Questions Tabs

 
You can submit your question here and the Joslin team will answer online.
*Your name and email will not be shown
All questions are reviewed and answered by our resident expert!
I do not want to start insulin. My friend who started insulin now has to stay on it forever.
This is true to all patients with type 1 diabetes and partially true to certain people with type 2 diabetes. For patients with type 1 diabetes, the body does not produce insulin and so will need     more
Question Posted:
2011-03-18 11:11
Question: 
I am a 54 year old Japanese male. I took a blood test at the beginning of September. My fasting glucose level was 225mg/dl and I was diagnosed with diabetes. I didn’t check my A1C. Then by dieting I lost 10 pounds in 6 weeks. I am going on a carbohydrate-free diet. My fasting glucose level is around 100 and my glucose level 2 hours after meals is around 120-130. However, my blood glucose level increases to 160-170 after a meal that includes only a small amount of rice. Could you estimate my pancreas function or insulin secretory capacity? In addition, I would like to find a meal plan that is right for me. I cannot continue on a carbohydrate-free diet forever; it is too difficult for me. As far as medication is concerned, I prefer thiazolidinediones to sulfonylureas. Can I go with thiazolidinediones in my condition? Also, I exercise by walking and working out on a rowing machine for about a half hour each day, always within one hour of eating lunch and/or dinner.
Answer: 
You are doing very well by being able to control your after meal glucose to 120-130.
 
But you right. The way you approach it by eating a carbohydrate-free is not sustainable especially for Asians since rice is a major component of the diet. Besides, I am not convinced that carb-free diet is the way to treat diabetes. Our study has shown that traditional Asian diet consisting of brown rice, vegetables, with proteins and fats mainly from plant based food, is actually very good for Asian people. The results show that it reduces insulin requirement in the body and lowers glucose level both fasting and after meals. I suggest you experiment with the traditional Asian diet!
 
In terms of medications, I tend to stay away from sulfonylureas, given its potential to cause low blood glucose, weight gain and lack of sustainability over time. There are many different options, of which thiazolidinedione is one choice of many. Your health care provider will need to gather more personal and health information to determine if this is the most suitable medication for you.
 
Your exercise component is impressive. You might also consider adding some mild to moderate weight bearing exercise. Some studies have shown a combination of aerobic and weight bearing exercise yield the best result in terms of diabetes control.

Answer by: William Hsu, M.D.