Insulin, sulfonylureas, and TZDs are diabetes medications that may cause weight gain. But some, like metformin, may have weight loss potential. Others may be neutral to any weight changes.

Weight management is often crucial for people with diabetes. But some diabetes medications (antihyperglycemics) may cause weight gain. Others may cause weight loss or be weight neutral.

It’s possible to balance weight management with diabetes medications that may cause weight gain.

If you take or are thinking about taking antihyperglycemics

Your doctor should know whether weight gain is a risk factor for you when they prescribe a diabetes medication. Still, discuss your weight gain concerns with them.

Do not stop taking your medication without your doctor’s orders. Doing so may have serious consequences.

Medications may cause weight gain in various ways:

  • Increased appetite: Antihyperglycemics may increase your appetite by influencing your blood sugar, causing you to eat more and gain a little weight. Particularly, sulfonylureas may trigger your appetite via blood sugar fluctuations.
  • Slowed metabolism: If the medication slows your metabolism, you may burn fewer calories, even while resting, and gain weight without making other dietary changes.
  • Fluid (water) retention: Some antihyperglycemics may cause fluid retention and swelling, leading to weight gain.
  • Changes in fat storage: Some antihyperglycemics may influence the distribution of your body fat, and you may see abdominal obesity (central adiposity) or visceral fat buildup.

While weight gain is a side effect of different diabetes drugs, this doesn’t mean you will experience weight gain as a side effect. And if you do, how much you may gain will vary from person to person.

Remember, weight gain from medication is temporary, and there are ways you can manage it.

While many diabetes medications may actually help you lose weight, some list weight gain as a potential side effect.

According to a 2018 Canadian research review of numerous medications and 2020 clinical guidelines from Veterans Affairs and the Department of Defense, antihyperglycemics associated with weight gain include:

Research estimates a potential weight gain of 8.8 pounds (lb), or 4 kilograms (kg), in the first year of treatment with sulfonylureas such as:

  • glimepiride
  • glipizide
  • glyburide

Weight gain often depends on the dose and medication. For thiazolidinediones (TZDs), such as pioglitazone and rosiglitazone, the weight gain potential is 3.3 to 8.8 lb (1.5 to 4 kg) within the first year of treatment.

But weight gain isn’t a guaranteed side effect for everyone, even while taking medications that commonly cause it.

Your doctor should know whether weight gain is a risk factor for you. They’ll factor this into their prescription and dosage recommendation.

Several diabetes medications can help with weight loss. Speak with your doctor about their recommendations.

Metformin, a first-line diabetes treatment, is often recommended in combination with insulin or other antihyperglycemics. Combination treatment may offset some weight gain.

Many diabetes medications may help with weight loss. These include:

The following are other diabetes medications that may cause weight loss:

A note on weight-neutral diabetes medications

Not all diabetes medications will cause weight changes. Some are said to be potentially weight neutral, including:

  • alogliptin
  • nateglinide

However, in some cases, these antihyperglycemics were also found to cause weight gain. Discuss with your doctor the benefits of potential weight-neutral antihyperglycemics.

It can be tricky to balance weight management alongside diabetes care. Your doctor will have recommendations for what you can do.

Do not stop taking any medications without speaking with your doctor first. They may suggest an alternative antihyperglycemic or change your dosage.

Some strategies for weight management include:

A registered dietitian can also help you create an eating plan that works for you, your diabetes, and any other health conditions you may be managing.

Not sure where to find a registered dietitian? Try Healthline’s FindCare tool.

Diabetes medications may cause weight gain, but others have weight loss potential or are weight neutral. Work with your doctor to create a diabetes treatment plan that works for you.

An individualized treatment plan that considers both blood sugar and weight management is necessary for optimal diabetes care.

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