I've Started Taking Avandia. What Changes Do I Need to Make to My Diet?

How do you adjust your dietary intake when taking Avandia to cope with its lowering effects on blood sugar?

Miriam Solomon
Internet

As recommended by the American Diabetes Association, all people with type 2 diabetes should adhere to a low-fat, high-fiber diet to improve their blood sugar levels. In fact, diet and meal planning, in combination with exercise and insulin-sensitizing medications such as Avandia, play a critical role in lowering blood sugar levels, as do medications that manage blood pressure and lipids. Both kinds of medications may also reduce underlying problems in type 2 diabetes which are caused by or associated with insulin resistance.

The American Academy of Clinical Endocrinologists generally recommends a daily diet of 55 to 60 percent carbohydrates, 10 to 20 percent protein and no more than 30 percent fat, along with 20 to 40 minutes of physical activity every 48 hours. One of the most important factors is the balance between exercise and diet. People with type 2 diabetes should talk with their physician or diabetes educator to create an individual schedule that includes meal planning, exercise and medication.

Education about type 2 diabetes leads to better management of nutrition and health. Without education, many people don't realize the important role that insulin-sensitizing and other medications play in diabetes management. Medication helps to achieve recommended glucose, cholesterol and blood pressure levels, which is necessary for comprehensive management. By combining these medications with balanced meals and exercise, all of which are necessary to manage diabetes, overall well-being can be achieved.

Martin Freed, MD, FACP
Philadelphia, Pennsylvania

How Can I Treat Necrosis Lipoidica and Diabetic Dermopathy?

What are necrosis lipoidica and diabetic dermopathy? Who gets them? What can be done to treat them? Are there any doctors who specialize in this field?

Lawrence Fiffer
Howard Beach, New York

While skin disorders are common in people with diabetes, with up to one third experiencing a problem at some time, diabetic dermopathy (DD) and necrobiosis lipoidica diabeticorum (NDL) are both rare.

Both DD and NDL are found on the shin area of the lower legs. DD may appear as light brown scaly patches, and these lesions may be circular or oval in shape. It is believed to be caused by a problem in the small blood vessels. It has also been associated with findings of diabetic neuropathy, kidney disease and ocular retinopathy.

NDL is similar to DD but is deeper and larger. The appearance may resemble a scar with purplish edges, and its lesions may be of cosmetic concern. The lesions may be painful or itch and, unlike DD lesions, can crack open. There are conflicting reports as to whether poor diabetes control contributes to this disorder. It does, however, seem logical that tight control would help prevent this problem as it does so many other complications of the disease.

While treatment alternatives have been reported, physician specialties that deal with this problem include dermatology, podiatry and surgery.

Neil Scheffler, DPM
Baltimore Podiatry Group
Baltimore, Maryland

How Soon After a Meal Should I Test My BGs?

In your interview with Dr. Alan Marcus ("Dr. Marcus's Diabetes Tips," November 2000, p. 42), he advises that people widen their range of blood sugar readings to include more "after meals". This term often puzzles me, as I am not sure whether this means "immediately" or "one hour " or "two." Usually post-prandial means two hours, I think, but I felt he was suggesting a different regimen. Is this correct?

Anonymous

The ideal approach to when to check blood sugar is to individualize it so you always get the most important information. "Waste not that finger stick" should be one of the golden rules of diabetes care.

First, find out when your blood sugar goes the highest after eating. Is it one or two hours after beginning to eat? Then, since the goal is to prevent high blood sugars from occurring, and the effectiveness of all interventions (medicine and lifestyle) is determined by their ability to prevent high blood sugars and result in euglycemia (known to some as happy glycemia), check your blood sugar at that time and use that to make changes in what you and your health care team are doing.

The exception to this is in pregnancies among women with diabetes, when all the studies are consistent with the message to check and normalize at one hour.

Remember, the clock starts ticking when the teeth start chewing.

Alan Marcus, MD
South Orange Endocrinology
South Orange, California