Real Life with Type 2 Diabetes

Welcome to the second installment of our monthly series, Jim's Journey. Jim was diagnosed with type 2 diabetes in August of 2007. When we talked to Jim last month, there were several areas that he wanted to improve in his diabetes-treatment plan. How is Jim doing this month with some of these issues?

Jim's June 2008 Stats

• Height: 5 feet 8 inches
• Weight: 224.5 lbs.
• BMI: 34 (obese)
• Smoking Status: 2 to 3 packs a day
• Medication: Metformin 1,000 mg., twice a day
• Current A1c: 6.7
• Current Fasting Blood Glucose: 126
• Current Average Blood Pressure: 130/80

Jim's Weight:

Jim has lost 5.5 pounds, bringing his weight down from 230 pounds to 224.5. This is a good steady rate of weight loss averaging about a pound a week. Jim attributes this to watching his portions and being more active now that the nice summer weather is here. Jim's hobby is maintaining the fish pond that he constructed and landscaped last year in his backyard.

I offered Jim a BMI chart, so he could keep track of his progress. We figured out that his starting BMI last month was 35. This is in the obese range for his height and weight. Jim has 72 pounds to lose before his BMI is in a normal range of 20 to 24 and a weight of 130 to 160.

We talked about breaking up the total weight loss into smaller, more achievable goals, gradually working toward a healthy weight. Jim states that he would be happy if he could get his weight down to about 175. Lowering body weight by even 7% can help lower blood glucose levels and blood pressure. Setting small manageable goals for weight loss is often more motivating than thinking about the total amount of weight that should be lost.

Jim's Diet:

Jim is cutting down on portion sizes, stating that he used to eat much larger meals. Now he is used to eating more moderately sized portions and can no longer eat as much at a meal.

Jim is having a hard time giving up his Pepsi habit, often drinking 2 or 3 a day, especially at work or when doing yardwork. Jim discussed the possibility of alternating glasses of Pepsi with glasses of water when he is thirsty, so he can begin to cut down on his daily consumption.

I helped Jim set up an account on About.com's Calorie Count Plus, which is an online motivational website for customizing a diet plan and keeping track of daily calorie, fat, carb and protein intake. Jim can log in his food and activity every day and chart his progress.

• Calorie Count Plus

Exercise:

Jim has decided that the exercise program that he was going to follow last month was much too intensive and time consuming to fit into his busy schedule; it would have been too hard to keep up for the long-term. Instead, he's decided to start with 10 minutes a day of exercise. He feels this will get him in the habit of exercising every day, and he figures that as he gets used to daily exercise, he will gradually devote more time per day to it.

• Exercise and Diabetes - How Much is Enough?
• 10-Minute Timesaver Workouts
• Get Moving! Losing Weight with Exercise

The 2nd-Shift Dilemma:

Jim is trying to eat more regular meals and stick to a schedule. It is still difficult for him not to snack while at work. He often starts the shift with a snack of candy, chips or ice cream, he explains, "I don't eat lunch before I go to work, so when I first get there, I'm hungry and need to eat a little something." Jim says, though, that he is bringing better choices for his dinner break and focusing on more protein and less carbs. He adds, "I don't snack nearly as much as I used to."

• The Average Guy's Guide to Losing Weight

Jim's Smoking:

Jim says that he is actually smoking more this month than last month, between 2 to 3 packs a day. Jim understands the importance of quitting and knows that he should. He is planning on quitting soon. I showed him About.com's Smoking Cessation website, which offers a lot of good information, motivation and support through its very active forum. Jim may find the motivation he needs there.

• Smoking Cessation

Medication:

Jim still has difficulty remembering to take his predinner dose of Metformin when he is at work. He often gets too busy and forgets to take it during working hours. Sometimes he forgets to bring the Metformin to work at all. Jim came up with a plan to keep a spare bottle of Metformin in his mailbox at work or in the glove compartment of his car, so that it would always be available to him.

• Medications for Diabetes

Jim is considering talking to his doctor about glucophage XR, the generic extended-release version of metformin. Glucophage XR is usually prescribed once daily before the evening meal. Jim feels that a once-a-day medication may be easier to remember.

Next Month...

We'll continue to follow Jim's progress with weight loss and exercise. Will he cut down on his Pepsi consumption? Will he continue to find a way to eat regular, healthful meals while working second shift? And most importantly, will he be able to kick the smoking habit? We'll find out ... as we follow Jim on his journey.