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December 12, 2000

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Question from a dietitian in Clarion, Pennsylvania, USA:

I have a 42 year old male patient with type 2 diabetes. I read your previous notes about chewing tobacco and carb content. He chews two cans per day and wonder how this would affect blood sugar control. How do I find out the carb content of flavored chewing tobacco ?


This is undoubtedly hard information to come by. My suggestion would be to engage your client in a “fact-finding mission.” A period of food, medicine, blood glucose monitoring, and chewing record-keeping should reveal pretty accurately what the effect of his preferred “chew” is. What is the blood glucose before chewing and after? This would need to be viewed in relation to food intake and medicine action, of course, but with your help, he should be able to interpret what’s going on when he engages in this (risky!) behavior.

Additional comments from Dr. Stuart Brink:

Get him to stop chewing, and you solve the problem immediately. If he will not, then call the manufacturer and ask them what other garbage they put in chewing tobacco besides tobacco/nicotine?