Blood Sugar and Weight Control
A series of case studies
Suzanne Friesen, RD, CDCES
The information in this presentation
is for general education purposes only.
Please discuss your specific health care needs
with your medical provider.
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Blood Sugar and
Weight Control
Strategies to Lower Blood Glucose and Weight
• Follow a low-carb eating plan
oReplace carbs with protein, fat, and non-starchy vegetables
• Avoid snacking
• Restrict eating time/intermittent fasting
• Walk if blood glucose (BG) is high
• Drink plenty of calorie-free fluids
Low-Carb Eating Plan
• 130g carbohydrate daily or less
• Choose high quality, high fiber carbs
oBerries, pinto beans, Greek yogurt are
high quality
oWhite bread, cheese curls, candy are
not high quality
Male in His 30s
• Newly diagnosed Type 2 diabetes
• A1c = 7.9%, triglycerides = 275
• Recent hospitalization prior to our visit
• Currently eats a very high carb diet (lots of rice)
• Weight = 230 lbs, BMI = 34
His Goals
• Lose weight
• Normalize blood sugars
• Get off all diabetes medications
• Increase exercise
Plan to Achieve Goals
• Eating 100g carbohydrate daily or less
• Intermittent fasting 16 hours 5 days/week
• Eight hour eating window, typically 12 – 8 p.m.
• Walking 6x/week, 30 – 60 minutes
Follow-Up Visit Four Weeks Later
• A1c = 6.4% (was 7.9%)
• Triglycerides = 127 (was 275)
• Weight = 214 lbs, BMI = 31 (↓16 lbs)
• Walking 6x/week, 30 – 60 minutes, added strength training
• Checking BG 1-4x/day, 100% in range
• Off all diabetes meds
Eight Weeks Later
• Weight = 208 lbs (↓22 lbs), BMI = 30
• Continues with diet changes
• Continues exercise program
• Remains off diabetes meds
Eight Months Later At Primary Care Visit
• Weight = 170 lbs, BMI = 25 (↓60 lbs)
• No medications at all
Female in Her 60s
• Type 1 diabetes mellitus for 35 years
• Insulin pump: Total daily insulin 80 units
• Weight = 232 lbs, BMI = 42
• A1c = 9.1%
• Eats high carb meals and snacks, fast food, processed food
• No exercise
If You Take Insulin
• Meal-time insulin covers the carbohydrate
• Higher carb meals require more insulin
• Higher insulin doses can cause weight gain
• Timing of meal-time insulin matters
• Rapid acting insulin should be taken 15 – 20 minutes before first bite
• Regular insulin should be taken 30 – 45 minutes before
Plan
• 3 meals daily, stop snacking
• 100g carb/day, accurate carb counting
• Start walking: 5+ minutes daily
• Regular communication with doctor/diabetes educator for insulin
pump adjustments
Follow-Up Visit Four Weeks Later
• Weight = 220 lbs (↓ 12 lbs)
• Total daily insulin = 23 units (was 80 units)
• Walking daily 15 minutes
• Eating 3 meals/day, no snacking, no fast food
• Food records: Plenty of vegetables cooked and raw, salads, eggs,
Five Month Follow-Up
• Weight = 191 (↓20 lbs)
• A1c = 6.7% (was 9.1)
• Walking 6+ days/week 30+ minutes
• Total daily insulin dose 20 – 24 units
• Continues with same meal plan
Eight Month Follow-Up
• Weight = 173 lbs (↓ 59 lbs)
• A1c = 6.4% (was 9.1%)
• Walking/exercising daily 60 minutes
• Continues with low-carb eating plan
• Total daily insulin 20 – 24 units
Female in Her 70s
• Type 2 diabetes 3 years, prior history of pre-diabetes
• Weight = 155 lbs, BMI = 30
• A1c = 8.7%
• Jardiance 25mg every morning
• Walks 5 days per week, 2 miles
• Goals: Lose 10 pounds, lower A1c
Plan
• 100g carb/day divided over three eating times
• Avoid after dinner snacking
• Add protein, natural fat, non-starchy vegetables (to replace carb)
• Continue walking 5x/week, 2 miles
Four Week Follow-Up
• Weight = 149 lbs (↓ 6 lbs), BMI = 29
• Eating 3 meals daily, no snacks (most of the time)
• Continues walking program
• 4 blood sugar results in meter but all in target range!
• Very pleased with her weight loss
• Food records: Eggs, cottage cheese, Greek yogurt, bread, sausage,
some vegetables, chicken, fish, cheese, potatoes, tortilla chips, some
Nine Week Follow-Up
• Weight = 148 lbs (↓ 7 total, ↓ 1 lb in last 5 weeks)
• Disappointed in small amount of weight loss
• Reports feelings of hunger
• Continues walking program
• No blood sugar tests in meter
Plan
• Reviewed BG testing and encouraged to test twice per week
• Great walking program: Keep up the good work!
• Hunger: Add more protein, natural fats, vegetables, fluids
• Okay to eat ALL carbs recommended: choose high quality, high fiber
• Low-carb snacks if needed
Four Months Later at Primary Care Visit
• Weight = 146 lbs (was 155 lbs), BMI = 28
• A1c = 7% (was 8.7%)
• Jardiance 25mg daily
We offer:
• Individualized diabetes education, on site or virtual visit
Centralized locations
• Saint Luke’s Hospital of Kansas City
• Saint Luke’s North Hospital
• Saint Luke’s South Hospital
• Saint Luke’s East Hospital
• Hedrick Medical Center
Saint Luke’s Primary Care
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• saintlukesresources.org
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Q&A
• Q: Can I get the recipe for the Almond Bread?
A: https://www.allrecipes.com/recipe/263032/90-second-keto-bread-in-a-mug/#nutrition
• Q: Once your A1C has normalized, will you always be a diabetic?
A: Studies show remission is possible. See the DiRect trial for details
• Q: Would you consider white rice a good quality card? or should I do brown rice?
A: No, white rice is refined. Brown rice only slightly better in that it has a small amount of fiber but just as much carb as white rice.
• Q: I eat mid-meal snacks like carrots or nuts. Should I not eat mid-meal snacks at all? A: It’s best not to snack
Q&A
• Q: Is low carb good for someone that has heart stents
A: A low carb, fresh, whole foods eating plan is good for anyone. High blood sugars are bad for the heart and bad for blood flow
• Q: Is peanut butter an alright protein?
A: Peanut butter and nuts are healthy fats and protein
• Q: For the fasting, does that mean nothing to drink as well? A: Drink plenty of calorie free fluids during the fasting time
• Q: Thoughts on 8 hour eating intermittent fasting vs 5-2 plan?
Q&A
• Q: What are examples of non-starchy vegetables?
A: Everything but peas, corn, potatoes
• Q: When you are a sugar craver, is having sugar free jello, pudding, popsicles, etc... ok?
A: yes
• Q: Please refresh on how to count carbs
A: Recommend you meet for an individual consult with an RD, CDES virtually or in person. You
will receive an individualized plan as well as written resources. 816-932-2707
Q&A
• Q: Do the sugar alcohols count as carbs? Malitol, xylatol, sorbitol, etc. Some sources count those like any other carbs, others say to exclude them.
A: Sugar alcohols are carbohydrates but feel free to subtract them from the total carb grams on a food label. • Q: Is elderberry supplement good for lowering blood sugar?
A: No idea but I am not a fan of supplements which claim to lower blood sugar. We already know what lowers blood sugar and it is a fresh, whole foods, low carb diet, exercise, weight loss if needed, and diabetes medications.
• Q: I get nauseated frequently I think due to Ozempic so I tend to eat to stop the nauseusness then I gain weight. I am on insulin at night only now as got off of the novalog. Any suggestions for me?
A: The GI side effects from Ozempic tend to subside with time. However I suggest you try drinking some hot broth or perhaps herbal tea rather than eating. If you can, lie down until the nausea subsides.
• Q: What about sugar free vitamin water?
Q&A
• Q: I'm a type 2 diabetic august a1c was 13.9 started taking my glimepiride ate right went in 8 weeks later -a1c 8.2 - but the Dr wanted to put me on more meds -including ozempic and metformin - why?
A: Possibly because the A1c is still above 7. And possibly because the addition of ozempic allows for weight loss and blood sugar lowering and may allow you to stop the glimepiride. Glimepiride is a weight enhancing medication. Metformin improves insulin resistance without causing weight gain. It is a good idea to discuss your medication concerns with your doctor.
• Q: My worst numbers are first thing in the morning, when I wake up. Options to help with this?
A: It is common to have highest blood sugars first thing in the morning due to release of stored glucose from the liver overnight. Are your blood sugars in target range at other times during the day? Focus on the
cornerstones: low carb diet, increase exercise, lose weight if needed, take diabetes meds as instructed. Are you snacking at night? If so avoid.
• Q: are you seeing that patients using the Libre freestyle monitor (the one that stick on your arm) having better BG control?
Q&A
• Q: What is the best time to take metformin rx is 2x a day morning and evening
A: this can vary depending on the individual. Sometimes recommend twice daily with first and last meal of the day, sometimes one dose at bedtime, sometimes all of it in the morning. Everyone is different and we really look to individualize based of blood sugar data, side effects, etc.
• Q: Can you suggest a good phone app for recording food and counting carbs? A: Loseit.com, carbmanager.com, mysugr.com
• Q: I’m diabetic as are both parents - whom I share a house with. Are the guidelines for carb levels the same (130 or less) no matter age or gender?
A: These can vary individually and I recommend meeting with an RD, CDES to set up an initial plan. However, 130 grams of carbohydrate daily or less is considered a low carb eating plan.
Q&A
• Q: About how long does it take to bring high blood sugar (185 average) down if I eat correctly and continue with my walking 150 min per work, get enough sleep, etc. I am currently not able to get my Ozempic and am having to go it alone.
A: As you can see from the case studies presented, significant change happened after 4 weeks of following the new plan.
• Q: need ideas for snacking. what do you think about glucerna and or protein powder
A: I am not a fan of either. Research shows better results/outcomes with limiting eating to 3x/day, no
snacking. It is almost always best to eat real food rather than supplements and meal replacements (which are highly refined). In my opinion meal replacements are for people who are unable to eat solid foods. If you must snack, choose low carb snacks (less than 5g carb per serving).
• Q: Is it ok to take Apple Cider Supplements and being diabetic on Metformin? Will it interfere with the medication?
Q&A
• Q: What are the best nuts to eat ?
A: All nuts and seeds are fine. However some contain more carbohydrate than
others. Pistachios and cashews are a bit higher carb that others.
• Q: There is an business in Overland Park named "Help your Diabetes". Do you
know anything about this group? It looks like it is a franchise
A: I’m afraid I have never heard of this company.
• Q: What is a good resource for learning more about Intermittent Fasting? I've
never heard of it for diabetes II.
Q&A
• Q: I don't get off of work until 2300. I go home and my husband and I eat dinner around
midnight. Our blood sugar in the morning around 0900 my blood sugar is anywhere from 100 to
135. what would you suggest I do.
A: A fasting blood sugar of 100-135 is good (goal less than 130). In general I would recommend a
light/low carb dinner meal and try to have a 12 hour overnight fast before you eat the next day.
• Q: If you are taking metformin tablet, how long should they be taken before a meal?
A: Typically recommended to take metformin right before the meal or the middle of the meal or
at the end of the meal. Really depends on if you are having any GI symptoms.
Q&A
• Q: I have been reading quite a bit about fat being a big part of insulin resistance so I confused
about recommended fats?
A: I recommend you eat a MODERATE amount of healthy fats (avocados, nuts, nut butters, olive,
olive oil, fatty fish). Avoid deep fried foods and man-made fats and processed foods high in fat.
• Q: Are Type 1 diabetics even supposed to be fasting? Is this for type 2 only?
A: Intermittent fasting can be done safely by persons with type 1 or type 2 diabetes. It should
only be done under the guidance of your diabetes care team.
• Q: where can I find more info about the intermittent fasting?
A: Diatribe.org, books: The Diabetes Code by Dr. Jason Fung, MD or The Obesity Code
Q&A
• Q: Is it good/bad for insulin to stay in your system longer?
A: This depends. In general with meal-time insulins you want them to work fast, do their job and leave! Then there is less likelihood of low blood sugars between meals. But with basal insulins such as Lantus,
Levemir, Tresiba, Toujeo, which cover the NON-FOOD needs, long is good because it allows for only taking one shot daily.
• Q: If you do intermittent fasting what are concerns about regulating blood sugars first thing in the morning? any dangers with going too low not eating? what if you have other meds where taking with food is
recommended?
A: It is important to consult with your care team BEFORE undertaking intermittent fasting as diabetes medications as well as other medications (particularly blood pressure & heart meds) may need adjusting. There is a danger of low blood sugar if you are taking insulin or other diabetes meds.
Q&A
• Q: I was also told that diabetics should not do intermittent fasting.
A: Intermittent fasting can be done safely by persons with diabetes. As mentioned above—
consult with your care team BEFORE doing intermittent fasting.
• Q: Is butter a natural fat?
A: Yes.
• Q: My dad (74 yrs. old) was just recently diagnosed w/adult onset type 2 diabetes. Interestingly
he already was a healthy eater and exercised regularly. I believe the doctor told him it was
genetic. Is it likely that at some point I will get diabetes also, especially if I don't eat well and
don't exercise? I just turned 50 in December. I just did a biometric screening about two weeks
ago and all of my #s were good. Sugar level was 87.
Q&A
• Q: On intermittent fasting, can beverages be taken? (morning coffee)
A: Yes, drink plenty of calorie free liquids during the fasting period.
• Q: How many meals do we eat during the restricted eating time of 12 - 8pm
A: This is up to the individual however I think it is reasonable to keep it at 2-3 eating times.
• Q: Do you have a vegan nutritionist for diabetics?
A: All of the dietitians in our diabetes clinics can help with vegan/vegetarian eating plans
• Q: Can protein supplements be taken safely?
Q&A
• Q: How does stress impact my BG?
A: Stress, both physical and emotional can raise blood sugars. Stress can cause an increased release of stress hormones which raise blood sugar. I encourage people to focus on ways to manage the stress in their lives because it’s probably not going to go away completely.
• Q: What has the greatest impact on A1C - diet, exercise, or ??
A: Food, activity, stress, diabetes medications all impact the A1c. The answer will depend on the individual. I have patients who cannot exercise at all but with diet changes have significantly lowered their A1c. We know exercise has so many benefits andwill improve insulin sensitivity so we encourage exercise of some sort for all.
• Q: What is insulins role in losing weight? And what's the best way to raise a blood sugar when low and trying to lose weight? A: Insulin is a fat storage hormone so as insulin levels increase (either by injection or naturally because a person is eating more) the weight will rise. As insulin levels are decreased-naturally or less injected-weight will decrease. If a person is taking insulin and having a pattern of low blood sugar- they need less insulin. During a low blood sugar reaction it is important to eat or drink 15g of fast acting carb immediately and re-check blood sugar in 15 minutes to make sure it has risen to a safe range. For low blood sugar
