Endocrinology (including Diabetes)/PCOS and Glucose/Insulin levels

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Question
I was diagnosed with PCOS when I was 15 (now 42).  I have gained quite a bit of weight and although I am pretty active, I don’t really do a lot of actual “exercise.”
 
I recently had a physical and my physician ran some blood work (A1C test) and the result was 6.9.  Glucose was 96 after fasting, but he said it appears my sugar goes up and has trouble going back down.  So, I have to monitor my glucose (1x a day) now and increase my metformin to 2 pills a day and go back in 90 days for more blood work.  He also says to cut out carbs, eat 30% less and eat smaller meals more often.  

By the way, I received my monitor today and tested it at 3pm.  The result was 140. The only thing I’ve eaten today was 2 eggs, 2 pieces of toast and an orange juice for breakfast at 10:30am.  
What am I suppose to do when my glucose is high.   Most importantly, what is this blood glucose and how does it work?  In simple easy to understand terms, please. I have done so much research and I am having a lot of trouble just trying to understand how all this (glucose, insulin, etc) stuff works.

My question is what should I be eating?  I’ve been watching what I eat and it seems everything has carbs and if it doesn’t have carbs and doesn’t have calories (i.e. pickles) it has tons of sodium.

Answer
Tammy,

I don't know if your physician told you, but an A1C of 6.9% puts you in the "diabetic" range (which starts at 6.5%).  He already has you on metformin, but you may need to consider using other medications to lower it if changing your diet/lifestyle does not work.  

As far as what to eat goes, you can eat some carbs, but you just need to try to pick ones that don't spike your blood glucose.  Basically, all carbs eventually get digested into glucose, which ends up the blood first before it can used as a fuel around the body (particularly for the brain and nerves).  Some of it usually gets stored as glycogen in muscles for use during exercise, and a smaller amount is stored in the liver (the organ that either stores or releases glucose to keep your blood glucose levels normal).  Generally, the more processed carbs are (white flour, white sugar, white rice, etc.), the faster they raise your blood glucose.  Think of them as being partially predigested for you by the manufacturer.  The more you can eat foods close to their natural state, the better off you'll be.  Also, you may want to limit your intake of carbs to no more than 40 percent of your daily calories (which you can track online using SuperTracker.gov or a program like MyFitnessPal.com).

At rest, your body's main mechanism for taking excess glucose out of blood and storing it elsewhere is the hormone called insulin.  Your insulin doesn't normally work well (that's the definition of insulin resistance), so it takes more to get the job done, or when you have diabetes, it's not getting the job done well enough. When your blood glucose is high, the only natural recourse you have to lower it is to exercise.  When you're active, your muscles can take up blood glucose as a fuel without needing any insulin to do so.  Try seeing if you can add in some resistance/weight training as well as that really helps you retain muscle and keep your carb storage capacity higher.  I have lots of tips about how to make these lifestyle changes on my web site at www.shericolberg.com.  I hope you can find info there that helps you.  Sheri  

Endocrinology (including Diabetes)

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Sheri Colberg, PhD

Expertise

I am an exercise physiologist with a PhD who specializes in diabetes--as such I CANNOT answer general questions about other endocrine problems as I am neither an expert in all areas of endocrinology nor am I a medical doctor. My expertise lies in answering questions about diabetes (of any type) and physical activity, so please limit your questions to those areas. I can help you if you want to begin exercise or if you're already a diabetic athlete, and I am prepared to respond to questions about physical activity to which even your diabetologist may not know the answer. I can give suggestions about changes in your diabetic medications that differing types and intensities of exercise may necessitate, but I will have to refer you to your regular health care team to get final approval to make such changes. I can also answer questions about physical fitness, exercise metabolism, prediabetes reversal, and prevention of type 2 diabetes and diabetic complications.

Experience

I have both personal and professional experience in the areas of diabetes and exercise/physical activity. On a personal level, I have had type 1 diabetes since 1968, and I have been an avid exerciser since I was a child. Professionally, I have been conducting clinical studies on diabetes and exercise since 1992, largely with funding from the American Diabetes Association. I am also the author of 8 books related to diabetes, exercise, and more: The Diabetic Athlete (2001), Diabetes-Free Kids (2005), The 7 Step Diabetes Fitness Plan (2006), 50 Secrets of the Longest Living People with Diabetes (2007), The Science of Staying Young (2007), Matt Hoover's Guide to Life, Love, and Losing Weight (2008), Diabetic Athlete's Handbook (2009), and Diabetes? No Problema! (2009).

Organizations
I am a Fellow of the American College of Sports Medicine, a professional member of the American Diabetes Association (and professional volunteer for the ADA), and a former member of the Board of Directors of the Diabetes Exercise & Sports Association.

Publications
I have published research and review articles in the following journals and magazines: Diabetes Care, Diabetes, Journal of Diabetes & Its Complications, Diabetes Self-Management, Medicine & Science in Sports & Exercise, Journal of Applied Physiology, The Physician and Sportsmedicine, Journal of Clinical Investigation, International Journal of Obesity, FASEB Journal, The Diabetes Educator, Journal of Physical Education, Recreation, and Dance, Clinical Exercise Physiology, Clinical Diabetes Reviews, Insulin, ACSM's Health & Fitness Journal, Biomechanics, On the Cutting Edge, Diabetes Technology & Therapeutics, Microvascular Research, Drug Benefit Trends, ACSM Certified News, Diabetes Health, SportEX Health, Diabetes Focus, Diabetes In Control, dLife-For Your Diabetes Life, Pediatrics for Parents, and My TCOYD (Taking Control of Your Diabetes) Newsletter. I have also been interviewed in myriad other magazines, such as Men's Health, Men's Fitness, Diabetes Forecast, Countdown Magazine, Joe Weider's Muscle & Fitness, Health, Tidewater Parent, Barron's News, Diabetes New Day, and Newsweek International.

Education/Credentials
I have an undergraduate degree (1985) from Stanford University, a Master's degree in exercise physiology (1987) from the University of California, Davis, and a Ph.D. (1992) from the University of California, Berkeley, in the same field. I also spent two years in an NIH-funded postdoctoral research position in endocrinology (studying obesity, diabetes, metabolism, and exercise) at the University of Pittsburgh School of Medicine (1993-1994).

Awards and Honors
• Fellow, American College of Sports Medicine (FACSM) - 1996 • Old Dominion University Darden College of Education Young Investigator Grant Award – 2003 • Honor Society of Phi Kappa Phi, Old Dominion University Chapter – 2004-Present • Great Women of the 21st Century by the American Biographical Institute – 2005 Edition • Old Dominion University Darden College of Education Largest Research Grant Award – 2006 • Old Dominion University Darden College of Education Publications Award (for greatest number) – 2006 • Saint Louis University, The Max K. Horwitt Memorial Lecture Distinguished Lectureship Award – 2008 • Old Dominion University Darden College of Education Publications Award – 2009 • Old Dominion University Darden College of Research Grants Award – 2009

Past/Present Clients
I have consulted for numerous groups, including Can-Am Care, Numera|Social, California Commission on Peace Officer Standards and Training(about candidates with diabetes), Animas Corporation (an insulin pump company), Therasense, Inc. (makers of the Freestyle blood glucose meters), Council of Healthcare Advisors, and the City of Chesapeake (Virginia) Health Department.

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