Brief Answer:
Hello and Welcome to 'Ask a Doctor'

Detailed Answer:

Hi,

With diabetes, there is, as you probably know, a problem with your insulin and the metabolism of carbohydrates, particularly what we call 'high glycemic load carbohydrates".

To gain weight without raising your blood sugar unnecessarily there are some "tricks" to put on the weight without affecting your blood sugar adversely.

First, fats have more calories than carbohydrates or protein and they affect the blood sugar very little. The trick is to increase good fats, not saturated fats that clog arteries and lead to heart disease. You will want to increase monounsaturated fats from nuts, seeds, nut butter, extra virgin olive oil (cooking, salad dressings) and avocados/olives. These will add extra calories without adversely affecting your heart or blood sugar. Then the polyunsaturated fats from vegetable proteins and vegetables are also a good way to add nutrient-dense calories to the diet without much effect on blood sugar.

Second, avoid large meals and overstressing the insulin response. Small, frequent meals throughout the day will work better at efficient energy utilization without stressing the insulin.

Third, obtain a chart on high glycemic Load carbohydrates and try to avoid these as they adversely affect blood sugar. Now there is a glycemic index and glycemic load. You want to pay attention to glycemic load and choose those foods lowest on the glycemic load list to manage your blood sugars most optimally. A glycemic load food should be below a score of 20 in the portion size identified in the charts. Charts are on the internet or in paperback book references.

Fourth, to gain lean mass instead of body fat, combine your extra calories with strength training to funnel those calories into building muscle instead of putting on body fat which is metabolically inactive. Strength training involves working with body resistance exercises and weights. This will also facilitate efficient glucose utilization.

Fifth, monitor your weight on metformin. You are taking twice a day and the side effect of metformin is weight loss and diarrhea. Some weight loss is caused by diarrhea so I encourage you to eat water-soluble fibers and dietary fibers up to 25 grams per day to maintain good bowel function and to avoid weight loss from diarrhea.

I hope these suggestions give you good guidance for gaining your desired 5 lbs. If desired, I can send a handout on glycemic load if you cannot find a good book or reference on the internet. If all else fails you may add a supplemental drink to your diet called Glucerna to add calories without affecting sugar. Glucerna may cause a precipitous drop in blood sugar so monitor sugar if you start this dietary drink supplement.


Thank you for this consult. Good luck and let me know if I can be of further assistance.

Regards,
Kathy J. Shattler

---