. doi:10.3390/nu12061561
- Leidy HJ, Clifton PM, Astrup A, et al. The role of protein in weight loss and maintenance. Am J Clin Nutr. 2015;101(6):1320S-1329S. doi:10.3945/ajcn.114.084038
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