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Ask the Endo

3 Minute Read
Ask the endo

Dr. Charles AlexanderHave a burning question about diabetes? Dr. Charles Alexander, diaTribe's medical advisor, is here to answer questions and give insight into real issues readers are facing.

Dr. Alexander is an endocrinologist with more than 35 years of experience in diabetes – in both direct care and research. Dr. Alexander spent nearly 25 years working in Outcomes Research and Medical Affairs at Merck before retiring in 2016. Before that, he practiced diabetes, endocrinology, and internal medicine in Los Angeles for 10 years and was a clinical professor of medicine at the Keck School of Medicine of the University of Southern California. 

Dr. Alexander is board-certified in Internal Medicine and Endocrinology-Metabolism and is a fellow of both the American College of Physicians and the American College of Endocrinology. He has been an advisor for the diaTribe Foundation since 2016.

Question: One thing that does not seem to be covered by any diabetes organization is diabetes and menopause. My insulin needs increased as I went through menopause. I also gained weight without changing my diet or exercise routine. My endo blamed me, saying I wasn't taking good enough care of myself! This led me down the path of diabetes distress, something I'd never experienced before and hope I never do again. So, I ask that you discuss diabetes and menopause. What are the effects of menopause on the body? How does menopause affect insulin needs? We need this! Thank you.

Dr. Alexander: It’s sad when healthcare providers blame the patient, especially when it causes diabetes distress. Levels of the female hormones (most notably estrogen and progesterone) fall dramatically during menopause. Changes to these hormones can affect blood sugar levels and make managing diabetes more difficult. In some women, menopause can lead to other changes like more abdominal obesity as well as higher blood pressure. It’s great that you have continued your diet and exercise routine, but you may need to have your medication adjusted to compensate for the hormone changes. The impact of changing hormones on diabetes management isn’t well understood and there is an urgent need for more research about menopause and diabetes to help provide answers to your questions. 

Question: As a person with type 2 diabetes, what is the significant, practical difference between consuming equivalent amounts of glucose from sucrose, and getting it from a starch such as a potato or white rice (or for that matter, a whole grain in the context of its fiber and minerals)? This seems to be somewhat controversial, though I’ve always understood the two to be practically equivalent for a type 2. Thanks. 

Dr. Alexander: For both type 1 and type 2 diabetes, the difference between consuming equivalent amounts of glucose from sucrose, and getting it from a starch is how fast the food or drink is absorbed, which is known as the glycemic index – a measure of how quickly it can make your glucose rise. Not all carbohydrates work the same. Some trigger a quick spike, while others work more slowly. Orange juice and other fruit juices cause the quickest spike. It's best to eat a whole orange, which has a lower glycemic index compared to orange juice, whenever possible. Foods with a lot of fiber like whole wheat pasta have the lowest glycemic index and work the slowest. Also, remember that physical activity affects your glucose levels, so exercise after a meal will help slow the rise in glucose.    

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