Type 2 Diabetes: A Disease, Not a Choice

Amy Tenderich of the blog Diabetes Mine featured an interview yesterday with John Anderson, who raced with Team Type 2 in last year's Race Across America ("John Anderson: Proving Type 2 Diabetics Can Be Athletes, Too").  I found his story is inspiring on many levels, but what I think brought it to the attention of many is not merely that he has type 2 diabetes and is an endurance athlete (*gasp!* ;-), but that he was an athlete before his diagnosis (*double gasp!*).  This sure doesn't fit the media stereotype of type 2 diabetes being the disease of "fat, lazy" people.  (And don't get me started on the stereotype of "fat" people as "lazy."  Grrrrr.)

But, oh yes, I bought into the type 2 stereotype initially.  Then I encountered Jenny Ruhl's excellently researched article, "You Did NOT Eat Your Way to Diabetes".  Wow, talk about an eye-opener!  I think it helped, turning the shame and guilt into anger--both at the stereotype and the disease.  I embarked on trying to be as opposite as possible, striving to find my inner athlete, to shake the stereotype.  Only to find later, after some longtime school friends found out I completed my first sprint tri, that my being "opposite" was just another, that's-so-Pubsgal, way of my being "me" all along.  The "me" that had been adrift in a hyperglycemic fog all those years.

I think the thing that one reason why lifestyle is addressed as a cause, is that for many people, taking good care of one's body can help delay or prevent diabetes symptoms and complications.  For me, properly taking care of my type 2 diabetes through nourishing my body with types of foods (and amounts of foods) that keep my blood sugar levels low and steady, exercising regularly, and taking medication (metformin in my case) helped me to become more energetic (even before the fat loss) and to lose much of the extra body fat I'd been carrying.  These things won't change my genetic makeup, or enable me to regrow beta cells in my pancreas.  You can do all the right things and still have to adjust treatment as your body changes over time.  But maybe doing the right things will delay or prevent complications of this disease.   

So, good luck to all of the teams--especially Team JDRF, Team Type 1, and Team Type 2--in this year's Race Across America!  (Teams start this bike race from Oceanside, CA to Annapolis, MD tomorrow, so it's not too late to follow them!)

P.S. [Later on] - Of course, now I'm laughing to myself about getting all riled up here.  Especially since all 8 or so of you who read this blog have heard me rant about all this before.  But maybe the "Race Across America" is news to some of all y'all.

P.P.S. - And speaking of great athletes, Team Shrinking Jeans did it!!!  Woo hoo!!!  Congrats to them all on their completion of the San Diego Rock & Roll Half-Marathon and for raising $43,725.65 for the Leukemia and Lymphoma Society!  THANK YOU!!!

The Big Blue Post + Weekly Update 11/18/09

The Big Blue Test!

Saturday was World Diabetes Day 2009. Landmarks all around the world were lit up in blue in honor of diabetes awareness. And Tu Diabetes sponsored an event called "The Big Blue Test," in which people with diabetes would test together, exercise together, and then test again. The point of exercising was to raise awareness of how exercise can help with blood glucose levels.

Thanks to Thing 1, here is my Big Blue Test, in pictures!

Here I am, ready for The Big Blue Test! (That's my *eager* face!)

Testing: 1, 2, 3.... Used my pinkie, guess I was in a *fancy* mood.

95 before exercise!

It was a beautiful fall day, so I decided to go for a walk. I wanted to see how a lower impact exercise would affect my numbers.

I took a brisk, 15-minute walk, I'm guessing about 3/4 mile to 1 mile in length.

Here's the view from the end of my street. Wish I could have treated you to a view of some lovely horses, too, but the pasture was empty.

"Holy coronitas!!!" You can't see what I'm disbelieving, but it's a reading of...64?!?!
Must be a bad strip, I'll test again....

Second test: 69?!? Testing one more time...

Third and final test: 70! Think I'll have a little snack....

So there is some variation on test strips. This batch, on the whole, has seemed a little lower during the month, so it will be interesting to see how I trend on the next batch of test strips. But still, when I looked at other Big Blue Test participants' results on Twitter during the day, many had dramatic drops after only 14 minutes of exercise. I knew exercise was beneficial, but it was interesting to me to see how even mild exercise could make a noticeable difference. As my good friend Foodie McBody tweeted to me, "It's too bad the (weight) scale doesn't show such wonderful and instantaneous results, eh?"

I saw other participants' results going up rather than down; that had to be discouraging! There are variations on how one's body responds to exercise, and I've noticed this in my own experience. Sometimes I tend to run a little higher on race days (race-day excitement affects my blood glucose levels), when I perform harder exercise (stress on my body can raise blood glucose levels-I noticed this more when I was starting to run), and when I am not getting enough rest.

Anyhow, if you're newly diagnosed and have been advised by your doctor or diabetes educator to use exercise as part of your plan to manage your diabetes, why not try your own "big blue test" and see if your results confirm or deny the effect of exercise on your blood glucose levels? (Unless, of course, you cannot exercise due to disability or medical advice!)

Progress last week

7-day blood glucose average: 88 (met goal of less than 120) <-skewed a bit by the BBT
7-day fasting blood glucose average: 95 (met goal of less than 120)

Weight goals: +1.6. Drat, back up in the 190s! I'm not doing so hot with my eating at home...I've pin-pointed it to stress-feeding, and I need to figure out a better outlet than grabbing salty, high-calorie snackage.

Food goals:
- Brought lunch from home on only one work day, but went nice & healthy & somewhat frugally on the buying days and used protein that I already had in my desk (love dry roasted edamame!).
- Ate lots of veggies. I think this is the first weekend in some time that I didn't make my ratatouille.
- Got in at least 4 meatless meals but 0 fish meals.
- Fiber: at least 4/7 days were over 30.

Exercise goals: Didn't meet 30/day for 5 days, but I wasn't expecting to do so this week.
Total estimated mileage: 21.56 miles
- Wednesday: 20 minutes run (1.44 miles)
- Thursday: 40 minutes walk (1.84 miles) + 10 minute video (ab exercises)
- Friday: 37 minutes (20 walking the dog, .25; 17 running, 1.44 miles) + 1 hour vigorous playing at the park with the kids
- Saturday: 15 minutes walk (.75 mile)
- Sunday: 15 minutes on stationary bike (no mileage estimate)
- Monday: 35 minutes walk (1.84 miles)
- Tuesday: 60 minutes spin class (monitor broken, so I have no idea of the distance; estimating 14 miles)

Sleep: Met goal of 7 hours/night.

Goals for this week

7-day blood glucose average goal and fasting numbers: below 120.
Weight goal: Maintain or make progress toward goal.

Food goals:
- Keep going with the veggies!
- Rein in the nuts and dark chocolate; pass by some of the "just a taste of this" and "I'll have a dab of that." Get the homefront eating under control.
- Bring lunch from home 4/5 work days.
- 4 or more meatless, low-fat meals and 2 or more fish meals.
- Track fiber. Minimum 30 grams fiber/day. (Include both insoluble and soluble sources.)

Exercise goals:
30 minutes of activity 5 days/week. Prepare as best I can for the Pillar Point 10K on Sunday!

Misc. goals:
- 7 or more hours sleep/night.

Just a couple of quick things...

Saturday was World Diabetes Day, and I participated in the Big Blue Test! To participate, one took one's blood glucose reading at 2 p.m. local time, exercised for 14 minutes (because WDD is on November 14), and then take another blood glucose reading after exercise. WOW! I'll be providing my results on Wednesday; you can read about FoodieMcBody's experience with the Big Blue Test on her blog. (We're in the same time zone, so we had some overlapping tweets regarding the test and our results, which was fun!)

If you're up between 1 a.m. PST and dawn on Tuesday (tomorrow!) morning, be sure to check out the Leonids meteor shower!

Back on Wednesday!

Got Type 2? Here's a List of Resources

Welcome, MizFitOnline readers!

If you or someone you know has type 2 diabetes, you might like some of these handy (and, I think, dandy) diabetes-related resources.

Locate free health screenings: See this article on "The Savvy Senior" about how to find free or low-cost screenings for any number of medical issues.

Free online diabetes resources:

Jenny Ruhl's "Lower Your Blood Sugar" article is a good place to start if you are recently diagnosed; I highly recommend her excellent Blood Sugar 101 book or web site. (I think it saved my life, or at least my eyesight and a limb or two.) Some of the medical people might feel that her blood glucose recommendations are extreme; however, if you compare the ADA, Joslin Diabetes Center, and the American Association of Clinical Endocrinologists recommendations, you’ll see that not even the experts agree. (My own medical team had made different recommendations, mainly because of different perspectives of how to bring a new patient on board, not because they felt that higher was better.)

UCSF Online Diabetes Education provides online education for people with diabetes. If you have a friend or loved one with computer access but who does not have access to a diabetes educator, this is a terrific first resource! It does promote higher carb intake than the lower-carb sites like Blood Sugar 101, but who says you can't do it in phases? This site has a lot of information you'd get from a diabetes educator, and if you're without one, it may help getting one closer to better blood glucose management.)

Diabetes etiquette tips for people without diabetes (PDF file) provides a guide to what is and is not helpful for interacting with your friends and family who have diabetes, from the Behavioral Diabetes Institute.

dLife is a good general resource with lots of articles. My pal Travis from Tu Diabetes contributes articles for this site. Their article on "The Plate Method" may be helpful if you are in a dining situation in which you need to guesstimate portions (or are just fed up to HERE with weighing and measuring stuff).

Tu Diabetes is a social networking site for people with all types of diabetes. It's a good community for not feeling quite so alone with the disease.

Exercise Guides

Gold's Gym has a free (and nicely done) guide to starting an exercise program, applicable for any gym. You can download it from their "Fighting Diabetes with Fitness" web page. I like that they advised new exercisers to set goals, work up to their goals (rather than going gung-ho in the first session, getting sore and tired, and abandoning it), and to combine strength training and cardio. (I would set more performance-based goals instead of weight or size goals to begin with, though.) In a way, my recommending this is kind of ironic, because I always associated this gym with the serious fitness people and felt very intimidated by it. But with much encouragement from my blog buddies and trying it for a week, I found it to be a really positive place.

To get started running, I started with the Zen Habits Beginner's Guide to Running. But now, there's also the amazing Julia Jones's 5K Training Program (via Two Fit Chicks and a Microphone). Not a runner? Train to walk a 5K! Training for an event helps reinforce your fitness goals and can benefit a good cause, too.

Finally, here's what I do: A friend of mine wanted to know what I was doing to manage my type 2 diabetes, so I summarized it here. (Standard disclaimers apply, not a doctor, don't play one on TV, etc.)

"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.

American Diabetes Alert Day

Today is the 21st annual ADA "American Diabetes Alert Day". I'm a *leeeetle* bit skeptical about people wanting to excavate head from sand regarding their risk for diabetes...but that's based solely on my own experience. For the longest time, and with all of the risk factors staring me in the face, I.did.not.want.to.know. Oh, I knew it was going to be "someday." I suspect that was part of the problem: because I felt it was inevitable, I went the "eat, drink, and be slothful, for tomorrow we shall have diabetes" route. Oy. [shaking head in self-reproach] Why are smart people so dumb sometimes?

I have to admit, though, facing up to my diagnosis was the catalyst for quite a lot of good changes in my life. I feel so much better now and way more energetic. I don't know what the future will bring with me and this disease, but my priority right now is best quality of life for as long as possible. Maybe, just maybe, putting some of the good stuff I've learned into play much earlier could have made "someday" a little later. While challenging at times, being healthy is not as onerous as I had previously suspected.

Anyhoo, I thought I'd share some items I've stumbled across....

Gold's Gym (Hey! That's MY gym!!!) has a new initiative for Diabetes Alert Day, including a free (and nicely done) guide to starting an exercise program. You can download it from their "Fighting Diabetes with Fitness" web page (http://www.goldsgym.com/healthy/diabetes.php). I like that they advised new exercisers to set goals, work up to their goals (rather than going gung-ho in the first session, getting sore and tired, and abandoning it), and to combine strength training and cardio. (In a way, it's kind of ironic, because I always associated this gym with the serious fitness nuts. But after I got over feeling intimidated--with much encouragement from my blog buddies--I've found it to be a really positive place.)

Excellent article on Diabetes Mine, highlighting various Alert Day goings-on. I like that Amy highlighted LifeScan's list of resources for those with little or no health insurance.
http://www.diabetesmine.com/2009/03/dismissed-on-diabetes-alert-day.html

And, if you did take the risk assessment, or have been recently diagnosed, there are some really great references available in these places:
Blood Sugar 101; especially Jenny Ruhl's "Lower Your Blood Sugar" flyer
UCSF Online Diabetes Education (Promotes higher carb intake than the lower-carb sites like Blood Sugar 101, but who says you can't do it in phases? This site has a lot of information you'd get from a diabetes educator, and if you're without one, it may help getting one closer to better blood glucose management.)

Hmmm...I also discovered today that the ADA "Tour de Cure 2009" has an event in Palo Alto, California...and it's on June 14. Mr. Handsome-and-Handy's and my 15th wedding anniversary and my diagnosis day. All together now with the eerie coincidence sound effect: wooooooWEEEEEEEwoooooooo! Oh, and they have a 25K (11.47 mile) ride. How doable! (I've gotta get me one of those hot, "Red Rider" jerseys!!!)

If You've Had Gestational Diabetes, Please Read

If, like me, you've had gestational diabetes, please read Jenny Ruhl's latest article, "Myth Busters: Gestational Diabetes Is Indeed Real Diabetes." Whether you believe the article or no, she offers a compelling argument (convinced me!) and good advice for post-pregnancy follow-up.

If I had known after my first pregnancy what I know now, I guess I would still be doomed (at least 50% chance of doom, anyhow) to develop diabetes. But I would have saved my poor pancreas years of some serious abuse.

Weekly Weigh-in: -53

Feeling good, down -2 pounds this week. Blood glucose levels are great post-meal but still drifting up above 120 sometimes. That seems to happen more when I eat dinner later in the evening, even when my post-meal numbers are fantastic. Might just be one of those things I can't control, but perhaps next time I have a late dinner I'll try to make it lighter and see if that impacts things.

Yesterday's visit with the diabetes educator nurse and the nutritionist went pretty well. They felt I'm doing very well with my progress. It had been a couple of months, so I don't think they were expecting to see that much less of me. ;-) They had a copy of my lab results and were a bit concerned that the HDL/LDL numbers weren't looking quite as good as the rest of my cholesterol panel. So we discussed cutting saturated fats. I felt a little daunted, frankly. While I've been doing fine with balancing my carbs and eating better ones, I have been lax on the fats. We do eat a lot of red meat, and I loooooove crispy chicken skin or the charred fatty bits on the meat. Don't get me started on bacon, it's my passion. I held a mild grudge for years against my brother-in-law for burning the gourmet bacon we brought to his house one time. So...*sigh*...I wouldn't say I replaced sugar and refined carbs with fats--I already was eating plenty of fats, too, right along with the sugar and refined carbs--but the fats aren't my special focus from a reducing blood glucose levels standpoint. When I go a little over my fat portions, I haven't been stressing about it. So, while it hasn't noticeably impacted the weight loss so far, it is impacting future health. It's time to start gradually removing that prop. (*heavy sigh*)

My nutritional challenge for the week, then, is to have at least 3 meals with no meat/cheese/eggs/animal-based fats and at least 2 meals with fish. I was pretty close yesterday at lunch: black beans and salad and fajita-style veggies...with a small sprinkle of cheese (probably about 1 Tbsp). Yesterday's breakfast was one: fat free cottage cheese and a slice of flax toast with sugar-free jam. (I'm not counting my snack, since that's not a meal with protein or fat servings and I've been going fat-free with my Greek-style yogurt all along.) I bought some firm tofu and some tofu-based sausage, so we'll see how those go.

I've also made the fitness goal of running a 5K race quarterly. (Although I'm eyeing a couple of runs in November that look promising...) So it was back to running this morning, 35 minutes in swirling mist, I kept having to wipe off my glasses.

Weekly weigh-in: -51!

Down 2 pounds this week. Woo hoo! I passed the 50-pound mark. I still have a long way to go until I reach my goal, but it feels really, really great to be closer.

I'm also happy to have progressed in my arm strength training. I moved on to two 7.5 pound weights (my original 5-pound hand weights plus my husband's 2.5 lb ankle weights)...my arms still feel wobbly today.

5K in less than a week! AAAAIIIEEEEE!!! I haven't done the full distance in awhile, so I'm hoping I'm ready for it. Maybe tomorrow morning I'll do a trial run again.

The 50-pound Retrospective

Okay, here's the really weird part of all these physical changes: dealing with the fact that people (0ther than my nearest and dearest) now notice that I've dropped the weight equivalent of a small child. I guess I'd expected to quietly do my thing and not have anyone notice or comment at work. It started subtly, with comments about my hair looking nice...and I hadn't had a haircut in weeks. I just assumed that "Your hair looks nice" was the new, polite way of saying, "Daaaaaaaang, you have lost a TON of weight!"

Now it is pretty much the latter observation. (But said in a kind, positive way...I'm very fortunate to have nice coworkers.) I generally respond with a grin and a "thanks," but sometimes it gets a little weird...like when coworkers say I'm "inspiring" and proceed to tell me how hard or impossible it is for them to eat properly, exercise, and lose weight. I'm still working on these areas--or at least the first two, with the latter being a nice by-product of improving health. But after the first month or so, it hasn't been as hard for me as I thought it would be when I was the one thinking that eating sensibly would be hard and booooooring and--chuh!--forget about squeezing exercise (painful, unpleasant business, that) into my busy schedule. I listen, and do mention that I felt the same way, and tell them how I'm doing it if they ask. But I don't feel exceptional, I mean, if *I* can do it....

What's really weird is that sometimes I feel like an imposter. I know that you can't fake the results; I have focused and taken action to get where I am now. I don't fake likes and dislikes...for example, I don't pretend to hate chocolate or to love vegetables. (I do love 'em...except lima beans.)...and while I do feel good after a run, often as not I don't feel like running first thing in the morning. But I haven't divulged to most people that I have type 2 diabetes and that keeping it managed is driving me to make these seemingly "impossible" changes. Confession time: I feel ashamed of having gotten it, although I believe (in my mind at least) that it wasn't just sustained bad habits that got me here, genetics and possibly other factors contributed. For me, doing everything I can to manage it makes me feel less ashamed. Fear of what would happen if I didn't do anything about it also motivates me. Would I have had the "stick-to-it-iveness" without those really big sticks waving around behind me? Moot question at this point, although not sure what would have been the catalyst after 14 years of being overweight...not sure "feeling tired of being fat and out of shape" would have been enough, but then, it has been for others and may have been for me, too.

Anyone out there going through similar? How have you dealt with it?

Weekly weigh-in: -49!

Down 2 pounds this week; yeay! Blood glucose levels mostly good, although I had a few mornings last week when I went over 120; boo!

Things are screamingly busy for me right now, but I just wanted to thank everyone who's been tuning in for your comments, even though I haven't had a chance to respond personally yet. They encourage me tremendously. (And no, not just to post more silly stuff on my blog. ;-) Getting healthy used to be such a solitary quest, but with the great blogs and fun comments and communities, not so much anymore! Best of luck to everyone this week!

Weekly weigh-in: -47!

Down 4 pounds this week; yippee!!! I'm down into the next decade (2teens vs. 220s!) I didn't change much on the food front, but I did more exercise and made sure I got the proper amount of fluids. (I also did my arm strength training an extra day.)

Fasting blood glucose has been running a little higher, though; boo! I've had a few days where it was over 120. I suspect it's from eating dinner later in the evening. I really need to plan better around late work nights.

I also did my official "monthly measure" today. Actually, I did it late last week when the scale hadn't budged much. Both times it was really encouraging. Since beginning back in May, I've lost 5 inches from bust, waist and hips!

All that said, I still have a long way to go: 14 pounds until I'm at my halfway point; 28 pounds until my BMI is merely in the "overweight" (instead of the "obese") range. And who knows when until the fasting blood glucose levels get where I need them to be. But it was nice to enjoy seeing some progress this week.

Wishing success to everyone else in the process of getting healthy!

The Near Occasion of Pistachios

It used to be sugar that drove me wild with desire, but now...

...they're in my desk drawer...

...naked...

...salty...

...green...

...pistachios!


A 16 oz. bag of them...well, 14 oz now, I've ate a couple of ounces so far (not in one sitting, thank goodness!). Shelled, roasted, salted...no, I did NOT have the good sense to get the ones in the shell, so I'd have to remove them one-by-one.

I got a really bad craving for them yesterday. What to do? I'd already had some with lunch, and I knew I needed to choose my usual yogurt/flax+wheat germ/fruit snack. I thought, "Try the scent-tasting trick." So I dug out the bag and inhaled deeply three times. Mmmm, salty goodness! Then I got myself a cup of tea. So far it seems to have worked, but there are still 14 beguiling ounces in there....



In other news, I found it really difficult to drag myself out running today. "Thing 1" had a rough night last night and woke us up after having a bad dream. ("Thing 1" refers to our 6-year-old son; "Thing 2" is our 4-year-old daughter; both affectionately dubbed from The Cat in the Hat's mischief-makers.) I think he's anxious about starting school next week. It's been thickly foggy all week long in the morning, and it was like jogging through an Impressionist painting, except I'm sure Monet's garden didn't have drought-stricken lawns and gopher mounds. I did stick with it and did my 2 miles (in 40 minutes...I'm going to get so lapped by the 5K walkers at the Pumpkin Run, but my goal is to simply finish before they pack up everything and leave). I'm not sure whether the inside or outside of my jacket was more wet. (Ew, too much info, I know!) But I felt very good afterward.

Moving my Metformin dose to the morning seems to be making a difference in my fasting blood glucose. Today it was 134, which is the lowest it's been since I started tracking (about 10-15 less than usual). Unfortunately, I got more of a spike from my workout (145) than breakfast (131). I wonder if any studies have been done to figure out how much weight loss affects blood glucose numbers. The current thinking is that losing 5-10% of your body weight (if overweight) and 30 minutes of exercise daily can make a difference for preventing diabetes among those with a predisposition for it (58% less likely, per the Diabetes Prevention Program study), but I was unable to find numbers for how much your blood glucose would go down as you reduce your BMI. Maybe it's not something that's possible to track, especially among newly diagnosed people who are doing everything at once: exercise, sensible eating, and (in some cases) medication.

Weekly Weigh-in: - 34 pounds!

Yippee! Down another 3 pounds this week.

"Hello, my name is Pubsgal, and I'm a scale addict..."
How often to weigh is a topic of much debate among those pursuing weight loss. From my Weight Watchers days, I remember their strict admonition to weigh only once a week, so as to avoid angst over the daily ups and downs. However, I've also read that daily weighing can be helpful for some people ("Does the Scale Promote Weight Loss?").

I weigh daily each morning, but I track on a weekly basis and measure monthly. I find that a daily check, and watching the number over the week helps me calibrate things. This week, for example, I was a little worried about whether there'd be a loss, as the scale didn't seem to be budging much. So I made some lower-fat choices and stuck to my food plan a bit more closely. I probably would have been really discouraged if there'd been no progress, and I've gotten spoiled by the quick progress. Tune in a couple of months from now to see the hand-wringing and hair-pulling!

In some ways, blood glucose monitoring is even more crazy. I've seen a downward trend in general, but I thought there'd be a more dramatic impact from the medication as well as following my food & exercise plan. We'll see what the diabetes educator has to say about it after my appointment today; she'll probably chuckle when she sees how many times I checked my blood glucose after starting metformin: "Oh my gahd!!!! I'm going hypo!!!! I just know it!!!!...Oh. 124. (90-130 being a normal pre-meal or fasting range.) Okay, so things aren't exactly plummeting, here." (Disclaimer: it's always a good thing to test when you think hypoglycemia is happening, not to make light of my reaction; however, my blood sugars have been so high for so long that "normal" feels like a low to me.)

"Habits are at first cobwebs, then cables." -Spanish proverb

Weekly Weigh-in: -31 pounds!

Wow, this is getting good! I'm a little over 25% of my way to my goal weight of 143. I still have 91 pounds to go, though, so it's going to be a long haul. On the other hand, I guess it's a milestone in some ways, because I now have less than 100 pounds to lose!

Good stuff I've noticed so far:

• My largest size pants (26W) are really, really baggy.

• Pants I haven't worn since I started working again fit nicely, and are even a little baggy in the thighs. How weird, though, how differently clothes are sized!
  

• No more worries about blouse buttons popping!

• Feeling really good on all levels! Physically, I'm feeling terrific and have much more energy than I used to. Mentally, I feel really positive. Sticking with exercise especially makes me feel happy, even when it's not progressing quickly and when I experience setbacks (tweaking a muscle, going on vacation), because it's a miracle to me that I'm doing it at all.

• Compliments from friends and family.
  

On the blood glucose front, well, I'm perplexed about my fasting numbers. I don't know what it was that I ate at dinner last night--we ate out at "Whole Paycheck" (what we at work call "Whole Foods," since it's our unofficial company cafeteria), and was it the cioppino? The pickled ginger with the sashimi? The tabouli salad? The two slender, crunchy bread sticks? The two bites of pineapple and one bite of honeydew? All of the above? Anyhow, post-meal was 152--not great, but in range for a post-meal. However, my fasting this morning was also 152 (it had been dropping into the high 130s after starting metformin), as was my post-breakfast. And it's so weird, because we did a lot of walking around last night, and I started doing some weight exercises. I started taking metformin on Saturday, so you'd think by Tuesday it would be showing something. This is so frustrating, to be doing everything nearly perfectly, and to be having great progress with weight loss, and yet to NOT have the fasting numbers I want. Maybe I ought to try some middle-of-the-night testing to see if the numbers are dropping too low....

So yes, last Thursday my doctor prescribed metformin, 500 mg. in the morning for starters. I had a headache over the weekend, but it's hard to say that was whether I was stressed about starting it or something else. I did not have the unfortunate gastrointestinal symptoms people tend to have, but on the other hand, we're starting with a low dose. I don't think it's the extended release type. I've also felt a bit more tired than I had been feeling, getting out there and exercising has been a little more challenging, but I know those are other side effects, so I'm just pushing through it.

Weekly Weigh-in: -28 pounds!

Yeay!!! I've lost over 10% of my starting weight!!!

And, hurrah! I survived the family Michigan trip! I lost 3 pounds and I had as good of control as possible over the numbers. I didn't keep up with my exercise routine, but I was generally active. I didn't eat to plan, but I did skip the obvious offenders and kept my choices low-carb in general. I probably ought to have had more veggies. My splurges: lots of sugar-free popsicles, one double White Castle with middle bun removed, half of a Villa Bakery pizza roll. My only regret is not having stopped in at Uncle Ray's in Fenton for a memorial scoop: the founder, Uncle Ray himself, passed away last month. Especially since I was good and did not drink what I really wanted: a margarita. I stuck to one and a half servings of wine. I felt a little bitter about that (grumble, grumble, how come everyone ELSE gets to drink and eat what they damn well please, grumble grumble), but my sister-in-law's mom was there, and she's diabetic, and she was a poignant reminder of the trouble I'll have if I don't do my best now to get things under control.

Said sister-in-law lent me a fleece jacket (Eddie Bauer, XXL) that she said she doesn't fit anymore (it's too big) and that she also said she had lent to her pregnant sister (who isn't exactly petite either). I like the jacket, but it was a little discouraging to think that I was receiving someone else's "too big" hand-me-downs. It reminded me of how far I have to go, and it seemed to lessen how far I've come already. I know that totally was not her intention, though; she just wanted a good home to a favorite jacket. On the other hand, I know the cost of her struggle with weight & health issues, so I'd better live up to my intention and do the opposite: I now hereby choose to look at it as an inspiration: "she did it; so can I!"

Weekly weigh-in: -25 pounds!

Hurrah! I'm down to 240, only 5 pounds more than when I went back to being a desk jockey 3 years ago. I wish I'd taken measurements at the beginning, but I'm down about an inch all over in the past month. Average weight loss has been 2.8 pounds/week.

My long term goal? 143 pounds.
My medium-term goals? Break 200 by end of the year, be "overweight" instead of "obese" by 2/2/2009 (my 41st birthday).
My short-term goal? Survive our family trip without going crazy!!!

I'm a little worried about our Michigan trip. I know everyone will be supportive, there is always plenty to eat, but I'm worried more about (1) keeping up with my exercising and (2) getting quality food and (3) being without my food scale. (Heh, I guess I'm just worried about everything! ;-)

Here's the game plan:

1. Be okay with maintaining rather than obsessed with losing. As long as I haven't gained, I'm ahead of all our other Michigan trips by at least 5 pounds.
2. Pack and use the exercise tapes if it's too hot to exercise outdoors. Try to exercise before shower time. OK to skip Wednesday and Saturday, do not skip Monday if our flight leaves in the afternoon.
3. Keep as active as possible. If there's a choice between sitting or standing, take standing, and add fidgeting.
4. Insist on going to the grocery store for stocking up on food I need. Cottage cheese for breakfast will be fine, need "veggie tray" veggies at minimum (broccoli, carrots, celery), apples, and Triskets for when I need a whole grain alternative for starch.
5. Pack the flax!
6. Portion-wise, err on the side of smaller, except regarding veggies. I'm sure Mom P has some measuring cups.

"Someday" is Now: Part of the Explanation

I saw a figure cited on the FAQ for alt.support.diabetes that blew me away. Was it true? I researched it and found the following quote in the document "Type 2 Diabetes Risk After Gestational Diabetes," produced by the National Diabetes Education Program:

"After pregnancy, 5 to 10 percent of women who had GDM are found to have type 2
diabetes. Women who have had GDM have a 20 to 50 percent chance of developing diabetes in
the next 5 to 10 years following pregnancy.(1, 2)"

References:
1. National Institute of Diabetes and Digestive and Kidney Diseases: National diabetes statistics fact sheet: general information and national estimates on diabetes in the United States, 2005. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, 2005.
2. American Diabetes Association: Gestational diabetes mellitus (Position statement). Diabetes Care 2004; 27(Suppl. 1): S88-S90.

Whoa. Would it have made a difference in how I've lived the past four years? Hard to say, really. I think part of me wanted to deny diabetes. I got rid of all the paraphernalia once I was declared "in the clear." I should not only have gotten a post-breastfeeding food plan, but have monitored things now and then over the years.

Instead, I let myself climb up to 265 lbs. I was one of the unusual people who lost weight during pregnancy, and my post-second child weight was 210 lbs. I could kick myself for not trying harder to maintain that weight. Now I'm having to battle it down again. On the plus side, I'm down to 242 lbs (-23 lbs!). I still have a looooooong way to go, but it's a good start.

As I expected, the diabetes educator is recommending that I start a medication to help control my numbers. My post-meal numbers are within range, but my fasting are out of line. Looking at the average over the past month, my a1c numbers are going to be a lot better the next time I get that checked. Speaking of fasting, I tested my husband's fasting blood glucose this morning. 86! He's overweight, too, but does not have the family history. He's been on a low carb diet since his visit to the cardiologist a few months ago, the doctor said he's probably sensitive to carbs. We both started taking calcium supplements then, and with the extra vitamin D, I wonder if that was a catalyst in my "awakening" to the fact that I didn't want to be so friggin' huge anymore.