Tuesday, March 07, 2006

Lab results

Here it is a month gone already and I haven't posted anything. I was never much of one for journals.

I got the results of the lab work from my last checkup two weeks ago:

Blood Sugar:
Fasting - 130
A1C - 6.4

Cholesterol:
Total - 159
HDL - 43
LDL - 90
Trigl - 130

Blood Pressure:
129/80

I am very pleased with the results. In addition, I feel at least ten years younger (which is to say I probably feel like my actual 43, and not like an old geezer).

My weight is down to 264. That's a forty pound loss since August of 2005. I'm beginning to see my next goal of 250 on the horizon. If everything goes like it's been going, I should get there by mid to late summer.

Exercise is probably the single most important factor to which I can attribute this improvement. I now get a forty-minute workout on the treadmill on a regular basis. A few of those minutes are spent actually jogging these days. After I work on the treadmill I do some pushups. I can only do about ten at a time. I do three sets of ten with about a minute rest in between.

BG readings at night are quite good. Last night it was 112. Of course, this morning it was 121.

I remain...

Mr. Dawn Phenomenon.

Tuesday, February 07, 2006

Exercise

The one thing which has had the greatest benefit to me on the diabetes battlefront is exercise. I am amazed and impressed with the results of adding exercise to my lifestyle. Here are some important things I am learning about exercise:

1. The results are immediate. I can drop my blood glucose as much as 60 points after a thirty minute workout. I have measured before and after results on several occasions and post-exercise BG levels are always significantly lower.

2. The results are long lasing. BG levels stay reasonable even two or three days after a workout, provided I don't stray too much in my food choices.

3. It improves many other aspects of my life. I sleep better. I am more alert during the day. I feel more motivated to work. I'm just in a better mood overall.

Of course we've all had it drummed into us how beneficial exercise is for years. The problem is getting started. For someone like me who hates to exercise it is difficult work. I think I've discovered the reason why so many people like me have trouble getting started on an exercise program. We're told by health and fitness professionals that we have to get so many minutes of exercise per day. The numbers seem to vary from expert to expert (30 minutes per day; 150 minutes per week; etc.), but whatever number they give out, they fail to explain that this is an ideal number.

You see, if you tell a person like me that I need to get 30 minutes per day of exercise, then I immediately picture this stopwatch in my head, and begin dreading the drudgery of trying to fill the next 30 minutes with some sort of exercise. This is no way to start an exercise program.

I've tried starting exercise programs like this in the past and they've all failed. Even now, despite seeing the benefits of exercise; despite the feeling it gives me afterwards; I am still reluctant to get started. So, what I do is this: I tell myself that I'm just going to exercise for ten minutes. Generally, after ten minutes, I realize that I'm enjoying myself more, and so I try to go another five minutes. This process continues every few minutes until I finally reach 30 minutes. These days I'm inclined to continue up to forty minutes or more.

Another thing that helps is feedback. I was skeptical about buying a treadmill, but I didn't want any excuses for not walking when it was cold this winter, so I went shopping for one. I found a friend who wanted to sell his. I've had it since November and I can honestly say that it is one of the best purchases I've ever made. And the reason it I like it so much is feedback.

What do I mean by feedback? To understand this, you need to know something about my treadmill. It displays speed, distance, heart rate, incline, and calories burned. This feedback is important to gauge how you are doing, but it serves another purpose in this way: Let's say you've walked for twenty minutes. You look down and see that you've gone nine tenths of a mile. Well, gosh, why stop at twenty minutes when you just have a little ways to go to reach one mile? So you keep going to one mile. At that point, you look down and see that you've burned 127 calories. I'm not sure how accurate the calorie meter is, but nevertheless, if you just stay on a short time longer you can make it 130 calories. So you keep walking until 130 calories pops up. Then you notice, you've been on the treadmill for about 24 minutes. Well, heck, might as well make it an even 25, right? Now add in the factor that you're listening to music while you're walking. So you reach 25 minutes and the current song is only half through. Why not keep going until the song finishes? By the time the song has finished you look down and notice that you've gone 1.42 miles. Gee, if you stay on just a little longer you can make it an even 1.5 miles...

You can see how if you continue this process of response to feedback that what started as a ten or twenty minute workout can easily become a longer thirty or forty minute workout.

I'm going to talk more about exercise in future posts.

Wednesday, February 01, 2006

Supplements, etc.

Aw, heck! Now I've been mentioned on Diabetes Mine, so I guess I better write something.

Recent interesting diabetes news:

Most of you have probably already heard that the brain plays a significant part in BG control, but in case you haven't...

More evidence that genetics is involved in diabetics.

As important as finding a cure is, so are advances in treatment to repair damage.



Supplements
My experience with supplements can be summed up in two words: "mostly harmless". I have tried a number of things: chromium picolinate, cinnamon, fenugreek. None of these supplements have appeared to have any effect on my BG numbers.

One thing that does seem to help some is ginseng. I have tried both the Siberian and American variety. I take a 550mg tablet right after a meal along with my metformin. It seems to lower my BG a few points (ten or so), as compared to times when I take the metformin alone.

In fact, the only thing that has a significant positive effect on my BG (apart from diet) is exercise. That will be the subject of a future post.

At least supplements are (relatively) cheap, easy to find, and mostly harmless.

Tuesday, December 27, 2005

My Approach to Diet

Today's news is related to the topic of this post: New Findings on Low-Glycemic-Load Diets for Weight Loss.





Any doubts anyone might have about whether my low-carb approach to controlling my blood sugars was effective were dispelled over the Christmas holiday.

Things were going very, very well for me; in fact I even got a couple of below-100 BG readings prior to December 17th. That Saturday, my father came down for a visit, and he and I made Zeppoli di Natale (Italian Christmas rolls). From that point to now, I've over-indulged in the constant stream of zeppoli, cookies, peanut brittle, etc, as well as more breads and pastas. The result: blood sugars have sky-rocketed.

Contributing to the problem was the fact that I haven't been exercising as regularly. But with Christmas over, I'm ready to get back on the wagon. This morning I tossed out the few remaining zeppoli, stuck to oatmeal and coffee for breakfast, and went with a salad and bit of moussaka for lunch. Tonight it will be another salad for supper, followed by 25 minutes on the treadmill.

I have trouble believing that people can keep their blood sugar in control with a high-carb diet. Perhaps some people do. After all, we are all very different, and I must keep in mind that this is a very individualistic disease. Still, the evidence that high carbohydrates contribute to high blood sugar is overwhelming.

I have been overweight for most of my life, but I can mark the point at which I ballooned to one hundred pounds overweight as coincidental with following the advice offered in the book "The T-Factor Diet", which was all the rage in 1992. The author, Martin Katahn, PhD, claimed that carbohydrates did not make one fat, and that diets high in complex carbohydrates (especially high in fiber) were thinning. If I could get my hands on Dr. Katahn, I'd beat the crap out of him.

Reading his book led me to eat breads, pastas, rice, potatoes, and even sugar with wild abandon. Instead of losing weight, I put on the extra fifty pounds which probably led to the development of my diabetes. A diet high in carbohydrates, for me, is out of the question.

Since getting serious with my diabetes, my diet has changed in the following ways:

1.The most hi-carb food I eat is probably oatmeal. Although fairly high in carbohydrates, it is also high in fiber, and does not seem to raise my BG very much.

2.I mostly avoid six foods: bread, potatoes, rice, pasta, milk, and sugar. Occasionally, I will eat small amounts of these foods (bread in a sandwich; potato in the above-mentioned moussaka, a small serving of pasta and sauce), but for the most part I treat these foods as poison.

3.I have added much larger portions of vegetables to my meals. Especially prevalent these days are lettuce, cabbage, cauliflower, broccoli, cucumbers (and related pickles and zucchini), and squash.

4.I have put in larger portions of meat of all types, yet avoid breaded meats.

5.Since cholesterol is not a problem for me, I use copious amounts of butter in my oatmeal and on my vegetables, and do not avoid fat on my meats. My coffee is lightened with half and half or cream.

6.For all other foods, I examine the glycemic load (GL), and try to consume only those foods with a low GL. Apples, oranges, and carrots fit the low GL category, and make up the major portion of any snacks I have.

I have learned through trial and error that strictly following this diet makes it much easier to lower my blood sugar.

There are other advantages to this diet which should give pause to high-carb proponents. For starters I am losing weight. I now weigh 275 (down from 304). I do not crave foods which are bad for me. I am satisfied with smaller portions. My cholesterol numbers continue to improve. To those who say that such a diet is impractical or dangerous, I say nonsense, the numbers don't lie.

Thursday, December 01, 2005

Glucose meters

Today's diabetes news items I found interesting...
Test will try to fend off type 1 diabetes.
The Seattle Times reports about a treatment which may help type 1 sufferers stop or delay the progression of the disease.

Participating in aerobic routines and resistance training is as effective as medication
Macleans reports on a Canadian study which indicates that aerobic exercise and resistance training works as well as medication to control blood sugar.

Alzheimer's Could Be Diabetes-like Illness, Study Suggests.
Some intriguing research which indicates that insulin resistance in the brain is at the root of Alzheimer's disease.




There is so much I want to write about my battle with this disease it is hard to decide where to start. I finally sent in my rebate for my glucose meter today, so meters are on my mind.

There are some things about my current physician's approach to diabetes treatment which I like, and some which I do not. One of those things I dislike is his attitude towards testing. In the two years since I was diagnosed, he has never recommended that I test. On one hand he encourages me to be very proactive with my diet, and especially to exercise as much as possible, yet on the other hand he seems to expect me to be passive about tracking my condition. In the beginning, I would have agreed with this attitude. After all, I reasoned, what can you really do about a high BG reading anyway?

The fact is, you can do a lot about your BG readings through food choices, activities, etc. But the only way you can make intelligent choices is to test.

Because my doctor never recommended testing, he didn't recommend any particular tester. I didn't know much about them. Television ads are little help. They largely focus on the speed of results. This is a feature I do not understand. How much difference is there, really, between waiting five seconds for a result, and waiting seven seconds; or even ten or fifteen seconds? Are you so busy that you can actually get that much more accomplished in those two to ten seconds? Unencumbered with any predispositions or information, I shopped for a meter.

I began at my pharmacy, which is a Walgreens. They offered a number of different brands of meters. Two which interested me were on sale. One was a TrueTrack Smart System, which carried the Walgreens label, for about $17. The other was the FreeStyle for $10. I asked the pharmacist if he knew anything about them. He said that the main thing he noticed was that the FreeStyle strips were twice as much as the TrueTrack. Since my meter wasn't a prescription, I could see that the cost of strips would be a major expense. Even though the TrueTrack meter was more expensive, it seemed smart to purchase it, and save money in the long run on test strips.

I took the Walgreens meter home, and followed the instructions. Setting it up was more complicated than I imagined. There was a code chip to be inserted into the meter, which had to match the code on the test strips, and then further related adjustments (the geek in me is still curious about the need for test strip codes). Then I had to go through the control solution test (the need for which did make sense). Finally, I was ready to load the lancing device and test. My first result was 130. Since it was about two hours after a rather large breakfast, I thought this looked very promising.

I decided to start a routine of testing at bedtime, and upon awakening. The first night my result was 200. The next morning it was 277 (what!). For several days my numbers would jump around all over the place, but always high numbers (200+) in the morning. Then one morning after eating nothing but salad the previous day, and exercising the previous evening, I awoke to a reading of 230. This really shook me up. I walked downstairs, somewhat in a state of shock, thinking that it just couldn't be right. I immediately went back upstairs to retest. Now, less than five minutes later, the result was 177. A 50-point drop in less than five minutes? I could only conclude that I had a defective meter.

Another thing I didn't like about the Walgreens meter was that I frequently had to re-test. Even after lancing, and squeezing out a drop of blood large enough to fill a bucket, the meter would often fail. This required re-lancing (OUCH!), more blood, a new test strip… I began to wonder if I was really saving money after all.

I returned to Walgreens to purchase the FreeStyle. It was still on sale for $10, but next to it was the FreeStyle Flash. This promised a free data cable and software, plus it was smaller. Even though it was $74, it came with a $40 rebate. It also claimed to require the smallest blood sample on the market. Even though it was expensive, with more expensive test strips, I was compelled to buy it.

I liked the FreeStyle Flash almost right away. First of all, the coding thing was easier to deal with. Secondly, the lance was much less painful. Additionally, they seemed to tell the truth about the small amount of blood needed. Finally, the results I was getting seemed more realistic: while they were high, they never exceeded 200. Since I've owned it, I've tested about 60 times, and have never had to re-test once. The morning of my last doctor's visit the FreeStyle Flash pegged my FBG at 141. The test at the doctor's office came back as 140. That seems pretty accurate to me.

Here's what I learned: it pays to shop for meters. Accuracy and consistency should be the highest criteria. I have since discovered that Consumer reports rated 13 meters in their August, 2005 edition. They gave very good marks to the Onetouch, FreeStyle, Accu-Check, and BD Logic brands. The TrueTrack received the lowest marks of all the meters tested, receiving merely a "fair" rating, and was specifically marked down for consistency.

I've also learned that information about one's BG levels can really help in getting them lowered. My average has gone from about 144 to 137. This motivates me to work harder.

Tuesday, November 29, 2005

Hello, I'm Mr. Dawn Phenomenon

My life changed in October of 2003 when I was diagnosed with type 2 diabetes, though how much my life had changed didn't really dawn on me for almost another two years. At first, I was unworried about the diagnosis. With a fasting blood glucose (FBG) level of 131 and an A1C of 7.1, I was convinced that I was "barely over the line" when it came to being diabetic. This was based on the information that in years past, a person was not considered diabetic until FBG reached something like 200. My conclusion was that the doctor had made a hasty diagnosis, and that I was really pre-diabetic. If I watched what I ate, and got a little exercise, all would be well.

I felt vindicated in my attitude three months later when I returned to the doctor's office. My FBG was 85 and A1C had dropped to 6.0. I had lost about ten pounds as well. My doctor was so pleased with my progress, that he encouraged me to keep up the good work, and to come back in six months (instead of the usual three-month schedule which he keeps with most of his diabetic patients).

Six months later I was back. This time FBG was 95 and A1C still around 6, so I was told he didn't have to see me for another six months. I had, however, gained back some of the weight I had lost. I had also let my diet slip a bit, and had stopped exercising as often. At the same time I was under a lot of stress because my mother was dying of cancer. If I had known then what I know now, I would have gotten a glucose meter and started testing. My good checkups had made me complacent about the seriousness of the disease.

After another six months I returned. My mother had passed away two months prior, and I was back up to around 300 pounds. I exercised very little. My diet wasn't completely shot. I still watched what I ate, but was sneaking more high-carb foods like donuts and french fries, which I had previously avoided. My FBG was 110 and A1C was 6.5. The doctor frowned at my weight gain, but told me I didn't have to come back for another six months.

All things considered, I thought I was doing very well, but nothing could have been further from the truth. In about three months I began to have several seemingly unrelated health problems, the most troubling of which was frequent urination.

In August of 2005 I saw the doctor at my six-month checkup, and things were clearly out of control. My FBG was 154 and my A1C was 8.5. Any doubts I might have had about my diabetes were squashed: I was diabetic.

The jump in the numbers got my doctor's attention too. He prescribed metformin; 500mg twice a day after lunch and supper. He also warned that I was in serious need of exercise, and recommended that I work out about 150 minutes per week.

Progress was slow at first. It took a few weeks for the metformin to start to do its thing. Finding an exercise regimen that I liked was also difficult. I began to cut back on carbohydrates, particularly bread, potatoes, and sweets.
After about a month I began to notice a significant lessening of my appetite. It appeared that the metformin was starting to work. I also began to lose weight. I purchased a nearly-new treadmill from a friend who wanted to give it up, and started using it religiously.

Another big step I took was purchasing a glucose meter. Even though the doc had not told me to test my blood sugar, I was curious to know how I was doing. I began testing pretty frequently, trying to get an idea about what would raise my glucose, and to see how well the metformin was working.

My physician had put me back on a three-month checkup schedule. I returned in early November, 2005 to find significant improvement. FBG was 140 and A1C was 7.5. I had also lost 18 pounds. I was sent off with the encouragement to keep doing what I was doing. Most of the other health problems I was having cleared up. I felt better than I had in more than ten years.


This blog is my record of my progress with this disease. I am learning many things about my body chemistry, about nutrition, about exercise, and about this terrible affliction. One of the things I am beginning to grasp is that this disease is very individualistic. It is hard to find the right combination of controls, because what works for one person may not work for another. I think it is important for each individual diabetic to sift through the screeds of information, suggestions, and opinions to find those tidbits which are helpful. This is not easy. The process requires work and patience. I am working on my own answers and this journal is a tool to help me figure out what works for me. I am allowing others to read it and comment on it because some of the things I do or say may be of benefit to other diabetics. I know that reading about what others have tried has certainly helped me.

To many fellow diabetics, the name of my blog will make perfect sense. I frequently experience what is commonly called "dawn phenomenon". Dawn phenomenon occurs when one's fasting blood glucose reading is higher upon waking, than the previous night at bedtime. The difference for me is often 25 to 30 points. Last night, for example, at bedtime my BG was 114 (best reading I've had so far, by the way). This morning it was 140. There are a few theories about what causes such swings, but nobody seems to have a definite handle on it. Furthermore, while some physicians take it seriously enough to prescribe insulin for their patients, others, like my doctor, just shrug their shoulders at it, preferring to only monitor the A1C average. My case is more frustrating because of its inconsistency: some mornings I have it, and some mornings I do not. So far, I have not found any kind of pattern to account for it, and therefore am at a loss to counteract it.

In closing this first post, I want to touch on a topic which I think is most important. There is a lot of talk (particularly at the ADA) about "diabetes management". I would like to make it clear that I am not interested in diabetes management. I am interested in diabetes control. A mere difference in semantics, you say? Not to me. In my mind, the word "management" denotes reacting to situations which are out of one's influence. "Control", on the other hand, has a more confident connotation. It is proactive. The only way to deal effectively with this disease is to hit it head on.

Finally, it is important to have hope. That is why I will be including news about treatment and research breakthroughs on this blog. When I was diagnosed in 2003, I began researching this disease. I am convinced that within eight to ten years there will be a cure for type 1 diabetes. A cure for type 2 will soon follow. Even closer to us are advances in treatment such as non-invasive insulin delivery, non-invasive glucose monitoring, more effective medications to treat insulin resistance, and more studies on the effects of nutrients and supplements on blood glucose. About 170 million people worldwide have diabetes. If all those people were in the same country, it would be the world's eighth largest nation. The market potential alone is enough to spur tremendous amounts of research into treatments and cures. And that is good news for diabetics. Have hope, fellow sufferers, some day this scourge will end.