Why some diabetics won't exercise

On a forum I'm sometimes in, I ran across this comment from someone in a class for exercise instructors. He's talking about these students discussing diabetics.

This is a class of people honed in to health, exercising, being fit. They couldn't comprehend the mentality of "I'd rather take some pills to sustain me for a little while and die horribly". I get it. People really are that lazy. They really are that resistant to change. "Exercise" and "diet" really are THAT much worse for them than a horrible death.

Which is to say, I understand THAT people choose that. I don't necessarily understand WHY.

I can partially explain it.

I'm insulin resistant, aka pre-diabetic. This is partly genetic, and partly a result of PCOS. So I know what it feels like to have insulin problems (though not full-blown diabetes) and try to change your diet.


A diabetic/insulin resistant person has blood sugar which seesaws violently unless externally controlled. The most obvious way to control it, and one which is easiest to develop independently, is to take frequent small sugar doses.

In other words, to keep a can of soda or a bag of lollies next to you, and take a sip or eat a lolly (candy? sweet?) every five to fifteen minutes.

This keeps your blood sugar kind of even. Rocky-even, but enough to keep you functional.

Take the candy or soda away from a person who's doing this, without replacing it with a proper low-glycaemic-index diet, and they feel AWFUL. Absolutely rotten, and effectively non-functional. Their blood sugar spikes after a meal, then within half an hour they're sluggish, they can't think, they can't focus, and their body is telling them they're starving.

And a single glass of Coke will make them feel good again.

Even converting to a low-glycaemic-index diet, under controlled circumstances, knowing what you're doing, feels ghastly. I've done it several times, and had to repeat it because the temptation to 'just have a small glass of soda, it can't hurt' is so strong.

A low GI diet works, and keeps you functional, but it feels very, very different to the lots-of-small-hits-of-sugar diet. And any time you forget to eat on time in a low GI diet, you know that peanut paste sandwich on multigrain bread will take at least ten minutes to kick in, but a small glass of soda or a couple of lollies would make you feel good almost instantly.

It takes a lot of willpower to keep to the proper diet. I can only do it with a bag of nuts or seeds kept close at hand at all times.

I can also only do it now that I've found foods that count as good AND satiate me - like dahl, or vietnamese rice paper rolls with a lean meat inside.

My first tries failed miserably because I couldn't figure out a low-GI diet that actually had enough protein and healthy fats to keep me functional; other than one which included a lot of meat. And whenever we had a lean time financially, I felt so guilty about dominating the food budget with meat that I'd try to stop eating it so often, and thus get all low-blood-sugar awful, and the cycle would resume.




As for the exercise: that feeling of new muscle developing, that I'm told is kind of pain and kind of not? To me, at least, that's painful. Okay, I have a pain disorder, so that doesn't necessarily correlate to everyone.

But it is a strange feeling to someone who's not used to it. On top of that, there's the fact that the novice is probably overextending themselves anyway and thus getting 'real' pain. Plus they don't know how to avoid chafing or blisters.

Plus there's probably no sweat-wicking clothing available in their size anywhere (except PERHAPS specialist shops that you athletes know about but we don't), and they may not have ever heard of sweat-wicking clothing anyway.

So exercise means pain, blisters, chafing, unpleasant sweating, probably fungal infections in the folds of their skin (they also probably don't know about the truly effective antiperspirants, only the supermarket ones), and no pleasant results that they can ever detect.

Noone ever teaches these people about proper effective blister preventions, or sweat-wicking clothing, or the truly effective antiperspirants, or effective anti-chafing and anti-fungal treatments. The only reason - ONLY reason - I ever learned about them was a friend who was into athletic things, and was horrified that I didn't know.

On top of that, exercise doesn't feel good for them. It's difficult and heavy and they don't get any feeling of accomplishment. If they're trying dance, they don't feel pretty. If they're trying to run or power walk or something, they don't feel fast. They don't feel strong in the gym, or skilled in 'fitness karate' or other 'skill' sports. You'll have to help them learn to feel pleasure in exercise, it doesn't come naturally for them.


So to you, the choice is serious medical problems, or fun exercise and yummy foods like Vietnamese rice paper rolls, dahl and saffron rice, and tofu or lean meat stir fries.

To them, the choice is serious medical problems, or serious medical problems aggravated by a life of torture (the exercise), and where they're denied the only foods they've found that make them feel anything near 'okay'.

It's not laziness. Okay, it's not necessarily laziness. It's actually a sensible quality-of-life decision when you really learn about it from their point of view.

If you really want to help a diabetic friend (of the 'doesn't exercise or eat well' type), try this:

1. Help them explore low-GI filling foods. Don't try to make them change their diet yet. Instead, help them find foods they enjoy, can afford on a long term basis, and will make for themselves (or can reliably find in the supermarket).

2. In the course of this, help them explore exercise. Go on a picnic and throw a frisbee with them, even for only two or three passes. Park a little further from the entrance to the supermarket. Or park at the same distance, but walk with them through one or two more shops than they'd normally walk. Have your coffee at a coffee shop rather than in their kitchen or yours.

Make it VERY small amounts of exercise at first. They need to learn what their body feels like when its moving, and to learn that it's okay.

3. Get them 2 litres worth of glass resealable bottles, and have them fill them with water every morning and empty them by the end of the day. They might need to squeeze some lemon into them, or have a water filter, or make some sort of tea, but anything like that's fine. Plain water tastes icky to some people.

4. Help them gradually swap high-GI regular meals for low-GI ones. Switch their evening meal from white-flour pizza or KFC to dahl and buryani or a home-made roast with all the (healthy) trimmings. Encourage them to make hummous from chickpeas and have it with chopped veg for lunch.

5. Continue the exercise. Expand it until they're the one suggesting you go fly a kite in the park. Keep an eye on them for signs of blisters, rashes, chafing, and other problems, and help them get those dealt with and prevented in future. Help them find affordable exercise-appropriate clothing in their size: that will be challenge enough for you, much less them.

6. Get them to keep nuts and seeds and other convenient but healthy & low-GI snacks on hand at all times.

7. Once they're comfortable with all of that, NOW you can take the soda and lollies away. Some of them will have dropped them already. If not, support them through the transition.
Let them know it's normal to feel awful, or just strange, during the transition, and be there for them while they go through withdrawal. It really is a kind of withdrawal.
Let them know that they can expect to feel different once it's completed - they're switching from one type of blood sugar control to another, and they're going to need to adapt to the new 'base metabolism'. But once they're used to it, they'll actually be more functional and more comfortable than with the old system.

8. And with the new base metabolism, they'll have more energy for exercise. Now you can introduce formal exercise.



I hope this explains it, and that you find this helpful.

On Exercise and Nutrition

What is health?
Actually, I don't know. All I do know is how to give my body the same kind of care I give my car and my house. Decent fuel, decent maintenance, sensible use. If I do that, I hope it'll repay it with as much health as it can give.

So let's talk about fuel. Food and drink.

If you read my article 'On Bodies', you'll know that I think people come in a wide range of shapes and sizes. This 'standard serving' stuff that nutritionists talk about is useless. People aren't all the same, they don't all need so many grams of this, so many litres of that.

I use the hand as a measure. Why? Because if you're a small build, your hand is small. If you're a large build, your hand is large. It's a measure that adjusts to suit you.

Each person needs the following:
Protein.
Vitamins and minerals.
Fibre.
Energy-providing fuel.
Trace amounts of fats and oils.
Water.

Protein
Protein is available from animal sources, such as meat, fish, eggs and milk. It is also available from plant sources, most commonly seeds. The usual seeds humans eat are legumes and grains, and in combination, one legume plus one grain will provide a full set of proteins humans need.

Vitamins and Minerals
We humans need a bewildering variety of vitamins and minerals, and get most of them from plants. I have a mnemonic which ensures I get them all: I make sure I eat each part of a plant at least three times over the course of a week.
To eat roots, I eat potato, carrots, swedes, turnips, or onions.
Stems are celery, asparagus stalk, broccoli or cauliflower stalk, and rhubarb.
Leaves are easy to recognise: lettuce (any variety), spinach, cabbage and brussels sprouts are all leaves.
Flowers are harder to recognise, but broccoli and cauliflower are both flowers. We eat very few flowers.
Green beans are seed pods and seeds (the seeds inside the pods).
Seeds are all grains and legumes, most nuts, and many spices.
Fruits are tomato, pumpkin, and squash, as well as all the things we call fruits at the grocer's.

If you aren't sure which part of a plant a fruit or vegetable is, ask your grocer. A specialty grocer can also give you advice on how to prepare anything in his or her shop.

Fruit and vegetables are best fresh, and start to lose nutrients from the moment they're picked. Freezing, canning or drying preserves most of the nutrients.

Herbs and spices also contain vitamins and minerals. Flavour your food with a variety of different herbs and spices: it increases both the 'yum' and the nutrition factor.

Fibre
Fibre is found in fruits and vegetables, and is in fact the indigestible part of the plant. It helps signal when you've eaten enough (by making you 'feel full'), helps your body digest the rest of the plant, and then acts like a gentle cleaning sponge as it goes through your digestive system.

Energy
Energy in food comes from carbohydrates, fats, and (to a small degree) proteins. Carbohydrates are found primarily in fruits and vegetables, and have been refined by animals into honey, and by man into sugars such as 'sugar' aka sucrose, glucose, and corn syrup. We don't actually need the refined stuff, it just tastes good. Our bodies are good at doing the refining.

Fats and Oils
There are certain fats and oils which the body requires. Fruits, vegetables and lean meats actually provide them in sufficient quantity for health, though certain oils are better for the body and brain than others. Exactly which are best is still a matter of study, but in the interim I'm splashing a bit of semi-refined olive oil on my salads.

Water
Or rather, any liquid that is mostly water, and most foods. You'll feel the lack of it more than you'll feel an excess. Dehydration symptoms include dry mouth, dry eyes, dark urine, tiredness, headaches, dizziness, or hangover-like symptoms.

It's easy to experiment and find out if you're feeling icky because of dehydration: drink water. If the ickiness eases or goes away, you were dehydrated and you can prevent future occurrances by drinking more water.

Portion sizes

If you get your protein from an animal source, you need about enough lean meat to cover the palm of your hand each day, at about the thickness of your hand.
If you get it from legumes and grains, eat about a handful of each daily.

If you eat dairy foods, you can get enough calcium for your bones from three serves of dairy a day. One serve is a piece of cheese about half the size of your palm, or a glass of milk or yoghurt. (Milk or yoghurt are too messy to measure with your hand.)
If you don't eat dairy foods, you'll need to make a special effort to get calcium. Supplements are available, or you can get it from some tofu, some green leafy vegetables, some nuts, or the edible bones of some fish. See a nutritionist, or a good vegan information source.

Eat about seven handfuls of vegetables or fruit a day, and try to eat a wide variety of them over the course of a week. This will give you enough fibre and enough vitamins and minerals.

Eat a range of herbs and spices over the course of the week. This will help you get trace elements you might otherwise miss out on.

We do not need to eat anything specifically for the energy. We did when most people were doing heavy work all day every day: a pioneer going out to weed and plough a farm with no machinery, or chop trees with a hand axe, needs the energy provided by a traditional farmer's meal laden with syrup and fried in lard or oil.
If you're doing that sort of heavy work or heavy exercise, please consult a nutritionist. Modern , healthier versions of the farmer's breakfast are available.
If you aren't doing unusually heavy work or exercise, your hand-measured portions of fruits, vegetables and meats will provide you with plenty of energy.

NOTE: These portion sizes are based on the minimum exercise given below. If you do more exercise, you'll need a little more of the fuel, protein, vitamins and minerals than is stated here. How much more will depend on the amount of exercise, but if you learn to listen to your body, it will tell you.

Is that enough?
Learn to recognise the hunger that comes from the guts or the muscles, rather than from the mouth or the 'appetite' part of the brain.
Your gut-hunger is a bit slow to realise it's fed, so eat until you're still just a little bit gut-or-muscle hungry, then put the rest of your meal away in the fridge. If you're still hungry half an hour later, come back and eat more.

Your body also needs exercise.
How much exercise you give it will affect how much of each type of fuel you need - just like your car needs more petrol (gas to some) if you run it further.

My minimum exercise standard for a body:

Every day

• make each joint go through its full range of motion.
• stretch each muscle bundle.

Every other day

• go for a walk which challenges you slightly. Measure your distance by fatigue: you should feel a kind of pleasant tiredness when you return through your front door. Do it at a speed where you can speak comfortably, but not sing.
  

That's it. You can replace the walk with anything else: swimming, throwing a frisbee for the dog, riding a bike, taking the kids to the local free museum. Anything where you move, and preferably move the majority of the large muscles of your body.

If you want to actually improve your health, or to shape your body, you'll need more exercise. But for maintenance, that will do.


Yummy stuff
You will have noticed that I haven't discussed chocolate, iced pretzels, doughnuts, cake, or any other treat foods. Your body doesn't need them.
You do. Or at least, you might. Eat them, but eat only as much as you actually enjoy. Stop as soon as you realise you're eating it just because you paid for it. Better to waste the extra than to put it on your hips as fat.

Here's a rule of thumb: everything you eat must pay for itself, either in nutrition or enjoyment. Follow that rule, and you should be fine.

WARNING
If you are doing a lot of exercise, have a metabolic problem, or find that following these rules of thumb causes you to gain or lose weight, check with your doctor.
Heavy exercise changes the rules, and so do disorders such a diabetes and thyroid problems. Your family doctor will be able to help you find the rules of thumb appropriate to your own body and lifestyle.

On Weight Management

Healthy weight management is about controlling how much of the optional-extra body tissue you have. Your body is actually extremely malleable, and can produce extra tissue in many places - professional athletes sometimes have very large hearts or major arteries, and musicians who play wind instruments can have remarkable lungs.

However, there are three types of body tissue that ordinary people can relatively easily choose to control.

1. Muscle
   
2. Bone
   
3. Fat

As a general rule, if you need to gain weight, you should try to gain muscle and bone. If you need to lose weight, you should try to lose fat.
In an otherwise healthy body, gaining muscle and bone will also add enough supportive fat for the larger body (if it doesn't, see your doctor).
In a healthy body, significant loss of muscle or bone are signals of illness, starvation or inactivity, and generally indicates that you should see a doctor.

Muscle and Bone
Your body develops muscle by using it. As your body develops muscle, it also develops the supporting bone.

To develop muscle and bone, your body also requires building blocks, nutrients and energy - in other words, protein, vitamins and minerals, carbohydrates, fats and oils. The process of making muscle also requires plenty of water, so make sure you drink.

I never recommend intentionally losing muscle or bone. A healthy human body will regulate muscle and bone development based on how that body is used. If you think you need to lose muscle, bone or both, see your doctor.

Almost everything I have to say about developing muscle and bone is in my articles On Exercise and Nutrition and On Bodies.


Fat

WARNING
I am not a doctor. If you have a metabolic illness (an illness which affects how your body digests and uses energy), see your doctor and any specialists she refers you to. The information in this section of the post relies on rules of thumb which may or may not apply to you.

Energy digested > energy used = energy stored.
Energy used > energy digested = energy consumed.

That is the fundamental truth of managing your body fat. Nothing you can do changes that truth, the most you can do is tricks to modify what energy gets used or digested.

Your body stores extra energy as adipose tissue, more commonly known as fat. Fat has four purposes in the human body:

1. It stores energy.
2. It acts as 'packing peanuts' for many of your vital organs, cushioning them against damage and helping to hold them in place.
3. It insulates your vital organs against temperature variation.
4. It's a cushion. You have fat in places like the pads of your feet, the 'sitting' part of your buttocks, and your hands.
   

You must have the 'packing peanut', cushion and insulation fat - if you don't, you will get sick. Never try to lose weight so much that you lose that fat. If you have already lost this fat, see a doctor as soon as possible. The doctor will be able to help you regain it.

Estimating how much body fat you have is difficult. Wikipedia has an entry on body fat analysis. I also found a useful series at stumptuous.com on body fat.
(Note: the URLs at the base of the article are broken. Here are part 2, part 3 and part 4.)

Healthy fat management is about controlling how much of the energy-storing fat you have. You do this by manipulating two factors: what you use, and what you digest.

What you use
Muscle uses a lot of energy.

Muscle at rest uses some energy.
Muscle that has been used in the last day or two uses more energy.
Muscle that's active uses the most energy.

To use more energy, make and use muscle. It's as simple as that, and there are no shortcuts.

What you digest
There are few ways to manipulate your digestion that I consider to be smart and healthy: there are only two I'm comfortable with.
The first is painfully simple: only eat what you're willing to digest.
The second is a variation on the first, and uses the glycaemic index to manipulate the sugar-storage system of your body.

Here's an oversimplified version of how your body's sugar-storage system works:

• When you eat carbohydrates, your stomach and gut convert them to sugars and put it in your blood.
• When there is sugar in your blood, your pancreas puts out insulin based on the amount of sugar there is in your blood.
  
• Insulin does many things, but the relevant one is that it tells your body to store any extra sugar in your blood as fat.

If you eat carbohydrates that your stomach and gut convert to sugar quickly, they put it in your blood quickly. There's lots of extra sugar floating around that your body doesn't need right at that moment, so your body stores it as fat.

If you eat the same energy load in carbohydrates that are digested slowly, the pancreas puts out insulin more slowly. This gives your muscles more time to grab the sugar to use while you walk back to the office (or whatever you do), and the sugar never gets converted to fat.
If you're trying to put on weight, use the glycaemic index to find slow-digested carbohydrates anyway. Putting on muscle improves your whole-body health and metabolism, in ways which are too complex for me to explain here (ask your doctor). Your muscles need this sugar to develop.

The glycaemic index is a number that tells you how quickly the average human body digests any given foodstuff.

For more information about the glycaemic index, contact any reputable diabetes association or website, or check the GI homepage.

Diabetes is, in part, a disease of the insulin system. The glycaemic index is especially helpful for diabetics, but is useful to everyone.

There are other ways to control what you digest, such as using tablets which prevent you from digesting fats and oils. Fats and oils are necessary in themselves, and many contain useful vitamins, minerals and other essential elements. I don't like the idea of preventing the body from digesting them, but I admit that I may be biased. If you want to manipulate your digestion, talk to your doctor.

In summary

• Gain muscle and bone.
• Manage your fat stores.
• Energy in > energy out = more fat.
• Energy out > energy in = less fat.
• More exercise = more muscle.

On Bodies

There's been one time in my life when a strange man's thigh was pressed against mine, and I didn't mind. He was a weight-lifter from New Zealand, as was his buddy, and the two of them and I were all assigned seats in the same row in a plane from LA to Auckland.

We were all big people, a bigness of muscle and bone, not fat. Our shoulders were pressed against each other, our thighs touched, and we had no choice. The stewardess who was checking on us promised to move me once we'd taken off. A fifteen hour flight is no place for a trio of big people to be jammed together in small seats.

Our culture expects and values thin builds: the plane seats, for example, relied on thin builds. Our bodies, however, range from the naturally thin to the naturally big.

We can't shape our bodies very much. Our basic shape is genetic - we are born to be a certain build. But we can modify which variant of that build we will become. A person born with a narrow bone structure can choose to develop a wiry strength, a dancer's grace, or a marathon runner's speed. They can also choose to aim for the thin beauty of a modern model, or of the older models of earlier eras. Another alternative is to do nothing with the body shape, and let it fall where it may. Or even to try to eat their way to curves the body is designed not to have.

Builds of the other extreme - the large builds like me or those weightlifters - have similar choices. Our strength will never be wiry, but we can develop our native strength. We can be just as graceful as the thinner dancers, but we won't be chosen for the ballet. (Arabic and Indian dance both value the larger bodied grace, however.) We're unlikely to be as fast as our thinner relatives, but we can develop what speed we have.

Larger builds can never attain the thin beauty of the modern model, the best we can hope for is a starving ugliness. Instead, we should hope to attain the beauty of Venus, as painted by Rubens or Boticelli. (Men of this build can seek sportsmen, actors or models of similar build to emulate.) Unfortunately, many of us give up on our bodies, having accurately determined that we can never resemble Kate Moss. Some of us are so naturally large we will never even resemble Marilyn Monroe or Jayne Mansfield.

There is, however, no need for the very large, the very small, or the in between to despair. Within the limitations of build, our bodies are very malleable. They'll do whatever they're asked to do, if they're asked long enough to develop the resources.

In other words: if you want the body of a dancer, dance. If you want the body of a runner, run. Your body will shape itself according to what you do with it, and to its basic build. If you have a sedentary job and sedentary hobbies, your body won't look like an athlete's. With active hobbies (or work), it will.

Choose an active hobby or sport (or several) that interests you. Study the bone structures of the professional, and active amateurs in the sport. Look at the ratio of shoulder width to height, and hip width to height, and compare theirs to yours. Look for the variation (or variations) of the sport that has several people with similar bone structures to yours: that's the form of the sport that your body is designed for, and you can realistically aspire to have your body look like theirs.
You can do sports that aren't populated by those of your build: there are heavy-set marathon runners, and lightly-built power-lifters. Just be aware that your body is (most likely) not designed for that sort of sport, and you will have more difficulty than those whose bodies are suited to it. Do it for fun, and for health, not to be spectacularly good at it nor to look like those who are, and you'll be fine.