Sorry, this is very long and rambling and disorganized. Any advice, thoughts or comments are very welcome.

I began dieting in January, and I think I have done very well to this point. I've lost 55 lbs in just under 4 months by calorie counting and regular exercise. I keep my calories to 1200-1500 daily, with occasional days over 1500 but under 2000 (usually special occasion celebrations - weddings, holidays, etc.). I weigh or measure everything I eat, log everthing, and do my tracking in an excel spreadsheet (which I know many don't recommend but which works for me). When I started out I was tracking just calories and fat, but over time had added fiber and protein to my tracking sheet. I aim for 20-30% of calories from fat, 25% or more of calories from protein, and 25 grams of fiber per day. All this seems to have been working well for me, and I have been very satisfied with what I'm doing and eating and have never fallen off the proverbial wagon.

Then came last week. My husband was admitted to the hospital with a serious infection, and while there was diagnosed with Type 2 diabetes. After spending 5 days in the hospital we came home, and are now struggling with his blood sugar, insulin doses and diet changes. I started a food log for him modeled after my own, and since I'm tracking his carb intake I've started tracking my own as well.

I used to make separate meals for my husband and I, but since we've been home from the hospital (granted, it's only been a few days), I have been cooking the same things for both of us - I just eat smaller portions than he gets. I am following the basic plan set forth by the diabetes educator at the hospital for my husband's carb intake. In doing this, my carb intake has averaged ~115g per day (which seems high; is it?), my fat intake has gotten higher (though still under 30%), my fiber isn't hitting 25g, and my calories aren't high enough (under 1100 the past 3 days).

I am struggling. I want to eat more of the foods I usually do to get my fiber and calories where they should be (I want my berries, I want my yogurt), but I don't want to snack in front of my husband when he can't eat those same things, and I don't want to eat more of the higher fat meals I'm preparing for him, and so I'm undereating. And I'm underfeeding him too - he's not gotten enough calories the past three days either (around 1500), and the fat content is too high. I worry that the carbs I'm feeding him are too high as well, despite the diabetes educator saying he should get 60-70g per MEAL. I don't know how to eat lower carb but keep my calories in a normal range and my fat intake down. In fact, I don't know how to eat lower carb at all. I feel like I'm starting from scratch, and I don't know whether what I'm doing now is healthy or not, and I worry my weight loss will stall.

Obviously my husband's needs are medical ones, and so whatever I need to do for his health I will. But I'm just not sure how best to go about it so that it works for his needs and for my weight loss as well. I know I need to be patient to figure this out, but I feel responsible for making sure he's eating correctly and am worried I'm not doing all of this "right". Counting calories was easy. The carbs are stressing me out.

Thanks to anyone who reads all of this. Some of it is just me venting my worry and frustration, and I appreciate being able to do that here.


Edit: In case it's useful information at all (for anyone who has an sense of what I should be cooking and eating for myself and my husband, or what kind of caloric intake is appropriate for him), my husband is also obese, but to a lesser degree than I am. He is 5'11" and weighs 231 lbs.

Try to set up an appointment ASAP with the hospital's nutrition department.

Agree with MOnica - that's crucial - but he needs to be doing his own tracking (if he's kind of out of it now, he needs to take that over as soon as he can) ... HE is the one to be responsible for his health and you for yours. And if you're the one handling his, who is handling yours? There will be no energy left and you'll be soon back up.

You can inform him what the meals are if you're the main meal-maker and work to stay with low carb options for him as well, but he needs to be the one doing his own tracking.

Good luck - sounds like you're in a tough spot of rushed learning, but he needs the education as well when you meet with the nutritionist - in fact, ensure they understand that he needs the info for himself so they don't assume you'll be handling it and he misses out on the info.

What is he doing with this? Did he get what the diabetes counselor was saying? He's gonna be who will need to manage this out in the real world. You really don't have to change your diet if it's working for you. Moderate carb diets don't have to be high in fat. The carbs just have to be moderated. I always ate the same things as my family, just strict portions. When I wanted sweets, I modified them with a sugar free or no sugar added variety. Sometimes, depending on the person, there can be some sweets or fruit added and it won't affect the blood sugars too much if there is enough protein and fat in the meal.
I remember it being a little confusing at first. You never really know what will run the blood sugar up 100% of the time but after eating on plan and testing the blood sugars you'll start to see trends.

I agree-- you've got to get him back into a meeting with a nutritionist or a diabetes educator, and let HIM do the learning! Often, Type II Diabetes can be well controlled with diet alone, so this is a must.

A few pointers that I've learned through my work in the healthcare field:
(** Here's the disclaimer where I say "This isn't medical advice, see a doctor!"** haha)

A great way to simplify meals (this is appropriate for both diabetics and non-diabetics):

-Half of your plate should be non-starchy vegetables/salad greens
-Take the other half of your plate and split it in two; one part should be a serving of lean protein, about the size of your palm, and the other part should be a serving of carbs.
Easy, right?

As for snacks, remember the importance of pairing proteins with carbs. Proteins provide fullness and slow digestion, (allowing the body to maintain a steadier blood sugar level/avoiding the crash that follows ingesting huge amounts of simple sugars), while carbs provide glucose and energy for the cells. Most of the foods we eat already incorporate fats, so don't worry too much about that.

In general, choosing low fat dairy, high fiber carbs, and lean protein paired with vegetables and the occasional piece of fruit will be great for you both.
It's important to eat every 3-4hours, and to stay well hydrated, too.

That being said, seek out all of the professional assistance you can, and learn together There is a wealth of information out there, and it can feel overwhelming. The good news is, you are motivated and you've got each other for support!

He did see a dietitian, correct? He can always ask to see a dietitian again. Also, call your local hospital and see about diabetes education classes. Most have them and although they might be a long class, they are worth it if he get a better understanding of how to meet his new dietary requirements. Those classes are full of such valuable information but not all Doctors think to refer their patients.

For help with what lower carb looks like, here are some book recommendations:
The South Beach Diet by A. Agatston
The Sonoma Diet by Connie Guttersen
The Complete Beck Diet for Life by Judith S. Beck

Get them from the library, just to get a notion what this is like and incorporate some ideas.

I agree with everyone else about your husband.

As far as you're concerned, if you want to stay in the same calorie range but lower your carb intake, then you have to accept that the calories have to come from somewhere else, which is fat and protein. A lot of people (including professionals) have such a negative attitude about fat. I used to have a negative attitude about fat. Then I did some reading, saw a few documentories, and learned that fat is actually good for you, as long as you're getting the healthy kind.

I eat 1200-1600 calories a day. I eat 50-75 net carbs a day. That means on an average day I get around 65g of fat and 125g of protein. It seems like a lot of fat to some people, but it comes mainly from eggs, a little cheese, almonds and pistachios. I eat 3-4 servings of veggies a day, and 3 servings of fruit. On the average day I eat under 8oz of meat.

You've done wonderful so far! If you've been happy with what you're doing then I wouldn't think you would really need to change it up all that much.

I have really no advice about eating low carb, but I did want to add this: You mentioned not wanting to eat berries in front of your husband. I'm pretty sure that berries have a very low glycemic index. Even though they have sugar, there fiber more than balances it out.

115g of carbs is not a lot.

If you are eating more fat that equates to more calories. 1 gram of fat is 8-9 calories and 1 gram of a carb or protein is 4 calories. I would say increase your lean protein to increase your calories.

You are already doing great because you are trying to do what is right. Good for you!

Congrats on your loss thus far you're doing great!

I don't know squat about diabetes but I can tell you that 115g of carbs is not a lot. I can also tell you that I would be more concerned about protein than carbs or fat. I only track protein and calories and here is why. Protein is the main driver for retaining lean body mass (muscle) as you lose fat which is controlled by caloric intake. If I eat enough veggies and fruit I figure I'll get enough fiber.

I also wouldn't be too concerned about your calories occasionally falling lower than your goal.

What little I have read about diabetes is that you can "cure" it by losing weight. So if I were your husband that would be my number one goal. Going from 230 to 180 would probably do it. Definately seek professional advice.

Goodluck!

Thank you very much to all of you for your feedback. I really appreciate it. I needed to get some of this out and get some outside perspectives.

My husband absorbed as much as he was able while high on pain meds and running on very little sleep in the hospital. The diagnosis came was a shock for him, and was overwhelming and pretty devastating at first - especially finding out that he'd need to be on insulin. We also got very conflicting information while in the hospital - the diabetes educator telling us he needs to have 60-70g carbs per meal for 3 meals per day, and the doctor telling us he must eliminate all sugar, bread, potatoes, pasta, rice, etc. from his diet(this as the hospital was feeding him those items daily in his diabetic meals). I have been educating him to the extent of my very limited knowledge since we returned home from the hospital. He knows how many carbs equal a carb serving, how many carbs are in the foods I'm preparing and the snacks he's eating, how to choose low-carb snacks if he's hungry between meals at work, how much insulin to give himself depending on what values he gets on the blood sugar meter, etc.

We are looking forward to getting some additional information in the next few weeks... we had an appointment with our PCP today, we see the endocrinologist on Friday, and another doctor next Tuesday. I asked the PCP a bunch of my questions today, and he told me to write them down and ask the endocriniologist, lol. I believe the endocrinologist will refer us to a dietician. The hospital does have some classes, but the next series doesn't start until the end of May and so we will have to wait until then. The endocrinologist we will be seeing is a partner in the hospital's diabetes education program, so everyone should be on the same page.

As far as the tracking goes: my husband will be tracking all of his own stuff eventually, but right now the tracking is one way I can help him out while he gets adjusted to all the other changes. Am I probably taking too much of this on myself right now? Yes. But I'm doing it because (knowing my husband) I believe it's the best way to ease him into this so that he will see some initial improvements that will keep him from giving up and reverting to bad habits. When I made the changes in my life to help me to lose weight, it was a choice. It "clicked" and I just got moving on it immediately. The changes he must make are a necessity for him, not a choice he came to on his own, and I sincerely think that's a much tougher adjustment. And he's having to make a lot more changes than I had to make.

Regarding fat: I am giving him protein snacks to avoid the carbs between meals, but these typically contain fat. Reduced-fat cheese, nuts, etc. They are good fats, I know, but I have become so used to eating pretty low fat that I worry he won't lose weight if I am giving him too much fat. His fat intake the past few days has been ~55g. I take it from several of your posts that this number is ok... I guess I've just always heard that % calories from fat should be lower than 30%, and 55g of fat in a 1500 calorie day is more than 30%. The nutritionist I saw previously recommended 25% of calories from fat.

Protein: TooManyDimples, John and others, could you tell me a bit about what you eat to get your protein intake above 100g daily? I am happy to feed him (and myself) more protein, but after chicken, lean beef, eggs and low-fat cheese, I get pretty stuck when it comes to adding substantially more protein without adding much fat or carbs (he's already getting non-fat milk daily, but that's a carb serving as well). Sadly, he doesn't eat fish and we can't have seafood in the house (we keep mostly kosher at home).

Fiber and Carbs: Can anyone help me understand a bit better glycemic index and net carbs? I assume net carbs are the carb grams minus the fiber grams; is that the case for both soluble and insoluble fiber? Should I be tracking total carbs, or net carbs? I definitely have a good sense of high-fiber foods and am used to selecting those for myself, but I need to understand better how the fiber content impacts the number of carbs he can/should consume each day.

John: Weight loss is definitely a main focus, probably secondary only to keeping his blood sugar managed while we get there.

Sorry for all my questions and rambling. I know these are all questions I need to ask a nutritionist or dietician, and I know I just need to be patient in the meantime. I am feeling less stressed today than I was yesterday... I suppose I just want to be able to do this "right", right now, and it frustrates me that I don't know how.

Thanks again for your comments, advice, and encouragement. I really appreciate it.

I am sure they already told you this, but as he loses weight his diabetes will get (most probably) in check and will be more stable. In some rare cases it gets to be so insignificant that insulin is not needed anymore.
So dieting (within healthy limmits) is also a cure to some extend.
What I mean to say is this: Have patience and go through this with courage and determination. This CAN change for the better and probably will. It is good to keep a goal in mind while going through hardships.
I wish you and your hubs the best.

Chicken, ground turkey, eggs, canned tuna, cottage cheese, and beef are the staples of my diet. I also have protein shakes on a regular basis. I get in a minimum of 200g of protein a day. He is a smaller guy so he doesn't need as much but I'd shoot for 100+ grams a day.

Weight lifting also increases insulin sensativity but before doing any I'd talk to the doctor.

I HIGHLY recommend "THe First YEar Type 2 Diabetes". It's an easily understood yet fairly comprehensive guide to the questions newly diagnosed diabetics often have.

http://www.amazon.com/First-Year-Typ.../dp/1569245460

YOu might also want to look at the web site "Blood Sugar 101". I learned a LOT there, even if I don't agree with it all.

I'd also suggest that you look at some diabetes forums... there's a lot of good support and info on meds out there. Lots of conflicting info about diets, because each person reacts to carbs and meds a bit differently. But having that support, and knowledgeable been-there-done-that folks who can help you through the rough spots, is definitely worth it.