Ask an Expert: Diet and exercise resources for people with diabetes

Q: My 34-year-old sister weighs 363 pounds and has been diagnosed with diabetes. Our entire family is physically active and wants to help save her life, but we have no idea where to begin with such an overweight person. Where can we get information on a suitable diet and exercise program for her?

Answer from Susanna Reiner, R.N., B.S.N., diabetes nurse educator, Providence Diabetes Education Services:

Your sister is very lucky to have such a supportive, loving family. I'll be happy to suggest some resources that can help her or anyone who has been newly diagnosed with diabetes. But first, let me address how you and the rest of your family can help.

Understand that your sister is probably feeling pretty overwhelmed right now. She undoubtedly knows that her future health depends on her making a lot of lifestyle changes “ including losing weight“ to control her diabetes. But lifestyle choices are very personal, and she needs to decide for herself which changes she is ready to focus on.

Advice and opinions from others, no matter how well intended, may be perceived by her as intrusive or judgmental, and may leave her feeling even more overwhelmed than before. I've had more than one patient tell me about their frustrations with the "diabetes police" in their lives.

One of the best things you can do for your sister is to be there for her without judging her actions. She may just need someone to listen to her when she is expressing her feelings about her new diagnosis.

Ask her how she would like you to support her, and then gently follow through.

An encouraging word about weight loss

The prospect of losing a substantial amount of weight may seem daunting. But the encouraging news for your sister and others with diabetes is that losing even just a little weight -- 10 or 15 pounds -- can improve diabetes control.

Excess weight, particularly around the belly, makes it harder for the body to use insulin effectively. (The role of insulin, a hormone produced by the pancreas, is to help fuel the body's cells by allowing them to draw glucose, or sugar, from the blood and use it for energy. If insulin doesn't do its job, the amount of sugar in the blood rises instead of being drawn out to fuel the cells. Over time, this can damage almost every part of the body.) Each incremental loss in weight improves the body's ability to use insulin more effectively.

Your sister may find it heartening -- and more realistic -- to focus on smaller, more manageable goals, knowing that she'll be improving her health every step of the way. Eating a balanced diet and getting regular exercise -- two important lifestyle changes for anyone with diabetes -- will help her get there.

Where to begin

One of the first steps that a lot of people choose after being diagnosed is to sign up for a diabetes self-management class or for individual consultations with a certified diabetes educator. If your sister is interested in either of these options, she may request a referral to Providence Diabetes Education Services from her primary care provider.

A diabetes educator can work with your sister to develop a meal and exercise plan that will help her achieve those incremental weight-loss successes. If she has personal questions or concerns, a diabetes educator can discuss these with her as well.

One caution about exercise: Since the rest of your family is physically active, it may be tempting to try to motivate your sister to exercise along with the rest of you. Before starting a new exercise program, however, she should talk to her primary care physician about her health condition and get recommendations for the types of activities that will be safe for her. Her health care provider may recommend that she take an exercise stress test to see how her heart reacts to exercise.

For further dietary ideas, I recommend the American Diabetes Association's Virtual Grocery Store, which offers meal-planning strategies, a guide to understanding nutrition labels, and hundreds of terrific recipes.

As a concerned sister looking for reputable resources, you may want to view a few web sites yourself to become more informed about your sister's condition. I recommend these:

The American Diabetes Association

Behavioral Diabetes Institute

When your sister is ready to make a change, you can support her by suggesting that she start slowly and set short-term, realistic goals. If she does not achieve a goal the first time around, encourage her not to be too hard on herself and to try again. Once she has achieved her short-term goal, she may feel confident enough to set a new goal or to improve on her existing goal.

Thank you for taking the time to ask about your sister. I hope this information is helpful to you, and I wish your sister success in her diabetes management.

February 2007