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Orinda, CA: A recent headline said, ADA Backs Low Carb Diets. The interestingpart to me is that low carb diets are backed equally with low calorie diets for weight loss, but blood sugart control is not really mentioned in the article summarizing the new position paper. What's up with that?

Sue McLaughlin: ADA has a document it publishes for doctors and other health care providers that summarizes the latest research and makes recommendations on how to treat and prevent diabetes. The document is called the Standards of Medical Care for People with Diabetes.

This year, one of the changes was to acknowledge that low-carbohydrate and low-fat calorie restricted diets work about as well for short-term weight loss. I can't speak to the headline or the article, but the position of the ADA is that 1.) weight loss is difficult and 2.) people should have access to tools that may help them. Some people are able to lose weight, and keep it off, by cutting back on fat, and some do better cutting back on carbs. The ADA simply said, both ways are acceptable. I'll add the phrase - but you must be committed to your plan.

The true key is to find a way of eating that works for you for the rest of your life! The idea is to get off the roller-coaster of weight loss and regain . . . and find something that works for you!

The second part of your question - why isn't blood sugar control mentioned. The recommendation is in the section on losing weight - this is for people who have diabetes and for those without diabetes. If you'd like to actually read the document yourself, you can at: http://care.diabetesjournals.org/content/vol31/Supplement_1/

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Vancouver WA: I have been living with Type 2 diabetes for 8 years and I am trying to lose weight. I have a serious problem with carbs and I know they raise my blood sugar, but I am doing better. I would like to know how many gram of carbs and protein should I have daily to lose weight?

Sue McLaughlin: There isn't a magic number of grams for carbs, fat and protein to help you lose weight. For many people trying to follow a healthy, balanced diet either to lose weight or help manage diabetes, I suggest they try the Plate Method. This is simply where you divide your plate and fill 1/2 of it with non-starchy vegetables (like salad, brocoli or spinach), 1/4 of it with protein foods (like chicken or fish) and 1/4 of it with starchy foods (like brown rice or sweet potatoes). To this, you can add 8 oz of milk and 1/2 cup of fruit and you have very simply planned your meal. The only other thing to remember is to keep the depth of your food to the thickness of the palm of your hand . . . and to watch the amount of fats you add to your foods.

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Willamston, SC: Is a weight loss program such as Weight Watchers safe for someone with diabetes who needs to lose weight ?

Sue McLaughlin: There are a lot of different programs available to help people lose weight. Weight Watchers encourages keeping track of what you eat every day and provides a support system along with the program. Both of these can be very helpful when trying to lose weight. Using this type of plan is a great option because you get to pick the foods and the portions of food to eat. As you're deciding what to eat, keep in mind how much carbohydrate is in the meal so you can keep your blood glucose management on track. The key is to pick a program that works for you and stick to it! Good luck Just a safety tip as well. If you take medication and you start to eat less, you may need a change in your medicines so make sure you give a call to your doctor if you start having low blood glucose levels.

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Shawano, WI: How many grams of carbs do you recommend per day for someone with type 2 diabetes? Type 1?

Sue McLaughlin: Unfortunately, I don't know enough about you and your medical history to tell you what would be appropriate. How much carbohydrate you eat at meals depends on many things including your activity level, your food preferences, and the type of medication you take. Managing diabetes is about having these 3 things, food, exercise and medication (if you take it) in a balance. For many people with type 2 diabetes, a starting point is about 45-60 grams of carbohydrate at a meal. This is a very rough estimate. Some people will need more and some will need less. If you are keeping a record of your blood glucose levels and what you eat, you can use the information to see if there are any patterns in your numbers. For example, am I high in the morning or low right before dinner. You can then use the records to decide if what you are eating is matched up to the other 2 factors.

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Pocatello, Idaho: I find myself craving citrus fruit...I hope they are okay to eat. I am new to this and an still trying to figure out a balanced diet. Which fruits and vegetables are the best for me?

Sue McLaughlin: All fruits and vegetables are good for you! Most of them are foods that we wold call nutrient dense. Choose those that are most vibrant in color to get the greatest amout of vitamins and inerals in your diet. Eating a wide variety helps to maximize the nutrients you will get from them. Citrus are particularly nutritious since they are a great source of vitamin C, potassium, and fiber. All you need to do is include the carbohydrate you eat from your fruit and vegetable choices into your meal plan. Or use the plate method I mentioned before where ½ your plate is for non-starchy vegetables and a side of ½ cup of fruit or 1 small piece of fruit like an orange makes the perfect dessert. Just a note on starchy vegetables like peas, corn, and potatoes. They contain more carbohydrate then the non-starchy type, so you count them like eating a grain or starchy food.

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Richmond, VA: From my understanding, losing weight can help some people control their diabetes. However the main function for losing weight is to prevent future problems such as heart attack and disease. Losing weight helps lower blood presure and triglyceride readings, which also lead to heart attack and disease. Am I right?

Sue McLaughlin: You are right - losing weight can help some people with managing blood glucose levels, and lowering blood pressure and triglycerides. It also helps reduce the risk for heart attacks and stroke. Let me explain a little more. As you've probably heard, type 2 diabetes is related to insulin resistance. This means that insulin has trouble getting into the cells where it lowers blood glucose levels. Losing weight can help to reduce insulin resistance so either your own insulin or your medicine will work better. Most people will get the biggest impact with losing weight early in their diagnosis of diabetes when your body is still making some insulin. Because losing weight helps with the other problems you mentioned, it's a worthwhile effort! The best approach to weight loss ia a program that includes calorie-reduction and exercise.

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huntsville, al: Sue, I have had type 2 for 2 years now...My 1st A1c test was 6.9 and my wgt was 200lbs. My Dr caught it very early on and I control it with diet and exercise. I now have my A1c @5.9 and average daily readings fasting a.m. are 105 and p.m. is around 89. I have started a pretty good work out regement,(last 2 months) I do 30+ minutes of cardio in the morning and run 1.5 to 2 miles in the evening, I walked 2 to 3 miles a day before that. My question is My blood sugar has dropped to 60 a couiple of times in the evening after I run and I have to throw in some carbs to get rid of the shakes. Is this normal to drop so low?? I have just recently gotten my A1c in normal range and only took the Avandia for a month or so (didn't like the possible side effects). Thanks,charlie

Sue McLaughlin: Congratulations on all the changes you've made! Sounds like you are doing a great job of managing your diabetes. If you've checked your blood glucose and it is 60 after you run, I?d suggest having about 15 grams of carbohydrate before your run and see if that helps. Low blood sugars are more common for people using insulin or certain types of pills that lower blood glucose levels, but it sounds like you are not getting quite enough carbohydrate to fuel all of your exercise. I would also suggest you document what you eat before you run as you may find some carb foods are better at helping you maintain your blood glucose levels than others.

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Pittsburgh, PA: I try to eat healthy-- and eat at home as much as I can (since i can control the ingredients better). Recently, I've been in a rut eating peanut butter and jelly sandwiches most every day for lunch. I've have disagreements with family over whether peanut butter is healthy.

Sue McLaughlin: Weight gain or loss is all about calories. Peanut butter is relatively high in calories - about 190 calories for 2 tablespoons, but it also contains protein, fiber and healthy fats.So even though high in calories, it has a lot of nutrients and the good fats can help you stay full. Peanut butter by itself will not make or break losing weight. What matters is what you eat for the whole day. You can decrease the calories of a peanut butter and jelly sandwich by using the thin sliced "diet" bread and sugar-free jelly. Watch what you have with it - for example, have raw or steamed vegetables or maybe a piece of fruit so the calories for your lunch is still low. To pick the healthiest peanut butter, consider a brand with oil on the top when you first open it because it will have fewer hydrogenated oils added. There are often labeled as "natural" peanut butters.

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Northwood Nh: I have been diagnoised with Type II diabetes since 11/05. I was told from the very beginning to avoid all white such as flour, sugar and salt. However why is it when I look for recipes for diabetics the majority use white flour, white pasta etc. What is the true direction of no whites?

Sue McLaughlin: Avoiding sugar and white flour is good advice for everyone because sugar is empty calories and white flour is not as nutritious as whole grain flour. Whole grain flour contains all the part of the wheat kernel - the bran, the wheat germ, and the starchy white part. White flour only contains the starchy part. The bran provides fiber and the wheat germ provides many of the nutrients from whole grains. So it is best to eat whole grains when you can. Over the past 5 or so years, it has been much easier to find whole grain foods such as whole wheat pasta instead of white pasta. Whenever you have the option, choosing a whole grain product is going to be more nutritious than a white-flour based product. That being said, baking with whole wheat flour makes the product a little different, but I'd encourage you to try. If you want to experiment with recipes to make them healthier, substitute 1/4 to 1/2 of the white flour with whole wheat flour.

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Big Bend National Park, Tx.: I am unable to get to a grocery store due to the remoteness of my location. What do you suggest when fresh produce is unattainable?

Sue McLaughlin: I would suggest using canned or frozen fruits and vegetables. For frozen fruits and vegetables, select those without added salt, sugar and fat if they are available. They are just as nutritious as fresh produce. For canned foods, select fruits in fruit juice or light syrup and for vegetables, choose those with less sodium and without added fats.

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Colorado Springs, Co: I've always been a big soda drinker and have been researching how this and other drinks affect diabetics. Recently I read an article online that said that orange juice does not raise your BG level due to flavonoids that are in it. Is this true and are there any other juices that are like this? Would juices that are 100% juice be better than diet soda for a diabetic?

Sue McLaughlin: This is not true. 100% juice will raise blood glucose levels. In fact, drinking juice is how many people treat a low blood glucose reaction as the juices quickly raise their blood glucose level.

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Pensacola, FL: I'm on Weight Watchers and a big element of the program is knowing your hunger signals and lerarning to recognize satisfaction. I find with diabetes and crazy blood sugars, I can't trust my hunger signals. Sometimes I have none and then I go low. Or I'm ravenous from being either high or low. How can i deal with this?

Sue McLaughlin: If you are having a lot of swings in blood glucose levels, I'd suggest you sit down with someone on your diabetes management team for starters. Bring these things to your visit: 1.) blood glucose records 2.) list of what and when you eat 3.) list of diabetes medications 4.) exercise routine. That will help us in analyzing the causes of your blood glucose fluctuations so we can help you trouble-shoot and make adjustments. Once you have more stability in your blood glucose readings it should help make it easier to tune into your body's signals for hunger and satiety.

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Newark, NJ: My brother was just diagnosed with type 2 diabetes. He told me that if I lose weight, I can keep from getting it. Is that true? My doctor says I need to lose 40 pounds.

Sue McLaughlin: It is true that keeping your weight in a healthy range can decrease your risk for getting diabetes. There was a study a few years ago, called the Diabetes Prevention Program, that showed losing 7% of your body weight can delay or prevent getting diabetes. Seven percent is about 15 pounds for a person that weighs 200 pounds. The people in the study lost weight by making lifestyle changes such as exercising 150 minutes a week and reducing calories and fat in their diet. If you have a close relative (parent or sibling) with diabetes, you are at higher risk for getting the disease. Making some changes to lose weight can help you prevent from getting it. One way to lose 10 pounds over a the next year is to find 100 calories in your diet that you can cut out. This may be 1 tablespoon of salad dressing or 1 slice of bread. But if you do this everyday and don't replace it with other food, you can lose 10 pounds and lower your risk for diabetes.

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Miami, FL: A friend said I need to find out my BMi before I try to lose weight. I looked it up and it seems like the BMI is there to tell me if I am fat. I already know I'm fat. What good is knowing my BMI anyway?

Sue McLaughlin: I like your question, sometimes we get so caught up in things, you can lose the common sense. The BMI is a tool that professionals and researchers use to classify weight status. You probably remember the weight tables that were used before. You had a normal range, anything above and you were told to lose weight. This is similar but it takes your height into account so it is a single range that is the same for most adults instead of being different for each person. This makes it easier to interpret research and apply a number for a whole population of people. For the individual, it is probably most helpful to look at your own weight history. What is your highest adult weight? What is your lowest adult weight? What did you weigh in high school? From there, you can set a goal to gradually lose weight based on your own history. For most people, it is unrealistic to weigh less at 50 than you have ever weighed in your adult life. But, you can set a goal for what you weighed before getting married, or having children, or whatever was a turning point in your life when your weight began to change. Ideally, a BMI between 20-24.9 is linked to lower rates of chronic disease, but it may not be realistic for everyone. When setting a weight loss goal for yourself, start with 5-10% of your body weight. So if you weigh 200 pounds, that would be 10-20 pounds. This small amount of weight loss will give you a real health boost! A reasonable rate of weight loss that you can maintain is 1-2 pounds per month.

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Chcago, IL: Is the main cause of being Type2 being overweight? I read that it was simply a metabolic disorder but overhead a relative over the holiday saying that I had diabetes because I was a "big fat pig who couldn't stop eating." What is the truth?

Sue McLaughlin: There are many risk factors for getting diabetes. Some of them are things you cannot change, such as your age and your family history - the older you get, the higher your risk. If you have family members with diabetes, it shows some genetic predisposition to diabetes, so you are at higher risk. There are other factors though that also increase your risk. For example how active you are and your weight. Being overweight is a risk factor for diabetes and about 80% of people with type 2 diabetes are overweight. The more risk factors you have for a disease, the more likely you will get it.

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Kansas City, MO: Ok, I am a new Diabetic, and I am on pills (metforman) for it. I saw my doctor today, and he informs me that I will probably gain weight taking the pills. I am already 5ft 8 and weight 240 which mean I am already OVER WEIGHT!!! I DON'T need to gain more weight. So what can I do????????? HELP!!!!!!!!!

Sue McLaughlin: There are some medicines for diabetes that do cause weight gain, but my experience has been that most people do not gain weight on metformin; some even lose a small amount of weight. If your blood glucose levels have been very high, with improving your numbers, if you continue to eat as much as before, you could gain weight. This is because the calories from glucose that used to spill into your urine are now being used by your body. In addition, with rehydration, people typically regain several pounds. So do be careful and think of this as a new opportunity to make some lifestyle changes when you start the pills. I would suggest you keep a food diary and follow-up with a Registered Dietitian in your area.

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Plano, TX: Will losing weight cure my diabetes?

Sue McLaughlin: No, there is no cure for diabetes. Once you have diabetes, you have it. But it is possible that losing weight can make diabetes easier to manage or could lead to taking less medicine. Some people, like those who have had bariatric surgery, have lost so much weight that their blood gluocse levels are normal. However, because of the genetic predisposition associatione with type 2 diabetes,if a person were to gain weight back, it is expected the diabetes would return just as quickly.

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ADA Moderator : We're close to the end of our time here today.

Do you have any thoughts you'd like to leave us with Sue?

Sue McLaughlin: Taking care of diabetes takes a lot of work and choosing to make lifestyle changes also takes a lot of work, but it's worth it. Don't be afraid to ask your health care professionals to help support you - we are here to help!

The key points for losing weight:
1. pick a plan you can stick to
2. make sure the plan includes calorie-reduction and exercise
3. set realistic goals - 1-2 pounds a month weight loss is easier to maintain for the long run

One thing I always tell my clients who want to lose weight - Try to find something in your diet that is about 100 calories. It may be 1 tablespoon of salad dressing or 1 slice of bread. If you cut this from your diet every day, you can lose 10 pounds in a year.

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ADA Moderator :

That's it for today. Thanks so much for taking the time to be here Sue.

Thanks to all of you who joined us by asking great questions or by just tuning in. If you wish to continue any of today's discussions please feel free to visit the ADA Message Boards.

Keep up to date with all the ADA Live events and reference the archives here.

We hope you found this interesting and informative and that you'll join us again next time here at ADA Live. Our guests will be Rite Aid Pharmacists and Diabetes Care specialists at 1:00 p.m. EDT Thursday, February 7, 2008. See you then.