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Insulin-Related Weight Gain in Type 2 Diabetes: Practical Guidance

Author : Sanofi
Editorial team

Introduction to Insulin Therapy and Associated Weight Gain Concerns

Managing Type 2 diabetes (T2D) presents as a challenge, with many individuals eventually needing insulin therapy to maintain adequate glycaemic control.1 People with T2D often feel apprehensive about initiating insulin therapy due to various psychosocial concerns, including fear of insulin-related potential weight gain.1,2 Hence, it is essential to help address related concerns carefully before introducing insulin therapy.

Achieving an optimal equilibrium between blood glucose management and weight considerations plays a key role in enhancing adherence to insulin therapy.1 This is in line with recommendations from the 2022 American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) consensus report which emphasises the importance of weight management as a core component of holistic, and person-centric approach to T2D management.3

This article examines evidence-based strategies for mitigating insulin-associated weight gain while optimising glycaemic parameters. Particular attention is given to insulin selection, structured titration protocols, and comprehensive management approaches that can be effectively implemented in clinical practice to help address this challenge.

Understanding the Link Between Insulin and Weight Gain

Potential weight gain while on insulin therapy can result from a combination of physiological and psychological factors, including:

Anabolic effects

Insulin, an anabolic hormone, promotes the storage of fat and inhibits the breakdown of protein, contributing to increased body mass.4

Defensive snacking

Previous studies have shown that individuals on insulin therapy tend to consume additional calories to prevent or manage hypoglycaemia. This defensive eating behaviour may eventually contribute to weight gain.4,5

Reduced energy expenditure

People with T2D sometimes follow a lifestyle with reduced physical activity due to fear of hypoglycaemia. This may contribute to weight gain.6

Hence proactively addressing these factors is essential both when starting and continuing insulin therapy.

Practical Strategies to Help Address Insulin-Related Weight Gain Concerns

With an appreciation of factors that might influence weight during insulin therapy, several approaches could be considered to help address these concerns while supporting glycaemic management. A comprehensive, multi-faceted approach that addresses insulin selection, education, technology utilisation, physical activity, and nutrition may offer the best opportunity for successful outcomes.3

Weight effects in Type 2 Diabetes

When considering insulin options, it has been observed that modern insulin formulations with similar glycaemic benefits may have varying effects on weight among people with T2D.

  • Patient-level meta-analysis of the EDITION studies showed that insulin glargine U300 had glycaemic control effects similar to glargine U100 but was associated with 0.28 kg less weight gain (p<0.05) over 6 months.7
  • Similarly, results from multiple treat-to-target trials have shown that insulin detemir was associated with a favourable weight profile compared with NPH insulin and insulin glargine U100, while achieving similar glycaemic targets.8,9

Educational Approaches That Help Driving Success in T2D Management

Evidence-based educational interventions are effective components of insulin initiation protocols to help address weight management concerns.

Creating awareness around fasting plasma glucose target (80-130 mg/dL) driven self-titration algorithms can mitigate risk of hypoglycaemia and may help prevent unnecessary weight gain.10-12

The practical titration guidance protocols can be integrated in conversations related to effective insulin use,10-12 providing a framework for addressing insulin-associated weight concerns while supporting optimal self-management practices.

Good to Know: Managing Weight Concerns During Insulin Therapy

When discussing weight concerns with people on insulin therapy, consider these evidence-based approaches that can be integrated into personalised care plans:

digital-heath-tools

Digital Health Tools

 

Meta-analyses indicate mobile app integration was associated with body weight reduction (-0.84 kg) in people with T2D, with more pronounced reduction in people with obesity (BMI >30 kg/m2) or when combined with behavioural support components. Applications incorporating Technology-Enabled Self-Management (TES) Feedback Loop showed promising outcomes through technology-driven communication between patients and healthcare teams and analysis of patient-generated health data.13,14

 

physical-activity

Physical Activity Recommendations

 

The ADA and EASD recommend approximately 150 minutes weekly of moderate-to-vigorous aerobic activity, breaking up sedentary time with brief activity breaks, maximising glycaemic effects with ≥45-minute post-meal activity, and implementing a small steps approach, where adding ~500 steps daily has been associated with 2-9% reduced risk of cardiovascular morbidity and all-cause mortality.3

 

nutritional-approaches

Nutritional Approaches

 

European and American clinical guidelines support personalised carbohydrate monitoring for optimising meal timing and food choices. Lower glycaemic load meals and increased soluble fibre intake may offer benefits within dietary approaches. Protein intake around 1.2-1.6 g/kg/day may influence satiety hormones like GLP-1 and PYY, offering additional weight management considerations.15-17

Balancing Glycaemic Control and Weight Management: A Way Forward

By addressing weight gain concerns associated with insulin therapy directly and providing evidence-based strategies, you may help patients overcome their hesitation about starting on insulin.3

Key takeaways

  • Educating patients on the realities of insulin therapy may help them accept insulins and mitigate potential weight gain.
  • You can support your patients by providing them with tangible actions that are easily implementable to help them with their diabetes treatment and weight concerns.

Explore other resources to aid in patient conversations on Campus

Fear of Hypoglycemia

Strategies to address patient concerns about low blood sugar events

Fear of Losing Normal Life

Supporting patients through lifestyle transitions

Importance of Glycaemic Control

Evidence-based approaches to optimise glycaemic outcomes

  1. McFarlane SI. Insulin therapy and type 2 diabetes: management of weight gain. J Clin Hypertens (Greenwich). 2009;11(10):601-607. doi:10.1111/j.1559-4572.2009.00063.x

  2. Home P, Riddle M, Cefalu WT, et al. Insulin therapy in people with type 2 diabetes: opportunities and challenges?. Diabetes Care. 2014;37(6):1499-1508. doi:10.2337/dc13-2743

  3. Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45(11):2753-2786. doi:10.2337/dci22-0034

  4. Russell-Jones D, Khan R. Insulin-associated weight gain in diabetes—causes, effects and coping strategies. Diabetes Obes Metab. 2007;9(6):799-812. doi:10.1111/j.1463-1326.2006.00686.x

  5. Ramachandran A, Venkatraman S, Moses A, Vijayakumar G. Hyp-O-besity: Unmet Challenge in Management of Type 2 Diabetes Mellitus and Cardiovascular Risk. J Diabetes Metab. 2015;6(4):520. DOI: 10.4172/2155-6156.1000520

  6. Zaharieva DP, Riddell MC. Insulin Management Strategies for Exercise in Diabetes. Can J Diabetes. 2017;41(5):507-516. doi:10.1016/j.jcjd.2017.07.004

  7. Ritzel R, Roussel R, Bolli GB, et al. Patient-level meta-analysis of the EDITION 1, 2 and 3 studies: glycaemic control and hypoglycaemia with new insulin glargine 300 U/ml versus glargine 100 U/ml in people with type 2 diabetes. Diabetes Obes Metab. 2015;17(9):859-867. doi:10.1111/dom.12485

  8. Hermansen K, Davies M, Derezinski T, Martinez Ravn G, Clauson P, Home P. A 26-week, randomized, parallel, treat-to-target trial comparing insulin detemir with NPH insulin as add-on therapy to oral glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetes Care. 2006;29(6):1269-1274. doi:10.2337/dc05-1365

  9. Rosenstock J, Davies M, Home PD, Larsen J, Koenen C, Schernthaner G. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia. 2008;51(3):408-416. doi:10.1007/s00125-007-0911-x

  10. Kuritzky L, Reid TS, Wysham CH. Practical Guidance on Effective Basal Insulin Titration for Primary Care Providers. Clin Diabetes. 2019;37(4):368-376. doi:10.2337/cd18-0091

  11. Blonde L, Merilainen M, Karwe V, Raskin P; TITRATE Study Group. Patient-directed titration for achieving glycaemic goals using a once-daily basal insulin analogue: an assessment of two different fasting plasma glucose targets - the TITRATE study. Diabetes Obes Metab. 2009;11(6):623-631. doi:10.1111/j.1463-1326.2009.01060.x

  12. Meneghini L, Koenen C, Weng W, Selam JL. The usage of a simplified self-titration dosing guideline (303 Algorithm) for insulin detemir in patients with type 2 diabetes-results of the randomized, controlled PREDICTIVE 303 study. Diabetes Obes Metab. 2007;9(6):902-913. doi:10.1111/j.1463-1326.2007.00804.x

  13. Cai X, Qiu S, Luo D, Wang L, Lu Y, Li M. Mobile Application Interventions and Weight Loss in Type 2 Diabetes: A Meta-Analysis. Obesity (Silver Spring). 2020;28(3):502-509. doi:10.1002/oby.22715

  14. Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A Systematic Review of Reviews Evaluating Technology-Enabled Diabetes Self-Management Education and Support. J Diabetes Sci Technol. 2017;11(5):1015-1027. doi:10.1177/1932296817713506

  15. Ibrahim SMH, Shahat EA, Amer LA, Aljohani AK. The Impact of Using Carbohydrate Counting on Managing Diabetic Patients: A Review. Cureus. 2023;15(11):e48998. Published 2023 Nov 18. doi:10.7759/cureus.48998

  16. Vlachos D, Malisova S, Lindberg FA, Karaniki G. Glycemic Index (GI) or Glycemic Load (GL) and Dietary Interventions for Optimizing Postprandial Hyperglycemia in Patients with T2 Diabetes: A Review. Nutrients. 2020;12(6):1561. Published 2020 May 27. doi:10.3390/nu12061561

  17. Leidy HJ, Clifton PM, Astrup A, et al. The role of protein in weight loss and maintenance. Am J Clin Nutr. 2015;101(6):1320S-1329S. doi:10.3945/ajcn.114.084038

 

TOUJEO® (insulin glargine 300 units/ml) – Abbreviated Prescribing Information

NAME AND PRESENTATION: Toujeo® 300 units/ml SoloStar, solution for injection in a prefilled pen. Toujeo® 300 units/ml DoubleStar, solution for injection in a pre-filled pen. 1 ml of solution contains 300 units of insulin glargine. Each SoloStar prefilled pen contains 1,5 ml of solution for injection (equivalent to 450 units). Each DoubleStar pen contains 3 ml of solution for injection (equivalent to 900 units). THERAPEUTIC INDICATIONS: Treatment of diabetes mellitus in adults, adolescents and children from the age of 6 years. POSOLOGY AND METHOD OF ADMINISTRATION*: Toujeo® is a basal insulin for once-daily administration at any time of the day, preferably at the same time every day. When needed, patients can administer Toujeo® up to 3 hours before or after their usually time of administration. The dose regimen (dose and timing) should be adjusted according to individual response. In type 1 diabetes mellitus, Toujeo® is to be used once-daily and must be combined with short-/rapid-action insulin to cover mealtime insulin requirements. In patients with type 2 diabetes mellitus, the recommended daily starting dose is 0.2 units/kg. Toujeo® can also be given together with other anti-hyperglycaemic medicinal products. Switch: When switching from insulin glargine 100 units/ml to Toujeo®, this can be done on a unit-to-unit basis. When switching from a treatment regimen with an intermediate or long-action insulin to a regimen with Toujeo®, a change of the dose of the basal insulin may be required and the concomitant anti-hyperglycaemic treatment may need to be adjusted. Close metabolic monitoring is recommended during the switch and in the initial weeks thereafter. For switch details see full SmPC. Special populations: Toujeo® can be used in elderly people, renal and hepatic impaired patients and adolescents and children ≥6 years. Renal impairment & hepatic impairment: insulin requirements may be diminished. Elderly: progressive deterioration of a renal function may lead to a steady decrease in insulin requirements. Children: Toujeo® can be used in in adolescents and children based on the same principles as adult patients. When switching to Toujeo®, dose reduction on basal and bolus insulins needs to be considered on an individual basis to minimize risk of hypoglycaemia. Safety and efficacy in children below 6 years have not been established, no data are available. Method of administration: For subcutaneous use only. Rotate injection sites to reduce the risk of lipodystrophy and cutaneous amyloidosis. Toujeo® must not be administered intravenously or in insulin infusion pumps. The Toujeo® SoloStar and Toujeo® DoubleStar pre-filled pens have been specifically designed for Toujeo® and no dose re-calculation is required for either pen. When changing from Toujeo® SoloStar to Toujeo® DoubleStar, if the patient’s previous dose was an odd number (e.g. 23 units) then the dose must be increased or decreased by 1 unit (e.g. 24 or 22 units). Toujeo® DoubleStar prefilled pen is recommended for patients requiring at least 20 units per day. Toujeo® must not be drawn from the cartridge of the Toujeo® SoloStar pre-filled pen or Toujeo® DoubleStar pre-filled pen into a syringe or severe overdose can result. For administration details see full SmPC. CONTRAINDICATIONS*: Hypersensitivity to the active substance or to any of the excipients listed in the full SmPC. SPECIAL WARNINGS AND PRECAUTIONS FOR USE*: Record name and batch number of administered product to improve traceability of biological medicinal products. Toujeo® is not the insulin of choice for the treatment of diabetic ketoacidosis. Instruct patients to continuously rotate injection site to reduce risk of lipodystrophy and cutaneous amyloidosis; delayed insulin absorption and worsened glycaemic control may occur after injection at affected sites. Sudden change in injection site to unaffected area has resulted in hyperglycaemica; blood glucose monitoring is recommended after changing injection site and dose adjustment of antidiabetic medications may be considered. The prolonged effect of insulin glargine may delay recovery from hypoglycaemia. Insulin glargine 100 units/ml and Toujeo® are not bioequivalent and are not interchangeable and switching may result in the need for a change in dose and should only be done under strict medical supervision. Switching patients between other insulins and Toujeo® should be done under strict medical supervision and may result in the need for a change in dose. Intercurrent illness requires intensified metabolic monitoring. In rare cases the presence of insulin antibodies may necessitate adjustment of insulin dose. If pioglitazone is used in combination with insulin, especially in patients with risk factors for development of cardiac heart failure, patients should be observed for signs and symptoms of heart failure, weight gain and oedema. Pioglitazone should be discontinued if any deterioration in cardiac symptoms occurs. For further details on special warnings and precautions for use see full SmPC. DRUG INTERACTIONS*: Substances that may enhance or reduce the blood glucose-lowering activity and increase susceptibility to hypoglycaemia are detailed in the full SmPC. PREGNANCY AND LACTATION*: There is no clinical experience with use of Toujeo® in pregnant women. For insulin glargine no clinical data on exposed pregnancies from controlled clinical studies are available. A large amount of data on pregnant women indicate no specific adverse effects on pregnancy and no specific malformative nor feto/neonatal toxicity of insulin glargine. The use of Toujeo® may be considered during pregnancy if clinically needed. It is unknown whether insulin glargine is excreted in human milk. No metabolic effects on breast-fed newborn/infant are anticipated as insulin glargine is digested into amino acids in the gastrointestinal tract. EFFECTS ON ABILITY TO DRIVE*: Patient’s ability to concentrate and react may be impaired as a result of hypoglycaemia or hyperglycaemia or, for example, as a result of visual impairment. Patients should be advised to take precautions to avoid hypoglycaemia whilst driving. UNDESIRABLE EFFECTS*: Very common: Hypoglycemia. Hypoglycaemia may occur if the insulin dose is too high in relation to the insulin requirement. Common: Lipohypertrophy; injection site reactions. For full list of undesirable effects consult the full SmPC. Clinical study safety data not available for children <6 years. OVERDOSAGE*: Mild episodes of hypoglycaemia can usually be treated with oral carbohydrates. More severe episodes may be treated with intramuscular/subcutaneous glucagon or concentrated intravenous glucose. PHARMACOLOGICAL PROPERTIES: ATC Code: A10A E04. MARKETING AUTHORIZATION HOLDER: Sanofi-Aventis Deutschland GmbH, D 65926 Frankfurt am Main, Germany. LEGAL CATEGORY: Medicinal product subject to medical prescription. DATE OF LAST REVIEW: March 2026

*Abbreviated Prescribing information based on the EU SmPC as of Nov 2023.

Before prescribing the product always refer to your full local prescribing information as this information may vey from country to country.

For local details, please refer to below information.
Sweden: Rx, (F), A10AE04. Toujeo is reimbursed for all patients with type 1-diabetes and for patients with type 2-diabetes where other insulin treatments are not sufficient to reach the treatment target because of repeated hypoglycaemic events. For further information, and also information concerning price and packaging, see www.fass.se. In Sweden Toujeo is provided by Sanofi AB, Box 30052, 104 25 Stockholm, Tel: +46 8 634 50 00, www.sanofi.se. For questions on our medicinal products, please contact: infoavd@sanofi.com.

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MAT-BE-2501239 v1.0 05/2026