Disguise Your Exercise.

Back when I was going to school most students still grabbed their books off the front seat of the car, tucked them under their arm, locked the car (with a key) and headed the direction of their class. That is exactly what I was doing one cool night in mid November on the campus of The University of South Florida.

As I walked to class I couldn't help but notice a couple of dozen guys playing basketball on the outdoor courts. The lights were just coming on as the sun was now out of sight well below the tops of the trees. Although I really enjoyed the Exercise Physiology lab I was headed to, I have to say I was a bit envious of the fun the guys were having playing basketball. They were hollering and laughing while they hustled up and down the court putting in layups and stealing the ball. The courts were to the right of me and I remember always watching the guys play until I was well beyond them.

Eventually I reached my classroom where I spent the next two hours sitting and listening to my professor lecture. When class was over I headed back to my car. By now it was good and dark, that is, except for the bright lights shining down on the basketball courts where interestingly there were a lot of guys still playing ball. As I approached the courts, now on my left, I noticed something that made me stop in my tracks and look down at my watch. What was so surprising was that it was now 8:15 and a handful of the guys that were playing when I was on my way to class over two hours ago were still playing!

I was pretty surprised to see that. These guys had been been playing for over two hours. I stopped for a moment and watched them. They looked like they were having great fun. They looked tired and at times they were huffing and puffing. It didn't seem to matter though, it didn't seem to bother them, probably because they were having so much fun playing they weren't even thinking about how tired they were.
I began walking again, back to the car, but now thinking, "I wonder if these guys have any idea of the good, high quality, exercise they have been getting for the last couple of hours and all of the benefits they will derive from it?

I doubt it. I bet their plan was simply to come out and play some basketball for a while and have some fun. Who knows, maybe as far as they are concerned the exercise they are getting is just a side effect or just an added benefit.

Everyone needs to find something, or some things, that they like to do, that they look forward to doing, but that is physically active and also good for them while they are doing it. I call this disguising your exercise.

Article Source: http://EzineArticles.com/6659780

Diabetes Belt Diagnoses

There are numerous demographic statistics available for learning about diseases ranging from heart disease to peritoneal mesothelioma. The availability of this data collection helps in disease prevention and health promotion. Recently, a new geographic segment within the United States has been associated with Diabetes. 

 According to the American Diabetes Association nearly 26 million people in the United States have diabetes. A recent study has revealed what researchers have long suspected. There is a high concentration of diabetes in the Southeast. Although the study does not differentiate between type I and type II diabetes, more than 90% of all diabetes in the United States is type II or adult onset diabetes. The study, which was done at the county level, reveals a pattern of type II diabetes in the Southeast that encompasses parts of fifteen states.

The national average for diabetes is 8.5%, but in what has now been defined as the diabetes belt, the rate is more than 11%. The states that comprise the diabetes belt are Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia. The distribution, however, is far from even. States like Ohio and Texas have only a few counties with higher than normal rates while some states like Alabama have high rates in the majority of their counties. The entire state of Mississippi has a diabetes rate of 11% or more.

Researchers first identified this area of the Southeast in the mid 1960's as the stroke belt. Though the areas are not identical to the diabetes belt, the overlap is striking. A combination of factors such as high fat diet, obesity, hypertension, lower quality of healthcare, and lower socioeconomic status were found to be contributing factors to high mortality rates from stroke for those in the eleven states identified during that study. Today these same factors along with a sedentary lifestyle are contributing to the increase in diabetes in the same areas of the Southeast. 

It was once thought that the higher concentration of African Americans in these areas contributed to higher rates since African Americans are more prone to diabetes. However, new research has found that even those living in these areas that are predominantly younger, white, and not obese are more likely to be diagnosed with type II diabetes than those living elsewhere. Researchers offer several possible reasons for this. Both stroke and diabetes are strongly affected by cultural and behavioral factors in addition to commonly recognized risk factors. Recommendations for those living in these areas include increasing physical activity, maintaining a healthy weight, and paying special attention to dietary choices.

This post is written by guest blogger,  Jenna Walters

Never Put Off Exercise You Can Do Today Until Tomorrow

Those are my new words to live by. Actually I have a lot of words I try to live by and these are the latest I have added to my list. I am hopeful that by doing more exercise and eating well, and reducing my stress, I will see my 90th birthday and still be sharp enough to know that it is my 90th birthday when it  rolls around.

I want to be able to get up out of a chair, not a wheelchair, by myself, unassisted, and walk over to get my second small piece of cake (after all it is my birthday). I would like for all of my friends, at least my best friends, to "Never put off exercise they can do today until tomorrow" either because I would like to still have some friends of mine around to come to my 90th birthday party. After all, what's the point of having a party if there is no one there but me?

I have been trying to live by these words for about a month now and have discovered that my overall weekly exercise time has increased (It is so rewarding when something you try works). I am sleeping better, have lost a little weight, and am not getting sleepy sitting at my desk mid afternoon nearly as often as I was. In short, it's working.

So what was my motivation for this idea of mine? It seems as though I am always pressed for time and getting to workout is a major priority of mine. At the beginning of each week I look at the week ahead to see when I can get in a quick 30-40 minute workout. There are some weeks when it looks like I have three days in a row that I can exercise, then two days later maybe another two days in a row. So what I have done in the past (which I now do differently) is exercise several different body parts and then save the other parts for the next day. Here's the problem. About half of the time something comes up the next day and I don't get to workout. Then I end up aggravated at myself for not going ahead and exercising more of my body the day before when I was already at the gym and had a few minutes remaining that I could have done it.

So now, whenever I am about finished working out and notice I have a few minutes left I will go ahead and exercise another muscle group or two. I no longer save it for tomorrow because you never what tomorrow will bring. Things come up and emergencies happen so get it done when you can. At least that is what I have been doing and so far I have been able to increase my overall exercise time. Try it.

By: Milt Bedingfield

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Milt received his graduate degree in exercise physiology from The University of South Florida and has been teaching people with diabetes about the disease and how to care for it for the last 18 years.

Article Source: http://EzineArticles.com/6842855

Know When To Take A Day Off

There she was, awkwardly stepping out of the ladies' locker room. She reminded me of a new born trying to stand on new legs. Her two piece Speedo covered very little of the road rash she acquired barely 24 hours before.

I could hear her fellow teammates, all runners, bikers and swimmers waiting to enter the pool for their evening workout, making random comments about her being there. As for me, I was thinking...well, more on that later.

Her name was Julie, a registered nurse by profession, who by the way, was a very talented forty plus year old triathlete, particularly good at cycling.
I had known and coached her for at least the last three years. Julie was a delightful lady that everyone liked.

With every step she took, Julie would either wince or laugh depending on the comment she was reacting to.
I soon realized that Julie was coming over to see me. In her left hand she held an ace bandage. As she got close I could see where several layers of skin had been peeled of her shoulder and about a five by five, still raw looking abraision on her right hip. Below that was a severely scraped up knee.

When she got close enough I finally asked her, "What are you doing here?"
"I have to swim," she sort of whined, and in a way, begged. She knew it wasn't a smart thing to do but she felt she had to do it.
"Julie, you have no business being here," I told her, "Go home and recover, then come back when you are better."
"I can't, I have a race next week. I need you to wrap my ribs for me. I think I have a cracked rib."
"Julie, you can't swim with a cracked rib. You have got to go home and let things heal. This is dumb you know better than this," I told her.
When she realized that I was really against her getting in the pool, then she started pleading.
"How about if I just kick with a kick board, I won't even use my arms?"
"That's not going to do you any good, Julie, I responded.
"I'm just going to try it. If it hurts too much I will get out," she told me.
Eventually she convinced someone to wrap her ribs with the ace wrap and she got in.
She tried to swim. That didn't work. She tried to swim slow. That didn't work. She tried to kick with a kick board, too painful. A few minutes later she looked up from the pool and sadly, reluctantly,admitted, "This isn't working, I'm getting out."

It was painful watching her as she struggled to get out of the pool and I felt bad for her, but more than that was amazed that someone with her intelligence would try to swim with all of her abrasions, and worse than that, a broken rib or two.

Julie's contention was that even swimming slowly, or if she couldn't do that, kicking with a kick board back and forth was better than doing nothing. She was fearful of losing her conditioning she had worked so hard to get. The truth is, for a well trained athlete like Julie, swimming slowly or kicking slowly is of no benefit when it comes to helping her maintain her high level of conditioning because the intensity level is too far below what she is capable of when she pushes herself. Low intensity training dos nothing to maintain a high VO2 max.

If Julie had type 2 diabetes and was simply interested in burning up some sugar, or was simply interested in burning some calories for weight loss purposs, then low intensity exercise would be of benefit.

In this case though, since Julie doesn't have diabetes she would be far better off accepting the fact that she is injured and do everything she can to take good care of her wounds so that they will heal faster so that she can get back to training at her usual intensity level.

Over the many years that I coached competitive athletes I saw similar scenarios such as this frequently. A runner or swimmer or cyclist would develop a very sore knee or back or shoulder, some type of injury that kept him or her from performing at their usual level of exertion, and then rationalize that walking the track if they couldn't run, or cycling slowly perhaps a longer distance than if they were healthy and could ride fast for a shorter distance, would somehow help them maintain their fitness level. This is simply not the case.

This is not to say that slow, easy workouts are of no benefit. They do have their place as part of a well thought out training program, however, are of little to no benefit and may actually be harmful when injured.

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Milt has been teaching people with diabetes about the disease and how to care for it for the last 18 years. Milt has also coached and trained adult athletes for over 20 years.
Milt beleives that performing regular exercise is not stressed as much as it needs to be by health care providers and is always trying to change that for the better.

Which Is Most Important - Eating Less Carbs Or Getting Exercise?

Not long ago I wrote an article about type 2 diabetes stressing the need for exercise. This is not at all uncommon for me as I strongly believe (based on my observations and 18 years of experience teaching people about their diabetes) that performing daily exercise is the most important thing most people can do to best manage their disease. Now, undoubtedly, there are going to be skeptics out there that say it's all about how many carbs you eat.

Well, the number of carbs you eat does have a lot to do with good blood sugar management I wholeheartedly agree, but it is shortsighted to say that it is all about carbs because it is not. If in fact someone has some really excessive habits such as drinking a liter of coke a day, or putting away a bag of Oreos before bed at night, or even drinking a half gallon of chocolate milk, or orange juice daily, then the most important and quickest thing that they can do to improve their diabetes is to eliminate those habits.

But for you folks that are healthy enough, and have your doctor's blessing, I challenge you to try adding exercise into your diabetes treatment mix, at least 5 days a week, gradually building up to thirty minutes a day. As for those of you that are already getting some exercise, but have not observed any benefit,it may just not be enough and you may want to consider doing more.

In all but the rarest of circumstances, adding exercise to the treatment plan for managing type 2 diabetes will have a substantial positive impact on maintaining good blood glucose control.

After all, putting less fuel in the tank (sugar in the blood) is good, but performing regular exercise and using as many muscles as you can, as often as you can, enables you to use the gas in the tank (reduce the amount of sugar in the blood). Eating less carbs is only half the solution to good blood glucose management, the other half is getting more physically active.

Remember, getting exercise should not be unpleasant. It should not hurt, it should not be something that you dread. Believe it or not you will actually start to miss it on the days you don't get to do it. I know that is hard to believe but it is so true.

To get started try this. Simply replace something that you do that is inactive (watching a rerun of a sitcom, doing a crossword puzzle, etc.) with something that is active (watering the plants in the yard, sweeping the porch, taking the dog or cat for a walk, or giving your pet a bath (an extra bath never hurt anyone as far as I know). As time goes on, build from there.

And by all means, forget the no pain, no gain foolishness. For the vast majority of people in the world pushing to the point of feeling pain is totally unnecessary.

Now get started... please.

Article Source: http://EzineArticles.com/6608084

The C-Peptide Blood Test And How It Could Save Your Life

Do you believe that there is one simple blood test that could prevent a person from developing type 2 diabetes? Well, there is. It is called a C-Peptide blood test and will give you an idea as to how much insulin you make. If the results indicate there are above normal amounts of insulin circulating in your blood, this may be a sign that your body has become resistant to the effects of insulin, thereby causing your pancreas to start overproducing insulin to compensate. The idea here is that if a normal amount of insulin can't get the job done then maybe more will.

You see before insulin is insulin, it is proinsulin, a long chain of carbon atoms with various attachments. When this long chain is cleaved into two shorter chains, one half of the resulting chain is called a C-peptide and the other is referred to as insulin. There should be a 1:1 ratio between the two.  By measuring the C-peptide chains in the blood you can determine the amount of insulin.

In the vast majority of those people that develop type 2 diabetes, an over production of insulin, or hyperinsulinemia, precedes the under production of insulin when blood sugar levels begin to rise, eventually reaching abnormally high levels characteristic of type 2 diabetes.

It is realistic to believe that if elevated levels of insulin in the blood, hyperinsulinemia, could be identified sometime before the insulin producing beta cells begin to fatigue and stop working, and steps could be taken to reduce insulin levels in the blood to more normal levels, then maybe the development of type 2 diabetes could be diverted.

It can justifiably be argued that everybody should have a C-Peptide test at regular intervals to see if they are elevated. If so, patients could be counseled early as to how they may modify risk factors (their lifestyle) such that the progression to type 2 diabetes may be halted. Once my patients learn the pathophysiology of their diabetes, many are quick to ask why they never had a C-peptide performed, thinking as I have just written, “If I had known I was developing a problem maybe I could have done something about it before so many of my beta cells quit working and now have diabetes which I can never get rid of.”  

Consider that two major studies, the Da Quang study and the Finnish study both demonstrated that with appropriate lifestyle interventions over half of the participants studied that were on their way to developing type 2 diabetes had their blood sugar levels drop back into the normal ranges.

I encourage people that have family members or close blood relatives with type 2 diabetes to ask their doctors to perform a C-Peptide blood test every so often to see if insulin levels are elevated. I also encourage people that are somewhat overweight (even as little as 10-15 pounds) and get little to no exercise request this simple blood test from their doctor.

I am not being dramatic when I say it may provide the “heads up” that could save your life.

For more information on Diabetes, please see my website at: ExercisesToHelpDiabetes.com

and at: Prediabetesinfo.com

The C-Peptide Blood Test And How It Could Save Your Life

Do you believe that there is one simple blood test that could prevent a person from developing type 2 diabetes? Well, there is. It is called a C-Peptide blood test and will give you an idea as to how much insulin you make. If the results indicate there are above normal amounts of insulin circulating in your blood, this may be a sign that your body has become resistant to the effects of insulin, thereby causing your pancreas to start overproducing insulin to compensate. The idea here is that if a normal amount of insulin can't get the job done then maybe more will.

You see before insulin is insulin, it is proinsulin, a long chain of carbon atoms with various attachments. When this long chain is cleaved into two shorter chains, one half of the resulting chain is called a C-peptide and the other is referred to as insulin. There should be a 1:1 ratio between the two.  By measuring the C-peptide chains in the blood you can determine the amount of insulin.

In the vast majority of those people that develop type 2 diabetes, an over production of insulin, or hyperinsulinemia, precedes the under production of insulin when blood sugar levels begin to rise, eventually reaching abnormally high levels characteristic of type 2 diabetes.

It is realistic to believe that if elevated levels of insulin in the blood, hyperinsulinemia, could be identified sometime before the insulin producing beta cells begin to fatigue and stop working, and steps could be taken to reduce insulin levels in the blood to more normal levels, then maybe the development of type 2 diabetes could be diverted.

It can justifiably be argued that everybody should have a C-Peptide test at regular intervals to see if they are elevated. If so, patients could be counseled early as to how they may modify risk factors (their lifestyle) such that the progression to type 2 diabetes may be halted. Once my patients learn the pathophysiology of their diabetes, many are quick to ask why they never had a C-peptide performed, thinking as I have just written, “If I had known I was developing a problem maybe I could have done something about it before so many of my beta cells quit working and now have diabetes which I can never get rid of.”  

Consider that two major studies, the Da Quang study and the Finnish study both demonstrated that with appropriate lifestyle interventions over half of the participants studied that were on their way to developing type 2 diabetes had their blood sugar levels drop back into the normal ranges.

I encourage people that have family members or close blood relatives with type 2 diabetes to ask their doctors to perform a C-Peptide blood test every so often to see if insulin levels are elevated. I also encourage people that are somewhat overweight (even as little as 10-15 pounds) and get little to no exercise request this simple blood test from their doctor.

I am not being dramatic when I say it may provide the “heads up” that could save your life.

For more information on Diabetes, please see my website at: ExercisesToHelpDiabetes.com

and at: Prediabetesinfo.com

Strategies To Get People With Diabetes To Exercise

A colleague of mine recently read one of my articles at a diabetes internet site. The article had discussed how invaluable exercise was in the successful management of type 2 diabetes. After reading my article she commented on Facebook that it was a nice article but didn’t solve the problem as to how health professionals were to actually get their patients up and moving.

It’s one thing to tell patients that they need to get up and start getting some exercise.

That is relatively easy, although it is still not done as often or with the enthusiasm that it could be. It is quite something else to actually get them to do it. I think most all of us would agree on that.

So I got to thinking, “what would I do, or what have I done in the past with patients that needed to get started exercising?”  One time I had a patient and his wife come in for an exercise consultation. When I asked, “What can I do for you today, “the wife responded, He doesn’t do anything all day but sit and watch TV or eat or sleep. He needs to get some exercise but I can’t get him to do anything, all he does is sit there or he’s sleeping.”

“Is that accurate?” I asked the husband.

He shrugged his shoulders, clearly not happy to be here with me.

“So if I have this right, you sit in a recliner pretty much all day to except to get up and go to the bathroom,” I asked.

“The only thing he does is go to the mailbox to get the mail,” adds his wife.

“OK, then you are doing something,” I said, “just not much. How long does it take to get to the mailbox, get the mail, and return to your chair?”

“ Probably 4-5 minutes,” he answered.

“And how do you feel when you get back from picking up the mail?” I asked.

“A little tired, but not bad,” he responded.

“OK, this is what you do. What time do you go to get the mail?” I asked.

“About 12:30,” he answered.

“I want you to also go to the mailbox shortly after you eat breakfast and again late in the afternoon. Now, granted there will only be mail in the mailbox once a day. Do you think you can do that?”

The patient looked at his wife. She looked at him. He then looked at me.

“I think I can do that,” he said, with a surprising glimmer of enthusiasm in his voice.

“OK,” I said, “that sounds good. Now, I want you to do that for the next three weeks.”

“OK, I think I can do that,” he reaffirmed.

My patient actually looked excited, well somewhat excited.

“Now, after three weeks, I want you to walk an estimated 50 yards beyond your mailbox, then turn around and come home. After two weeks of that walk 100 yards beyond your mailbox before you turn around to go home. Believe it or not, your walking will start getting easy.” My patient and his wife just looked at each other and starred. I think I could hear them agreeing with each other.

“I think this could work the wife stated,” still looking at her husband.

The couple looked noticeably happier now versus when they came in. I told them to let me know how it was going and to call me with any questions.

I never heard from them again. I believe they moved back up north.

My patient may now be to busy running marathons to call or write.

Diabetes Education- How much would you be willing to pay? What is it really Worth?

How much would you be willing to pay for Diabetes classes? Let me rephrase that. How much is it worth?

How about forty thousand dollars? Not too many years ago that was considered about the going rate for open-heart surgery. Fortunately, your health insurance would usually pay for a good chunk of that.

But really, think about it, if your insurance wouldn’t pay for it, and your quality of life was starting to go downhill, fast, and you couldn’t walk from the living room to the bathroom without getting out of breath or experiencing chest pain, would you have the surgery, even if you knew you had no way to pay for it?  

 

What if the doctor told you that the open heart surgery was necessary to save your life, that without it the quality of your life would continue to deteriorate until eventually you would be bed ridden and then soon after die of heart failure? Would you elect to have this bank breaking open-heart procedure? I'm thinking yeh, you probably would. Even though it might cost close to $100,000.00 by the time all medical bills are paid I’m thinking most people would. I know I would, or I think I would.

So again how much money should it cost you for 10 hours of diabetes education? Keep in mind it is not surgery and requires no hospital stay. (Well, at least not early on, for most people anyway) In fact highly educated doctors are not even the teachers. In many cases, if you are lucky, a highly trained certified diabetes educator will provide the education.

Several years ago my mom developed lung cancer. The surgeon came into her room and said what do you want to do? Before he had a chance to completely explain her options she responded, “ Take it out. I want this out of me as soon as possible.”

“So you want me to operate and remove the affected part of your lung,” the doctor asked.

“Yes, as soon as you can, the sooner the better,” she told him. My mom was 81.

She had the surgery and is doing well. The total cost of the surgery, including the hospital and doctor bill came to about $50,000.00. With out the surgery my mom may not be here by now.

You know frequently, when first diagnosed with diabetes, a lot of people don’t even feel badly, yet, you know the first year or so, before the onset of complications like heart disease (Two out of three people with diabetes develop heart disease), nerve disease (Diabetes is the leading cause of non-traumatic amputations), eye disease (Diabetes can impair vision and lead to blindness), and kidney disease (Diabetes is a leading cause of kidney dialysis).

Recently I had two suspicious moles frozen. After they were frozen, they swelled up, dried up and fell off. The doctor didn’t really think either amounted to much but said he could get rid of them if they bothered me. It cost about $200.00. The thing about it is that unlike the open-heart surgery and lung surgery… and diabetes education, if I hadn’t had my two moles removed I would have been none the worse.

Just in case you haven’t figured it out by now receiving diabetes education soon after diagnosis is of the utmost importance. I tell people in class that I cannot imagine successfully managing diabetes without attending a comprehensive diabetes class. (The American Diabetes Association recommends all newly diagnosed patients with diabetes receive 10 hours of comprehensive education soon after diagnosis). By the way, insurance usually wll cover 10 ours of diabetes education within the first twelve months of being diagnosed.

I can assure you that mismanaged or ignored diabetes will eventualy lead to some life changing problems, problems that you want no part of. Diabetes education is as much a lifesaver as open heart surgery and cancer treatment. (And much less expensive at only a fraction of the cost!) However, sadly, there are far too many people with diabetes that fail to see the value of education.

 

Over the last fifteen or so years this has led to most hospital based diabetes education programs closing their doors, as education programs could not support themselves. Now most of the hospital based diabetes education programs that still exist are outpatient programs, many of which struggle to survive as patients are reluctant to pay more than a small co-payment or their deductible for education they feel is not worth the price.

 

Twenty-six million people have diabetes, 336 million worldwide. Another seventy-two million people nationwide have prediabetes. Although not curable type 2 diabetes is highly treatable, if you know what to do.

 

I used to think that doctors were the only ones that could save lives. I have learned over the years that diabetes educators and the education they provide can save lives as well. It would seem as though there are two parts to diabetes education; part 1- getting the person with diabetes to realize how important diabetes education really is, and part 2- educating the person with diabetes about diabetes. Right now diabetes educators may need to focus on part-1so we can continue part 2.

 

Yes, diabetes education is right up there with heart surgery, cancer treatment and substance abuse rehab.  when it comes to saving lives. Concentrated efforts by informed professionals in the healthcare and insurance industry need to be made to affect a change in the public perception of the role comprehensive diabetes education plays in the lives of those with diabetes.

Exercise helps get the rust off type 2's rusty hinges

Years ago, actually many,many years ago, I used to get out in the yard with my dad and we would do yard work together, pretty much ever Saturday. I remember those days well, and I learned a lot from my dad over the years. Back then as I learned how to take care of the lawn, little did I realize one thing he taught me I would later use when teaching my patients about diabetes.

I remember late in the afternoon on Saturdays, after the mowing and edging was done, my dad and I would settle down in the front yard with a trash can between us and start pulling weeds. I always got such satisfaction seeing how I uncovered some healthy St. Augustine grass after removing the weeds that covered it. I remember every so often my dad would look over at me and emind me to make sure I was getting the root of the weed when I pulled it. Otherwise he said the weed would grow back.

It is well known that insulin resistance, what I like to call "rusty hinges," is what leads to type 2 diabetes in most cases. With type 2 diabetes nutritin plays a very important role. Because people with type 2 diabetes have a much harder time getting sugar out of their blood and into their muscle, fat and liver cells, they would be wise to put less sugar in the blood to begin with. This of course means  there would be less sugar to remove from the blood. Although over time, consuming less sugar is likely to contribute to weight loss, which in turn will reduce insulin resistance, eating less sugar is something people with diabetes have to do since they cannot make adequate amounts of insulin. In time with more and more beta cells becoming dysfunctional less sugar can be consumed or more medication will be needed to keep blood sugar levels reasonably well controlled. Unfortunately, eating less sugar doesn't deal with the root of the problem, insulin resistance, exercise does. Exercise directly deals with the root of the problem, insulin resistance, or "rusty hinges". Everytime someone with type 2 diabetes exercises, in a sense, it's as if they are sanding the rust off of the hinges and then spraying them with WD-40. Exercise directly deals with the root of the problem, insulin resistamce, like no other treatment.  For many people with type 2 diabetes exercise is the most important thing they can do to manage their diabetes.

By Milt Bedingfield, MA, CDE

Exercises to Help Diabetes

I frequently get asked the question,"What is the best exercise for people with type 2 diabetes?"

I then ask the class, "What do you all think is the best exercise for people with diabetes?"

Depending on how much time I have in class that day, I usually let them discuss it for a while.

Then I ask, " Well, what do you think?"

"Walking, oh yeh, it's the best," somebody answers.

"Swimming is better," someone else says, "It doesn't hurt my knees like walking does."

"How about riding a bike?" somebody asks from the back of the room wanting her view to be heard.

"The best exercise is the one you like the most or the one you are able to do," I tell them.

In most cases it doesn't matter what exercise you do, but how often you do the exercise. Far too often a patient will tell me they walked all over the park or the zoo or rode bikes for two hours on Sunday, not to get any more exercise for the next three or four days. That is absolutely no good and of minimal to no value. Exercise, regardless of what exercise, needs to be performed on a regular basis to be of any significant value. I will revisit this in a moment.

As to the exercises that will help diabetes the most, all exercises have their pros and cons. As an example, walking burns more calories in thirty minutes than swimming because walking is weight bearing and swimming is not. Does that make walking a better exercise? No, it simply means that walking burns more calories than swimming. Swimming on the other hand uses muscles in both the upper and lower body. As I said, every exercise has its pros and cons.

People should choose exercises that are the most fun to do or that they enjoy.

For those people that are not too fond of exercise they should do the exercise they dislike the least.

Getting back to the frequency of exercise. The latest guidelines suggest that all adults should exercise a minimum of 150 minutes per week with no more than two days between exercise sessions. The length of time can be divided up a variety of ways with the key being not to overload yourself on any one day. Exercise can be performed twice in one day doing 15 minutes in the morning and 15 minutes in the evening if that makes it any easier to accomplish. The important thing is to get it done, REGULARLY.

Always check with your doctor first and let him/her know what you intend to do. Never exercise when you are sick or right after a meal as this puts an extra strain on your heart.

Have you ever heard the expression "Slow and regular win the race?" It's new, try it.

Prevent Prediabetes from Becoming Type 2 Diabetes

Depending on who's statistics you are looking at, there are almost three times as many people with pre-diabetes as those with type 2 diabetes.

The general concensus is that there are about 26 million people with type 2 diabetes, approximately 19 million that know it and another 6-7 million that do not. This means that there are a whopping 72 million with pre-diabetes, those with fasting blood sugar levels greater than 100mg/dl. but less than 126mg/dl. Normal blood sugar levels are less than 100mg/dl. first thing in the morning before eating.

What is so very unfortunate, is that the vast majority of the 72 million people with pre-diabetes will end up developing type 2 diabetes in the not to distant future. And although type 2 diabetes is highly treatable, it is not curable, and these newly diagnosed type 2's will have it for the rest of their lives. In spite of what you may read or hear, type 2 diabetes is not reversible or curable even with weight loss. It is only better managed.

As a certified diabetes educator for the last 18 years, what frustrates me most, is that in the majority of  cases of pre-diabetes, particularly those with an early diagnosis, developing on to type 2 diabetes is preventable. This is worth repeating. If those people with pre-diabetes make some serious lifestyle changes immediately, then the development of type 2 diabetes may be prevented.  

People with pre-diabetes need to be told at the time of their diagnosis, rather emphatically, what they need to do to lessen their chances of eventually developing type 2 diabetes. Instructions need to be given. Referrals need to be made. The seriousness of the diagnosis needs to be conveyed to the newly diagnosed patient. The patient needs to know that they may be able to avoid diabetes if they do this, this and this.

Newly diagnosed pre-diabetes patients need to seek instruction on how much exercise to engage in, how to improve meal planning, and how much weight needs to be lost. Taking this advice and acting on it quickly is likely to mean the difference in developing diabetes or not. 

Insulin Resistance, Pre-Diabetes, Then Type 2 Diabetes, In that Order

Insulin resistance is the cause of type 2 diabetes about 80 percent of the time. There are two known causes of insulin resistance: being overweight and leading a sedentary lifestyle.  There is no clear evidence that one of these conditions is more harmful than the other or is more responsible for insulin resistance. What is very clear though is that being overweight, even if only 10 pounds or more, and getting little exercise, causes insulin resistance and can ultimately lead to type 2 diabetes.
Now can the insulin-resistant overweight person decrease his or her insulin resistance by losing some weight even if not getting any exercise? Most definitely, no doubt about it.

Generally speaking, in cases where the patient is overweight, weight loss is routinely recommended as a first line treatment for type 2 diabetes. Sometimes simply eating better such as more nutritious foods and less junk food is enough to cause weight loss. When patients can do this it is wonderful, however, research shows that maintaining the weight loss for an extended period of time without simultaneously performing exercise is very, very difficult. As you probably well know the lost weight usually comes back within one to two years after losing it.

What if a person with insulin resistance starts exercising regularly but fails to lose any weight? Is the exercise beneficial? Has it helped? Yes it has, it definitely has, no mistake about it. Exercise will lower insulin resistance even if no weight has been lost. (Are you beginning to see why exercise is such a big deal?) Perhaps the person didn't lose any weight because they made up for the calories burned during exercise by eating more. Maybe the person did lose some fat but gained muscle mass equal in weight to the amount of fat lost. The scale would show no change in weight even though the percentage of body fat had been reduced. Hence, using traditional bathroom scales is a big drawback when measuring exercise/diet success.

Anyway, my point is this, that exercise can and does reduce insulin resistance even without weight loss. So when I do encourage exercise it is primarily to reduce insulin resistance and secondarily to promote weight loss. If weight loss does occur as a result of starting to exercise or exercising more, then you can expect even greater improvements in insulin resistance.

I do want to make it clear that when I recommended exercise to a patient, it is first and foremost to help in reducing insulin resistance, secondarily it is to assist a patient in their weight loss efforts. Research has repeatedly shown that exercise by itself is not likely to result in sustained weight loss. Similarly, research has also shown that diet plans that significantly restrict caloric intake are not successful for long-term weight loss when carried out exclusive of exercise. The best chance for long-term success with weight loss is to gradually work up to exercising a minimum of 250 minutes per week and to reduce caloric intake.

Just Who Is Responsible When You Develop Type 2 Diabetes?

It struck me as to just how bad things really were last Friday night when I was putting my seven year old daughter to bed. she had asked me to lay down on the bottom bunk until she fell asleep. I hadn't even gotten comfortable when I heard my two oldest daughters, ten and fourteen, starting to argue in the living room. I picked my head up off the pillow to hear what the fuss was about.

They were arguing about the television remote. It seems that only one of the two was working and they both wanted it. Why? Because then they wouldn't have to get off the couch in the living room ( about 10 feet from the TV) and the bed in the bedroom (less than 10 feet from the TV) to change the channel. They're young, they're kids, and that's sad (not sad that they are kids but sad that they will argue and fight just to keep from having to get up to turn the channel on the TV).

I had a feeling this argument was going to need some dad intervention and that I was probably going to have to get up and go in to the living room. But as I waited a few seconds to see if the problem would work itself out I laid there thinking, "Man, this is exactly what I talk about at work when I am teaching class and it's happening right under my nose here at home. Both of my daughters want the remote control so they don't have to get up to change the channel."

Just as high levels of cholesterol frequently contribute to heart disease, this kind of attitude (I don't want to have to have to get up, let's make things as easy and less physical as possible) contribute greatly to the development of type 2 diabetes.

As a teenager I never dreamed that someday I would be able to use a remote control device to turn on and off the TV., Change the channel, or to rent a movie. I never thought that someday I would be able to open the garage door with the push of a button either, or open and close the van door and trunk with the push of a button, and sharpen a pencil without cranking a handle. Could everyday goings-on get much easier and less physical? Should it? As new technologies emerge, everyday tasks are likely to get even easier, that is, take even less physical effort. This is not good.

In our country, and probably every other country in the world, if engineers can figure out a way to make life easier, requiring less physical exertion to perform tasks, they usually do. Advancements in technology have led to great accomplishments with more still to come, however, there is a tremendous downside to all this technology. Too many times these advancements in technology enable us to get through the day performing less activity.

Human beings were meant to be physical, not sedentary. Initially, going way back, we were "hunters and gatherers." Back then if people wanted to eat they had to hunt their prey and gather their grains, fruits or vegetables, all requiring physical activity. If they didn't feel like doing it, they simply didn't eat. As we all know, today it requires very little effort to acquire food. Additionally, we can accomplish so many tasks now by pushing the button on a remote. We live in a time where thumb strength is probably greater than ever, but the rest of our body, probably 98 percent of it, is used in physical activity less than ever before. This, over time can lead to a multitude of of health problems, including metabolic syndrome, prediabetes, type 2 diabetes, obesity and heart disease.

Type 2 diabetes is a very serious, incurable illness, but it is usually preventable. Previously referred to as a lifestyle illness it is now termed "a lifestyle illness." Let's get off the couch.

Opinions On Type 2 Diabetes

Since I started writing articles for the Huffington Post about diabetes, and how diet and exercise impact the development of the disease, my pieces have received some pretty spirited comments. I really like it when I receive comments on my articles because it means people are reading them and that they have an opinion. Regardless of whether a reader's opinion agrees or disagrees with my own, I really enjoy reading what he or she has to write.

I began writing about diabetes in the Huffington Post because, after teaching patients for nearly 18 years about all aspects of type 2 diabetes, I realized that there were things about their diabetes that they didn't understand; that had never been explained to them. A large majority of the patients I taught didn't have a good understanding as to why they developed type 2 diabetes. They also didn't understand the value of losing weight (body fat) and getting regular exercise, as it pertains to controlling their diabetes. I started writing here because I wanted to get that message out to more people.

What I have found so interesting is that although there are those that appreciate my information and appear to learn from it, there are many strong opinions out there that differ from mine.
Although many agree that improper eating habits can lead to the development of type 2 diabetes, there are widely different attitudes as to what type of diet will prevent or improve diabetes control.

Many readers condemned and blamed the shift to a higher percentage of carbohydrates in the American diet in recent years. Some comments went so far as to recommend a near abstinence of carbohydrates, in favor of a higher fat diet. A more moderate view expressed was that people should consume only complex carbohydrates and avoid as many simple sugars as possible, pinpointing the large consumption of simple sugars as responsible for the development of type 2 diabetes.

Because some people that develop type 2 diabetes are reportedly of normal body weight and exercise regularly, a large number of people commented that type 2 diabetes is a result of genetic influence, apparently unrelated to being overweight or getting little exercise. Recently, I read a comment stating that insulin resistance only got worse with age, could never be improved or reduced, and that it seemed as time went on less and less carbohydrates could be tolerated.

All of these comments were very interesting and I was for some reason surprised as to the confidence each writer had that his or her viewpoint was the right one. Some readers even suggested I read the work of this guy or that guy. And some really impressed me by what they seemed to know about diabetes.

I see that I do have my work cut out for me. I will keep writing and explaining that insulin resistance causes type 2 diabetes about 80 percent of the time. I will also keep writing about how weight loss and exercise can work wonders to improve it.

Thanks for reading and please keep writing.

How do you reduce, Improve or Eliminate Insulin Resistance?

In recent articles I have referred to insulin resistance and how it leads to type 2 diabetes about 80 percent of the time. There are two known causes of insulin resistance: being overweight and leading a sedentary lifestyle.  There is no clear evidence that one of these conditions is more harmful than the other or is more responsible for insulin resistance.

What is very clear though is that being overweight, even if only 10 pounds or more, and getting little exercise, causes insulin resistance and can ultimately lead to type 2 diabetes.
Now can the insulin-resistant overweight person decrease his or her insulin resistance by losing some weight even if not getting any exercise? Most definitely, no doubt about it.

Generally speaking, in cases where the patient is overweight, weight loss is routinely recommended as a first line treatment for type 2 diabetes. Sometimes simply eating better such as more nutritious foods and less junk food is enough to cause weight loss. When patients can do this it is wonderful, however, research shows that maintaining the weight loss for an extended period of time without simultaneously performing exercise is very, very difficult. As you probably well know the lost weight usually comes back within one to two years after losing it.

What if a person with insulin resistance starts exercising regularly but fails to lose any weight? Is the exercise beneficial? Has it helped? Yes it has, it definitely has, no mistake about it. Exercise will lower insulin resistance even if no weight has been lost. (Are you beginning to see why exercise is such a big deal?) Perhaps the person didn't lose any weight because they made up for the calories burned during exercise by eating more. Maybe the person did lose some fat but gained muscle mass equal in weight to the amount of fat lost. The scale would show no change in weight even though the percentage of body fat had been reduced. Hence, using traditional bathroom scales is a big drawback when measuring exercise/diet success.

Anyway, my point is, that exercise can and does reduce insulin resistance even without weight loss. So when I do encourage exercise it is primarily to reduce insulin resistance and secondarily to promote weight loss.

If weight loss does occur as a result of starting to exercise or exercising more, then you can expect even greater improvements in insulin resistance.

I do want to make it clear that when I recommended exercise to a patient, it is first and foremost to help in reducing insulin resistance, secondarily it is to assist a patient in their weight loss efforts. Research has repeatedly shown that exercise by itself is not likely to result in sustained weight loss. Similarly, research has also shown that diet plans that significantly restrict caloric intake are not successful for long-term weight loss when carried out exclusive of exercise. The best chance for long-term success with weight loss is to gradually work up to exercising a minimum of 250 minutes per week and to reduce caloric intake.

Diabetes Does Not Still Exist to Benefit Pharmaceutical Companies

I received a number of unexpected and interesting comments after my article was published here last week entitled, "The Key to Preventing Type 2 Diabetes." Some of the comments suggested a naivety on my part whereas others simply exposed a lack of knowledge in regard to type 2 diabetes.

Perhaps the comments that surprised me the most were those suggesting that diabetes had not been cured or would not be cured, because there was too much money to be made from the disease. The comments inferred that the pharmaceutical companies, blood glucose strip manufacturers and doctors all have too much to gain financially for type 2 diabetes to be cured. Granted, all of the above would stand to lose millions of dollars if type 2 diabetes was cured, I do not believe for one minute that every effort to cure and/or eradicate diabetes is not being made.

I certainly hope there are not many people that truly believe diabetes, cancer, heart disease and Alzheimer's still exist because health related companies make more money treating the illness versus curing it. How sad that would be.

A number of people indicated that it is all genetics driven, that type 2 diabetes is a disorder that we inherit from our parents, lessening our own responsibility for developing the disease. The tendency to develop type 2 diabetes can be passed from one generation to another. This does not mean, however, that if your mom or dad has type 2 diabetes that it is pretty much a certainty that you are going to develop type 2 diabetes, particularly if your lifestyle is different. It works more like this.

If your mom and dad were lean, fit and trim, and this was a result of them eating healthfully and exercising very regularly, then their risk of developing type 2 diabetes would be low. If as their child you learned their same habits and were fit and trim and active, and stayed that way through adulthood, then your risk of getting type 2 diabetes would be low as well.

On the other hand, if both parents, or even one, tended to over eat and led a more sedentary lifestyle, then they would be at higher risk of type 2 diabetes, as would you, if your lifestyle was that of your parents. We often grow up and adopt the same type of lifestyle as our parents or those we have been around. This as you can imagine can be good or bad. Our parents can set a good example or a poor example.

So basically, if your mom or dad, let's say, is at risk for type 2 diabetes because of lifestyle issues and eventually develops type 2 diabetes, then if you were their child you would now be at risk. But, if your lifestyle was significantly more healthy than the parent that developed diabetes, then you very likely would never become diabetic. Unfortunately, in my estimation, too many people are under the misconception that if their parents, sister, or brother has diabetes that if they end up with the illness that it was inevitable; it's not. You have a lot of control over your future whether you have a family history or not.

Yes, as I said in my previous article, type 2 diabetes is highly preventable, if you know what steps to take to prevent it. Too many times, due to a lack of knowledge, etc. children of a parent with type 2 diabetes end up with the same illness. I like to always tell my patients that if they do not want their kids to develop type 2 diabetes, to encourage the kids to be as physically active as possible and to make sure that they maintain a normal bodyweight. If they do this, their kids may never develop the illness.

I do want to point out that it is entirely possible to develop type 2 diabetes when fit and trim. We do not see this happen too often but it can. These cases can be a bit more tricky to figure out. In some of these cases we are looking at a late onset type 1, but that's another story, for another time.

One last concept I would like to clear up is that once you have type 2 diabetes you will likely always have diabetes. (This is something that people often have a hard time understanding, that I explain in very simple terms in my book.) To the best of our knowledge, in spite of what some might have you believe, type 2 diabetes cannot at this time be cured. It is certainly possible though, that with lifestyle modifications and weight loss, blood sugar levels may return to normal, in some cases due to reduced needs for insulin.

You see, by losing excess weight, eating less carbohydrates and sugar, and becoming more physically active, you require less insulin to maintain normal blood sugar levels, which is good since with type 2 diabetes you can no longer make as much insulin as someone that does not have diabetes (and never will be able to again). Under these conditions (and this is the key) the reduced amount of insulin that can still be made by the pancreas may be enough to keep blood sugar levels normal, but the diabetes is still present and as soon as the person becomes careless and starts to put weight back on, or eats too many sweets and becomes less active again, blood sugar levels will climb right back up to abnormal levels. This is because increasing needs for insulin due to weight gain, eating too much, etc. cannot be met by the pancreas.

The Key to Preventing Type 2 Diabetes

It is estimated that approximately 57 million people have prediabetes. To me, one million sounds like a lot, I can't even begin to fathom a number as big as 57 million. This enormously, huge number is twice the number of people that already have diabetes, estimated to be 26 million.

A little over one-quarter of these people, approximately seven million don't even know that they already have the disease. In fact, it is estimated that one out of every two people that are newly diagnosed with diabetes already have at least one diabetes related complication at the time of their diagnosis. These complications do not occur overnight, which means the diabetes did not just recently develop. The real tragedy, is that in most diabetes complications are not reversible. Can you imagine, "Well your lab results came back and it looks like you have type 2 diabetes. And that numbness and sporadic burning you have been experiencing in your feet is what we call neuropathy. It is caused from having diabetes. You are going to have it from now on because it doesn't go away once you get it?" Think of the frustration; imagine the anger.

If you put aside for a moment the mental anguish and physical discomfort associated with diabetes, consider the following. In 2007, the total direct and indirect health care costs of diabetes were 174 billion. Medical costs are over twice as high for people with diabetes than those without the disease. Diabetes is undoubtedly one of the most expensive illnesses of our time.

For as long as I have been an adult, I can remember the cost of health care being an issue. The selection of our presidents has been decided in large part based upon their position on health care reform; how they were going to improve it or fix it.

Type 2 diabetes is highly treatable and equally important, highly preventable, particularly if insulin resistance, or "rusty hinges" as I refer to it is diagnosed early. It should be well known by now, but apparently is not, that a lifestyle that includes overeating and little physical activity is the major reason why about 80 percent of the people that have type 2 diabetes develop it.

It is obviously unknown just how many people understand the cause and effect relationship of a sedentary lifestyle, overeating and weight gain, and the development of type 2 diabetes.

Ideally, it would be great if all people knew this and made the necessary lifestyle changes to ensure they were eating right and getting enough physical activity to avoid developing this unfortunate yet seriously expensive disease. In reality though we all know that this is not the case and will never happen.

If a serious dent is to be made in the growing number of people that are annually diagnosed with type 2 diabetes, then meaningful interventions years before the actual diagnosis need to take place.

Imagine planting a seed in the ground and then waiting 10 years for the young tree to grow and mature enough to produce fruit. If on the fifth year you change the tree's environment or the care of the young tree then it may postpone the day in which it produces fruit. Change the environment enough and it may never produce fruit.

The same is true of type 2 diabetes. Type 2 diabetes takes about 10 years to develop from the time insulin resistance first begins until the day the blood sugar levels actually climb above normal for the first time. If in the fifth year, or earlier, it is identified that the person has become insulin resistant

(The amount of insulin being produced by the pancreas can be measured and if elevated above normal levels indicates insulin resistance) then steps can be taken to reduce or eliminate the insulin resistance. By doing so this may stop the progression that ultimately leads to diabetes.

I would like to suggest that when a doctor has a patient that is at risk for type 2 diabetes perhaps by meeting certain criteria (family history, being overweight, sedentary, metabolic syndrome, etc.) that blood work be done, such as a C-peptide test, that would inform the doctor as to how much insulin the patient's pancreas is producing. An over production of insulin is called hyperinsulinemia and is a good indication that there is insulin resistance. If there is an overproduction of insulin then it would obviously be appropriate for the doctor to discuss the findings with the patient and explain the extreme need to make some lifestyle changes in hopes of  averting the development of type 2 diabetes.

A key point here that needs to be emphasized is that to avoid developing type 2 diabetes, insulin resistance needs to be identified and reduced, or eliminated before a sufficient number of the insulin producing cells in the pancreas stop working. By doing this, type 2 diabetes can often times be prevented, however, once type 2 diabetes has been diagnosed it is not thought to be curable.

As I mentioned previously, there are an estimated 57 million people with prediabetes, most of which do not fully grasp the severity of their situation, that they are likely to go on to develop type 2 diabetes, if they do not make some swift and sometimes drastic changes in their lifestyle behaviors. The remainder of the 57 million people do not even realize that they are prediabetic.

Granted, there are also those that know they are prediabetic and that they risk developing type 2 diabetes in the near future but choose to do nothing to prevent it. These people are beyond the scope of this article.
 
In summary, with the numbers of people being diagnosed with type 2 diabetes rising faster than ever before, I recommend looking into the feasibility of periodically checking insulin levels in patients at risk for prediabetes and type 2 diabetes that meet certain criteria, such as a family history, being overweight and/or sedentary, been diagnosed as having the metabolic syndrome, or having an elevated lipid profile.

With the high costs of treating patients with type 2 diabetes, it would be cost effective, at the least, in my estimation, to routinely check insulin levels in these at-risk individuals with the goal in mind of identifying people with clinically documented hyperinsulinemia and then providing them with the information necessary to help them positively change their lifestyle, thereby preventing type 2 diabetes in the future.

Could Your Favorite Restaurant Be Partially Responsible For You Developing Diabetes?

It is my favorite restaurant; well actually, you may call it a fast food restaurant. I don't think of it as that because what I eat there is healthy, really. In my estimation it is the best of the bunch, fast food restaurants that is. But like everything in life, it has its drawbacks, and peculiarities as well. As an example, the sandwich I eat is grilled, not fried. The fried chicken sandwich is quite tasty but contains considerably more fat than the grilled chicken sandwich. This is what puzzles me, I would think that the chicken that is grilled would be less expensive than the one that is fried but it's not. I guess this is one of those things about the restaurant business that I am naïve about. Of course I have learned over the years that eating healthy is usually more expensive than not.
              
Now for the real drawback, the real reason I am writing this post. At the restaurant that I frequently visit the folks at the counter are exceptionally pleasant, well groomed and almost always greet me with a smile.

They have obviously been well schooled in customer service. They have that down pat. But what I didn't know, never having been in the restaurant business, is that their training doesn't stop with customer service. It goes beyond that to include marketing. And I'm guessing that marketing is as big a part of their training as customer service. So big in fact that if an employee is not heard repeating the proper phrases to customers often enough it is likely to come back to haunt them at evaluation time.

Do not underestimate these folks behind the counter because they know what they are doing (at least the ones at this establishment). I used to think that when I was asked, " Would you like to make that a meal by adding fries for only ... more?" they were just being helpful, informing me that I could get a bigger, more satisfying meal for only a little bit more, and that it was a better deal for me. Or when they said, "Would you like to add a dessert to that for only a dollar more?" they were being nice, as if to say, "You look like you could use a delicious dessert today." No, no, no, no, boy was I wrong. How could I have been so naïve? Apparently it's all about the bottom line. Asking these questions may mean the difference in the restaurant having a so-so month versus a profitable month.

Sadly, I must admit I have walked into this restaurant, knowing what I was going to order, a chicken sandwich and drink, and been asked, "Would you like to add fries to that today?" and I answered, "Yes". Just like that. It was that easy. And all they had to do was ask. I was swayed, influenced, and that is all it took. I didn't need those fries. That's way too much grease for me and usually leaves me feeling uncomfortably full the rest of the afternoon. Then quietly, so silently no one could even hear me but me, I called myself a wimp.

Now you may be thinking, "Hey, that's not so bad, particularly if you only do it once in a while". Well, you are probably right, at least in my case, for now. I am reasonably fit and still more lean than fat.

But for the customer trying so hard to do better with their eating this makes it very, very tough. Perhaps they are desperately trying to lose weight because they have high blood pressure or a heart condition. Maybe they have been diagnosed as having the metabolic syndrome or pre-diabetes, or even worse, type 2 diabetes, all of which would benefit greatly from weight loss. These people may struggle with their self-discipline as it relates to food on a daily basis. Just by asking these folks if they would like fries, or a cookie, or to "super size," may weaken their resolve sufficiently enough to result in them caving in to the temptation. It doesn't take much and restaurants know that. Heck, it happened to me.

What about the customer that responds, "Not today, I'm trying to lose some of this weight" and the girl at the counter replies, "Oh, but it's Friday, one day's not going to hurt you." That in my mind is a tremendous disservice.

It is such a shame that, in this case, what is good for the restaurant's bottom line is not in the customers best interest, or more blatantly put, bad for the customer.

This is not an example of a win, win situation by any means.

Companies have to make money and the more the better as long as others don't begin to suffer because of it. But in this case, customers pay for it, twice, not just in dollars and cents but in the adverse effects the extra, usually unnecessary food has on their bodies.

I will continue to frequent this restaurant, because overall I consider it a very nice place that has always treated me well. But next time I am asked if I want fries or a cookie to go with my sandwich, without hesitation, I will say, "No thank you."

I encourage you to do the same. You'll thank yourself for it sooner than you think.

Type 2 Diabetes and Exercise

Many years ago when I was in graduate school studying exercise physiology we were taught how to calculate target heart rate ranges. More specfically, a range where someone exercising should strive to keep their heart rate in order to get the most out of the exercise. There were several means of doing this, all involving different formulas. It was common practice for aerobic instructors to stop their classes at various times just long enough for the participants to do a pulse check. "Get that heart rate up girls. Is it in your target range?" Even today, almost twenty years later, when you go to the gym you see various programs printed on the touch screen of the treadmills, bicycles, stair climbers and ellipticals explaining that if you do this workout it is for "cardio" and if you do this workout program it is for "fat burning." I like all this stuff, I loved graduate school and what I learned, but, in my estimation, this is a little too much, going a bit too far. There is a place for this degree of sophistication; for competitive athletes, professional athletes and Olympians, but not for the guy or gal that is just trying to stay fit, keep their weight down, burn up some sugar and just plain feel good.

In the six years I operated an in-house exercise program for people with diabetes and saw over five hundred patients, it is doubtful that I ever calculated a target heart rate range that I wanted the patient to follow. It simply wasn't necessary. That is not to say that having some type of gauge for determining exercise intensity is not needed because it is, but it is simple. It's called the talk test. Here's how it works: If you and your exercising partner are walking so fast that it becomes too difficult to talk because you are too out of breath, simply slow down (However, if what your partner is talking about is boring you to death or you simply don't feel like talking, then don't slow down). If, on the other hand, you are walking so slowly you have enough breath left to start singing or telling jokes, then you need to go a bit faster. Never, ever, ever, let the saying, "No pain, no gain" influence  the intensity of your workout.

 Another thing I used to do was watch the people breathe while they were exercising. If they were able to get all of the air they needed through their noses while they were walking, elliptisizing or cycling then they were not working hard enough. I would tell them that they needed to exercise vigorously enough so that they needed to breathe through their mouths to get the air they needed.

 I tell patients to pay attention to how they feel when they exercise and to adjust the intensity accordingly. As long as the person remains relativley comfortable without sharp aches and pains or breathlesness while doing the exercise then they are probably safe. It is always wise, however, to let the doctor know your exercise plans just in case he or she wants you not to exercise or follow different guidelines.

In summary, do what works best for you when you exercise. Just make sure you exercise......daily!!