Diabetic Home Management

Question

In response to comments that has lead to a vast discussion in this forum,I would like to pose this question.This is not any real patient's case.I just wanted make myself aware.I just wish we should be aware of answers to such questions because DM is a very difficult to manage and these questions often haunt us when we are diabetic.

A case of Asian,52 yrs T2DM for 20years,taking Insulin 24IU at meals and 50IU at bed time,obese,being Hypertensive(controlled on medication),with no other complaints other than left eye cataract,planning for surgery.
The questions are:
1.What should be his diet plan?

2.What are his cut off values for carbohydrates distributed over intake of food in a single day's plan?How it should be distributed?

3.What is the perfect plan for intake of food?How it should be distributed in one day?What are the types of foods and amounts of each variety to be taken in a cost effective way?

4.What are the expected challenges that may lead to uncontrolled BG even after a perfect meal plan for at least 6 months?

5.What are the precautions that need to be kept in mind which may lead to uncontrolled situations of BG?Then what are the modifications that can be made in diet on home management basis other than hospital setup?

6.Any other information that should be considered?

7.Is there something else that I should know if I were to take care of such person?

I wish a detailed explanatory response (if possible) heath professional or expert or anyone who experience same situations or anyone who has done extensive research or any one who are already experienced in managing such ranges.If possible,please add details of reference materials,links (without infringing copyright).Any suggestions are widely appreciated.Thank you.

diabetes86 · Accepted Answer

Hi Vedadhar

You have asked a good questions.
There just is no 1 answer for it.
Questions 1,2 and 3 are the same. how many carbs to eat

To start with what is diabetes, among other things its the inability of our bodies to regulate Blood Sugar (BG).  So we have to regulate it.

I hope you drive a motor vehicle.  If I asked you how much gas to use to go 40 KPH what would your answer be?  It would probably be use as much gas as needed, till the speedo reaches 40KPH


Well  The same for diabetes.  Think of carbohydrates (carbs) as the gas throttle, insulin as the brakes.  You need to use both in the correct amount to go, up hill, down hill or with a heavy load, and of corce the vehicle.  A truck needs more gas and brakes than a motorcycle. 

For driving you have a speedometer, For diabetes we too have a meter, its a BG meter.

Taking a set amount of insulin at each meal will NOT give an even BG UNLESS that person eats EXACTLY the same thing each time AND it is the correct amount of insulin for that carbs in the meal.

There are LOTS of things that effect BG how many carbs you eat how much insulin YOUR body makes, how insulin resistant YOU (your friend) are.

The easy answer is IF your BG is over 140 US (140/16 = 7.8 Your measure) you could eat less carbs.  When you are down to as few carbs as you can eat and be able to do that long term (eating style) if your BG is still to high you need to add medication.  How much only as much as needed to get your BG under 7.8

Medication can be exersice, pills and or injections.  Insulin is one of the better drugs for diabetes as it is a natural hormone that our bodies make and need.

Question 4 ... Answer; Things change,  get sick BG goes up travle and eat out you get higher carbs BG goes up, do extra work BG goes down.

Question 5;  If your on insulin and many other Diabetes drugs you can get Hypo... low BG if it goes low enough you will pass out even lower you can die.  If your aon any BG lowering medication you NEED a BG meter and a fast ating carb to carry with you ALL the time.  To use when your BG goes under 3.8.

As in driving USE your speedometer (BG METER ) to adjust your gas (carbs) and brakes (insulin) to maintain a good BG of 3.9 to 7.8

This is just the surface there are whole books written on how to control diabetes. two of the best are 

Think Like a Pancreas  by Gary Scheiner
Using Insulin  by John Walsh

The point that was trying to be made was you dont HAVE to eat carbs, If your BG is between 3.9 and 7.8  your brain IS getting all the BG it needs.

eating a large amounts of carbs and using a large amounts of insulin leads large BG swings if your application of them is off a little.

Also look up "eat to your meter" on line  it is probably the BEST way to manage diabetes.

I know I did not give you the answer you wanted, there is no 1 answer.  There are tools and BG meters , for every person is different.

Good luck hope I explained it well enough

Super_sally888 · Answer

nice response diabetes86.

Control blood sugar carefully.  If possible keep below 140 (7.8) all the time and also avoiding low blood sugar.

Dose insulin as required to control blood sugars, testing frequently to ensure correct dose.

Testing of basal and bolus requirements as per book, "think like a pancreas"

Minimise carb intake.

Increase exercise (ideally 30 minutes minimum of walking per day), additional will be beneficial.  Ie. 30  minutes twice a day.  Or more vigorous eexercise, if the patient is able... but with monitoring / adjusting of insulin  to avoid lows.

If patient can understand detailed book, then book Diabetes Solutions by Dr. Richard Bernstein also very helpful in techniques to have excellent blood sugar control.

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