More
Close

Expert Q&A

There are many theories used to explain why some people are...
There are many theories used to explain why some people are overweight, but how do you know which claims about gaining and losing weight are true? We’ve combed through some common explanations to find out what’s fact, what’s fiction, and what’s in between.
Q: I hear watching the glycemic index of foods can help lower...
Q: I hear watching the glycemic index of foods can help lower blood glucose. What do glycemic index and glycemic load mean? A: The glycemic index (GI) measures the increase in blood glucose levels during the two hours after eating a particular kind of food. Some foods that contain carbohydrate create a quick and more dramatic rise in blood glucose, such as white rice and dry cereal. Others cause a slower and less dramatic rise, such as legumes (beans) and pasta. Glucose is the standard for the glycemic index, and it is assigned an arbitrary number of 100. Several GI food lists have been developed, assigning foods GI numbers relative to the glucose standard of 100. GI numbers are available only for several hundred commonly eaten foods, such as carrots, watermelon, and potatoes, but not for mixed foods, like casseroles and vegetable soup. GI does not consider the portion of food, but glycemic load (GL) does. The GL takes the glycemic index of a food and considers its common serving sizes to give a more practical indicator of the effect of that food on blood glucose. Many of the foods with a low glycemic index are healthy foods. Consider eating more whole grain breads and cereals, legumes, and fruits and vegetables. Include these foods in your eating plan, but don't omit foods with a higher GI if they are healthy and you enjoy them. Can Glycemic Index Help Control Blood Glucose? Hope Warshaw, R.D., CDE, is a contributing editor to Diabetic Living and author of Diabetes Meal Planning Made Easy, fourth edition (American Diabetes Association, 2010). Answer reviewed July 2010 How Many Carbs Should You Eat a Day
Q: I've been going to the gym for over a year, but I haven...
Q: I've been going to the gym for over a year, but I haven't lost any weight. My doctor has told me to exercise more. I've tried going six days a week, but my weight has stayed the same. What can I do to lose weight? A: Research shows that exercise alone rarely leads to weight loss. In fact, exercise seems to play a bigger role in maintaining weight loss than losing weight. To lose weight, pay careful attention to both what you are eating and, even more important, the amount you eat. It's helpful to use measuring cups and spoons and a food scale to keep you honest about your portions and help you become a good estimator when you eat out. To be more mindful of what and how much you eat, keep a food diary. Research shows that people who keep food records often have greater success at weight loss and maintenance. Your food diary will let you see your eating patterns exactly as they are and not as you imagine them. It can help you spot foods you can reduce or eliminate. You are doing great with exercise. Keep it up, and you may want to mix up the types of exercise you do. Don't let yourself get bored. Remember to not just focus on your weight on the scale. By exercising regularly, you have likely increased your muscle mass, energy level, and more. It is well-known that regular exercise improves both health and type 2 diabetes in myriad ways. Madhu Gadia, M.S., R.D., is a certified diabetes educator.
Q: I was recently told I have metabolic syndrome. Can you...
Q: I was recently told I have metabolic syndrome. Can you explain what this means? A: Metabolic syndrome, insulin resistance, or cardio-metabolic syndrome (the American Diabetes Association's preferred name) is thought to be a precursor to pre-diabetes and type 2 diabetes. Several conditions are commonly seen together, caused by both chronic inflammation and insulin resistance: overweight elevated blood glucose (but not high enough to diagnose pre-diabetes or type 2) high blood pressure abnormal blood lipids -- low HDL (good) cholesterol, high LDL (bad) cholesterol, high triglycerides excess fat around the midsection (abdomen) It is well known from type 2 diabetes prevention studies that the best action you can take to reverse and manage this condition is to lose 5-7 percent of your current weight, choose healthful foods, limit your fat intake, and be physically active. Learn your target goals for blood pressure, lipids, and glucose, and strive to hit these targets even if you need to take some medications. Keeping these numbers in the target zones is what will keep you healthy over time. Jeannette Jordan, M.S., R.D., CDE, is the American Dietetic Association's national spokesperson for African-American nutrition issues and oversees nutrition education at the Medical University of South Carolina.
Q: My daughter is 35 pounds overweight and has been diagnosed...
Q: My daughter is 35 pounds overweight and has been diagnosed with type 2 diabetes. I'm confused and overwhelmed. I thought only adults could get type 2 diabetes. Please tell me what I should do. A: It used to be that type 2 diabetes was only diagnosed in adults older than 40. But an increasing number of young people -- and kids -- are overweight and developing type 2 diabetes. Without knowing the age of your daughter, it's difficult to give specific advice. However, losing weight gradually by eating more healthfully and becoming more physically active can help her control her blood glucose levels. Ask your health-care provider to refer your daughter to a diabetes education program or a registered dietitian. Children need help from their parents. Use this as an opportunity for the entire family to eat more healthfully and become more active. That will make it easier for her to change her lifestyle. Positive reinforcement is important, and you should give it to her frequently. Madhu Gadia, M.S., R.D., is a certified diabetes educator.
Q: About six years ago my husband went on an insulin pump, which...
Q: About six years ago my husband went on an insulin pump, which has been a lifesaver. I can't imagine anyone keeping a better record of his carbohydrates and insulin. In looking for sugar-free products, we've been reading a lot of labels and have discovered that most cookies that claim to be sugar-free are sweetened with sugar alcohol. Can you explain what sugar alcohol is and if it's OK for him to eat? A: First of all, good work on reading labels -- it's the best way to know what's in the foods you're eating. Sugar alcohols are a group of calorie- and carbohydrate-containing sweeteners that are neither sugar nor alcohol. Unlike non-nutritive artificial sweeteners, which are also used to sweeten some sugar-free foods, sugar alcohols can elevate blood glucose levels, but to a lesser degree than the same amount of carbohydrates. Sugar alcohols are metabolized incompletely by your body, so they contribute fewer calories and have less impact on blood glucose levels than sugar has. They can contain an average of 2 calories per gram versus 4 calories per gram of other carbohydrate sources. Commonly used sugar alcohols include: sorbitol mannitol xylitol maltitol lactitol erythritol isomalt hydrogenated starch hydrolysates People who take insulin or some oral diabetes medications may have problems with insulin reactions after eating foods made with sugar alcohol because of the slow digestion rate. You may need to take less insulin if you eat such products. You should also know that desserts made with sugar alcohol typically are not much lower in calories and fat than their regular counterparts. The 2008 Nutrition Recommendation published by the American Diabetes Association states that "there is no evidence that the amounts of sugar alcohol likely to be consumed will reduce glycemia (sugar in the blood), energy intake, or weight." If eaten in excess, sugar alcohols can have a laxative effect or cause gas. There is also a range of glycemic responses to different sugar alcohols, so research is under way to determine appropriate recommendations. If you have questions about a particular sugar alcohol, talk to a registered dietitian or a certified diabetes educator to find out how it might fit into your husband's daily eating plan. Jeannette Jordan, M.S., R.D., CDE, is the American Dietetic Association's national spokesperson for African-American nutrition issues and oversees nutrition education at the Medical University of South Carolina. Madhu Gadia, M.S., R.D., is a certified diabetes educator.
Q: I want to consume less aspartame, but I still want to use a...
Q: I want to consume less aspartame, but I still want to use a low-calorie, sugar-free sweetener. What about stevia? Is it a healthy sugar substitute? A: A 2008 survey by the International Food Information Council showed that 45 percent of U.S. consumers who are aware of low-calorie sweeteners want to use less aspartame, sucralose, and saccharin. This desire has paved the way for plant-base sweeteners such as stevia, which is extracted from leaves of the Stevia rebaudiana plant native to South America. It takes very little stevia to equal the sweetness of sugar (stevia is 200-300 times sweeter than table sugar), so many stevia sweeteners contain erythritol, a virtually calorie-free (0.2 calories per gram) sugar alcohol that adds bulk. The extra bulk helps high-speed packagers accurately measure stevia and other low-calorie sweeteners. Erythritol is thought to be better tolerated by the digestive system than other sugar alcohols such as sorbitol. Your body absorbs very little erythritol, and studies suggest it doesn't affect blood glucose. Manufacturers are also combining two or more sweeteners that work synergistically to pump up the flavor and cut aftertaste (and, in some cases, trim costs). "For example, if you mix sucralose with aspartame in some foods, you don't have to use nearly as much to get the same sweetness level," says Roger Clemens, Dr.P.H., spokesperson for the Institute of Food Technologists.
Q: I hear artificial sweeteners can cause mild to serious side...
Q: I hear artificial sweeteners can cause mild to serious side effects ranging from headaches to cancer. Is this true? A: Food-safety experts generally agree that there is no convincing evidence of cause-and-effect relationships between these sweeteners and negative health effects in humans, says Mike Herndon, a U.S. Food and Drug Administration spokesperson. But what about anecdotal complaints from consumers, such as those who say aspartame gives them headaches? "There are likely genetic differences in our bodies' ability to break down artificial sweeteners," says researcher Linda McCauley, Ph.D., R.N., at the University of Pennsylvania in Philadelphia. "What bothers a few people may cause no issues for the majority." Others fear the sweeteners could be fueling the obesity epidemic by increasing appetite. However, researchers lack the long-term studies needed to determine if this concern is valid. Most experts believe low-calorie sweeteners can be a helpful part of a reduced-calorie diet.
Q: How safe is it for senior citizens to use products that...
Q: How safe is it for senior citizens to use products that contain aspartame? I've heard it can cause Alzheimer's disease. A: Unfortunately, many myths about aspartame continue to circulate over the Internet and in newspaper headlines. Negative allegations that aspartame may be associated with dementia are not based on science. Leading diabetes authorities, such as the American Diabetes Association, the American Dietetic Association, and the American Medical Association, agree that aspartame is safe for people of all ages, including people with diabetes. The body breaks down aspartame into the amino acids aspartic acid and phenylalanine, as well as a small amount of methanol. These components are found naturally in foods such as meats, milk, fruits, and vegetables, and in higher amounts than what you'd consume by using aspartame. Your body uses these components in exactly the same way, whether they come from common foods or aspartame. Aspartame, along with other sugar substitutes, offers people with diabetes greater variety and flexibility in food choices and helps them satisfy their sweet tooth. Jeannette Jordan, M.S., R.D., CDE, is the American Dietetic Association's national spokesperson for African-American nutrition issues and oversees nutrition education at the Medical University of South Carolina in Charleston.
Q: My physician told me she believes I have pre-diabetes. My...
Q: My physician told me she believes I have pre-diabetes. My grandmother had diabetes, and I hear that diabetes skips a generation, so is that why I have pre-diabetes? Is there any way to prevent getting actual diabetes? A: The fact that your grandmother had type 2 diabetes could certainly mean you have a higher risk of developing this common type of diabetes. People with a family history of type 2 diabetes are at greater risk, especially if you have a parent or sibling who had or has it. Genetics does play a role. We also know that Hispanics, African-Americans, and Native Americans have a higher incidence of type 2 diabetes. However, the notion that type 2 diabetes skips a generation is not true. If your grandmother had type 2 diabetes, your parents, your siblings, and your children are all at risk for developing it. Help your family members recognize that family history is one risk factor. Encourage them to talk to their doctor about their family history and ask whether their blood glucose should be checked, particularly if they have other risk factors such as being overweight, being a member of a high-risk ethnic population, or having heart disease. Jeannette Jordan, M.S., R.D., CDE, is the American Dietetic Association's national spokesperson for African-American nutrition issues and oversees nutrition education at the Medical University of South Carolina.
Q: My doctor told me that my fasting blood glucose was 117, I...
Q: My doctor told me that my fasting blood glucose was 117, I need to lose 100 pounds, I should eat more healthfully, and I should start exercising. Then he walked out of the office without giving me a prescription. How can I prevent diabetes? A: A fasting blood glucose of 100-125 mg/dl likely means you have pre-diabetes. Your blood glucose is higher than normal but not high enough to diagnose diabetes. There is a silver lining. Research shows that if you follow a healthful eating plan (especially limiting how much fat you eat and getting plenty of fiber), be active about 30 minutes five days a week, and lose just 5-7 percent of your starting body weight, you can delay or prevent the onset of type 2 diabetes without going on a medication. It is worth noting that research in people with pre-diabetes has shown that several of the blood-glucose-lowering medications are effective in delaying or preventing type 2 diabetes. At this point, none of the medications approved by the U.S. Food and Drug Administration for treating type 2 are approved for treating pre-diabetes. Keep in mind that pre-diabetes and type 2 are progressive. Over time, about 70 percent of people with pre-diabetes develop type 2, particularly if they don't make healthful lifestyle modifications. Most people with type 2 diabetes require some blood-glucose-lowering medication. Your main goal should be to control your weight and blood glucose. If you do need to take blood-glucose-lowering medicine, take it without shame or guilt. To learn more about diabetes and to get the support you will need to achieve your goals, find health-care providers who know about diabetes. Also request a referral from your provider to a diabetes education program. Find a diabetes education program in your area through the American Diabetes Association. Jeannette Jordan, M.S., R.D., CDE, is the American Dietetic Association's national spokesperson for African-American nutrition issues and oversees nutrition education at the Medical University of South Carolina.
Q: I was recently told that my blood glucose is rising and I...
Q: I was recently told that my blood glucose is rising and I'm close to having type 2 diabetes. Please suggest some literature with a listing of calorie, carbohydrate, and fat counts of all foods. A: Some books list the nutrition content of commonly available foods. The first book provides information for foods you generally purchase at the supermarket or convenience stores. The second book focuses on information for foods you purchase from or eat at large chain restaurants. The Diabetes Carbohydrate & Fat Gram Guide by Lea Ann Holzmeister, R.D., CDE (American Diabetes Association, 2006) Guide to Healthy Restaurant Eating, third edition, by Hope S. Warshaw, R.D., CDE (American Diabetes Association, 2005) To prevent diabetes, it's important to eat healthfully and exercise regularly. Some people can delay or prevent the onset of diabetes by losing 5-7 percent of their body weight through healthful eating and being active 30 minutes five days per week. Madhu Gadia, M.S., R.D., is a certified diabetes educator.
Q: I'm disappointed that many of your recipes contain sugar...
Q: I'm disappointed that many of your recipes contain sugar. I have diabetes and can't eat sugar. A: Actually, you can eat sugar even if you have diabetes. According to the Nutrition Recommendations published by the American Diabetes Association, people with diabetes can consume sugar or sucrose, as long as they count it as part of the total carbohydrates in their meal plan. Usually you will need to substitute the carbohydrate grams from the sugar for the carbohydrate grams from fruit, milk, or starches you normally eat at the meal. Or if you decide to eat more carbohydrates at that meal, you will need increase your insulin dose or adjust your other diabetes medication to keep your blood glucose in your target range. A registered dietitian or certified diabetes educator can teach you to do this properly. In addition, you'll note that while we list sugar as the first option in our recipes, we also test our recipes with sugar substitutes and, whenever possible, offer them as an alternative ingredient, along with the adjusted calorie and carbohydrate content. Jeannette Jordan, M.S., R.D., CDE, is the American Dietetic Association's national spokesperson for African-American nutrition issues and oversees nutrition education at the Medical University of South Carolina.
Q: A coworker told me I should take a chromium supplement to...
Q: A coworker told me I should take a chromium supplement to help control my blood glucose. What do chromium supplements do? Should I take one? A: Chromium supplements are recommended for some people with type 2 diabetes who are on oral medications and have poorly controlled blood glucose levels. Chromium should be used in conjunction with a healthful eating plan and prescribed medications for diabetes. Chromium is an essential trace mineral the body needs for normal insulin function when metabolizing carbohydrates. The body does not make this mineral naturally, but you can get enough by eating: egg yolks bran cereals whole grains nuts Consult your health-care provider before taking a chromium supplement or any other dietary supplement. Jeannette Jordan, M.S., R.D., CDE, is the American Dietetic Association's national spokesperson for African-American nutrition issues and oversees nutrition education at the Medical University of South Carolina.
Q: I've been told the sugar in raw fruits, such as pears and...
Q: I've been told the sugar in raw fruits, such as pears and apples, is not bad for me. Is that true? A: Correct. Fruit contains a two-unit sugar called a disaccharide, which is about half glucose and half fructose. But all sources of carbohydrates are converted to glucose in the body for energy. Fruit -- whether fresh (raw), canned, dried, packaged with no sugar added, or 100 percent fruit juice -- should be part of a healthful eating plan. Fruit provides a good source of energy, vitamins, minerals, and fiber (although juice doesn't provide fiber). The Dietary Guidelines for Americans recommend 2 cups of fruit per day for most average-size adults. The American Diabetes Association recommends following the Dietary Guidelines for a healthful eating plan. Do keep portion sizes in mind. Serving sizes are: a small piece of whole fruit, half of a large piece of fruit, and about 1/2 cup of canned or packaged fruit. Madhu Gadia, M.S., R.D., is a certified diabetes educator.
Q: My brother-in-law has type 1 diabetes and says he cannot have...
Q: My brother-in-law has type 1 diabetes and says he cannot have any sugar at all. He doesn't understand how Diabetic Living recipes can use sugar as an ingredient. Can you settle the confusion? A: The American Diabetes Association (ADA) recommends that sugar (sucrose) can be consumed by people with diabetes as part of their total carbohydrate count. This recommendation, first published in 1994, was a dramatic change from the old-school recommendation that guided people to avoid sugar. The recommendation changed due to research suggesting that sucrose and other sugars in foods do not have a greater impact on blood glucose levels than other sources of carbohydrates when eaten separately or as part of a meal or snack. The current ADA guidelines suggest that your brother-in-law should be more concerned about the total amount of carbohydrates he consumes instead of the source. He also needs to be concerned about eating similar amounts of carbohydrates from meal to meal, unless he takes insulin several times a day and adjusts his doses based on the amount of carbohydrates he eats. For people who need to lose weight and for those interested in eating healthfully, we recommend eating only small amounts of foods containing sugar because they may also be high in calories and fat. If your brother-in-law prefers to eliminate sugar for either health or blood glucose control reasons, that should be his decision. Jeannette Jordan, M.S., R.D., CDE, is the American Dietetic Association's national spokesperson for African-American nutrition issues and oversees nutrition education at the Medical University of South Carolina.
Q: My uncle has type 2 diabetes and wants to have a glass of...
Q: My uncle has type 2 diabetes and wants to have a glass of wine in the evening. Is it OK for people with type 2 diabetes to drink alcohol? A: The same guidelines for alcohol that apply to the general public also work for people with diabetes: If your uncle wants to drink alcohol, he should do so in moderation. However, because he may be taking a number of various medications and have other medical issues that might interact with alcohol, he should check with his doctor as a precaution. Moderation is defined by the U.S. government's Dietary Guidelines for Americans and other organizations as no more than two drinks a day for men and no more than one drink a day for women. One drink is defined as: 12 ounces of beer 5 ounces of wine 1.5 ounces of hard liquor (distilled spirits) Alcohol has 7 calories per gram. Some alcoholic beverages, including wine, contain a small amount of carbohydrates. All types of alcohol have been shown to have some heart-health benefits: raising HDL (good) cholesterol and improving insulin resistance. The biggest concern about alcohol intake is low blood glucose several hours after drinking. If your uncle doesn't take a blood-glucose-lowering medication, then this is not a concern. If he does take medication such as a sulfonylurea or insulin, this could be a problem. Therefore, when your uncle drinks alcohol, he should consume it along with food because alcohol affects blood glucose levels less when a person is eating at the same time. People who should not drink alcohol at all include: pregnant women people with medical problems People with medical problems such as: severe hypertriglyceridemia advanced neuropathy pancreatitis alcohol addiction Jeannette Jordan, M.S., R.D., CDE, is the American Dietetic Association's national spokesperson for African-American nutrition issues and oversees nutrition education at the Medical University of South Carolina.
Q: How do you cook your own meals, such as spaghetti with sauce...
Q: How do you cook your own meals, such as spaghetti with sauce, stews, or casseroles, and figure out the amounts of calories, carbohydrates, and fats? I can determine the individual foods, but mixed dishes are very confusing. A: The best approach is to use an online nutrition database of commonly eaten foods. Most likely nearly all the foods in your recipes will be there. The one published by the U.S. Department of Agriculture is ideal. Just search for the calories and carbohydrate and fat grams for the items that provide calories to your dish. Herbs, spices, and bits of garlic contain nearly no calories. USDA Nutrition Database Once you have your totals, divide the counts by the number of servings in the dish. Make note of these figures on the recipe card so you don't have to go through this exercise again. The good news is you likely have just a few recipes you want to put through this process. And even better news is that for Diabetic Living recipes, the work is already done for you. Madhu Gadia, M.S., R.D., is a certified diabetes educator.
Q: I read that high-fructose corn syrup causes type 2 diabetes....
Q: I read that high-fructose corn syrup causes type 2 diabetes. How can I avoid eating it? A: Consuming high-fructose corn syrup is not the sole factor for the cause of type 2 diabetes. (High-fructose corn syrup has a carbohydrate profile similar to that of white table sugar -- about 50 percent glucose and 50 percent fructose.) However, it is used to sweeten many prepared and commercial foods, and consuming too many foods with high-fructose corn syrup as well as other calorie-containing ingredients increases caloric intake and eventually causes weight gain in some people. It is the weight gain that leads to excess weight. It is excess weight along with other risk factors of type 2 diabetes that causes it. To avoid consuming high-fructose corn syrup, check the ingredients to see whether a food contains it. Also check to see how far down on the ingredient list it is. Ingredients are listed in descending order by quantity used (by weight). High-fructose corn syrup is often used as a sweetener in: regular soda candy frozen pops pancake syrup sweetened cereals fruit-flavor yogurt pasta sauces ketchup Jeannette Jordan, M.S., R.D., CDE, is the American Dietetic Association's national spokesperson for African-American nutrition issues and oversees nutrition education at the Medical University of South Carolina.
Q: Why do you give so many recipes with fruits and vegetables? I...
Q: Why do you give so many recipes with fruits and vegetables? I can't eat them because they raise my blood glucose. A: Before you give up on these valuable sources of nutrients, carefully examine your meals and the portions you eat. The Dietary Guidelines for Americans recommend that everyone, including people with diabetes, eat five or more servings of fruits and vegetables per day. Fruits and vegetables are excellent parts of a healthful eating plan. They provide low-calorie sources of vitamins, minerals, and fiber, and they're relatively low in calories. One serving (1/2 cup cooked) of a nonstarchy vegetable has 5 grams of carbohydrates and 25 calories. One serving of starchy vegetables (1/2 cup cooked) contains about 15 grams of carbohydrates and 80 calories One serving (1 small piece or 1/2 large piece) of fruit has 15 grams of carbohydrates and 60 calories. If your blood glucose is rising after you eat fruits or vegetables, check your portion sizes, especially for your fruit choices. Madhu Gadia, M.S., R.D., is a certified diabetes educator.
Q: How do sweet potatoes affect diabetes? Are they a good...
Q: How do sweet potatoes affect diabetes? Are they a good substitute for white potatoes? A: The same amount of white potatoes and sweet potatoes contain about the same amount of carbohydrates (1/2 cup = 15 grams of carbs). Sweet potatoes, however, have more fiber and are slightly lower on the glycemic index than white potatoes. For this reason, blood glucose will rise a little more gradually with sweet potatoes than with white potatoes. As far as nutrients go, sweet potatoes are a rich source of vitamin A and beta-carotene. As with all foods containing carbohydrates, keep in mind the importance of portion size and distribution throughout the day. Virginia Zamudio Lange, a member of Diabetic Living's editorial advisory board, is a founding partner of Alamo Diabetes Team, LLP in San Antonio.
Q: My doctor wants to put me on insulin. I have type 2 diabetes...
Q: My doctor wants to put me on insulin. I have type 2 diabetes; my A1C was 8.2. I don't want to take shots. How will insulin help? A: An A1C of 8-9 percent equates to an average estimated glucose level of 183-212 mg/dl. Long-term glucose levels in this range drastically increase the odds of developing a complication such as kidney failure, vision loss, or damage to blood vessels or nerves that can lead to heart disease, stroke, and neuropathy. As type 2 diabetes progresses, the pancreas makes less and less insulin. Many oral medications can help control your glucose levels early on. But once insulin production declines to a certain point, insulin is necessary. Today's insulin needles are super thin. You may find injections hurt less than blood glucose testing: The place you inject (abdomen, preferably) has far fewer nerve endings than the fingertip. Keep an open mind about insulin as your diabetes therapy. Set up a one-on-one session with a diabetes educator who can coach you through that first injection and teach you how to best time your doses. Virginia Zamudio Lange is an R.N., M.S.N, and CDE.
Q: I'd like some information on Byetta. How does this blood-...
Q: I'd like some information on Byetta. How does this blood-glucose-lowering medication work? A: Exenatide is the generic name for Byetta. It can help people with type 2 diabetes control their blood glucose levels. Exenatide has been approved by the U.S. Food and Drug Administration for use with two other blood-glucose-lowering medicines: metformin and sulfonylureas. It is not approved for use with insulin. Exenatide is an injectable medication, but it is not insulin. It is taken before the morning and evening meals. Exenatide imitates the actions of the naturally occurring hormone incretin, which is normally produced in the intestines to: slow the emptying of the stomach after eating, which slows the rise of blood glucose. suppress the release of glucose from the liver. stimulate the insulin-producing beta cells in the pancreas to produce more insulin after eating. The most common side effect is nausea, which tends to go away with time. Madhu Gadia, M.S., R.D., is a certified diabetes educator.
Q: I'm a 43-year-old woman with type 2 diabetes. My doctor...
Q: I'm a 43-year-old woman with type 2 diabetes. My doctor prescribed Byetta. It's helping me, but I can't afford it on my income. Can you guide me? A: Many pharmaceutical companies have patient financial-assistance programs. For Byetta, contact the Amylin Patient Assistance Program. The program is available for patients prescribed Byetta (exenatide) who do not have adequate insurance or other financial assistance and meet the eligibility criteria. To be considered, you need to complete an application form and provide information on financial status. If approved, you must reapply every six months. Call 800/330-7647 or visit amylin.com/products/reimbursement.cfm for more information. Virginia Zamudio Lange, R.N., M.S.N., CDE, is a registered nurse, certified diabetes educator, and a past president of the American Association of Diabetes Educators.
Q: I've had type 2 diabetes for nine years and take Novolin...
Q: I've had type 2 diabetes for nine years and take Novolin and Novolog insulins. Does insulin cause weight gain? If so, why? A: Some people experience weight gain when they first start taking insulin. This happens for several reasons. First, when blood glucose levels are high, your body is literally wasting the calories you eat because there's no insulin to help the body convert the food into glucose. When your blood glucose gets into better control with insulin, your body makes better use of the food you eat. Second, due high blood glucose levels, you may be a bit dehydrated. Third, and perhaps most important, insulin can make blood glucose too low if it's not adjusted correctly. If you're repeatedly treating hypoglycemia with food, this can result in excess calories and weight gain. Work with your health-care provider to adjust your insulin doses to minimize hypoglycemia. Learn to treat occasional low blood glucose levels with glucose tablets rather than food; it's easier to control the amount of calories you eat. If your weight gain is out of control, ask for a referral to a registered dietitian for assistance. Madhu Gadia, M.S., R.D., is a certified diabetes educator.
Q: I'm going out for lunch for the first time since being...
Q: I'm going out for lunch for the first time since being diagnosed with diabetes. I don't know what to eat or how to plan for it. Any ideas? A: I highly recommend visiting a diabetes educator, a health professional who specializes in teaching people how to manage their diabetes, including planning meals. Until you meet with a professional, follow the plate method -- a simple way to think about how much of which types of foods to eat. Visually separate your plate into quarters. Fill half of the plate with nonstarchy vegetables (salad greens, broccoli, cauliflower, green beans, sweet peppers). One quarter of the plate should contain 3-4 ounces of lean meat. The remaining quarter should contain starches (pasta, rice, beans, bread, potatoes). On the side, include 8 ounces of low-fat milk or a small piece of fruit. For taste, you can add 1-2 teaspoons of heart-healthy fat, such as low-fat butter spread or olive oil vinaigrette. To find a certified diabetes educator (CDE) or registered dietitian (R.D.) who can help you plan your meals, call the American Association of Diabetes Educators at 800/832-6874 or visit its Web site diabeteseducator.org/find. Check the American Dietetic Association site eatright.org/findanRD. Tips for Dining Out Virginia Zamudio Lange, R.N., M.S.N., CDE, is a member of Diabetic Living's editorial advisory board.