Meghana Kumar, MD

What Should I Look for When Buying Whole Grains? - The New York Times
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In many cuisines, white rice is a staple of the dinner table – but one cup of cooked white rice has almost 50 grams of carbohydrates! This can put someone with diabetes in a tough position when it comes to reconciling sitting down to a family meal with their health needs. Here are some healthy alternatives to white rice that won’t force you to compromise on flavor.

First some terminology:

A carbohydrate (carb for short) is a molecule that is broken down to sugar for use as energy in the body.

Net carbs represent the total carbs in a food item minus fiber (which is not digested and therefore does not impact blood glucose). Net carbs are comprised of simple and complex carbs. Simple carbs are quick to digest whereas complex carbs (which are made of longer chains of molecules) take longer to digest. Complex carbs do not spike blood sugar as dramatically or rapidly and provide energy for a longer duration. Therefore, complex carbs are considered a superior option for diabetics.

Low carb substitutes:

  1. Vegetable rice – You can make this yourself in seconds using a food processor or buy it ready-made. Any vegetable can be riced if you get creative – sweet potatoes, cabbage, cauliflower, broccoli, etc.  1 cup of cauliflower rice = 4 grams of total carbs, 2 grams of net carbs.
  2. Shirataki rice – Made from konnyaku flour, this rice can have a distinct odor and texture but is a great addition to a ketogenic diet. Look online for tips to make shirataki rice palatable. 1 cup = 5 grams of carbs, 0 grams of net carbs.

Moderate to high carb substitutes:

Brown rice, quinoa, couscous, barley, bulghur, buckwheat, farro, freekeh, and other grains are all still relatively high in starch, containing 30-50 grams of total carbohydrates per cup. But don’t write these options off completely! They also contain higher amounts of fiber and protein than white rice. They have varying amounts of important minerals like iron, selenium, and calcium. Most importantly, the carbohydrates they do contain are complex. These characteristics help carbohydrates to be absorbed and digested more slowly, allow you to stay full for longer with a smaller quantity of food, and are ultimately far better than white rice for your blood sugars.

Next time you go to the grocery store, we encourage you to step out of your comfort zone and try something new. The varieties are endless – if you don’t like brown rice, try brown jasmine or basmati rice. If not white quinoa, see if red quinoa is more up your alley. Happy eating!

Meghana Kumar, MD

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Thyroid hormone replacement is the mainstay of treatment for hypothyroidism, whether the hypothyroidism is caused by radiation, surgery, or Hashimoto’s disease (autoimmune destruction of the thyroid gland). The goal is to replace the body’s production of thyroid hormone in the most physiologic way possible. However, a quick internet search will reveal an overwhelming number of options for thyroid hormone replacement. In this article, we will break down the different brands of thyroid hormone available in the US and things to consider before selecting a formulation.

A normal thyroid gland produces 80% T4 (inactive thyroid hormone) and 20% T3 (active thyroid hormone). Various organs have enzymes which convert T4 to T3, which then mediates all the functions of thyroid hormone, from sleep to digestion to temperature regulation.

T4-only formulations:

Generic – Levothyroxine

Brand name – Synthroid, Levoxyl, Euthyrox, Unithroid, Tirosint

These medications are usually the first-line treatment offered. It is important to stay on the same brand or advise your doctor if you are prescribed a different brand than before. Different brands even at the same dose may have slightly different contents.

All these medications are comparable in effectiveness. Tirosint is notable because it comes in a gel capsule or solution form, which can help with medication absorption. Some patients may experience more stable thyroid levels upon switching from generic to brand name hormone.

T3 and T4 combination formulations:

Thyroid extract medications: Armour, NP Thyroid, Nature-Thyroid, WP Thyroid, Westhroid

Synthetic: Cytomel/Liothyronine (T3) plus one of the T4 medications listed above.

Most doctors are reluctant to prescribe thyroid extract medications (which are made from dried and powdered pig thyroid glands) because they do not simulate the normal human thyroid production closely. They tend to contain high concentrations of T3 which can cause highly variable levels and symptoms.  Prescribing T3 and T4 as separate pills allows the doctor to control the ratios of each.

A T3-only medication regimen is generally not prescribed.

There are a number of factors that go into selection of a thyroid hormone replacement. Your endocrinologist can talk to you further about which medication is the best choice for you, and why.

Meghana Kumar, MD

Glucometers have revolutionized the management of diabetes. Early glucometers were clunky, slow, and required large drops of blood. The oldest ones simply displayed a color that had to be correlated to a numeric chart. On the other hand, the sleek, pocket-sized devices of today are lightning-fast and accurate.

So it’s no wonder that self-monitoring of blood glucose has become the standard of care. At its best, it lights our path in achieving glycemic control. At its worst, it’s an influx of confusing data, a constant reminder of this condition. So how do we make sure the glucometer is an asset rather than a nuisance?   

5 things you should know about using a glucometer:  

  1. Timing matters. It’s not enough to merely check glucoses – your provider also needs a context for these glucose values. Make sure the date and time settings on the meter are correct, and if you keep a log, write the times alongside the values. Even better, make note of the relationship of the readings to meals. Checking pre-meal glucoses is a good place to start, and your doctor may want you to check 1-2 hours after a meal or overnight too.
  2. Clean hands, accurate readings. Wash your hands with soap and water – and dry thoroughly! Residue of certain substances (like fruit) can artificially raise your glucose reading. Water can make the glucose look lower than it really is. Alcohol swabs or hand sanitizer will work too in a pinch, but keep in mind that applying alcohol excessively may dry out your skin.
  3. Fingersticks don’t have to be a pain. Pricking on the side of the finger rather than the finger pad can help, since that region contains less sensory nerve endings, as can changing the lancet type or size. Alternate site testing (AST) refers to testing glucose from sites other than fingers – ie. Palm, forearm, thigh, abdomen. Ask your provider if your meter is approved for AST. Values from alternate sites tend to lag behind your actual blood glucose level, so the readings must be interpreted with caution.
  4. What to do when numbers don’t make sense. Each finger is giving you a different reading, or you’re getting vastly different readings only minutes apart – how frustrating! First, ensure that your test strips aren’t expired, the test strips were properly stored, and your hands are clean. Make sure you’re giving an adequate blood sample. Then give the control solution a try. This is the small bottle that comes with every new meter. Apply a drop of this solution on the test strip to verify the accuracy of the glucometer. Your endocrinologist can send a prescription of the control solution to your pharmacy (and remember, it has an expiration date, too).
  5. You can identify patterns too. Whykeep a log if the meter records all the glucoses? For one thing, it saves time at your appointment if the provider has a log to look through, leaving more time for us to discuss important management issues. But more importantly, a log helps you to recognize trends – like what that mid-afternoon vending machine treat does to your blood sugar.