Q: I weigh 50 kg, which is underweight for my height of 5 feet 4 inches. I was diagnosed with diabetes 4 weeks back. My sugar values were very high (ranging 400 mg/dl). I started taking sulphonylurea 5 mg per day and rosiglitazone (Avandia) 4 mg per day. My fasting sugar level now consistently varies between 75 and 95. However, my post lunch values are high, ranging between 190 and 230. I take only 2 chapattis per meal with a lot of vegetables. Please advise a proper vegetarian diet. Is it practical for me to gain weight? I have lost about 15 kg in the last three years. Does it mean that my muscle tissue is dead or just shrunk? I am trying to theorize that, if the muscle shrinks, naturally the area available for insulin/sugar receptors will become less leading to my current condition. Does this makes sense? My HbA1c 3 weeks back was 14.5. Is HbA1c an indicator of poor diabetes management or can it be raised due to other causes? I want to achieve an A1c level of 5.5 and post lunch sugar level of less than 140. Please advise.

A:Fasting sugar level varies between 75 and 95. This is somewhat low, and you run the risk of getting low sugars at night. I would suggest you ask your doctor and reduce the night dose of your medicines. You need a proper balanced diet, with enough calories to help you regain some weight: discuss this with a good dietician who will assess your present diet and suggest modifications. If you have lost 15 kg in the last three years, it sounds like you have been having diabetes for the past several months and did not know it. Insulin helps the body utilize glucose for fuel purposes. When it is deficient, you have to utilize your own muscle tissue to survive, i.e. your tissues were starving in the midst of plenty and burning themselves up. With treatment (which includes enough food, regular exercise to build back your muscles, and proper drugs, which may include insulin soon) you would be able to regain weight to a more comfortable level. For someone your height your weight should be 55-60 kg. If your HbA1c was 14.5, it indicates poor diabetes control. It would obviously be high because you were not managing your diabetes (because you did not know about it). Prolonged poor diabetes control (as reflected by high HbA1c) results in the complications of diabetes. You want to achieve A1c level of 5.5: I personally think that maintaining an HbA1c in the mid normal range is risky, and you should aim for a high normal value or just above it. Low sugars are to be avoided: they can be more disabling/damaging than high sugars. A good place to get further information is the ADA site: diabetes.org.