"What Do You Do?"

Recently, Fitness Surfer asked for my advice for a friend of hers with prediabetes.

I'm not a medical person [BIG OL' STANDARD DISCLAIMERS APPLY!], but I'm happy to share what's been working for me. Naturally, your mileage may vary and you should discuss with your doctor, do your own research, etc.

Type 2 diagnosis itself sure put the wheels in motion for me. Being diagnosed made it mandatory for me to get myself back to good health. What I didn't realize at the time was that the disease symptoms themselves were working against me: I felt tired and fuzzy-headed a lot, and that made it hard to feel motivated to exercise and to eat properly (which involves a bit more effort and clear-thinking than eating whatever, whenever).

But what do I do, specifically? Here's a list:

I monitor my blood glucose levels and strive for normal blood sugar levels.

If you kinda sorta suspect that you *might* be at risk for diabetes, it is tempting to keep your head buried in the sand about it. (I did. Bad idea.) Not everyone who is overweight, obese, or
morbidly obese develops type 2 diabetes; from what I've read, there are other factors involved.

That said, I would recommend getting screened. I had been reluctant to let a doctor test me, but I did a health screening at my local drugstore and it confirmed that I had diabetes. (I had the
HbA1c test, which shows the "average" of the past few months, not just the fasting blood glucose test.) I also had a pretty awful cholesterol panel and low bone density.

Faced with these facts, I didn't feel like I had a choice: I needed medical help. I suppose I could have ignored it, or researched it and tried to control it on my own. But without a blood glucose meter, I knew I would be flying blind...and would possibly *become* blind if I wasn't successful. I went to my doctor, and got a prescription for a blood glucose meter; this tool tells me how what I eat affects my blood glucose levels, by giving me a "snapshot" of my blood glucose level at the time of testing. I was instructed to test once in the morning before eating, and once after one of my daily meals, between 1-2 hours after the meal. I ended up testing more, to see how certain foods affected my blood glucose levels, and sometimes when I felt not quite right.

Yes, that means it's now part of my permanent insurance record. Yes, it meant a lot of hassle and stress and appointments at first. But boy, if I could bottle up the feeling of "Before" vs. "Now" and let people try it, the difference would astound them.

So...what's a "normal blood glucose level"? Surprisingly, it's subject to debate. The American Academy of Clinical Endocrinologist levels (http://www.aace.com/pub/pdf/guidelines/OutpatientImplementationPositionStatement.pdf; it's the 3rd page.) recommends a Fasting/Preprandial of Fasting/Preprandial of less than 110 mg/dL and a 2-hr Postprandial of less than 140 mg/dL (source: http://www.phlaunt.com/).

I exercise at least 30 minutes/day, 5 days/week. It doesn't have to be super strenuous (although it usually is now, because I'm training for a sprint triathlon). I aim for mix of cardio and strength.

The biggest eye-opener for me when I went to see my diabetes educator was her "prescription" for 30 minutes of exercise 5 days/week, to help reduce my blood glucose levels. "You need to view this as being as important as taking medicine," she said. I took up running--which, ironically, raised my blood glucose levels after running at first. (However, this wasn't as much of an issue once I got into shape, and as I figured out how to fuel my body before I ran.) I needed something high impact for better bone density, but moderate exercise would have had a similar effect on blood glucose levels. I also started doing light strength exercises for upper body bone density, but developing some muscle mass also helped with the diabetes, I believe.

I became an athlete.

I was going to write, "I am becoming an athlete"...I still don't know which phrasing I prefer, because I don't know what one has to achieve to say, "I AM an athlete." I train for and participate in events, rather than it being a one-time thing. But anyway, it's more about the mentality of training for a specific goal rather than the mentality of "I'm on a treadmill to nowhere...." I wrote about this new mentality before my first 5K (other than my one high school cross country season) here:
http://oppositelife.blogspot.com/2008/10/detest-running-try-walking-5k.html

I found that having an event scheduled helped me stick to my new exercise habits. This blog entry has links to training programs for a 5K walk. I myself didn't follow the ubiquitous couch-to-5K program; I felt it was too intense for my level of fitness at the time. (Er, pretty much zero, and morbidly obese, clinically-speaking.) I set my own pace, more along the lines of the Zen Habits article "Beginner's Guide to Running" (http://zenhabits.net/2007/05/beginners-guide-to-running/). Once I did my first event, though, I was hooked! I decided to do one event per quarter. My 2009 race schedule (and reports) are down at the very bottom of the blog page, if you're curious about them.

The downside is sometimes you feel like you need to do more, more, more...but don't fall for that one. MizFit had an excellent article last Wednesday, "Overtraining: Less Can Be More." Excellent discussion in the comments, too.

I developed a food plan. Yes, for me, it meant developing portion control and other sensible eating habits.

I started with my gestational diabetes food plan, but then I did a little research online and found that a lot of people with diabetes were finding good success with lower-carb diets. (Varying from
Atkins-style low carb to more of a South Beach-style diet.) I based my food plan on the Low-carb Diabetes Diet on Prevention.com's web site (http://www.prevention.com/cda/article/the-low-carb-diabetes-plan-that-works/548c68f271903110VgnVCM10000013281eac____/weight.loss/popular.diets/low.carb.diets/0/),
although I adjusted for a little more dairy. (I like my yogurt!)
Having an understanding of food exchanges helps with this; refer to
this document for more details: http://dtc.ucsf.edu/pdfs/FoodLists.pdf

Other articles that helped me:
"How to Get Your Blood Sugar Under Control": http://www.phlaunt.com/diabetes/14045524.php
"What Can You Eat When You Are Cutting Carbs?" http://www.phlaunt.com/diabetes/18856280.php

At my meals, I ensure that I have a balance of protein and not too many carbs; at least one serving each per meal or snack. When I had gestational diabetes, I learned from the nutritionist that one can maintain a more even blood sugar by spreading out one's carb servings throughout smaller meals and snacks during the day and by ensuring that you eat a little of your protein when you eat your carbs. (Similar to the recommendations made by the insulin resistance diet authors.) I eat a lot of non-starchy vegetables, sometimes omitting a starch serving in favor of more non-starchy vegetables. I eat as "clean" as possible: fewer processed foods, more "real" foods. Oh, and I kicked the diet soda habit...not sure how much that helped, but I suspect it did.

I don't have any "forbidden" foods. (In fact, I just ate a tiny, totally-worth-it, chocolate-caramel truffle.) Forbidding foods totally backfires for me. I may choose to not eat or drink certain things in general (e.g., diet soda) or at certain times (e.g., Hmmm, I had a piece of bread with dinner, so I will postpone having dessert until tomorrow night.). This doesn't mean the choice is always easy and painless, though! I've had plenty of times where I thought to myself, "Oh, why can't I just eat any ol' thing I want???" I may choose to eat smaller portions of a food, so that I don't screw up my blood sugar readings. So far, that has worked for me.

I found a backup plan: the plate method.

If the above seems like way too much analyzing, try a "plate method."

Here's one: http://www.dlife.com/dLife/do/ShowContent/inspiration_expert_advice/expert_columns/rondinelli_jan06.html

Here's the Zone system version: http://www.zonediet.com/EATING/QuickStartGuide/tabid/108/Default.aspx

I find the "plate method" very useful when dining out or on vacation. I weigh and measure portions when at home, but when I can't, this works nicely.

I found some alternatives for when food cravings hit.

I was super-strict when I was working to get my blood glucose levels under control. It probably took about a month to get rid of the intense sugar-cravings. (It was worth it, because now I find a lot of the foods that used to trigger me are sickly sweet to me now.) When I got hungry in between meals, or felt like I wasn't quite satisified after a meal, I went for "free foods" that were high on flavor and low on calories: Good Earth Original tea (strong, sweet cinnamon flavor), good-quality broth (beef and chicken when I was getting used to reducing my portion sizes), lots of non-starch veggies. The occasional sugar-free candy,
popsicle, jello, or gum. (Here's the Mayo Clinic's Free Food exchanges list, since the ADA web site is not responding: http://www.mayoclinic.com/health/diabetes-diet/DA00076)

I take 2 fish oil capsules and 2 calcium+vitamin D pills per day.

I started doing this a few months before diagnosis, because my husband's doctor recommended this to improve his heart health and cholesterol. I figured it would probably be good for me, too. I believe it's helped my low bone density and my cholesterol, in combination with the other changes.

I take metformin, as prescribed by my doctor.

The Diabetes Prevention Program study indicated that lifestyle changes plus metformin therapy can prevent or help delay the onset of Type 2 diabetes. (UCSF's Diabetes Education Online summarizes this study here: http://dtc.ucsf.edu/type2/health-management/what-trial-research-shows/dpp.html) I balked at the idea at first, but it became obvious (about 1 month after trying) that exercise and dietary changes alone were not reducing my blood glucose levels enough. It seems to work well for me, though. Metformin regulates how the liver releases sugar into your bloodstream. It requires a doctor's prescription.

No, I did not have any surgery.

I'm a wuss. From what I've seen personally, observing people I know who have had this surgery, it does get the weight off, and pretty quickly. But it's not what I'd call the "easy" way...the surgery itself is probably the easiest part, actually. Adjusting to life after surgery is extremely challenging. So I'd definitely recommend giving lifestyle change the "matter of life or death" try before going this route.

There has been a lot of press about gastric bypass surgery "curing" diabetes. But what does a "cure" look like? You might want to read this and decide for yourself:
http://diabetesupdate.blogspot.com/2009/07/real-truth-about-gastric-bypasss.html

I track everything...more or less.

I created my own health log to keep track of it all, because I was writing it all down in a notebook and that got onerous. I have a single sheet, with each day being a column, and rows that track my two blood glucose readings, my food intake, supplements/medication, water, exercise, and some misc. things (flossing, foot care, fiber intake). I've gotten a bit lax on the food tracking lately, and my weight tended to rollercoaster over the last few weeks. But when I stick to
my plan completely, I see good results.

I gained inspiration from the health and fitness online community.

So many wonderful sites; I have all of my regulars in my Blogroll.

Bloggers in this space who successfully manage their type 2 diabetes are Biz of "The Biggest Diabetic Loser" (http://biz319.wordpress.com/) and Foodie McBody of foodfoodbodybody (http://foodfoodbodybody.wordpress.com/ - she was first diagnosed with prediabetes, and then diabetes...very inspiring story and similar to my own). I also like Alan's "Type 2 Diabetes - A Personal Journey" (http://loraldiabetes.blogspot.com/), although he doesn't post as
often. I'm a dedicated follower of Jenny Ruhl and her excellent work ("Blood Sugar 101" book and web site, plus her "Diabetes Update" blog provides excellent research summaries/discussions, see http://diabetesupdate.blogspot.com/). And there's Amy Tenderich's "Diabetes Mine" (http://www.diabetesmine.com/) which includes blog + additional resources.

You'll probably see me quoting the MizFit and Cranky Fitness blogs a lot, because I enjoy their humor, perspectives, and the insightful comments they inspire.

Even before diagnosis, the tiny seed of "hey, it *is* possible" was planted by reading (and re-reading) Lynn Haraldson-Bering's story on cnn.com: http://www.cnn.com/2008/HEALTH/diet.fitness/02/08/weightloss.lynn.bering/index.html, and then reading her full story on her "Lynn's Weight-Loss Journey" blog (and she continues on her "Lynn's Weigh - The Journey Continues" blog, which sustain my "hey, it's possible to maintain, too!" thoughts).

I have lots of help from my incredibly supportive family.

This blog focuses a lot on me and my journey. But deep down, I was motivated by my desire to be as present and functional as possible for as long as possible for my family: my husband and my two children, whom you'll see mentioned as "Mr. Handsome & Handy" and "Thing 1" and "Thing 2" (ala the Dr. Seuss pranksters). My husband thought that the Healthpoint article made it sound like I was a single mom, and nothing could be further from the truth. He takes care of our home and our kids, and he cooks wonderful, healthy meals for us all. I often work late, and most of the time there's a pre-measured dinner in the toaster oven waiting for me, as well as a lunch packed for the next day. (He's also frugal, and this helps keep me out of Whole Foods! ;-) Because he handles a lot of tasks, my stress level is lower (and stress is bad for your blood glucose levels). If I make it look easy, he's a big reason why.

Anyhow, hope this summary helps, both Fitness Surfer's friend and anyone else out there who's looking for their own answers about how to deal with type 2 diabetes.