Letter to a Diabetic

I was recently contacted by a young woman who has diabetes, looking for information about how to live healthier and happier, in other words, as a Liveabetic. But note, a Liveabetic can be ANYONE, not just diabetics! So whether you are diabetic or not, read on because there are some good nuggets here. That said, hopefully the "Know This" points will give diabetics jump forward in their day-to-day care.

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First a bit of quick history about my diabetes:
I was originally diagnosed as “pre-diabetic.” This progressed to a diagnosis of “Type 2”. Then eventually to a non-diagnosis of “you have an interesting presentation of diabetes” in January.

From late summer 2009 to January of 2010 my diabetes went from being manageable with diet, exercise, and oral medication (Metformin 500mg 3x daily at meals) to increasingly elevated glucose levels (eventually over 200) that remained high regardless of how carb controlled I ate, how disciplined I was at taking my medication, or how much I exercised. I was trying to do P90X at the time (an extreme home exercise program) and the workouts which originally lowered my glucose level resulted in extremely high levels near 300 and over. I became frustrated, and nearly apathetic about my care – especially since I had seen my primary physician about the issue and was told to “eat more carbs in the morning and less in the afternoon and evening.” I asked him if there was a diabetic specialist, nutritionist, or any classes locally where I could get more help, but he didn’t know of any.

Missy researched and found a Joslin Diabetes Center located at UC Irvine, about 15 minutes from where I live. Associated with Harvard Medical, they are one of the premier spots for diabetes management (as in day-to-day care, not “doc I have a boo boo), and are the only one located in California. How lucky is that? My mom (also diabetic in case you didn’t know) is jealous and always curious about what I learn from them to help her care.

Why is all this relevant?
The first thing you MUST know about your diabetes is that it will change over time. As you age, as your metabolism changes, as your pancreas or insulin resistance changes, as your lifestyle changes, so too will your diabetes change. I belabor this point, because nobody told me that, and I JUST figured it out (although I am overly dense in many instances – this being one).

KNOW THIS #1 YOUR DIABETES WILL CHANGE

So why all the weird diagnosis?
At my heaviest I got up to 203 pounds. Pictures of me at the time show a chubby desk surfer who worked too many hours with poor nutrition and no exercise. I’m not proud of that. Anyway, I think my doctor speculated that my diabetes was Type 2 because A) I was more than 10 pounds over my BMI which has a 50% increase for things like diabetes, and B) my mom is diabetic so it may run in the family.

Now that I’ve got some history, I can look back and see what was really going on. In some people the pancreas “putters out.” This happens gradually, and over time. In other words, I was never Type 2, which is better described as insulin resistant (I hate the terms Type 1 & Type 2). Late last summer my pancreas took a turn for the worse. It is still working, and through good diet, regular exercise, and diligent insulin treatment, my levels are phenomenal. But to my earlier point, my diabetes WILL change. I don’t know when or how, but I MUST look out for it.

KNOW THIS #2 YOU MUST LOOK OUT FOR YOUR DIABETES TO CHANGE

Be All About the ER
Before I knew I was diabetic I started changing things little by little. I’m all about the “ER”. Live healthER, eat bettER, or you’ll end up in the “ER”. (Catchy? I’ll make T-Shirts :-P) I won’t cite all the research that shows that incremental lifestyle change is sustainable more so than rapid dramatic change, but I’ve assumed this to be true. However, to be successful you need to A) have health goals you are trying to achieve, and B) track your progress.

Before my original diagnosis I had changed what I was eating, going from regular soda to diet. Not that diet soda is the BEST choice, but it IS healthER than the empty calories of regular. I started exercising in little bits. I wasn’t going to do a triathlon in my shape, but I was moving which was bettER than my 100% sedentary lifestyle. I created a program called “the credible threat”, where you take an embarrassing photo of yourself (I was dressed like George from Seinfeld in the infamous underwear couch pose – google it), tell 5 friends your goal by a date of your choice, select a sponsor who can validate your success or failure, and if you don’t make it all your friends get to see the picture. I gave myself 3 months to loose 10 pounds, Missy was my sponsor, and 5 of my work buddies were aware and eagerly waiting. I made it down to 180 pounds ahead of schedule, so my picture was never released.

About 6 weeks later I learned I was diabetic. I was frustrated because I felt like I had worked so hard, won the battles, lost the war. Now I know that weight was likely not the culprit, because my diabetes is due to my pancreas “puttering out” and not being 500 pounds of insulin resistant out-of-shapeness. But ultimately its about being your own advocate. YOU are responsible for trending toward being healthy or sick. So the question isn’t are you healthy, the question is “how are you trending?”

KNOW THIS #3 YOU ARE RESPONSIBLE FOR HOW YOU ARE TRENDING

So What Do You Do About It?
On a side note, I know there is a lot of stress, but few professions compare with the number of overweight, smoking, overworked, under-rested, and generally unhealthy lifestyles as the medical profession – especially nurses! Of course, this is anecdotal based solely on my own experience, so it may be unfounded. Even so, don’t let this happen to you, it isn’t worth it.

There are lots of people who go to their doctor, get a referral to an endocrinologist, take their meds and hope for the best. My insulin actually says “take between 5 and 10 units at meal time.” Good to know, except for the fact that this would kill me or leave me in a permanent diabetic coma. Here are some things I recommend:

Find a GREAT Endocrinologist
[note: if you are NOT diabetic, substitute "great doctor" or "great specialist specific to your condition" here]
You definitely SHOULD find a great endocrinologist. Do what it takes to find one, because you probably need meds now, and if you don’t, you WILL at some point. Remember, your diabetes WILL change, and you need a great diabetes specialist there when it happens.

KNOW THIS #4 YOU MUST FIND A GREAT ENDOCRINOLOGIST

Find a Diabetic Nutritionist
[note: if you are NOT diabetic, I would still recommend an appointment with a nutritionist. Understanding GOOD nutrition is not the same as good eating]
You definitely SHOULD find a nutritionist who specializes in diabetes. You need to learn about calories, carbs, offsets like proteins and fats, and how to manage portion size. But the BIG TAKEAWAY here is that generally speaking, you just need to eat a healthy nutritious diet, like any other person, non-diabetics included. Even though you are a nurse, you will learn things from a nutritionist.

KNOW THIS #5 YOU WILL BENEFIT FROM A DIABETIC NUTRITIONIST

Track What Your Body Is Doing
[note: this is relevant to non-diabetics as well. You may not need to track your blood glucose, but you might need to track your blood pressure, or something else. Understanding what your body is doing is HIGHLY RELEVANT for EVERYONE!]
Carbs are not the enemy. You know you need them for energy. Lack of carb control however is another thing. Pay attention to how many carbs you can handle. My meals are generally between 15g and 45g, or 1 to 3 carb units. I know my meal time adjustment of 1 unit insulin to 1 carb unit. However, unique to me, I can handle 1 carb unit if my glucose is between 100 and 150. Also, I subtract a unit if my blood glucose is under 100. At first there was a lot of information to figure out, and I had to learn how my body works. I did this by tracking all my daily information, and now I can tell you my average fasting bloods (between 100 and 110), my average meal time insulin (2 to 3 units), average daily long acting insulin (7 units), average exercise (currently zero minutes, but was 50 minutes daily as of a couple weeks ago), average sleep (7 hours), stress level (was about 2/10, but is up to 4/10 lately), and energy level (was 8/10, but now about 6/10).

Ouch, lots of number crunching there. I hope you don’t have an aversion to numbers, because you will be dealing with them more and more. On a positive note, my simple math computation skills are making black jack much easier, and I’m ready for my next vacation to Vegas!

My point here is that you need to track what is going on with your diet, exercise, medication, blood glucose, sleep, stress, and energy. There may be other things specific to you worth tracking as well. For example, cholesterol and high blood pressure, combined with high blood glucose form the trifecta for diabetics. I’m lucky to not have issues with cholesterol and blood pressure, but you never know, and since I know things will change, I track it as a method of monitoring. If you don’t track it, at least for a little while you WILL NOT KNOW what is going on with YOUR BODY. To point #3 above, YOU are responsible for how you are trending, but if you don’t know what your body is doing, you don’t know what to do to stay in the right direction.

KNOW THIS #6 IF YOU DON’T TRACK YOU DON’T KNOW HOW TO TREAT

Be Personally Accountable About Your Total Health
Unless you go in to an appointment and tell your doctor “doc, I’m tired all the time”, they will never ask you if you are getting enough sleep. Moreover, the ads for meds on TV that say “if proper diet and exercise are not enough, talk to your doctor about X” are somewhat misleading, because my guess is that MOST people do not exemplify a failure of proper diet and exercise (as a nurse you probably see a lot of this).

What does this mean for you as a diabetic? You need to be more vigilant than ever about your health. And I’m sure it will agree with your training that good nutrition, sleep, and stress reduction are all positive things for your health. Your doctor will treat illness, which is important and something I want when I’m dealing with whatever it is. Your endocrinologist will help you treat your diabetes. But YOU need to pick it up on these other fronts. I wish someone had told me this, but again, some of the most self-evident things are what we tend to miss. In other words, it is impossible to live poorly and expect medication and medical science to be the only things pulling you into balance, because that is a fix to a problem, not a sustainable day-to-day lifestyle.

This brings me to my tracking sheets again, and why I track all of that information. It is like I have a daily journal of how my body is operating. I print out my sheets, 3-hole punch them, put them in my binder, and record daily. I’m a little crazy, anal retentive, excessively organized, or whatever. That said, I HAVE NEVER HAD BETTER SUCCESS at managing my TOTAL HEALTH, than when I am tracking ALL of this information. At the end of the day I have a wonderful wife, beautiful daughter, and I have a responsibility to be healthy and live a long happy life with them. These are important things for you as well, being married and looking to start a family. Your health can’t be taken for granted, or handled lightly. You are a diabetic, which requires a serious commitment.

I have to say, I don’t know enough about your organization or discipline. I don’t know if keeping up on something like a daily tracking system is sustainable for you. I know that is asking a lot of my mom as well (but I can’t live without it). Even so, I’ve got her tracking, and will check in with her from time to time to do a week or two of tracking sheets. This exercise as an occasional reset can be fairly productive, and allow you to make course corrections. It also reinforces the self-accountability you will need.

KNOW THIS #7 PERSONAL ACCOUNTABILITY IS ESSENTIAL

You Are Absolved Of Your Sins
It always bugs me when I hear things like:

“Diabetes results from obesity.”
This is true, but not always true. I think it leads non-diabetics to think that getting diabetes is a result of living a crappy lifestyle. I thought this too, and believed I did it to myself. I carried some guilt about it for a long time. Bottom line is, whatever the cause of your diabetes, if you start trending healthier and make regular steps in that direction, forget the past and work forward. It’s the “every day is the first day of the rest of your life” attitude, so put a fist in the air and go kill it today!

“Diabetes can be managed with good diet, exercise, and medication.”
Also true. However, what is implied here is that if you are having issues with YOUR diabetes it is because YOU are sucking at YOUR treatment. I think it leads non-diabetics to believe that it isn’t a serious issue like cancer or Aids or you name it. Look you can loose toes, go blind, end up in a coma, oh yea and DIE. It’s a serious thing. And remember, your diabetes WILL change. So yea, take care of yourself with extreme vigilance. But know that when things go haywire it isn’t necessarily your fault. Its all about the response, and if you work to correct and trend healthier, then you aren’t just living with diabetes, you are a full on diabetic warrior!

“Diabetes can be cured by dropping the weight.”
I like The Biggest Loser. It motivates me. What can I say? But I always cringe when I hear these enormous people saying “I’m off of my diabetic medication, whoo hoo, I’m not diabetic anymore, I’m awesome and all you diabetics suck eggs because you haven’t lost 400 pounds like me and cured YOUR diabetes.” Ok, some of that may be implied, I’m just paraphrasing here. I guarantee you that they WILL be diabetic again. They might not be insulin resistant at this point, but their body has changed as a result of gaining so much weight. In time it will likely catch up with them, and they will once again be diabetic.

Good News About Pregnancy & Diabetes
This last point is particularly important since you are trying to start a family. Many women get prenatal diabetes. Often this goes away following birth, and the loss of pregnancy weight. But in most cases diabetes will return. It may be years, but it catches up. You already have diabetes and will need to deal with that through a pregnancy. But there is GOOD news here.

I like to think of diabetes as the bad guy in a horror movie. He always walks with slow lumbering steps, but no matter how fast the victims run they can’t escape. I’ve always been suspicious of their failure to get away, but I digress. Diabetes follows you around, slowly, creeping, persistent. It won’t go away. If you find out about it when you get pregnant you are dealing with everything from morning sickness, hormones, mood swings, hot flashes, and on and on depending on how easy or difficult your pregnancy is. Then on top of that you have to deal with learning and managing diabetes? UGH!

So the silver lining is that you already have diabetes, and can learn how to manage it BEFORE you get pregnant. I guarantee you, if your diabetes is managed well, your pregnancy WILL be better. Even if it is a difficult pregnancy, it will be easier than if your glucose levels are though the roof or crashing to lows!

Ah, but remember that your diabetes WILL change. So once again, I’m back to the tracking sheets and all the information you need to know in order to manage your diabetes. I would suspect that in preparation for becoming pregnant, this will be especially helpful, and once you are pregnant it will be essential.

What About Tracking With an App?
Yea, I’ve looked into that.

Missy found one called Track 3 (http://www.coheso.com/track-d.html) but it was for iPhone only – app store download here (http://itunes.apple.com/us/app/track3-diabetes-planner-carb/id318622618?mt=8).
I’ve got a blackberry, which isn’t supported by this app. Otherwise I would have tried it.
Also, while this app tracks meds, glucose, and carbs, it doesn’t account for my exercise, other nutritional requirements, sleep, stress, and so on. In other words, I like a more complete picture of my total health that isn’t supported in any app I’ve found.

If you look you will find apps for dieters that track calories and exercise. But I have similar issues with them. I’ve thought about building an app based on my worksheets, and know engineers that could help with the development. Even so, it will take investment to build so it is a nice dream for now. I’m a techie and the old pen and paper approach is workable for me for now. Such is life.

Hopefully All That Helps
Having diabetes sucks. It takes me longer to prepare food and eating out or without nutritional labels is difficult. When my blood is high I’m irritable. I have to carry a tester and insulin and food with me everywhere. [Insert more complaints here]

But what are you going to do? Life isn’t fair, and so you deal with it. Hopefully my data dump here gives you a jumpstart on things that took me years to learn. If I think of anything else I’ll send it over.

For my ongoing thoughts about health and diabetes I would also encourage you to read and follow my blog www.liveabetic.com. Liveabetics can be ANYONE committed to trending healthier, not just diabetics, but it is certainly a critical topic for us.

Ultimately your good health is the most important thing in your life. Without it you lose everything else, especially the time and quality of time you have with those you love – and quite frankly what else really matters?

Feel free to ask questions via email, but I would also encourage you to give me a call. I regularly talk through diabetes issues with my mom, and it helps inspire both of us to live healthiER.

Tracking Is The Key To Success!

& On That Note, Game Plan Is ALMOST HERE!!

I'm Sooooooo excited!! I've been using my Game Plan system for a few months now, and it is about to be available through LeFever Wellness!!

I've really learned so much about my health in the last couple months because I've been tracking things from so many points of view. Anyway, more on that in the next couple days.

Just for Fun

Left: me at 203 lbs.
Right: me today at 150 lbs

My recent low was 138 lbs, but I was unhealthy due to my diabetes. Under-insulation was causing me to lose weight because I couldn't absorb the nutrients. Now I'm back on track, getting to a healthy weight, and gaining lean muscle weight.


At 203 lbs I was out WAY out of balance. No wonder I look so unhappy!

I'm A Little Off Balance - But What Else Is New?

Sleep
I haven't been sleeping enough. I've had a lot on my plate the last couple days so I've been burning the midnight oil. Good time for a weekend. I think I'll sleep in tomorrow.

Stress
My stress is up due to a few things going on in my life. On my 1 to 10 scale of stress I usually float around 1 or 2. Maybe that is just the healthy stress of having things to get done. I've been up around the 4 to 5 range lately. I'm curious to see what impact that will have.

Mood
I have been more positive about things lately. Since I've been actively making myself think about my mood I've noticed that my mood has actually improved. That said, I can tell that the slight skew in other areas of my health have caused some symptoms related to my mood. In particular I've noticed that my patience is a little short. To remedy that I've been trying to bubble up a little bit, realize that the small things are small, and focus on the more important things. My beautiful 2 year old daughter is always happy to help, and spending time with her and my wonderful wife is a great way to remember what is truly important! Of course, these are my wonderful girls, you will have to go get some of your own. I highly recommend it!

Exercise
I didn't technically get my workout in, but I DID spend an hour or so cleaning up the house, and we walked about a mile and a half or more with friends down to get yogurt. So I guess that counts as having some activity in my day. My body definitely has that "I've been walking" feeling, so that is a good sign.

Nutrition
My calorie intake is WAY down. I think it is so interesting that, just by eating when I am hungry, my caloric needs can fluctuate almost 1,000 calories! When I'm regularly doing my P90X workouts (I need to start that again so keep me accountable Dale E.!) I eat about 2,500 calories. But I'm between 1,500 and 1,700 calories now. That might actually be a little off now that I think about it. I haven't completely had an appetite recovery since being sick, so it might come up to about 2,000 calories when I'm off P90X, for a fluctuation of about 500 calories.

Medication
On a positive note, my insulin needs haven't gone up that much. Although, that is likely because I'm just not eating as many carbs. When I'm doing P90X I need more carbs for the extra energy, which in turn requires more insulin. I'm probably also benefiting from the lasting effects of the exercise I've done, my work out yesterday, and the activity I had today. It all counts, and I can see the effects in the level of insulin dependent.

I don't think of myself as Type 1 diabetic, I think of myself as an insulin dependent diabetic. If you are insulin dependent (or dependent on any medication) the question is, "how dependent are you?" I mean, I have to have it, but it is nice to see that I am doing OTHER THINGS than just relying on the medicine to solve my problem. And actually, by doing those other things I get a combined approach to solving my issue, which is always better.

What Will I Do About It?

Well, I need to bubble up a bit and look at the big picture. The last week and a half there have been a number of big things come up. I've had to prioritize those things over my health. Life happens, and that is part of life. But the key is to contain it. If your lifestyle becomes the problem, then you are really in trouble.

So, I need to start by assessing my big life priorities. My health is one of these, because without it I can't live longer, happier, and spend more and better quality time with the people I love.

With that called out, I need to begin a small recovery phase to bring things back in line. I pushed things a bit to get through a couple little bumps. Fine. Now lets get back to it. I'm going to sleep in tomorrow (if my daughter will let me), get in a good workout, and eat some healthy food. I'm going to relax a bit, because I need some down time.

Then I'm going to focus on getting back into a routine that incorporates the healthy things in my life. You know and love them, and we talk about them all the time; sleep more, stress down, mood up, nutrient dense, exercise well, and consistent medication.

How Are You Trending?

NOTE what is going on up there. As I track, I notice and observe differences base on what is going on with my body. Are YOU this in tune with your body? If not, you should be. Take diabetes out of the equation - we can all be Liveabetics. Everyone should have some general idea about how many calories they eat, sleep they get, exercise they do, stress they are under, general mood, and medication requirements. These things will change over time, and you must be aware of the changes.

KNOWING HOW YOU ARE TRENDING IS CRITICAL TO YOUR SUCCESS

Think of it like this. Do you know how much you earn, or how much is in your bank account, how long it takes you to drive to work, what time your lunch break is, etc.? To live practically I guess these are important, but in the grand scheme of things they are fairly small. You won't be laying on your death bed thinking, "if only I had spent more time commuting to work." But you may be thinking, "geez, I wish I had taken better care of myself, got more exercise, eaten better, and spent more time with the ones I love."

It doesn't matter if you just "blew it" eating a whole pile of those delicious onion rings, a massive dinner, and the over sized piece of chocolate cake (mmm cake!) at the restaurant with friends. Tomorrow is a new day, so lets start it off right. ARE YOU WITH ME?

If I can get 1 person this week to start taking an active role in living better, my Liveabetic movement will have been successful. Are YOU that person? If so, leave me a comment and tell me and all the other Liveabetics out there that you are going to start kicking butt and getting healthy!

This weekend I'm going to sleep in, smile more, get some exercise, and eat healthy. If you are motivated to do better, comment and let me know! It will motivate me to do better with my help, and will hopefully inspire others to do the same!

Back to the Exercise

Being off of my exercise for a week and a half, I wasn't feeling up to a full blown P90X workout. So to get started I did a basic circuit of treadmill and arms. Even if you don't have a treadmill you could do something similar just going for a walk.

I did four, seven minute intervals on the treadmill varying speed and incline. I started out with more running, but as my knee began to hurt I shifted more to the incline. See my treadmill tips below for more ways to maximize your workouts.

Before my first treadmill interval, I did 30 wide fly push ups, 16 iso curls, and 10 wide front pull ups. My focus was on getting wide because that is my weak point. When you find exercises that are your worst, or least favorite, I recommend working on them more often toward the beginning of your workout before fatigue sets in. Also, try to do more of them so that you improve where it counts the most.

So my workout ended up looking like this:

Push ups, curls, pull ups (P/C/P)
7 min treatmill
P/C/P
7 min treatmill
P/C/P
7 min treatmill
P/C/P
7 min treatmill
P/C/P
Cool down

Without trying, I ended up with 50 minutes of exercise. And I don't just stand around between sets waiting to recover. I'm all about keeping my heart rate up. Granted, I do need to motivate myself toward the end, so that does add a little time, but I'm not relaxing - my heart rate never drops.

Treadmill Tips

Hate working out on a treadmill because it is long and boring? Then you are doing it wrong (in my opinion). Break things down into intervals.

For example, take a 5 minute period, walk for 2 minutes, speed up to a jog for 2 minutes, then slow it back down for a walk for 1 minute. Then get off the treadmill and do some jumping jacks, squats, push ups, or whatever you can do without any equipment right next to your treadmill. I like to incorporate curls, pull ups, and other exercises that require hand dumbbells, exercise bands, or a pull up bar, but that isn't necessary to do this sort of a workout.

Now get back on the treadmill. Do another 2 minutes of walking. This keeps your heart rate up, but allows you to recover from the anaerobic exercises you just did. Now increase the incline up to a reasonable level that makes you work - if its too easy you need to kick it in to gear, its only 2 minutes! Then slow it back down to a walk for the last minute. You guessed it, off the treadmill for more exercises.

Exercise Movement Tips

When designing my workouts I like to come up with 9 different exercise movements that work the same part of the body. For example, on an arms day I'll do push ups, curls, and pull ups. On a legs day I'll do squats, lunges, and a Yoga chair position.

Really Jeff, 9 exercises? I don't know that many!
Yes you do. For example:
Circuit 1: Wide push ups, iso curls, wide pull ups
Circuit 2: Regular push ups, regular curls, reverse grip chin ups
Circuit 3: Narrow push ups, full supination concentration curls, and narrow grip pull ups

But wait, what the heck are iso or full supination curls? It sounds worse than it is. You can Google them, have Coach Greg show you how to do them, or send me an email. But if you feel like that is too much, stick to regular curls, or just do push ups and pull ups.

The idea though, is to give yourself some variety in your workouts so that you use your muscles differently. This will make them stronger than if you are just pounding out the same movement all the time. AND this applies to EVERYONE, not just the guys on muscle beach. It would take you a LONG time to look like one of those guys.

The end result is that you will keep your heart rate in a good range your whole workout. Your body will be challenged both aerobically and anaerobically. The result will be great calorie burn while building good lean muscle.

IF YOU ARE TRYING TO LOOSE WEIGHT OR TONE YOU NEED TO DO THIS. When you work your muscles you significantly increase your burn. Without the exercises in between the treadmill time (in other words, treadmill alone) your burn will last a little while after your workout (depending on your length and intensity). But if you really bring it, and do some good treadmill and exercises together, your burn could last for hours, or even until the next day. Great up side right?

Take it Outside

If you don't have a treadmill, or just want to enjoy some fresh air, you should take it outside. Be sure to put on some sunscreen first!

You will need a stop watch, and you might even want to carry along an exercise band. You can do the same thing as the treadmill, mix up the walking and jogging. You can stop and do push ups, or if there is a pull up bar on your route do a few.

I need to do this. Coach Greg promised a park run tentatively tomorrow!! If this happens, I'm going to wear biking gloves. That way my hands won't get torn up when I do push ups. This may not be an issue for you, but I have wrist problems, so I do push ups on my knuckles. Knuckles + concrete isn't a pretty picture.

Lets Bring It People

I was very pleased to see David and Missy posing their workouts in response to my last blog post. I'd love to hear from more of you!

Been Sick

Last Tuesday I got the stomach flu. That can be vary dangerous when you are diabetic. But I was able to maintain phenomenal blood glucose levels for several reasons:
1. I went into it with a healthy lifestyle of eating right, exercising, and having stable blood glucose levels.
2. After getting sick, I would drink about 1/3 of a can of full sugar soda.
3. I tested, tested, and tested some more to make sure my levels were staying where they needed to be.

Even though the worst of it was over in about 24 hours, I was lethargic and lacked an appetite until late in the day on Sunday. I was only eating around 400 calories a day, and yet, my blood glucose levels stayed between 90 and 120 without even trying. Most of the time they were between 100 and 110! 100 is sort of the ideal target, so that was like winning the lottery.

So then what happened?

Well, there have been a few other things going on in my life that I won't bore you with that have been causing me to lose some focus here. I haven't exercised since last Tuesday (I worked out before getting sick), I've been eating higher carb comfort foods, haven't been sleeping as well as I should, and my stress levels are up.

At this point my body is starting to lose control. Sort of like a waterfall, where the water is all smooth and together, but after 20 or 30 feet it can't hold it together anymore and it blows apart into a state of chaotic free fall. THAT inflection point is where I am right now.

So what will I choose to do?

On one hand I say to myself, "well, I'm dealing with a lot right now. I need to get caught back up with my work. I need to make sure I feel strong enough to exercise. Blah blah blah."

On the other, I look at my wife and daughter and say, "I need to be committed to my own health, so that I live longer, live stronger, and set a good example for my daughter."

Its the whole, "the hardest part of the journey is the first step" thing. Or maybe its, "a journey of a thousand miles begins with the first step." Or it could be, "a journey of a thousand miles is easier to fly than it is to walk."

In any event, it is difficult to budge. In a week and 2 days I've become sedentary. I need to get moving. I need to say to myself, "Jeff, YOU are a Liveabetic, which means that you have a commitment to life, and right now you are failing yourself and those who love you."

The truth hurts a little, but it is the truth. I'm going to work out tomorrow, Thursday, April 22. If you are reading my blog, and you work out too, let me know by posting a "I did my workout" comment to this post! That will motivate me to know that my struggle has helped at least one other person.

Endocrinologist Appointment Went GREAT!

I had an endocrinologist appointment today at the Joslin Diabetes Center in Irvine Ca, and he was so impressed with my progress. Since putting me on insulin just about 3 months ago, everything has been brought into control. He didn't test my blood, so I don't have an A1C to report, but based on my average glucose levels from my testing meter I know it would be pretty good.

Its funny, because I know so much more about my health now, which is a direct result of using the Game Plan worksheets. I knew I had gained some weight (a good thing in my case), I knew that my glucose levels were doing great, I know why I experience highs and lows and what to do about it. It is AWESOME!!

I Just CRUSHED My P90X Workout!

I know that many of you aren't interested in extreme exercise, and that is totally cool. My mom for example, I just want to get her moving. If you can't remember the last time you did something active, stop reading and go do something.

As for me, I'm at a place in my life where I want to push hard and really try to get fit. It motivates me even more now that I've discovered a few of our friends here in Irvine are also doing the X. LETS BRING IT PEOPLE!! (fists raised).

I'm in my 3rd week of the P90X program and I'm noticing improvements. I just did a personal best in reps on a few exercises. I have noticed that my form on the Ab Ripper exercises is getting better. But it is all about trending. I'm trending in the right direction. I'll never "get there", so I can't say "I have a long way to go." I killed it today, and that is what counts.

How I'm Trending - The LeFever Wellness Game Plan

What is The Game Plan System?
People always ask, "how are you doing?" Without getting overly analytical about the philosophy of language here, this might be the same as "how are you trending?"

When my diabetes changed, I needed something that would be effective at tracking things that are relevant to my health. I recalled taking a diabetic management and health class at the Alta Bates Diabetes Center in Berkeley California, where the instructor had said that the nutritional program for diabetics was a baseline healthy diet relevant to everyone (diabetic or not).

I wasn't happy with anything I could find out there, so I began to develop my own system: The Game Plan tracking sheets. As these have developed I've generalized them so that you can track all things relevant to YOU.

I've worked in conjunction with my neighbor and friend Greg LeFever to make sure that I'm tracking (generally) the most important things. And through this work, the LeFever Wellness Game Plan Workbook is coming to be.

I've incorporated easy ways to track the following:
+ Diet
+ Exercise
- Sleep
- Energy
- Stress
- Testing (more relevant to diabetics than non-diabetics)
- Medication (as it relates to whatever medication you might take)

This *should* provide a reasonable overview of your total wellness. You don't HAVE to track EVERYTHING if you don't want to. I do, because I want to know what is going on with my body. But arguably my health situation is more complicated and sensitive than a non-diabetic. But, if you are diabetic or have a similar health situation, my hope is that the system I've been developing can help you take control of your health and live longer, healthier, and be happier!


How I'm Trending
So now that you know what the Game Plan worksheets are, and why I've developed them, lets get to how I'm trending. I'm going to provide regular updates on this blog about my personal progress. Hopefully this will encourage some of you as well!

I'm tracking my numbers and totaling them up daily. I enter my daily totals into a weekly sheet and average them for the week. I then put my weekly averages into quarterly sheet which should allow me to average things and see how I'm doing over time. This quarterly average is important for diabetics who (should) have a regular A1C Test done. The A1C test gives you your average blood glucose level over about 3 months - a good measure of your general diabetic health. Of course, my sheets will give a much more complete picture.

Here are my numbers for the first 3 weeks:
(~ Scale of)

Baseline:
Sleep (hr/min)... 7:20 | 6:50 | 7:53
Energy ( ~ 10).... 6.6 | 6.1 | 6.5
Stress ( ~ 10)...... 2.1 | 3.4 | 1.5
Mood ( ~ 10)....... 6.2 | 6.7 | 7.7

Targets: Sleep 8:00 | Energy 10 | Stress 0 | Mood 10

Food:
Calories... 2,447 | 2,502 | 2,229
Carbs ........ 178 | 220 | 194
Protein...... 212 | 148 | 115
Fats........... 106 | 113 | 87
Fiber............ 41 | 35 | 41

Calorie target for me is 2,500, based on a calculation for doing P90X workouts.

Exercise:
Daily workout percentage: 71% | 57% | 57%
Average total daily workout time: 0:50 | 0:42 | 0:37

I need to get my percentage of daily workouts up. Ideal would be about 85%, or 6 days out of 7.

Testing:
Average glucose level: 112.5 | 117.3 | 109
Average number of lows: 0.6 | 0.1 | 0.4
Average number of highs: 1.1 | 1.0 | 1.0

My averages are really great. The range is between 70 and 135, but the goal is to land on 100.
I'm having too many lows and highs. Ideal would be zero for both, but that is difficult. The lower the better, but averaging 1 high per day isn't great.

Medication:
Novolog (meal time insulin).. 12 | 14 | 11
Lantus (baseline insulin)........... 7 | 7 | 7

The Lantus is a once daily injection. Recommended starting dose is 10, but I've been right at 7 with perfect fasting levels in the morning as a result of my combined efforts.
The Novolog will go up and down based on the number of carbs in my diet. Because I'm doing the P90X system, I require more carbs, and thus more Novolog insulin adjustment.

Perspective:
To put the medication in perspective, if you eat like crap and don't exercise, a diabetic would need MUCH more insulin to correct. And even if you are able to pull your blood glucose into check, you will still be suffering the effects of high calories, fats, cholesterol, a sedentary lifestyle, etc., etc.

To put it all in perspective, YOU NEED to take it ALL into consideration, and find the right balance for YOU to make it work. You need more than the doctor and meds to make this happen. You need to think about what you are eating, getting regular exercise, getting more sleep and reducing stress. Tracking energy and stress also gives you insights to your general health, and being aware will help you improve your attitude.

If you have any questions let me know. I'd also encourage you to contact Coach Greg. He is a certified nutritionist and trainer, and can help you figure out what will work best for you.

OH MAN!!

The first theme today was "hazmat crew"

Sick Kid
Lily has been sick, really for the first time in her young life. She doesn't understand what throwing up is, so I've spent the day cleaning up kid vomit from the carpet. But I love her so much it doesn't matter! She is getting better now. Which of course means that Missy is coming down with it now. So round 2 is tomorrow.

Called On My Crutch!
If you know me, you know I pretty much bleed Diet Mountain Dew. I used to be proud of that (weird thing to be proud of I know), but I'd like to start making changes for the better. Anyway, I got an email from Coach Greg that said "Whats up with the soda?" (We are neighbors and he saw me pulling the 12 pack out of the back of my car - BUSTED!!) BUT he has a great point. I need to transfer myself to healthier forms of caffeine. In the ideal world I wouldn't drink caffeine at all, but with several irons in the fire - one being a rambunctious 2 year old, I need my fix. Possibly a saving grace, Coach Greg sent out an email to THIS ARTICLE that explains caffeine is a metabolism booster. Makes sense.

The second theme today was "lack of follow through"

SOOOOO, I DIDN'T WORK OUT TODAY
I know, and after all that preaching about how you have enough time. The reality is, that if I get up early and work out, I get it done. If I think I'm going to get it in later in the day, all bets are off. Sometimes it happens that way, but there are no promises. Especially when you have a sick kid! To get on track I'll wake up tomorrow and read my own post from yesterday to motivate myself.

And when did it get so late
Man, I haven't been sleeping as much lately. I can't believe it is almost 1:30 AM. I need to hit the sack. I've been using my game plan tracking sheets so I know what has been going on. Time to get real and pull my self back onto the straight and narrow.

I NEED To Work Out

The last couple days I haven't had time to work out. UGH! I HATE to say that because it sounds so stupid. I didn't forget to eat. I made time to go to the bathroom. How did I NOT have time to get in some exercise?

There are a few things here...

1. Tomorrow is the first day of the rest of my life.
All is not lost. I'm not going to "slip" into a degenerative cycle because I had a couple off days. I'm going to focus. Tomorrow is Saturday so I'll plan out my day, prioritize, and make sure to get in some exercise. Even a little counts - something, anything.

2. It doesn't require an hour of my day.
Exercise is cumulative. Coach Greg will tell you that!
I've been working my way through the P90X program, and I'll try to get in my workout tomorrow. But if I can't I'll focus on doing some exercises throughout my day. Strategies for this are below if you are interested.

3. I make the most of things I'm already doing.
I take the stairs, I park out a little further in the parking lot (usually). I choose not to get lazy with my day. If there is an opportunity to do something active rather than inactive that accomplishes the same thing (stairs vs. elevator) choose the active thing. I don't always do this, but I try to.

4. I'm still benefiting from work I've already done.
I may not have put in my time today, but I usually do. This means that I'm still on fire from the time I have put in. It also means that I do things that many people don't.

5. No More Excuses, I'm Going To Get It Done
I'm worth more than getting out of shape, and so are you. I don't care if I only have 20 minutes tomorrow, I'm going to work out. It just doesn't matter. I'm going to make time for my family because tomorrow is Saturday. But you know, I'm going to make time for myself too, because the time I spend exercising is an investment in my being around for more years. And I want those years to grow old with my wife and see my sweet girl grow up. So yea, I'm going to find time to work out. And I bet that if I make it to 20 minutes, I'll plow through to 30 or 40 just because.

WHAT CAN BE DONE??
This isn't rocket surgery. And yet, obesity is an epidemic. Confused?
Here are some examples of things I do to get more active. I'm not an expert, but it seems like getting active is a good start. So I do these whether I'm getting in a workout or not, because being active applies to EVERYTHING! Your workout should be icing on the cake, but you MUST make the cake. MMM, cake! No no, forget the cake! Get active.

Abandon your cart? You deserve to be fat!
I NEVER abandon my cart at the grocery store. There is nothing more lazy than this. What does it take you to return it? 2 minutes? And after all the walking you JUST DID in the store. If you were really in that much of a hurry you could be running through the store, but you didn't do that did you? Even when I have a full cart and my 2 year old daughter, I unload everything into my car, then take the couple minutes to walk the cart back to the store and enjoy the stroll back to the car holding the hand of the cutest little girl in the world! Presto - that is 2 minutes of movement I wouldn't have gotten otherwise. My point - if you abandon your cart you are choosing to be inactive, squishy, and in A shape not IN shape.

Make the Easy Active Choice
I have stairs and walk up and down them many times throughout the day. I choose to walk every other stair when going up. Not exactly the same as doing squats, but not a bad way to up the intensity. When I'm feeling extra sprite I explode up the stairs to increase the intensity further. I have a hand on the railing so that I don't fall, but this is a great way to get some lower body movement in.

You Have Time To Pee, You Have Time For Squats
Next time you go to the bathroom, drop and do 20 push ups, or 20 squats. Use good form and put a smile on your face, because you are revving up your metabolism. Think of your metabolism as your calorie and carb burning gas pedal. Little pumps on the gas speed up the burn. And you can do this without really breaking a sweat. Do what you can do. Start small, work your way up. If more people assumed that movement was as necessary as eating and going to the bathroom we would all be in much better health.

But They Will All Think I'm Crazy
So be the crazy one. I'm good with that. But then again, I'm trying to GAIN muscle weight, and they are thinking about being a contestant on The Biggest Loser, so who is crazy again? If you're worried about people in your office thinking you are crazy, then maybe you should just pack on 400 pounds and die of a heart attack - NO WAIT - DON'T do THAT. Get more active and look better and make those sedentary people jealous of your new awesome physique! I've done push ups and squats when I've worked in a cubical and it actually got others doing them too. Well, it got some people doing them, others chose to be inactive. But it turned my perspective around. I wasn't worried about them thinking I was crazy, I thought of them as being the crazy ones. Go for a fast paced walk, and stop at each block corner and do some push ups or squats. People in their cars will be like "damn, I should be doing that instead of this milkshake and fries!"


Exercise Made Easy
So you've got enough reasons to exercise, but exercise is hard and boring, and I don't like to do it, and its easier said than done, and wahhh wahhh pssssst.

Exercise can be fun. I'm trying to motivate my mom to exercise more, and I think this might be a good point for her - so listen up mom!

Here is What I Do #1: Break It UP
If you HATE, LOATHE, DESPISE, exercise, break it up.
Get a watch or timer. Walk for 2 minutes then 20 squats. 2 more minutes then 20 lunges. 2 more minutes then 20 jumping jacks. Repeat that 3 times. If you do it in less than 22 minutes I'll be surprised.

What happens is that you get so focused on the INTERVAL, and WHAT IS NEXT, that your mind is thinking about that and not "Oh geez I have 15 more minutes of walking on the treadmill." BUT your mind is actively engaged into your exercise, not watching TV while on the treadmill.

Here is What I Do #2: Break It Up Some More
I know, YOU are special. You REALLY HATE, REALLY LOATHE, REALLY DESPISE exercise. The ONLY form of physical strain that works for you is lifting the super-sized milkshake high enough to take a sip from the straw. I get it.

So break the 3 circuits above into different times of the day. Do one loop through in the morning; another mid-day; and one in the evening. If you are in different places and don't have a treadmill, go for a walk. Most of the time if you look you will find a way to make this possible. You just need the motivation.

Here is What I Do #3: Tell People About It
If nobody knows you are trying to get healthier, it is easy to stop. Build in some accountability. Tell your family and friends that you are trying to get healthier. If you have kids, tell them. Again, do what you are capable of doing, but remember that getting healthier is an investment in yourself, extending your life and the quality of the life you have, and it is an investment in making more time to spend with all of these people. So tell them you are doing it and why you are doing it. I'm so on fire about it that I talk to everyone about it. Quite frankly I think my friends and family wish I would shut up a little bit about it.

Here is What I Do #4: Do What You Can Do
I'm doing P90X. I want to go run a 5K because I'm a little crazy and think that would be fun. But it doesn't matter what I'm doing. Do what you can do. If that means that you walk to the end of your drive way and back, then do that. But whatever it is, do it. Then, do it some more. And then some more.

Here is What I Do #5: Eat Something HEALTHY Afterward
The most important food you consume is what you eat in the first 30min to 1 hour after exercising. All your muscles are ready for nourishment and you need to give it to them. Personally I like ProGrade Workout Protein, mixed with one scoop of the ProGrade Meal Replacement, with 2 TBSP of peanut butter and 8oz of water. Quick soap box here, but the COST to your wallet for that fast food isn't much, but the COST to your body is high. Conversly, the ProGrade mix costs a little bit, but A) it replaces a meal (reduces your other food cost for that meal), and B) gives your body some awesome nutrient rich goodness. Sometimes I think I just work out so I can drink that delicious slice of heaven!

In the interest of full disclosure, I would love it if you would pick up some ProGrade from the links above and help out my buddy Coach Greg. And, if you have any questions about the stuff (remember I'm not an expert about any of this) contact Greg and he can help you out. Here is his website: www.LeFeverWellness.com.

Getting the Right Blend

I thought about the major areas of health that I needed to track. It is possible I’m missing some, but these seemed like a pretty good start:

- Food
- Exercise
- Medication
- Sleep
- Energy
- Stress
- Mood

Food (diet) and Exercise

This isn’t a diet plan. What you weigh is important, but notice that I’m not tracking that. I believe you should focus on getting fit and healthy first. If you do that the weight loss will follow.

So to that end, it is important to eat the right foods. I’m not a nutritionist, which is why I talk regularly to Coach Greg LeFever from LeFever Wellness. I even pulled him along with me to my diabetic nutritionist meeting a couple months ago. Since he is a certified nutritionist AND personal trainer, he can really give me the scoop on my day-to-day diet and exercise.

Medication and Western Medicine

On one hand I think there are lots of people that ignore their health, then go to their doctor to fix the problems. On the other hand, I know there are people out there that vow to never take medication and hold a bias against the medical industry. I’m somewhere in the middle, and try to take the benefits of each without getting militant about it.

I think you need a good primary doctor, and specialists as needed. You should be research the medications being recommended, and be your own advocate. It is entirely possible that a good portion of the medical insurance and pharmaceutical industry is going straight to hell, so listen and learn as much as you can so you aren’t just a paying customer.

My position is that western medicine is an essential component to overall health, but it isn’t the panacea many people assume it is. As for me, I need my insulin. I tried managing my diabetes without it and couldn’t control my blood glucose levels.

Sleep, Energy, Stress and Mood

I’ve never had a doctor ask me how I was sleeping, or if my stress has been elevated lately. I suppose if you have issues with these things, then it might be a relevant question, but for most that wouldn’t come up. Nonetheless, I believe that amount of sleep, energy level, stress level, and mood are worth tracking. Getting enough sleep, reducing stress, and tracking overall mood and stress will tell you volumes.

For example, if you were to average 8 hours of sleep per night, and remove things from your life that cause undue stress, you would be healthier.

How Livabetic Came To Be

Fall 2009 – Changes in my body led to serious health issues

Jan 2010 – I went to a diabetic specialist at the Joslin Diabetes Center at UC Irvine in CA and got new tools for dealing with my diabetes.

I started to realize that there were many things my doctors and nutritionists would never ask that had HUGE implications for my health.

I also noticed that the anti-medical crowd didn’t have all the right answers either, often times because their positions didn’t take my specific situation into account.
I began to realize what should be a no-brainer. You need a balanced blend of different perspectives, need to become an expert in your own health, and apply the best thing for the best situation.

I’m not a doctor, nutritionist, or an expert in anything. But I can tell you exactly how my body is working, because I am becoming very disciplined in taking care of my own health.

What is a Livabetic?

Initially it was an offshoot of my diabetes, an obvious play on death vs. life. But I think that anyone can be a livabetic, because isn’t about being “not-diabetic” and completely about being focused on living a healthy life.

Diagnosing yourself as a livabetic is simply a firm commitment to your own health. That’s it.

The Purpose of This Blog

Working on my health is the most important gift I could give to myself, and to my wife and daughter. It will hopefully give me more time with them, and make that time better quality.

There are a few people in my life, family and friends, who have motivated me to do better with my health. I hope I have also motivated them. So, if I can motivate anyone through this blog to take their health seriously, and give the gift of a longer, better, healthier life to themselves and those around them, then it has succeeded.