Are Your Meds Making You Fat?

One of the frustrations of diabetes is the way everyone tells you to lose weight. Then they give you medicine that makes you gain weight. Some of the worst offenders are insulin and the thiazolidinedione drugs, pioglitazone (brand name Actos) and rosiglitazone (Avandia). Why do these drugs cause weight gain, and what can you do about it?


To recap: As you know, Type 2 diabetes is a disease of insulin resistance. Your muscle and brain cells don’t want the glucose that the insulin is trying to bring, so they resist. The glucose stays in the bloodstream.

At first, the beta cells in the pancreas try to compensate by pumping out extra insulin to overcome the resistance. When the beta cells can’t keep up, or when the resistance gets too severe, you start running high blood sugar and developing symptoms of diabetes.

When Insulin is Low
People with Type 1 diabetes don’t make enough insulin, period, and people with Type 2 develop a low-insulin situation over time. What does that do to you? With insufficient insulin, glucose can’t get into your muscle and brain cells to be burned as fuel. It can’t get into the liver to be stored as starch, and it can’t get converted into fat. Why not? Because insulin does all those things.

So, when you don’t have enough insulin, you won’t gain weight, because your body can’t do anything with the glucose, and you wind up urinating it away. That’s why weight loss is a classic symptom of Type 1.

Then You Inject
Now this is the tricky part—if you have Type 2, and you are given insulin, the fat storage will resume full speed. Insulin resistance doesn’t affect fat storage. But because of insulin resistance, you will get only a partial improvement in glucose uptake by your muscle and brain cells. So the glucose starts to get stored as fat instead of being lost in the urine. The result is weight gain.

There are other reasons for insulin-related weight gain. Christine McKinney, M.S., R.D., C.D.E., of Johns Hopkins University explains that if people experience hypoglycemic episodes on insulin, they will likely eat more to avoid them. Also, when people find out they can eat whatever they want but avoid high blood glucose by taking more insulin, some react by blowing off their diet. Insulin may also increase appetite directly, she says.

Actos and Avandia, the TZD (thiazolidinedione) drugs, can also cause significant weight gain. In studies, the more Actos people took, the more weight they tended to gain. Taking Actos with insulin increased the weight gain. The reason is that a TZD helps a person’s insulin work better, so less sugar is lost in the urine.

What Can You Do About It?
The Mayo Clinic says that weight gain is avoidable with insulin. But you have to cut calories significantly. A lot. With insulin, your body uses food more efficiently, so you just don’t need as much of it. Mayo gives the usual advice about fruits, vegetables, whole grains, smaller portions, not skipping meals, and getting much more physical activity.

If you’ve ever had a bout of hypoglycemia, it’s important to figure out what caused it. If you don’t know, you’ll probably eat more to avoid another one, and you’ll gain weight. If you find that insulin is increasing your appetite, you may want to eat more vegetables or drink more water to suppress hunger. But some drugs can also help.

In the Actos studies, people who took metformin (Glucophage and other brand names) along with Actos gained less weight. In fact, metformin is used as a weight loss drug in psychiatric patients, because some of the psych meds cause a lot of weight gain.

Another diabetes drug that causes weight loss is exenatide (brand name Byetta). Byetta is a synthetic version of a protein originally found in Gila monster saliva, but don’t let that stop you. This drug stimulates the beta cells to produce insulin, but not all the time. Only when blood glucose is up.

More important for the weight thing, Byetta can reduce appetite and delay food absorption. So if you’re trying to lose weight with diabetes, you might look into this drug. But it is injectable, and it is expensive. (If cost is a problem, I guess you could go out and get your own Gila monster.)

Wish We Had Better
I’m sorry that I don’t have any magic solution for this. I think it’s just such a shock to people who have been wasting glucose for so long, that when they finally get on insulin and start using glucose better, they can’t believe how much less they need to eat and/or how much more exercise they need to get. Going on insulin really is a major life challenge.

Does anyone else have any tricks or strategies? Anyone with Type 2 who has started insulin and not gained weight? Or figured out how to lose it back? Let us know.

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  • CalgaryDiabetic

    Dear David.

    Last fall by weighting and writing down absolutely everything I put in my mouth for 60 days I managed to loose 10 lb. My specialist and my wife made fun of this and plus it is was very stressful. They both said to eyeball the food you eat. Totally stupid advice when you are starving constantly. I do no think the Doctors realize how toxic insulin is for most people. This is not 100% true as I met a type one who takes insulin, has no insulin resistance, is lean and trim and feels well. It would be good to have a specialist that HAS Diabetes.

    Getting a good night sleep would help loose weight, this is based on empirical observation since I have no means to insure a good night sleep to carry out the experiment properly. Pills only work in a hit or miss fashion. And they too give you the munchies as do most legal psychotic drugs(anti-depressants, anti-anxiety, sleeping, etc, the whole bloody lot I have tried).

    Seriously considering as a last ditch measure to stop taking any rapid insulin and only living on the slow acting basal dosage of Latus. In addition to this a fanatical low calorie and very low carbohydrate such as preached by Dr. R. Bernstein. Otherwise I think it is a downward spiral leading to death within a few years.

    Starting insulin may have been the greatest mistake I ever made. Not sure if there was any other option except Dr. R. Bernstein as Avandia did not work at all which is funny since it is supposed to combat insulin resistance. Byetta did not exist.

    I suspect that I have just lived too long. In the past in Slovakia my ancestor’s would have died by age 45. Until that age I was physically fit and very healthy in spite of the American life style.

    How about Amylin has anyone added that to their insulin regime. Putting a staw in the mouth and crazy gluing the rest? Metformin makes me quite sick.

    Desperate in Galgary, send advice nothing is too corny.

  • Fayetn

    My feelings about the Diabetes Meds causing weight gain is attributed to my own feelings.
    I was diagnosed with Type 2 Diabetes in the
    Winter of 2007. I was then placed on Metformin
    twice daily. My hunger increased and I do
    have to watch closely the amount of food I ingest.
    I have lost a total of 25 pounds since the
    diagnosis, and am thankful for the weight loss.
    It is a daily vigil for me to stay on track,
    with everything that I am now responsible for
    keeping up with. I wish in the near future, that
    a cure is found for any Diabetes. Until then,
    we are all responsible for the care and needs
    of ourselves, our loved ones, family and
    friends with Diabetes.

  • David Spero RN

    Hi CD,
    Sorry to hear things are so rough. It seems like you have identified two possible solutions – the Bernstein very low-carb approach, and/or getting on Byetta, which may help.

    I’ve certainly heard from dozens of people who were reborn on Bernstein’s diet.

    I also think that hunger can be partially controlled by eating lots of green fibery vegetables – lettuce and cucumbers and things like that. Greens. You can pretty much eat as much of them as you want. It’s better than starving, IMO.

  • CalgaryDiabetic

    Dear David. I will try your suggestion to eat bulky foods to see if they are more filling. Anyways it may be much more difficult to eat a 1000 calories of broccoli than 1000 calories of cheese. I had some success in the past eating sauerkraut which is the same concept.

  • KG

    I thought I read somewhere that Byetta cannot be taken by someone who is taking insulin. I also read that it may have similar side effects to Metformin (which in my case was explosive diarrhea–with no prior warning).

    Does anyone know if one can take Byetta and insulin, or stop insulin and start Byetta?


    • James MacQuarrie

      No worries. I have been on Byetta and Insulin for about 3 years. My Pharmacy was unable to get Byetta for 7 weeks and I put on 3 kilos.
      There is now a weight reducing injection called Liraglutide which is being hailed as a great breakthrough in both Diabetes and Obesity.
      Here in the
      UK, drugs are not readily available owing to the Governments dictats

  • dkay

    I just want to bawl my eyes out reading all of this. I have joined a weight loss program and have lost 20 lbs., but I am stuck there and can’t seem to move. I, too, feel hungry most of the time and I, too, log all of my food. I never feel like I have ‘enough’ to eat and yet the fat sticks to me like glue. I’ve been using insulin for a year or so now and also Lantus at night. At first on my diet, I lost rapidly and was able to reduce my insulin by almost half. Now, as time goes, on, it’s inched it’s way back up to almost where it was originally. I just feel so darned defeated. If it’s not one thing…it’s another…

    My weight loss plan (LA Weight Loss) sells Control Trim, which is some type of fiber that I’m sure expands in the stomach to give that “full” feeling. Is this worth a try? I’ve worked so hard at avoiding their gimmicks, but I’m tempted by this one. The label says very low carb.

  • St. Paul Mike

    I’ve been trying to follow a modified Dean Ornish diet described in “Dr. Neal Barnard’s Program for Reversing Diabetes.” Dr. Barnard’s diet can only be described as a high-carb diet with no or little refined carbs, much fiber (greater than 40 grams per day), and low-glycemic. It limits or tries to eliminate foods that contribute to blood glucose fluctuations. No animal products are allowed in this diet. Non-animal fats are also severely to totally eliminated.

    I take metformin, glipizide, and Actos. Since starting the diet about seven weeks ago, I have lost about 5 pounds and my measured blood glucose has dropped about 50 to 100 mg/dl. Over the last three months my A1C has dropped from 10.2 to 8.4. My Doc was pleased and encouraged me to continue this diet. I should mention that I have not been the strictest adherent to this diet; but I have had no animal products and have mostly avoided non-animal fats over the past seven weeks.

    This not the easiest diet in the world to follow, especially when eating out. I did start it out of my frustration with not making any progress with other diets. It does have the advantage of allowing you to eat as much as you want with the allowed foods. But beware that eating all the beans, barley, and brown rice that you want can lead to unwanted gastric results.

    I would appreciate feedback on this approach and hope it gives some hope to other Type-2 diabetics.

  • DonnaDB

    I’ve had type 2 for twelve years. For the first eight, I was able to control it with diet and exercise. (I was and still am over-weight, but I lost about 25 lbs and kept it off.) Slowly my numbers started creeping up so my MD put me on metformin. No major probs, but he felt my numbers were still running too high so he added ACTOS. My numbers dropped like a charm, but I started blowing up like a baloon. I was still walking and measuring, but in six months I gained 35lbs, my blood pressure shot up and was retaining lots of water (and getting very depressed). My doctor had me stop ACTOS, upped the metformin and added a water pill. The weight started to come off very, very slowly. However, my numbers continued to stay high. Two months ago he added Januvia and things are getting back to normal. I’ve shed about 25lbs with 10 more to go. I’m really watching my carbs and walking and the combination is working. It’s taken over a year, but I think I’m pretty well balanced.

  • marcie

    Just a note on this statement

    >>. . . In fact, metformin is used as a weight loss drug in psychiatric patients, because some of the psych meds cause a lot of weight gain.

    This is true, but there’s more to the problem with these meds than just causing weight gain.
    Most of the “atypical” psych meds for bipolar depression cause elevated blood sugar, which is information that’s in the warning section of the drug comapanies’ monographs. In fact, diabetes — not reversible elevated blood sugars — is a known risk of these meds.

    When these medications are prescribed, it’s often a choice between having the patient be unable to function or being suicidal and the great risk of developing diabetes.

    The choices are that “between a rock and a hard place” situation.

  • marcie

    Hi, Kath —

    Yes, it is written that a person taking insulin should not take Byetta. I’ve never seen it clarified as to whether this refers to those with Type 1 or with Type 2.

    Since Byetta is a medication that relies on the body producing insulin, it does seem counterintuitive for those with anyone on insulin to take it. However, there is a “similar” drug for those who are type 1, called Symlin.

    It’s true that Byetta can cause several kinds of digestive tract problems, but usually these are at least partially a dosage-related problem, and they usually fade with continued use.

    I’ve had Type 2 since autumn of 2000. Most of that time I was on metformin (I still take 500mg @ bedtime) and was fortunate enough to be able to keep my A1c below 6. However, early in 2006, I was bitten by a pit bull and had to take Augmentin, a very strong antibiotic. This caused my blood sugar to go up, and I developed a severe yeast infection, for which I had to take an anti-fungal medication. As with others, sometimes when a person with Type 2 gets sick, their blood sugars go berserk. In fact, I could not get my blood sugars back under control.

    My A1c went up to 9.0!!!

    After starting Byetta, within 2 months, my A1c was down to 6.7. Two months after that, it was down to 5.1. It continues to stay under 6.0.

    You could NOT get me to stop taking Byetta. This is the feeling for many who are taking it. Have you ever read any of the columns/articles written by David Mendosa? He sings its praises much more than I do.

    Byetta used to make me have stomach aches — not abdominal, but up in my stomach. This faded, but then I started feeling nauseated after eating. That, too, passed. Now, it just makes me feel full sooner than I expect to. Now THIS is a digestive tract “problem” that I can live with — LOL.

    I’ve never taken a medication that didn’t warn of some possible side effects. (“Possible” is a very important word to note.) Mostly, though, those I’ve taken haven’t caused me any trouble. If I hadn’t given them a try, being worried about the possibility of having problems, I wouldn’t have discovered that almost none of them were amy problem for me, and I wouldn’t have received their benefits.

    It might be very helpful for you, if your doctor suggests you taking Byetta, to start on the low dosage and see how it goes. You might be thrilled with how well it works for you.

  • marcie

    David —

    My standby for hunger is sugarless gum.

    The kind of Trident that comes in the smaller package — not the one in the thin, flat one — has a very long lasting flavor. This is great, because one of the sweeteners used in it is a sugar alcohol.

    It seems to me that this brand’s assorted flavors are really, really strong. The one that’s seemed fine is the one in the lightest green package — it has a picture of a blue and white striped mint on it.

  • CaroleLynne

    Don’t hate me because I am thin – how many times have we heard that? I went to my Endo thinking my sudden weight gain over 4 months of 15# was my whacked out thyroid. I had been having FBS numbers under 109 for three years and was told I had impaired fasting glucose. She put me on Metformin ER 1500mg. Now I say “Don’t hate me because I do not have any GI distress thank goodness.” I am on a statin for cholesterol and she added an ARB because I do work out a lot and I occassionally spill protein. I initially lost 5 pounds and then everything stopped-I cannot budge that scale – I eat 5 small meals a day. I eat very low carb. I eat what is recommended, whole grains, fiber, lots of the right veggies, I start each meal with protein first. AFter seeing three doctors I have differing opinions from all three. The original Endo had me come in one day fasting, drink Glucola, and every 30 minutes they used a FreeStyle meter on me to check my numbers. At 4 hours I was at 277 so she announced I am a Type 2. Two other doctors scrunched up their faces and said “Insulin resistance with metabolic disease and you cannot be diagnosed properly with a meter.” I say “who cares at this point I would not be doing anything any differently. I am doing every thing I would be doing if I was properly diagnosed. By the way my A1c is 5.6 and was 5.5 a year ago. So what am I? I don’t know but I do have a new Endo and she said I should stop the Metformin, one local doctor agrees, and a doctor I see for something else in a university setting says stay on the Metformin-talk about being confused. But now people are saying things like low carb is better and I find myself questioning the ADA recommendations of having to eat a certain amount of carbs per day. So what is a gal to do? Oh and I did have GI problems once when I thought if 3 are supposed to help me lose weight what would taking 4 do (and I did ask before trying) the 4th dose had me running so I am back on three at dinner.

    Part of me thinks it is what it is-I am doing what I can, working out, eating good food, and stuck at 15 pounds I can’t get rid so stop crabbing and live with it – but it is all where it should not be – it is abdominal not good for my health. Thanks for your blog.

  • Risabe

    I take insulin <b>and</b> Byetta. I had to back off of the 10 mg dosage of Byetta because I was nauseated all the time. I still get nausea but it does not last nearly as long on the 5 mg dose. I also take Levimir. Lantus did me absolutely no good whatsoever. Sugars still run high in the am. I am on a lot of insulin, and I am trying to back it down, but at what cost?

  • Rhonda RN

    Dear All

    I was diagnosed with Type 2 around 1995 and it has been a struggle ever since. I did have gestational as well.

    I developed a slight wt problem around 8 years but really began climbing after child birth finally reaching 350 at my highest wt. With diet exercise and meds got down around 320-330 range. No matter what I did I gained with Avandia.

    Although I made significant lifestyle changes, I swore off fast food forever (after watching SUPER SIZE ME) with total compliance with diabetic diet and meds, every year my HGB1AC climbed. A couple of years ago they put me on Byetta and I dropped to 307. I stayed there for a few years now and couldn’t break that weight. Also my Blood sugars began to climb to about 250 with the Glucophage and Amaryl. With the Byetta I went down to 150-175 (6.9 from 8.2).

    The Byetta changed the constant hunger but it also changed my food preferences. I call it the ana-abuse for food. I could no longer eat rich foods and lost the preference for beef especially. I did prefer cheeses and bread. Anything high in glycemic index would make me ill and severely nauseaus. Something rich like mole sauce would cause severe stomache cramps. But over time the blood sugar began to rise again so they put me on Lantus at night. Again my values dropped but wt began to climb to 320 even though the my eating patterns stayed the same.

    At the beginning of the year I got a severe respiratory infection which turned into asthma and I ended up on the dreaded prednisone. BS went up to 380 ( a first) and very frustrating. The Lantus and the NPH would not effectively cover these high blood sugars. Out of desperation I converted to Dr Barnard’s vegan diet.

    Dramatic results almost instantly. Within a month I dropped to 292 and lost 3 inches around my waist and hips. Blood sugars dropped as well (hgb1ac from 8.2 to 7.8). I am also doing weight watcher points to keep the eating plan in perspective. I have stayed at this weight and can not drop any lower mostly because of the high doses of prednisone. I am being weaned off and should be totally off within 2 weeks. I am really anxious to see what happens with the vegan diet after I am off the prednisone. I believe this will be the lifestyle change that will change the disease and am hopeful it will give me that edge to reverse this disease process and get off the meds. As a side note my Blood pressure also changed drastically and I am holding that med and stopped taking the NPH.

    Even though it seems hard there are so many soy products around the transition has been much easier than I thought.


  • CalgaryDiabetic

    Dear CaroleLynn. Amazing that the other doctors scoff at using the 5 sec civilian meter for the glucose uptake test. The old 60 second meters were much more accurate. Still at 277 even if you slice off 20% that will still make you a full fleadged diabetic. You seem to have it under very good control with the HA1C so low so keep up the good work. Loosing weight and KEEPING it off requires tremendious amounts of DAILY exercise. How not to gain weight escapes me but do whatever you can to minimize weight gain. Diabetes is an all out war do not slack off.

  • Sandi

    I have gained very little weight, but I have been very active I do a lot of home improvement projects and gardening. I used to do almost no physical activity. I have also cut down on fast food to almost zero.

  • Steve

    How about gaining weight because when taking insulin all it does is cause puffiness like water weight gain? I can stop taking insulin and loose all that “water weight” within a few days….and back to normal weight. This is NOT weight gain because of over eating. I once gained over 20 pounds within 3 weeks time because of taking insulin. I was so uncomfortable and couldn’t get around, wear any of my clothes….I stopped taking insulin and all that weight went off and I was back to my normal weight again. Does anyone out there experience this??? On top of the weight problem, once I am on a regime of insulin along with weight gain I begin to not feel well…and once I stop the insulin, I begin to feel better and of course, loose the puffiness etc… My body is so different from other people. I have started taking Flaxseed oil for getting my blood sugars to stablize and reduce…so I think this is probably a better alternative. If anyone has anything like me…please respond! THANKS!

  • tancy nancy

    I have been type two since about 1996. in october2008 my dr put me on janumet glucotrol and actos I have put on about 30lb. it is now january 2009. I can not stand myself I think I would reather just stop my meds and just take my chances
    does any one have any advice for me I dont want to die but I dont want to be FAT either

  • teresa

    I*’ve been telling my Doctor that Metformin makes me gain weight, he didn’t believe me. To prove it, I didn’t take it for 6 months, but keep taking my gliclazide. I lost 15 kilos, continued what I was doing, eating and working at the same time. Then I went back to it, because he said, I’m killing myself for not taking the medication. Within 3 months, I ballooned and gained that 15 kilos. Still he doesn’t believe me.I found out that he doesn’t want to change my med/s because it was the only med/s that will be covered by my insurance. I’m so upset, and I hope doctors out there will be more than willing to listen to their patients, not only to these insurance companies. They are risking their patients life and this is not what they promised when they oated for being medical practitioners.

  • lori

    MY son found this site on stumbleupon unreal. I have type 2 am 41 diagnosed in 96 after the birth of my 3rd child. I just had my 4th child 3 months ago a surprise to say the least. My Dr. took me off avandia 4 mg twice day. Started taking novolog 20 units before each meal then later in 2nd trimester added humilin 20 units at bed time. My a1c sterted at 10.5 in 1996 and in 2006 I had it steady at 6.5 . I was able to keep it at 6.7 all during the pregnancy. Now it is up to 6.8 in just 3months.I am still on the novolog 28 units 3 times a day and now lantis at bed time 28 units. My FBC is up from 134 to between 168 -197.and my 2 hr after meals is 270 or higher . I am insulin resistant so is taking more insulin going to help. I am now having headachs all the time and the bottoms if my feet hurt so bad I can barely walk in the morning. I exercise regularlyand eat healthy. I was on south beach but had to stop during the pregnancy.I am seriously thinking about stoping the insulin and going no carb to see if that helps . I have gained 20 lbs. since starting the lantis.If any one out there has any advice I would love to hear it .I have a family that needs me to be healthy for a long time.

  • David Spero RN

    I am sorry for not replying sooner to some of these heartfelt questions. I hope the other comments helped you. Teresa’s story is a good argument for national health insurance, isn’t it?

    Lori, an A1C of 6.8 isn’t all that high, but it does sound like you’re on the “take more insulin, get more insulin resistance” slide that Calgary Diabetic talked about in his post.

    You said you gave up South Beach during pregnancy. You might want to go back on something like that, or go even lower-carb like Dr. Bernstein recommends. And as you can see from the comments, a vegan, high-fiber approach is also working for a lot of people. So I’d recommend one of those, plus as much activity as you are comfortable with. I’d also advise not making yourself crazy about it, because stress raises blood glucose and promotes weight gain.

  • Niraj Sharma

    Can Dark Chocolates reduce levels?
    In my case. I have type 2 diabetes.On Insulin Humalog (50%lispro and 5o% Lispro Protamine 24 units before meals). My HGB 1AC was 9.1 and now it has come down to 7.9 in 4 months. I have gained 3 Kgs in this period.
    Sometiime back I couldn’t resist eating Swiss dark chocolates. One peice, between meals for 4-5 days and also after dinner. Usually (rarely) whenever I eat chocolates or sweets or have coke. I immediately feel hunger and dizzines. But when I ate these chocolates (the Swiss make one’s) I didn’t have any sypmtoms and further more I didn’t feel hungry after 3-4 hrs. of meal. when I checked with my glucometer the levels were lower than to the levels which were during that period.
    Maybe my insulin resistane got less or the beta cells were triggered.
    I feel the best soloution to lowering your sugar levels is eating less food. And depressing your huger. we can get used to this if we try it for few days. And suppliment the deficency by having fruits with less sugar content.
    And most of all sometimes and only sometimes a peice of dark chocolate.
    Diabetes is curable mentally. By thinking and eating right. Both in less quantity.

  • Brian Davey-Thompson

    Hi, just to get this problem out in the Media, I had bout of sickness at last xmas which left my thighs slightly numb (like anaesthetic), they still like this today. It’s been slow happening but my muscles have gradually became stiff, with burning pains/twitching, now in my body as well as limbs, but my doctor keeps telling me it is stress, have had full blood screen and nothing crops up. Today my neck has started seizing up with pain into my head.
    I have been on Venlafaxine 300mg, Quietiapine 600mg, Priadel(Lithium) 800mg plus thiroid, cholesterol and a small dose of omeprozole for some 18 years and pre meds was 9.5 stone am now 14 stone. Where do I go from here?? Any advice as to getting tested?? FOR WHAT, WITH WHO, DO I NEED TO GO PRIVATE?? Although I don’t have any spare cash.
    Kind Regards Brian Davey-Thompson

  • Brian Davey-Thompson

    Hi, apologies from Brian (the above blog), I’ve inadvertantly put this on the wrong site. Regards Brian Davey

  • Insulin can certainly make you put on some pounds.