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You've asked and we've answered your questions about managing diabetes in the following categories:

Diet and nutrition

Weight management and physical activity

Cardiovascular disease risk and children

First, congratulations on your weight loss! Losing even 10 pounds will improve your blood sugar readings and HbA1c. It also will help lower your blood pressure and LDL ("bad") cholesterol and raise your HDL ("good") cholesterol.

It's hard for most people to get enough physical activity to substantially reduce their weight. Regular physical activity must be combined with sensible eating — and, most importantly, portion control.

Even when physical activity and reducing calories are used together, people often reach a plateau. The number of calories that your body needs depends on your body weight. The heavier you are, the more calories you can eat to maintain your body weight. As you lose weight, though, you may need to adjust your calorie intake downward to keep losing weight.

Sometimes if people have been severely restricting their calorie intake, they may lower their metabolic rate. Then they may need to add 100 to 200 calories per day of healthy foods to rev up their metabolism.

When people have been working at weight loss for a long time and feel that they've hit a plateau, it's often a good idea to take a break from actively trying to lose more and spend some time maintaining this new weight. Also, varying the type of physical activity can be helpful. By doing this you will not only use different muscle groups, but you will be less likely to become bored. In addition, you may want to assess how much and what types of food you are eating. It is easy to believe you are eating less when in fact you are taking in more calories than is necessary. Remember to drink enough water, too — it helps your metabolism and cellular function.

Losing weight is hard work. The people who are most successful in the long-term are those who have lost weight slowly and steadily and who have learned to incorporate sound eating habits and moderate levels of physical activity into their everyday life.

2.

I just joined The Heart of Diabetes program and I've started working some physical activity into my daily routine. But my blood sugar seems a little more out of control. How does my becoming more active affect my blood sugar?

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Alain Bertoni, M.D., M.P.H., assistant professor in Public Health Sciences and Internal Medicine at Wake Forest University School of Medicine in Winston-Salem, N.C., explains:

Becoming more physically active is a great way to help control your diabetes. When you walk or do other moderate-intensity physical activities such as biking, swimming or dancing, you burn more calories than when you're sitting still. Your now-active muscles take up sugar from the blood to use as energy. This tends to lower your blood sugar levels, which is generally good.

Many people with diabetes can exercise safely. Before beginning any exercise program, consult with your healthcare provider to help choose the safest activities for you, given your age and medical history. Once your healthcare provider has given you the green light, increase your physical activity. By doing regular physical activity, you will probably lower your blood sugar levels (as measured by the HbA1c test) and may make it easier to reach your diabetes treatment goals.

However, be aware that the change in blood sugar levels during a particular exercise session may cause blood sugar to drop so low that it could cause hypoglycemia (extremely low blood sugar levels). This may be more likely to happen if you use insulin or oral drugs in the sulfonylurea family. To guard against this, you should know your usual symptoms of hypoglycemia and carry a source of sugar with you such as tablets, hard candy or juice (with real sugar, not artificial sweetener). If you experience hypoglycemic symptoms, stop exercising and eat or drink the source of sugar. Other general precautions include:

• don't take your medications just before exercise, and
• don't skip meals.

If you have experienced hypoglycemia during exercise, especially if severe passing out or if milder cases have occurred several times, consult with your healthcare provider or diabetes educator before continuing your exercise program. You may need to coordinate your eating, exercise and medication times, test your blood sugar levels before exercising, or eat a heart-healthy snack (like a piece of fruit) just before exercising.

Finally, pay close attention to your eyes, feet and joints. Wearing shoes that don't fit properly or doing more demanding exercises (like jogging) may cause injuries. Lower-impact sports and good socks/athletic shoes may help guard against this. Report blisters or ulcers to your healthcare provider immediately. Certain strenuous activities (like racket sports) may cause problems with your eyes if you already have significant retinopathy.

3.

I am eating right, and increasing my activity, but my waist size is still big. Is this okay, or am I still at risk?

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Dr. Lori Mosca, an American Heart Association volunteer and director of preventive cardiology at New York-Presbyterian Hospital explains:

Waist size is a very important predictor of having unhealthy levels of blood cholesterol, high blood pressure, and pre-diabetes. For men, if the number is over 40, or for women if the number is over 35, risk increases. The research is beginning to tell us that it's not IF you're fat that matters, but WHERE you're fat. It seems the belly is not just a simple storage depot for fat but is a pretty active place in the body that leads to a lot of metabolic abnormalities that increase the risk for cardiovascular disease, such as heart attack or stroke. At this point we can't fully explain why, but we do know that an oversized waist is a red flag.