Type 2 Diabetes: I Got This

Several years ago I took my daughter to her first high school dance. She was going to meet her girl friend at the dance. She didn't have a date, she was to young for that as far as I was concerned, but she did want to go to the dance because she thought it would be fun. As we got in the car and headed down the street I asked her if she had this and that, trying to make sure she had everything. She seemed a little tense. Finally she told me in a tone that let me know I was bugging her, "I got this." So, I stopped asking.

A few quiet minutes later and a little further down the road my daughter blurts out, "I don't have my ticket. I left it in my bedroom. We have to go back."

So much for, "I got this." Ever since that day when my daughter tells me, "I got this" I tell her,
"That's what I'm worried about."

About a week ago, I was in the grocery store and saw someone that I have known for close to thirty years. We were not close, but someone I used to see almost daily and now only run into once or twice a year. She has type 2 diabetes.

Back when she was first diagnosed over ten years ago she told me one day how she came to find out she had type 2 diabetes. She told me she was on vacation and developed an infection on her big toe. The infection worsened and would not heal no matter what she did. The doctor she went to apparently suspected diabetes as wounds many times do not heal as they should when you have diabetes. He is the one that diagnosed her diabetes. Unfortunately, for my friend however, her toe was so badly infected it could not be saved and was amputated shortly after her diagnosis. Apparently she had diabetes for a while without knowing it. There are many, many people, an estimated five million people that have diabetes today and don't yet know it.

So, you are wondering, what does that have to do with taking your daughter to a dance and her forgetting her ticket? Remember when I said I was asking my daughter questions in the car trying to make sure she had not forgotten anything and she said, "Dad, I got this?" and then several minutes later she blurted out. "Dad, I forgot my ticket". Well, I guess to put it bluntly, no she hadn't "Got this." But she certainly thought she did.

Similarly, when my friend told me she had developed type 2 diabetes, and particularly when it had progressed to the point of her needing to have her big toe removed, I emphasized the need for her to attend a comprehensive diabetes class to learn more about the illness and how to take care of herself. After all she already had one toe removed, which is no small consequence of having diabetes. In spite of my strong encouragement to get education, the response I got was very similar to my daughter's "I got this", or "I know what to do". After hearing her response I tried again to convince her but my comments fell on deaf ears. She wasn't really deaf but you know what I mean.

Last week when I saw her at the grocery store, she was heavier than I had ever seen her. She was in a motorized cart. She didn't look good to me. I didn't approach her because I didn't want to rehash her situation or all that had gone wrong since our talk many years ago. I just felt sad and highly frustrated.

Why is it that when someone that knows about diabetes and how it can ravage the human body when not understood and cared for, recommends to someone that they seek education about the disease so they can take better care of themselve, they refuse to do so. So often they rely on a friend they know with the disease and choose to get advice from them, a terrible idea. There is a tremendous amount of misinformation out there. Often they will tell me that they read a book about diabetes or heard a TV doctor talk for ten minutes about it, or was told by their doctor just to "watch it". What on earth does that mean? What is the patient supposed to watch? They don't know what to watch because they never got educated about diabetes!

I feel myself getting excited now so I will stop. I feel sad for my friend but at the same time aggravated at her for not doing what I suggested, because she doesn't look healthy. Remaining overweight is one of the worst things to do when you have diabetes.

The worst thing about this situation is that it happens so frequently. Perhaps you yourself have type 2 diabetes and have been putting off attending a class about the disease. Do yourself a favor, a tremendous favor, and attend a ten hour comprehensive diabetes class where the instructors are Certified Diabetes Educators. It will change your life, for the better.

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

New Emphasis On Resistance Training For People With Type 2 Diabetes

There is renewed interest in resistance training for people that have type 2 diabetes. It is not just about aerobic (or cardio as people often refer to it) exercise any longer. More and more research is showing that performing resistance exercises two to three times per week can be just as beneficial as doing aerobic exercise for people with type 2 diabetes.

For at least the last couple of decades, or more, performing resistance training (hereafter referred to as RT) was considered taboo for many people with type 2 diabetes because of the potential risk of aggravating a preexisting blood pressure problem, thereby increasing all of the health risks associated with high blood pressure.To the contrary, RT in some form or another is now encouraged by The American College of Sports Medicine for patients with type 2 diabetes as long as their blood pressure is normal or they have high blood pressure that is under good control. In addition, it is assumed that the patient has the approval from their doctor to do RT and that there are no other contraindications.

In regards to the blood pressure, however, the key point to make here is that the blood pressure needs to be well controlled before engaging in RT. If the blood pressure is not well controlled that is when serious health problems are likely to arise.

In fact, it is well known by many healthcare professionals, that patients with controlled hypertension that properly perform RT on a regular basis can actually improve their resting and sub-maximal blood pressure as well as reduce some, or sometimes all, of their hypertensive medications.

The latest guidelines from the American College of Sports Medicine and American Diabetes Association recommend that RT be included as part of a well balanced exercise program that also includes aerobic exercise and stretching. The frequency of the RT should be three times per week if possible.

RT is often thought to be lifting barbells or dumbbells or using "the machines", but these are just two methods of doing RT. Stretch cords will provide resistance when stretched and are used often in exercise classes. If you have used stretch cords before and found that the resistance provided by the cords became too easy after a while and seemed of little benefit after a while, all you need to do is go to a cord that provides greater resistance or use two cords instead of one. Properly used, stretch cords should work for just about anybody, even those with plenty of muscles.

Another option is getting in a pool, lake or other large body of water (the bath tube does not count), and using the resistance that the water provides to strengthen your muscles. Keep in mind that the slower you move a body part through the water, the less the resistance, whereas the more rapidly you move through the water the greater the resistance.

The most important thing to remember here is that if you have high blood pressure that you make sure it is under good control before you begin doing RT. Secondly, select a type of resistance training that works best for you.

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Milt has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

What Researchers May Say About Diabetes, Obesity And Heart Disease

Someday, many, many years from now, long after the epidemic of type 2 diabetes has settled in and further ravaged our already struggling healthcare system, anthropologists and other social scientists will search for clues as to why highly educated populations such as the United States, Europe, and those elsewhere, succumbed to such an illness. Particularly in light of all that we know about what usually causes type 2 diabetes and how to best treat it.

Someday, again after I am long gone, I foresee a headline on the front page of the local paper, oh no wait, we probably won't have newspapers then, probably news updates will only appear on our pesonal informational devices, commonly referred to as PID's (I made that word up, but I think it will certainly catch on). Anyway the headline will read, "Thumb size my be best predicter of longevity." The article will say something like this:

Researchers from an online university, have discovered that the size of the thumb bones of men and women living in the early 21st century is inversely proportional to the size of the muscle mass in their thighs.

Thumb size was also found to be highly correlated with longevity. The study conducted by a group of  scientists from The Silicon Valley Virtual University (hereafter referred to as SVVU) looked at both men and women between 25 and 50 years of age that died of obesity, type 2 diabetes or heart disease between 2060 and 2070.

Radioactive isotope studies and basically looking through a high powered microscope revealed that the thumb bone that is connected to the wrist bone which is connected to the arm bone, was more dense and contained a higher mineral content than persons born 100 years earlier.

Furthermore, evaluation of the thumb's surrounding musculature revealed a statistical significant 52% increase in size of the muscles that flex and extend the thumb. Dr. Tom Thomas Thomason, lead researcher of the study was quoted as saying, "We are puzzled by the findings at the moment but will enlist the support of the world's best minds and try to make sense of what we have found."

Off the record, Dr. Thomason said that once all of the data is looked at carefully by everyone involved, he believes that the present theory that anyone with a larger than usual thumb is caused by adolescent sucking of the thumb will be debunked in favor of a newly emerging  theory that larger thumbs are now the result of evolutionary changes adapting to the increasing reliance on remote control devices in the 21st century such as remotes for the garage door, remotes for the television, remotes to lock and unlock the car, video game controllers, and  texting.

In response to the high repetitive nature of texting and the use of video controllers muscles controlling the thumb(s) must become stronger and have greater endurance. We have uncovered some unpublished data that indicates the average male and female of high school age texts an aveage of 50-100 times per day. This places a tremendous overlod on the flexion and extension muscles of the thumb.

Additionally, with all of the time spent using remote control devices for gaming and to make physical jobs easier, people in the early 21st century became far less active. It is my belief that this has led to the increase in death due to obesity, heart disease and diabetes.

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

What Is It Going to Take to Get Exercise On An Even Keel With Diet For People With Type 2 Diabetes?

There is no doubt that when you have type 2 diabetes everything you put in your mouth is going to have some effect on your blood glucose levels. We first and foremost think about the carbohydrates or sugar we eat, however, in addition to that we have to take into consideration the effect proteins and fats have as well. An excess ingestion of protein is likely going to raise blood glucose levels. A moderate to heavy consumption of fats in a meal will slow down the rate at which glucose leaves the stomach and enters the blood. Without a doubt nutrition plays a tremendous role in the successful management of type 2 diabetes. The same is true for type 1 diabetes as insulin infusion into the body needs to basically match the amount of carbs consumed, however, for the time being I am going to limit my comments to type 2's.

Increased physical activity (I just go ahead and call it what it is, exercise) and maintaining a normal body weight, usually referred to as making positive "lifestyle choices", has been cited repeatedly as central to preventing and/or controlling prediabetes and diabetes. The problem with this is it seems not enough people with type 2 diabetes are heeding this advice, and healthcare professionals such as doctors, nurses and Certified Diabetes Educators are not explaining the need for exercise in strong enough terms.

Patients newly diagnosed with diabetes commonly realize the need for eating better, which in their minds means eating less carbohydrates even if they don't recognize the need for reducing their fat intake and losing some weight, but they don't often see the relationship between having diabetes and the increased need for exercise. It has been my experience that when patients are willing to make a change in their lives to better manage their diabetes it usually has to do with limiting the number of carbohydrates they consume, not increasing their activity level.

Limiting carbohydrates is a good start but not at all likely to be enough to effectively manage type 2 diabetes long term. It's only half of the equation, only part of the solution. Exercise is vitally necessary, as well as limiting carbs, because as more and more beta cells cease to function and less insulin is produced, carbohydrate intake will out of necessity need to be at a bare minimum, which still may not allow for good management of blood glucose levels.

It is my contention that healthcare providers, including physicians, nurse practitioners, and diabetes educators need to impress upon their patients with type 2 diabetes that getting regular, almost daily exercise, is equally as important as watching what they eat. Not only that, we need to take the time to explain to patients the latest exercise guidelines established by the American Diabetes Association. If patients express concern about whether or not they can perform exercise due to a health condition, every effort should be made to help the patient problem solve their situation so that some form of exercise is possible. Exercise is to valuable a treatment for patients to simply dismiss it due to a medical problem.

I believe healthcare providers need to make the need for exercise more clear to patients with type 2 diabetes and go the extra step in recommending current exercise guidelines.

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Milt has been teaching people with diabetes about the disease and how to care for it for the last 19 years. Visit Milt's other website at: http://www.MasteringType2Diabetes.com

Which Is Most Important - Eating Less Carbs Or Getting Exercise?

Not long ago I wrote an article about type 2 diabetes stressing the need for exercise. This is not at all uncommon for me as I strongly believe (based on my observations and 18 years of experience teaching people about their diabetes) that performing daily exercise is the most important thing most people can do to best manage their disease. Now, undoubtedly, there are going to be skeptics out there that say it's all about how many carbs you eat.

Well, the number of carbs you eat does have a lot to do with good blood sugar management I wholeheartedly agree, but it is shortsighted to say that it is all about carbs because it is not. If in fact someone has some really excessive habits such as drinking a liter of coke a day, or putting away a bag of Oreos before bed at night, or even drinking a half gallon of chocolate milk, or orange juice daily, then the most important and quickest thing that they can do to improve their diabetes is to eliminate those habits.

But for you folks that are healthy enough, and have your doctor's blessing, I challenge you to try adding exercise into your diabetes treatment mix, at least 5 days a week, gradually building up to thirty minutes a day. As for those of you that are already getting some exercise, but have not observed any benefit,it may just not be enough and you may want to consider doing more.

In all but the rarest of circumstances, adding exercise to the treatment plan for managing type 2 diabetes will have a substantial positive impact on maintaining good blood glucose control.

After all, putting less fuel in the tank (sugar in the blood) is good, but performing regular exercise and using as many muscles as you can, as often as you can, enables you to use the gas in the tank (reduce the amount of sugar in the blood). Eating less carbs is only half the solution to good blood glucose management, the other half is getting more physically active.

Remember, getting exercise should not be unpleasant. It should not hurt, it should not be something that you dread. Believe it or not you will actually start to miss it on the days you don't get to do it. I know that is hard to believe but it is so true.

To get started try this. Simply replace something that you do that is inactive (watching a rerun of a sitcom, doing a crossword puzzle, etc.) with something that is active (watering the plants in the yard, sweeping the porch, taking the dog or cat for a walk, or giving your pet a bath (an extra bath never hurt anyone as far as I know). As time goes on, build from there.

And by all means, forget the no pain, no gain foolishness. For the vast majority of people in the world pushing to the point of feeling pain is totally unnecessary.

Now get started... please.

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

The C-Peptide Blood Test And How It Could Save Your Life

Do you believe that there is one simple blood test that could prevent a person from developing type 2 diabetes? Well, there is. It is called a C-Peptide blood test and will give you an idea as to how much insulin you make. If the results indicate there are above normal amounts of insulin circulating in your blood, this may be a sign that your body has become resistant to the effects of insulin, thereby causing your pancreas to start overproducing insulin to compensate. The idea here is that if a normal amount of insulin can't get the job done then maybe more will.

You see before insulin is insulin, it is proinsulin, a long chain of carbon atoms with various attachments. When this long chain is cleaved into two shorter chains, one half of the resulting chain is called a C-peptide and the other is referred to as insulin. There should be a 1:1 ratio between the two.  By measuring the C-peptide chains in the blood you can determine the amount of insulin.

In the vast majority of those people that develop type 2 diabetes, an over production of insulin, or hyperinsulinemia, precedes the under production of insulin when blood sugar levels begin to rise, eventually reaching abnormally high levels characteristic of type 2 diabetes.

It is realistic to believe that if elevated levels of insulin in the blood, hyperinsulinemia, could be identified sometime before the insulin producing beta cells begin to fatigue and stop working, and steps could be taken to reduce insulin levels in the blood to more normal levels, then maybe the development of type 2 diabetes could be diverted.

It can justifiably be argued that everybody should have a C-Peptide test at regular intervals to see if they are elevated. If so, patients could be counseled early as to how they may modify risk factors (their lifestyle) such that the progression to type 2 diabetes may be halted. Once my patients learn the pathophysiology of their diabetes, many are quick to ask why they never had a C-peptide performed, thinking as I have just written, “If I had known I was developing a problem maybe I could have done something about it before so many of my beta cells quit working and now have diabetes which I can never get rid of.”  

Consider that two major studies, the Da Quang study and the Finnish study both demonstrated that with appropriate lifestyle interventions over half of the participants studied that were on their way to developing type 2 diabetes had their blood sugar levels drop back into the normal ranges.

I encourage people that have family members or close blood relatives with type 2 diabetes to ask their doctors to perform a C-Peptide blood test every so often to see if insulin levels are elevated. I also encourage people that are somewhat overweight (even as little as 10-15 pounds) and get little to no exercise request this simple blood test from their doctor.

I am not being dramatic when I say it may provide the “heads up” that could save your life.

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

Exercise Helps Get The Rust Off Type 2's Rusty Hinges

Years ago, actually many,many years ago, I used to get out in the yard with my dad and we would do yard work together, pretty much ever Saturday. I remember those days well, and I learned a lot from my dad over the years. Back then as I learned how to take care of the lawn, little did I realize one thing he taught me I would later use when teaching my patients about diabetes.

I remember late in the afternoon on Saturdays, after the mowing and edging was done, my dad and I would settle down in the front yard with a trash can between us and start pulling weeds. I always got such satisfaction seeing how I uncovered some healthy St. Augustine grass after removing the weeds that covered it. I remember every so often my dad would look over at me and emind me to make sure I was getting the root of the weed when I pulled it. Otherwise he said the weed would grow back.

It is well known that insulin resistance, what I like to call "rusty hinges," is what leads to type 2 diabetes in most cases. With type 2 diabetes nutritin plays a very important role. Because people with type 2 diabetes have a much harder time getting sugar out of their blood and into their muscle, fat and liver cells, they would be wise to put less sugar in the blood to begin with. This of course means  there would be less sugar to remove from the blood. Although over time, consuming less sugar is likely to contribute to weight loss, which in turn will reduce insulin resistance, eating less sugar is something people with diabetes have to do since they cannot make adequate amounts of insulin. In time with more and more beta cells becoming dysfunctional less sugar can be consumed or more medication will be needed to keep blood sugar levels reasonably well controlled. Unfortunately, eating less sugar doesn't deal with the root of the problem, insulin resistance, exercise does. Exercise directly deals with the root of the problem, insulin resistance, or "rusty hinges". Everytime someone with type 2 diabetes exercises, in a sense, it's as if they are sanding the rust off of the hinges and then spraying them with WD-40. Exercise directly deals with the root of the problem, insulin resistamce, like no other treatment.  For many people with type 2 diabetes exercise is the most important thing they can do to manage their diabetes.

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

Exercises To Help Diabetes

I frequently get asked the question,"What is the best exercise for people with type 2 diabetes?"

I then ask the class, "What do you all think is the best exercise for people with diabetes?"

Depending on how much time I have in class that day, I usually let them discuss it for a while.

Then I ask, " Well, what do you think?"

"Walking, oh yeh, it's the best," somebody answers.

"Swimming is better," someone else says, "It doesn't hurt my knees like walking does."

"How about riding a bike?" somebody asks from the back of the room wanting her view to be heard.

"The best exercise is the one you like the most or the one you are able to do," I tell them.

In most cases it doesn't matter what exercise you do, but how often you do the exercise. Far too often a patient will tell me they walked all over the park or the zoo or rode bikes for two hours on Sunday, not to get any more exercise for the next three or four days. That is absolutely no good and of minimal to no value. Exercise, regardless of what exercise, needs to be performed on a regular basis to be of any significant value. I will revisit this in a moment.

As to the exercises that will help diabetes the most, all exercises have their pros and cons. As an example, walking burns more calories in thirty minutes than swimming because walking is weight bearing and swimming is not. Does that make walking a better exercise? No, it simply means that walking burns more calories than swimming. Swimming on the other hand uses muscles in both the upper and lower body. As I said, every exercise has its pros and cons.

People should choose exercises that are the most fun to do or that they enjoy.

For those people that are not too fond of exercise they should do the exercise they dislike the least.

Getting back to the frequency of exercise. The latest guidelines suggest that all adults should exercise a minimum of 150 minutes per week with no more than two days between exercise sessions. The length of time can be divided up a variety of ways with the key being not to overload yourself on any one day. Exercise can be performed twice in one day doing 15 minutes in the morning and 15 minutes in the evening if that makes it any easier to accomplish. The important thing is to get it done, REGULARLY.

Always check with your doctor first and let him/her know what you intend to do. Never exercise when you are sick or right after a meal as this puts an extra strain on your heart.

Have you ever heard the expression "Slow and regular win the race?" It's new, try it.

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

Prevent Prediabetes From Becoming Type 2 Diabetes

Depending on who's statistics you are looking at, there are almost three times as many people with pre-diabetes as those with type 2 diabetes.

The general concensus is that there are about 26 million people with type 2 diabetes, approximately 19 million that know it and another 6-7 million that do not. This means that there are a whopping 72 million with pre-diabetes, those with fasting blood sugar levels greater than 100mg/dl. but less than 126mg/dl. Normal blood sugar levels are less than 100mg/dl. first thing in the morning before eating.

What is so very unfortunate, is that the vast majority of the 72 million people with pre-diabetes will end up developing type 2 diabetes in the not to distant future. And although type 2 diabetes is highly treatable, it is not curable, and these newly diagnosed type 2's will have it for the rest of their lives. In spite of what you may read or hear, type 2 diabetes is not reversible or curable even with weight loss. It is only better managed.

As a certified diabetes educator for the last 18 years, what frustrates me most, is that in the majority of  cases of pre-diabetes, particularly those with an early diagnosis, developing on to type 2 diabetes is preventable. This is worth repeating. If those people with pre-diabetes make some serious lifestyle changes immediately, then the development of type 2 diabetes may be prevented.  

People with pre-diabetes need to be told at the time of their diagnosis, rather emphatically, what they need to do to lessen their chances of eventually developing type 2 diabetes. Instructions need to be given. Referrals need to be made. The seriousness of the diagnosis needs to be conveyed to the newly diagnosed patient. The patient needs to know that they may be able to avoid diabetes if they do this, this and this.

Newly diagnosed pre-diabetes patients need to seek instruction on how much exercise to engage in, how to improve meal planning, and how much weight needs to be lost. Taking this advice and acting on it quickly is likely to mean the difference in developing diabetes or not. 

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

Insulin Resistance, Pre-Diabetes, Then Type 2 Diabetes, In that Order

Insulin resistance is the cause of type 2 diabetes about 80 percent of the time. There are two known causes of insulin resistance: being overweight and leading a sedentary lifestyle.  There is no clear evidence that one of these conditions is more harmful than the other or is more responsible for insulin resistance. What is very clear though is that being overweight, even if only 10 pounds or more, and getting little exercise, causes insulin resistance and can ultimately lead to type 2 diabetes.
Now can the insulin-resistant overweight person decrease his or her insulin resistance by losing some weight even if not getting any exercise? Most definitely, no doubt about it.

Generally speaking, in cases where the patient is overweight, weight loss is routinely recommended as a first line treatment for type 2 diabetes. Sometimes simply eating better such as more nutritious foods and less junk food is enough to cause weight loss. When patients can do this it is wonderful, however, research shows that maintaining the weight loss for an extended period of time without simultaneously performing exercise is very, very difficult. As you probably well know the lost weight usually comes back within one to two years after losing it.

What if a person with insulin resistance starts exercising regularly but fails to lose any weight? Is the exercise beneficial? Has it helped? Yes it has, it definitely has, no mistake about it. Exercise will lower insulin resistance even if no weight has been lost. (Are you beginning to see why exercise is such a big deal?) Perhaps the person didn't lose any weight because they made up for the calories burned during exercise by eating more. Maybe the person did lose some fat but gained muscle mass equal in weight to the amount of fat lost. The scale would show no change in weight even though the percentage of body fat had been reduced. Hence, using traditional bathroom scales is a big drawback when measuring exercise/diet success.

Anyway, my point is this, that exercise can and does reduce insulin resistance even without weight loss. So when I do encourage exercise it is primarily to reduce insulin resistance and secondarily to promote weight loss. If weight loss does occur as a result of starting to exercise or exercising more, then you can expect even greater improvements in insulin resistance.

I do want to make it clear that when I recommended exercise to a patient, it is first and foremost to help in reducing insulin resistance, secondarily it is to assist a patient in their weight loss efforts. Research has repeatedly shown that exercise by itself is not likely to result in sustained weight loss. Similarly, research has also shown that diet plans that significantly restrict caloric intake are not successful for long-term weight loss when carried out exclusive of exercise. The best chance for long-term success with weight loss is to gradually work up to exercising a minimum of 250 minutes per week and to reduce caloric intake.

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

How Do You Reduce, Improve Or Eliminate Insulin Resistance?

In recent articles I have referred to insulin resistance and how it leads to type 2 diabetes about 80 percent of the time. There are two known causes of insulin resistance: being overweight and leading a sedentary lifestyle.  There is no clear evidence that one of these conditions is more harmful than the other or is more responsible for insulin resistance.

What is very clear though is that being overweight, even if only 10 pounds or more, and getting little exercise, causes insulin resistance and can ultimately lead to type 2 diabetes.
Now can the insulin-resistant overweight person decrease his or her insulin resistance by losing some weight even if not getting any exercise? Most definitely, no doubt about it.

Generally speaking, in cases where the patient is overweight, weight loss is routinely recommended as a first line treatment for type 2 diabetes. Sometimes simply eating better such as more nutritious foods and less junk food is enough to cause weight loss. When patients can do this it is wonderful, however, research shows that maintaining the weight loss for an extended period of time without simultaneously performing exercise is very, very difficult. As you probably well know the lost weight usually comes back within one to two years after losing it.

What if a person with insulin resistance starts exercising regularly but fails to lose any weight? Is the exercise beneficial? Has it helped? Yes it has, it definitely has, no mistake about it. Exercise will lower insulin resistance even if no weight has been lost. (Are you beginning to see why exercise is such a big deal?) Perhaps the person didn't lose any weight because they made up for the calories burned during exercise by eating more. Maybe the person did lose some fat but gained muscle mass equal in weight to the amount of fat lost. The scale would show no change in weight even though the percentage of body fat had been reduced. Hence, using traditional bathroom scales is a big drawback when measuring exercise/diet success.

Anyway, my point is, that exercise can and does reduce insulin resistance even without weight loss. So when I do encourage exercise it is primarily to reduce insulin resistance and secondarily to promote weight loss.

If weight loss does occur as a result of starting to exercise or exercising more, then you can expect even greater improvements in insulin resistance.

I do want to make it clear that when I recommended exercise to a patient, it is first and foremost to help in reducing insulin resistance, secondarily it is to assist a patient in their weight loss efforts. Research has repeatedly shown that exercise by itself is not likely to result in sustained weight loss. Similarly, research has also shown that diet plans that significantly restrict caloric intake are not successful for long-term weight loss when carried out exclusive of exercise. The best chance for long-term success with weight loss is to gradually work up to exercising a minimum of 250 minutes per week and to reduce caloric intake.

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

Could Your Favorite Restaurant Be Partially Responsible For You Developing Diabetes?

It is my favorite restaurant; well actually, you may call it a fast food restaurant. I don't think of it as that because what I eat there is healthy, really. In my estimation it is the best of the bunch, fast food restaurants that is. But like everything in life, it has its drawbacks, and peculiarities as well. As an example, the sandwich I eat is grilled, not fried. The fried chicken sandwich is quite tasty but contains considerably more fat than the grilled chicken sandwich. This is what puzzles me, I would think that the chicken that is grilled would be less expensive than the one that is fried but it's not. I guess this is one of those things about the restaurant business that I am naïve about. Of course I have learned over the years that eating healthy is usually more expensive than not.
              
Now for the real drawback, the real reason I am writing this post. At the restaurant that I frequently visit the folks at the counter are exceptionally pleasant, well groomed and almost always greet me with a smile.

They have obviously been well schooled in customer service. They have that down pat. But what I didn't know, never having been in the restaurant business, is that their training doesn't stop with customer service. It goes beyond that to include marketing. And I'm guessing that marketing is as big a part of their training as customer service. So big in fact that if an employee is not heard repeating the proper phrases to customers often enough it is likely to come back to haunt them at evaluation time.

Do not underestimate these folks behind the counter because they know what they are doing (at least the ones at this establishment). I used to think that when I was asked, " Would you like to make that a meal by adding fries for only ... more?" they were just being helpful, informing me that I could get a bigger, more satisfying meal for only a little bit more, and that it was a better deal for me. Or when they said, "Would you like to add a dessert to that for only a dollar more?" they were being nice, as if to say, "You look like you could use a delicious dessert today." No, no, no, no, boy was I wrong. How could I have been so naïve? Apparently it's all about the bottom line. Asking these questions may mean the difference in the restaurant having a so-so month versus a profitable month.

Sadly, I must admit I have walked into this restaurant, knowing what I was going to order, a chicken sandwich and drink, and been asked, "Would you like to add fries to that today?" and I answered, "Yes". Just like that. It was that easy. And all they had to do was ask. I was swayed, influenced, and that is all it took. I didn't need those fries. That's way too much grease for me and usually leaves me feeling uncomfortably full the rest of the afternoon. Then quietly, so silently no one could even hear me but me, I called myself a wimp.

Now you may be thinking, "Hey, that's not so bad, particularly if you only do it once in a while". Well, you are probably right, at least in my case, for now. I am reasonably fit and still more lean than fat.

But for the customer trying so hard to do better with their eating this makes it very, very tough. Perhaps they are desperately trying to lose weight because they have high blood pressure or a heart condition. Maybe they have been diagnosed as having the metabolic syndrome or pre-diabetes, or even worse, type 2 diabetes, all of which would benefit greatly from weight loss. These people may struggle with their self-discipline as it relates to food on a daily basis. Just by asking these folks if they would like fries, or a cookie, or to "super size," may weaken their resolve sufficiently enough to result in them caving in to the temptation. It doesn't take much and restaurants know that. Heck, it happened to me.

What about the customer that responds, "Not today, I'm trying to lose some of this weight" and the girl at the counter replies, "Oh, but it's Friday, one day's not going to hurt you." That in my mind is a tremendous disservice.

It is such a shame that, in this case, what is good for the restaurant's bottom line is not in the customers best interest, or more blatantly put, bad for the customer.

This is not an example of a win, win situation by any means.

Companies have to make money and the more the better as long as others don't begin to suffer because of it. But in this case, customers pay for it, twice, not just in dollars and cents but in the adverse effects the extra, usually unnecessary food has on their bodies.

I will continue to frequent this restaurant, because overall I consider it a very nice place that has always treated me well. But next time I am asked if I want fries or a cookie to go with my sandwich, without hesitation, I will say, "No thank you."

I encourage you to do the same. You'll thank yourself for it sooner than you think.

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

Type 2 Diabetes: Painless Finger Pricking......Really!

Checking your blood sugar should not be painful.....at all. It should not hurt and it should not leave a mark on your finger. In fact I tell my patients that when they gently (that's a hint) place the lancing device next to their finger and press the trigger, they should hear the click of the device firing and the thought should go through their head, "Hmm, I didn't really feel that, I wonder if I missed? I mean that. You should never feel the need to flinch,wince or even whine. But everyday I see people with marks and small bruises all over the tips of their fingers. No need for that.

This is what you do. Try to always poke your 4th or 5th finger on either hand. Make sure your hand is warm. Cold hands do not bleed well at all. Clean your finger. Alcohol swabs are fine but make sure all of the alcohol evaporates before you poke it. Then drop your hand between your knees and shake it vigorously. This will ensure that the alcohol evaporates and draw blood down to your fingertips. The next step is to squeeze the base of the finger you plan on poking and gradually, making circular motions, work the blood towards the tip of your finger. Then adjust your lancing device halfway between the lowest and highest (deepest) setting. Now you are ready to actually poke yourself. Gently, very gently, touch the lancing device against your finger, slightly to the side of center. Press the release button on the lancing device and then take the device away from your finger. If you have done a good job no blood will be visable, yet. But, give the base of your finger a little squeeze and viola! Here comes the blood. If you have done a good job you will not be able to find where you have poked yourself in an hour.

You can find this tip as well as other valuable information in my book entitled: Prescription for Type 2 Diabetes: Exercise

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

What’s Wrong With You When You Have Type 2 Diabetes? All Of The Why Questions Answered Simply

When you have type 2 diabetes what exactly is wrong with you?

You blood sugar levels are too high.

Why?

Because you don’t make enough insulin

Why?

Because a lot of the beta cells in your pancreas don’t work anymore.

Why not?

Because they were overworked, became exhausted and died.

Why were they overworked?

Because the doors to the muscle, fat and liver cells do not open as easily as they should, the beta cells decide to help out by making more insulin to help in getting the doors to the cells open so that the sugar can leave the blood stream and enter the cells.

Why do the doors to the cells become hard to open?

There are two big reasons. Both are equally important. One reason is being overweight. The second reason is not getting enough exercise.

 In summary, the two biggest reasons most people develop type 2 diabetes is because they have a bit too much fat on their bodies and they do not get enough exercise. 

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

The Argument For Weight Loss When You Have Type 2 Diabetes

 Weight loss for people with type 2 diabetes can literally be a life saver. This is such an important statement that it deserves repeating. (Actually it is something that I should probably scream into the streets) If you have type 2 diabetes losing weight can save your life. And just in case there is still any confusion about what I wrote above, one last time. If you have type 2 diabetes and are even a little bit overweight, then losing weight can be of tremendous help to you. The more you weigh the more you should lose, ideally. But if you are overweight, even if you can lose only a portion of what you weigh, and you try and try, and that is still the best you can do, it is still a lot better than not losing any. Your beta cells (the little cells in your pancreas that make insulin) will love you for it because they won’t have to work as hard trying to make as much insulin.

 Remember, if you weigh less you need less insulin. This is a good thing because when you have type 2 diabetes you can’t make as much insulin as you are supposed to because many of your beta cells have stopped working.

If the beta cells don’t have to work as hard because you weigh less then the remaining beta cells, those still working, may last longer. 

 If you really are motivated to see a big improvement in your diabetes management, then if you believe you are overweight, try to lose at least some of it. Your efforts will be rewarded.

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.



Muscle mass is important when you have type 2 diabetes.

For years and years aerobic exercise (or cardio) as people tend to refer to it lately, was considered to be the best type of exercise for someone with type 2 diabetes. In many cases resistance exercise such as lifting weights has been downplayed or discouraged, possibly because of the fear that resistance training may aggravate or increase the risk of retinapathy, hypertension or other cardiovascular problems.

As we continue to research the effects of exercise on diabetes, increasing evidence shows that contrary to earlier beliefs resistance training is not only OK for most people with type 2 diabetes but something that should be an integral part of their exercise program. A blend of aerobic and resistance training is likely to maintain or improve cardiovascular conditioning and increase muscle mass.

Until recently the need for increasing muscle mass has apparently been overlooked. It is important to make clear here that skeletal muscle extracts more sugar from the blood than any other organ. The more muscle mass there is, the more sugar can be extracted from the blood.

Certainly, physician approval is advised before taking on any new exercise program, however, once approved it is generally recommended to involve all of the major muscle groups 2-3 times per week when doing resistance exercise.

Exercise gets the rust off type 2's "rusty hinges"

Years ago, actually many,many years ago, I used to get out in the yard with my dad and we would do yard work together, pretty much ever Saturday. I remember those days well, and I learned a lot from my dad over the years. Back then as I learned how to take care of the lawn, little did I realize one thing he taught me I would later use when teaching my patients about diabetes.

I remember late in the afternoon on Saturdays, after the mowing and edging was done, my dad and I would settle down in the front yard with a trash can between us and start pulling weeds. I always got such satisfaction seeing how I uncovered some healthy St. Augustine grass after removing the weeds that covered it. I remember every so often my dad would look over at me and emind me to make sure I was getting the root of the weed when I pulled it. Otherwise he said the weed would grow back.

It is well known that insulin resistance, what I like to call "rusty hinges," is what leads to type 2 diabetes in most cases. With type 2 diabetes nutritin plays a very important role. Because people with type 2 diabetes have a much harder time getting sugar out of their blood and into their muscle, fat and liver cells, they would be wise to put less sugar in the blood to begin with. This of course means  there would be less sugar to remove from the blood. Although over time, consuming less sugar is likely to contribute to weight loss, which in turn will reduce insulin resistance, eating less sugar is something people with diabetes have to do since they cannot make adequate amounts of insulin. In time with more and more beta cells becoming dysfunctional less sugar can be consumed or more medication will be needed to keep blood sugar levels reasonably well controlled. Unfortunately, eating less sugar doesn't deal with the root of the problem, insulin resistance, exercise does. Exercise directly deals with the root of the problem, insulin resistance, or "rusty hinges". Everytime someone with type 2 diabetes exercises, in a sense, it's as if they are sanding the rust off of the hinges and then spraying them with WD-40. Exercise directly deals with the root of the problem, insulin resistamce, like no other treatment.  For many people with type 2 diabetes exercise is the most important thing they can do to manage their diabetes.

The Absolute BEST Exercise!

The absolute BEST exercise you can do when you have type 2 exercise is something we discuss in my class every week. Then generally after several minutes of discussion, or arguing, depending on the class, I will tell them the answer. The absolute very best exercise............is the one you like the most and/or willing to do. I tell my patients that I don't care what exercise they do, as long as they do it and do it regularly. Pretty much all exercises have their good points and their weak points. Consider walking and swimming, two strong candidates for best exercise. Walking burns more calories in 30 minutes than swimming, however walking uses mostly only the muscles in the lower body which is a major drawback.

Swimming, although burning less calories in 30 minutes than walking, uses all of the major muscle groups all over the body. Which exercise is better? They are both very good. By far what is most important is just to do the exercise. By selecting an activity that you like, even though it may have it's drawbacks,  you will increase the odds of you getting your exercise in each day. Think about it.

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

What To Do At The Airport: Exercise

I am at the airport waiting to board my plane. My conference is now over and I'm heading back home.

I'm not even home yet and I have a major monumental goal to achieve between now and when I come to this convention next year, to see how many people with type 2 diabetes I can get to exercise, more than they are doing now, on a regular basis. I don't want to leave my goal open ended but I need to determine a number I am looking for.

I need to sit down with a calculator when I get home, but with all of the people who I come in contact with, I am thinking somewhere around 1,200 people.

When I accomplish that goal I will be thrilled, because I will know that I have significantly, positively influenced these people's lives in a way that will help them lead healthier, longer and far more productive lives.

Please let me know if I have or can help you.

Try this the next time you have to fly. After going through security and getting to the right concourse, instead of going straight to one of the food, snack or Starbucks locations to load up on something you probably don't need but are willing to eat to pass the time, stop, and think.

Make a smart choice. You are about to be on a plane, sitting, doing nothing for at least an hour, but probably more like two, three, or maybe even four. WHAT YOU need to do is walk the concourse for 10 minutes before you get a snack and wait for your plane.

THE BEST choice would be to walk for at least ten minutes and not snack. Ask yourself do you REALLY need it or would you just be eating it to help pass the time. You can easily consume 600-800 calories while sitting, snacking and waiting for your plane. Choose the healthy alternative, GRAB a bottled water and walk the concourse until you have finished it.      

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.

How You Got Diabetes: This Is WhereThe Story Begins . . .

Think back to the day you were diagnosed with diabetes. For the purposes of explanation, let’s say you were diagnosed June 1st 2006. Now go back five years before that. That puts us at June 1st 2001. This is when it all started, where the story begins.

I think it was a Tuesday. Let’s say when you woke up that morning your blood sugar level was a healthy 75mg/dl., a completely normal reading. Remember, Mg/dl represents milligrams per deciliter. Now you eat your breakfast. You had a bagel with cream cheese and a large glass of milk. Bagels are virtually all carbohydrate, or sugar, all of which will enter your blood stream after digestion. There is little to no sugar in the cream cheese; it is mostly fat with some protein. The milk contains sugar, protein and fat, all of which will enter the bloodstream.

So far, so good, everything is normal. As soon as the sugar from the meal starts getting into the bloodstream a message from the blood is sent to the beta cells in the pancreas telling them to get busy and start making insulin. The beta cells respond and start making the necessary insulin. The insulin is transported from the beta cells to a major blood vessel where the insulin enters the bloodstream. Upon entry into the blood, the insulin molecules grab hold of some sugar.

Once the sugar is firmly in the insulin’s grasp, the insulin molecule carries the sugar to a muscle, fat or liver cell. Upon arrival at the cell, in this case a muscle cell in the right thigh, the insulin looks for a convenient door to open so it can escort the sugar inside.

After a suitable door is found the insulin knocks on the door and asks permission to bring the sugar inside.

“Yes, by all means, please, open the door and come in. I have been expecting you,” says the small voice coming from inside the cell.

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.NewlyDiagnosedDiabetes.com.