June 3, 1999
Meal Planning, Food and Diet
Question from MSN.com:
I am a 50 year old female diabetic. I was placed on 2 hyperglycemic oral mediations had the same effect each time. I developed severe nausea and vomiting resulting in dehydration (so severe that my husband, who is a paramedic educator, has standing orders for an IV).
For 10-15 years I have had problems with motility due to an ileojejunal bypass, 8 surgeries for total obstructions, a re-anastomosis, bowel plication and a modified gastric stapling (an effort to keep the majority of my stomach, when full, off my intestines causing adhesions and obstructions). The bowel plication resulted in numerous artificial bends in my intestines. At every artificial bend i have fistulas. Due to the fistulas I have been on a severely restricted fiber diet. The last time vegetables and fruit were added, in the form of strained baby food, I spent 5 days on an NG tube.
Now I am in a real bind. I am now on insulin and still do not have anywhere near acceptable control of my blood sugar. All the nutritional information I can find is based on increasing fiber and reducing fats and carbohydrates. I have been told I have gastroparesis and the slow motility is causing a problem in control. I can not find any nutritional information to help in getting a meal plan that will work with my insulin and give me control.
Currently I am trying taking insulin 90 minutes before a meal, test before eating and again 3-4 hours later. It is also suggested that the meal/snack be skipped if blood sugar is over 200. My average is 236, and am rarely under 190.
Do you have any suggestions about how to modify my diet to improve my blood sugar control? The local RD’s say they can’t help because I need to decrease my carb’s and fat. My current diet allows for no measurable fiber; if I cut out fats and carbs, what’s left?
Answer:
I think you need to see a dietitian who has worked with patients with diabetes and gastroparesis. It is a challenging situation. It is usually best to limit all fluids with meals and give very small amounts of food over time. One can not eliminate fats and carbs since, as you state, there is not much left. Using a insulin pump with Humalog insulin usually can result in better blood glucose control (give the bolus insulin after the meal, using a square wave bolus so there is not a great influx of insulin). I do not know if medications for gastroparesis have been tried yet; they may be quite helpful.
LSF
