Use of insulin and weight gain: optimizing diabetes nutrition therapy.

The prevalence of diabetes in the United States is increasing at epidemic levels, with over 20.8 million people, or approximately 7.0% of the population, affected. While diabetes is projected to increase by 165% in the next 50 years, many people with diabetes are unable to reach recommended glycemic targets. Although more intensive therapy, often incorporating insulin, is clearly required for many patients, potential side effects, such as weight gain, can deter patients from optimal therapy and undermine the efforts of registered dietitians to improve diabetes self-management. Weight gain occurs following insulin therapy for a number of reasons, including caloric retention because of improved glycemic control; excess caloric intake; decreased caloric expenditure; sedentary lifestyles; and unphysiologic action of conventional insulin formulations. However, weight gain with insulin therapy is not inevitable, and the downward spiral in diabetes management associated with weight gain can be avoided through education and careful attention to therapy regimen. Registered dietitians must be involved before and after initiation of insulin therapy to help patients avoid or minimize weight gain, maximize adherence and glycemic control, and avoid the long-term complications of diabetes.