Diabetes Weight Loss: Week by Week. Jill Weisenberger

or buy some attractive new ones. Use nothing larger than a 9-inch plate for dinner, 1-cup bowls for cereal, ½-cup dishes for ice cream and other desserts, and 1-ounce shot glasses for M & M’s, jellybeans, and the like.

      TIP!

      Visit www.mindlesseating.org for more information about mindless eating and how to break free of it.

Keep Moving

      For weight loss, blood glucose control, and overall fitness, you should engage in both cardiovascular (aerobic) and strength-training exercises. If you have any doubts about beginning an exercise program, or about cranking it up a notch if you’re already active, talk to your physician first. If you started walking last week or just started wearing a pedometer, keep it up this week and do a bit more, if possible. Our emphasis this week is on cardiovascular exercise. Walking, swimming, biking, stair climbing, dancing, and other activities that get you breathing heavily for several minutes strengthen your heart. This type of activity aids weight loss by burning calories, giving you a boost in energy (this is why being tired is a poor excuse not to exercise), improving triglyceride and cholesterol levels, increasing insulin sensitivity, and lowering blood glucose levels.

      You may feel overwhelmed with the recommendation to engage in at least 150 minutes of cardiovascular activity weekly. If so, take it slowly. Any amount of activity is better than none. Thirty minutes is better than 20, and 20 minutes is better than 10. Set SMART goals for exercise, just as you do for dietary changes. Examine where you are, where you want to go, and make strategies to get there. The best activity to pick is the one you enjoy, and the best time to do it is the time that works for you. For example, if exercising before bed makes it hard to relax into a good slumber, you might be more consistent if you exercise before dinner. Be sure to pick an indoor activity for bad weather days as well.

      During exercise, you should work hard enough to improve fitness, but not so hard to hurt yourself. Warm up for a few minutes with some slow walking and some gentle stretches before beginning your aerobic activity. Do something similar after your activity. Adjust your intensity up or down to hit the range you are aiming for. As your fitness improves, add either a few minutes to your exercise routine or pick up the intensity a bit. Listen to your body and follow the pace that’s right for you.

      Rate Your Exercise

      A useful tool to help you judge your exercise is the Borg Rate of Perceived Exertion (RPE) Scale. It helps you assess your level of effort. The Borg Scale ranges from 6 to 20. Generally, a rating between 12 and 14 indicates a moderate level of intensity.

      Here’s how you use it: while doing physical activity, rate how you perceive your level of exertion. Consider how strenuous the exercise feels to you, including your sense of exertion, effort, and fatigue. Focus on your whole body’s level of exertion, not just on any one part of your body. Then, choose the number on the scale that best represents how you perceive your level of effort.

      The Borg Scale runs from 6 (no exertion at all) to 20 (maximal exertion). A 9 is “very light” exertion, such as an easy, slow walk. At 13, the effort is “somewhat hard,” the work is tiring but you can keep going on. For 15, you’re working out pretty hard, and at 17, the physical activity is strenuous and tiring. When you get up to 19, it’s hard to consider keeping up this level of exertion for any length of time.

      It’s important to try to honestly assess your exertion level. Don’t think about how difficult you think the activity should be. Just scan your body and fairly assess how hard it is working. Honest assessments will yield the best results. For more information, check out this website: www.cdc.gov/physicalactivity/everyone/measuring/exertion.html.

      Avoid Low Blood Glucose During and After Exercise

      Both losing weight and becoming more active improve insulin action. If you use insulin or any of the pills that sometimes cause low blood glucose, exercising puts you at risk for hypoglycemia both during the activity and for as long as a full day later. To avoid exercise-induced hypoglycemia, follow these guidelines.

      • Measure your blood glucose before starting to exercise. If it’s below 100 mg/dl AND if you take medications that can cause low blood glucose, you will need a snack of about 15 grams of carbohydrate or whatever amount is necessary to raise your blood glucose to 100 mg/dl. A small piece of fruit will usually do. If you take no diabetes medications, it is unlikely that you need a snack.

      • If you are exercising at a very high intensity, doing interval training, or doing intense weight training, you may need a carbohydrate-containing snack both during and after exercise to help prevent hypoglycemia some hours later.

      • Measure your blood glucose frequently before, during, and after exercise to learn how different activities uniquely affect you. Check whenever you feel like your blood glucose is low.

      • Always carry a source of carbohydrate in case you experience hypoglycemia. Follow the Rule of 15 if your blood glucose ever drops below 70 mg/dl.

      — If you have your blood glucose meter, use it. If your blood glucose is less than 70 mg/dl, or if you don’t have your meter but believe your blood glucose is low, consume 15 grams of carbohydrate. It’s best to use pure glucose in the form of tablets, gel, or liquid because it works quickly and contains a minimum of calories. Some good choices include:

      2–5 glucose tablets (check the label for the proper dosage)

      1 tube of glucose gel

      2 tablespoons of raisins

      4 ounces of regular soda or fruit juice

      1 tablespoon of sugar or honey

      1 cup of nonfat or low-fat milk

      Do not use candy bars and desserts because they add calories, saturated fats, and work slowly. If that is all you have, however, use it.

      — The second half of the Rule of 15 is to wait 15 minutes after treating before eating anything else or resuming activity. Measure your blood glucose again. If it’s still low, consume another 15 grams of carbohydrate.

      — Recheck your blood glucose in another 15 minutes. Continue to treat with 15 grams of carbohydrate and recheck in 15 minutes until your blood glucose is back to normal.

      — If your next meal is hours away, you may need a snack.

      More from Bill K

       Exercise is a big part of my diabetes management and weight-loss plan. Sometimes when I’d exercise, though, my blood glucose would go too low, which forced me to take in extra carbs to push it back into my target range. Weight loss is difficult under any circumstances, but being forced to eat to keep my blood glucose up was making it a lot harder. I worked with a certified diabetes educator, who is also a registered dietitian, to help adjust my insulin dose, so my blood glucose wouldn’t go too low. That did the trick. By reducing my insulin, I was able to eat less, which reduced my calorie intake. Weight loss is definitely achievable with persistence.

Reflect on Your Food Record

      You’ve kept your food record for at least two weeks by now. Take some time to look at it carefully. What patterns do you see? Perhaps you’ve noticed that you eat mindlessly in front of the television or feel the need for sweets in the afternoon. Maybe you tend to take second and third helpings, even though you’ve had enough to eat. Do you eat too fast, without fully tasting your food? By monitoring your own behaviors and progress, you can identify problem areas and take note of the strategies that work for you and those that do not. Some people like to review their food record daily and to write notes about things they did well or not so well. Then, they set a goal for the next day. Other people prefer to reflect on their food records weekly. Do what you prefer and what works for you and put those SMART goal practices into action.