Can insulin affect your weight or eating habits?

Diabetics depend on insulin for survival, but every medical intervention comes with side effects. If you think insulin is causing unnecessary weight gain, here's what you can do about it—the safe way.

• Roughly one in three people with type 2 diabetes already uses insulin, often in combination with metformin or other diabetes medications that help your body use insulin efficiently.
• Though it's true that insulin used to be considered a "last resort" drug for type 2, the new thinking is that starting insulin sooner isn't a sign that you've failed at controlling your diabetes. Instead, it's becoming a smart, blood sugar-controlling move that compensates for your body's dwindling ability to produce its own insulin.
• Most people have already lost half of their insulin-producing capacity when type 2 is diagnosed. Yet fears about daily injections, weight gain and low blood-sugar episodes can lead to a mindset experts call "psychological insulin resistance."

Here's the good news about insulin: weight gain is not inevitable. But it can happen. In one study, people with type 2 diabetes who used insulin gained eight more pounds over 10 years than those who didn't.

Stay safe: don't alter your dose

Whatever you do, resist the temptation to skimp on insulin to drop pounds. In one study, 86 percent of women who followed this dangerous practice developed vision-threatening eye problems within four years because of high blood-sugar levels. Here's what you can do to compensate if insulin is hurting your weight:

• Daily exercise may stave off weight gain. In a 2010 study, insulin users who didn't gain weight got about a half-hour more moderate-to-intense exercise daily than those who put on pounds.
• One study found that a long-acting insulin called detemir helped 68 percent of people who used it avoid weight gain or even lose nearly a pound in three months.

• Those who use insulin may be at risk for low blood-sugar episodes if they don't eat enough or if they delay a meal, take too much insulin or exercise more than planned. Some may also have such episodes after having an alcoholic beverage.
• A "low" can leave you feeling shaky and sweaty—and can be dangerous if you're driving a car.
• New research shows that about 10 percent of people with type 2 and about 20 percent with type 1 don't feel the usual telltale signs of dropping blood sugar and as a result, are six to 17 times more likely to have levels fall dangerously low.