Jay making time to do strength exercises in his hotel room

My name is Jay Smith, and I have been a patient at the Joslin Clinic since 2005. I just completed the first phase of  Why WAIT, a weight loss and intensive treatment program offered at the Joslin Clinic.

During the last session of the 12-week program we were reviewing our successes during the first phase, and keys to continued success in managing our weight and blood glucose levels. A slide asked the question. What are the three keys to continued success?

1. Exercise (No real surprise here, since exercise was a major component of the program).
2. Exercise (My guess was going to be proper diet, but I get the point)
3. Exercise (Hmm, I think they are trying to tell me something)

Although diet is an important component, it sunk in what they were trying to tell me. The benefits to exercise in maintaining a healthy weight and blood glucose levels are my top priority. Armed with this new philosophy and motivation I was exercising 5 to 6 days a week, and feeling great.  One of my first barriers was a work conference that would be breaking my routine.

I planned my meals, packed healthy snacks and my gym bag. I woke up earlier the first morning, and was ready to hit the hotel gym before registration.  I found the hotel heath club, and went to open the door, but it was locked. I pulled my room key from my gym shorts pocket, and searched for a place to insert the key.

Then I saw a sign showing the gym hours. It was Sunday morning and the gym did not open until 8:00 AM. I was disappointed, knowing that I wouldn’t have time once the conference started, and I didn’t want to start my week without exercise. I thought maybe I could jog outside, but it was very cold.

As I started to ascend a few steps from the hotel lobby to the elevator it hit me. This is a hotel, why not just climb stairs for 20 minutes and then uses the resistance bands back at the room? I had a great work out, and felt energized when it was time to register for the conference.

By Jay Smith, Joslin Patient

Due to the Why Wait program I realized that many of the barriers that stop me from exercising are very easy to overcome, and exercise is a priority. I am still early into phase 2, but have been able to exercise at least 5 days a week. Although exercise is a priority, it doesn’t need to be controlled by time or place.

The Pilates technique helps to increase lean muscle mass

It’s no surprise that when you have diabetes keeping physically active is a crucial part in managing the disease.

But it’s hard to stay motivated and committed to your fitness goals when you’re doing the same exercise routine day in and day out. With May being National Exercise Month, there’s no better time to explore or experiment other fitness routines to help control and manage your diabetes.

Muscle takes up glucose better than fat, so the more muscle you have, the better your blood glucose numbers should register, whether you have type 1 or type 2 diabetes. Pilates is all about body weight and resistance training, which increases muscle mass.

Another benefit-the greater the muscle mass the more calories burned at rest, equating to greater amounts of weight loss.

Pilates specifically works the deep muscles of your body’s core—the abdomen, obliques, lower back, inner and outer thigh, and buttocks. It’s a system of exercises designed to develop strength, flexibility, muscular endurance, coordination, balance, and good posture.

This core strength focus of Pilates could also reduce the amount of abdominal fat mass—the more fat you have at your waist line and tucked around your organs, the higher your risk for type 2 diabetes.

There are six principles in Pilates-concentration, control, centering, breathing, flow, and precision-that train the body to move with limited stress on your joints. Pilates focuses on slow, gentle movements to engage deep core muscles often overlooked in workouts that use large movements, heavier weights, and machines.

There are two types of Pilates: floor-based and machine-based. Floor-based Pilates takes place on a mat on the ground, using elastic bands, balls, bricks, and exercise rings to build balance and strengthen the core. In machine-based Pilates, you use two machines, the Cadillac and the Reformer, which are a system of springs and pulleys that add weight and resistance.

When the core is strong, alignment and posture improve, relieving stress on the joints and muscles. This is one of the reasons Pilates is often recommended for back pain as well.

Pilates mat exercise is generally done lying down, sitting, and sometimes kneeling. These positions make Pilates exercise well-suited for people who may not be comfortable standing for long periods, or in exercise systems that require a lot of shifts of weight.

In addition, Pilates exercise can be modified for different levels and physical needs. Therefore, people of all sizes, shapes, and ages can do Pilates. An experienced instructor will be able to adjust mat exercises to help you gradually improve strength and endurance, working your way into Pilates exercises.

In both types of Pilates, exercises are performed in sets and repetitions. While you do hold some moves for a certain number of breaths, as with yoga, in Pilates exercise you remain in regular motion for the majority of the class.

Be sure to check with your doctor before starting Pilates or any exercise routine. If you do decide to take a Pilates class it’s essential to let your instructor know you have diabetes. There also may be some exercises, like rolling or going upside down, that are not appropriate for those with high blood pressure, diabetic retinopathy, musculoskeletal issues or other medical problems. Be sure also to check your blood glucose before and after the session and maintain blood glucose at safe level.

Birch was diagnosed with type 1 diabetes at age 29. Growing up with a father who had type 1 diabetes, he knew what to expect from the disease having seen firsthand the challenges his father faced over the years.

He has been physically active throughout his entire life, playing his favorite sport, hockey, as both captain and MVP of his high school team. He continues to play now in a local men’s league.

Prior to participating in Ironman triathlons with his father, Birch had very little experience in triathlon races which include swimming, biking, and running all in one.

“I almost puked when I first heard what an Ironman entails,” said Birch.

A full Ironman triathlon begins at 7:00am and must be completed by midnight. The race consists of a 2.4 mile swim, a 112 mile bike ride, and a full marathon 26.2 mile run, raced in that order without a break.

About a month after Birch was diagnosed with type 1 diabetes his father visited him in Texas. His father had always been involved in triathlons and over the years had talked about participating in an Ironman triathlon someday.

While they were talking over some brisket and beef ribs at Salt Lick BBQ, Birch said to his father, “Let’s just do it. What’s holding us back?”  His father replied with, “Absolutely nothing.”

They began training the next day for an Ironman. Triathlons have a few shorter distance races that lead up to an Ironman which Birch competed in first: Sprint, Olympic, ½ Ironman, and then the full Ironman.

Birch’s first triathlon was a Sprint distance (0.47 mile swim, 12.4 mile bike ride, and a 3.1 mile run) in Marble Falls, Tex. His performance was quite impressive, finishing first in his age group and receiving a trophy.

He went on to complete an Olympic distance (0.93 mile swim, 24.8 mile bike ride, and 6.2 mile run) in Austin, Tex and a ½ Ironman (1.2 mile swim, 56 mile bike ride, and 13.1 mile run) in Michigan. Each race taught him something different about how to get faster and to better manage his blood glucose levels.

Birch explained the easiest way for him to deal with type 1 diabetes on a day-to-day basis is to not eat carbs or sugar. However, since our bodies are fueled by carbs and that’s where we get our energy from, that obviously won’t work during a triathlon.

His doctors in Texas couldn’t offer him any advice and his triathlon coach told him up front he knew nothing about diabetes. Therefore, a lot of what Birch and his father do to control their diabetes during these races is through trial and error.

“The first thing, and most importantly, you need to know is your insulin/carb ratio.  This ratio is different for everyone.  Mine is about 1 unit/20 carbs when I’m actively working out and about 1 unit/15 carbs when I’m not active or on vacation. When you work out your body is more sensitive to insulin,” he said. “Then, you need to have a detailed food/insulin plan starting at 4:30am through the end of the race (for me about 6pm).”

One thing he’s learned from previous races is that he must have fast-acting insulin in his body to convert the carbs to energy. Without that insulin in his body, he can’t utilize those carbs which results in high blood glucose dehydration cramps and poor performance.

Birch and his father completed their first Ironman triathlon in Tempe, Ariz. on Nov. 18, 2012. He participated as a fundraiser for Team Joslin and raised over $17,000 for the High Hopes Fund.

“Some people might come up with excuses why they couldn’t complete an Ironman…but diabetes doesn’t define me or anyone else. It’s part of your life now, so you just have to deal with it the best way you can,” explained Birch. “Life is too short to say, ‘I can’t’ or ‘I won’t.’ Doing the Ironman with my father was an awesome life experience and not once did I ever think I couldn’t do it. A lot of people asked me, what if you can’t/don’t finish?  I just said, ‘I will finish.’”

Together, Birch and his father have created the IronDiabetic team dedicated to find a cure for type 1 diabetes. They’ve been following their training protocol and have been competing in triathlons and other races.

Try to get as close to 10,000 steps per day! It can be hard, so start slow and work up to the big goal

As part of National Exercise Month, Joslin Diabetes Center is starting a Show Us Your Pedometer campaign to motivate people to increase their daily physical activity.

A pedometer, which is a portable device that measures a person’s physical activity throughout the day, is an effective and simple tool that can be utilized to boost your motivation to exercise. Both children and adults can utilize pedometers to track their daily movements or steps.

Although pedometers are designed to be worn at the waist, you can also wear a pedometer on your arm or ankle. Most importantly, your pedometer should be placed on an area of your body that creates the most movement throughout a typical day.

When you are considering which pedometer to purchase, it is important to evaluate accuracy, comfort, price and personal preferences.

Consumer Reports suggest the following brands for accuracy, but other pedometers will suffice as long as you adjust them for accuracy purposes:

• Omron HJ-112
• New-lifestyles NL-2000
• Sportsline 330, 343, & 345
• Yamax SW-200 and SW-700

You can also monitor your daily movements and steps by downloading a pedometer app on your smartphone.

The Washington Post and Beth Israel Deaconess Hospital offer several suggestions:

• The Accupedo Pedometer Widget (for Android; $4)
• Pedometer Pro GPS+ (for iPhone, iPad and iPodTouch; $3)
• BIDMC Pedometer” in iTunes Store or Android Market (Free)

The National Center on Health, Physical Activity and Disability (NCHPAD) recommends that you should reach approximately 10,000 steps per day (this may not be ideal for an individual beginning a physical activity program or for an individual with a disability).

How to measure exercise:

• Attach the pedometer in the morning and continue to wear it all day
• At the end of the day, record your steps
• Calculate your average daily steps at the end of each week and then create a goal for the next week
• Keep a log where you record all of your progress
• Repeat this process for the remainder of National Exercise Month

The most important part is to stay active and track your progress using a pedometer, and remember, to have some fun while you are exercising!

Join Joslin’s pledge to become more active by sending a picture of yourself or someone you know using a pedometer to the Joslin Twitter @joslindiabetes or the Joslin Instagram, @joslindiabetesctr, using the tag #mypedometer.

How many steps will YOU take?!

(Information from the NCHPAD)

The Joslin Nurse Educators—Thecla Gordon, Stacey O’Donnell, Melissa Karas, Marianne Chojnicki, Sue Ghiloni, and Laura Schwab—are all Registered Nurses(R.N.) and Certified Diabetes Educators (C.D.E.).  They work with patients to develop care plans that work within each individual schedule and lifestyle. “We really try to get them to develop their own self-care goals,” says Thecla.  “And we make sure the get the best of what they really need.”

During their first visit, patients see a nurse for an hour-long appointment to make sure they understand their diagnosis and how to manage their diabetes on their own. “We help expose their barriers,” says Thecla, and then they develop ways to take those barriers down, or at least work around them. “We try to coach them and motivate them to embrace self-care,” she says.

The Joslin nurses do more than meet with patients on a one-on-one basis. They participate in the many programs Joslin offers to make self-care more manageable, including the DO IT program (a four-day intensive diabetes “tune-up”), the Why WAIT program (a 12-week motivational weight loss program), and the numerous group classes such as the pump and continuous glucose monitor programs.

Well-versed (and helping patients) in all areas of diabetes, “every nurse here has a unique gift and style,” says Thecla.

Thecla likes to meet with patients who have mental health barriers in their care. Sue works with the pregnancy clinic and the insulin pump program. Stacey teaches about diabetes technology, such as pumps and glucose monitors, and educates young adults on proper type 1 diabetes care. Melissa and Laura specialize in weight management, and Mary Ann works with hospitalized patients.

The nurses at Joslin strive to make diabetes care fit as seamlessly into day-to-day life as possible by getting to know their patients and understanding the ways they like to live their lives.

“It’s a special relationship,” says Thecla. “We really care.”

The best way to avoid fluctuations in blood glucose is to check your blood glucose often. Check your blood glucose before, half way, and after the exercise session to gather data and learn the impact of different types of exercise and any physical activities on your blood glucose in order to improve glucose control.

Continue Reading –>

Jackie Shahar, manager of the Exercise Physiology department at Joslin, works with patient James Dugan in the Joslin gym.

Good nutrition without physical activity is like eating one-half of a really tasty sandwich. Although the half maybe nourishing and appealing, it isn’t fully satisfying. To achieve good health and excellent glycemic control you need both halves of the sandwich. Just as you may need a dietitian partner to help you maneuver the serpentine world of healthy eating, a guide in your exercise journey can be a lifesaver, also.

National Exercise Month is a good time to talk about the dietitian’s partner, the exercise physiologist (EP). Now most people are familiar with dietitians and have some idea of what they do and why seeing one would be a good idea if you have diabetes. However, determining why their doctor wrote out a referral for an appointment with an exercise physiologist may leave a lot of people scratching their heads.

Some people confuse exercise physiologists with physical therapists. Physical therapists help restore muscle and limb function after people have had an injury, but you don’t have to be injured to benefit from the services of an EP (such as Joslin’s own Manager of Exercise Physiology, Jackie Shahar M.Ed., R.C.E.P., C.D.E.,). Planning for and starting an exercise program can be challenging for many people with diabetes. EPs can help you learn how to exercise safely no matter what your starting condition is.

James lost nearly 50 pounds in half a year working with Jackie and the Why WAIT team at Joslin (Why WAIT is a 12-week motivational weight loss program offered at Joslin)

Excess weight, joint problems, diabetes complications such as retinopathy, neuropathy and nephropathy all require specialized techniques to make exercising safe. EPs have the anatomical training to be able to recommend exercises that will improve your cardiovascular and muscle strength without worsening your other medical condition(s).

The EP is trained to identify lifestyle-related issues that promote poor health and to design and implement a behavior-based treatment plan aimed at modifying those lifestyle behaviors. Lack of time and distaste are two of the reasons people give for not wanting to exercise. One of the EPs strength’s is the ability to match exercises to your lifestyle.

The EP will first analyze your current fitness level, and come up with a complete, individual exercise plan to improve your cardiovascular function and blood glucose control that takes into account your medical condition(s). Says Jackie– “For people with diabetes, an exercise physiologist is an excellent choice as a coach because he/she understands how exercise can affect blood glucose levels.“

According to Health Careers.org, the Board Certified Exercise Physiologist (EPC) is trained to:

• Administer exercise stress tests in healthy and unhealthy populations
• Evaluate a person’s overall health, with special attention to cardiovascular function and metabolism
• Develop individualized exercise prescriptions to increase physical fitness, strength, endurance, and flexibility
• Design customized exercise programs to meet health care needs and athletic performance goals

EPs must have a degree in exercise physiology and/or has been certified by the American Society of Exercise Physiologists (ASEP).The coursework includes hard science courses such as Kinesiology (functional anatomy), biomechanics, exercise physiology, psychophysiology, cardiac rehabilitation, exercise testing and prescription, ECG interpretation, and statistics.

You might consider seeing an EP in the following circumstances

• newly diagnosed with diabetes or pre-diabetes
• trying to prevent diabetes
• trying to lose weight or gain weight
• seeking help in getting your blood glucose under control with exercise
• trying to improve your aerobic capacity or increase muscle mass
• diagnosed with other health conditions besides diabetes that will benefit from an exercise plan (e.g. high blood pressure, high cholesterol and high body fat)
• finding an exercise regimen that best fits your goals, health conditions, culture and lifestyle

Not every recognized diabetes education program has an exercise physiologist on staff. If your program doesn’t, ask your health care provider for a referral to an independent practitioner or check out the American College of Sports Medicine ProFinder website: http://certification.acsm.org/pro-finder

Get moving this May!

After one of New England’s longest, coldest, and snowiest winters, spring has finally bloomed! The winter season sometimes causes people to slip into a workout funk because gym routines can become boring and repetitive. But the brighter and warmer days are a great excuse to get out of the sweaty gym and enjoy some fresh air! May is National Fitness and Exercise Month so there’s no better time to get active outdoors than right now!

Exercise has many positive benefits for people with diabetes. It can lower blood glucose, improve insulin sensitivity, reduce the risk of heart disease, improve your blood pressure, cholesterol, mood and posture, strengthen your muscles and bones, reduce stress and anxiety, and make you sleep better. But before you get out there remember to track your blood glucose before, during, and after exercise. This will help you judge exactly how your body responds to different types of exercise and help you prevent potentially dangerous blood glucose fluctuations.

As the warmer weather rolls in you can ditch running on the treadmill and head back out into the open air. Many people prefer jogging outside because you have the freedom to choose various routes for a change of scenery. If you get tired of running the same courses through your neighborhood, find a nearby park or river to run along. One of the most popular running destinations in Boston is along the banks of the Charles River. The river loop has clean, paved trails with beautiful views of the city full of people running along to keep you motivated!

Try taking a nice run with a friend--be they human or canine

Jogging is a popular aerobic exercise with many health benefits for your mind and body. Research has shown that regular jogging can help prevent or reduce the risk of type 2 diabetes, coronary heart disease, cancer, obesity, and osteoporosis. It can also help fight depression, stress, and insomnia. Jogging will improve your cardiovascular endurance and overall muscle tone while strengthening your bones.

Another alternative outdoor exercise routine would be to dust away those cobwebs and hop on your bike for a cruise around town! Whether you’re riding as a mode of transportation or just for fun, there’s no better feeling than that cool breeze whisking across your face.

Cycling can help you lose weight, reduce stress, and most importantly improve your fitness. It’s a low-impact exercise that’s easier on your joints than running or other high-impact aerobic activities-but it still helps you get into shape. It can help tone and strengthen your muscles, especially the lower half of your body including the calves, thighs, and buttocks. Instead of driving to work, ride your bike-it’ll benefit both your health and the environment!

Also, make an effort this spring to incorporate walking into your daily life. Consider walking your kids to school or to the bus stop in the morning. Walk to pick up groceries or run errands on your lunch break. Take an evening walk after dinner with your family through the neighborhood. Or take your dog for a walk through a nearby park to enjoy the freshly blossomed flowers and trees.

Walking is a low-impact aerobic exercise to build your cardiovascular endurance with less of a demand and stress on your joints than other high-impact aerobic exercises. It can offer the same benefits of jogging when done for a long duration and at a moderate intensity. Choose to walk up hills to add intensity to your walking routine. Walking uphill builds more muscles in your lower body because there is greater resistance. You can also increase the speed of your walk or add on an extra mile to make it more challenging.

Some people may have difficulty walking due to joint or muscle problems, others may have foot problem such as neuropathy, Charcot foot or foot ulcers. Speak with you doctor before starting any exercise program and find out the best exercise for you.

For any of these outdoor physical activities consider inviting friends. It’s more fun exercising in a group and it will keep you driven to reach your spring fitness goals!

Celebrate with us on our blog, facebook.com/joslindiabetes, and @JoslinDiabetes on Twitter! And Joslin is pleased to announce that we’re now on Pinterest and Instagram! So follow us all month long for tips on incorporating exercise into your life.

Unlike glucose, which potently stimulates insulin release, fructose is known to be a weak activator of insulin and dampens the response of glucagon-like peptide (GLP-1), a hormone known to maintain insulin levels. Both of these conditions can lead to increased hunger signals and higher glucose levels in the blood.

The fMRIs showed that glucose-sweetened drinks reduced blood flow in the regions of the brain affecting a person’s feelings of satiety, while fructose produced less of a decline in blood flow in some of the same regions. In these satiety regions, reduced blood flow signals to the body a feeling of fullness, regulating food intake.

The participants’ ratings of their satiety level correlated with the blood flow information provided by the fMRIs. Participants’ level of satiety was significantly increased when they drank the glucose-sweetened beverages, but not so for the fructose-sweetened drinks. Although total calories ingested have the largest effect on body weight, hunger is a significant driving force behind the urge to eat and calories consumed. The inference being the less hungry you are, the less you will eat and the less weight you will gain.