Hormonal
In type 2 diabetes patients initiating insulin therapy, pre-insulin weight loss combined with rising or persistently high HbA1c is the strongest predictor of excessive post-initiation weight gain (≥5 kg).
If you are starting insulin and have lost weight recently while your blood sugar numbers were going up, expect to regain that weight. This is likely 'catch-up' weight as your body stops losing sugar through urine. It is a sign the insulin is working to correct your metabolism, not necessarily a failure of your diet. Monitor your weight, but do not let fear of this specific type of gain prevent you from starting life-saving therapy.
Patients that lost weight parallel with HbA1c rise in the two-years pre-insulin, showed the most pronounced weight gain. Of these patients, roughly one out of five (20.3%) gained 5 kg weight or more.
Why this rating
Large retrospective inception cohort (n=5086) with rigorous statistical modeling (AUROC 0.668-0.712), though observational design limits causal inference.
Source
Determinants of excessive weight gain after the initiation of insulin therapy in type 2 diabetes mellitus: Retrospective inception cohort study (ZODIAC 60)
Mireille A. Edens et al. · Diabetes Research and Clinical Practice · 2023
DOI 10.1016/j.diabres.2023.110719
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