12-days-diabetes-hpi

The 12 Days of Diabetes from the Health Performance Institute!

Click here to view the event on our Facebook page.

Continue on to learn more about it.



Starting December 12 and finishing December 23, we will host a FB Live video each day. The videos will be short – 3-5 minutes – and will discuss some of the things type 2 diabetics struggle with on a daily basis. A few of the scheduled topics include discussions about food and hunger, the good news and bad news surrounding type 2 diabetes, how what you have been told about exercise is probably wrong and a lot more. See the image for a list of all 12 topics.



In each of the videos, we will discuss the topic and tell you what to do so you can improve your condition.

Type 2 diabetes is a serious condition. It’s expensive and debilitating and we don’t seem to be making progress in treating the condition. If you are serious about improving your health and making real progress in controlling your diabetes, the 12 Days of Diabetes from us is what you need.

Please join us. Everything is free and there are no strings attached. Please tag all of your friends, family members, co-workers and anyone else you think should hear this information!

Click here to view this event on Facebook. When there, scroll through and click “Going” for all 12 days of Diabetes. While the first live video is scheduled for noon on December 12, we will be hosting the live video each day at a different time, depending on scheduling. So click “Going” to stay updated on the next video times!

Insulin Sensitivity Webinar

Thank you for viewing our webinar!

Listed below are links where you can download the files discussed during the webinar – the exercise tip sheet and the Module 1 Guide.

A link to enroll in the HPI Diabetes Academy, as discussed during the webinar, is also below.

Click here to download the slides used during the webinar.

Purpose of the Webinar: Stress the importance of improving insulin sensitivity, which is not done by conventional treatment methods.



Exercise Tip Sheet

Module 1 Guide

As mentioned during the webinar, we have an offer to enroll for an exclusive discount of $150 off.

If you’d like to enroll, get access to all 10 Modules of the HPI Diabetes Academy, all of our webinars and more, click the image below to be taken to our shopping cart where you can enroll right now and get immediate access to our website!

Here is how the process will work:

When you click the link below, you will be taken to our shopping cart. Once your transaction is complete, you will be automatically taken to the “Account Creation” page for the HPI Diabetes Academy website. From that point, all you have to do is create your account and you are registered and enrolled!



See you there!

Glycemic Control for Patients With Type 2 Diabetes Mellitus



Controlling blood sugar is not enough!

A recently published article confirms what many other articles have shown:

For type 2 diabetics, controlling blood sugar does not reduce the risk of complications.

Link to Abstract

A pull-quote from the conclusion in the abstract:

“Discordance exists between the research evidence and academic and clinical policy statements about the value of tight glycemic control to reduce micro- and macrovascular complications.”

In other words, what type 2 diabetic patients are being told about controlling their blood sugar and it reducing their risk for kidney disorders, vision problems or pain-related issues, is not consistent with the research.

In fact…

“This evidence reported no significant impact of tight glycemic control on the risk of dialysis/transplantation/renal death, blindness or neuropathy. …however, most published statements and guidelines unequivocally endorsed” the benefits.

So we have a conundrum…

Not really. There are at least three issues here

One off blood tests indicate nothing

When we visit the doctor and have a fasting blood sugar test done, it indicates almost nothing regarding blood sugar control. A step in the right direction would be to monitor blood sugar control with regular A1c tests.

Wholly invested in controlling blood sugar

Everything we do regarding treatment of type 2 diabetes and/or prediabetes (a terrible term) is geared to control blood sugar – we’ve built the entire industry around it. Whether it be the medication, a fasting blood sugar test, or “official statements” from AHA, CDC, NIH or the ADA, it’s all about controlling blood sugar and reducing risk.

This leads to zero positive impact on the cause of type 2 diabetes – insulin resistance.

Maybe type 2 diabetes really is an insidious condition

It is quite possible that insulin resistance and blood sugar dysregulation are more complicated than we currently think and/or know.

It is amusing, telling and disturbing when a complicated concept is taken to a point where it is too simple – simple beyond reason.

But…if the risk for these complications in type 2 diabetics is higher, it means those without type 2 diabetes have a lower risk. So it plays some role – maybe we don’t really understand if the risk is causative or associative. But the risk is there.

So what should you do?

First, understand and come to grips with the fact that artificially controlling your blood sugar (in other words, through medication) is not enough. In spite of what your healthcare professional(s) tell you, the evidence simply does not support it.

Second, take steps to improve insulin sensitivity, which will decrease insulin resistance. Some of these steps include the right diet, proper exercise and ensuring enough sleep (I recently hosted a live webinar on these very topics. If you’d like to view it, enter your name and email address below).

If you can improve insulin sensitivity, you make progress on naturally controlling blood sugar – as opposed to artificially. The more consistent you are, the more your insulin sensitivity improves. The more it improves, the more your body starts acting like someone who doesn’t have type 2 diabetes.

In the long run, and as noted above, this reduces your risk.

View the Webinar

Enter your name and email address below to view the webinar on improving insulin sensitivity mentioned above.

3 Keys to improving insulin sensitivity

What they aren’t telling you!

As a type 2 diabetic, you are keenly aware of the importance in controlling your blood sugar. Whether it is with your diet, the frequency or dosage of your medication, this point is hammered home!

But there is something they aren’t telling you.

Everything you are instructed to do is to control blood sugar:

  • Medication? Find the right dose so the numbers are where they like them?
  • Diet? These are the exchanges. Use them, but eat fewer calories.
  • Exercise? Go burn some of those calories you just ate!

This is nonsense.

It’s nonsense because…

Controlling blood sugar will not fix anything. Sure, you want to keep your blood sugar in check and taking your medication will help you do that. But…type 2 diabetes (and prediabetes) is a problem of insulin resistance. You’ve been told that before, right?

Insulin resistance is what causes your blood sugar to rise. Taking medication to control your blood sugar does nothing to improve insulin resistance!

So you take your medication and check your “numbers.” But what happens when your medication runs out? You need a refill or your blood sugar goes back up. Right?

This is the problem!

In order to improve your health and control your condition, you need to improve insulin sensitivity. This will allow your body to deal with the elevated blood sugar naturally, as opposed to doing it artificially with medication.

So how do you do that?

The Metabolic Problem

Outside of the obvious, type 2 diabetics are fundamentally different than non-diabetics when it comes to their metabolism. For example, at rest they burn a significantly higher amount of carbohydrates to produce calories than their non-diabetic counterparts. This is a major problem because we should all be burning fat while at rest. This holds true as they exercise – they burn a significantly lower percentage of calories from fat at all levels of exercise intensity. Beyond the metabolic and exercise differences, they have a hard time dealing with hunger and feeling satisfied because of this metabolic problem.

This is why the standard approach doesn’t work.

When you combine this with the above information – medication that controls blood sugar doesn’t improve insulin sensitivity – it is no wonder that average type 2 diabetic is told they will never be able to get off of their medication. Nothing is done to properly help them.

Improving Insulin Sensitivity is Key

There are three ways a type 2 diabetic can improve insulin sensitivity:

  • Proper diet
  • Proper exercise
  • The right amount of sleep

I know. Very groundbreaking, right?

But something in this list is key: The word proper! Because if the right kind of food is not eaten, the right kind of exercise is not done and if the right amount of sleep is not part of the equation, insulin sensitivity will not improve.

Proper Diet

The diet for a type 2 diabetic should do at least two things: 1) reduce the overall glucose load on the body. This will help reduce fat storage and help the liver better regulate circulating blood glucose (one of its many important functions). 2) It should promote a fat-burning state so that while at rest, a type 2 diabetic can decrease the amount of carbohydrates their body is burning. Did you even realize you could do this with the proper food choices?

Proper Exercise

Any kind of exercise is better than no exercise, but when it comes to a type 2 diabetic, some exercise is superior. Exercise that promotes fat-burning should serve as the bulk of physical activity. It is like a sledgehammer, battering your metabolism into submission and forcing it to get better at burning fat. Note: This will also help with the resting metabolism problem. So it has a nice side benefit. Another thing to mention: This type of activity should be continuous and last more than 30 minutes – with an hour being optimal. Why? Because it takes a while for your body to get into a good fat burning zone. You need to get in that zone and then stay there.

The right amount of sleep

A lack of quality sleep is associated with every chronic condition known to man. Type 2 diabetes is no different. Further, most people don’t necessarily need to go to bed earlier to improve the quality of their sleep. They just need to change a few things in the last hour or so before they go to bed. After a good dinner the night before and a good night’s sleep, your metabolism is just about perfect.

Start doing these things

If you start doing these things, your insulin sensitivity will improve. Your body will start controlling blood sugar naturally, like it is supposed to do.

The longer you do this, the more your insulin sensitivity will improve, which means in the long run, you won’t have to panic if/when your medication runs out.

If you’d like to learn more…

I recently hosted a webinar on these very topics.

If you’d like to view a recorded version of the webinar, enter your name and email address below and we will send it to you right away.

Why knowing what happens to digestible carbohydrate is important

What happens to the carbohydrates we eat?

Type 2 diabetics (and many others) know they turn into blood sugar. Monitoring blood sugar is something a type 2 diabetic does daily.

But did you know that understanding what happens to blood sugar is also important? I’m not talking about whether it goes up or down after you eat a meal or snack. I’m talking about after the meal and after it has reached its peak – when it starts to go down. The blood sugar goes somewhere. Do you know where it goes?

If you don’t, you should. Because knowing this will help you understand the fate of blood sugar, how you can eat to change this and what impact it will have.

Setting the Stage

It is necessary to define a key term before explaining this process and the image above.

That key term is: digestible carbohydrate. Digestible carbohydrate is the amount of carbohydrate digested by your body after eating a food. For example, one cup of zucchini contains about 12 calories (3 grams) of digestible carbohydrate. By comparison, 1 cup of diced potato contains 28 grams of carbohydrate or 112 calories from carbohydrate. However, it contains only 96 calories of digestible carbohydrate. For most foods, the difference between total carbohydrates and digestible carbohydrate is the difference in fiber content.

In both instances (and all instances of eating food) our body must deal with the digestible carbohydrate calories from the food we eat. In the explanation below, it does not matter where those carbohydrate calories come from (zucchini, potato, cake or ice cream) – the principle is still the same.

The Fate of Blood Sugar

When we eat the zucchini or potato or drink a sugary beverage, there are two outcomes for blood sugar (at least as they relate to this article): 1) some of the blood sugar will be consumed by the body to produce energy; and, 2) the rest will be stored.

The first one is easy to understand. When we eat (or drink) something, our body has to digest it. The act of digesting food is work for the body. Work for the body is done by “burning” or “producing” calories. Glucose can be used to “burn” or “produce” energy needed to do this work. So some of the blood glucose from the foods you eat will be consumed for energy production. But, depending on your circumstance and the amount of digestible carbohydrate you consumed, it is a relatively small amount. This means the rest of the blood glucose needs to be dealt with.

So what happens to the rest?

It gets stored and this is important for you to understand! There isn’t much we can do – one way or the other – to impact the amount of blood sugar that is consumed for energy production. Changing foods we eat, various combinations, whatever the case may be, there isn’t a significant change in the amount of glucose consumed during the digestive process. So this amount (whatever it may be) is pretty stable.

But we can have an impact on storage.

If you return to the image above, there is a cupcake and eggplant on the left hand side. The digestible portion of carbohydrate, that which doesn’t get consumed during the digestive process, gets stored as either glycogen or fat tissue. That’s what the arrows represent.

But how do we know what amounts goes into each and what can do to impact this?

Great questions!

First, our body would prefer to convert glucose to glycogen – the storage form of glucose. The remaining glucose, whatever doesn’t get consumed by producing energy, goes through step 1. This involves converting the glucose to glycogen and storing it – in either muscle tissue or the liver (the only real places our body can store glycogen). Step 1 continues until a condition is met: 1) Our body runs out of glucose that needs to be stored. If this happens, the process stops. Blood sugar is at “normal” levels and nothing else needs to be done. Or, 2) Glycogen levels in both the liver and muscle tissue are full and unable to accept more glycogen. When our body reaches this point, we go to step 2. Step 2 is converting glucose to fat and storing it in the fat tissue. We go through this step until blood sugar is “normal” and nothing else needs to be done.

Limiting Fat Storage

If you go back and look at the image, we can see the middle section (glycogen) dictates how much glucose gets converted to fat and stored in the fat tissue.

With that in mind, there are two things we can do to effectively minimize the amount of glucose that is converted to fat and stored in the fat tissue.

First, we can increase the storage capacity of glycogen. We can do this in one of two ways. By depleting our glycogen stores through dietary changes or exercise; or, by increasing the amount of muscle tissue on our body. Both of these strategies will work to increase the amount of digestible carbohydrate that gets stored as glycogen and decrease the amount of glucose that gets converted to fat and stored as fat tissue.

The second thing we can do is limit the amount of digestible carbohydrate we eat. Overall, the less digestible carbohydrate we consume, the less there is to convert to fat and store in fat tissue.

Both of these strategies will work to decrease fat storage. As an added benefit, it will also improve the body’s ability to access the fat stores, which helps improve insulin sensitivity. A positive outcome for type 2 diabetics.

Digestible Carbohydrate is an important concept to understand

Overall, as a type 2 diabetic, knowing how certain foods spike your blood sugar is important. However, knowing what happens to the digestible carbohydrate may be even more important to know.

Since we can eat foods that decrease (or limit) fat storage, we can impact our overall blood sugar. This will work to improve insulin sensitivity, so that we can control our blood sugar more naturally – instead of using medication to do it. Beyond all that, none of us like storing body fat – we don’t like the way too much of it makes us feel or look, but the negative impact it has on insulin sensitivity makes it worse.

Understanding this and acting accordingly will have a positive impact on your condition.

Webinar: Why Wellness Fails April 2016

Below is the recording from our webinar on Why Wellness Fails to control medical costs, recorded on April 13, 2016.

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Please share across all of your social networks!

The information included in this webinar is important. We know the drill – healthcare costs are crippling all of us. However, with the right approach to wellness and by implementing the right programs, we can have a significant impact!

Unfortunately, the standard, run-of-the-mill “Wellness Programs” are unable to accomplish this!

If you have questions or need help, download the vCard for Brian Sekula (below) and reach out. We are glad to help!

 

A pdf version of the slides.


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Links for further reading

One slide in the webinar had links to additional articles on our website(s). Here the links:

Additional Readings
Type 2 Diabetes is killing your company.
Is exercise more difficult with type 2 diabetes?
RPE and determining exercise intensity.
Dinner with the husband, the shakes and metabolic flexibility.
2015 Member of the Year: Kathryn.
The IARC: Red Meat and Cancer.

 

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Is Exercise More Difficult with Type 2 Diabetes?

Is Exercise More Difficult with Type 2 Diabetes?

We will answer this question shortly.

But first, when talking about whether exercise is more “difficult” for type 2 diabetics, the question is really referencing exercise intensity. There are a number of ways to measure/monitor exercise intensity. We prefer to use Ratings of Perceived Exertion (RPE).

The question refers to a scenario like this:

Given two individuals where everything is the same (age, gender, height, weight, etc…) when performing the same type of exercise, is it more difficult for the type 2 diabetic?

The answer to this question: Yes (in general)1

To illustrate, let’s say the exercise we referred to above is walking at 3 mph. The typical non-diabetic might rate the intensity of this activity at a 3 or 4 on a 10-point RPE scale, while the typical type 2 diabetic might rate it a 5 or 6 on the same scale.

Since RPE is a measure of intensity and 5 or 6 is higher than 3 or 4, we would have to say that, in general, type 2 diabetics have more difficulty with the same activity than non-diabetics.

Why is exercise harder for Type 2 Diabetics?

Look no further than resting metabolism. Metabolically unhealthy (which is what type 2 diabetics are) have a higher respiratory quotient at rest when compared to metabolically healthy individuals. This means type 2 diabetics are using a larger proportion of carbohydrates as a substrate to produce energy. Further, substrate utilization predicts intensity: The more carbohydrates, the higher the intensity.

For type 2 diabetics, this means that even at rest they are producing energy differently than non-type 2 diabetics. And when we change the intensity, like walking at 3 mph for example, this relationship holds true. So they continue to operate at a higher intensity, which is what makes exercise more difficult for type 2 diabetics.

If this is the case, how should we approach exercise and exercise intensity for type 2 diabetics?

Type 2 Diabetics and Exercise

From a metabolic perspective, type 2 diabetics operate at a higher intensity level in comparable exercise because their ability to use fat as a substrate to produce energy has been compromised. (See this for an example). In other words, the average type 2 diabetic has difficulty in using fat to produce energy.

This difficulty in using fat to produce energy makes it harder for type 2 diabetics to lose weight.

This should be addressed first.

Improving metabolic flexibility in type 2 diabetics

In the literature and even within both The Academy and the HPI Diabetes Academy, we refer to this as metabolic flexibility: The ability of the metabolism to switch between substrates (carbohydrates or fats) to produce energy. For someone lacking metabolic flexibility, their ability to switch is compromised. Since type 2 diabetics have difficulty in using fat to produce energy, their metabolic flexibility is compromised.

So the first objective should be to “un-compromise” them by improving metabolic flexibility.

The two best approaches to fixing this are with food and exercise. Since this article is about exercise, we will omit the food part.

We only have two recommendations for exercise: low-intensity and/or high-intensity. Both are effective for different reasons.

Low intensity is effective because it forces the body to get better at using/burning fat during the exercise session. There are a couple of caveats, however:

  1. The intensity must be lower than normal, due to the compromised ability to burn fat.

  2. To be most effective, duration must be longer than 30 minutes – the longer the better. As it takes time for the body to fully get into a fat burning mode, shorter duration activities are not as helpful.

High-intensity exercise is effective because it helps improve the body’s ability to burn fat outside of the session. Earlier, we mentioned that type 2 diabetics have a higher respiratory quotient at rest, which means they are using a higher proportion of carbohydrates to produce energy. As the body adapts to high-intensity exercise, it starts fixing this problem. The end result is a lower respiratory quotient, which means the body is using a larger percentage of fat to produce energy at rest.

On a related note, this is why we aren’t big fans of jogging for most people until they get to a point where metabolic flexibility has improved.

Yes, exercise is more difficult for type 2 diabetics

But this problem can be fixed with an appropriate exercise prescription, one that improves the body’s ability to burn fat during exercise and at rest.

This will result in the increased ability to perform comparable exercise at a lower intensity.

Endnotes

1We say in general, because there are always exceptions and this refers to the average.

RPE and Determining Exercise Intensity

While heart rate (HR) is a popular way to measure exercise intensity, we prefer Ratings of Perceived Exertion (RPE) and will explain why in this post.

When using HR, you workout at some percentage of Max HR; for example between 50-60% or 70-80% of Max HR. The usual way to determine Max HR is by subtracting your age from 220 (Max HR = 220 – age). Once you know Max HR, the upper and lower ends of your HR range can easily be determined.

This seems simple and straightforward but technology doesn’t always get it right. For example, there is a class action lawsuit against Fitbit, claiming their technology and/or algorithms are inaccurate. This can have serious consequences for the user, particularly at the higher end of intensity.

We prefer RPE

RPE stands for Ratings of Perceived Exertion and the key word here is “perceived.”

The “perception” of how hard you are exercising is important for evaluating the overall intensity of the workout. And it is probably more accurate than measuring heart rate only. For example, let’s say you were working out hard – near your maximum capacity. You would certainly “feel” like you were working hard, but if you were using a HR monitor to determine intensity and this HR monitor consistently under-reported your HR, you might think you weren’t working hard enough. This would be in spite of how you “feel” and might compel you to try or push yourself harder. This could lead to a dangerous situation.

The RPE scale takes this into account.

Using numbers on a scale and descriptors for how you should feel at various levels of intensity, a user can accurately identify exercise intensity.

This is probably the most popular RPE scale. If you’ve ever taken a treadmill test – either for a research project in college (or graduate school) or at the cardiologist office, you probably saw something like this.



Notice on the left there are numbers for rating the intensity of exercise and descriptors on the right for helping you pick the most appropriate rating. This is the perception part we refer to and think is important.

While the ratings correlate with HR, they are not 100% accurate.

In both The Academy and HPI Diabetes Academy, we use a slightly different RPE scale – the CR-10 Scale.



We use this version for a couple of reasons:

One, it starts at zero. Notice the scale above starts at 6. We prefer a scale that starts at zero so we have a better anchor point for a resting intensity.

Second, it is much more convenient than any type of HR monitor.

Once a person is comfortable with using the scale, nothing else is needed.

To finish this up, the green areas indicate how we prescribe exercise for those in our programs. We recommend either “light” or “hard” exercise and prescribe intensity using this scale. For example, light workouts should have an RPE of 2-5 while hard workouts should have an RPE of 7+. We skip “6” on purpose and it’s not because there is no descriptor. There is a metabolic reason.

Beyond the two points mentioned above, this also allows our users a lot of flexibility. They can do any activity they’d like, as long as it meets the RPE criteria. This means they aren’t restricted to walking, jogging, cycling or any activity where measuring HR might be problematic (like swimming).

This is why we like to use RPE for measuring exercise intensity.