In Categories: Practical Tips

Approximately 90% of people with type 2 diabetes are overweight or obese.1 While obesity often contributes to the development of diabetes, the bigger driver of weight gain is the high insulin levels that are found well before the diagnosis of diabetes.

There are some good reasons why the standard advice of “eat less, exercise more” doesn’t deliver results for people living with type 2 diabetes.

Reason #1: With type 2 diabetes, insulin is high, and insulin is a fat-storage hormone2

Everyone has glucose, a type of sugar, in their blood at all times. Glucose is a source of energy that largely comes from eating carbohydrates. Simply put, when you eat carbohydrates, your blood sugar rises.

Insulin is produced by your pancreas, and insulin has many functions in the body. One of insulin’s functions is to help get glucose out of the blood and into cells where it can be used.  In order to do this, insulin rises along with glucose.  So when you eat carbohydrates and glucose rises, the insulin is rising as well. Once in the cells, glucose is mostly used for energy. If you have type 2 diabetes, this process doesn’t work well anymore: your body has become resistant to the signal of insulin, so the insulin isn’t as effective at moving the glucose out of your blood. That’s how you end up with high blood sugar levels after eating carbohydrates. Having chronically elevated blood sugar levels is dangerous, so your body needs to do something about it.

Your body responds by making more and more insulin to try to get the job done. Recall now that insulin has many functions, not just to facilitate the removal of glucose from the blood. Insulin also works to promote the storage of fat and to block the release of fat from fat storage. So instead of losing weight, you just keep gaining, thanks to all that insulin.

Reason #2: Typically recommended eating patterns often backfire by keeping you hungry and keeping your blood sugar high3

If you’re like most people with type 2 diabetes, you’ve been told to eat carbohydrates but eat fewer overall calories, and to eat small meals throughout the day to keep your blood sugar steady; you’ve probably been advised to count your carbs and eat enough of them to keep your blood sugar up after taking medication to lower it—confusing, right?

What many find as a result is that they’re always hungry, always thinking about food and facing cravings. What’s at work is a survival instinct that even the strongest-willed person can’t withstand for long. This is a situation where your physiology is fighting against you. Even worse, those frequent small meals with carbohydrates create spikes in your blood sugar followed by drops in your blood sugar—a blood sugar roller-coaster that stimulates frequent hunger.

Reason #3: Type 2 diabetes medications can drive weight gain4

Remember how your body’s own insulin is a fat-storage hormone? That’s also true for insulin that has been prescribed to you, whether delivered by injection or by pump. That’s why a common side effect of prescribed insulin is weight gain. Another class of medicine for type 2 diabetes, Sulfonylureas, work by stimulating the pancreas to produce more insulin. And once again, more insulin in your body means more fat storage and more weight gain.

What’s the solution?

People living with type 2 diabetes are insulin resistant, meaning their tissues are not responding as they should to insulin. Insulin moves  sugar from your blood into your cells. If your body does not respond to its own insulin, then your blood sugar will remain chronically elevated, and your body will produce more insulin. The most direct solution is to decrease the source of high blood sugar itself—carbohydrate consumption.

In fact, insulin resistance can be fundamentally referred to as “carbohydrate intolerance” because when carbohydrates are consumed by someone who is insulin resistant, blood glucose is not lowered as effectively. So, by eating fewer carbohydrates, we both reduce the glucose load in the blood, and decrease the release of insulin.

Nutritional ketosis is a natural metabolic state in which your body adapts to burning fat over carbohydrates as its primary fuel. While carbohydrate consumption triggers spikes in blood sugar, fat consumption does not, making it a better source of fuel for people with insulin resistance.

how carbs, protein and fat affect blood insulin

In a clinical trial, patients lost an average of 12% of their starting body weight within six months by using a medically supervised treatment that included the employment of nutritional ketosis. In addition, 56% of patients with type 2 diabetes reduced their HbA1c to below diabetic levels.5

Read more about nutritional ketosis and how it can be an effective diabetes reversal method when paired with physician supervision here.

To learn more about how food affects blood sugar, watch my video series here:

32 Comments

  1. Avatar

    This was the best advice I have read. Something I could understand. I need to lower my sugar levels and A1C fast as I am having surgery in one month. Thank you so much for this article.

    Reply

  2. Avatar
    help find a cure August 10, 2018 at 12:04 am

    Misfolding proteins are the cause of many diseases ….. to find cures they must be studied ..

    Reply

  3. Avatar

    Hi,

    I’m a diabetic on metformin (2 x 1,000 mg daily) doing IF and Keto for 11 weeks now, and yes, I lost some weight. But since about 2 weeks, the dawn phenomenon kicks me out of ketosis every morning again, and the weight loss stagnates, although I don’t eat more than 10g carbohydrates daily, and my protein intake follows your recommendations.
    I read your blog post about the dawn phenomenon, and I follow your advice from there too. But still, my diabetic symptoms become worse again (feet, sight), and I don’t know what to do. Any ideas for me? Thanks!

    Reply

    1. Avatar

      Thanks for your question! We asked Dr. Phinney and Dr. Bailey and this is their response:

      “Unfortunately we cannot give specific medical advice over the internet in someone who is not an established Virta patient. You might find useful information on our blog post “To Fast Or Not To Fast” (https://blog.virtahealth.com/science-of-intermittent-fasting/), and for people with type 2 diabetes struggling with weight and glucose control, measuring blood ketones to insure that one’s diet is resulting in nutritional ketosis can be helpful.”

      Reply

    2. Avatar

      I had this issue, look at the graph carbs are not the only macro to spike insulin protein in EXCESS convert to glucose in a process called gluconeogenesis at a rate of 1g of protein to 0.56g of glucose. I’m so carb intolerant that the excess protein does play a role in my insulin spikes
      Realising this issue [I developed T2 diabetes on 15yrs of Atkins no cheats, eat protein freely] I now eat the WHO guidelines for minimum protein based on GOAL weight plus 10-20g so about 50-70g of protein a day and I now eat one meal a day as vegetarian to achieve this.
      No more dawn phenomenon morning BG reading now great too AND weight slow to go BUT now weigh the lowest I have in 30 yrs !

      Reply

    3. Avatar

      I’m in the same boat you are. Very frustrating!

      Reply

    4. Avatar

      Dawn Phenomenon was an issue for me to, I actually developed T2 diabetes on 14.5 yrs of Atkins – too much meat/protein. Hyperinsulinemia sucks!

      I now use the WHO guidelines on protein intake based on GOAL weight. I’m a carnivore whom has become semi vegetarian to bring protein intake down.

      I aim to eat two meals in a short window around 6 hours.
      I have my last meal at least 5 hrs before sleep – hard when you’re working
      I take my main meal to work and eat the smaller one in the evening OR make my evening meal a high fat, Low carb/protein one – vegetarian.
      Longer fasts can help 23/24 hr ones, which I never thought I could do as hunger never fully switched off with KETO – key to this is HIGH fats over 90% of calorie intake as graph above shows fat barely raises insulin

      Note eggs are high in ketogenic amino acids and so more tolerable as a protein source

      The morning blood glucose was the last one to come into the normal range and only by eating lower protein did I achieve this

      Reply

  4. Avatar

    I don’t understand the numbers,If I can only have 20grams of carbs a day how many calories is this??

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  5. Avatar

    Thank you for sharing this very helpful information about how dangerous also for obese people that they are more prone to diseases such as diabetes.

    Reply

  6. Avatar

    The “cure” is simple, lose weight. I’ve lost almost 50 pounds, dropped my blood sugar by almost 30 pounds, and dropped my A1C almost a full percentage point in less than 6 months. How? I’ve changed my habits. I eat no more than 1,650 to 1,750 calories per day (it takes a few weeks to get used to it). I walk at least 60 minutes a day at work (not all at once – fit it in when you can). Then every day after work when I get home I work out with weights for 30 minutes or so, then spend 20+ minutes on the stationary bike. It takes willpower – granted, I still drink too many beers on Friday night, but that’s my indulgence. I don’t buy cookies or cakes or ice cream – sugar is the devil! You have to take control of YOUR life.

    Reply

    1. Avatar

      The “cure” is NOT simple. Especially if a person is disabled. Great for YOU that you can work. Great for YOU that you can walk 60 minutes a day. Great for YOU that you can work out. Great for YOU that you can ride a bike. There’s a huge percentage of folks out there that face serious life challenges and are unable to just do your “simple” weight loss plan. So NO, losing weight for diabetics is IN NO WAY simple. Otherwise, NOT ONE OF US WOULD BE FAT!!!! NOT. ONE. OF. US. WANTS. TO. BE. FAT.

      Reply

      1. Avatar

        You are conflating “simple” and “easy”. If you are blind, have no legs, or have a true illness that prevents exercise, then being overweight might not be the biggest worry. I would venture to say, adapting to the sitation is the first concern.

        Also, weightloss is pretty much all diet. You can lose tons of weight sitting down staring at a wall. The trick? Eat. Less. Food.

        It is simple, but nobody says it is easy.

        Reply

      2. Avatar

        Bless your heart. I also have CVID. Gaining. Can’t hardly work out. No answer. Tried every type of eating plan. Weight keeps coming. No sugar even. Very careful with food. It’s a nightmare. I feel for u

        Reply

      3. Avatar

        👍

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      4. Avatar

        I think industry has pushed a carb diet. I remember in the eighties being told in high school football to lift weight and eat a high carb low fat diet. Tobwork out real hard on weights and then eat a bunch of pasta etc. and that fat was bad. But a high fat diet what you body doesn’t use will not turn into blood sugar. Whereas carbs Once your body has used what it can of it will turn into blood sugar . I have been on a somewhat keto diet for a year now and I can tell you that if you eat a high fat diet and drink only water and make sure to eat 50grams of protein a day you won’t be hungry. What makes us hungry is the carbs. Every few hours or so you need them.

        Reply

    2. Avatar

      Please don’t think that because something is “simple” for you it is for everyone. I eat roughly 1,500 very low carb calories a day, workout several times a week, have a full time job where I am also walking for the majority of my day plus I’m a busy parent with very little down time. I’m lucky if I can lose a half pound in a week. Keep in mind that there is never a one size fits all solution.

      Reply

  7. Avatar

    Calories and carbs are two different things which must be calculated separately. Low carb foods often have lots of calories, butter, cream, meat, nuts, pork rinds, all low carb but high calorie foods. You need to read the labels or look up the foods you are eating. I worked 12 to 16 hour shifts, very physical job, and took in at least 3,000 calories a day, but kept my carbs under 30. I lost over 140 pounds in a year and a half. The amount of calories you can consume and still lose weight depends on the exercise you get. If you are not active, you have to count calories along with carbs if you want to lose weight.

    Reply

  8. Avatar

    My question is this. How does a type 2 diabetic gain weight while at the same time having a greatly reduced ability to create insulin? A common response from a doctor is that type 2 diabetics do not produce insulin because of an impaired/damaged pancreas due to insulin resistant overload. I as a type 2 diabetic take about 50 units of insulin per day to control my disease.

    My doctor claims that I barely produce any insulin at all (his best guess). It would seem to me that if the rule (notion) of 1 unit of insulin per day per kilogram of body weight were true in a healthy non-diabetic, then I should only weigh about 100 kilograms plus whatever weight my natural insulin production would add in. Adding in the fact that I am insulin resistant should lower that weight even more, but that is not the case. Please explain if you can.

    Reply

    1. Virta Health

      There is no one size fits all approach to Type 2 diabetes, insulin production/resistance and weight gain. An individual’s weight is based on many different factors and isn’t something that can be predicted based on the amount of medication you are taking. What we do know is that, when blood sugar levels are high, insulin will store excess sugar as fat and this can lead to weight gain. This can be insulin that is produced by your body (even in smaller amounts) or insulin that is provided via injection/pump.

      Reply

  9. Avatar

    WHAT YOUR POST DOES NOT MENTION IS THE “WHY”.. One of insulin’s functions is to help get glucose out of the blood and into cells where it can be used…If you have type 2 diabetes, this process doesn’t work well anymore:..THE REASON WHY IS…(FAT BLOCKS THE RECEPTORS IN THE CELLS THAT THE INSULIN IS TRYING TO UNLOCK…FAT IS THE PROBLEM). So ..here is a problem that hasn’t been dealt with, reduce carbs..yes..but also reduce fat..you may say..reduce carbs and there will be fat loss..yes…but not enough in the cellular level…so..we are still barking up the wrong tree.

    Reply

    1. Virta Health

      If you are interested in learning more, we have a full description of how diabetes works in this video series with Dr. Sarah Hallberg: https://blog.virtahealth.com/reversing-diabetes-101-truth-about-carbs-and-blood-sugar/

      Reply

  10. Avatar

    so I guess the key of weight/fat loss is simple (not easy)..just control/keeping your blood insulin low by doing low carb, fasting or perhap some exercise..am I right?

    Reply

    1. Virta Health

      Being in nutritional ketosis will accelerate the rate at which the body burns fat, and this is a fundamental key to the short- and long-term benefits of a ketogenic diet. However, if the extra fat that is burned is compensated by an increase in dietary fat, then no body fat loss will occur (but there still can be other benefits from sustained ketosis). Most people carrying excess fat tissue who achieve nutritional ketosis by eating natural low-carbohydrate foods initially feel more satiated, allowing them to eat less fat than they burn, which results in net fat loss. It is important for long-term success to make sure that fat intake doesn’t exceed needs, which would then lead to weight gain.

      Reply

  11. Avatar

    I have had a full hysterectomy & have an under active thyroid. Now I am diabetic 2. I try so very hard to lose weight. When I go to the doctor’s office & get on the scale it’s so disappointing. I feel like giving up. I have been going through this since I was 24 & now I am 47. I also have acid reflux now too & don’t eat a lot of food. I don’t understand why I can’t lose weight.

    Reply

    1. Avatar

      I am right there with you , & the meds cause stomach problems 😥

      Reply

  12. Avatar
    Denise Fonville March 26, 2019 at 9:17 pm

    Hi, I’m 41 yrs old and I’ve been dealing with diabetes since I was 23. I’ve gone up and down in my weight. I’ve noticed that stopping the insulin (although extremely dangerous) the weight just falls off. I started off at 343 lbs on insulin, stopped it, and got down to 215 lbs in under a year. I also noticed that the additional swelling that I had while on insulin also went away. I won’t speak for every diabetic, but when I take insulin I swell up.
    I agree that with a healthy diet, exercise, and a nice dose of Cassia Cinnamon before each meal, we can reach our weight loss and blood sugar goals.

    Reply

    1. Virta Health

      Hi Denise, thank you for your observation. Insulin is a fat storage hormone, so individuals who are receiving insulin injections will frequently have weight gain as insulin stores excess sugar from their blood as fat.

      Reply

    2. Avatar

      I just started the wLmart insulin and gained 20 pounds in 2 months. And feel like I’m blowing up. What s with that

      Reply

  13. Avatar

    I am type 2 use to weigh 220 dropped down to 185 and mow I weigh 198 I would like to get back up to 215 to 220 no matter what I try I cant gain. Weight why and yes I do protein shakes daily

    Reply

    1. Virta Health

      There are many reasons why you may not be gaining weight, so we can’t provide specific advice via this forum. For many people, increasing calories from fat is an easier way of gaining weight as each gram of fat contributes 9 calories versus 4 calories for 1 gram of carbohydrate or protein.

      Reply

  14. Avatar

    I have PCOS and insulin resistance. I’ve followed a very Low Carb diet and have kept a diet log/diary for 12 years, initially weight came off fast, kept it off for almost 5 yrs, then I struggled to not gain, eventually figured out I was also in peri-menopause. The last few yrs I’ve gained…10 lbs in a month, plateaued, then a 15 lb gain, plateaued, regularly struggling Not to gain then *bam* another 10 lbs! The hormone fluctuations heading into menopause are all I can blame. It’s been horrible on my self-esteem, horrible on my energy level, the thought of exercising is a distant memory. Other PCOS symptoms became exaggerated as well…cystic acne, excess hair, thinning hair on my head. The insulin resistance aspect for a woman makes losing weight impossible as hormones fluctuate. Good luck to all with insulin resistance who also have the uphill battle of weight loss!

    Reply

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