Background: One of the first treatment goals in type 2 diabetes management is 5-7% weight loss. However, weight loss while on insulin is rarely achieved because it requires a complex interplay of lifestyle changes, self-monitoring of blood sugars, and anticipation of hypoglycemia with resultant lowering of insulin doses. In fact, patients often gain weight on insulin therapy. Putative mechanisms include improvement of glycemic control at expense of low blood glucose, anabolic effect of insulin increasing fat storage and defensive eating habits due to fear of hypoglycemia. Here we present a motivational case of weight loss in type 2 diabetes.

Clinic Case: Patient was a 51 year old woman with insulin-dependent diabetes since 1993 who lost 88 pounds in 2 years. Her medications consisted of 70/30 mixed insulin (total daily dose = 150 units), Metformin and a GLP-1 receptor agonist. Over the course of 2 years she started eating smaller portions of food with resultant hypoglycemia. Her total daily dose of insulin is now 50 units per day, weight has decreased from 332 pounds to 244 pounds and A1c has improved from 8.7% to <6%.

Conclusion: Maintaining patients on high doses of insulin encourages a pattern of over-eating (feeding their insulin) and sedentary lifestyle. There is a need for best practice guidelines on how to safely de-escalate insulin doses as patients start insulin-sparing medications or institute lifestyle changes for the benefit of weight loss.


Y. Gorantla: None. H. Sonnabend: None. J. Hwang: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at