by Jim
(Wilkes-Barre, Pa., U. S. A.)
QUESTION:
By Jim, Wilkes-Barre, Pennsylvania, USA
About one year after bypass surgery, I became prediabetic and was treated with metformin. My blood sugar was usually 95–125 mg/dL. During a stress test, I was mistakenly given a double dose of digoxin and my heart stopped. I now have both a defibrillator and pacemaker and take several medicines, including insulin. Within three months, my waist increased from 30 to 36 inches, with a large lower-abdominal bulge and marked breast enlargement. I was told that insulin sometimes causes this and that nothing can be done because insulin goes to those areas. Am I stuck with the abdominal and breast enlargement? My heart condition limits the exercise I can do.
Quick Answer
Insulin can contribute to overall weight gain, but it does not normally send fat specifically to the lower abdomen or breasts. A lower-abdominal lump may be fat accumulation from repeated injections into the same area, called lipohypertrophy. Rapid abdominal enlargement can also reflect general weight gain or fluid retention from heart failure. Breast enlargement may be body fat, true gynecomastia, fluid, or a medication effect. Because you have serious heart disease and several new physical changes, arrange a prompt examination and complete medication review rather than assuming insulin is the only cause.
Answer by Dr. Albana Greca, MD, MMedSc
Hello Jim,
I am sorry that you have experienced such serious complications. You should not stop insulin or any heart medicine on your own, but you also should not accept the explanation that insulin simply “goes” to the abdomen and breasts.
Yes. When insulin lowers glucose, fewer calories are lost through the urine and the body can store more glucose and fat. Appetite, reduced activity after a major cardiac event, recovery from illness, and treatment of previously high glucose may also contribute.
However, insulin-related weight gain is usually more general. It does not adequately explain marked breast enlargement or a distinct bulge below the belly button. Review our guide to insulin side effects and safe treatment.
Repeatedly injecting insulin into the same small area can cause a rubbery or fatty swelling called lipohypertrophy. Insulin may then be absorbed unpredictably, causing unexplained high or low glucose readings.
Ask a diabetes nurse or clinician to inspect and feel your injection sites and observe your technique. Do not inject into a lump, thickened area, scar, bruise, or tender skin. Rotate injections systematically within approved areas and use a new needle as instructed. Do not suddenly move away from a heavily used lump without discussing glucose monitoring and dose safety, because insulin may absorb more efficiently from healthy tissue.
Lipohypertrophy can gradually decrease after the area is rested, although a large persistent lump may require specialist assessment. Our page on diabetes and weight gain explains other reasons body weight may change after treatment begins.
Because you have had bypass surgery, cardiac arrest, an implanted defibrillator, and a pacemaker, rapid abdominal enlargement must also be assessed for fluid retention or worsening heart function. Fluid may collect in the abdomen and may occur with leg swelling, shortness of breath, difficulty lying flat, cough, fatigue, or rapid weight gain.
Contact your heart team urgently if:
Your weight rises suddenly, your abdomen or legs become more swollen, you are more short of breath, you need extra pillows to sleep, you wake gasping, have chest pain, fainting, new palpitations, or your defibrillator delivers a shock. Severe breathing difficulty or chest pain requires emergency care.
Weigh yourself each morning after urinating and before breakfast, using the same scale and similar clothing. Ask your cardiology team what amount of daily or weekly weight gain should trigger a call and whether you have individual sodium or fluid limits.
Breast enlargement in a man may be increased chest fat, called pseudogynecomastia, or growth of glandular breast tissue, called gynecomastia. These cannot be distinguished reliably without examination.
True gynecomastia may be related to age, weight gain, liver or kidney disease, thyroid or hormone problems, or medicines. Some heart medicines—particularly spironolactone—and several other drugs can cause it. Digoxin has also been associated with gynecomastia, but your current medicine list and examination are more important than assuming one cause.
Ask your doctor to examine the breasts and review every prescription, over-the-counter medicine, and supplement. Depending on the findings, tests may include liver, kidney and thyroid function and selected hormone tests. A hard one-sided mass, nipple discharge or bleeding, skin dimpling, nipple retraction, or enlarged lymph nodes requires prompt evaluation.
Do not reduce insulin merely to lose weight. Instead, your diabetes clinician can determine whether the dose is higher than necessary or whether another glucose-lowering medicine may safely reduce insulin requirements. Any change must account for your heart condition, kidney function and other medicines.
Many people with implanted cardiac devices can exercise, but the safe intensity depends on heart function, rhythm history, device settings and recent procedures. Ask for a supervised cardiac-rehabilitation plan rather than experimenting alone. Walking, stationary cycling or light resistance work may be possible after clearance. Our guide to diabetes and exercise can help you prepare questions for your cardiac team.
Jim, you may not be permanently “stuck” with these changes. The outcome depends on whether the main cause is overall weight gain, injection-site lipohypertrophy, fluid retention, true gynecomastia, or a combination. A careful examination is the essential next step.
This educational answer does not replace examination by your cardiology and diabetes teams or individualized medication advice.
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