Category Archives: Dr. Sheri Comment

Do Diabetic Athlete Survey by May 15

DiabeticAthleteHandbookWebcover

Are you physically active and do you have diabetes (of any type)? Now is your chance to share how you manage your diabetes regimen while doing a variety of activities!

A new edition of Dr. Sheri Colberg’s book, Diabetic Athlete’s Handbook, is coming out in Spring 2019. Please complete the diabetic athlete survey at the link below no later than May 15 for possible inclusion.

https://www.diabetesmotion.com/athlete-survey

Please pass the survey on to everyone else you know who is active with diabetes. Thanks for your time and input!

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New book on fitness and diabetes

My latest book, Diabetes & Keeping Fit for Dummies, was released this week, just in time to help you start the new year out right. It covers everything you need to know about getting or staying fit with diabetes or prediabetes. Even if you don’t have diabetes and want to improve your insulin action and prevent type 2 diabetes, this book is for you! Check it out today! Available on Amazon.com or Dummies.com.

Musings on Reaching 50 Years with Diabetes

In a break from my usual postings, this one is a stream of consciousness diatribe on my person experiences. Please indulge my musings since I’m nearing the half-century mark of living (well) with type 1 diabetes.

I got diabetes back in the Dark Ages (1968) of its treatment. The only feedback I had on my blood glucose levels was testing my urine, which was several hours behind my actual levels and no reflection on my immediate levels. I never had a number to go with a bright orange (4+) reading of my urine–meaning that I was at the high end of the scale for glucose in my urine–but it did give me a lot of negative reinforcement. It told me that I was “bad” or “not in control” or an unlovable kid–or something along those lines. In other words, it was worthless and only made me feel bad about myself and my diabetes as I grew older. I was convinced that I was going to die from diabetes complications before graduating from high school.

Getting a blood glucose meter when I was in my early 20’s–after 18 years of diabetes without there being any to measure it–was both eye-opening and terrifying. I actually had to go through the emotional stages of dealing with a chronic disease. I realized that I had likely been running in the 200s most of the time (despite taking my insulin as prescribed and following a “diabetes diet”). No more head in the sand! I had diabetes for good and had to deal emotionally with having it. Getting it as young as I did (age of four) and then not having the tools to manage it had effectively allowed me to avoid all of that before.

Once I got a meter, I religiously kept a log of everything affecting me and my blood glucose–food, insulin dosing, exercise, stress, lack of sleep–until I had a handle on how my body reacted to almost everything. In fact, I wrote down everything for over 25 years! Doing that, along with getting a PhD in exercise physiology and teaching nutrition for 19 years at the college level, gave me a greater understanding of how complex our bodily systems are when it comes to keeping blood glucose levels at optimal levels using suboptimal methods (insulin delivery through the skin instead of from the pancreas being the worst barrier of them all). Many of these methodological shortcomings of managing type 1 diabetes are still in play today.

I look forward to meeting the milestone of living for half a century with type 1 diabetes soon and getting my 50-year medals from Joslin and Lilly for doing so. It’s an accomplishment that is worth bragging about–even though I’m fine with living with diabetes at this point in my life. It would be nice to have a cure, but I’m okay with it either way. I live life to the fullest and focus on the important things in life. Because diabetes is largely responsible for teaching me to do that, having it has really been more of a blessing than anything else.

Is Sitting the New Smoking?

Sitting

Make no mistake: sitting less time overall is a good idea for myriad health reasons, but is sitting as bad for you as some would suggest? Is it really the new smoking? In 2017 alone, a slew of new research studies has looked at various health detriments associated with prolonged sitting, even in adults who exercise regularly.

For adults with type 2 diabetes, bouts of either light walking or simple resistance activities benefit not only their glycemic responses to meals (1; 2), but also markers of cardiovascular risk. Both types of interrupting activities are associated with reductions in inflammatory lipids, increases in antioxidant capacity of other lipids, and changes in platelet activation (3).

What is good for one may not be as beneficial for all, though. For example, in adults with low levels of frailty, sedentary time is not predictive of mortality, regardless of physical activity level (4). Sitting more if you are already frail likely just increases frailty and mortality risk, which is not surprising. Along the same lines, being less fit matters in how you respond to breaking up sedentary time. Middle-aged adults with low levels of cardiorespiratory fitness gained the most metabolic benefit from breaking prolonged sitting with regular bouts of light walking, which included five minutes of light walking every 30 minutes over a 7-hour research period (5). If you’re already very fit, adding in some light walking breaks during the day is not going to have as much of an effect—again not surprising.

For in adolescents in school, reducing their sitting time (both in total time and length of bouts) has been shown to improve their blood lipid profiles and cognitive function. A “typical” day (65% of the time spent sitting with two sitting bouts >20 minutes) was compared with a simulated “reduced sitting” day (sitting 50% less with no bouts >20 minutes (6). Can teens stand to improve their health this week? Again, it cannot hurt to break up sedentary time, so why not do it? More recess breaks for teens would be good—and for everyone else for that matter.

All is not lost for people with limited mobility or no ability to engage in weight-bearing activities. Including short bouts of arm ergometry (five minutes of upper body work only every 30 minutes) during prolonged sitting attenuates postprandial glycemia (following two separate meals) when done by obese individuals at high risk of developing type 2 diabetes, even though they remain seated (7). People who cannot walk or stand can, therefore, break up their sedentary time in other ways that can also be metabolically beneficial.

As for other health benefits, breaking up sedentary time is associated with a lower risk of certain types of cancer. In a recent meta-analysis, prolonged television viewing, occupational sitting time, and total sitting time were all associated with increased risks of colorectal cancer in adults (8), which is the most common type after breast/prostate and lung cancers. That study reported a dose-response effect as well, suggesting that both prolonged total sitting time and greater total daily sitting time (2 hours) were associated with a significantly higher risk of colorectal cancer.

In summary, even just the most recent evidence is convincing enough that prolonged sitting is bad for you, and many more studies published similar results in prior years. Is sitting as bad as smoking, though? That remains to be proven. However, you really cannot argue with a recent international consensus statement on sedentary time in older people (9). It states, “Sedentary time is a modifiable determinant of poor health, and in older adults, reducing sedentary time may be an important first step in adopting and maintaining a more active lifestyle.” In fact, the best advice may simply be to consider the whole spectrum of physical activity, from sedentary behavior through to structured exercise (10). Putting yourself anywhere onto that spectrum is definitely better than sitting through the rest of your (shortened) life.

                                                                                                                                                            References cited:

 

  1. Larsen RN, Dempsey PC, Dillon F, Grace M, Kingwell BA, Owen N, Dunstan DW: Does the type of activity “break” from prolonged sitting differentially impact on postprandial blood glucose reductions? An exploratory analysis. Appl Physiol Nutr Metab 2017;42:897-900. doi: 810.1139/apnm-2016-0642. Epub 2017 Mar 1124.
  2. Dempsey PC, Larsen RN, Sethi P, Sacre JW, Straznicky NE, Cohen ND, Cerin E, Lambert GW, Owen N, Kingwell BA, Dunstan DW: Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities. Diabetes Care 2016;39:964-972
  3. Grace MS, Dempsey PC, Sethi P, Mundra PA, Mellett NA, Weir JM, Owen N, Dunstan DW, Meikle PJ, Kingwell BA: Breaking Up Prolonged Sitting Alters the Postprandial Plasma Lipidomic Profile of Adults With Type 2 Diabetes. J Clin Endocrinol Metab 2017;102:1991-1999. doi: 1910.1210/jc.2016-3926.
  4. Theou O, Blodgett JM, Godin J, Rockwood K: Association between sedentary time and mortality across levels of frailty. CMAJ 2017;189:E1056-E1064. doi: 1010.1503/cmaj.161034.
  5. McCarthy M, Edwardson CL, Davies MJ, Henson J, Bodicoat DH, Khunti K, Dunstan DW, King JA, Yates T: Fitness Moderates Glycemic Responses to Sitting and Light Activity Breaks. Med Sci Sports Exerc 2017;8:0000000000001338
  6. Penning A, Okely AD, Trost SG, Salmon J, Cliff DP, Batterham M, Howard S, Parrish AM: Acute effects of reducing sitting time in adolescents: a randomized cross-over study. BMC Public Health 2017;17:657. doi: 610.1186/s12889-12017-14660-12886.
  7. McCarthy M, Edwardson CL, Davies MJ, Henson J, Rowlands A, King JA, Bodicoat DH, Khunti K, Yates T: Breaking up sedentary time with seated upper body activity can regulate metabolic health in obese high-risk adults: A randomized crossover trial. Diabetes Obes Metab 2017;23:13016
  8. Ma P, Yao Y, Sun W, Dai S, Zhou C: Daily sedentary time and its association with risk for colorectal cancer in adults: A dose-response meta-analysis of prospective cohort studies. Medicine (Baltimore) 2017;96:e7049. doi: 7010.1097/MD.0000000000007049.
  9. Dogra S, Ashe MC, Biddle SJH, Brown WJ, Buman MP, Chastin S, Gardiner PA, Inoue S, Jefferis BJ, Oka K, Owen N, Sardinha LB, Skelton DA, Sugiyama T, Copeland JL: Sedentary time in older men and women: an international consensus statement and research priorities. Br J Sports Med 2017;19:2016-097209
  10. Dempsey PC, Grace MS, Dunstan DW: Adding exercise or subtracting sitting time for glycaemic control: where do we stand? Diabetologia 2017;60:390-394. doi: 310.1007/s00125-00016-04180-00124. Epub 02016 Dec 00112.

…And Stay Active: My Profile of Success

Sheri exercising pulldown closerI would like to share some of my personal story about why physical activity matters to me and how I have lived successfully with type 1 diabetes for almost 50 years to date. My success with diabetes is undoubtedly related to my decision to be physically active.
The secret to my overall success, both professional and personal, is that I made a conscious choice to live my life by one guiding principle: Live life first, and be diabetic second. In the beginning, I’m not sure it was even a conscious choice (I was only four years old when diagnosed with type 1 diabetes), but rather just an integral part of my personality. I am not one to let obstacles keep me from reaching my goals. Having diabetes has undeniably been one of the greatest challenges to living my life the way I want to, but it has almost never been an insurmountable one.
It’s hard to even imagine life without diabetes when you get it as young as I did. I don’t remember much about being diagnosed other than feeling sluggish and tired all the time. The biggest irony was that my mother had avoided becoming a nurse because she hated needles, but the doctors wouldn’t let me out of the hospital before she learned how to give me shots. She apparently practiced for days shooting water from a syringe into an orange all week. When she gave me my first shot in my arm, she jabbed the needle so hard it rebounded back out. I am told I said, with tears streaming down my face, “Mommy, go practice on the orange some more.”
Diabetes has, in many ways, been a blessing in disguise. It likely had a positive impact on my family’s overall health because our whole family switched to the same diet that was prescribed for me at the time—a balanced diet of carbs, protein, and fat with lots of vegetables, some fruit, and very limited intake of sweets and refined foods. Having diabetes has also been a positive, shaping force in my life when it comes to exercise and physical activity. As such, I have amended my original guiding principle to include, “…and stay active” for that reason: Live life first, be diabetic second, and stay active.
While many people view exercise as a punishment, I fully embrace using diabetes as an excuse to put my workouts first! I started exercising regularly way before it was trendy and known to be good for your health (and blood glucose). I was always active as a kid, playing in the woods, building forts, and just being a tomboy. As a preteen, I began exercising regularly on my own and doing organized sports because being active was the only thing that made me to feel like I had any control over my blood glucose. Way back then no one had blood glucose meters (only inaccurate urine testing), but I could tell being active helped with my blood glucose.
To this day, I still exercise six to seven days a week, and my passion is helping others with all types of diabetes do the same—safely, effectively, and for a lifetime. I vary my daily workouts to keep them fun and to stay injury-free and advise everyone else how to do so. When people ask me how I manage to do all I do, I tell them simply, “I work out.”
Diabetes also led me to an early calling as a healthy lifestyle and diabetes motion expert. When I was about twelve, I spent a week in Kansas with my grandmother, who had what they called “borderline” type 2 diabetes. She was on yet another diet to lose weight, and I decided to help her with dieting while I was there—acting like a personal trainer or fitness coach. I weighed her in every morning, helped her measure out her food (like cottage cheese), and made her jog laps around her backyard. At the start of the week, she agreed to pay me $1 for every pound she lost with my help. She lost eight pounds that week—was I ever a rich kid! Little did I know back then that she likely lost a whole lot less after the first week and gained it all back over time. I just remember her always being about the same body size and shape every time I saw her.
Back then my grandmother was the only other person I knew with diabetes. Later when I was in graduate school working on a degree in exercise physiology, she starting suffering from myriad complications including a heart attack, followed two years later by a major stroke and smaller ones that eventually left her incapacitated. She was bedbound and unable to communicate or feed herself for most her last six years, and she had partial amputations of both of her legs due to chronic ulcers. During one visit, I looked at her and thought, I don’t want to live like that. Consequently, most of my life and career I have focused on how to stay healthy with diabetes and avoid complications. To me, what’s most important is living well while you are alive. That’s why I preach about how important a healthy lifestyle is to maintaining your quality of life (whether you have diabetes or not) and that just living a long time without good health should not be your goal.
You certainly don’t have to get a PhD in exercise physiology like I did to understand the metabolic changes that occur with exercise, but learning why it is so beneficial can be very motivating. You can virtually “erase” overeating mistakes with exercise, and you can keep yourself from getting other health conditions (like heart disease). I’m sure that I am only in excellent health after almost 50 years with type 1 diabetes because of my lifestyle choices—and I want to stay that way until I reach my last day.
As I always say, “What’s the point of living longer if you can’t live well and feel your best every day of your life?” Take my advice and live life first, be diabetic second, and stay as active as you possibly can every day of your healthy (and hopefully long) life.

Diabetes Motion: Practical advice about exercise and fatigue solutions

Whether you’rDiabetes Motione new to exercise or a sports enthusiast, diabetes can get in the way of being physically active. To deal with this problem, I founded a new information web site called Diabetes Motion (www.diabetesmotion.com), given that I’m one of the world’s leading experts on diabetes and exercise. The mission of Diabetes Motion is to provide practical guidance about blood glucose management to anyone who wants to be physically active with diabetes.

Without a doubt, being physically active is good for the body, heart, and mind. If you are already an avid exerciser, then you know the benefits of exercise for your health and diabetes control. If you are just thinking about getting serious about sports or fitness activities, then you have a lot of positive changes to look forward to.

Exercise can help you build muscle and lose body fat, suppress your appetite, eat more without gaining fat weight, enhance your mood, reduce stress and anxiety, increase your energy, bolster your immune system, keep your joints and muscles more flexible, and improve the quality of your life. For many people with diabetes, being physically active has made all the difference between controlling diabetes or letting it control them.

What you may not know is what type of exercise or physical activity you should you be doing or how much of it is recommended for optimal health and the best blood glucose control. The good news is that you can get different (but all good) benefits from doing a variety of types of daily movement, which gives you a lot of options. In fact, exercising regularly is likely the single most important thing you can do to slow the aging process, manage your blood sugars, and reduce your risk of diabetic complications.

Need help with revving up your exercise? If your exercise performance been less than you’d hoped recently, here are some potential causes of fatigue (and solutions):

Inadequate rest time: You may be getting through your workouts well, but then fail to perform when you have races and events simply because you didn’t take enough rest time to restore glycogen and fully recover. It’s critical to cut back on your workouts (“taper”) for at least 1-2 days before a big event and keep your blood glucose in good control so your glycogen levels will be as full as possible on race/event day.

Blood glucose and glycogen stores: It’s harder for your body to restore your muscle glycogen (stored carbs) between workouts unless you’re eating enough carbs and have functioning insulin available. Your carb intake doesn’t have to be tremendous—probably just 40% of your total calories coming from carbs will suffice—but your blood glucose absolutely needs to be in good control for your muscles to restore carbs optimally.

Iron: Having low iron stores can cause you to feel tired all the time, colder than normal, and just generally lackluster. You can get a simple blood test done to check your hemoglobin (iron in red blood cells) and your overall iron status (serum ferritins). If your body’s iron levels are low (due to diabetes or non-diabetes causes), taking iron supplements can help, along with eating more red meat with lots of absorbable iron.

Magnesium: You may have a magnesium deficiency, especially if you take insulin or your blood glucose levels are not optimal. Magnesium is involved in over 300 metabolic pathways. If you’re deficient, your exercise will be compromised and you may even experience some muscle cramping. To correct a deficiency, eat more foods with magnesium in them—such as nuts and seeds, dark leafy greens, legumes, oats, fish, and even dark chocolate—but taking a supplement may also help.

B vitamins: For people with diabetes, thiamin (vitamin B1) deficiency is also a likely culprit in exercisers and can be further depleted by alcohol intake. People who take metformin to control diabetes can also end up deficient in vitamins B6 and B12, both of which are essential to exercising well. Consider taking a vitamin B complex daily.

Thyroid issues: Having lower levels of functioning thyroid hormones can cause fatigue and poor exercise performance. Have your main thyroid hormones (TSH, T3 and T4), but possibly also your thyroid antibodies if your thyroid hormones levels are normal and nothing else is helping your exercise (specifically antibodies to thyroid peroxidase), especially if you have celiac disease.

Still stumped? If you’ve been through this list and had everything check out okay, then consider other possible issues like your hydration status, daily carb intake (adding even just 50 grams per day to your diet may help), other possible vitamin and mineral deficiencies (vitamin D, potassium, etc.), statin use (some statins taken to lower blood cholesterol cause unexplained muscle fatigue), and frequent hypoglycemia.

Please visit www.diabetesmotion.com for more helpful information about being active with diabetes.

Taking Insulin? Avoid Getting Fat!

fat upload

A lot of people with type 2 diabetes delay going on insulin for as long as possible because they’ve heard horror stories about how much weight it can make them gain (or maybe they just don’t like shots), but people with type 1 don’t have a choice.  While it is true that insulin treatment is often associated with weight gain and more frequent bouts of hypoglycemia (low blood sugar), the real question is, why?

Some theories to explain insulin-induced weight gain are that when using insulin, your blood sugar is (usually) better controlled and you stop losing some of your calories (as glucose in your urine when your blood sugars exceed your urinary threshold) and that you may gain weight from having to eat extra to treat any low blood sugars caused by insulin. If you’re taking oral medications to lower your blood sugar and they are not working, however, insulin may be your main option for better control.

A few research studies have looked at whether weight gain is simply a result of eating more when you’re on insulin. One such study found that weight gain was not due to an increase in food intake, but rather that your body may increase its efficiency in using glucose and other fuels when your glycemic control improves—making you store more available energy from the foods you eat as fat (even if you’re eating the same amount as before you went on insulin) (1).

So, what can you do to avoid weight gain if you have to take insulin?  First of all, you should try to keep your insulin doses as low as possible because the more insulin you take, the greater your potential for weight gain is.  The best way to keep your insulin needs in check is to engage in regular physical activity.  By way of example, some people with type 2 diabetes who were studied gained weight from insulin use while others did not.  Interestingly, the main difference between the “gainers” and the “non-gainers” was that the gainers were less physically active (2). Moreover, in people with type 1 diabetes, taking insulin doses that effectively manage blood sugars can also lead to weight gain, but increases in activity levels have been shown to prevent getting fatter (3).

During any physical activity, your muscles can take up blood glucose and use it as a fuel without insulin and then following exercise, your insulin action is heightened for a few hours and as long as 72 hours—meaning that you will need smaller doses of insulin to have the same glucose-lowering effect.  It is my personal experience that regular exercise is the best way to prevent insulin-induced weight gain, but your insulin doses will also need to be adjusted downward to prevent low blood sugars that cause you to take in extra calories to treat them.

Second, you may be able to avoid weight gain by taking a look at the type of insulin(s) that you are using.  For example, in overweight type 2 diabetic subjects, use of once-daily Levemir (detemir) caused less weight gain and less frequent hypoglycemia than use of NPH (4), even combined with use of rapid-acting injections of a separate insulin for meals (and the same is likely true when using Lantus, or insulin glargine).  Anyone taking basal insulin alone (once or twice daily) or following a basal-bolus regimen can benefit by making sure that insulin doses are regulated effectively to prevent blood sugar lows and highs—while using as little insulin as absolutely necessary to get the desired glycemic effect.

In other words, the type of insulin you use and the doses you take are both important to consider in the overall management of your diabetes and your body weight, regardless of which type you have. Just as importantly, though, is how you choose to manage your lifestyle, both your exercise and your dietary choices.  Changes in your lifestyle, such as cutting back on refined carbohydrates that require larger doses of insulin to cover them and exercising regularly, are likely your best bets to counteract any potential weight gain caused by insulin use.  An added side benefit is that if you have type 2 diabetes and start exercising regularly, you may actually lose fat weight and be able to lower your insulin doses more or get off of insulin injections completely.

References cited:

  1. Jacob AN et al. Weight gain in type 2 diabetes mellitus. Diabetes Obes Metab. 2007 May;9(3):386-93.
  2. Jansen HJ et al. Pronounced weight gain in insulin-treated patients with type 2 diabetes mellitus is associated with an unfavourable cardiometabolic risk profile. Neth J Med. 2010 Nov;68(11):359-66.
  3. Jacob AN et al. Potential causes of weight gain in type 1 diabetes mellitus. Diabetes Obes Metab. 2006 Jul;8(4):404-11.
  4. Fajardo Montañana C  et al. Less weight gain and hypoglycaemia with once-daily insulin detemir than NPH insulin in intensification of insulin therapy in overweight Type 2 diabetes patients: the PREDICTIVE BMI clinical trial. Diabet Med. 2008 Aug;25(8):916-23.