Hello, I'm Smokey and I'm new to this board. Usually I'm only on computer software/hardware and gaming sites. But I thought maybe I could get some answers here.

My wife, Snowflake, was diagnosed with type 2 diabetes this summer. She is overweight, has high blood pressure, TMJ, severe migranes and 'female' problems. She is also bipolar and has bpd (borderline personality disorder).

She is on Avandamet 4mg/500mg twice daily, Benicar for high blood pressure, and naproxen for pain. She is not on any meds for her BP or BPD anymore, having found a way (ME) to control any 'episodes'.

My main questions relate to blood sugar levels.

1. When Snowflake had a colonoscopy, she had to fast for 24 hours with only clear liquids before the test. Before the 24 hours, she could not have any fiber or protein or dairy. We monitored her BS levels every two hours as directed. She was jumping all over the place. She awoke with levels of 150, two hours later she had plumeted to 102, then two hours later 154. With only clear diet soda, water, and hot tea with no sweetner, what made her levels jump so badly?

2. She now takes the Avandamet in the morning and in the evening, before she was only taking it in the mornings. Before, her levels never went below 100, now she drops below 70 almost every day. She gets shakey and sometimes doesn't make any sense. The other day she went down to 42. Any suggestions or reasons why this happening?

3. Snowflake recently joined an organized women-only exercise program. It's a 30 minute workout consisting of weight training and aerobics. Can this attribute to her dropping levels?

I'll be happy to answer questions about her diet, etc... I know she's pretty strict on what she eats, she follows a regime she read about online, i think the American Diabetes Association. Half her plate is full of veggies all the time, one quarter meat, and one quarter other stuff, like rice or potatoes.

Thanks in advance...

Smokey :D

Your wife may need to adjust the meds she takes for diabetes. She should not allow the blood sugar level to drop below 70. She could pass out or go into a coma.

Best is to have the doctor refer her to a Diabetes Educator to help work out a food plan just for her.

Rice and potatoes turn into sugar real fast and will allow the sugar level to spike and then take a plunge down too low.

Best to keep blood sugar level steady all day long. Usually eating 6 small meals is better for some people than eating 3 meals.

The Diabetes Educator will be able to tell her how many carbs to have each meal, each snack, etc. Usually that amount will be too much and we have to reduce it.

I personally control via diet/exercise only and can eat 30-35 individual carbs per meal from mostly non-starch foods. More than that and my blood sugar will spike.

The white foods such as rice, potatoes, bread, etc. will raise sugar level too high for most diabetics.

In order to bring my diabetes under control I chose to eat lean meat and green veggies, walk 2 miles a day on treadmill.

PORTION control is very important in controlling diabetes. 3 oz. is considered a normal serving of meat. 1/2 c. cooked veg or 1 c. raw veg is a serving. Starch foods will be smaller serving size depending on the food. 1/2 banana, 1/2 apple, 2 apricots are examples of fruit.

I have found that a mixture of oatmeal, oat bran, wheat bran, soy granules, flaxseed meal makes a nice filling, satisfying breakfast. The beauty of this mixture is that my blood sugar level 2 hrs. later will be lower than my fasting number. This does not work for me at lunch or dinner. I dump a box of each together except for the flaxseed meal which needs to be kept in frig. Add 2 Tablespoons when I serve. Dannon brand Carb Control Yogurt is tasty and makes a good addition to the oatmeal mixture making it nice and creamy for only 3 carbs per serving. Some people do well with oatmeal and others do not.

Diabetes is an "individual" disease. Everyone needs to test before meals and 2 hours after meals in order to find out what different foods are doing to their sugar level. Then choose foods that do little or no harm to blood sugar level.

I found the ADA diet to include too many starches for me. Diabetics need to reduce amount of starches and sweets to bring diabetes under control.

The Dr. Bernstein book about diabetes is a good one to read. SugarBusters is a good book. Search the internet for "diabetes" and learn all you can about the disease.

Hi Smokey, The most important thing to know about diet is that it must be individualized based on many factors - you can never take another person's specific diet and expect that it will work for you.

Marie offered some great advice, but you must keep in mind that how her body responds to carbs and specific foods may be quite different than how other diabetics will tolerate foods. For example, some diabetics cannot consume potatoes or rice without problems, but many diabetics can and should eat these high-fiber natural foods. Some can eat oatmeal, but many diabetics cannot. For me, I cannot eat pasta or oatmeal ever - but potatoes and brown rice (not white) are just fine, in moderation.

Also food portions really must be determined by a persons specific body size - just because USDA and ADA call 1 serving of meat 3 ounces, does NOT mean that Snowflake should necessarily only be eating 3 ounces of meat in a meal, especially if she is significantly overweight.

And while diet specifics really must be individualized, there are general diet strategies that work for most T2 diabetics. I recommend that you take a look at the thread "Explain Tight Control" to learn how I completely reversed my T2 diabetes and other health issues with diet and excercise. And again, remember that the specifics (calories, portion sizes, and carb ratios really must be specified for an individual) The link to that thread is http://www.healthboards.com/boards/showthread.php?t=213548
If you provide Snowflake's age, height, weight, and activity level I can make further recommendations

I firmly believe that liver detoxification plays a vital role in controlling diabetes - especially for people that are on many medications. The liver is working overtime to flush the toxins out of the body, and it's exhausted by the time it must metabolize the food you eat. So, you need to support liver function in any way that you can. The BEST way to accomplish this is by eliminating all toxins from the diet. This includes chemical additives, preservatives, artificial sweeteners (including diet sodas). Common foods that increase the toxic load and are best eliminated from the diet include deli meats, processed cheeses slices, some dairy products (read labels, for example on cottage cheese and yogurt), soups, gravies, breads, and any processed, pre-packaged prepared foods. Think natural and fresh - read labels, and minimize ingredients. Drink lots of pure water.

Regarding Snowflake's hypoglycemic episodes - Excercise is definately contributing to her low numbers, and this can probably be easily controlled with some planning. How often does she eat during the day? She probably needs to consume a snack that combines carb and protein about 1 hour before her excercise session (I assume this is Curves - and make sure she finishes with the stretches!). She can't allow her glucose level to drop this low - she will experience a glucose rollercoaster effect, bouncing between highs and lows.

As Marie pointed out, Snowflake would benefit by attempting to maintain a steady glucose level all day, even if initially that number is higher than where she ultimately wants to be. The metabolism needs to become balanced. This is accomplished by eating smaller frequent meals throughout the day and accomodating for planned excercise to avoid glucose plummets.

To answer your other question about glucose levels during a fast - there are some good explanations of this in the thread "Numbers higher in the morning? But how?" Here is the link: http://www.healthboards.com/boards/showthread.php?t=216069

In summary, with a bit of effort and focus, Snowflake should be able to control her diabetes and may even find that she doesn't need the meds if she is sticks to her diet and excercise plan. Of course this is something that needs to monitored with her doctor. When I was on diabetes meds (the worst 11 weeks of my life), I finally announced to my dr that I was not going to take them anymore. I told him to give me 6 months to gain control of my glucose levels and only then would I reconsider taking the meds. I gained control in just 4 months and am happy to say that I am med-free.

I definity will read the links you so kindly provided.

Yes, she started Curves last week, she's been there three times, and is going again this afternoon.

My wife is 40, 41 on Nov 3rd. She is 5ft 1 inc in stocking feet. She weighs about 205. Curves is the most exercise she gets, unless you count climbing the stairs to the house( about 15 very large and steep steps) , and going upstairs to the bedroom and bathroom. (1 flight).

She's been to the dietician, to the pharmacy's diabetic program. The dietician recommended 'exchanges', and the she said the program was more management and psychology than anything useful. She learned the psychology in college, and she has a management degree. She was bored.

Our health insurance only pays for Snowflake to monitor her levels two times a day. It would be more if she were on insulin, but we had to fight to get two testings a day, the insurance only wanted one. So she rotates the testing schedule each day: example: Monday: 5am fasting, 730am two hours after breakfast. Tuesday: before lunch, then two hours after lunch. Wed: before dinner, then two hours after dinner, Thursday: morning and bedtme. Of course, if she feels 'weird', she tests it then also. That's how we found out about the lows.

Okay, portion control: last night she had a 3 ounce piece of grilled chicken breast, no skin, using a garlic pepper seasoner for flavor. She had half a plate full (probably 1 cup) of steamed brocolli, cauliflower, snow peas, and water chestnuts, seasoned with a bit of margarine and the garlic pepper again. She also had a small portion of wild rice, maybe a 1/4 cup. To drink, she had iced tea, no sugar (she's NEVER used sugar in her iced tea), no sweetner. Two hours after dinner her levels were 115. This morning she had a bowl of (1 cup) whole mixed grain (generic brand) cereal with 1/2 cup of 2% milk. No sugar or sweetner added. I think there may be been raisins in the cereal. Her fasting level today was 145. Two hours after breakfast, her levels were down to 135.

Snowflake drinks water like crazy, probably 2-3 gallons a day at work. She had to get a special note from her doctor so she could have extra bathroom breaks. She also drinks, as I mentioned, iced tea with no sweetner, hot tea, usually Chamomile, with no sweetner. Milk, once a day. She can't stand diet pop, so unless there's nothing else to choose from, she won't have that.
And coffee, with a bit of powdered creamer, less than 1/2 tsp.

Through out the day at work (she only works Mon, Tue, Thurs, Fri) Her snacks usually consist of a handful of peanuts or popcorn. she also snacks on cucumber slices, and plain lettuce for the crunchiness.

She takes her own lunch to work, so she usually makes herself some steamed veggies, which she reheats in the microwave, and some sort of meat, leftover chicken or fish, or tuna salad, that she prepares herself.

She's changed her, and our, eating habits quite a bit since we found out about the diabetes. I'm even losing some weight.

But what about fruit? Frozen yogurt? Goodies?

She thought it would be easier if someone one would just give her a sample diet for a few days and then she could make appropriate changes. However, almost every diet we've seen includes food we either don't have access to, or can't afford.

Thanks for the answers, and I"ll be reading the links you sent me. Congrats on being med free... that's what Snowflake and I want to....

Smokey, Sorry for the delay, I was out of town for a few days!

According to the info you provided, Snowflake needs about 1750-1800 calories per day to maintain her weight when she excercises. A lot of that depends on how hard she really works when she is at curves. I see a lot of women just go very lightly on the machines while others really pump them. You need to find out if she is working up a sweat, and what her heart rate is at each check point. That will somewhat indicate how much energy she is expending.

In order to lose weight, she will need to reduce her caloric intake by 10-20% at her current activity level. My recommendation is that she starts off with a diet of about 1600 calories per day. If she is unable to lose at that level after 2 weeks, then decrease further to 1500 calories per day.

Based on the formulas provided in the thread "Explain Tight Control" her numbers translate to:
5 meals per day with a ratio of 50% carb, 25% protein, 25% fat
Each meal would consist of:
320 calories
40 carb grams
20 protein grams
9 fat grams

3 meals + 2 snacks per day with a ratio of 50% carb, 25% protein, 25% fat
Each meal would consist of:
400 calories
50 carb grams
25 protein grams
11 fat grams

Each snack would consist of:
200 calories
25 carb grams
12.5 protein grams
5.5 fat grams
Based on the information you posted above, she eats great meals for lunch and dinner, but her breakfast and snacks would benefit with some modification.

Cereal with milk is, unfortunately, not a great breakfast for a T2 diabetic. Breakfast is the meal that sets the stage for glucose control throughout the day and it is vitally important to balance your macronutrients. Here is a snapshot of that breakfast:

2 cup of grain cereal with raisons
193 calories
45 carb grams (91%)
2 protein grams (4%)
1 fat gram (5%)

1/2 cup 2% milk
70 calories
7 carb grams (41%)
4.8 protein grams (28%)
2.4 fat gram (31%)

Meal Total
263 calories
52 carb grams (79%)
6.8 protein grams (10%)
3.4 fat gram (11%)As you can see this meal is extremely carb-heavy. It is also too few calories to carry her to the next meal or snack. This also provides a good example of the detail to which you need to calculate the componants of all meals and snacks.

My recommendation is to add protein to her breakfast - she needs 20-25 grams of protein, not 7! In order to keep her calories at the right level she may need to have less cereal or less milk. Just as I recommend to others - get out a pad and pen and start planning some meals that fit into the ratios above. At first it is not easy, but it is a learning experience. You will find that there are certain foods just not worth having because it is too hard to fit them into the plan.

Make sure Snowflake's snacks have some nutritional value and aim meet the ratios above. Munching on cucumbers does not make a snack. That's "chewing" not "eating" :D

Let me know what you think.