Hi,
Welcome back to icliniq.com.
It is a pleasure to hear back from you. I am happy to know that blood sugars have come under control. She is undoubtedly a highly motivated lady. The reasons for better control are:-
1. Improved Thyroid control: This increases the metabolic rate. That is, with normal thyroid hormone levels, more blood sugar is burnt with the same level of exercise. Please maintain her TSH levels between 0.5 to 1 for optimal control of thyroid and diabetes.
2. Energy- Consumed due to exercise is produced by burning blood sugar. An increase in activity (from 2 to 3 km walk per day earlier, to 3 to 5 km per day) has helped regulate blood sugar levels. Further, I presume that an increase in exercise without a concomitant increase in carbohydrate intake has also helped by reducing insulin resistance.
3. As mentioned earlier, blood sugar depends solely on the number of carbohydrates (sugars in different forms), apart from calorie intake. Golden Rule: low calorie (around 1200 calories per day); low carbohydrate ( 100 gm carbohydrates), low fat (10-20 gm of MUFA fats), high protein (60gm per day) diet is ideal in people with diabetes. A suggested diet chart is given below.
4. Overdose of Insulin --> hypoglycemia --> instant stimulation of counter-regulatory mechanism which shoots up the blood sugar even beyond ideal levels (called Dawn's Phenomenon).
5. Impending Kidneys' involvement as a diabetic complication. Insulin is excreted by kidneys. Impaired kidneys --> reduced insulin excretion --> increased insulin levels in the blood --> further reduction of blood sugar. Please get her urine for microalbumin levels done. Increased Microalbumine levels in the urine suggest impaired kidneys' function.
An increase in exercise, abstaining from restaurant food, and normal thyroid hormone levels were probably responsible for better diabetic control.
Summarized recommendations:-
1. Try to adhere to the suggested diet plan.
2. Increase exercise further, preferably gymming, aerobic exercises, and brisk walks.
3. Progressive reduction in body weight to 132 to 143 lbs in a phased manner.
4. Meticulous, sustained control of TSH between 0.5 to 1.0 for six months --> thereafter, reduce Thyronorm (Levothyroxine) dose so as to bring up TSH between 1.0 to 2.0.
Recommended investigations:-
1.Five blood sugar estimations on any day (Fasting; just before lunch and dinner (before giving insulin); and, at 3 AM.
2. Blood urea, creatinine.
3. TSH level.
4. Urine for microalbumin levels.
5. Ultrasound of kidneys.
6. Take the HbA1c index after two months.
Suggested diet plan:-
Early morning:
Tea (without sugar) one cup.
Crackers - 2
Breakfast:-
Stuffed flat bread - 2 small
Yogurt - (one cup).
or
Egg white, or Cottage cheese one medium bowl.
Plain flat bread - two small.
or
Vegetables with beaten rice or oats, or broken wheat - one soup bowl.
Mid morning:
Apple, or guava or orange one.
Lunch:
Salad (10 minutes before lunch) one Medium bowl.
Capsicum with cauliflower one medium bowl.
Lentils - one soup bowl.
Flat bread - two.
Evening:
Milk, or green tea, or herbal tea, or lemon water one cup.
Roasted chick peas or puffed rice - one cup.
Dinner:
Salad (ten minutes before dinner).
Fla bread - two.
Bottle gourd - one cup.
Yogurt - one cup.
Late night:
Skimmed milk (no sugar) one glass.
Lastly, I hope you find my response helpful, informative, and enlightening. Please feel free to revert to me for further queries, along with recommended investigation reports.
Regards.