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"Clearly no diet works reliably," says Jan Harper of San Jose, California. Harper, who has type 2 diabetes, takes oral medications to control her diabetes and tries to adhere to a "good diet"-the advice most often given to people who have type 2. However, as Harper laments, what is a "good diet" or the "right diet" for a person with type 2 diabetes? Does such a thing actually exist?
"There is so much conflict about high-protein versus complex carbs versus just counting carbs, even among the non-fad nutrition experts," observes Harper.
Does Any Diet Really Work?
Diabetes Interview recently asked readers who have type 2 diabetes about their experiences with dieting as a means of controlling weight and blood-glucose levels as well as achieving overall diabetes management. While some say they have found the secret to keeping the weight off and the blood-glucose levels down, others have encountered more frustration than reward.
Robert Abowitz, a type 2 from Tehachapi, California, finds that everything he does-as far as dieting is concerned-is wrong.
"If I try to eat sensibly in the morning [1 cup of cereal and skim milk], my blood glucose still goes up to an unreasonable level," he reports. "It seems that everything I try results in higher blood-glucose levels within one or two hours."
Most readers agree that they face not one problem with eating and maintaining good control, but several.
Norm Houlton, a type 2 from Maine, describes himself as "seriously overweight" and takes 16 units of insulin each evening and 1000 mgs of Glucophage during the day. Houlton calls himself a "sweets addict."
"I love sweet stuff," he says. "Each and every day is a struggle to not eat sweets. Most days I do okay, but lately, for some reason, I have been eating way too much."
Houlton says he has tried eating a "normal" breakfast as often as he can (for example, cereal, orange juice and toast), but that often goes "out the window" during the week, when he is in a hurry and instead settles for an "Egg McMuffin-type thing" at the cafeteria.
"The main thing that frustrates me about meal planning is my lack of interest in it," notes Houlton. "I watch people around me cooking good things and bringing interesting lunches to work, and I realize that I simply have no interest in that. I know how to do basic cooking-it's just that I can't be bothered."
Annette Klein of Baltimore, Maryland, has had type 2 diabetes for 21 years and is treated, as she describes it, "as a type 1." She reports that she has tried dozens of diet programs and food plans over the years. None have worked for her.
"My current diet says 'no sugar or salt, very little fat and no taste!'" exclaims Klein. "If it tastes good, I probably can't have it!"
Klein notes that she tried one of the low-carbohydrate/high-protein diets for a few weeks but stopped when she developed microalbuminuria (protein in the urine).
Last fall, Klein stopped taking all oral type 2 medications and now injects NovoLog insulin every time she eats, plus a shot of Lantus at bedtime. She has lost 25 pounds but still considers herself "morbidly obese."
Sticking With It - Not as Easy as It Sounds
As some will attest, developing a good dietary regimen and sticking with it are not as easy as one might think.
Much like a New Year's resolution, the resolve to lose weight often falls by the wayside, and it is difficult to remotivate yourself.
When Darlene Harris of Fort Worth, Texas, was diagnosed with type 2 diabetes in September 2001, she attended a two-week education class at her local hospital. She was delighted to find out she could have most all foods. However, she says, the key was portion control.
For the first two months, Harris wrote down every bite she put in her mouth and kept a daily food log, which she entered into her computer. She also kept a running total of her daily intake of carbohydrates, calories and fat as well as a daily exercise and blood-glucose log.
"I did great. I lost 30 pounds and did not feel deprived," reports Harris.
However, at the end of last November, she developed a terrible flu virus. While she was sick, she did not count carbohydrates, did not exercise and did not measure her blood glucose.
"Since I have been sick, I have not been able to motivate myself to get back to my lifestyle change. It seemed like for a while my whole life revolved around my diabetes and writing down everything I ate, calculating the carbs, exercising, et cetera. I was getting frustrated with the time it took daily to do all of this. I guess getting sick gave me an excuse not to do it anymore."
Other people with type 2 assert that their dietary regimen has resulted in weight loss and better control, despite the fact that their typical diet-as Susan M. Ouellette of Fall River, Massachusetts, puts it-is "boring!"
"It's almost the same food every day," she says. "If my sugars are on the 'okay' side, I try to remember what I had to eat."
A typical daily meal plan for Ouellette looks like this:
Ouellette says her biggest problem is trying to make sure she eats the right amount of food each day.
Jeannette Smith of Racine, Wisconsin, was diagnosed with type 2 diabetes in March 2000. Ever since her diagnosis, she says, going grocery shopping takes twice as long.
"I now read the nutrition labels. Once, one of my daughters said I was no fun to go grocery shopping with anymore because I read all the labels. I told her, 'I have to.'"
Smith said her type 2 diagnosis meant having to give up regular soda. When the urge to have a soda hits, she drinks the diet version. Smith adds that managing her diabetes and weight is easier because she has a physician who "doesn't expect anyone to be a saint."
"I haven't lost much weight since my diagnosis, but I haven't gained any either."
Doing Whatever It Takes
Other people with type 2 diabetes observe that finding the right diet sometimes requires a little leg work.
Larry Strawn, a type 2 from Portland, Oregon, says that for many years he followed the "pyramid" diet endorsed by the American Diabetes Association "with consistently poor results, medication changes and eventual insulin treatment."
During this time, Larry said, he was accused of not following the diet and was horribly discouraged.
"Then I found a book called 'The Schwarzbein Principle' and began trying the author's approach to diet. Previously, my average blood glucose was 280 to 320 mg/dl. Now my numbers are typically 98 to 140 mg/dl. I feel much better in every way."
The 'Zone' Diet
Linda Camozzi of Orangevale, California, was diagnosed with type 2 diabetes in October 1998. She started on Glucophage, gradually increasing her dosage to 850 mg three times daily. She later added Avandia and worked with a dietitian.
Her fasting blood glucose, however, gradually worsened to 260 to 280 mg/dl, with after-meal readings getting as high as 350 to 420 mg/dl.
"Nothing seemed to help," remembers Camozzi. "I followed the diet, took the meds, exercised and saw an endocrinologist, but I still felt awful most of the time."
Camozzi's 2001 New Year's resolution was to do "whatever it would take to get the diabetes under control." She decided to start the "Zone" diet (created by Barry Sears).
"I did mention to my doctor what I was planning," she says. "He was a bit skeptical, but he okayed it."
In early January 2001, Camozzi started with a week of intensive blood-glucose monitoring. She tested her fasting levels as well as monitoring before meals and one and two hours after meals. She checked her blood glucose after snacks, before and after exercise, before bedtime and if she woke up in the middle of the night.
Camozzi eliminated rice, potatoes, pasta and bread from her diet and avoided starchy vegetables. She ate lots of fresh fruits, vegetables, nuts, salads, fish and chicken.
Camozzi has also "quit" fast food, soda and coffee. If she is unsure of a particular food, she tests before and after eating it.
"If a food or beverage triggers high readings, I quit using it. I use Balance Bars and ZonePerfect bars when I need a quick snack."
Camozzi expected to lose some weight, but she reports that her blood glucose started "dropping like a stone before I had lost so much."
"I had to start cutting back on my meds, and by the time I was able to get in to see my doctor, I was off the Glucophage," she says. "Pretty soon, I was off the Avandia too."
Since starting the Zone diet, Camozzi's fasting blood-glucose levels are in the 95 to 105 mg/dl range. One-hour after-meal levels, she notes, run about 120 to 140 mg/dl.
She has lost 53 pounds.
'Dr. Bernstein's Diabetes Solution'
Robert Hocking of Sterling Heights, Michigan, is another person who has benefited from a low-carbohydrate diet, which he started three years ago.
"My diabetes [at the time] was out of control," Hocking recalls. "One minute I would be in the 300s, and the next minute I would be in the 50s."
Hocking purchased "Dr. Bernstein's Diabetes Solution," a book written by Dr. Richard K. Bernstein.
"It explains how to exactly match your food intake with your insulin injection, by finding out exactly how much 1 gram of carbohydrate and 1 gram of protein raise your blood glucose and how much 1 unit of insulin lowers your blood glucose."
Hocking says he started skipping breakfast-he has dawn phenomenon-except on the weekends. On the weekends, he eats a three-egg omelet, 2 ounces of feta cheese, 2 ounces of meat in the omelet (usually Polish sausage) and 1.5 ounces of bacon.
For lunch each day at work, he eats 2 cups of romaine lettuce, 1 ounce of pecans, 3 ounces of chicken, one hard-boiled egg, and 6 tablespoons of Wishbone Berry Vinaigrette dressing.
For dinner, he eats 6 ounces of protein (either fish, chicken, steak, pork or sausage) and lots of steamed vegetables (1.5 ounces of asparagus, 2.5 ounces of broccoli, 2.5 ounces of cauliflower, 1.5 ounces of zucchini).
Hocking's snacks consist of 3 to 4 ounces of macadamia nuts, 4 ounces of hard cheese (usually super sharp) and sometimes 3 to 4 ounces of mixed nuts.
Hocking says his last A1C test was 4.5%, and his A1C usually stays in the 4% to 6% range.
After following the Bernstein-recommended diet for about six weeks, Hocking went back to his doctor with all of his logs.
"My doctor looked at me and said, 'Whose logs are these?' He had a real hard time believing that they were mine, because they were almost picture perfect, whereas the previous logs were all over the place. I told my doctor about the regimen I found that worked, and how I adjusted it until it fit me just right, and my doctor said, 'Whatever you are doing, keep doing it.'"
Ray Termini of Morris, Illinois, follows the Weight Watchers diet and has had a good experience, "provided you count the points and record what you eat until you have lost the weight you want."
Morris says a typical diet for him is bread or cereal and yogurt or skim milk for breakfast, a light sandwich with pretzels and fruit for lunch and "almost anything" for dinner.
Throwing in Exercise
For others, maintaining control of weight and diabetes doesn't result from diet alone.
Donna Anderson, an insulin-treated type 2 from Fort Worth, Texas, says exercise makes the biggest difference in maintaining tight control. Ander-son does 40 minutes on a treadmill with her target heart rate at 70 percent of maximum for 30 of those minutes. She then does crunches to strengthen her stomach and back muscles or lifts weights.
However, diet also makes a difference in Anderson's control.
"I generally eat 45 grams of carbs at each meal," she says. "I generally have no more than 25 grams of fat per day and no more than 6 ounces of protein per day. Those are divided up between my three meals depending on what I want at each meal."
A typical weekday meal plan for Anderson includes the following:
Anderson adds that she tries to stay away from foods that she has found raise her blood glucose (for example, "potatoes, pasta, pizza").
"I seldom eat dessert, preferring to get my carbohydrates during my meal," she says. "On occasion, usually when eating out, I take a little extra insulin to allow me to have more flexibility in what/how much I eat. I don't do this often because of the extra calories (translate that to mean weight gain) and the extra fat that usually comes with those meals."
A Process of Trial and Error?
So what is a type 2 to do? With type 2 diabetes comes rules and restrictions, trial and error and trying to find exactly what works for your weight and blood-glucose control.
But everybody has to eat. Right?
Maybe Jan Harper is right when she suggests there is too much "conflict" about how a type 2 should eat. Maybe Darlene Harris is right when she admits that finding a good dietary routine and sticking with it can be a difficult proposition. Or maybe Susan Ouellette is right when she says the secret to losing weight is following a "boring" diet.
Perhaps the best diet for a person with diabetes-as Cheryl Alsip of Salcha, Alaska, puts it-is simply going through the cumbersome process of figuring out exactly what the right plan is for you.
"By the time I'm even halfway through this process, I lose my appetite and just don't eat," says Alsip-tongue in cheek.