MEDICATIONS: I started by being more diligent about taking Metformin regularly, instead of carelessly skipping doses. But I knew that that wouldn’t be enough. So I decided to also significantly alter my diet and exercise regimen.
DIET: I was already on what I thought was a “low-carb” diet (almost no sugar; limited rice, pasta, starchy foods like potatoes) but decided to be more strict about limiting the starchy foods, as well as reducing snacking (chips etc.)
EXERCISE: I decided to work with a Personal Trainer — primarily to keep me honest. My first session was on March 14th, and I decided on a weekly cadence of 4–5 sessions of one hour each, with about half the sessions focused on strength training, and the other half on cardio.
Even though the numbers were much improved, they were still in RED. In the meantime, I had been reading up on diabetes again, and I wanted to get the numbers to be much better — ideally below the “pre-diabetic” range.
CONTINUOUS GLUCOSE MONITOR: On May 6th, I started using Freestyle Libre — a Continuous Glucose Monitor. For the first time, I had visibility and insight into my glucose levels in near-real-time, and more importantly, the changes in these glucose levels; this visibility is critical for behavioral change.
This was on Sat May 11. I had gone to brunch at a local Indian Restaurant, where I got a plate of three small Idlis (rice cake) along with tea (milk, no sugar). An hour later, I saw my glucose level peaking at over 200!! And there was nothing I could do except to wait it out.
Thankfully I didn’t have to wait too long; within an hour, the numbers were back in the ~100 range. But that was a very valuable lesson — it showed my the impact of rice + milk in tea on my blood glucose, and I have not had either rice or milk since. And my glucose level has not gone over 170 since. Similarly, I also saw that the overnight numbers varied based on how well I slept the night before.
DIET: With this near-real-time visibility into my glucose levels, I was able to further refine my dietary choices. In particular, previously while I was strict about sugars and sweets, I thought that the non-sweet carbs were “okay”. By looking at the numbers, I figured out that the other carbs also had significant impact, and I significantly reduced their intake as well. I also figured out that the glucose levels didn’t go up as much if I also took protein prior to taking the carbs (I believe this is b/c protein also triggers insulin response), so I decided to order my eating accordingly.
At this time I also learned about Time-Restricted Feeding (TRF), a form of Intermittent Fasting ( https://en.wikipedia.org/wiki/Intermittent_fasting). After hearing from a few of my friends who practiced TRF, I decided to give it a shot. I settled on 16:8 TRF, which meant eating in 8-hour window (and not eating for the next 16 hours). In practice, all this meant for me was that I had to skip breakfast. It turned out to be much easier than I was expecting, and I didn’t really feel hungry during the fasting intervals. I have now been doing TRF for the last few months, and at this time, I don’t see any reasons to not continue.
EXERCISE: Part of my original concern was potential hypoglycemic incidents when I worked out. I was pleasantly surprised to see the opposite — when I exercised, my sugar level went up, not down. On many days, my sugar levels were higher while working out than after eating!! One explanation is that the body responds to increased energy expenditure by release glycogen from liver. I also reviewed my exercise regimen — ensuring proper recovery especially after the strength-training days. I have gone from 4–5 workouts/week to 3–4 workouts/week.
NUMBERS: I was religiously checking the numbers every single day. And I was really happy the first time the average went below 100!!
The Libre site provides a lot of good analytics — this is really easy-to-use. As you use the Libre App to measure the glucose levels, it also uploads the numbers to the cloud. And you get fully up-to-date analytics right away.
And I was also downloading the raw data from Libre web site to Excel and running my own analysis — which showed progress week-by-week.
I was happy to see these numbers trending in the right direction for most of the weeks. And I computed A1C= (Glucose+46.7)/28.7, as per https://professional.diabetes.org/diapro/glucose_calc
Hooray!! The numbers are now all in-green. My doctor was surprised by how low both these numbers were; he was even more surprised by my response. I thought the A1C should have been lower — I had been forecasting 5.4!!
Based on the numbers, my Doctor reduced the Metformin dosage from 850mg x 2/day to 500 mg x 1/day. He also made me aware that my fasting glucose numbers (and A1C) will go up, but he is okay with the numbers being a little higher.