Diabetes & Weight Loss: A Physician's Guide to Managing Blood Sugar and Shedding Pounds

Photo by Artem Podrez

Read Time: 4min 00sec

Introduction:

As a physician, I often have conversations with my patients about their health goals and concerns. One topic that frequently comes up is managing diabetes while trying to lose weight. In this article, I'll share a hypothetical conversation with a patient, discussing diabetes, A1C, nutritional guidelines, and strategies for managing blood sugar levels and shedding pounds. But first, let's dive into our discussion, which is filled with practical tips and actionable pieces of advice.

Physician: "I understand that you're trying to lose weight while managing your diabetes. Before we dive into strategies, let's first discuss what diabetes is. Diabetes is a chronic condition where your body either doesn't produce enough insulin or doesn't use it efficiently, leading to elevated blood sugar levels.

A1C, or glycated hemoglobin, is a type of blood test for measuring your average blood sugar levels over the past three months. It's a helpful indicator of how well your diabetes is being managed. The A1C criteria are as follows:

• Normal: Below 5.7%

• Prediabetes: 5.7% to 6.4%

• Diabetes: 6.5% or higher

Now, let's discuss some strategies for managing your blood sugar levels while losing weight. To begin with, can you tell me about your typical daily meals and snacks?"

Patient: "Well, I usually skip breakfast, have a sandwich for lunch, and then have a big dinner with my family."

Physician: "One helpful strategy is to eat smaller, more frequent meals throughout the day. This strategy can help prevent blood sugar spikes and crashes. Aim for three balanced meals and two healthy snacks daily, including lean protein, healthy fats, and fiber-rich foods like vegetables and whole grains.

As for carbohydrates, a general guideline for people with diabetes is to aim for 45-60 grams of carbs per meal, but individual needs may vary. Again, be sure to consult with a dietitian for personalized recommendations.

A practical tip is to use the 'plate method' for portion control.

Patient: "I've heard about the plate method for managing my diet, but I'm not quite sure how to apply it. Can you explain how it works and give me some examples of lean proteins, whole grains, starchy vegetables, and non-starchy vegetables that I can include in my meals?"

Physician: "Absolutely! The plate method is a simple and effective way to create balanced, nutritious meals to manage blood sugar levels and support weight loss. To use the plate method, imagine dividing your plate into three sections:

1. Fill half your plate with non-starchy vegetables.

2. Fill one-quarter with lean protein.

3. Fill one-quarter with whole grains or starchy vegetables.

Here are some examples for each category:

Lean Proteins:

• Skinless chicken or turkey breast

• Fish, such as salmon, tuna, or cod

• Shellfish, such as shrimp, crab, or scallops

• Lean cuts of beef, like sirloin, tenderloin, or round

• Lean cuts of pork, such as loin or tenderloin

• Tofu or tempeh

• Legumes, such as lentils, chickpeas, or black beans

• Low-fat dairy products, such as cottage cheese, Greek yogurt, or part-skim cheese

• Eggs or egg whites

Whole Grains:

• Brown rice

• Quinoa

• Whole wheat pasta

• Whole wheat bread or wraps

• Whole grain barley

• Bulgur

• Farro

• Oats (steel-cut or old-fashioned)

Starchy Vegetables:

• Potatoes (white or sweet)

• Corn

• Peas

• Winter squash (such as butternut, acorn, or spaghetti squash)

• Parsnips

• Plantains

• Beans (such as kidney, pinto, or navy beans)

Non-Starchy Vegetables:

• Leafy greens (spinach, kale, collards, lettuce)

• Broccoli

• Cauliflower

• Cabbage

• Brussels sprouts

• Asparagus

• Green beans

• Bell peppers

• Zucchini or summer squash

• Cucumbers

• Tomatoes

• Eggplant

• Onions"

Patient: "What about exercise? I've heard it's important for weight loss and blood sugar control, but I'm unsure where to start."

Physician: "Exercise is indeed important. It can help improve insulin sensitivity, lower blood sugar levels, and promote weight loss. Try to achieve at least 150 minutes of moderate-intensity aerobic exercise per week, like brisk walking, swimming, or cycling. Also, incorporate strength training exercises two to three times per week to help build muscle, which helps burn more calories, even when resting.

A practical tip is to start with activities you enjoy and gradually increase your exercise duration and intensity. This process will help make exercise a sustainable part of your routine."

Patient: "But what if my blood sugar levels drop too low during exercise?"

Physician: "Always check your blood sugar levels before and after exercising, and keep a quick source of glucose handy, like glucose tablets or a small juice box, in case of hypoglycemia. Also, exercise about an hour after eating a meal or snack to ensure your body has enough fuel.

A practical tip is to wear a medical ID bracelet that indicates you have diabetes, so in case of an emergency, others can provide appropriate assistance."

Patient: "Lastly, what about medications? Can they help me manage my blood sugar levels while losing weight?"

Physician: "Yes, there are medications that can help manage blood sugar levels and may even promote weight loss. For example, metformin is a commonly prescribed medication that helps with lowering blood sugar levels and may assist with weight loss. Additionally, GLP-1 receptor agonists like liraglutide and semaglutide can help regulate blood sugar levels and have been shown to contribute to weight loss. However, only some medications are suitable for some patients. It's essential to have an open discussion with your healthcare provider about your specific needs and goals.

A practical tip is to keep a medication log and track your blood sugar levels consistently to help your healthcare provider better understand your response to the medications and make any necessary adjustments."

Conclusion:

Managing diabetes while trying to lose weight can be challenging, but with the right strategies, achieving both goals is possible. By understanding diabetes, A1C, and nutritional guidelines, you'll be better equipped to make informed decisions about your health. Remember to consult your healthcare provider before making changes to your diet, exercise routine, or medication regimen. Together, you can develop a plan that works best for you and your unique needs.