Some Questions on T-2 Diabetes

[seekerlady]

Being the significant other of the T-2 here, I've been the one doing all the research on diabetes. I round up the info and pass it on to him.

One of the things that I have not been able to find the answer to is his weight. He was sick for quite awhile before we realized that he had diabetes. He was losing weight. He's 6'1". His top weight was 205, his median weight was 185, but until he was diagnosed he had dropped down to 162. It wasn't that he wasn't eating, he just was losing weight.

Now in all the reading it seems that for a majority of those that have diabetes have weight issues, so all the reciepes that I find are geared to losing or maintaining weight.

The Dr. put him on glyberide. He takes 5mgs. in the morning and 2.5 in the evening. She said that it would help him to gain weight in addition to getting the bg low.

I've noticed that he hasn't lost anymore weight, but he still hasn't gained anymore back. His cholesterol is normal. He also has high blood pressure so, the sodium intake has been watched also.

I'm at a loss on how to handle his diet. Do we let him eat as he was eating before and just be more conscientious of the sugar and sodium or do we follow a strict diabetic diet?

His bg has not reached a normal level yet. His average is between 140-200. That's better than the 300 range that it was at in the hospital. The glyberide seems to be doing the trick there.

Is there anything that I should be asking his doctor about his weight? Should he be drinking those nutritional drinks? I've looked at glycerna, but it may be good for the sugar, but not much on the fat content. So, anyone have any suggestions?

Seeker

[labob]

Rapid, unexplained weight loss can be a symptom of diabetes -- it was for me. Then, after I was diagnosed and started taking glyburide, I experienced a short term weight gain of about ten pounds, which I quickly lost again after my bg was more or less under control (which took about 10-14 days after diagnosis). If your significant other was diagnosed fairly recently, that might explain his recent weight loss and current less-than-optimal (though much improved) bg levels.

I'm not a doctor or a nutritionist, but I would think that the first order of the day would be to figure out what your S.O. can eat, and how much, to achieve the pre- and post-meal bg levels that his doctor recommends. I think you'll find that the only way to discover that is by a little experimentation and lots of testing. Don't be afraid to deviate from what you might consider to be the "standard diabetic diet" if you find that it isn't working. I've found in the almost three months since my diagnosis that watching carbs is key -- I do OK with carbs in beans, vegetables, and even pasta, but for me bread and rice cause really significant spikes. Maybe keeping a log of what works and what doesn't for your S.O. will help you come up with a meal plan.

I recognize that this is easier said than done -- my S.O. keeps thinking that foods that are good for a low cholesterol/low fat/low sodium diet are necessarily good for someone trying to control blood glucose, but the those concerns don't always match up, at least in my experience. So for the time being, keep away from stews that consist almost solely of beans, pasta, barley, corn, peas, and potatoes (both white and sweet), as my concerned S.O. prepared in a very good willed but misguided attempt to keep evening meals "nutritious" (it's a miracle that rice, barley and oatmeal weren't also included). My diet now consists of lots of non-starchy vegetables (though I still eat meat and some starches and carbohydrates) -- it's just a question of determining what works. There really are lots of options.

So I guess what I'm suggesting is that after you get the bg levels under control, you can worry about weight, but until then, I would focus on one issue at a time. If you feel that the weight issue is really pressing, then you might want to increase some fats, especially since your S.O.'s cholesterol level allows for some flexibility. But I would bet that post-diagnosis, your S.O. is simply going to find a new set point for his weight, and so long as he isn't feeling weak or light-headed, that might be OK.

[greendavid]

There's no such thing as a "diabetic diet" (despite all the books on the shelf). It's a matter of eating a wide variety of healthy foods, concentrating on whole grains and vegetables. The most important thing is to spread carbohydrates through the day so they don't overwhelm the malfunctioning pancreas (which cannot respond with adequate insulin, as it does in a person without diabetes).

Here's a compact explanation (http://www.mercynorthiowa.com/services/Dialysis/carbohydrate.shtml) of "carbohydrate counting" which is one method of arranging a daily diet.

Here is the nutrition section from the Joslin Diabetes Center (http://www.joslin.org/managing_your_diabetes_709.asp).

Here's a page from the American Diabetes Association (http://www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp) about the "diabetes food pyramid". In my opinion, the ADA in general focuses too much on the mythical "meal plan" which can only be provided by a "Registered Dietician". You, however, may find that a professional food counselor would help you, and your doctor may be able to refer you and get it paid for.

Food is the most important thing for a Type 2, along with exercise, and it can take a while to figure it out. I haven't yet.

--greendavid

P.S. Don't let your husband make you do all the work! Not healthy for your relationship in the long term. (Like you asked me....)

[seacomp]

The most important thing is to spread carbohydrates through the day so they don't overwhelm the malfunctioning pancreas (which cannot respond with adequate insulin, as it does in a person without diabetes).

I'm sorry David, I'm not trying to rain on your parade, but your just wrong. T2 diabetics for most of the course of their illness produce plenty of insulin, 2, 4, 8 times what a health person produces. It kust that the body can not effectively use that insulin to absorb glucose into muscle cells. This is called insulin resistance and is the defining factor of T2 diabetes. It is only in the final stages of T2 diabetes that a pancreas "burns out" and can be said to be malfunctioning.
At that point, the T2 diabetic has to go on insulin.

[greendavid]

Hey, I love the rain! I live in Seattle!

You're wrong about type 2, though. From the American Diabetes Association (http://www.diabetes.org/type-2-diabetes.jsp):

In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin.

From the Joslin Diabetes Center (http://www.joslin.org/managing_your_diabetes_522.asp) at Harvard:

Type 2 (formerly called adult-onset or non insulin-dependent) diabetes results when the body doesn’t produce enough insulin and/or is unable to use insulin properly (insulin resistance).

Also, several of the oral medications used in treating type 2 (principally the sulfonureas like glyburide and glipizide) are "insulin secretagogues" or stimulators, to induce the pancreas to produce more insulin.

Insulin resistance is the hallmark of type 2, but the pancreas can also be malfunctioning early in the disease. I don't know if there's a clinical test to separate the effects in individual patients (and I don't think it matters to the treatment).

[seacomp]

but the pancreas can also be malfunctioning early in the disease. I don't know if there's a clinical test to separate the effects in individual patients (and I don't think it matters to the treatment).
If this true about the pancreas failing early in T2, I've never heard of it.
There are tests (peptide-c on some threads here) that can see what your pancreas is also producing. When the pancreas is not producing, early in T2 - it's really what people here in this forum call Type 1.5.
The difference does matter in treatment, IMHO, but in subtle ways.

Both Joslin and the ADA are notorious for being well behind the curve of diabetes treatment, for example they were both against the use of meters by patients for the longest time. Their greatest expertise is in CYA.

[vvti-le]

Hey, I love the rain! I live in Seattle!

You're wrong about type 2, though. From the American Diabetes Association (http://www.diabetes.org/type-2-diabetes.jsp):

In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin.

From the Joslin Diabetes Center (http://www.joslin.org/managing_your_diabetes_522.asp) at Harvard:

Type 2 (formerly called adult-onset or non insulin-dependent) diabetes results when the body doesn’t produce enough insulin and/or is unable to use insulin properly (insulin resistance).

Also, several of the oral medications used in treating type 2 (principally the sulfonureas like glyburide and glipizide) are "insulin secretagogues" or stimulators, to induce the pancreas to produce more insulin.

Insulin resistance is the hallmark of type 2, but the pancreas can also be malfunctioning early in the disease. I don't know if there's a clinical test to separate the effects in individual patients (and I don't think it matters to the treatment).
+1, I also learned about the same thing on T2 Diabetes. I was first prescribed with Glyburide, then Glucovance until the sulfonylureas wasn't effective enough so now I'm on insulin. In my case my pancreas didn't produce enough insulin. I tried Actos which helps the body effectively use insulin to absorb glucose into muscle cells but it didn't work for me.