My father has “borderline” diabetes, and he has developed problems with his heart (no heart attacks yet, but he is on several medications). It’s hard for him to find right things to eat; everything is either not good for him because of his diabetes, or not good for him because of his heart trouble. Unfortunately, the two conditions seem to play against each other. He is underweight as well, and this makes it even more difficult to put on any weight. Can you make any dietary suggestions? Can you recommend any publications that would assist in this situation?

Diabetes and heart trouble often go hand in hand. Blood sugars after eating can be marginally abnormal for many years in some people before diabetes is discovered, and this seems to contribute to heart problems.

I have a couple of suggestions. I think it would be helpful to talk to your dad’s health care providers about the true extent of his “borderline” diabetes. This is an old term that used to be applied to people early in the course of type�2 diabetes. Since most people in that situation are heavy, it would be interesting to know whether the doctors are thinking your father has type�1 or type 2 diabetes. Type 1, in certain slowly developing forms, can appear in older people, even though this is more unusual than finding type 2 diabetes in an older person. The type of diabetes has a major impact on which medicines would most likely be used to assist with blood sugar control.

Regardless of the type of diabetes, however, stable control of the blood sugar is an important goal to your dad’s overall health. High blood sugars are hard on the heart and circulation in the long run, and low blood sugars are hard on the heart in the short term.

As for the nutrition choices, my best advice is to focus on healthy food choices that your dad enjoys and are consistent with his cardiac situation. People with diabetes need the same nutrition as anyone else and can even enjoy sweets as part of an overall healthy eating approach. In general, choose low fat proteins (less red meat and fried foods), eat fish at least three times a week, take in lots of vegetables as appetite will allow, choose whole grain breads and cereals — even occasional sweets made with healthier fats are fine. The key in diabetes is not to avoid certain foods, but to confirm with blood sugar testing (preferably before and after eating) that the foods and portions eaten are resulting in desirable levels of glucose control.

Depending on the diabetes medicine your dad is talking (if any), it may be necessary to distribute smaller portions of his preferred carbohydrates more evenly through the day to achieve glucose goals. The American Diabetes Association recommends target blood sugars of 80-120 mg/dl [4.4-6.7 mmol/L] before meals and no higher than 180 mg/dl [10 mmol/L] after meals. Your dad’s doctor can tell you if these values are best for his situation.

The American Diabetes Association website has a number of good publications on food and diabetes. They can help your family learn about the carbohydrate content of the foods your dad prefers and enjoys. With that information, you can begin to figure out how to distribute those choices to take advantage of his appetite and still keep his blood sugars under control.

If there is a dietitian in your community who is also a Certified Diabetes Educator, such a person may be helpful in providing greater personalization of this advice.

BB