The 7 Step Diabetes Fitness Plan

PRAISE FOR
The 7 Step Diabetes Fitness Plan

“The important message from this book is that losing weight may not be the panacea it was once thought to be for people with type 2 diabetes. In fact, becoming fit may have a greater effect on your blood glucose control than losing weight. And only exercise seems to be able to reduce the amount of internal stomach fat that is the most dangerous kind.

“This should come as good news to the many type 2 diabetes patients who have extreme difficulty losing weight (especially when given diabetes drugs that cause weight gain) and who suffer from constant nagging from health care workers who tell them to 'just lose a little weight and your diabetes will go away'”.

“Colberg, an exercise physiologist, explains this in detail and then gives useful tips on how to work more exercise into your daily regime, how to exercise, and how to stay motivated to exercise.”

—GRETCHEN BECKER,
author of The First Year—Type 2 Diabetes
Prediabetes: What You Need to Know to Keep Diabetes Away

“The 7 Step Diabetes Fitness Plan is a must for all people with type 2 diabetes who want to take control of their disease. While the focus of the book is on exercise, it provides both an excellent review of what’s known about what causes diabetes as well as a great review of dietary and psychological factors that impact on it. Its practical program of diet and physical exercise will help everyone who has diabetes or is at risk for diabetes improve their health.”

—RICHARD S. SURWIT, PHD,
Duke University Medical Center,
author of The Mind-Body Diabetes Revolution

About the Author

The information in this book is intended to help readers make informed decisions about their health and the health of their loved ones. It is not intended to be a substitute for treatment by or the advice and care of a professional health care provider. While the author and publisher have endeavored to ensure that the information presented is accurate and up-to-date, they are not responsible for adverse effects or consequences sustained by any person using this book.

Foreword

Anne Peters, MD

MY LIFE IS devoted to taking care of people who are at risk for diabetes as well as those who already have diabetes. My patients come in all shapes and sizes, ethnicities, and ages. Some have been diagnosed recently; others have been dealing with their diabetes and its challenges for many years. I see people I can help and, sadly others whose complications from diabetes are too far advanced. Increasingly I see patients who are asking how to avoid getting diabetes and I rejoice in this trend. To be able to stop this disease before it begins is one of the joys of my life. I see overweight and sedentary middle-aged men and women who wrestle daily to change their diet and exercise habits so they won’t suffer from complications of diabetes, such as blindness or life on dialysis. On the same day that I see a fifty-six-year-old double amputee in a wheelchair, I may also see a seventy-six-year-old who’s had diabetes since the 1940s who never misses his daily four-mile walk with his dog. I know that for each and every one of these people, diabetes complications can be minimized or prevented altogether. I laid out the path to doing so in my own book, Conquering Diabetes (Hudson Street Press, 2005); now Dr. Colberg gives you a complementary route to succeeding in accomplishing these same worthy goals.

As an exercise physiologist, Dr. Colberg’s focus is more on physical activity than mine as a diabetes physician is. In fact, she is the person I turn to when I need to know more about how to treat an athlete. Having accompanied my swimmer, Gary Hall Jr., to the Sydney and Athens Olympics (and helping him win six medals, three of them gold!) I am often sought out as an expert on diabetes and exercise. But truth be told, Dr. Colberg is my expert, and now she can also be yours.

Personally, I dislike exercise. Every second I am exercising, I am thinking about how soon I can stop. My brain is engaged in a continuous conflict between my desire to quit and my commitment to stay fit. Since it is always a struggle, you’d think I’d give it up. But do you know what I hate even more than exercising? Being out of shape. I hate how I feel if I don’t exercise. And although I dislike the act of exercising, I am always glad that I’ve done it.

I am definitely not a saint about exercising regularly. There are weeks in which I can exercise only once or twice, and there are weeks, occasionally, when I go on strike because my body needs a break. But the following week I’m back to the routine. Perhaps the most valuable lesson about fitness that we can all learn from Dr. Colberg is how to fit more physical activity into our daily lives so naturally we don’t even realize we’re doing it. For example, on an average day at the clinic, I put in close to ten thousand steps just going from patient to patient—so I’m not doing as badly as I thought. When I do find time to fit in my more formal exercise routine, I’m just enhancing my fitness level that much more.

Diabetes is growing at an epidemic rate, in the United States and worldwide. According to the most recent statistics, from 2000, one out of every three children born in the United States will develop diabetes in their lifetime. This number increases to one in two if the child is Latino or African American. What’s traditionally been known as “adult-onset” diabetes is being diagnosed at younger and younger ages. If a person is diagnosed with diabetes at age twenty, that person can count on seventeen fewer years of life compared to a person without diabetes. Seventeen years. It could mean you won’t live long enough to retire, or play with your grandchildren, or celebrate your thirty-fifth wedding anniversary. Even if you get diabetes later in life, say at age sixty, nine years of your life will be lost. But the good news is that if you take good care of your diabetes, you don’t have to miss out on these and other wonderful experiences due to complications that are—and I can’t stress this enough—preventable.

So, why wait until you have diabetes—or irreversible health complications that limit your quality of life—before you do anything about it? It is no longer enough to sit back and let your physician tell you what to do. Each of us must become empowered health-care consumers. Medicine is changing rapidly, and sometimes even doctors have trouble keeping up. Many people take their health for granted until they become ill, when it is often too late for doctors to make a big difference anyway Dr. Colberg’s 7 Step Diabetes Fitness Plan will not only help those who have diabetes to live well with it, it will help those who don’t have it from developing it in the first place. It’s never too soon to take your life (and your health) into your own hands and to live well, become fit, and enjoy a longer, healthier life.

Anne Peters, MD, one of the top twenty physicians treating diabetes in America, is director of the University of Southern California clinical diabetes programs and professor at the USC Keck School of Medicine. She is also currently the physician in charge of developing the nation’s largest outreach program for community-based diabetes prevention and treatment. Her research has been published in such leading medical journals as the Journal of the American Medical Association, the Annals of Internal Medicine, the American Journal of Medicine, and Diabetes Care.

INTRODUCTION

Ignorance Is Not Bliss

AMERICANS ARE UNDENIABLY getting heavier by the minute. Maybe Lyou also find yourself lamenting about your ever-increasing body weight, but wonder if all that extra fat means that your health will invariably suffer. The answer is that it depends. Many people who put on too much fat also suffer from other health problems, including diabetes. In fact, a diabetes epidemic is currently sweeping the nation—and the world.

More than 90 percent of people developing diabetes are developing type 2 diabetes, characterized primarily by insulin resistance, or an inability of the hormone called insulin to work effectively to keep blood sugars (referred to throughout this book as blood glucose, or BG) in check. Although a minority, the people with type 1 diabetes, which is caused by their bodies’ own destruction of insulin-producing beta cells in the pancreas (essentially autoimmunity triggered by an environmental cause), can also develop an insulin-resistant state that makes their diabetes harder to control. Of late, a new type of diabetes—unofficially known as type 1.5 diabetes, or “double diabetes”—has been emerging; it has characteristics of both type 1 (autoimmunity) and type 2 (insulin resistance) diabetes, making it difficult to make an accurate initial diagnosis in all cases.

If you are reading this book, that means either diabetes or a pre-diabetic condition (characterized primarily by insulin resistance, with a closer-to-normal BG level) has already happened to you or someone you know or care about. Perhaps your doctor recently told you that you have type 2 diabetes, which is frequently diagnosed by a fasting BG level of 126 milligrams per deciliter (mg/dl) or above first thing in the morning, or perhaps your sugars have been hovering in the prediabetic range (100 to 125 mg/dl prebreakfast) as your body weight has been creeping up. You may want to blame the half-dozen glazed doughnuts or that triple-fudge sundae you just ate, instead of diabetes or predia-betes for a passing BG reading of 200 mg/dl, but you can’t. The reality is that regardless of what you eat, your BG level will never spike above 140 mg/dl if you don’t already have one of these health conditions.

A doctor may have already advised you to lose some weight to better control your BG, but is losing weight the only solution? If it is, then most people are out of luck. The reality is that only a fraction of the millions of dieters—with or without diabetes—succeed in losing weight and keeping it off permanently. Obesity and diabetes are currently overtaking our nation. Two-thirds of American adults are considered overweight or obese, and that number is rising fast, particularly among younger adults and youth, based on their body mass index (BMI).

Even more alarming is the fact that children born nowadays have a one-in-three chance of developing diabetes in their lifetime, and for many minority groups, the risk is close to a whopping 50 percent. More than 20.8 million people in the United States already have diabetes, and the projected number of Americans with diabetes by 2030 is over 30 million. That’s an overwhelming number of Americans with diabetes, and that doesn’t even include the more than 40 million insulin-resistant, prediabetic people who have a strong potential for developing it. Moreover, among the nearly 370 million cases of diabetes projected worldwide by 2030 (up from 170 million in 2000), the United States lags behind only India and China, two countries with much larger populations.

Why should you worry about diabetes?

As many as a third of the people who have diabetes don’t even know it. So, is ignorance bliss? Absolutely not, because you can’t fight back against diabetes—or even prediabetes—unless you’re aware of your condition and ready to do something about it. Having diabetes is definitely something to worry about.

Diabetes has the potential not only to rob you of, on average, more than 12 years of your life, it can also dramatically reduce your quality of life for more than 20 years. Diabetes can result in compromised physical capacity, partial limb amputations, loss of mobility, chronic pain, blindness, chronic dialysis, and heart disease. For women, the reality may be even worse: 38.5 percent of average females born in the year 2000 or later are predicted to develop diabetes; diabetes will cut short the lives of these women by 14.3 years if they are diagnosed by the age of forty and lower their quality of life for 22 of the years they do live.

Our current national health problems are irrefutably serious. In fact, the generation of Americans now being born is the first ever predicted to die before their parents. If you or your kids have diabetes, you have twice the risk of dying compared to anyone without the disease, and if you’re younger when diagnosed with diabetes (age twenty-five to forty-four), your risk is almost four times as high as your nondiabetic counterparts. Diabetes is the sixth leading cause of death in the United States, based on death certificates listing it as the cause. However, these statistics belie its significant negative impact on longevity, as many death certificates list diabetes only as a contributing cause of death; still more fail to mention it at all. For instance, if someone with diabetes dies from a heart attack, the death certificate may not even list diabetes as a cause or contributor, even though it is well documented that poor control of BG levels accelerates the blockage of coronary arteries, which leads to heart disease. A newly released study from the World Health Organization found that diabetes kills more people worldwide than was previously suspected: it is currently the cause of 3.2 million deaths per year, or 6 deaths every minute.

Heart disease is the leading cause of death in people with diabetes. In fact, if you have diabetes, you now have the same risk of having a heart attack as someone without diabetes but with known heart disease who has already had at least one coronary event. Many undiagnosed people with type 2 diabetes actually first learn of their condition shortly after having their first heart attack. It’s likely that they have already had undetected diabetes for a number of years, long enough for it to cause significant damage. Plaque buildup in the coronary arteries begins in childhood. In adulthood, the heart disease process continues, and when commonly coexisting health issues such as high blood pressure and elevated blood fats are also present, plaque formation is further accelerated. Moreover, almost three-fourths of adults with diabetes have high blood pressure (an average reading of above 130 over 90), which may or may not be effectively controlled with medications. Insulin resistance itself may be even more important to control than BG levels to reduce your risk of a heart disease.

Diabetes is also well known for its damaging effects on the eyes, kidneys, and nerves, which can significantly lower quality of life. Poorly controlled diabetes is the leading cause of new cases of blindness among adults, and proliferative diabetic retinopathy (one form of diabetic eye disease) alone causes tens of thousands of new cases of blindness each year. In addition, diabetes causes six other eye diseases, including glaucoma, cataracts, and neuropathy of the optic or eye muscle nerves. Diabetes is the leading cause of new cases of end-stage kidney disease, treatable in the short term with dialysis and in the long term only with kidney transplants. As for damage to the nervous system, 60 to 70 percent of diabetic individuals have mild to severe nerve damage, including impaired sensation (numbness) in their feet or hands, gas-troparesis (slowing of the digestion of food), carpal tunnel syndrome, hypoglycemic unawareness (loss of ability to sense low BG levels), and orthostatic hypotension (severe dizziness when standing up). The majority of toe, foot, and lower limb amputations, or more than 40,000 amputations annually, also occur among people with diabetes. As if all this weren’t enough, diabetes is also the cause of increased incidence of periodontal (gum) disease and the greater incidence of birth defects in infants born to mothers with poorly controlled BG levels.

The point of discussing the more negative aspects of diabetes is not to depress or scare you, but rather to convince you that your primary goal should be to prevent, reverse, or effectively control insulin resistance and BG levels so that you can prevent these complications from ever happening to you. The good news is that they are almost entirely preventable with good BG control. An added bonus is that the majority of the same strategies used to control diabetes and its complications will also reverse a prediabetic state and potentially prevent diabetes from ever happening to you in the first place.

The problem with current diabetes care, however, is that most people never achieve or maintain optimal control over their BG levels (“optimal” means average BG in a normal or near-normal range, or a gly-cated hemoglobin level of no more than 7 percent). In fact, according to a recent report, only 37 percent of people in the United States with diagnosed diabetes ever achieve this level of control, and as many as a third of the others are still unaware of their condition and the damage it is already causing to their bodies.

All is not lost

Can you live a long and healthy life with diabetes? Certainly, and this book will teach you the steps to take to do so. After reading this book, you will also understand better why losing a significant amount of your excess pounds is not the cure-all it was once believed to be. Yes, it is possible to be fit but still overweight and to live well with diabetes (or pre-diabetes).

Now I’d like you to get up, stretch, and walk around for a bit (actually, I’d like you to repeat this between every fitness step); then, come back and read on to learn the seven steps to diabetes fitness. (A handy recap of all seven steps can be found in Appendix A, at the back of the book.) You will learn all you need to know to become more fit in every sense of the word, and to live a longer, healthier life without dieting—and in spite of having diabetes.