I recently contacted you regarding corrections I needed to make with my exercise program. The information was quite useful and thank you for the addition of web sites that I can share with other patients.

My question now relates to NEED for weight loss. How do I use insulin, eat carbohydrates, and drink water with the need to reduce calories and increase my activity level for weight loss? Two dietitians have instructed me to eat 45 to 55 carbohydrates per meal. If I eat more than 45 grams, I gain weight!

The issues regarding weight loss are some of the most difficult to talk about. The approaches vary. Most do not take into account all the issues that impact on weight. For instance, you can diet well, but if you are not exercising at the same time, you are probably not going to lose much weight. You can address carbohydrates, but calories are the real currency of weight, and so on and so on.

My recommendation is to find someone that will work with you through the process. Dietitians are good to give you a starting point, but you also need their input when you are troubleshooting what is not working and what is left to try. At our institution, we have available counseling with both dietitians and an exercise physiologist. You need to have a safe but effective exercise prescription. When you talk with the dietitian, you need to know how you eat and what are your weaknesses. In a broad sense, drinking water is good and helps fill you up. However, sometimes it may make you nauseated or result in other problems you need to address. In addition, control of blood sugars cannot be lost in this. You may also want to learn how to use meal replacements.

I know that Pittsburgh is a good town for diabetes care. I would recommend finding a diabetes center or health center where your needs are met and who has follow-up.

Sorry I have no specific wisdom about weight loss. It is a tough deal.

JTL