Training a Diabetic. Any Advice ?

[Dreamliner]

She's a heart attack survivor, is obese and on insulin. I am almost certain that significant weight loss will markedly improve her prospects, but I'm certainly open to any advice on any nuances I should be aware of. I can get people losing weight in my sleep. But this is not your garden variety case.

[ufbeta]

Type I or II?

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[Dreamliner]

Type I or II?

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Thanks for chiming in. She's Type II. Doctor put her on the American Diabetic Association Diet, which sounds ketogenic. I understand that many can eat protein and fat ad libitum and lose weight as long as they severely restrict carbs.

She gained 10 pounds on it.

She also tells me that no diet has worked for her. However, I don't get the impression that actual calorie-counting has ever been a part of the equation, only the hope that making wiser food choices of food substitutions would be sufficient.

I've also inquired about her feeding frequency and how her blood sugar behaves over the course of the day and am waiting to hear back from her on that.

She needs to lose 100 pounds and has joint issues. So, I'm not going to go hog-wild on exercise with her. She needs to get weight off in a hurry. Her doctor tells her she's "walking a fine line."

[Dreamliner]

Since I'm coaching her online I'm having her assemble a team of friends and peers who will provide her with the support she needs to lose the weight. She acknowledges that she has to be firm with the people in her life who are perhaps unconsciously sabotaging her weight-loss efforts and gravitate to the more positive influences. I told her that she needs to be somewhat ruthless about this.

[ufbeta]

Sounds like the right plan. I'm more familiar with type I (daughter is type I) and it's affects. Type II can have different causes but inactivity and diet seem to be the most common causes. I've never heard of diabetics having issues other than watching their levels a little more prior/post workout. With type II you hear all the time of reduced insulin dependence after sustained exercise and dietary programs. Unfortunately all the exercise in the world won't help a type I.

[Dreamliner]

Thanks for the feedback! Very sorry to hear about your daughter. Does diet help much with Type I ?

[ufbeta]

Thanks. You have to be mindful of diet (count carbs and give insulin) but she could be the healthiest eater on the planet and it wouldn't change the fact that her body cannot produce insulin. Fortunately she hadn't really had much junk food before she was diagnosed so she doesn't know what she's missing.

[diehardgator1]

My wife was diagonised type 2 Had sugar count of 253 went on diet walked on walker twice a day ate salmon twice a week 10 days later rechecked at 153 another 10 days later 104 just had it checked again and it was 84 She does take 500 milg of med twice a day Doctor said he was going to take her off med next visit if she kept this up. Her triglycwerdies from 240 to 67 her cholestrol 245 to 167 lost 21 lbs Yes walking and diet will make a big difference

[Dreamliner]

Thanks for that. After much discussion she agreed that she could stick to 1,200 calories a day. After all, a doctor she saw had recommended 800 calories a day. She said that here blood sugar runs quite high whether she snacks or not. So she's agreed to limit herself to three small meals a day.

She's negotiated the first two days successfully. Says that whereas her blood sugar typically runs over 400 (and sometimes as high as 500), the highest reading she's gotten over the last two days is 198.

Delighted for your wife! It certainly does appear to be the case that Type II can be reversed through moving more and eating less.

[gator0254]

I have found that eating smaller portions multiple times during the day helps - probably 6 to 8 meals/snacks a day

Munching snnakcs like carrots, celery to give the head / stomach a diversion - mid-day - small apple

Bring your lunch - control the calories - eat healthy items

Use your palm to size portions - be careful as to carbs you have on intake

[96Gatorcise]

dream, just wanted to give you a heads up, be very careful what you suggest. Do not and I repeat do not tell her anything specific or put anything in writing that constitutes a meal plan for her. She is considered special population and the state has very specific guidelines when it comes to this area. Only an RD or MD can give her a specific meal plan. Basically it is against the law for you as a personal trainer to recommend a specific meal plan for her. And if you do and something happens you can be held accountable.

Do your homework on the state regs before you go forward.

[Dreamliner]

I have found that eating smaller portions multiple times during the day helps - probably 6 to 8 meals/snacks a day

Munching snnakcs like carrots, celery to give the head / stomach a diversion - mid-day - small apple

Bring your lunch - control the calories - eat healthy items

Use your palm to size portions - be careful as to carbs you have on intake

Thanks for the input. We decided that she'd do best if she ate the same meals over and over again so that she wouldn't have to worry about calories. I had her write out six meals. These are the only meals she can eat for 28 days. She eats three of them one day, the other three the next day. And she continues to alternate thusly. She knows this will not be terribly fun. But she also knows that it will be fun losing 100 lbs. and regaining her health and vigor and looking like a million bucks.

The problem I see with the 6-8 meal a day notion is that, when you need to establish and aggressive calorie deficit, frequent feedings has you eating your meals out of thimbles! Who wants to go through life like that ? :wink:

[Dreamliner]

Just wanted to thank 96Gatorcise for having my back on this one. I have secured the woman's doctor's approval. The woman has lost 22 pounds to date. Her A1C has dropped from 13 to 10. And whereas her blood sugar readings hovered between 400 and 500 a month ago, they hover between 80 and 220 at present. She has astounded me with her readiness to curb her eating and to increase her movement. Her present goal is to lose 100 pounds by next summer.

[Dreamliner]

Update: spoke with the woman tonight and she's lost 4 pant sizes since she's started. She's probably lost about 30 pounds in a matter of weeks.

It is a bit frustrating because I'm working with her, her doctor and her nutritionist ... and her doctor and nutritionist are at odds with each other over her dosage and type of insulin. Also, the nutritionist is not living in the real world as she does not seem to understand that my trainee is living on a limited income, what with the complicated meal plan she's suggesting and the type of insulin she's recommending.

Good news is that everyone agrees on 1,200 calories a day. And my trainee is shining through as she is sticking to our original plan, getting in plenty of walking and has just started a rudimentary strength program I designed for her.

Honestly, are people dying, all over the world, because they don't get precisely 45 grams of carbs per meal, eat every five hours and get 15 grams of carbs at bedtime ? Sheesh!

And here's the kicker: regarding the 45 grams of carbs her nutritionist says she has to get each meal, it should be 15 grams of this, 15 grams of that and 15 grams of another thing.

Really ?

[96Gatorcise]

Update: spoke with the woman tonight and she's lost 4 pant sizes since she's started. She's probably lost about 30 pounds in a matter of weeks.

It is a bit frustrating because I'm working with her, her doctor and her nutritionist ... and her doctor and nutritionist are at odds with each other over her dosage and type of insulin. Also, the nutritionist is not living in the real world as she does not seem to understand that my trainee is living on a limited income, what with the complicated meal plan she's suggesting and the type of insulin she's recommending.

Good news is that everyone agrees on 1,200 calories a day. And my trainee is shining through as she is sticking to our original plan, getting in plenty of walking and has just started a rudimentary strength program I designed for her.

Honestly, are people dying, all over the world, because they don't get precisely 45 grams of carbs per meal, eat every five hours and get 15 grams of carbs at bedtime ? Sheesh!

And here's the kicker: regarding the 45 grams of carbs her nutritionist says she has to get each meal, it should be 15 grams of this, 15 grams of that and 15 grams of another thing.

Really ?

the nutritionist is an idiot and you should tell him/her that. She is stuck in the old world. New research is coming out everyday the refutes the 6 meal carb based diet.

D, you need to read up on this guy. www.jackkruse.com the guy is a neurosurgeon who looks at it from the brain and biochemistry point of view. Very fascinating stuff.

He says it all boils down to a leptin problem and fats cells not communicating with the brain.

[Dreamliner]

Intriguing site. Seems that more and more I'm seeing Paleo and IF working together. That said, it does raise a couple of questions on carb cravings:

(1) My understanding is that all humans are born with an innate preference for sweets. If this is the case, why would carb cravings be considered abnormal or a sign of hormonal imbalance ? Seems like it would be a natural tendency.

(2) Taubes cited a longitudinal study in which people who permanently transitioned to ketogenic reported that carb cravings took several months, or even longer, to abate. And some reported that they never abated. This begs the question, if carb cravings are so durable, so natural, why not indulge them but simply reduce them so as to create a calorie deficit, then be done with it ?

Yes, I realize that I'm conflating carbs and sweets. But I'm guessing there is some overlap.

[Dreamliner]

I know that Martin Berkhan referenced this study awhile back. It showed that late carb-eaters experienced the effect of leptin moreso than those who spread their carbs throughout the day:

http://life.nationalpost.com/2011/12/20/play-your-carbs-right/

[Dreamliner]

Additionally, aren't higher cortisol levels in the morning a normal and necessary state ?

[96Gatorcise]

Intriguing site. Seems that more and more I'm seeing Paleo and IF working together. That said, it does raise a couple of questions on carb cravings:

(1) My understanding is that all humans are born with an innate preference for sweets. If this is the case, why would carb cravings be considered abnormal or a sign of hormonal imbalance ? Seems like it would be a natural tendency.

(2) Taubes cited a longitudinal study in which people who permanently transitioned to ketogenic reported that carb cravings took several months, or even longer, to abate. And some reported that they never abated. This begs the question, if carb cravings are so durable, so natural, why not indulge them but simply reduce them so as to create a calorie deficit, then be done with it ?

Yes, I realize that I'm conflating carbs and sweets. But I'm guessing there is some overlap.

1) I have not heard that it is an innate preference. What type of sweets are we talking about? natural sweets from fructose (sweet fruits) or processed sugary sweets? I can see a natural tendency if it is the former since the occur in nature and have been around a long time.

2)Do you have a link to the study I have not read it. I agree with your statement, satisfy the tendency but again I think it comes down to selection of carbs (veggies vs. processed or refined) from a hormonal stand point natural carbs are better for stable production.

[96Gatorcise]

I know that Martin Berkhan referenced this study awhile back. It showed that late carb-eaters experienced the effect of leptin moreso than those who spread their carbs throughout the day:

http://life.nationalpost.com/2011/12/20/play-your-carbs-right/

I have seen that and it is an interesting study. My take is Kruze is not against carbs but from his stand point you need to get the your system working to put yourself in an optimal zone to burn fat as a source of fuel and too high a bodyfat stops that process.

you are correct on coritsol, its natural rhythmic cycle is high to low. But when it stays at a constant high rate throughout the day and overtime it wrecks havoc on the other hormones in the body that signal to burn fat. So if you are obese you would want to keep it as low as possible to allow the other hormones (leptin) to signal to burn fat and correct the system, once in balance the natural rhythm would return.

Personally I have started to follow Kruse's leptin Rx and have already have seen results. I have switched to a am feeding window and do more of my fasting evening and over night. My carb cravings have become none existent. My waistline has dropped with little weightloss. I think it was that I was just bloated or inflamed and now as my hormones are beginning to reset the inflammation is reducing. my joints, back and muscles feel great and my day long energy levels feel more consistent. I am going to continue to read his site and track my progress.

I find his view from a biochemical, hormone, brain view to be fascinating.

[Dreamliner]

1) I have not heard that it is an innate preference. What type of sweets are we talking about? natural sweets from fructose (sweet fruits) or processed sugary sweets? I can see a natural tendency if it is the former since the occur in nature and have been around a long time.

2)Do you have a link to the study I have not read it. I agree with your statement, satisfy the tendency but again I think it comes down to selection of carbs (veggies vs. processed or refined) from a hormonal stand point natural carbs are better for stable production.

(1) I can't point to any one study but it is commonly asserted as axiomatic. Do you know anyone, offhand, who doesn't like sweets ? I don't. And I doubt that the source matters, whether fruit, HFCO or even artificial sweetener. In other words, people like to eat things that taste sweet.

(2) It's in Taubes "Why We Get Fat." BTW, are you familiar with Anthony Colpo ? He regularly savages Taubes. He's a former low-carber who switched to extremely high-carb, getting a great deal of his carbs from white rice, white bread, etc.

He also savages Martin Berkhan! As an aside: more and more I'm beginning to think that while IF may confer certain health benefits, it works for weight-loss not because it 'switches on fat-burning mode" but simply because it is, for many people, a convenient strategy for establishing a calorie deficit. In a way, it's a little like turning back the clock to 1980, and further back. Feeding frequency has increased over decades and is correlated with increases in obesity.

[Dreamliner]

I have seen that and it is an interesting study. My take is Kruze is not against carbs but from his stand point you need to get the your system working to put yourself in an optimal zone to burn fat as a source of fuel and too high a bodyfat stops that process.

you are correct on coritsol, its natural rhythmic cycle is high to low. But when it stays at a constant high rate throughout the day and overtime it wrecks havoc on the other hormones in the body that signal to burn fat. So if you are obese you would want to keep it as low as possible to allow the other hormones (leptin) to signal to burn fat and correct the system, once in balance the natural rhythm would return.

Personally I have started to follow Kruse's leptin Rx and have already have seen results. I have switched to a am feeding window and do more of my fasting evening and over night. My carb cravings have become none existent. My waistline has dropped with little weightloss. I think it was that I was just bloated or inflamed and now as my hormones are beginning to reset the inflammation is reducing. my joints, back and muscles feel great and my day long energy levels feel more consistent. I am going to continue to read his site and track my progress.

I find his view from a biochemical, hormone, brain view to be fascinating.

Sounds great on the bloating, energy levels, etc! I wouldn't blame you for sticking with it. Now, do you suppose that's primarily the diuretic effect of carb reduction ? If so, this begs another question: to dump fluid, must one go ketogenic, or nearly so, or is carb reduction relative ?

Personal example: I usually fluctuate between four-pack and six-pack. I do have a predilection for PB&J sandwiches and bananas. It's basically my favorite meal. Some days I'll eat two of each. Now, when I feel like I'm getting a little heavy (for me) I just cut them out temporarily ... and the abs come out very quickly.

So, the question is, is that because I dropped about 100g carbs or is it because I dropped about 1,000 calories ?

On the brain, when I was studying counseling, in seminary, we spent about half the time on brain research. And not only can the brain be fascinating, it can be downright spooky!

[Dreamliner]

BTW, my trainee's doctor is a looney too. When she asked him whether she had a slow metabolism, his response: "Honey, you don't have a metabolism!"

[mastoidbone]

Some advice----she probably has had diabetes for a LONG time---so expect her to have some degree of neuropathy, issues with balance and gait due to nerve damage, perhaps vison loss----so keep that in mind when giving her activities.

Also---they can have terrible foot problems.

Also---they often have coronary artery disease without symptoms---so keep that in mind when starting exercise.

[Dreamliner]

Some advice----she probably has had diabetes for a LONG time---so expect her to have some degree of neuropathy, issues with balance and gait due to nerve damage, perhaps vison loss----so keep that in mind when giving her activities.

Also---they can have terrible foot problems.

Also---they often have coronary artery disease without symptoms---so keep that in mind when starting exercise.

Thanks. Yep, she's a mess. I'm a different kind of trainer in that I don't generally envision 'working the fat off' of morbidly obese people. They need to get a handle on their eating first. The first six weeks I just had her walking a bit. Just this week we've introduced movements like squatting to a sofa and such. I'll save the gymnastics until she's peeled off another 60-70 pounds or so.

Good to see you over here!

[el_lagarto]

and her doctor and nutritionist are at odds with each other over her dosage and type of insulin.



http://i307.photobucket.com/albums/nn283/Cudy_1986/207m44p.gif

[Dreamliner]

The woman weighed in at 198 yesterday. This is the first time she's been under 200 in many years. But now her nutritionist is telling her that as she gets her blood sugar under control it's going to make it very difficult to lose more weight. She also told my trainee that wanting to lose 100 pounds is unreasonable and that if she goes under 160, on her 5-2 frame, that she'll be 'skin and bones.'

[96Gatorcise]

The woman weighed in at 198 yesterday. This is the first time she's been under 200 in many years. But now her nutritionist is telling her that as she gets her blood sugar under control it's going to make it very difficult to lose more weight. She also told my trainee that wanting to lose 100 pounds is unreasonable and that if she goes under 160, on her 5-2 frame, that she'll be 'skin and bones.'

:no: I have nothing more to say........

[Dreamliner]

The woman's blood sugar readings are now normal, between 80-120 from reading to reading.

She quickly lost over thirty pounds, then put about 8-10 back on, very quickly, evidently. due to fluid retention from switching blood pressure medications. She intends to switch back to the original meds, as soon as she can afford it (she recently lost her job), but I'm telling her to keep her eye on the ball: contain calories, be active, shed bodyfat.

I wish that obese folks with degenerative medical conditions everywhere knew what this woman now knows. You don't have to lose all the weight you want to lose to enjoy SIGNIFICANT health benefits. This woman may have already put years back on her ticker.