Restarting My Health — My First Year As A Diabetic Physicist
I woke up, did my morning routine, and had my first (of many) self-monitoring of my blood glucose level. I had 145 mg/dl… It was time to restart my health.
- Weight: 96kg (212 lbs)
- Body Mass Index (BMI): 30.3 (obese)
- Fasting glucose: 140–180 mg/dl
- Hemoglobin A1c: 9.1%
- Fitness level: none
- Overall mood: crap
The first week
I remember two, very strong feelings I had during the first week following my diabetes diagnosis — physical and mental:
I was hungry all the time. My new diet which I took upon myself instinctively — limiting my intake, especially carbs — still without a deep understanding of the basics of balanced nutrition, left me in a state of hunger. My overweight body was responding like I was a drug addict desperately needing a fix. The worst thing was lying in bed at night trying to decide if I will be able to fall asleep feeling hungry or should I get out of bed to eat something, probably bouncing up my blood glucose level.
I could have definitely prevented myself from reaching this point. My condition was avoidable or at least, without the technology to edit my own genes (yet…), its onset could have been delayed for many years. I could have done it in so little effort if I would only care to think about my health.
How come that I knew so much about so many things? I knew about the universe and the basic laws of nature, I knew how to design and write complex computer simulations running in parallel on thousands of CPUs, I knew tons of information about the 2nd World War (which is my main interest area in history), I have a personal library with hundreds of books — biographies, history, science (and science fiction), management, etc… — but I knew absolutely nothing about what it takes to live a healthy life? It is not more complex than the things I do know or can learn on my own.
The simple answer to this question is that I did not care to know. Now I had no option but to learn everything I can but this will not reverse my situation — it will only help me to manage it.
I have started reading and learning about diabetes online. I also began taking Metformin — 1 pill (850mg) per day with food. My morning blood glucose levels were between 130–145 mg/dl. I think I have lost about 2kg (4.5 lbs) but nothing really happened — those values might have been just a normal fluctuation.
- Weight: 94–96kg (212 lbs)
- Body Mass Index (BMI): 30.3 (borderline obese)
- Fasting glucose: 130–145 mg/dl
- Hemoglobin A1c: 9.1% (did not do a new test)
- Fitness level: none
- Overall mood: still crap
The first month
The morning self-monitoring of my glucose level was now a part of my routine. As a scientist, I had to follow my progress with graphs and charts so I started a new Excel spreadsheet where I logged my daily glucose levels and weakly averaged levels. Each day had its mood set according to the daily values. If it was just 1 mg/dl smaller then the day before — I was feeling high. If it was 1 mg/dl higher — the sky seemed like they were about to fall. The 5 seconds wait for the glucose meter to do its job seemed like much longer than they actually were.
Learning about diabetes
Like I do with any new subject I want to learn in my professional life — I started to read and learn about diabetes. For the first time, I understood the difference between type 1 and type 2 diabetes, I read about insulin production in the pancreas beta-cells, about insulin resistance and the role of metformin in regulating the body’s glucose cycle. Too much biochemistry to my taste — but I had no choice.
I learned about the epidemic proportion of diabetes in the world’s population and its roots in modern, western, lifestyle — both due to people’s negligence of their own health but also due to the commercial interests of the large food corporations. I was not sure if being a part of the global diabetic community of about 8.5% of the world’s population (2014 statistics, according to the WHO website) made me feel better or worse.
The internet is bursting with websites and information about diabetes — its causes and the ways to treat it. With approximately 80 million (!) Google search hits for the question “How to reverse diabetes” I guess I was not the only one who is concerned with his situation. The bad news is that at the moment diabetes cannot be reversed, only managed. The good news is that it can be managed quite simply if you are determined to manage it.
And one last but very important thing — among the hundreds of millions of Google search results with the term “diabetes” there are many millions of web pages with inaccurate, incorrect, and wrong information — some of them at the top of the search result page. Some of the bad information can be attributed to the amateurism of its writers leading to misunderstanding or misinterpretation of scientific research, but some are almost surely frauds designed to extract money out of concerned people hoping to get healthy.
I had no choice but to start reading some of the original research papers in the medical journals in order to understand better and decide to myself what is right and what is not.
Every diabetic knows that diet is one of the most important factors in managing the disease. Only now, at the age of 40, I knew it too. I began to understand the difference between carbohydrates, proteins, and fats, their importance to body functionality, and the correct consumption proportions. Damn! most carbohydrates turn into glucose in my body immediately even if they are not sweet. I used to live on carbohydrates… I like them so much…
There are many different diets advocated as being the “best diet for diabetes”, some are contradicting, some are not based on scientific evidence. I have decided not to take any extreme measures. I have lowered the amount of food I ate (mainly between meals), reduced the number of carbs (completely ceasing to eat empty carbs like white bread, white rice, etc.) and increased the number of fresh vegetables I ate.
Lentils, oh lentils, green, orange, black, I almost sure that I ate more lentils in the last year than in my entire life before diabetes.
For the first time in my life, I have actually read the nutrition facts of the foods I was buying or thinking about eating. Suddenly, I realized, there was sugar EVERYWHERE. I completely stopped eating sweet food and deserts and was determined not to be tempted to. I thought it was one of the hardest decisions I made. In retrospect, it was not a hard decision at all — a small price to pay to be healthy again.
One thing I noticed from the first moment — it was much more easy and simple to eat bad food. The less food I ate and the more healthy I wanted it to be — the more I was thinking about it and more time I was devoting to prepare it. No more quick dinners. The change in the diet affects your entire daily routine.
Oh, and I was still hungry. My food addiction will subside eventually but I think it will never go away.
I was much more educated and knowledgeable but still had a long way to go. It was not easy but I was beginning to see results. My close family started to notice my weight loss and most importantly, my blood test results returned better and not just the glucose levels but cholesterol and other indicators associated with bad life habits were leveling off — those were not fluctuations anymore but rather distinct. The Excel graph was on his way down. I was a bit more healthy than a month ago.
- Weight: 90kg (198 lbs)
- Body Mass Index (BMI): 28.4 (no more obese — just overweight)
- Fasting glucose: 100–130 mg/dl
- Hemoglobin A1c: 8.2%
- Fitness level: none
- Overall mood: determined
The first three months
I did not follow exactly my physician’s order — I am stubborn and have my own opinion plus, I am also a doctor… doctor of philosophy (Ph.D.). He instructed me to increase the daily metformin dose to 3 pills a day but I have increased it only to 2 pills per day at the end of the first month.
Physicists prefer to change only one variable at a time and I wanted to know how much my diet and exercise routine affected my health without mixing its outcome with the medication’s effect. Everything else remained the same.
My situation — my new diet, my new running routine (see below), and my mood — affected everyone, but I had the complete support from my close family. This is an absolute must when you take on yourself such a huge change in lifestyle — a change that affects the lifestyle of your entire family. I am extremely grateful to them.
First and foremost was my wonderful wife. “For better and for worse” turned out to be not just a slogan but a real oath that I cashed in (and hopefully never again) — both on the emotional side and on the practical side. She encouraged me, reassured me, and gave me the confidence and the peace of mind I needed to resolve my situation.
As a physician herself, she helped me tremendously in understanding my situation and what should be my health goals. She helped me with the professional literature I was reading to better understand diabetes. I was constantly amazed by how much she knew about every subject I inquired about.
Nevertheless, sometimes my new and forced interest initiated disputes between us when I disagreed with the common medical recommendations or practice and stated out loud that after I read a few recent papers I think my physician (who “devoted so many years of his life to become an expert”) is wrong. I have this tendency to argue with the medical establishment, going back to my wife’s pregnancy period (this is a topic for a different post). We had some rough nights but we made it… she still loves me…
On the more practical side, it turned out that my wife was happy to embrace the change in our diet and to improve her own health and our joint meals and eating habits changed together. Soon she also followed my new exercise routine and altogether lost the few pounds she long wanted to lose and leveled her blood test as well. As a physician, she saves lives on a daily basis but the stress, the emotions, and the long night shifts do their harm. It gives me great satisfaction to know that out of my bad situation I was able to improve her well-being.
The first real connection between my new health status and my kids came as a shocking revelation to me but not immediately after my diagnosis. It was one morning (or evening) when I have fixed them a bowl of their favorite breakfast cereals. With my new habit of glancing at the nutritional facts table, I have noticed it was mostly carbs. What was I feeding my kids with? They share my genetics (only the good parts I hope)…
We have not decided anything explicitly but our kids’ diet did change even thou we took a very relaxed approach to it. After all, they are kids and sugar is part of their everyday life… We try to lower or limit the number of sweets they eat — for example, we do not have sweetened drinks or cookies at our house on a regular basis anymore. We do try to make their meals generally healthier, although this is far from being enough and I know we should do more (oh, we should also do more with their iPad addiction at the same time). Overall, it gives me a very good feeling to know that we (and them) are more aware of what they eat and that their eating habits became a little better.
They also noticed the change — both physically (i.e. my weight loss) and in our lifestyle, including their eating habits. I explained that I was too sweet and that’s was not good so I had to change it and now I was less sweet. Since they are both under 10 years old it did not disturb them too much and they needed no further explanation. I guess they found it somewhat confusing since they kept asking me why I was taking a “candy” (i.e. metformin) before lunch and dinner.
A crucial ingredient in diabetes management and for achieving overall good health is to exercise on a regular basis.
The main difference between changing diet and changing physical routine is that we must eat every day and so this creates enough opportunities to take action with our eating habits. On the other hand — in order to exercise we need to be pro-active and find the time and motivation to take action in our busy daily routine and so this increases the initial activation barrier.
I hated to exercise. I did not like the yearly work trips that included lengthy walking sessions and our family trips were designed with minimum walking instances. I did join an occasional invitation to a group bike riding but did not last long.
Above all, I hated running.
So I have decided to start running…
The famous Nike trademark is so right — If you want to run? “Just Do It”.
I have started with an 800m run without any running accessories and with shoes that were not designed for running. I barely finished it, I was breathless and probably reached a dangerous heart rate for my age and fitness level. It was bad, but it made me feel good about myself since I was taking action to promote my own health and I decided to continue this routine for 2–3 times a week.
Something amazing and absolutely unexpected for me had occurred after about one month into my new running habit — I started to enjoy it. I was waiting for my running day and I was challenged to get better and to improve my abilities. Plus, I had observed an unambiguously positive influence of my training on my blood glucose levels. The research on this subject is valid and solid. Now I had first-hand proof of it on my own health.
In 3 months I have managed to complete 5k runs consistently. WOW.
I think I will write a detailed post on my experience in the future.
Things have progressed well and I have seen very positive results. I was starting to feel healthier. I even lost more than 10kg (22 lbs) since I have begun my journey — completing my wife’s instructions to lose at least 10% of my weight. My lifestyle changes had a positive impact on my family’s health as well which made me happy even more.
After some pleading from my wife, I made an appointment at a diabetes clinic with a physician who specializes in diabetes and whom my wife knew. I did not want to go since I felt I knew enough but she insisted, somewhat offended for all her medical colleagues around the world that had trained for so many years to become experts and which I decided would not benefit me anymore…
At my appointment, I have described what I was doing to manage my diabetes. I showed my excel graphs and my predictions for my steady-state hemoglobin A1c level using nonlinear extrapolations depending on different assumptions regarding red blood cells half-life time (ok, this was a bit technical). We even discussed some of the current frontline diabetes research including the promise of restarting the pancreas beta cells functionality that was demonstrated recently in mice.
Before I left the doctor wondered why I came since I was clearly managing my diabetes well and by the book and she did not think she had anything to add… What could I say? I had my orders…
- Weight: 83kg (183lbs)
- Body Mass Index (BMI): 26.2 (overweight)
- Fasting glucose: 95–105 mg/dl
- Hemoglobin A1c: 6.3% (pre-diabetic value)
- Fitness level: 5k run
- Overall mood: confident
The first half-year
By now, things have settled into a routine. I monitored my glucose level each morning but thought a bit less about what I ate and when I ate it (a somewhat surprising tip on my behalf to anyone who is interested in sustaining a healthy diet — do not count calories. It is inaccurate, time-consuming, and useless practice unless you are a professional athlete. Just understand the basics of nutrition and eat accordingly). My hunger faded but I was still aware of it. I kept running at least 3 times a week, increasing my mileage each week. I was generally less obsessed and occupied with my diabetes.
I have found new topics for discussions with my family and friends that I (and actually even them) never thought would be of interest to me. The physicist in me was trying to understand everything from “first principles” and I was reading and learning about diabetic research, nutrition, and about the biomechanics of running. More than one time I was told that I was taking all the fun out of the running when I discussed it in scientific terms. I did not listen to those comments — for me, it was a perfect combination.
Outside of my close family, it took a while but people started noticing the change I was going through. In the beginning, it was just my close circle friends who noticed that my eating habits have changed (we usually eat lunch together at work). But quite soon everyone noticed my shrinking body dimensions. At first, they were complimenting, but as my weight continued to decrease some also asked quietly whether everything was ok.
I had no intention to hide my condition so everyone who asked got a complete and detailed account of my health condition — from diagnosis and up to that point. While talking with people I discovered something interesting — I either found out that the person I was talking with also had diabetes (some of them I knew for a long time and never knew they had the disease) or I found out that he had minimal to no understanding about diabetes and its causes — they were exactly like me before my diagnosis. In both cases, our discussion usually led to topics such as health, good nutrition, exercise, and so on… Everyone wants to be healthy. It is just that many (like me) do not care enough to be active about it, assuming that everything will be ok forever. If I could only make some of them think a little bit more about their own health — that’s great.
The first half-year summary
After just six months — my blood test results were surprisingly good. All my diabetes signs disappeared — glucose and hemoglobin A1c are at a normal, healthy range. My theoretical model predictions based on my recorded glucose level history converged around a hemoglobin A1c level of 5.5–5.7% but I got 5.3%! Physicists do not like to be wrong. I do not like to be wrong. This time, I thought, I could make an exception. My other long time unhealthy blood markers have reset to normal as well. GREAT!
Without meaning or planning to — I dropped another 10 kg and reached a weight of 73 kg (161 lbs). I think the last time I weighed this much was at the age of 18… Many people comment that I look younger. All of my clothes, especially my pants, are oversized now. I bought a belt for the first time in my life.
With my blood test results and my fitness level reached with 3 running sessions per week (I managed to reach 10k), I think I was more healthy than ever before. Nevertheless, I did not mislead myself — I still had diabetes and to keep my good health I will need to continue my routine forever. It is fine with me.
- Weight: 73kg (161lbs)
- Body Mass Index (BMI): 23 (healthy weight)
- Fasting glucose: less than 100 mg/dl
- Hemoglobin A1c: 5.3% (normal value)
- Fitness level: 10k run
- Overall mood: optimistic
The first year
I am a trained diabetic now. I follow the general rules of diabetes management along with my own set of rules I have chosen according to my best scientific judgment and my personal preferences. My morning routine usually includes a glucose check although since my levels are stable I do not check every day. I still take 2 pills of metformin per day which serves as a constant reminder of my situation.
I thought everything will be a smooth ride after I reset my blood glucose values but things are not exactly going according to the plan.
First, with running came the running injuries — nothing fancy, just a textbook case of ITB syndrome. As with diabetes, I had to learn about running injuries as well. At least now I have a new joke: “Everything in physics is based on conservation laws — for example, the conservation of mass, momentum, and energy. There is also conservation of problems — for me, I have turned my biochemistry problems (i.e. glucose levels) to biomechanics problems (running injuries)”. Physicist jokes… As my exercise routine decrease so my blood glucose level increased almost immediately.
Second, I got a bit careless with diet. Too much self-confidence. I started to eat cornflakes (although small portions) in the evenings. Small changes, small amounts but still — it mattered.
Last A1c test gave 6% which although by all means is very good for diabetes patients it pissed me off. I want my 5.3% back. I will get it.
- Weight: 73kg (161lbs)
- Body Mass Index (BMI): 23 (healthy weight)
- Fasting glucose: less than 100 mg/dl (occasionally a bit higher than that)
- Hemoglobin A1c: 6%
- Fitness level: switched to cycling and swimming (hope to get back to running soon)
- Overall mood: realistic
At the age of 40, I got a wake-up call — my health was not guaranteed. Although there are many things which are outside of our control — there are many more which are. This is the lifelong conclusion I take with me — for my family and myself.
I did not plan to write so many words about my first year after my diabetes diagnosis. Nor did I know in advance that I had so much to write. Apparently, I had, and I probably have more. In the gigantic jungle of the internet with the hundreds of millions of websites — I guess the odds that someone will read this post are extremely small (except for my wife…). Still, I am glad I wrote this post and if someone, somehow, happens to read it — I hope it will be helpful or motivational for them as well, whether they are diabetes or (preferably) not.