In part 6 of this Exclusive Interview, Dr. Stuart Weiss shares his diet and and exercise suggestions that he gives his patients in this talk with Diabetes in Control Publisher Steve Freed during the AACE meeting in Austin, Texas.
Dr. Stuart Weiss, is currently an Assistant Clinical Professor of Endocrinology at NYU Langone Medical Center. He has a long history of clinical practice in the management of patients in the field of diabetes, endocrinology and metabolism.
Transcript of this video segment:
Steve: I would imagine every endo, even every physician, they do certain things that they think maybe they invented, or what makes their practice different, why they’re successful. They’re certain things that you go over with patients always and you feel that that’s helped you to be more successful with that patient. What are the things that you do, I know you don’t tell patients to watch what you eat and exercise and let them walk out the door, that you don’t do. So what DO you do so that you can be successful with anybody that walks through the door who has type 2 or even type 1 diabetes?
Dr. Weiss: Either way, I talk about diet a lot. I talk about how foods turn to sugar at different rates and how as a type 2 diabetic your insulin is slow, it comes but it’s slow, and as a type 1 you have to match the insulin up to the food so eating a typical American breakfast which would be a cereal or oatmeal all these things that we think are okay, they’re really not that good for diabetics to eat. So, I talk more about eating eggs and protein and having some fat with their meals rather than simple carbohydrates that most people tend to eat especially in the morning because they’re fast and easy. I talk about that and I talk a lot about not eating close to bedtime, that generally applies for everybody. Type 1s it’s almost impossible to match the insulin up to the sugar derived from food when people go to sleep. Either they’re not taking enough most of the time or they’re taking too much and it’s really really hard to hit the ball on the nose when people are eating late at night. Type 2 diabetics also I tell them eating and sleeping is good if you’re a bear and you need to sleep for 3 months, otherwise eating and sleeping is absolutely not a good idea. People work late in New York City and they come home late and then they eat late and then they fall asleep and then they wonder why they’re gaining weight. It’s a huge problem, you know going for a walk after dinner is a very simple approach to diabetes management and controlling the excursions in glucose. I like to tell people over and over again fish and green vegetables that’s kind of my approach to diabetes management. Just to limit the amount of carbohydrates and limit the risk for mistakes. If you’re making a mistake in counting carbohydrates, which everybody does, let’s say it’s a 10% mistake – 15 grams of carbohydrates is not a big mistake. If it’s 100 grams of carbohydrates — a bagel, muffin — you’re making a huge mistake and it’s going to become a major problem if the carbohydrate portions are large for both type 1s and type 2s.
Steve: You talk about nutrition. Because that’s probably maybe 90% of what causes their blood sugar to go up. What do you tell them about physical activity?
Dr. Weiss: Walking is good, the longer you walk the longer you live. I say that over and over again. There are lots of different ways of describing it but it’s fairly individualized. Exercise up to about 45 minutes or an hour may not lower blood sugar all that much right away, but different people respond in different ways, so that’s where CGM comes into play. You put the Libre on or get them to wear a Dexcom or buy one, then we can really see how they respond as an individual to exercise. Some people drop right away, other people drop the following morning, and you just have to figure it out. Basketball played for fun will likely drop the blood sugar; basketball played in a competitive way will probably raise the blood sugar. Again, individual variability, so sensing is really, really, really the most important thing.