The question then becomes, “What kind of exercise should I do?” I won’t presume to tell you, but I will give you a few guidelines. Most type 2 diabetics are approaching middle age if not already there by the time they figure out they have a problem. They are in no position to try to train like one of the Dallas Cowboys or Los Angeles Lakers. If you get too intense in your exercising you’ll probably strain something and that will be the end of that. Second, you will never be able to keep it up. In three months your fitness program will be history. And third, it isn’t necessary.
You don’t have to be buff; you don’t have to have a six-pack abdomen, and you don’t need the stamina of a Kenyan long-distance runner. But you do have to graduate from couch-potato status. The two rules to follow are these:
1. You should choose an exercise that will get your heart rate up a bit for about 30 minutes and will not be so unpleasant that you can’t keep it up long-term. We are talking lifestyle change here, not a crash program to get you in shape so you will look good in a bathing suit.
2. The exercise should not be so violent that it damages your joints or strains your muscles.
For most folks a brisk 30-minute walk four or five times a week is about right. Physicians recommend walking daily for half an hour. If you have a treadmill in your home or in a nearby fitness center, that will do the job. Treadmills have the advantage that, since they are indoors, you can still exercise during a snowstorm, or when the temperature drops below freezing, or when it is raining all those cats and dogs. If you have medical concerns or issues, ask your doctor before beginning an exercise program.
Whatever exercise you choose, determine to stick with it. In the fight against diabetes you need every possible advantage. Granted, diet is far more important than exercise, but this is not an either-or situation. Eat a proper diet, exercise, and stay at a decent weight. The good news is, with these weapons (along with medication or insulin shots if necessary) you can avoid being a victim. You can keep the lion at bay.
9
Watch Those Peaks
We have already discussed this a bit in chapter 1, but I want to go into a few more specifics and challenge you to have a deliberate plan to monitor the regular meals that you eat. Most of us fall into habits and routines with our meals. We have our spaghetti nights and almost always include a salad and some bread. On taco night we may serve beans to go with the tacos. When we have homemade hamburgers we usually have the same accompanying foods. For most folks this would be french fries, but hopefully you have removed those little monsters from your diet. Of course we sometimes have unusual meals or unusual combinations, but most of the time we dine on old favorites and combinations of foods we have eaten many times before.
There is nothing wrong with that. In fact regular times and meals are believed by some to be very healthy for us. Our bodies become adjusted to these rhythms. But now that you have blood-sugar issues it is not enough to keep the status quo. You absolutely must find out what your meals are doing to your blood-sugar levels. You need to start monitoring your post-meal blood-sugar peaks and discover just what works for you and what doesn’t.
In her great book Blood Sugar 101,3 Jenny Ruhl advises people to “eat to your meter,” meaning you should allow your blood-sugar meter to dictate what foods and meals are acceptable for you, and which ones to avoid.
There are about as many different opinions on the preferred diets for diabetics as there are boxes of high-carb cereals on your grocer’s shelves. Some would tell you to go strictly low-fat and avoid meat altogether (a perfectly ridiculous idea). Some would tell you that you can eat as many grain products as you please, as long as they are made from whole grains ( just as ridiculous). But you don’t have to take my word for it. Let your blood-glucose monitor settle the matter.
Keep in mind that having your blood-sugar levels high for long periods of time throughout the day (or constantly) will ruin your health and bring you to a premature grave. Every hour that your blood sugar is significantly higher than normal you are being robbed. Your kidneys are being ravaged, your heart is weakening, and your eyes and feet are under attack. The big question then becomes, how high is too high?
Again there are differences of opinion on this. The American Diabetes Association tells diabetics to strive for a blood-sugar level of 180 two hours after eating.4 The American Association of Clinical Endocrinologists says people with diabetes should keep their blood-sugar levels under 140 mg/dl as much as possible.5 Research indicates that when blood-sugar levels stay at 140 to 150 for prolonged periods of time, beta cells (the cells in the pancreas that produce insulin) start to die, neuropathy can set in, eyes can be damaged, and the potential for heart disease rises dramatically.
You can do your own research, but a good rule of thumb is to make sure your blood sugar peaks no higher than 140 to 150. With this in mind you are now ready to start monitoring your meals. As we mentioned before, everyone will not peak at the same time, so you will need to test yourself at several different points after meals to find your normal peak. Also, a meal high in fiber will break down more slowly and your glucose level will peak later. A bowl of beans is probably going to lead to a blood-sugar peak later than a bowl of Corn Flakes. A good starting place is to test yourself one hour after you take the last bite of your meal.
As you do this and find your levels too high for certain meals, don’t get discouraged. Identify the offender and adjust appropriately. A high reading doesn’t condemn all the foods that make up the meal. It means you need to figure out the major culprit for the high reading, and next time eat much less of that or else substitute some other food for it.
One test is not sufficient to condemn or justify a particular meal or food. There are other factors involved besides food that can alter our blood-sugar levels, so you should take at least three tests before deciding a particular meal or food is to be justified or condemned. But there is no doubt that eating thick-crust pizza washed down with soda is going to raise your blood sugar a great deal higher than a chef salad with a glass of water.
Buy a box of 50 or 100 test strips and get going. Get a little fanatical about it for a while. Check your post-meal peaks after every typical breakfast, lunch, and dinner you eat. You’ll be amazed at some of the things you discover. Some meals you thought were no problem may turn out to be not so great, and others you worried about may prove to be better than you thought.
Suppose you determine that your post-meal peaks will not rise any higher than 140 to 145. As you keep your blood sugar in check something interesting will happen. You will find that as you bring your post-meal blood sugar close to normal boundaries, your fasting blood sugar (the reading you get when you wake up in the morning, before eating) will go down as well. Often your blood-sugar levels will become so nearly normal that any doctor who tests you would swear you were not diabetic or even prediabetic. Of course you know that this could change in a hurry, were you to eat the way you used to. But you’re not about to do that, are you?
This is the absolutely best way to keep a prediabetic from becoming a full-fledged diabetic. It is also the means by which a diabetic can avoid all the complications of diabetes and live a full, healthy, and long life. When your post-meal blood-sugar peaks are kept “in bounds” meal after meal and day after day, you are on the road to victory! Your fasting blood-sugar tests, your A1C tests, and your general health will all start to fall in line. By giving your overworked pancreas a rest, you will allow it to recover, and it may well serve you faithfully for the rest of your life. But even if it can only limp along, contributing just a fraction of the insulin it did when you were young, as long as those post-meal blood-sugar levels stay in a decent range, all is well. If it also requires medication to help make this happen—do it! If it takes insulin shots—do it! (Under a doctor’s care, of course.) But by all means keep that blood sugar down.
The A1C test uses the condition of certain of your red blood cells to measure your average blood sugar over the previous three mo
nths. (More in chapter 48.)
10
Sandwiches and Bread
Once you understand that blood-sugar control has to involve a reduced-carbohydrate diet, you might conclude that sandwiches must become a thing of the past. You would be wrong. Bread is not something you need to forsake, but you do have to be discriminating about the type of bread you eat, and the amount.
Before we get to what is allowable, first let me dispel a myth that has been perpetuated by well-meaning but deluded folks: just because a bread is whole wheat does not mean you can eat as much of it as you like. Whole-wheat bread is definitely more nutritious than white bread, but it is almost exactly like white bread in its propensity to break down into sugar and hit your bloodstream with blazing speed.
Laura Dolson, who writes extensively about blood-sugar and diet issues, comments, “Whole wheat and white bread have essentially the same impact on blood sugar, which is to say you might as well be eating a big spoonful of sugar.”6
A blogger named Richard Smith decided to run a test on himself and compare the effects of whole-grain foods on his blood sugar to a 12-ounce Pepsi. The Pepsi, containing 42 grams of carbs, raised his blood sugar to 156 one hour after eating. But eating two slices of whole-wheat toast with milk raised his blood sugar to 173. Oatmeal and milk spiked his blood sugar to 163. Most doctors and medical “experts” would roundly condemn drinking the Pepsi (for diabetics) but would give the oatmeal and the whole-wheat toast a free pass. Smith concluded, “It is no surprise that meals with whole-grain starches have about the same effect on my blood sugar as drinking a 12-oz. Pepsi.”
In a word, bread can be a good food in moderation, but you have to be extremely careful. Let’s get back to sandwiches. You do not have to give up sandwiches! You just have to be discriminating about the bread that you use and the ingredients you place between the bread. You can order low-carb bread and bread mixes from any number of Internet companies. Check the carbs, but almost all of these are low enough to allow you to use two slices in a sandwich without running up your blood sugar. But if you’re like me, you prefer items that can be purchased at your local grocery stores. They’re almost always cheaper, you don’t have to pay for shipping, and they’re more convenient. And if possible you would prefer foods already made and ready to consume rather than things you have to bake.
So what can you find by way of bread at your local grocer? Go on a discovery trip to the bread section. Check out the whole-wheat breads there, deducting the fiber grams from the total carb grams to get the net carb content (fiber doesn’t digest so it will not normally raise your blood sugar). Most breads will be too high, but you can normally find one or two that end up in the eight or ten grams of net carbs per slice range. One of the best breads I have found is Nature’s Own Double Fiber Wheat bread, which has 13 grams of carbs per slice. But you can subtract the 5 grams of fiber, leaving only 8 net grams per slice. This means you can have a sandwich with this bread and only be getting 16 grams of carbs from the bread itself. That’s not too bad. As long as the stuff you place between the bread has few carbs your blood sugar should not rise very high.
Consider the lowly tuna sandwich for example. As long as you don’t use sweetened pickle relish, this is normally a very low-carb sandwich filler. The tuna’s carbs are not enough to mention. Traditional mayonnaise has hardly any carbs, and neither will the unsweetened pickle relish and bits of celery (and egg if you choose to include that). So when you eat a tuna-salad sandwich almost all your carbs are going to come from the bread. And for most type 2 diabetics and prediabetics, 16 grams of carbs is something you can handle in one meal. Your post-meal blood sugar should stay under the 140 mark. I usually have some low-carb yogurt with my sandwich and I’m good for hours.
Tuna is just one example. Sliced beef or chicken with cheese would be just as good, as would many other combinations. Another type of bread that should do the job for you is what is commonly called “sandwich rounds.” These are round, fairly flat bread slices that look like a condensed bun. Sometimes another version of this is known by “bagel thins.” These are very similar in carbs, with a top and bottom making up around 15 grams of net carbs.
It pays to read the nutrition information! Other breads on the shelf that look just as healthy and not much different in size may have as much as 25 to 29 grams of carbs per slice—50 to 58 grams for a sandwich. This is nearly double what the previous breads have, and it will “break the bank.” (You and your pancreas can’t afford it!)
One way to get truly low-carb bread is to make it yourself in a bread machine. The beauty of bread machines is that they do most of the work for you. You put the ingredients in them, turn them on, and go about your business. A few hours later you have a loaf of bread that is far lower in carbs than anything you can buy in the stores.
Bread is kind of deceptive. It doesn’t taste all that sweet, certainly not like Twix bars and chocolate shakes and Lucky Charms cereal and rocky-road ice cream. And it looks so natural and so healthy! But the little grains that make up those slices of bread are just waiting to be mixed with the acids in your stomach, where they will almost instantly turn into sugar molecules and surge into your bloodstream. Bread is a high-carb food. Don’t do away with it, but be careful, be discriminating, be moderate, and read those labels!
Low-Carb Bread for Bread Machines
This bread only has 2 or 3 grams of carbs per slice, so you can eat without guilt.
Ingredients:
1/2 cup water
1 egg
1 tablespoon butter or margarine
2 tablespoons Splenda sugar substitute
1/3 cup ground flaxseeds
1/4 cup soy flour
3/4 cup vital wheat gluten flour
1 teaspoon dried yeast
Directions:
Using a 1-pound capacity bread machine, combine ingredients according to order given in bread machine manual.
Select “light” browning setting.
Don’t remove bread until it is cooled.
Cut into slices and store, covered, in the refrigerator.
Yields 10 to 11 slices.
Note: This makes for a pretty spongy bread that tastes good but is a little hard to cut. If you prefer a harder bread that is easier to slice, you can be a little generous with the soy flour and flaxseeds. This will increase the carbs a bit, but not much.
11
Beware of Snacks
America is a nation of snackers! We love our chips and popcorn, our Cheez-Its and our candy bars, our peanuts and our cheese sticks. It seems like such a long time from breakfast to lunch, and even longer from lunch to dinner. And who can resist a nice evening snack as you watch that long movie or surf the Internet? Munching on something and sipping a drink just seem so natural while watching television or a computer screen. And going out to the movies just wouldn’t be the same without popcorn and a soda.
There are two major problems with snacks for those who struggle to keep their blood sugar in check.
1. Most of the snacks we love are high-carb and will wreak havoc on our blood sugar. The sweet things like cake, ice cream, pie, and so forth are loaded with sugar. Check your blood sugar an hour after you eat them and see what they can do to a perfectly normal state of things. But it is not just the sugary, sweet snacks that will do this. The chips, pretzels, and popcorn will do the same thing. Anyone who is going to get serious about corralling their blood sugar is going to have to look long and hard at the snacks they are eating and, to quote the song made famous by Bing Crosby, “eliminate the negative.”
2. Your base blood-sugar level is the level your body reverts to once it has dealt with the current load of blood sugar. When you have gone several hours without eating your blood sugar will drop and then remain fairly constant. This is called your fasting blood sugar. Although doctors normally want to measure this after you have gone eight or more hours without eating (usually in the mornings after a night’s sleep), most people will approach something close to th
at after going three or four hours of not eating, which is about the time that passes between breakfast and lunch, and between lunch and dinner. By the time you start your meal your blood sugar should have dropped down close to its base level, and your body is now ready for a moderate rise in blood sugar with the intake of your next meal.
But this never happens when you constantly snack in between meals. Many people will go only two to three hours before putting more food into their stomachs in the form of a snack. As a result their blood sugar never has a chance to get down to its base level.
For young people this is not much of a problem. Their bodies produce insulin in abundance and handle it efficiently. Often they will be back to their base level an hour and a half after eating. Not so with older, insulin-resistant folks like me (and probably you, since you are reading this book). When we snack between meals our blood sugar never has a chance to return to normal before being raised again by our snacking. The result of this is that our base level drifts upward. It typically goes from the 80s (healthy and normal) to the 90s (a bit high) to over 100 (too high) to the 126 mg/dl that is considered the mark of a diabetic.
The good news is that what comes up can also come down. By limiting your carbs, exercising, and avoiding so much snacking, you can give your overworked pancreas and blood-sugar mechanisms some rest, and they will express their gratitude by gradually lowering your blood-sugar levels overall, and your fasting blood sugar as well.
60 Ways to Lower Your Blood Sugar Page 4