Questions and Answers

[Guest guest]

July 2004 Questions & Answers

Please Note: The responses provided by the Educators are based on their

personal experiences and expertise as practicing diabetes health care

professionals, and are not to be considered diabetes management advice from

LifeScan.

Remember that the information provided by this site is for general background

purposes and is not intended as a substitute for medical diagnosis or treatment

by

a trained professional. You should always consult your own physician about any

healthcare questions you may have, especially before trying a new medication,

diet, fitness program, or approach to health care issues.

Q. Does menstruation affect blood glucose levels? (In other words, is there a

tendency for values to be higher or lower during menstruation?)

A: Suzanne's response: Most women and adolescent girls with diabetes will

experience fluctuations in their blood glucose levels before, during and after

their menstrual cycle. Most of the time, these fluctuations cause an increase in

blood glucose values, due to the extra stress that comes with the menstrual

cycle – although there are some women who actually experience the opposite.

The real concern is if these fluctuations are pushing you outside your target

blood glucose ranges. The important thing is to keep good blood glucose

records to see trends during menstruation, and then discuss these trends with

your

health care team.

Ask the Expert Archive

Q. Are there guidelines for types of exercise for people with diabetic

retinopathy?

A: Suzanne's response: Yes, people with diabetic retinopathy do need to be

careful with exercise. The general limitations involve stresses that would

elevate blood pressure or shake or jar the body too much. But your specific

limitations will vary depending on whether you are talking about

nonproliferative or

proliferative retinopathy, as well as the severity of the condition. All I can

do is give some very general guidelines.

The main points to remember are: As retinopathy progresses, you will find

yourself more restricted in exercise. And, you do need to check with your

physician before engaging in any type of activity to make sure it's OK for you.

The least advanced form of the condition is nonproliferative diabetic

retinopathy. People with this condition should avoid activities that would

dramatically elevate blood pressure, such as " power " lifting and any activity

where you

hold your breath while crunching your pelvic muscles. That puts a big strain

on your circulatory system. You should always focus on steady breathing during

exercise.

If your nonproliferative diabetic retinopathy becomes more severe, you'll

need to be even more careful. For example, you'll need to start avoiding

exercises with higher impact, or which would really shake or jar you. That would

eliminate some heavy competitive sports.

Those with proliferative diabetic retinopathy - which is the most advanced

form of the condition - need to focus on low-impact exercise. It's probably OK

to engage in things like swimming, walking, low-impact aerobics and stationary

cycling. Avoid things like weight lifting, diving, racquet sports, jogging and

high-impact aerobic activities.

Again, the key is to look to your physician for guidance on what activites

are safe.

[Editor's note: LifeScan.com may include articles related to this subject.

For more information, search on " retinopathy " or a related term in the " Ask the

Expert " search or the general site search.]

Ask the Expert Archive

Q. Would birth control medications have an effect on my sugar control?

A: Suzanne's response: Yes, both estrogen and progesterone, which are found

in birth control medications, can cause an increase in blood glucose levels.

However, no two women are alike and some will see less of an effect than others.

If you're taking these medications, you need to monitor your blood glucose

levels to see if you are experiencing an increase in your blood glucose level.

If you see your levels increasing significantly, please notify your physician.

Ask the Expert Archive

Q. I was diagnosed with type 2 recently, and I am very much overweight. I

immediately cut out carbs from my diet, and did lose about 14 pounds within the

first 3 weeks. But then, I was told that I needed to be eating whole grains,

fruits and vegetables. I added these foods back into my diet – and I not only

stopped losing weight, but also regained some! I’m discouraged and not sure

what

to do next.

A: Suzanne's response: Learning to manage diabetes right after being

diagnosed is very, very challenging. But don’t be so frustrated that you

become

discouraged. You might start to make poor choices for your health. I’ll try to

put

into context what you’ve been experiencing, and offer some suggestions for

next

steps.

First of all, most of the 14 pounds you lost on your carb-cutting diet were

just fluids, not actual weight loss. You do need a certain amount of

carbohydrates in your meal pattern to provide energy -and give you essential

vitamins

and minerals. You cannot rely just on supplements.

You also need to eat a certain amount of fruits and vegetables daily. The

recommendation is that you get 5-9 servings per day. But while that sounds like

a

lot of food, it isn’t as much as you might think. A cup of cooked vegetable

equals two servings. A piece of fruit can also be a serving. Once you get into

the habit of eating fruits and vegetables, you will find that it is not

difficult to get 5-9 servings.

It sounds like you would benefit greatly from a few sessions with a diabetes

educator and a registered dietitian. Please ask your physician for a referral

to them if you have not already been referred. It’s so valuable to get their

assistance as you learn how to manage diabetes. Exercise is equally important.

I would also ask for a referral to a physical therapist. Even if you have

trouble with strenuous exercise, the therapist can teach you activities that

will

help you with weight loss and blood glucose control.

You may be expecting too much weight loss too fast. I tell patients that the

normal weight loss with an individualized meal pattern is 1-2 pounds a month.

You should discuss your concerns with your health care team. If they feel that

you should lose weight more quickly, they can suggest safe ways to do it.

In conclusion: stay calm, and do not give up! The key to success is to become

informed about the management of diabetes, to work with people who can

provide guidance, and to set reasonable goals for improving your health.

[Editor's note: LifeScan.com may include articles related to this subject.

For more information, search on " weight loss " , " diet " , " nutrition " , " vegetables "

or a related term in the " Ask the Expert " search or the general site search.]

Ask the Expert Archive

Q. I have been carbohydrate counting for several years, but I still have

erratic highs and lows in my blood sugar. I weigh my food when appropriate and

consume about 90 grams of " total carbohydrates " per meal. Would I get better

results if I deduct all or part of the " dietary fiber " from the " total

carbohydrates " content of the food?

A: Suzanne's response: You are obviously very careful to keep track of what

you eat, and I commend you for your attention to detail. But, be careful not to

always blame blood glucose fluctuations on food!

You have to remember that there are various other factors to consider when

you evaluate blood glucose fluctuations, such as activity level and stress. Food

impacts blood glucose in many ways – not just because of carb content, but

also because of the timing between meals and snacks, the amounts eaten, the

types of foods, the preparation methods, and so on. That’s why it can be so

valuable to keep a log of test results and their relationship to daily events.

Because you say you monitor your food so closely, I’m not sure that dealing

with the fiber is likely to make much of a difference for you. But here is my

rule for fiber content: You can deduct it from the carb count if it is 5 grams

or greater. If it is less than that, it will not make a significant

difference. Remember that there are different kinds of fiber - soluble fibers,

for

example, may not be eliminated via the intestinal tract and thus are more like

“

carbs.â€

[Editor's note: LifeScan.com may include articles related to this subject.

For more information, search on " fiber " or a related term in the " Ask the

Expert " search or the general site search.]

Marilyn

Moderator for

Diabetic_Recipes

dnevessr@...

Opinions expressed are solely

my own and should not be

mistaken for

Professional advice.