Weight gain and insulin therapy

Abstract

Weight gain is common with insulin therapy in type 1 and type 2 diabetes. Excessive weight gain worsens glycaemic control and increases cardiovascular risk. It can also increase diabetic morbidity and mortality if it acts as a psychological barrier to initiation or intensification of insulin therapy, or affects compliance. Insulin-associated weight gain might result from conservation of previously excreted glucose, defensive `snacking' caused by fear or experience of hypoglycaemia, or the `unphysiological' pharmacokinetic profiles that follow sc insulin administration. Strategies to limit insulin-mediated weight gain include increasing insulin sensitivity through dietary modification, exercise or insulin sensitising drugs. Attempts to replace insulin using regimens that accurately mimic physiological norms should also enable insulin to be dosed with maximum efficiency. The novel analogue insulin, detemir, has not of the pharmacological mechanisms underlying this shown the usual propensity for weight gain. Elucidation of the pharmacological mechanisms property could further clarify mechanism linking insulin with weight regulation.