Should I Switch Insulin to Lose Weight?
Have any studies been done, other than by Novo Nordisk, to prove that taking Levemir causes little if no weight gain? I have gained a lot of weight taking Lantus, and I don't know if it would be better to switch to Levemir. Lee Safian, New Milford, New Jersey
Roger P. Austin, MS, RPh, CDE, responds: Insulin detemir (Levemir) and insulin glargine (Lantus) are both basal insulins. There have been a number of published studies comparing insulin detemir with other diabetes treatments. These studies were primarily funded by Novo Nordisk, the manufacturer of insulin detemir. Studies in patients with both type 1 and type 2 diabetes have shown a slight weight loss or slightly less weight gain in patients on Levemir when compared to other treatment options. However, these differences were small, and whether or not some insulins are worse offenders in causing weight gain is unknown due to lack of quality data. You may find it useful to discuss a change of insulins with your physician to see what happens in your case; however, in most cases, a significant lowering of A1C will likely result in some weight gain.
Weight gain with insulin use is not necessarily inevitable. The science of developing newer insulins over time has been directed at trying to better mimic the action of naturally produced insulin in the pancreas. The fewer insulin injections given per day, the less the insulin's performance will be similar to that of naturally produced insulin in the body. Understanding appropriate blood glucose targets before and after meals, as well as frequent and regular monitoring of blood glucose, is essential to successful individualization of insulin dosing and weight management. Minimizing weight gain also requires a good understanding of carb counting, practice of portion control, and the counsel of a registered dietitian.
Without oversimplifying, the challenge is to match your dose of insulin as closely as possible to your body's insulin needs throughout the day. This is affected by a number of different factors, including food consumed (especially carbohydrate), exercise, stress, insulin resistance, and more. Weight gain is more likely for people with frequent low blood glucose who must take in more carbohydrate to regulate blood glucose. Additionally, insulin use affects the brain's perception of hunger and satiety, thus affecting appetite and cravings. You should also recognize the influence that other medications you are taking may have on your weight.