When I met “Tom” he was a 50 year old office manager who was diagnosed with type 2 diabetes two years previously. His diabetes was progressing. He was taking the oral medication metformin at the maximum dose, but his A1c had increased from 6.7% to 7.3% over the previous 6 months and his doctor encouraged him to see me about “lifestyle coaching” as an alternative to adding a second medicine for glucose control.
I wanted to know more about his lifestyle and circumstances and health goals. Tom is a family man. He is a husband and father of 3 school age children. He wanted to to set a good example for his family and he felt his gradually increasing weight was holding him back from being the role model he wanted to be. He was anxious about whether the next few decades would lead to insulin shots or diabetic complications. He didn’t say so, but I suspected his expectations for a healthy retirement were very low due to his advancing disease. I learned that he liked most foods and enjoyed cooking. His wife did most of the cooking and grocery shopping, however. He was working 45 hours per week and was too tired after dinner with his family to think about exercise. He would usually watch television with his family until bedtime. On weekends he was involved in family activities. He was pleased that his children were involved in sports teams at school. The whole family would dine out at least twice on weekends, and would also usually gather for a family meal at his mother’s on Sunday evenings. His father had died 25 years earlier of a heart attack at age 51. Tom was worried that he might follow in his father’s footsteps with an early death due to a heart attack or other diabetes-related complication. He knew how devastating it can be to lose a father too early to a preventable disease, and he was determined to do all he could to avoid such a hardship for his own family. His mother had type 2 diabetes for the previous 10 years, was taking insulin shots, and was occasionally hospitalized with skin infections in her feet and legs as a complication of her diabetes. He worried about her ending up in a nursing home. His younger sister, who lived out of town, was 100 pounds overweight and had prediabetes.
He had been successful at all other aspects of his life. “Why is my health the one exception?” he wondered. He had gained 2 pounds a year since high school, and was now 220 pounds. At 5’10″ he was carrying about 50 pounds of excess body fat. He had tried to lose weight a few times before, by eating smaller portions and jogging, but these efforts gave 10 pound weight losses that were hard-earned and unsustainable. He always felt hungry and the exercise seemed like a chore. It took time away from his wife and children and didn’t seem worth the effort, for such a “small payoff”. Nevertheless, he was more determined than ever to succeed. He explained that he felt “stuck between a rock and a hard place” between the sacrifices required by poor health, versus the sacrifices required to regain his health.
He made a conscious decision that doing whatever it took to achieve the necessary lifestyle changes was a better deal than letting his health deteriorate. He said he knew from past experience that hard work and persistent effort would be necessary, and that he would be faced with temptations to eat poorly and to skip the exercise, but he would work hard to overcome the logistical and psychological barriers that had interfered with past attempts to get healthy. “Tell me what to do and I will do it” he said.
I repeated back to him my understanding of his reasons for regaining his health. I told him I would do everything in my power to help him reverse the diabetes as much as possible, and that we should aim for a full remission of the diabetes, meaning normal blood sugar without medication. He was surprised that I was so optimistic about his chances for remission. He was mainly hoping to avoid a second medication for the diabetes, and the notion that he could get off the metformin was very appealing to him. He already knew that I have a “program” for diabetes reversal, and he wanted to know what was involved.
In the next posting I’ll discuss my program for diabetes reversal. In the meantime, how is your own story similar and different from Tom’s?
— Michael Dansinger, MD
Read the series: