Brief Answer:
Hello and Welcome to HCM

Detailed Answer:
I know it can be so frustrating to be told to do something for your health and you just really don't know where to begin.

First, learning to manage diabetes takes some time and education. I suggest that if you are on Medicare you seek out a Medicare approved program that will pay for diabetes classes and individualized sessions with a nurse and dietitian.

At 72 and with difficulty ambulating, if you were my patient I would recommend some physical therapy for your knees and an exercise prescription from the physical therapy department.

Nutrition education is essential as weight loss with compromised mobility is more difficult. I calculated your caloric requirements using the Gold Standard Mifflin St. Jeor calculation and came up with 2481 calories to maintain your weight and 1500 calories to lose 2 pounds per week.

I suggest that you stick to lower glycemic load carbohydrates (lists available on the internet), low fat meats, gradually start increasing your fiber intake to 25 grams along with increased fluid in the amount of 8-10 glasses per day. Skip the juices and stick to fresh fruit. Eat 40 calorie thin bread to cut down on calories.
Vegetables are good sources of nutrients and fiber and don't forget to get low fat dairy in your diet.

For insurance coverage on weight loss you would have to check policies, but most will cover physical therapy.The Affordable Care Act has opened up more opportunities for insurance coverage for weight loss counseling, medication, surgeries - especially if your BMI is over 30, which yours is.

Glucosamine sulfate may help with the arthritis pain and research has shown that it does not aggravate insulin resistance or blood sugar increases.

Many people with diabetes also have a B12 deficiency. This can only be located by running a B12 level or doing a Shillings test. While a CBC may hint at a B12 deficiency, it is not diagnostic. A B12 deficiency can cause tiredness and fatigue as can having high sugars.

Research shows that a combination of resistance and cardiovascular exercises help you lose weight the fastest. Walking, although I am happy to see you are being active, is not enough to lose the amount of weight you need to lose in a reasonable amount of time. Physical therapy can provide you with home cardio exercises using bands and exercises you can do sitting down (knees) as well as specialized exercises for your knees.

Also, if you were my patient, I would have you evaluated for knee supports.

For help with an individualized meal plan, should you desire, you may find a local dietitian through eatright.org site and press "Find a local dietitian".

For Human Gold coverage, call customer service and ask if your policy covers Diabetic Education, Weight Loss Counseling, Fitness Clubs and/or Physical Therapy. To check for provider coverage call your local dietitians and see what insurance they take. Most Diabetic Education Programs are run out of your local hospital, so check there for programs. Some insurance covers Weight Watchers.

I hope I have provided you some direction.

Regards, XXXXXXX Shattler, MS,RDN

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