Practical Meal Plans

Q: Hi Ginny,

I am having trouble finding a nutritionist/dietitian to help me with meal plans. The books are some help, but not very personal or adaptable. I went to one that my insurance will pay for when I was first diagnose, but her suggestions were not really practical and we didn't have a good repore. I need practical doable plans for a single person. Eating a half a banana is not practical, just wasteful. Any suggestions?

Thank you.

A: First, let me tell you how sorry I am that your appointment wasn’t what you needed. I don’t know who your insurance is with, but insurance providers usually have lists of dietitians that are contracted with them. You may want to start your search with your insurance provider. Ask your insurance company to help you find another dietician. You can also check with your insurance to see if your primary care physician has a diabetes educator or care manager in his/her clinic who could help you. At your next diabetes visit, be sure and take all the information you were previously given. Take a few minutes at the beginning of the visit to let the new dietician know your exact needs. Your statement “I need a practical doable plan for a single person” would be a great place to start. If you were given a certain number of carbohydrates to eat at each meal, be sure and add that information too. If you need or want sample meal plans, be sure and ask because that would be very easy for a dietician to provide. Please let us know what happens in your search.

Do not give up! You are paying for this service and you should get the exact information you need from the visit. ginny

Diabetes meters and supplies in Salt Lake City

Q: There used to be a store on 33rd south in Salt Lake City Utah, where you could get diabetic products. It has now moved. I need to get my free style lite test strips somewhere other than through my insurance. My insurance wants me to get a different meter that is not the qualtiy that I currently have and there are probaly better meter now than what I have. If you could give me some information on the above, I would appreciate it.

A: I think the store you are looking for is either the Diabetes Specialty Center at 3793 South State, 801-483-1100 or JQ Medical at 2370 Ft. Union Boulevard, 801-942-8582.

First check with your insurance company to see what type of meters they will cover, often there are several meters. The next step would be to look at the meters to see if you like them and would feel comfortable using one of them. You can look on line for pictures of the covered meters but I think the best option would be to go to either of the diabetes supply stores to see the meters in person. The staff at either store should be able to give you advice about obtaining the supplies that will work for you. Be sure and look because the meters have changed over the past few years and you might find another one you really like!

Take care, ginny

Blood Sugar & Insulin

Q: Hi. It seems my blood sugar stays about the same, even though I have increased my insulin gradually over the past year.  I am frustrated and wonder why it isn't responding. 

A: This is a frustrating problem.  There are some things  to consider.  How high are your blood sugar readings?  What insulin are you using to bring the readings down? How much has the insulin dose changed over the past year?

Often using just a long lasting insulin will work to bring the blood sugar readings in range.  Sometimes if the blood sugar readings are 140-200 range,  increasing the dose by 1-2 units a week, gradually brings the readings into a more normal range without overdoing it.   Often when the readings are running higher, increasing the long lasting insulin by 3 units every 3 days usually brings the readings in range in a week or so.  Keeping very close track of the blood sugar readings when you start taking insulin or change the dose, helps to make sure the amount is correct.  Each body has different needs and our blood sugar readings let us know if our medications are helping the way they should.  If your readings continue to be high the type of medication and the dose you are taking may not be correct.   Your body may now need the help of another medication or a change in the amount of insulin you are taking. 

Please contact your doctor or diabetes nurse educator to let them know that the dose and the instructions you were given are not working.  They may also have some additional ideas about other lifestyle changes that may help your blood sugar readings too.  Please also discuss how frustrated you are. 

Please let us know what happens.  ginny

Type 1 - Fat Stores for Energy

Q: Hi Ginny,

I was diagnosed with type I when I was 8 (I'm 27 now). I take good care of myself, my last a1c was a 5.1 in April 2010 and they're usually in the 5 - 5.5 range. No diabetic complications of any kind, I'm fitter than most non-diabetics and my other blood tests are great as well. I don't have a sweet tooth and I try and keep my carb intake under 100g a day, but my metabolism is insanely fast so it's not always easy to do. I rarely go to the doctor for diabetes info - they have not been of help to me in many years and I seem to do better with the information I read and by testing new things on myself. My last resort is usually to go see an endo if I can't get a question answered or find my answer through a credible source so here I am. Anyway...onto the question....

Question

Do diabetics use fat stores for energy like a non-diabetic? I'm not entirely sure about this since glucagon exists for emergencies to release glycagen, but if diabetics don't produce natural glucagon, would the body revert to breaking down fat for a lot blood sugar?

Meaning, if there was little to no insulin in my body, or maybe just a small daily dose of lantus, would my body break down fat stores to utilize as energy? I'm asking because I want to shed some fat (probably just 2-3 pounds) so I can make a weight class for a rowing shell and need to find out how this works so I can find a way to work around this.

Thanks,
f.

A:

[From Dr. Robert E. Jones, MD, Medical Director of the Utah Diabetes Center.]


Ginny,


I agree that fat cells in people with T1DM are similar to non-diabetics.


Insulin is anabolic (allows us to store fat/glycogen) and anti-catabolic (prevents the breakdown of fat and glycogen). When insulin levels are low (such as fasting in non-diabetics or insufficient insulinization in people with T1DM), free fatty acids are released from fat cells. People with T1DM are clearly different because non-diabetics will make just enough insulin to maintain normal glucose levels whereas those with diabetes get hyperglycemic. Glucagon, growth hormone and catechols also interact by promoting lipolysis (fat breakdown) and hepatic glucose production, and in the case of people who have a pancreatectomy, ketosis is delayed several hours in comparison to people with T1DM who stop their insulin. This last observation has been attributed to glucagon deficiency in pancreatectomized individuals. Glucagon secretion in most folks with T1DM continues for many years post diagnosis, and autonomic insufficiency with catechol deficiency is a late complication.


I would encourage him to exercise and not lower his basal insulin dose.


Rob


[From Lisa Loertscher RD, CD, CDE]


Hi F.,


Kudos to you for maintaining excellent control of your diabetes without issues of low blood glucose! Staying consistent with your healthy lifestyle/personal health profile and losing 2-3 pounds requires continued vigilance with adequate basal and rapid insulins while creating an overall calorie deficit to induce weight loss.
To lose weight you basically need to consume less calories than you burn each day (or burn more calories than you eat). If you're eating a low carb diet, <100 g/day, take a look at the amount of fat and protein calories you're eating and cut back on these calories to create a deficit. Consistently choose leaner proteins like skinless poultry, fish, loin & sirloin cuts of beef and pork; cottage cheese as opposed to cheddar and Swiss and less fried and/or deep-fried foods. Watch the added fats such as salad dressings, mayo, butter and healthy oils and nuts as these pack a lot of calories in small volumes. By reducing your calories by 500 a day, you can theoretically lose one pound a week since one pound equals 3500 calories. Another way to reduce calories is to limit your overall fat grams to 65 per day.


Continue your regular exercise, monitoring your glucose frequently. While moderate-intensity exercise can cause hypoglycemia in type 1 DM, very strenuous high-intensity exercise like rowing at maximal exertion can cause an adrenaline response that can elevate your blood glucose rather than lowering it. The point is you may not have to consume additional carbohydrate before strenuous exercise, as you do with moderate exercise, unless you are hypoglycemic before you start. Checking blood glucose before and after exercise, and sometimes during, is the only way to know your glycemic response to various types and intensities of exercise. You may be able to avoid treating high BG resulting from intense exercise sessions with additional insulin, which as you know is a storage hormone.


I hope this is helpful. Best of luck to you in reaching your goals with rowing!


Lisa

Fasting or Non-Fasting A1C

Q: My husband had a fasting a1c test and today she said the test wasnt run as a fasting A1C, it was non fasting listed in the medical chart. Could the 7.5 be different if they were done for nonfasting, compare to fasting 14 hours?

thank you

A: The A1C test can be drawn fasting or nonfasting. It is an average of all the glucose readings over the past 3 months--maybe a little more heavily weighted by the blood sugar readings over the past few weeks, but not too much. The readings don't change quickly, like our glucose readings using our meters.

Fasting or not, and given the variations in laboratory results, take the reading for what it is---a general idea of how the blood glucose control has been going. If it's causing worries, have the test repeated. Talk to your diabetes educator and your doctor to see if they think it would be best to tighten the diabetes control a little.

Take care, ginny