September 12, 2005
Insulin Analogs, Weight and Weight Loss
Question from Bunnell, Florida, USA:
I have been on Lantus and Humalog for about five months. After trying Coreg for blood pressure, I have not been able to keep my fasting blood sugar under 150 mg/dl [8.3 mmol/L]. I take 80 units of the Lantus at 9 p.m., in the stomach, and now am using about 20 units of the Humalog three to four times daily, breakfast, lunch, and dinner and at 9 p.m., if I am not near a normal range.
I have gained nearly 50 pounds in the last year. I am 5 feet, 6 inches and my weight has gone from 140 to 190 a year ago. My hope for the Lantus was to escape the weight gain as I did not read anywhere that Lantus was as bad as the other insulins for the weight gain. I went from seven to nine units of Humalog to 20 and kind of figured the Humalog was the culprit. The more insulin, the more weight gain; the more the weight gain, the more insulin needed.
After all this description, my question really is, can I increase the Lantus to 90 to 110 units per day in hopes that I can cut back on the Humalog? I just cannot keep gaining weight. I have had my diet checked and am okay there. Istick to low carbohydrate foods and do get exercise, especially since I don’t have a car. I have no lows with the regimen I am on so I do not have to “repair” low blood sugar with food. I would appreciate any suggestions before I go to the doctor.
Answer:
As you have deduced, the marked rise in your insulin dose has induced the weight gain you have experienced. Insulin is a synthetic hormone that lays down fat and protein, in addition to lowering glucose levels. In addition, you are very insulin resistant, while requiring more than 160 units per day. The way to break the cycle is to induce a weight loss with a decline in calories and more exercise. This will allow you to cut the insulin dose, lose weight, etc. The use or oral insulin sensitizers is not without problems as the class of drugs known as TZDs (pioglitazone and rosiglitazone) can induce weight gain. This is not the case with metformin, which is associated with weight loss.
Your cutoff goal for blood pressure is less than 130/80 mm Hg. This is recommended to protect the eyes, kidney, and heart from the untoward effects of the high blood pressure with diabetes. The use of blood pressure medications from the group of medications called ACE inhibitors were actually associated with protection from the development of diabetes in patients with heart disease. Make sure there are no additional aggravating issues. These might include bad dentition, chronic sinus infections, excess alcohol intake, and any other intercurrent illnesses.
JTL
