So ... I'm diabetic.

Factual Questions
1

I had a general physical a few weeks ago (having reached a certain age), and my doctor called back a few days later and said he wasn’t happy about my blood sugar levels. He sent me for a full glucose challenge test and then announced that I’m diabetic. Gave me a bunch of brochures and booked me for another blood test six weeks later (now about three weeks ahead) and otherwise left me to it.

So … I could use some advice.

Doctor tells me that it’s very probably due to weight (excess) and exercise (deficit). My blood sugar level was 9, where the normal range is, as I understand it, 4 to 8. This frankly sounds rather marginal to me. But okay. I can certainly stand to eat better and exercise more.

So, over the last two or three weeks, I have:[ul]
[li]Drastically dropped my sugar intake. Chocolate is out, for a start.* I’m watching food that I buy, to keep to the low-sugar and low-fat varieties (less than 10g per 100g).[/li][li]Exercised regularly – half an hour’s brisk walk or cycling a day.[/li][/ul]

What more should I be doing? Any thoughts?

  • Yes, I know you can get diabetic chocolate. I’ve got several brands and they’re not bad. But they make me fart.
2

First of all, you should really talk to your doctor about this. He knows best and will be able to help you see patterns in your diet and how they correlate to your blood sugars. You could also talk to a dietician who specializes in diabetics.

Be advised that low-fat foods often have a ton of sugar pumped into them, so they may not be the best choice.

I’m a Type I diabetic and my last HbA1c (glycosolated hemglobin/hemoglobin A1c) was 7.1. My target range is 5-7. Even though it was only 7.1, my doctor is still breathing down my neck to get it back on target. Diabetes is about control.

It’s still really early in your diagnosis to say anything. Over the next few weeks, you’ll discover what you need to do. It depends a lot on the individual. Get a good rapport going with your doctor and don’t be afraid to turn to him (or whatever educator he refers you to) with any questions you have. TALK TO YOUR DOCTOR. (Meant with well-intended intimidation. :slight_smile: )

3

Do you have a blood glucose meter? They are affordable and really necessary for you to figure out what works for you and what doesn’t. Some people’s blood sugars will go up farther and faster than other people’s, or slower but stay up longer, or various combinations of things.

Remember that simple sugars like, well, sugar aren’t the only sugars out there. One major ingredient that has come under fire lately is high fructose corn syrup. For some people, that stuff has a very pronounced effect on blood sugar. My husband, for example, gets high spikes from it, then his blood sugar drops like a stone and he gets hungry.

Are you on medication? Even better reason to get a meter. Some medications (like glyburide) can cause low blood sugars. That’s potentially catastrophic.

Eat regularly. Small meals. Protein is filling and won’t bounce your glucose all over the map. Some people seem to be able to eat things sweetened with sugar alcohols without it affecting their glucose. My husband is one of those, though he has some gastric distress with most sugar alcohols.

Be extremely careful with “fat free” processed foods. Many times they use sugar as a substitute for fat. Read labels. You really want to pay atttention to the carbohydrate listing, not just the sugar.

And there are a few things that you really want to start avoiding in mass quantities. Rice and potatoes are things that are easy to overeat and can really drive up blood sugars. Eat whole grains, beans (sorry about the farting!), and veggies whenever you can.

4

You should absolutely talk about any diet plan with your doctor, and I’m the last person to tell you to go low-carb.

BUT, when my dad’s long-controlled blood sugar started to go upwards again, although he hadn’t been really eating anything he wasn’t supposed to, cutting out some “bad” carbs - eating wheat bread instead of white, eating wheat pasta (which to me is going way too far!), going low-carb with the beer, that sort of thing - really helped him a lot with those triglycerides.

I only mention it because some of that’s really easy for some people, like whole wheat bread - you don’t really have to deprive yourself, you just substitute. Of course, this was for a guy who had long ago cut out a lot of the sugars most of us eat.

5

As I said, I’ve another blood test due in three weeks or so, after which I expect to be seeing my doctor again. No blood sugar meter at present – this is something I’ll be wanting to talk to him about.

The whole food thing is further complicated by the fact that I also have coeliac – so have to avoid wheat and several other grains.

In any case – it’s all early days yet. The doctor did say he’s reasonably confident that my case can be controlled with diet, with tablets if necessary – but he thinks they likely won’t be.

In the meantime, yes, I’ve been watching both fat and sugar contents on food labels.

6

Call your health insurance company and find out what you are covered for in the way of a meter and supplies. Believe it or not, meters are almost always absolutely free one way or another, though specific health plans may limit you to certain brands and models. It’s the strips that will cost you, probably under your pharmacy coverage. Find out now what that is. You NEED to have a meter, even if your doctor tells you you don’t. Without one, you will have no way of telling if your diet/exercise/medication program is working. Diabetics need immediate feedback to know what works, and only a meter will provide that to you.

Since you have other dietary issues with your celiac, you also need a consultation with a dietician. As a newly diagnosed diabetic, this may well be covered under your health plan. Find out now so you know. You may also have a benefit for diabetic education classes offered through a local hospital or treatment center. Don’t think ‘those don’t apply to me’ - they absolutely do.

You might also want to check if your health plan offers something called ‘disease management’ programs, which is the field I work in. These programs provide you with education materials, a nurse phone line to call, and other information. They’re tailored for people just like you and can provide you with an ongoing source of support. They’re meant to encourage and support wellness for people with conditions like diabetes. If they’re provided, these are a free part of your health coverage. Most people aren’t aware if their health plans include this, so it doesn’t hurt to ask.

Diabetes is a long term disease that never goes away - but it can be controlled. Keeping your blood sugars in range now will make all the difference to your health in five, fifteen, twenty years. ‘Controlled’ probably means an A1c of 6.5 or less - the emerging thinking is that 7 is likely too high.

Best of luck to you! There are resources out there for you, and it’s well worth your while to be aggressive hunting them down.

Gytha

7

I have developed insulin resistance, which may or may not be a precursor to Type II diabetes. Based on experiments I’ve done with my diet and exercise, I’m willing to bet that I’d develop diabetes if I weren’t actively working against it.

The American Diabetes Association publishes some very good reader-friendly guides to living with diabetes (e.g., http://www.amazon.com/exec/obidos/ASIN/1580401619/qid=1100309052/sr=2-1/ref=pd_ka_b_2_1/102-0657956-5816156). These cover issues such as what your test results mean, the effects of high blood sugar, how to test your blood sugar, diet, and exercise.

I follow a plan similar to the one in Whitaker’s book Reversing Diabetes (http://www.amazon.com/exec/obidos/tg/detail/-/0446676586/qid=1100309219/sr=8-1/ref=sr_8_xs_ap_i1_xgl14/102-0657956-5816156?v=glance&s=books&n=507846). It’s similar to the South Beach Diet but also gives suggestions about exercise and vitamins. It also cites the relevant research, something that is lacking in many popular diabetes self-help books.

At this point, my typical diet is about 60% complex carbohydrates (non-starchy, less-sweet fruits and vegetables), 20% protein, and 20% fat. I eat about 1500-2000 calories a day (more with more exercise). I exercise at least half an hour a day. What works best for my metabolism (and weight loss) is walking on a treadmill before I eat breakfast.

I lost 50 pounds in half a year, then gained a good part of that back simply by not exercising aerobically. I’m now working on getting it off again by maintaining a good aerobic exercise regimen. I have lost 21 pounds since August 29th and have dropped my A1c (90-day blood sugar average) to 5.4 (my doctor threatened me with medication when I went up to 6.1). And I’ve got to say that I hate getting up and exercising, but my triglycerides have never been better.

Dropping your sugar and highly refined flour intake is probably going to be helpful. You might look for stevia in a natural foods store or online–it’s a plant-derived sweetener that’s much better for you than something like saccharine. It may also have blood sugar-lowering effects. If you must have chocolate, look for darker chocolates that have lower net carbohydrates (total carbohydrates minus fiber). Lindt makes several less-sweet chocolate bars. As for the side effects of some of the new sugars, try differnt ones. I can’t eat lactitol (what Hershey’s uses) because I’m lactose intolerant, but maltitol is okay. In addition, I loathe Diabetisweet (isomalt) and think Splenda’s okay, whereas my partner’s family all have the opposite reaction.

Even modest weight loss is very helpful for reducing the effects of diabetes and the cardiac complications associated with it.

Joslin Clinic has message boards that you might want to look at. They’re moderated by people with medical training. In addition, search SDMB as there have been a number of threads about diabetes and diet in the past. There’s an active thread in MPSIMS for weight loss support.

I’m not a medical doctor, but I’m happy to try to answer questions or point you toward resources.

8

Accu-Check was giving their “Advantage” meter away free just a couple of months ago, shipped with 25 free strips to your house, just by you calling them. I have my free meter sitting right in front of me. IIRC the number is 1-800-858-8072 - I do not know if the free promotion is still on, mind you.*

9

Fuck me. Replace the * with a **…

10

It wouldn’t be a bad idea to have your doc refer you to a nutritionist to map out a program specificly planned to your neds and lifestyle.

11

Well, the Accu-Check availability might be different in New Zealand, of course. :slight_smile:

I do have a bunch of brochures for local resources, though – Diabetes NZ, the local Diabetes Trust, etc. Plus a couple of friends are also diabetic and I must get around to talking to them about it. But sometimes, not sure why, it’s a lot easier to talk about things in a less … I dunno, immediate forum, like this.

I am, at least, building a useful list of questions for when I see my doctor again, though. Thanks everbody!

12

I have no idea whether or not it’s offered in NZ, but in the US we have diabetic education classes, which cover a lot of diabetic issues. They take two or three full days, but it’s really worth it. My insurance will pay for me to go to one of these classes every year or so, because the classes are cheaper than complications of diabetes.

If you can keep up your daily exercise, that’s excellent. It’s one of the best things you can do for yourself. Some diabetics are able to keep their disease in control with just diet and exercise. Good luck.

13

Re: the test strips and ‘sticks’ for your glucose meter. It’s been my experience under two different medical plans that even with a prescription, the companies won’t cover the cost up front. You may have to pay for the items up front, then file a claim with your insurance company. As long as you can show a copy of the prescription or diagnosis, they should cover it. The sticks are cheap, the test strips are not (about $1.00 each).

14

I was diagnosed with Type 2 about 8 years ago, and didn’t really start managing it til I put myself on a low-carb diet (Atkins). Almost immediately, my blood sugar, cholesterol, triglycerides and blood pressure improved, not to mention losing weight.

The main thing is to minimize high-glycemic carbohydrates, not just sugars. Read Atkins’ book; even if you don’t actually go on the diet, you’ll learn a whole lot about nutrition that every diabetic should know.