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Hi. I am a long time Fool who just found this board. I am 54 with type 2 diabetes. Over the past 3 years, I have had partial amputations on both feet. I still have open wounds on both feet which limit my mobility. My blood sugars are under pretty good control ( morning count of 100 - 125) with the use of Glucophage and Glyburide. However, about every six months my infection flares up and my leg swells to the point that I end up in the hospital on antibiotics.
I know I need to loose some weight ( I am about 309 ). And I am going on a low carb diet to help achieve it. My only success on diets in the past has involved diet and a lot of walking ( up to 2 miles a day). My present condition will not allow the walking , so I am looking for suggestions for help.

On another note, I have had no trouble getting shoes after the amputation. Thank God for insurance ( $1200 a pair). But, sox are a problem. Has anyone found anthing that might help. I am seriously thinking of starting an on-line company to assist amputees. How does "Stumpy-Sox.com" sound to you?
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On the bright side, you can tell the seasons every 6 months.

Seriously, you MUST lose weight, like 50%. You need to start the walking anyway. With your heft it will not be easy but like going downhill, the more you lose the easier the exercise will be. If doing it on the street won't work, do it in a gym. Talk with your doctor and nutritionist before starting your diet and exercise program - let them help you design your strategy, as it may involve adjustments to your medications as well.

Best of luck and remember you have friends here.
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Walking any distance is impossible. The pain and pressure on my open wounds makes this form of exercise undoable. If I walk,my feet get worse. As it is, my bone specialist says that I can expect a below the knee amputation within 5 years. His advise is don't push it.
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Hi Peter!!!

Have you thought about weight lifting. I would reccomend a weight machine, but if you don't have access to one, free weights. There should be some exercises for the legs too.

Just my two cents.

Good luck and hope the doc's perdiction doesn't come true.

Apathy4All
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Peter--

First off, if you don't mind, could you give us a bit more personal data? When first diagnosed? Average Hba1c's? When was your first real complication? How tall are you?

The "male' part of M/F we've already figured out.

Secondly..... if your doc was talking solely about 'don't directly aggravate an open wound' I can understand; BUT, if his 'take it easy' was more general, he's dead wrong; not unusual, by the way, among docs who aren't specialists in either diabetes or obesity. I recently changed Primary Care Physicians to one who is more 'aggressive' myself.

AND....I admitted to myself, last year, when I was almost 370 lbs (I'm 5'10", 48 years old) that I obviously was not going to lose the weight myself...I would have, by now, otherwise....so I found a good, physician supervised weight loss program (took some investigation), and started losing. It HAS to include NOT JUST a specific diet; but real work with a nutritionist, and a doctor, over a period of months; as well as a good weight loss support group. (Ours is excellent; we actually rotate doing different things; about 80% of them involving movement themselves).
Now, I've been 'stuck' at around 260 for the past five months or so; but, the good news, I guess, is that for the first time, I am kinda maintaining a 'lower' weight, and not going straight back to gaining.


Oh, yeah....after having been on Amaryl(glimepiride) for 5 straight years, I've been off of it since I started the diet. My usual Hba1c on the medication was maybe 5.5%, I think; now, after over a year of NO diabetes medication, I'm usually getting around 4.9%. And my LDL cholesterol and total cholesterol has really plunged; with HDL going up some.

WHATEVER medication you're on, if you start aggressively doing the diet/exercise thing...and keep with it....you almost certainly can reduce the medication by your own actions; trust me, God has not decreed--yet, anyway-- that you must take your current medications and dosages, unchanged, for life; you can improve. You can--and will--continue to get worse, if you do nothing (diabetes is a degenerative disease, after all); as well as postpone the time when you'll need insulin, which is very, very important. (Injected insulin is 'bad' for type two diabetics: when you start doing it, the added weight it helps put on, plus pushing you farther along the carbohydrate abuse cycle, speeds up the decline).

Each of us can only 'improve' so far with agressive diet, exercise, and behavioral improvement. For example, neither I, nor my doctors (both my PCP, as well as my separate, weight loss doctor), were sure I could wean myself 100% off diabetes meds totally by aggressive diet, exercise, support, and behavior training; if I had already 'deteriorated' beyond a certain point, I would have been able to reduce the dosage, but still need some of the meds. We know now, by hitting it aggresively, I was able to get off of it completely.

BUT...I will not be able to stay off the diabetes medication, and keep those good numbers, for the long-term, without seriosly losing more weight myself. My doctor won't be happy till I get below 180 (my high school graduation weight was 164). FAT TISSUE INCREASES INSULIN RESISTANCE-- which is what Type II diabetes is.

I also strongly second the recommendation on adding resistance exercises; e.g. weight training. It's basically mandatory for the over 50 Type II set, in terms of lean muscle mass and increasing insulin sensitivity and promoting long-term weight loss. "Push up the weights...roll back the years"..

It sounds like you are NOT being aggressive enough yet. Don't try to do it all by tomorrow; day after tomorrow would be fine (!!!). But also, get some help and support. You are treading a much thinner, sharper line than I am right now; you have much less room for error. YOU CAN SLOW YOUR DETERIORATION; no shit. You really can...and must....fight back; it IS worth it. You can reduce the meds..with doctor monitoring and quarterly Hba1c readings...with the aggressive diet and exerise you need.

Look, my wife and brother both have MS; I know a little about dealing with exerices where your legs are not working, er, 'perfectly'. There is STILL a TON of stuff you can....and should......do. You're not helpless! You can do it!!

It's up to you. Use us here, too; we want to help.

JP
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Good post, JP.


A couple things from my own limited experience:

1:> If i'm losing weight -- even a small amount, like a pound a week, my glucose numbers improve significantly. Typical range while losing weight has been 80-100 [on 500 mg glucophage]. One evening pig-out will pop the AM reading to over 120.

B:> i am able to lose weight on a wack-o diet of 6 small meals a day, with vast quantities of fiber and gallons of nutrasweet-water. One of the meals is typically a 10-oz brick of frozen spinach or about a pound of frozen mixed veggies, flavoured with lemon juice, butter, and a half an onion. Another meal: 3 carrots shredded, with 1/8 cup sunflower seeds, 1/8 cup raisins, a slug of lemon juice and a bottle-cap of olive oil. My weight loss goal is only about 40 lbs (210 to 169) over a period of a year. i wouldn't recommend this method to anyone seeking rapid weight loss, except under medical supervision.

III:> If i don't do my aerobic exercise, i begin to feel more tired & get more little aches and pains. This can lead me to even less exercise and more lethargy.


I also strongly second the recommendation on adding resistance exercises; e.g. weight training. It's basically mandatory for the over 50 Type II set, in terms of lean muscle mass and increasing insulin sensitivity and promoting long-term weight loss. "Push up the weights...roll back the years"..

Something for me to think about! Even if i don't have the $$$ for the weight room, maybe i need to find it -- or at least learn to love the push-up. Trouble is, that river in Egypt is incredibly ubiquitous.


cassandra

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Cassandra-

Appreciate you giving some examples of your diet. I'm saving them!

1:> If i'm losing weight -- even a small amount, like a pound a week, my glucose numbers improve significantly. Typical range while losing weight has been 80-100 [on 500 mg glucophage]. One evening pig-out will pop the AM reading to over 120.

Now, see, your responding so well like that, tells me that you'd almost certainly be able to back off the amount of glucophage over time; all the while watching your numbers, of course. (Remember, all oral meds have possible side effects, though they differ. For example, the amaryl/glimepiride I've now been off for 15 months, clearly stresses the pancreas over the long-term; as well as increase insulin resistance (the latter is my personal opinion; doesn't agree with the company's); and tends to increase weight (like most, but not all, diabetes type II meds).

Glucophage, if I'm not mistaken, has a potential liver concern. I think most docs would agree that management by strict diet and exercise alone is clearly 'healthier' than some diet, some exercise, some pigout, daily oral meds. And that if still taking oral meds, tightening up on the diet/exercise at least can help most people reduce the dosage. I honestl believe (guess) that you're a candidate for both.

B:> i am able to lose weight on a wack-o diet of 6 small meals a day, with vast quantities of fiber and gallons of nutrasweet-water.

Kiddo, that's NOT a 'wacko' diet; that's intelligent for usn's; and I should be more like you in that regard, clearly. type IIs have less ability to respond to food intake; therefore, smaller amounts of good food, spread over more times, is better, less stressful to our (broken) system, and healthier overall. My hat's off to you.
Kudos on the gallons of water. It took my doctor banging on me for months; but I finally have incorporated a few liters/day of real water into my daily diet. Doesn't even hurt anymore!!!

"Push up the weights...roll back the years"..

Something for me to think about! Even if i don't have the $$$ for the weight room, maybe i need to find it -- or at least learn to love the push-up. Trouble is, that river in Egypt is incredibly ubiquitous.


I got that phrase from an article on fitness for women that I had given my wife, by the way; she's 51, has MS, thinks walking and stationary bike riding is 100% all she needs. That article made clear that the relative importance of resistance training increasesas we age, not decreases.
In fact, this was emphasized by the lead Doctor of the series of Clinics of which my weight loss program is a part of. He spoke to us one evening; probably the biggest expert on exact, up to date info on obesity, diabetes, metabolism, and weight loss that I have ever personally listened to. He brought up, in the exercise portion of his talk, was that he has to work on Type II women harder than he does on men to get resistance training in. He says the women tend to think aerobics is the 'main' exercise they should get; and men pretty much know they need a mixture. But he said the reality is that most obese type II women need to get at least three days of some sort of resistance exercise in--each week, every week; and the men have to get at least 3-4 days of aerobics, each week, every week; to make sure each gets what they tend to ignore because of gender proclivities. So the 'push up the weights, roll back the years' especially for women, has now been emphasized to me recently by two different experts. My wife is resisting it...about the only resistance exercise she's getting right now....her resistance is merely the third confirmation I need of its importance.

YOU'RE DOING GREAT!!! KEEP UP THE GOOD WORK.

jp

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Walking any distance is impossible. The pain and pressure on my open wounds makes this form of exercise undoable. If I walk,my feet get worse. As it is, my bone specialist says that I can expect a below the knee amputation within 5 years. His advise is don't push it.

Does your bone specialist (or any of your doctors) have advice on how you could exercise?
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Walking any distance is impossible

In my previous incarnation as a Y member [employer subsidized membership], i recall people doing water aerobics in the shallow end of the pool. The viscosity of the water increases the required muscle effort, while the buoyancy reduces impact and weight loading on the legs/feet. i have also found that some swimming strokes can be done without the use of the legs [slow backstroke, skulling]. The aerobic benefits of these slow strokes are less than the benefits of standard lap-swimming, but epsilon is greater than zero.

Perhaps the solution to the walk/don't-walk conundrum is to get wet.

cassandra

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