Practical Living

Problems With Weight

I am 60 years old. In the last three years, I've had problems with my weight. I'm keeping a log of the foods I eat as well as the percentage of the fats, carbs, and protein that are in my daily menu.

I often find my situation very frustrating, wondering if I'm figuring them right. The measurements seem to be no problem; it's making sure of the percentages of each carb, fat, and protein. What is the best way to figure out these percentages?

My being overweight gives me problems with my back and legs, and sometimes it just makes me tired. However, I do walk and make sure I get some kind of exercise every day.

Barbara Woolsey Via the Internet

Bonnie Irvin, MS, RD, CDE, responds: Unfortunately, there is no easy way to lose weight. Weight loss occurs when you consume fewer calories than you use for energy. Adjusting the percentages of carbohydrate, protein, and fat in the diet does not necessarily reduce total calories. For example, compare the following two diets:

Percent of
Calories           1200-Calorie Diet      1800-Calorie Diet

50% Carbohydrate   150 g Carbohydrate =   225 g Carbohydrate =
                   600 Calories           900 Calories

20% Protein        60 g Protein =         90 g Protein =
                   240 Calories           360 Calories

30% Fat            40 g Fat =             60 g Fat = 540
                   360 Calories           Calories

The percentage of calories from carbohydrate, protein, and fat is the same, but the total number of calories is very different.

The number of calories a person needs each day depends on many factors including a person's height, weight, age, activity level, and medical status. Because we do not have any of this information about you, it is impossible to make a calorie recommendation. However, you can meet with a registered dietitian who can assess your needs and then help you determine an appropriate calorie level. A registered dietitian can also help select the best way to distribute the calories in the diet and suggest guidelines for cutting calories, such as reducing foods high in fat, choosing moderate portions, or substituting more low-calorie/nutrient-dense foods for higher-calorie/low-nutrient foods.

You are to be commended for keeping a diary of your foods. A food diary is a great way to identify food problems and help modify eating habits. You should bring the food diary with you when seeing your dietitian so that he or she can make suggestions based on your usual food preferences.

Daily exercise is also very helpful for losing weight. Walking for 30 minutes per day, or an average of 180 to 200 minutes per week, can result in a 10- to 15-pound weight loss per year. While this is significant, it is still only about one pound per month. If you are trying to control your weight with exercise alone, it may take several months before you notice a significant difference. Exercising while cutting back on calories will accelerate weight loss, but for many women, it is hard to lose more than half a pound per week.

I hope that you continue your efforts to lose weight. Your hard work will be well rewarded with better blood sugar control and a healthier body.

Fatigue & Pain

I have had type 2 diabetes for 10 years and have always been on sulfonylurea tablets. In order to prevent ups and downs in my blood sugar readings, my doctor recommended I take Glucophage (500 mg) two times a day. (I have also been taking Glucotrol.) It has been over six months that I've been on Glucophage.

Recently, I've been having a lot of muscular fatigue and pain, particularly in my legs. Do you think this could be related to the Glucophage and the acidosis that it may cause?

Chris Ramcharan Via the Internet

Gail Burniske, PharmD, and Stuart T. Haines, PharmD, BCPS, CDE, respond: Metformin (Glucophage) is an oral antihyperglycemic agent used in the treatment of type 2 diabetes. It has been used in the United States since 1995 and has been used in other countries since the 1970s. One of the most serious and potentially fatal side effects of metformin is lactic acidosis. This side effect occurs very rarely and only in those who have certain risk factors, such as kidney disease.

Lactic acidosis occurs when lactate builds up in the blood causing the blood to become acid-like. Lactic acidosis has a subtle onset and symptoms are similar to many other illnesses. The signs and symptoms include weakness, fatigue, muscle pain, heavy and labored breathing, shortness of breath, abdominal distress, low body temperature, and low blood pressure.

Metformin is eliminated (leaves the body) through the kidneys. Therefore, metformin may accumulate in the body if the kidneys are not functioning as well as they should. Kidney function should be checked before starting metformin and at least twice a year thereafter. Certain people are at high risk for developing lactic acidosis, particularly those with poor kidney function. These people should not use metformin.

People who have uncontrolled heart disease or a sudden onset of heart failure, severe lung disease, or who are over the age of 70 are also at higher risk for developing lactic acidosis. People who have any of these risk factors need to get their kidney function checked more often (a few times a year). In addition, people getting certain medical tests done with contrast dye should stop taking metformin 48 hours before and after the procedure to decrease the risk of lactic acidosis.

From the signs and symptoms you describe, it is hard to determine whether or not you are experiencing lactic acidosis from metformin. As you are probably already aware, diabetes has many complications that may produce symptoms similar to those you are experiencing. Peripheral vascular disease or neuropathy (nerve disease) can cause loss of feeling, numbness, or pain in the legs and feet. A simple blood test can be performed to determine your blood lactate level, your kidney function, and blood pH (to determine if your blood is acid-like). Your doctor can help you put the whole picture together to determine the most likely cause of your symptoms.

In summary, metformin is an excellent medication for the treatment of type 2 diabetes; it has been shown to save lives in clinical trials. People using it, however, should be aware of a rare but serious complication called lactic acidosis that can occur with its use. To ensure the safe use of metformin, those using it should have their kidney function checked at least twice a year, to make sure metformin is being cleared from their bodies as well as it should be.

Ask Us questions are answered by members of the Diabetes Forecast editorial board, who are members of the Professional Section of the American Diabetes Association. Information presented is not intended to be definitive nor is it meant to take the place of personal contact with various members of your health care team. It is essential that you check with your physician before beginning any new method of self-care.

If you have a question that you'd like to see published, please write to Ask Us, Diabetes Forecast, 1701 N. Beauregard St., Alexandria, VA 22311. Because of the volume of mail we receive, we are not able to answer all letters and we do reserve the right to edit for length. Although we honor requests for anonymity, all letters to Diabetes Forecast must be signed and have a return address.

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