dried fruit,

be insane).

When you say foods are hard to come by, exactly what foods?
If there are no vegetables or plain meats and she eats just
the cereal and rice you send then that is almost total carb.
The daughter would have more chance of convincing her mother
to break with the cultural idea of food. By the sound of it,
the only place the mother will find out about how to eat etc
is through her daughter with input from you. If there are
vegetables and meat and fish available there then the
daughter needs to push that and not rice. Tell her the
serious complications that will arise from bg's of that
level. Then the mother can choose between complications and
culture if all the facts are before her.

Hi jils

To answer your final question "i think she should eat more
often, exercise more often, drink more water, eat less salt
and less white rice.

Yes. Although the salt may not be a major problem. In thai
cooking there are other things, like palm sugar, bananas etc
to be concerned about.

But it's a little more complicated than that. The good news
is that you've sent her a meter. Now send her a copy of this
link: http://jennifer.flyingrat.net/

Read it yourself, it states what's needed fairly clearly.
Print it out for her and send it.

That won't solve her other problems - at those levels
(15-20mmol/L, 240-360mg/dl) simply changing her diet and
exercising may not be sufficient. If she has no other access
to doctors, at least it's a start. But if things get no
better she needs to contact a competent doctor and demand
proper treatment.

And don't send her any more brown rice - just try to get her
to cut back on ALL rice. Tell her to eat the muesli mix in
the evenings as a supper, not breakfast, and to try an
all-protein breakfast of meat, eggs or fish.

Cheers Alan, T2, Pottsville Beach NSW.

If you want to ring, translate oh for oh sev fiv to one to
one free.

Jils...

My heart goes out to you... and I think you are an angel to your friend
and her mother.

I've read all the posts and the responses.  And while it's difficult to
cross cultural boundaries, I think you can make a difference (you
already have) in this women's life.

Perhaps the best way to begin is with black and white ideas... you can
add in shades of grey later.

You are correct, eating smaller meals with less carbs and adding
exercise will make a world of difference.

So ask her for one month, to not eat rice, noodles or rice or wheat
products.  Tell her you know it is an odd request, but it is just for
one month... to see how her blood reacts.  Ask her to eat fish, meat,
poultry, eggs and vegetables (but not corn or potato) and to limit fruit
to berries (I don't know all the fruits avail in Thailand).  And to walk
for 20-30 minutes after each meal.

That is a beginning, that will likely show results.

Best of luck to you all.

Jennifer

thanks heaps to the people that have given me advice here; but more, can
someone explain to me please the different ways of measuring bgl, when i
google for info, i find readings that suggest 6-10 is normal, but other
types of readings that say 120 to 145. what are these different types of
readings? is it a metric/imperial things? is there a simple conversion?
thanks
jils

  "about 55 years old and a little overweight"  combined with sugars above
15 are two symptoms consistent with Adult-onset Type 1 diabetes.
Consistent doesn't mean "definite proof" but it is suspicious.

They also happen to be the two significant signs that I had when I became
Adult-onset Type 1 at age 54

If so,  she needs insulin injections and she needs them as soon as possible.

Even if she is actually Type 2,   she would benefit from insulin injections
at this time.    If she is Type 2,  the injections would help her normalize
then give her a fighting chance to control sugars with diet and exercise.

Regards
 Old Al

Jils, you seem to be a very caring person.  YOu gave her great advice
but she needs not to skip meals,  When you skip meals, the liver can
dump glucose into the system and cause higher numbers.  She could also
go low which wouldnt be good either.

I wonder if there are any books on diabetes in thai.  She needs to read
one. She also should not eat white rice if it raises her numbers.  She
needs to test much more often than she is now.  Testing is like a job
that you want to say take this job and shove it, but it is of the utmost
importance in gaining control

She needs to watch the total amount of carbs that she is ingesting, not
just starches.

Also, smaller portions can help in gaining control,  Everything is
according to the meter.

I am sure there is advice form Jennifer here that you can forward to
your friend.

Loretta

--
In tribute to the United States of America and the State
of Israel, two bastions of strength in a world filled with strife and
terrorism.

That's too bad!

Yes, it can be difficult.  Salt is not a problem for most people.  Only
those with high BP who are salt sensitive should be on a reduced sodium
diet.  The sticky rice would be quite a problem as would most of the sauces
used in Thai cooking because they often contain sugar.  I used to have a
Thai neighbor who gave frequent dinner parties.  When I dined there, I'd
bring a green salad to eat for dinner.  I always had some form of protein
such as cheese and eggs.  If I ate anything at all that she cooked, it was
one or two corn fritters.  I didn't see anything else suitable for me to
eat.  The Thai restaurants in the US all seem to list some sort of salad,
but I think the dressing is sugary and it may be some Americanized thing
that is not available in Thailand.

I do know that my neighbor said there were fruits and vegetables available
in Thailand that are not available here.  She often shopped in the Asian
markets and sometimes made things like Sushi and egg rolls and Teriyaki.
Another quick meal she frequently made was fried rice.  Fried rice might be
doable for a diabetic provided it was made with plenty of meat or eggs, and
vegetables and very little rice.

What do you mean by "different" foods?  I don't eat things that are
different.  But there are some things I don't eat any more.

I hate to say this but those things aren't really the best choice for a
diabetic to eat.  It is carbs that raise BG.  Cereal and dried fruit is
loaded with carbs!  So is brown rice.  The only advantage that has over
sticky rice is that it has a bit more fiber.

Probably a liver dump from not eating.  If she has type 2, then not eating
can cause this.

Maybe, maybe not.  Eating small frequent meals works for some people.  Not
for others.  Drinking more water won't help her BG.  But if she is
dehydrated (and she likely is with BG as high as 20) then she would need to
drink more.  And the salt thing has nothing to do with it.

As for the exercise, that is dangerous with BG that high.  That could drive
her BG higher and cause more dehydration.  She most likely needs to be on
meds and/or insulin, at least until her BG comes down.

My neighbor was born and raised in Thailand, but has lived in other places
including Sweden.  So her palate might be a little more experimental than
someone who hasn't traveled outside of Thailand.  She never came to like
cheese very much, although she did occasionally eat cheese pizza and she
liked the lasagna I made.

One thing I did notice about her and the other Thai women was that they
themselves ate very little rice.  They did cook a lot of it.  She owned a
rice cooker and it was always full.  And much of what they ate was not the
stuff most Americans would eat.  She cooked all sorts of strange looking sea
creatures and VERY spicy hot meat and fish.  The rice was only eaten to cool
off the mouth when too much spicy food had been eaten.  The rice was eaten
with the fingers and only a little pinch at a time.  When they took rice on
their plate, they only took about 1/4 of a cup at a time.

You might suggest that she have eggs for breakfast, perhaps cooked with
whatever vegetables she likes.  I know onions are available there, as are
peppers.  My neighbor used a lot of ground pork.  I am not sure what she
made with it, but I bought it for her on occasion when I went to the store.
She didn't have a driver's license and was dependant upon someone driving
her places or doing the shopping for her.  She also bought some kind of thin
beef.  I'm not sure what that was either.  I did ask her but she didn't know
the name of it.  I've seen something in my local market called Sukiyaki
meat.  That might be in.  She marinated it for a very long time and then
cooked it on the barbecue.  Pretty much all meats and non-starchy vegetables
are fine, provided they aren't in a really starchy or sweet sauce.

I had a neighbor from Mexico who told me she was afraid she'd get diabetes
one day since all of her older relatives had it.  I asked her what they ate
since I love Mexican food.  She said they ate pretty much what everyone else
ate.  Just a lot less of it.

http://www.joslin.org/Beginners_guide_665.asp

     There is no Such Thing as a "Diabetic Diet"
     Despite all the publicity surrounding new research and new nutrition
guidelines, many people with diabetes still believe that there is something
called a "diabetic diet." Many people with diabetes who are receiving
inadequate information about how to manage their condition imagine that this
so-called "diabetic diet" means they have to "avoid sugar."
     "That just simply isn't how meal planning works today with patients
with diabetes," says Karen Chalmers, R.D., M.S., C.D.E., a nutritionist at
Joslin in Boston and author of 16 Myths of a Diabetic Diet.

     "Simply stated, with proper education and within the context of
healthy eating, a person with diabetes can eat anything a non-diabetic
eats," says Chalmers.

     In response to this gap in knowledge about what people believe about
eating with diabetes, Joslin Diabetes Center has undertaken a campaign to
educate people with diabetes - and the general public -- about what the
nutrition issues are for people with diabetes.

     Unfortunately, for many people with diabetes - both those who have had
the disease for a while, and for newly diagnosed patients - the new concepts
around eating and diabetes are still not widely known, says Chalmers.

     What's the Truth About Diabetes and Diet?
     We know now  that it is okay for people with diabetes to substitute
sugar-containing food for other carbohydrates as part of a balanced meal
plan. Prevailing beliefs up to the mid-1990s were that people with diabetes
should avoid foods that contain so-called "simple" sugars and replace them
with "complex" carbohydrates, such as those found in potatoes and cereals. A
review of the research at that time revealed that there was relatively
little scientific evidence to support the theory that simple sugars are more
rapidly digested and absorbed than starches, and therefore more apt to
produce high blood glucose levels.

     Now many patients are being taught to focus on how many total grams of
carbohydrate they can eat throughout the day at each meal and snack, and
still keep their blood glucose under good control.

     Well-controlled blood glucose is a top priority because other research
studies have shown conclusively that all people with diabetes can cut their
risk of developing diabetes complications such as heart disease, stroke,
kidney and eye disease, nerve damage, and more, by keeping their blood
glucose as closely controlled as possible.

     What does this mean for people with diabetes?
     This means that a person who has worked with a dietitian and a
diabetes treatment team to figure out how many grams of carbohydrate they
can eat throughout the day can decide at any given meal what they will eat.
Those with diabetes who are not on insulin need to focus on keeping the
amount of carbohydrate they eat consistent throughout the day. Those on
insulin can decide both what and how much to eat at given meal (as long as
it doesn't exceed their daily allotment), and can then adjust their insulin
accordingly. "There aren't any foods that are 'off-limits,'" says Chalmers.
"Rather , one just needs to learn how to spend his or her grams of
carbohydrate wisely over the course of the day."

     Regular home blood glucose monitoring is then used to keep track of
the effects of meals and activity levels on their blood glucose. They work
with their healthcare team to make adjustments in their food intake,
physical activity, and medication to keep their blood glucose as close to
normal as possible.

     How does carbohydrate counting work?
     Most all foods (except meat and fat) contain some carbohydrate, and
carbohydrate has the fastest effect on increasing blood glucose. The number
of grams of carbohydrate that a person can eat each day or at each meal is
determined by such things as their weight; whether or not weight loss is a
goal (which it frequently is in people with type 2 diabetes); when and how
much physical activity is done (because physical activity will lower their
blood glucose); what diabetes medication or insulin they are taking, and
when; and other factors such as age and medical issues such as the presence
of high blood fats.

     For example, a 6' 2" tall man with diabetes who weighs 180 pounds and
wants to maintain his current weight might be told he could eat 350 grams of
carbohydrate spread out over the day. His goal would be to spread those
grams out over the course of the day so that he doesn't send his blood
glucose too high at any one time. If he is taking insulin or oral diabetes
medication, he might also have to manage when he eats his carbohydrate in
such a way that there is enough sugar from his meals in his bloodstream when
his medication is working its hardest.

     "We now know that in general, a sugar-containing food like a piece of
angel food cake may have 30 grams of carbohydrate in it, but that piece of
cake will have the same effect on your blood glucose as 2/3 cup of rice or
one cup of applesauce, both of which have 30 grams of carbohydrate in them,"
says Chalmers. "So, if this man's meal plan that he's developed with a
dietitian states that he can eat 60 grams of carbohydrate at a meal, it's
his choice where he 'spends' those 60 grams. One time he may have 2/3 cup of
rice and one cup of applesauce, because that's what he feels like eating.
Another time he may decide to eat a cup of applesauce, a cup of milk (12
grams of carbohydrate) skip the rice, and have the small piece of angel food
cake for dessert."

     People who develop diabetes when they are over 40 frequently develop
diabetes in part because they are overweight. Being overweight makes it more
difficult for their bodies to use insulin to convert food into energy. For
this reason, many patients with diabetes also have weight loss as a goal.
Because each gram of fat contains 9 calories (while a gram of protein or
carbohydrate contains only 4 calories), fat gram counting as a means of
losing weight becomes an additional nutritional tool for many patients.

     Frequently people with diabetes also have problems with high blood
fats and/or cholesterol levels, and will be prescribed a meal plan that is
low in fat as well. So even if they aren't overweight, some patients may be
counting grams of fat eaten at each meal or over the course of the day, as
well as how many grams of carbohydrate.

     There are many food lists available that show how many grams of
carbohydrate and fat are in most foods. Also, most any food you purchase in
a grocery story lists carbohydrate and fat content as part of the food label
requirements mandated by the federal government.

     Not a do-it-yourself project
     "Obviously using nutrition as part of an overall diabetes treatment
plan is not an entirely do-it-yourself project," notes Chalmers. "That's why
we can't just send people preprinted diets. You need to work with a
dietitian to determine whether carbohydrate counting, fat gram counting, a
combination of both, or the older exchange meal planning system will work
best for you. And you have to work with a dietitian to develop what your
meal planning parameters are -- how many grams of carbohydrate, how many
grams of fat, etc. you can eat each day.

     "But then the rest of it is pretty much up to you," she adds. "You get
your meal plan 'budget', and then you decide how to spend it at each meal.
Just as a person without diabetes can't eat cookies and cakes all day long
and expect to be healthy, if you have diabetes you have to eat a balanced
diet to remain healthy. But within limits, and with proper education, if you
have diabetes you can eat whatever anybody else does."

     Learn more about carbohydrate counting, click here.

     See our latest cookbooks and nutrition books at the Joslin Store.

http://www.joslin.org/Beginners_guide_665.asp

     There is no Such Thing as a "Diabetic Diet"
     Despite all the publicity surrounding new research and new nutrition
guidelines, many people with diabetes still believe that there is something
called a "diabetic diet." Many people with diabetes who are receiving
inadequate information about how to manage their condition imagine that this
so-called "diabetic diet" means they have to "avoid sugar."
     "That just simply isn't how meal planning works today with patients
with diabetes," says Karen Chalmers, R.D., M.S., C.D.E., a nutritionist at
Joslin in Boston and author of 16 Myths of a Diabetic Diet.

     "Simply stated, with proper education and within the context of
healthy eating, a person with diabetes can eat anything a non-diabetic
eats," says Chalmers.

     In response to this gap in knowledge about what people believe about
eating with diabetes, Joslin Diabetes Center has undertaken a campaign to
educate people with diabetes - and the general public -- about what the
nutrition issues are for people with diabetes.

     Unfortunately, for many people with diabetes - both those who have had
the disease for a while, and for newly diagnosed patients - the new concepts
around eating and diabetes are still not widely known, says Chalmers.

     What's the Truth About Diabetes and Diet?
     We know now  that it is okay for people with diabetes to substitute
sugar-containing food for other carbohydrates as part of a balanced meal
plan. Prevailing beliefs up to the mid-1990s were that people with diabetes
should avoid foods that contain so-called "simple" sugars and replace them
with "complex" carbohydrates, such as those found in potatoes and cereals. A
review of the research at that time revealed that there was relatively
little scientific evidence to support the theory that simple sugars are more
rapidly digested and absorbed than starches, and therefore more apt to
produce high blood glucose levels.

     Now many patients are being taught to focus on how many total grams of
carbohydrate they can eat throughout the day at each meal and snack, and
still keep their blood glucose under good control.

     Well-controlled blood glucose is a top priority because other research
studies have shown conclusively that all people with diabetes can cut their
risk of developing diabetes complications such as heart disease, stroke,
kidney and eye disease, nerve damage, and more, by keeping their blood
glucose as closely controlled as possible.

     What does this mean for people with diabetes?
     This means that a person who has worked with a dietitian and a
diabetes treatment team to figure out how many grams of carbohydrate they
can eat throughout the day can decide at any given meal what they will eat.
Those with diabetes who are not on insulin need to focus on keeping the
amount of carbohydrate they eat consistent throughout the day. Those on
insulin can decide both what and how much to eat at given meal (as long as
it doesn't exceed their daily allotment), and can then adjust their insulin
accordingly. "There aren't any foods that are 'off-limits,'" says Chalmers.
"Rather , one just needs to learn how to spend his or her grams of
carbohydrate wisely over the course of the day."

     Regular home blood glucose monitoring is then used to keep track of
the effects of meals and activity levels on their blood glucose. They work
with their healthcare team to make adjustments in their food intake,
physical activity, and medication to keep their blood glucose as close to
normal as possible.

     How does carbohydrate counting work?
     Most all foods (except meat and fat) contain some carbohydrate, and
carbohydrate has the fastest effect on increasing blood glucose. The number
of grams of carbohydrate that a person can eat each day or at each meal is
determined by such things as their weight; whether or not weight loss is a
goal (which it frequently is in people with type 2 diabetes); when and how
much physical activity is done (because physical activity will lower their
blood glucose); what diabetes medication or insulin they are taking, and
when; and other factors such as age and medical issues such as the presence
of high blood fats.

     For example, a 6' 2" tall man with diabetes who weighs 180 pounds and
wants to maintain his current weight might be told he could eat 350 grams of
carbohydrate spread out over the day. His goal would be to spread those
grams out over the course of the day so that he doesn't send his blood
glucose too high at any one time. If he is taking insulin or oral diabetes
medication, he might also have to manage when he eats his carbohydrate in
such a way that there is enough sugar from his meals in his bloodstream when
his medication is working its hardest.

     "We now know that in general, a sugar-containing food like a piece of
angel food cake may have 30 grams of carbohydrate in it, but that piece of
cake will have the same effect on your blood glucose as 2/3 cup of rice or
one cup of applesauce, both of which have 30 grams of carbohydrate in them,"
says Chalmers. "So, if this man's meal plan that he's developed with a
dietitian states that he can eat 60 grams of carbohydrate at a meal, it's
his choice where he 'spends' those 60 grams. One time he may have 2/3 cup of
rice and one cup of applesauce, because that's what he feels like eating.
Another time he may decide to eat a cup of applesauce, a cup of milk (12
grams of carbohydrate) skip the rice, and have the small piece of angel food
cake for dessert."

     People who develop diabetes when they are over 40 frequently develop
diabetes in part because they are overweight. Being overweight makes it more
difficult for their bodies to use insulin to convert food into energy. For
this reason, many patients with diabetes also have weight loss as a goal.
Because each gram of fat contains 9 calories (while a gram of protein or
carbohydrate contains only 4 calories), fat gram counting as a means of
losing weight becomes an additional nutritional tool for many patients.

     Frequently people with diabetes also have problems with high blood
fats and/or cholesterol levels, and will be prescribed a meal plan that is
low in fat as well. So even if they aren't overweight, some patients may be
counting grams of fat eaten at each meal or over the course of the day, as
well as how many grams of carbohydrate.

     There are many food lists available that show how many grams of
carbohydrate and fat are in most foods. Also, most any food you purchase in
a grocery story lists carbohydrate and fat content as part of the food label
requirements mandated by the federal government.

     Not a do-it-yourself project
     "Obviously using nutrition as part of an overall diabetes treatment
plan is not an entirely do-it-yourself project," notes Chalmers. "That's why
we can't just send people preprinted diets. You need to work with a
dietitian to determine whether carbohydrate counting, fat gram counting, a
combination of both, or the older exchange meal planning system will work
best for you. And you have to work with a dietitian to develop what your
meal planning parameters are -- how many grams of carbohydrate, how many
grams of fat, etc. you can eat each day.

     "But then the rest of it is pretty much up to you," she adds. "You get
your meal plan 'budget', and then you decide how to spend it at each meal.
Just as a person without diabetes can't eat cookies and cakes all day long
and expect to be healthy, if you have diabetes you have to eat a balanced
diet to remain healthy. But within limits, and with proper education, if you
have diabetes you can eat whatever anybody else does."

     Learn more about carbohydrate counting, click here.

     See our latest cookbooks and nutrition books at the Joslin Store.