Signs you may become diabetic

A patient of mine who is over 100 pounds overweight for her height had a few blood tests abnormalities that suggest the progression to diabetes may be occurring. Her fasting blood sugar was above 100 ( hers was 150).

Fasting insulin level was 36 ( normal is less than 24). This means her body is pumping out more insulin due to resistance to insulin from overweight. This is also reflected in the high fasting blood sugar. The body is not able to metabolize the sugar in the diet

The treatment for this is to lose weight and make better food choices. High fiber in the diet will help slow down the absorption of sugar into the blood and may help decrease the blood sugar after a meal

Less processed foods is important, since they convert to blood sugar rapidly and are low in fiber as well.

The third abnormality that is seen in patients who have trouble with insulin and blood sugar is elevated liver enzymes since the body converts sugar into fat in the liver. The fat surrounds the liver, and causes inflammation around the liver as well. It can be corrected with weight loss and the good choices mentioned above

Eating fresh fruits and vegetables, and whole grains are a great way to get more fiber into the diet. Try to stick to the number of calories a day that is recommended for weight control or 500 calories less a day if you want to lose weight

500 calories less a day can be achieved by decreasing intake of sugary foods, processed foods such as buns, breads, sweet desserts.


Diabetic at 37

This week I saw a new onset of type one Diabetes in a 37 year old otherwise healthy for height and weight male. His sister also became diabetic at the same age. I felt bad for him, having to count carbs and give himself shots of insulin.

Kudos for him, thanks to apps, and his diligence, he is documenting all he eats, and how much insulin he takes and his blood sugars. He is doing a wonderful job and off to a good start. Thats an example of technology to our advantage

I was able to tell him how many calories he needed in a day and to break them down into 30% protein, 30% fat and 40% as carbs with emphasis on complex carbs and high fiber instead of simple sugars

High fiber slows down the absorption of glucose and helps regulate blood sugar better. It may decrease his need for insulin in the long run.

New Year eating program- the basics

Every meal should contain a protein, a complex carbohydrate, a fruit and or vegetable.

Example- breakfast- oatmeal ( complex carbohydrate), fruit ( apple, orange, banana, blueberries) and protein may be one hard boiled egg, or one tablespoon of peanut butter, 1 ounce of cheese, 1 cup yogurt, ore one glass of milk

Lunch-example-Complex carbohydrate such as bread ( whole grain preferred over white), or 1 cup of brown rice. Protein can include 3 ounces of tuna, 1 egg,  1 ounce of cheese, 1/2 cup  of chickpeas or beans or 3 ounces of chicken breast or turkey breast. Choose a fresh fruit or vegetable such as grapes or sliced apples, or a fresh fruit salad to round out the meal. Shredded carrots or brocolli slaw or steamed mixed veggies add fiber to the diet without adding excessive sugar.

You can mix and match your fruit, veggies and protein and complex carbohydrates. You body runs on glucose, a simple sugar and needs the complex carbohydrates in the diet to break down slowly to simple sugars for energy over time. Too many simple sugars like table sugar sucrose, can lead to high insulin levels, and more fat deposited in areas of the body you dont want them. It can eventually lead to insulin requiring diabetes.

The complex slow to digest carbohydrates with high fiber and protein, cause a slow release of sugar into the blood stream and are your best bet against becoming an insulin dependent diabetic. If you are already diabetic, these eating habits can help lower your insulin requirements.

A high fiber fruit and vegetable diet also is treatment for constipation and irritable bowel and may prevent fatigue and prevent colon cancer.

How Sweet it is ( Said Jackie Gleason)

Is sugar really addictive?

Yes it is- you crave it because it increases your dopamine in the brain, and that makes you feel good, (when the insulin  helps sugar cross into the brain)-

I recommend no more than 10 grams of sugar per serving at breakfast lunch or dinner

If what you are eating or drinking has more- it probably is too much. ( see below)

cola sugar

Other names for sugar include High fructose corn syrup, glucose, lactose, malt syrup, molasses and sucrose, and evaporated cane juice, dextrose

Kick the sugar habit and slowly replace it with protein, Protein empties slower from the stomach and will slower the absorption of sugar into the blood. Fiber or a high fiber diet also slows the absorption of sugar into the blood.

Our obesity epidemic



Recently I had a difficult middle aged woman who weighed over 350 pounds come to me for weight loss advice. She also had a history of multiple miscarriages. The blood work that we did revealed she was diabetic in addition to her sleep apnea and other conditions.

At the prior visit I had made some healthy suggestions, none of which she was able to follow thru on. She admittedly had a danish with coffee and creamer with sugar for breakfast and either skipped lunch or ate on the run – while making poor choices.

For dinner tonight she was making 5 pork chops with cabbage for her and her husband to share.

I attempted to plan out a meal plan for her but met with resistance at every turn. I was however, able to lend insight into her miscarriages. She had a gene defect that leads to a problem with metabolizing  folic acid. I gave her recommendations on a geneticist to see for further evaluation into her folic acid problem,

I hope and pray she follows through with that as well as the endocrinologist who can help her with her new onset diabetes. Losing 10% of your present body weight (35 pounds) would be enough to reverse the diabetes.

Being active- such as walking also helps with reducing the resistance to insulin.

While it might seem a long road to travel, many have done it and I hope she does too.

Nutrition in Athletes and Doctors

Today I performed a body composition analysis on a 17 year old swimmer on her high school swim team. She practices 2 hours a day swimming. Her weight is 145 lbs and her height is 5ft 9 and a half of an inch. Her calculated energy requirements were 1524 calories at rest, and 3353 calories when active. She had 72.9 percent muscle mass and 27% body fat which are excellent for age and for a swimming athlete.
My numbers revealed a 55 year old mildly active physician who is 5ft 6 inches tall and weighed in at 195 pounds. I was 76.1% muscle and 24% fat. My resting energy calories (1744 calories) proved to be higher than the younger athlete (1524) because men generally have more muscle and less fat than women.
Activity is important in a weight loss program. You can see by these numbers that being active for two hours daily- uses up at least an additional 1800 calories a day.
While it may be difficult for the average person to be that active, the point is—that activity does help in burning extra calories, and maintaining muscle mass.
Only muscle burn calories- fat doesn’t.
Also- activity- helps produce endorphins and encephalons which are feel good chemicals that help to ward off depression.
exercise and activity also helps to increase the sensitivity to insulin. Along with weight loss, exercise may help to reverse diabetes in those who have adult onset diabetes associated with overweight.
Exercise is also a great way to deal with stress.

diabetes, prediabetes, diabesity, obesity, overweight, insulin, health, wellness, doctor

Diabetes type 2 in children70% of the 80 million americans with prediabetes go on to develop type 2 or adult onset diabetes. It is preventable by making changes. The earlier the action the better.

Prediabetes is a fasting blood sugar of 100-125. Get tested. A three month monitoring of your blood sugar ( only possible in a lab) is a hemoglobin A1c test. Prediabetics have 5.6-6.4%, diabetics are >6.4%. Get tested to know your results.

Being more active – more physical activity, taking the stairs, taking a 5 minute or ten minute break for a walk, can help burn calories and help trim off pounds over time with consistency and determination

Losing even 10- 20 pounds can help lower blood sugar, improve, blood pressure, cholesterol, increase energy and sleep as well as decreasing pressure on joints.

Portion control – make small changes, eat a little less than you are used to, a smaller sandwhich. Swap a calorie drink for a zero calorie drink and drink more water

Maintain a healthy weight and be active- being active- 30 minutes a day most days of the week and losing 5% of your present body weight can decrease the risk of type 2 diabetes by 60%. Being active- increases your sensitivity to insulin and may prevent you from needing insulin.

High fiber foods, ( 25-30 grams a day for an adult) including whole grains, beans, legumes, fruits and vegetables, will decrease the faster absorption of sugar into the blood that occurs with processed foods. Fiber helps to lower blood sugar by releasing the sugar into the blood slowly.

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