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Lifestyle Medicine: A day in the life of a lifestyle physician with diabetes

This morning, Elizabeth and I rolled out of bed right on time to get to the gym — I won’t say how early, as it distresses nighttime folk. I checked my blood sugar and found it was 105 mg/dl. Great! If it was below 100 mg/dl, I would have eaten a piece of fruit (apple or banana). As it was over 100 mg/dl, I drank 12 ounces of water and headed off to the gym. You should always hydrate in the morning after a long sleep because you lose water in sweat and your breath. Working out dehydrated is a bad idea.

Well rounded cardiovascular and strength training program is an important part in effectively managing diabetes.
Exercise: lifestyle intervention in diabetes management

At the gym, it was an upper-body resistance day — shoulders, chest, triceps and abs. That whole workout typically takes an hour to complete. During that workout my blood sugar went up to 135, which is a normal thing. When we exercise, our liver will briefly release more sugar to keep us from bottoming out.

The great thing about all types of exercise is it sensitizes our muscles to the effects of insulin for up to 72 hours, and it also allows our muscles to absorb sugar even without insulin — a double bonus. So all of that exercise helped to make room in my muscles for the sugar I was going to get with breakfast.

Breakfast: Lifestyle and Diabetes

Back at home, I checked my sugar again. It had fallen to 103 mg/dl, and I was ready for breakfast. I

Whole food plant-based nutrition plan is an important part in the  lifestyle management of diabetes
Nutrition: lifestyle intervention for diabetes management

took my six units of long-acting insulin (my total daily dose) and two units of short-acting meal-dose insulin. For breakfast, I had one of my new favorites: a huge fruit salad with baby spinach, apples, banana, strawberries, blueberries, chia seeds, chickpeas and half of an avocado. So good. Breakfast is typically my biggest meal of the day, so I load up. Whole foods are great way to manage your diabetes with a lifestyle intervention.

The breakdown on this meal is as follows: 471 Kcals, 16 grams of protein, 63 grams of carbs and 11 grams of fat. I’m guessing a lot of diabetics out there are looking at all that fruit and are alarmed by how high the carb count is. For a long time, a standard recommendation for diabetic diets has been low-carb regimes to keep glucose under control. More recently, this advice has been questioned by long-term data. It’s important to remember that high sugar is a symptom of diabetes, not the disease itself. Diabetes is all about either not making enough insulin, being insulin-resistant or a combination of both. A low-carb diet can and does lower blood sugars and as a short-term strategy can be effective.

But keep in mind a bagel or a Danish is an ultra-processed carb. If you thought of ultra-processed like “predigested,” you would be right. Those foods break down into blood sugar quickly and effectively, thus bigger glucose spikes. A piece of fruit is unprocessed. It has tons of water and fiber in it and has to be broken down the old-fashioned way. Thus, whole-food carbs are a healthier option. Sixty-seven percent of every calorie eaten in America these days is an ultra-processed calorie, so when your doctor says “avoid carbs,” this is what they are really talking about.

The other issue with low-carb diets has to do with what you eat when you aren’t eating carbs. These types of diets almost always end up being higher in fat content. Being exposed to higher fat amounts leads to accumulation of fat in your muscle cells and organs (pancreas and liver). This causes all kind of metabolic havoc. High fat in your muscles and liver blocks sugar from entering, thus the sugar gets trapped in your bloodstream for lack of somewhere else to go. In addition, fat building up in your pancreas causes the cells making insulin to function poorly — thus you have less insulin to work with.

Diets that are high in unprocessed carbs and are low in fat lead to significantly less insulin resistance, better blood sugars and fewer diabetic complications such as blindness, neuropathy and heart disease.

After breakfast, my blood sugar went up to 151 mg/dl. Elizabeth and I took a 20-minute walk, planned our day and generally enjoyed each other’s company. By the time my walk was over, my sugar had come back down to 96 mg/dl, and I was ready to shower and start my work day.

Lunch: Lifestyle and Diabetes

Around 11 a.m., I am always ready for lunch. A quick blood sugar check showed I was sitting at 117 mg/dl. So I took another two units of meal-time insulin and dove into lunch: “tofu-tuna” sandwich with cucumbers, tomatoes and red peppers: 378 Kcal, 20 grams protein, 66 grams carbs and 8.8 grams fat.

 Important in monitoring effectiveness of lifestyle interventions for diabetes
CGM Reading

Thirty minutes later, my blood sugar went up to 165mg/dl. I took my post-lunch walk-run — 15 minutes of brisk walking and a 15-minute light jog. That took my sugar down to 99 mg/dl. I went back to seeing patients and other “doctor stuff.”

Dinner time: Lifestyle and Diabetes

I eat a pretty early dinner, around 4 or 5 p.m. Eating too close to bedtime is hard on sleep patterns, so the earlier the better. My sugar was holding on at 93 mg/dl, so I took my last two units of insulin for the day and had dinner. I was feeling pretty lazy about dinner, so I had another tofu sandwich. Did you know that tofu blocks cholesterol production in your liver similar to how cholesterol-lowering medications work? They do. It’s part of how I got my cholesterol down from 250 mg/dl to 115 mg/dl.

I also found some Chia pudding with cherries Elizabeth had made, so I helped myself to that and an ounce of almonds as well for good measure: 686 kcal, 44 grams protein, 72 grams carbs and 38 grams fat.

After dinner, my sugar went up to 144 mg/dl, but an after-dinner walk brought it down to 123 mg/dl.

Lifestyle management of diabetes: Walking for 30-45 mins after a meal can lower your blood sugar by 30 points!
Walking is a great lifestyle intervention for diabetes!

This combination of nutrition and activity helps me feel energetic all day long (carbs are good fuel). All of the activity is good for my heart and strength. The activity also decreases insulin resistance and helps cut down the amount of insulin I need to take. Finally, the walks give me time to be with people I like and love, and that is great medicine too.

I hope all of this gives you some ideas of how you can add lifestyle interventions to your day and start getting more health span and longevity for your efforts.

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