Old diabetic guy: diet and exercise observations

[coldfront]

this is going to be long.  so you all might want to grab an iced tea...  but this post is about my health journey, especially over the past year.  it will cover being diagnosed diabetic, going on and off insulin... and some of the things I've figured out around the process.

so...


mid-October 2020, I called an ambulance and asked them to come get me and take me to the hospital.  I'd been feeling horrible and really didn't feel like I could safely drive the TWO MILES to the hospital.

Going in I knew I was dealing with high blood pressure, extremely overweight.  So far, all heart checks, circulatory checks were good.  no indications of disease.  At any rate, the hospital identified my A1C (blood glucose metric) as >14.  the scale only goes to 14.  My actual blood sugar levels were about 450 when I checked in.  As a result my kidneys and endocrine system had been doing everything they could to restore order.  I was dumping glucose as fast as possible (urinating a lot)... and my body had gone into something called diabetic ketoacidosis.  if my pancreas could of packed a bag and walked out I'm sure it would've...

spent the next 5 days in ICU where we worked on restoring electrolytes and reducing blood glucose.  then spent another 4 days 'on the floor' as we took it further down.  I took the opportunity to work with my nurses (asked if I could give myself the insulin shots - figuring might as well learn with teachers in the room, right?)...

discharged and headed home... where I was giving myself 5 shots a day.  morning and evening was for something called Tuojeo? a long acting insulin.  and then a shot of the fast acting insulin before every meal.  all through this I was sticking myself to monitor blood glucose every few hours.  and of course CHARTING the results.  from this I learned quickly what foods elevated my insulin levels and those that didn't. 


Healthy foods like bananas and apples?  shot me through the roof.   I could tolerate ONE orange every few days.  and strawberries every few days.  Bread, even whole grain breads, were not good.  pasta, rice (brown rice):  nope.  potatoes?  definitely not.

salad.  broccoli.  green beans... green vegetables were pretty good.  corn?  uh uh.
lean meats like sirloin?  great.  salmon?  eggs?  bacon?  absolutely.  Interestingly enough, of all the proteins, chicken seems to produce and insulin spike (not much, but some).

along with learning WHICH foods were better for me, I also began to understand 'how much':  too much of even the right things can/does elevate blood glucose.

so then, along about mid-December, just 2 months later, I finally was able to get in to see my endocrinologist who did a COMPLETE blood panel work up.  HEre's what we found:1.  A1C was already down to 9.  it takes 90 days for red blood cells to regenerate/fully replace in our blood, so it was already coming down.  (one year later my 1AC was 5.1)
2.  I had ZERO thyroid activity.  so checked it out for potential tumor (that's clean/clear).  my thyroid is 'rough/bumpy' (not smooth, silky like it's supposed to be) and I was diagnosed as having something known as Hashimoto's disease.  one potential driver of it?  gluten sensitivity.  fun diagnosis as someone of German descent,who's worked on wheat farms or in bakeries my entire life (approaching 60 years) and LOVES bread... this was, well, less than appreciated. 


so I left the endocrinologists office with a change in prescription:
1.  sythentic thyroid (oral pill taken first thing in morning, at least 30 minutes before meal or other meds)
2.  two forms of diabetic meds:  Synjardy RX (oral pill taken once/day) and Ozempic - a self-administered once/week shot.
the other really cool and amazing tool I was given was a Freestyle Libre 2 Continuous Glucose Monitor (CGM).  basically a probe that sticks into the back of your arm subcutaneously and measures SERUM sugar (it's not blood sugar, but it's highly correlated, just delayed from actual blood levels).  this gave me REAL TIME response to blood sugar levels and really linked foods to response.

I set my goals to try and keep my blood sugar below 100 ... and have been very successful with this really watching what I eat.  Breads, breaded products?  not very often and then not much at all.  98% of the time I'm between 70 and 100.  after 'being bad' (breakfast of eggs, greens and TOAST) I can/will spike up to 130, maybe 140 if I use small amounts of jam.  but I usually am back down under 100 within an hour of spiking.

I am diabetic.  Most importantly:  I am insulin sensitive.  that will never change.  It's like, for me, being a drug addict or an alchoholic.  but the things that I have to manage?  food.  the stuff that keeps us alive.  and is an important part of socialization (dinner, dates, thanksgiving, etc)


So here's the keys that I've learned for myself, about myself (and this should be expected to vary for you or anyone else).
1.  Trying to keep my total daily calories below 1500.  that's tough to do with a 3-meal approach.  I've gone to two meals a day, or at times one meal a day (OMAD).  also working with the concept of intermittent fasting:  when eating twice a day, trying to get it done within a 6-8 hour window.
2.  lean meats, eggs, fish, nuts and green vegetables like broccoli, asparagus, brussel sprouts, spring greens are my primary foods.  red onions (help with inflammation reduction), garlic, mushrooms...  most vegetables are steamed, but also great when grilled.  I do supplement at times with carrots and celery as well.
3.  real fats.  butter, avocado, nuts (mostly almond) are my sources.  Salmon.
4.  water.  white tea (brewed at home, then iced). no juice.
5.  sodas:  no really good diet versions out there.  but the ones I tolerate?  diet coke (with spicy foods).  dt dr pepper.  diet mountan dew.  I try to drink these sparingly ...
6.  EXERCISE:  I have goals.  But before I can run, I have to walk (and loose more weight).  started out walking one mile a day.  that was hard on an old fat guy.  kept at it.  occasionally taking a week off to recuperate... (as an ex highschool, collegiate athlete, this is/was hard.  MORE TRAINING and WORK HARDER is deeply ingrained, but older 'rubber bands' don't work like young 'rubber bands' used to...)  have been able to get up to 7 miles/day ... in about 2 hours of walking with hills.  have yet to be able to get and maintain a 35 mile or more total for a week.  body just gets too sore and eventually I have to take a longer break.  but progress is still being made.  of note through this?  the CGM has helped me understand how much exercise really helps keep blood glucose levels down.  ON average, about 10 units lower with consistent exercise.  also, that exercising later in day, evening is more effective at keeping glucose levels lower than doing if 'first thing in the morning'.  currently, I'm experimenting with trying to break up my 'miles' with half in the morning and half in the evening...


I do have personal goals.  most related to weight.  I have a target in mind that when I get to 'point A' I'll start incorporating some running into my walks.  when I get to 'point B' I'll look to add strength training back....  and the over-arching 'stretch goal' is to be back down to what we will just call 'high school' weight.  Since I'm 2 inches taller and over 40 years older... that just might be a stretch... but without goals, how do you ever get where you're going?

so, if you're a guy carrying abdomial fat (beer gut), maybe seeing things like skin tags (neck, armpits, etc)... starting to pee pretty frequently... and seeing your 1AC numbers hitting 6 and over... your doc is talking to you about type 2 diabetes already, is my guess. 


for me?  just my docs direction/advice wasn't as helpful to me as working with my endocrinologist.  Up until I really understood what was driving my condition, the only solutions I knew were to exercise MORE and eat LESS.  that's a piece of it...  but without my continuous glucose monitor, or worse, regular finger sticks and blood glucose checks... it was like trying to find my way around the house without electricity... I was working in the dark.

so, in terms of 'tale of the tape'.  I lost an average of 12 lbs/month for first year.  then hit a plateau which I'm currently on and trying to figure a way through.  Right now I'm 6 2 and 265lbs.  40 inch waist.18.5 inch neck.  Point 'b' for me is 200#.  as hard as it's been for the past year, the next part of the journey will be harder and require even more focus on my part.

my hope is that some of you might see some similarities in yourselves as I've shared my experiences.  it's a tough world and the foods we eat and have eaten for our lives aren't always the right foods for us as we age.  even though they taste great and are our 'comfort' places.

man do I miss home-made chicken and noodles over garlic mashed potatoes...with home-baked crusty bread fresh out of oven...  but on my current exercise, dietary approach?  I can probably indulge (and over-indulge) once a year.  something like thanksgiving?


Hope you all had a great Thanksgiving and looking forward to a wonderful Christmas.  Every day is a gift and those days with friends and family are blessings.  Count 'em.

[Donald Garner]

CF, tks for sharing this with us.  Good luck with your plan I hope you're able to reach the goal you've set for yourself.  Keep us updated on your progress.

[Champriderz]

I had a similar though thankfully a milder version of your story about twelve years ago and though I have an ongoing battle between food and A1C I will have made it to eighty years old in a few days.  It ain't fun but so long as you remember that if it tastes good spit it out you can' have it you can do it.

[D.W. Verts]

Wow CF, what a tremendous post. Keep up the due diligence, sir.

Dale

[coldfront]

ran across this the other day... it's a pretty good recap of how I eat.  don't get caught up in the whole 'keto' thing...  occasionally pause the video and look at the foods mentioned.  also pay attention to calories but especially TIMING of eating...

huge paradigm shifts for an old farm kid.

it's pretty much where I've gravitated and found myself....  some really good foods to eat in there...  but the 'really good stuff' like cookies, cakes, candy bars... COKE, DR PEPPER... and LEMONADE?  not in there.  dang. it.

[Oldfart9999]

Good info CF, congrats on getting the weight down and sugar down. I'm type 2, still "woops" the finger, I've lost 50 lbs over the years. Folks that have diabetes and need injections for joint pain have a double whammy, injections can spike sugar, it's what happens to me. Knowledge is key, learning what you can eat and when and exercise needed can make keeping it under control easier and a bit less painful.
Rodney 

[coldfront]

thanks Rodney.

after a lifetime of poor choices, I'm just in the beginning phases of 'getting my crap' together.  solutions to challenges get a lot easier when the root causes are identified.  makes the strategy crisp, clean and effective.

getting my mind around what it is to be 'insulin sensitive' and a few other pieces seems to have unlocked this for me.  like I said, prior to this?  it was all about feeling pretty disgusted, frustrated:  after all, being fat is just an issue with laziness, lack of will-power.

or so it seems ... even to my general practice doc.

he's on this journey with me as well.  younger 'kid' (they all are now it seems).  but just tossing metformin and/or insulin at the issue works on the symptoms, but does nothing for the underlying, root drivers...

some of this sucks.  a good bit of it is a real paradigm shift in my lifestyle.  none of these things are bad.  and they're all easily 'do-able'.   have to say this though:  as a single guy?  has to be much easier for me than if I were trying to do this with a wife/kids... 

[Ice Cold Peanuts]

Wow. Sobering thread. I can identify with much you've stated. I'm impressed with how you've met this challenge head on. Good luck and I hope to hear your success story when you meet your goals. Will be thinking of you. Scott

[coldfront]

Wow. Sobering thread. I can identify with much you've stated. I'm impressed with how you've met this challenge head on. Good luck and I hope to hear your success story when you meet your goals. Will be thinking of you. Scott

thanks scott.  life tosses challenges at all of us.  for me they're always best met head on and with a smile on my face.  most importantly, wanted to share this experience as I suspect many will see some similarities. 

solutions are not easy.  but they're not that hard either.  and having been through this, knowing how my family, friends were... and how my doctor (general practictioner) approached it:  not as helpful as it could have been.  stuff like NOOM, and GOLO, and promoters of KETO diet all kind of chip around the outside a bit.  but until it gets PERSONAL it's hard to really connect the dots.

the human body is an absolutely amazingly resilient, capable organism.  I don't have to tell anyone on here who has been in the Services...  the stuff 'average' guys do, are trained to do?  doesn't matter if they're in the olympics or not, that's WORLD CLASS stuff that gets done.  physically and mentally.


this is not that hard.  I lead and have a very blessed life.  this is just one more of those great opportunities in life that have been presented to me.  some of these opportunities came evident as I worked through my health issues.  and were supported as I worked with my parents through the past year.  I was learning from Dad up until the day he passed.  Continue that learning from my mom.  Great folks who have tried to live their lives as great people.  Not much in terms of money, but they always showed me that true wealth is family.  friends. 

i thought long and hard about this and decided if my experience could help anyone, it needed to be shared. 

[coldfront]

don't always get or stay keeping 'on' a thread.  but when it rolls back around, I add to it.
update... now two-plus years into this journey.

Last June I got a gym membership.  they had an outdoor pool and I used to swim a bit as a kid.  so started going every day.  first few weeks just getting to 500 meters in the hour I could reserve a lane was 'enough' (okay, more than enough).  I did have a goal to be able to swim 1000 meters (20 laps; one lap is up/back) without stopping.  by September I had made pretty good progress and was able to turn 3000 meters in an hour.  in that, I could string together 1500 to 2000 meters without stopping.  then I'd do 100 meter pieces until I hit the final total.  really hadn't thought I'd make it that far.  when I totaled up the total meters I swam last summer *June to mid-Sep* and converted to miles, I was closing in on 150.   the goal for this summer will be to be able to hit 4000 meters in an hour.  that's going to be, frankly, pretty tough for me.  But it's do-able.  maybe.

once water temps got too cold (4th time I sat at home shivering for an hour after swimming, I said 'enough') I moved inside.  to the weights and stationary bike (for the cardio/HIIT).

started easy, lifting light weights, doing relatively higher reps... knew I needed time not just for muscles but tendons and ligaments to stretch, strengthen.  it's been a journey of constant 'pain management', but continued to this day.  I am now spending 2.5 hours/day in the gym with the first 1.5 hours on the weights.

for weights, I've focused, targeted


abdominals:  huge lower back issues that drive muscle spasms.  have seen significant improvement in lower back health, mobility.  EVERY day starts off with 100 crunches (machine)


hamstrings:  had been seeing some knee pain, challenges on stairs and know first place to stabilize knees is the hamstrings.  the quads, rest of that comes along just fine.  (if you study the guys who work on increasing vertical leap/dunk capability, they really target the hamstrings).  that's paid off extremely well too.

then it was on to the usual beach muscle stuff:  bench press, behind the neck military press, lat pull downs, standing barbell frenchcurls, curls and a few other targeted exercises to round out some of the muscle shapes.

then it's on to a stationary bike where my approach combines cardio (elevated heart rate) with Intervals.  Basically, it's a 7 minute timed piece with resistance that elevates every 1 minute...  key for me is to keep my pedal rate at mid-90.  typically first rep I'm in the low 90 pedal rate and elevate through each of the 6 pieces until on the last one, my pedal rate average for the 7 minutes is at/close to 100.  between each bike 'piece' I walk two laps around the gym.  this keeps my heart rate up 'some' and also allows different stretch/range of motion to help move some of the lactic acid out of the muscles.  to do the 6 'reps' takes me 60 minutes.

on my smart watch, heart rate monitor, it looks like this:


this does get my heart rate 'up there'.  typically, in the 130-150 range.

I do this EVERY day.  just finished up a 21 day stretch... before I skipped a day.


as I type this, my rotator cuffs are complaining.  but I'm pushing through gently... as I warm up in the work, the mobility is there and the pain dissipates.


some might ask:  why the bike?  it's because before I went 'into the pool' I had been walking, added hills.  was at 7 miles in about 2 hours.  then my hip started screaming at me.  Docs said 'hip replacement'.  I went to the pool to work on strengthing muscles around the joint, flexibility.  get a base back... then to the bike for even more strength.  hip is definitely feeling better now and process seems to be working.

trying to figure out the next 'step' which would implement weights into a lower body regime on top of what I'm already doing.  things like lunges, squats...  maybe.

it's a process.  helps to have goals.

as for efficacy?
just got back from my doc.
A1c = 5.2Blood Pressure = 124/80weight =260 (height 6-2)
starting to see shoulders, clavicles again.  it'll be YEARS, if ever, for me to see abdominals...  but I am setting that goal of what I want to be as an 80 year old geezer.

sounds like a lot as I type this.  yeah, maybe so.  but it didn't happen overnight.  and frankly, as the rest of the key responsibilities in my life have fallen off (husband, full-time father) I now have the time to focus, stick to this. 


but the benefits?  gonna be a lot easier this summer when I have to set on a 10lb hydrilla gorilla and pull her out from 30 yards away...  and I don't expect to get tired on those multi-day trips out on the water. 


I am OCD to a degree.  I love 'process' and have a high tolerance for repetition.  even so, it would be boring BUT within the 'same daily routine' there are constant opportunities to 'do more'.  reps, weight, etc.

all of this is 'building the blocks' for my life after work.  when I am finally able to put down the day to day 'job' responsibilities and just get on with living and enjoying the time left.

[coldfront]

something else, that continous glucose monitor has been a real life-changer for me.

as I added the weights, and more higher intensity activities, I'd actually see blood sugar spikes.  seems when doing certain types/levels of exercise, the liver can dump glucose into the blood stream.
just kept at it... and NOW after a little over 4 months into the weights/bike, my blood sugar levels are pretty flat most of the time.  usually running in the 75 - 85 range.  (72 last doc check for fasting glucose).

with the increase in activity, I've also found that I was 'bonking':  running out of energy.  so I have started adding back carbohydrates in a meal about 2 hours prior to the gym.  usually that is in the form of strawberries or canteloupe.  two fruits that don't just totally jack up my blood sugar.  it's been a long dang time since I enjoyed BREAD.  even longer on pasta.  I can NOT imagine how difficult if not impossible this becomes if I'm married, have a family.  trying to ask others to 'eat like I need to eat' would be wrong.

it is what it is.  a guy just does what needs doing.

[Donald Garner]

CF, tks for the update.  Appreciated you sharing this with us. 

[Oldfart9999]

CF, congrats on getting your numbers down, it certainly does take hard work. I'm type 2 and had everything under control until I started needing surgeries and PT last year killed my numbers right now I'm running between 150- 200 for sugar readings, lack of exercise. Once I can get going in the gym again I'll be on the stairmaster and rebuilding my strength, because of my joints I'll be using machines instead of free-weights. Keep up the good work.
Rodney

[coldfront]

CF, congrats on getting your numbers down, it certainly does take hard work. I'm type 2 and had everything under control until I started needing surgeries and PT last year killed my numbers right now I'm running between 150- 200 for sugar readings, lack of exercise. Once I can get going in the gym again I'll be on the stairmaster and rebuilding my strength, because of my joints I'll be using machines instead of free-weights. Keep up the good work.
Rodney

rodney:  don't overlook the importance of your hamstrings to overall knee/joint health.  can be really critical to stable, as pain-free as possible, knees...

[Mike Cork]

First congratulations on all your success, I know how hard it is to make adjustments.

Wow, just now getting to this read. Reading through your OP I found myself relating in a say 1/4 of the seriousness or danger level. I am having serious trouble with my A1C, while I'm staying on the chart I've registered above 10 and my blood sugar levels over 300. That combined with my inoperative thyroid all combines to days that I feel. When I say feel, I know when I blow it and either forget my thyroid meds or sugar gets to high because I feel like I have 1000 pounds on my lap and just simply don't want to do anything for lack of energy. I've had days where I simply sat in the bottom of the boat and couldn't muster the energy to get up and fish.

Sadly it took my loss of fishing desire to take my doctor seriously. I'm lucky, with Trulicity, Metformin and Synthroid, along with seriously managing my diet (exactly as you describe in your OP) I'm well within numbers and they say I will survive.

I only weigh 200 pounds and dropping, doc wants me at 180. I haven't weighed 180 since I was 15 LOL but at a pound a week I'll be there in no time... Good thing I love vegetables LOL Bad thing is I have two 12 year old boys in the house that require a ton of snacking options that are not healthy...

[coldfront]

mike, the idea for me is not to 'crow' about my progress.  I've made good strides.  but know I have a lot more to go...  that's what goals, specifically stretch goals, are for.

my hope was that by sharing a LOT of the details that others could, might, find similarities in their situation and possibly help clarify a path.

one aspect of this is the concept of 'food as medicine'. 



I've also found along the way, and thinking back through my life, that a lot of what I've 'gotten' as doctor's advice, while following 'standard science' wasn't necessarily as helpful for me as it could have been.  much of what I've heard through my life has been '...work harder, exercise more and eat less...'

those are parts of what I am doing... but in all things, it's the little stuff that makes a whole world of difference.

who better understands this than guys who obsess over details of trying to 'successfully' chase those little green fish?

[D.W. Verts]

Anyone want a laugh? I'm doing some yoga. It's good my the mind AND body. And it hurts.

Dale

[coldfront]

Anyone want a laugh? I'm doing some yoga. It's good my the mind AND body. And it hurts.

Dale

must be doing it right.
now... Verts in yoga pants... gotta be a youtube video on that!  probably go viral...  give ole ginger billy a run for his money...

[Smallie_Stalker]

Anyone want a laugh? I'm doing some yoga. It's good my the mind AND body. And it hurts.

Dale

must be doing it right.
now... Verts in yoga pants... gotta be a youtube video on that!  probably go viral...  give ole ginger billy a run for his money...

"Verts in yoga pants"

Thanks Kurt. That's an image I can't gouge out of my minds eye. Just not enough therapy in the world.......

Sent from my SM-S908U using Tapatalk

[D.W. Verts]

You know, you share a secret with a few "friends"...

Dale