Managing Weight and Blood Sugar: A Guide for Diabetic Patients

Inquiry about weight loss in diabetes?

Hello, doctor.
I have been managing gestational diabetes for 13 years with medication, but my blood sugar levels have not been ideal.
My recent blood test showed a fasting glucose level of 172 mg/dL and a hemoglobin A1c of 8.5%.
I am 163 cm tall and weigh 62 kg, which is considered normal; however, I have gained 12 kg over the past year, primarily around my abdomen, with my waist circumference likely exceeding 89 cm.
I visited my family physician for a check-up, and all my indices were normal.
I also had an abdominal ultrasound, which showed no abnormalities.
My diabetes specialist mentioned that I have a "beer belly."
I have looked at some health websites and learned that a low-carb diet could help with weight loss and improve blood sugar levels.
I have been trying this for about three months, but I haven't lost any weight.
My hemoglobin A1c has decreased to 7.8%.
I was told that exercising would help with weight loss and lower blood sugar, but that hasn't worked either.
I am at a loss about what to do next.
Regarding my low-carb diet, I typically have one egg with unsweetened oat milk or unsweetened yogurt for breakfast, and my lunch is more flexible without carb restrictions.
For dinner, I eat steamed vegetables, braised dishes, sweet potatoes, and eggs, avoiding carbohydrates.
The braised dishes consist mainly of vegetables, mushrooms, and meat, and I have cut out sugary drinks.
I am unsure how to lose weight; my appetite is not large, and I don't feel very hungry, but I eat three regular meals a day.
I have reached a point where I am questioning everything.
On one hand, I want to improve my health, and on the other hand, I hope to reduce my belly size, especially since I am already experiencing some complications from diabetes.
I apologize for the lengthy message, and I appreciate your patience in reading it.

Dong, 40~49 year old female. Ask Date: 2023/04/20

Dr. Liu Hongxiang reply Family Medicine

Dear Ms.
Dong,
I hope this message finds you well.
After reading your letter several times, I can sense your efforts in managing your blood sugar levels; please continue to maintain this.
If you want to achieve weight loss effectively, it is essential to focus primarily on dietary control, with exercise as a supplementary measure.
I recommend consulting a nutritionist to determine the appropriate quantities and types of food to consume, while avoiding high-fat foods.
Additionally, it is important to keep track of what you eat, so that if you overeat during one meal, you can adjust your intake in the next meal accordingly.

Furthermore, I suggest visiting our clinic to check for any complications that may have arisen and to receive appropriate treatment.
Wishing you both physical and mental well-being.
Sincerely,
Dr.
Liu Hongxiang

Reply Date: 2023/04/20

More Info

Managing weight and blood sugar levels can be particularly challenging for individuals with diabetes, especially for those who have been living with the condition for an extended period, such as yourself. Your situation, characterized by a significant weight gain and elevated blood sugar levels, is not uncommon among diabetic patients. Here’s a comprehensive guide to help you navigate these challenges.

Understanding Blood Sugar Levels and Weight Management
1. Blood Sugar Control: Your current HbA1c level of 8.5% indicates that your blood sugar levels have been consistently high over the past few months. The goal for most diabetic patients is to maintain an HbA1c below 7%. Elevated blood sugar can lead to various complications, including cardiovascular disease, nerve damage, and kidney issues. It’s crucial to work closely with your healthcare provider to adjust your medication or explore other treatment options if necessary.

2. Weight Gain and Diabetes: Weight gain, particularly in the abdominal area, can exacerbate insulin resistance, making it more difficult to control blood sugar levels. This phenomenon is often referred to as "visceral fat," which is associated with a higher risk of metabolic syndrome and cardiovascular diseases. The fact that you have gained 12 kg in a year, primarily around your abdomen, is concerning and warrants a strategic approach to weight management.

Dietary Considerations
1. Carbohydrate Management: While you have made efforts to limit carbohydrates, it’s essential to focus on the quality of carbohydrates rather than just the quantity. Incorporate whole grains, legumes, fruits, and vegetables that are high in fiber, as these can help stabilize blood sugar levels. Instead of completely eliminating carbs, aim for balanced meals that include healthy fats and proteins, which can help you feel full and satisfied.

2. Meal Timing and Frequency: Eating regular meals and snacks can help prevent extreme fluctuations in blood sugar levels. Consider smaller, more frequent meals throughout the day to maintain energy levels and prevent hunger. This approach can also help manage cravings and reduce the likelihood of overeating.

3. Hydration: Staying hydrated is crucial for overall health and can aid in weight management. Sometimes, thirst can be mistaken for hunger. Opt for water, herbal teas, or other low-calorie beverages to stay hydrated.

Exercise and Physical Activity
1. Incorporating Exercise: Regular physical activity is vital for managing both weight and blood sugar levels. Aim for at least 150 minutes of moderate-intensity aerobic activity each week, such as brisk walking, swimming, or cycling. Additionally, incorporating strength training exercises at least twice a week can help build muscle mass, which can improve insulin sensitivity.

2. Finding Enjoyable Activities: Choose physical activities that you enjoy to make it easier to stick with a routine. Whether it’s dancing, gardening, or joining a local sports team, finding something you love can make exercise feel less like a chore.

Monitoring and Support
1. Regular Monitoring: Keep track of your blood sugar levels regularly to understand how your body responds to different foods and activities. This information can help you make informed decisions about your diet and lifestyle.

2. Seek Professional Guidance: Consider working with a registered dietitian or a certified diabetes educator who can help you create a personalized meal plan and provide ongoing support. They can offer insights into portion sizes, meal timing, and food choices that align with your health goals.

3. Emotional Well-being: Managing diabetes can be emotionally taxing. Don’t hesitate to seek support from friends, family, or mental health professionals if you’re feeling overwhelmed. Stress management techniques such as mindfulness, yoga, or meditation can also be beneficial.

Conclusion
In summary, managing weight and blood sugar levels as a diabetic patient requires a multifaceted approach that includes dietary modifications, regular physical activity, and ongoing monitoring. It’s essential to be patient with yourself as you navigate these changes, as sustainable weight loss and improved blood sugar control take time. Collaborate closely with your healthcare team to adjust your treatment plan as needed, and remember that you are not alone in this journey. With the right strategies and support, you can achieve your health goals and improve your quality of life.

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