CPAP and Meds No More?

A few years ago, I was prescribed a CPAP machine to treat sleep apnea. For sure, it practically eliminated my snoring and it definitely helped me sleep better almost immediately. And while I don't mind sleeping with the machine--I've gotten quite used to it, actually---I have to carry the machine with me when I travel.

Considering I am traveling pretty regularly now, it's a real consideration. Thankfully the airlines treat it as a "free" carryon, but I still have to carry it. I've also been in more than one hotel room where there isn't an outlet conveniently located near the bed. Not having to travel with it would be a benefit.

Meanwhile, it had been a couple years since I saw my pulmonologist and my appointment was this past Friday. Needless to say, the weight loss was pretty apparent and dramatic as it has been for my co-workers.

Given the significant weight loss and the fact my sleep apnea was pretty mild to begin with, he suggested I might not need a CPAP anymore. To confirm, I will need to do a home sleep study.

Of course, the problem with that is that I actually need to be home to schedule the appointment with the folks that will show me how to strap on the equipment. And, of course, to do the actual study. So it will be a few weeks.

Something else that came from that appointment: my blood pressure. It was...normal. Sure enough, as I'm testing at home, I'm starting to see normal numbers. That has to be fairly recent since even as recently as two weeks ago, I was still seeing slightly elevated blood pressure numbers.

Maybe I can stop carrying the medications as well? Certainly with my A1C at a 5.6%, I can make the argument that I don't need them anymore. We'll see when I talk to my primary care doctor in a week or so.

The Non-Scale Victory I'm Really After

While I've had plenty of scale victories, as it were, there have plenty of victories that cannot be measured on the bathroom scale. Oh sure, the non-scale victories are happening as a direct result of the ones I am achieving on the scale, the progress is not exactly linear.

Before and after

The above photo was surfaced by Google Photos a few days ago. It's one of those "Then and Now" photos. Then was four years and about a hundred pounds (or 45 kilos) ago. It was also before the real reason I am going down this road: a Type 2 Diabetes diagnosis which came in October 2014.

Back then, I definitely had some health issues. These included migraines, swelling in my feet, which got really bad on long flights, and sleep apnea. When Type 2 Diabetes and Hypertension were officially added to the mix, these items started making sense.

One of the diagnostic criteria for Type 2 Diabetes is your HbA1c number, otherwise known as just A1C, which is a measurement of your glycated hemoglobin, or a measure of how much sugar has been in your blood over the past 3 months.

The generally accepted ranges for A1C are as follows:

  • Below 5.7%: Normal
  • 5.7% - 6.4%: Pre-diabetes
  • 6.5% or more: Diabetes

My A1C was a 7.9% at first diagnosis, definitely in Type 2 Diabetes territory. During 2015, I had managed to get it down to a 6.1%, but then I fell off the wagon and before too long, it was back to a 7.1%.

Clearly what I was doing wasn't working. More specifically, the changes I had initially made were not ones I could stick with. As a result, I regressed.

Then, 10 months ago, I started down my current path of eating once a day and limiting sugars and carbs. These choices were made in order to reduce the frequency and the amplitude of insulin spikes impacting my system.

Sure enough, my average blood glucose came down. Here's my 30 day average from about a year ago.

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And my current average:

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My weight clearly went down.

Weight

Also, my A1C came down. My previous blood test in December had my A1C at a 5.9%. The one I took earlier this week shows my A1C at 5.6%. That puts me in the normal range but I am still taking Metformin.

The next obvious step would be to stop taking Metformin, and hopefully the blood pressure and statin meds as well. When I last discussed this with my doctor, he told me my A1C would probably go up about a half a point once I quit Metformin. As such, he would only agree to let me go off the meds once my A1C was a 5.0% or less. We'll see what he says when I see him in a couple weeks.

In any case, this is really the victory I am after: kicking diabeetus to the curb. I'm not going to say it's cured, but it's definitely down for the count. I plan to keep it that way.

Another Notch in the Belt

While I did get a new belt a while ago, I did keep one of my belts from when I had a 54 inch waist. Possibly a little more since, at one point, I struggled to get the belt on. Today, I decided to wear it, but had to punch another hole in it, as I shrank a little more since I last wore it.

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The distance between the holes? 14 and a half inches. Which definitely means these size 40 shorts I bought last week should fit quite nicely. We'll find out next week when I'm someplace warm enough to wear them.

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Meanwhile, I did get my blood drawn today, which include an A1C test. As usual, it will be a couple days before I find out the results. No urine sample this time, though. I guess my doctor was pretty sure I stopped peeing glucose out of my urine, which is something that happens when you have too much of it in your blood stream. Considering readings like this on my glucometer have been pretty common in the past several weeks, there's a good chance he's right:

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And, of course, the weight loss has continued, though it has slowed down a bit:

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Meanwhile, I await my A1C test results.

Blood Glucose Meters: Like Razor and Blades, But For Diabetes

The razor and blades model is well known and simple: give away the razors, make money off the blades. Or more specifically: sell one good at an artificially low price (or even give it away) that is reliant on another complimentary, consumable good. It's this consumable good where the real money is made.

The embodiment of this model in the tech space is inkjet printers. The printers (particularly the consumer models) are almost as cheap as the inkjet refills themselves in some cases. Which is why the last time I bought an inkjet printer, I found out what models of cartridges I could refill at Costco for significantly cheaper than buying new ones. Sure, we still have to buy new ones periodically, but it's cheaper than having to buy new ones all the time.

In the Diabetes world, our "razor and blades" device we simply must have: the blood glucose meter. The meters can be had for next to nothing, at least on Amazon. The strips, on the other hand, cost a fortune. Since they can't be reused, unlike a razor blade, which I reuse for weeks and weeks, a test strip can only be used once. This means buying new test strips on a fairly regular basis.

Back when I was first diagnosed with Type 2 Diabetes, it didn't take long for me to see just monitoring this condition was going to cost a fortune. The cost of the strips for the meter I was given when purchased through insurance: $25 for 50. Even if I'm testing just twice a day, which doesn't count "testing errors" and the like, that's over $180 a year. If I want to test more often, I'd have to buy the strips retail, which, it turns out is actually cheaper if you look on Amazon.

Thankfully, one does not need a prescription to buy a blood glucose meter or the test strips. This allows you to shop around. Back in 2014, I ended up trying the iHealth Labs Bluetooth meter. It had cheaper test strips and Bluetooth support, making it a worthwhile investment. It worked well enough for a time, but eventually the meter stopped being accurate. Which, as I found out later, is fairly common after a year or two.

This led me to using a different meter, one by Ascensia (formerly Bayer). The meter was cheap enough, had Bluetooth and whatnot, but ultimately synced to an app that didn't do much, or sync to Apple HealthKit. The strips, while significantly cheaper on Amazon, are not as cheap as some of the alternatives.

My most recent meter purchase was an EasyTouch Diabetes Testing Kit which includes everything you need to get started. The meter itself is a little larger than my previous meters, and lacks fancy features like Bluetooth, or even a backlit screen. Since I'm logging my blood glucose data into HealthKit manually using a Workflow I created, I'm not seeing a huge benefit to getting a meter that syncs with my phone.

My initial tests with this new meter: similar results to my previous meter. Considering I can get 50% more EasyTouch strips for the same price, it seems like a win-win.

Morning Has Broken My Blood Sugar No More?

In the past, I commented on how my blood sugar was sometimes significantly higher when I woke up than it was when I went to bed. Going back to my blood glucose readings from 2014 and 2015 (thank you, HealthKit), I can see I had some days where I would go to bed with a reading that was, say, 99 mg/dL, and wake up with a 134 mg/dL reading. I had plenty of days where the reverse was true as well.

I had the impression that I experienced Dawn Phenomenon in the past more often than the data says I did. I also thought it was a thing of the past. Turns out, neither is true. In fact, it's seems I should expect it.

When you eat a low carb high fat diet (in addition to only eating once a day), your fasting blood glucose can be higher! This is because your muscles are fat-adapted and don't need the infusion of glucose your liver pumps out in the morning. Even with that, insulin levels remain relatively low in this case, which is a good thing if you're trying to reverse the insulin resistance that goes with Type 2 Diabetes.

Even if I don't see the blood sugar spike immediately after I wake up, it is pretty common for me to see a somewhat higher blood glucose a few hours later. When my waking blood glucose is generally lower than it was before, the 10-15 mg/DL spike is not quite as concerning. Especially since it's generally lower by the evening, assuming I don't eat anything.

One other interesting tidbit from the above-linked article:

The HbA1c test estimates the average glucose level in the blood over the previous three months by counting the number of glucose molecules stuck on red blood cells. On a low-carb diet the HbA1c will almost always be lower than the FBG suggests, showing that good glucose control, or type 2 diabetes, is not an issue for that individual.

Which means my A1C could actually lower than the 5.2% my 90-day average blood glucose suggests. That would be a wonderful thing as maybe I will get to an A1C of 5.0%, which means I'll be able to go off my meds. I have another month or so before I go in for another set of blood tests, so it will be a while.

Meanwhile, I seem to have broken through my month long plateau. I lost almost 100 pounds or 45 kilos so far. In case you're new to following my weight loss journey, here's how I'm getting there.

My target weight? About 190 pounds or about 86 kilos. At least on the BMI charts, this would put me in the "overweight" category as opposed to the "obese" category I'm in now or the "morbidly obese" category I was in when I started. I can't even remember when I last weighed 190 pounds. Maybe in high school, if even then.

My doctor said he'd like me to see me at about 175 pounds or 79 kilos. Maybe l'll get there, but I've got a few milestones to reach before then. For example, my lowest known weight as an adult, which is only 13 pounds or about 6 kilos away.

Hitting a Plateau, But It's All Good

While I've been progressing nicely with my weight loss, the last six weeks has seen me in Barcelona, Las Vegas, and Bangkok, all for Check Point's CPX360 events. Two of the trips involved significant travel. The result? You might call it a plateau:

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On one hand, I should consider myself fortunate that any weight I gained, particularly in Barcelona and Vegas, was lost fairly quickly--enough that it didn't affect the floating average all that much, which this graph represents. On the other, I'm mildly frustrated to be stuck around the same weight for the last month or so.

Everyone trying to lose weight eventually stalls. It happened to me before when I did Atkins 15 years ago. The difference this time around is I'm aware of it and am using other yardsticks to measure progress. My waist, for instance, is an inch smaller than it was a couple of weeks ago, which has resulted in my clothes fitting a little better. My face? Also seems to be a bit thinner, just from pictures:

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The photo on the left was from late January in Barcelona, the one on the right a couple weeks ago in Gig Harbor.

It seems like I may have broken through the plateau based on the fact my average weight has recently dipped below 235 pounds, or about 107 kilograms. Whether that trend continues or not, I will find out in the coming days.

The real trend I'm concerned about? My A1C number. I won't know for another month or two until I get blood work done again. Still, my blood glucose has been fairly stable with the 30-day average being 105 mg/dL (or 5.8 mmol/L). That suggests I should have a lower A1C than 5.9%, but we'll see.

The good news is that I'm home for the next couple of weeks and the travel I've got planned after that will keep me fairly close to home. This should make it easier to stay on plan and continue to make progress (or at least not lose ground).

I Hardly Recognize You! You Look Fantastic!

I've been hearing variations of this over the last few weeks as I've been doing Check Point's CPX360 events in Barcelona and Las Vegas. For many who had met me previously, it's the first time they've seen me since I've started eating once a day, intermittent fasting, or whatever you want to call it.

And yes, the difference a year makes (or in some cases, only a few months) is quite striking, as these two pictures from roughly a year apart show:

Jan 2017

The above was me at Check Point's Sales Kick off in Las Vegas in January of 2017. Compare that to me at CPX360 in Las Vegas in February 2018:

Feb 2018

For those not keeping track, I'm about 90 pounds or 40 kilograms off my high water mark. My Type 2 Diabetes and high blood pressure are also significantly improved as well.

I posted these before and after pictures on LinkedIn. The response was overwhelming: more than 600 likes and over 70 comments as of this writing!

There is a lot of conflicting advice about how one can achieve these goals. Not only that, you have multiple industries that benefit to the tune of billions of dollars a year from maintaining the status quo. Trying to find your way through all that to something that works for you is...not easy to say the least.

For me, it has boiled down to the following five rules:

  1. Dietary fat is your friend.
  2. Sugar (real or fake) is your enemy.
  3. The less frequently you eat, the better.
  4. When crossing timezones, don't eat until you reach your destination.
  5. Get enough sleep.

What are these rules trying to achieve? It boils down to reducing the amount of insulin my body produces, both in terms of amount and frequency. This is because, as a Type 2 Diabetic, I have become insulin resistant, meaning my body must produce more and more insulin to achieve the same results.

While insulin is needed to metabolize the food you eat, too much of it in your body is clearly a bad thing. Since practically everything you eat invokes an insulin response, the only way you can reduce the frequency of insulin spikes is reduce how often you eat. To reduce the size of the insulin spike when you do eat, the best approach seems to be eat more dietary fat and little to no carbohydrates.

Not eating while traveling long distances is as much about reducing exposure to potentially bad dietary choices as much as it is about resetting my circadian rhythm. I can't claim it's a total cure for jet lag, but it definitely makes jumping a large number of timezones easier. The fact it also supports my larger health goals is a definite bonus.

What about sleep? Lack of sleep contributes to insulin resistance which is a bad thing. The good news is that I have more time to sleep since I spend less time eating and can thus work through breakfast and/or lunch.

Notice I have not put any strict guidelines in these rules. That's because the exact mix that works for me today may not work for me tomorrow and I may need to adjust. Also, the particular mix that works for me may not work for you.

For those who think I am starving myself by only eating once a day (or less), the reality is: I'm not. I've just finally gotten my body to a point where it is able to metabolize the food I previously ate and stored as fat, of which I still have plenty, even after losing as much weight as I have. My energy is better than it's ever been, especially on days where I am active. I sleep better. I'm making better food choices when I do eat (including eating less).

Unlike eating according to a particular diet, which can be difficult to do at times depending on where you are in the world, eating less frequently or even fasting is something you can do anywhere, anytime. Atkins was very effective at lowering my weight back in the early 2000s, but I found it very difficult to maintain, particularly as I started traveling more. When I stopped that way of eating, I gained more and more weight. I eventually started having health issues that ultimately led to a diagnosis of Type 2 Diabetes.

Now, when I do find myself in a place I've never been before, I don't feel guilty about trying the local food. Or, in the case of a celebration, I can indulge myself occasionally. Because, let's face it, life is going to happen.

After it does, I can get back to eating once a day. Maybe even fast for a couple of days to reset things.

The bottom line: I think I've found a lifestyle that works. I spend a bit more on coffee now (black or espresso), but I spend a lot less on food. I will eventually have to buy a new wardrobe, though clothes I haven't worn in years now fit again. I feel like a different person.

A few resources I've used in my health journey:

I'm by no means where I want to be, but I'm definitely in better shape than I've been in more than a decade!

The Annual Physical

Yesterday, I went to visit my doctor for my annual physical. The doctor made a few observations:

  • I'm at my lowest weight according to their records, which go back to 2009. He actually asked if I had weight loss surgery when I told him on my last visit what I was doing. Apparently my chosen lifestyle didn't make his notes, nor did he consider that I'd probably consult with him before doing that.
  • My diabetes is improving as my A1C went from 6.5 to 5.9. He even said I might beat it. It's certainly my goal to to beat it, but I also know it's not going to happen overnight either.
  • I am no longer "morbidly obese" according to the guidelines, I am just "obese." Guess that's an improvement.
  • I should probably set my weight target at 175 pounds (or a little under 80 kilos). Right now, I am aiming for 195 pounds (or about 88.5 kilos) and I'm still a ways off of that.

Meanwhile my weight loss progress had a bit of a setback after my recent trip to Barcelona, both due to the excellent food and wine, and the fact I brought back a cold. However, I am not worried about this regression as the path forward is clear, but more importantly, sustainable.

Victories Not Quite To Scale

From my last update about 6 weeks ago, I have made more progress at lowering my weight and improving my Type 2 Diabetes:

  • Weight: 245 pounds/111 kilos, about 80 pounds/36 kilos under my high water mark
  • Blood glucose (30-day average): 106 mg/dL or about 6.0 mmol/L
  • A1C (from blood test in late December): 5.9%

I can blame the higher blood glucose on the holidays, but then again, the A1C number is a bit higher than I was predicting based on averages around that time. Either way, the A1C is a trailing indicator that is still trending in the right direction.

I still need to buy some new clothing, but I'm putting it off as long as possible since I expect to shrink a little more. Meanwhile, a particular hoodie that I acquired two years ago and haven't been able to wear until fairly recently is still not quite big enough for my wife's tastes. The fact I can wear it at all is another one of those non-scale victories I've been having as of late.

My next doctor's appointment is in 3 weeks. Curious what he will think of all this. Even though he's not totally onboard with my regimen, the transformation that has occurred in the last 8 months is pretty dramatic. Compare my passport photos from March 2009, June 2008, and June 2017:

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To a few days ago:

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