Look, Ma, No More CPAP!

File this one under non-scale victory that actually does reduce my weight…of my travel bags.

Several weeks ago, I had an appointment with my pulmonologist to follow up on my use of CPAP. It had been two years since I saw him and, well, a lot changed since he saw me last.

He commissioned another sleep study to see how my sleep apnea was progressing. Unlike the last one, I got to do this one at home. The hardest part was picking a week that I was going to be home to actually do it.

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A couple weeks after I did the study, I got a phone call from my pulmonologist. On a weekend no less. He told me that while I still met the diagnostic criteria for apnea, I had fewer events per hour than previously (6 events versus 8), and I could try not using CPAP for a while and see how I did. He suggested also monitoring my blood pressure to ensure my blood pressure did not increase as a result.

So I tried it. While it's difficult to totally judge sleep quality when you're constantly changing timezones, I think I can say: going off CPAP did not make a ton of difference. My sleep quality seems relatively unchanged.

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Further, my blood pressure seems to be trending lower rather than higher.

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I just sent a note to the doctor with the results of my self-experiment. I informed him that, given these results, that I am planning to discontinue CPAP and will continue to monitor and use CPAP again if needed. He agreed with my strategy.

Which means my travels will be that much lighter now that I won't have to carry a CPAP with me everywhere I go. Sure, the airlines treat it as a "free" carryon, but it's still a hassle, especially going through some foreign airports.

The Progress Belt

While I have gotten rid of most of the clothing from when I weighed 300+ pounds, there is one item I am keeping: a 54 inch belt.

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At my biggest, I needed to use the very outer hole in that belt. That hole is 56 inches (or 142 centimeters) out! Yes, I measured. I guess the elastic in the pants I had stretches a bit more than I thought.

As I started losing weight and inches, I punched holes in my belt. After the smaller pants I had kept from years ago started getting too big, I bought new pants…and a belt of the proper size.

That said, I am still using this 54 inch belt as a way to track my progress and remind me just how far I've come. It's been critical since the scale has been relatively stable the last few months, yet my waist continues to shrink (slowly but surely).

The shorts and pants I bought with the 40 inch (about 100 centimeters) waist are now a little loose. And those XXL shirts I have kept for years and started wearing again are…a little big, now.

For most of my adult life, the only places I've been able to buy clothes that properly fit is ordering from the King Size catalog and/or going to Big and Tall sections/stores. You don't realize just how much this limits your wardrobe choices or how expensive this is until you're suddenly able to buy clothing in...a normal store.

In fact, I remember the first time I had done this. I had went to go get pants at Fred Meyer, which is one of the only local stores that has a Big and Tall section. While I did buy stuff from their Big and Tall section, I also bought stuff from the "normal" section as well, including a coat off the clearance rack from the "normal" section!

And then I discovered I could buy clothing from Costco, which was a game changer. Not necessarily for the selection, but the prices. And the fact it's even an option now.

Meanwhile, I may (crossing fingers) have broken through my weight loss stall. I'm about a pound off my lowest weight this year, which I hit about two months ago, but my weight crept back up a little.

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And yes, this weight loss happened just after I got back from Switzerland. I guess all that cheese didn't hurt me. :)

Intermittent Fasting, 1 Year Later

It's been roughly a year since I took charge of my health by making two major changes to my eating habits:

  • When I eat, which is typically only once a day. Some days, I will not eat at all. Other days, I may eat twice a day. It depends on where I am in the world, what's going on, and so on.
  • What I eat, which is mostly low in carbohydrates, high in fat. You might call it a ketogenic diet, or even the induction phase of Atkins (the 1970s version). I had previously done Atkins in the early 2000s with some success, so this part of the change was somewhat familiar.

This was done gradually over the course of several weeks. During fasting times, I will drink black coffee or tea, which I initially had with heavy cream, but I cut that out except during mealtimes. I will also occasionally have chicken broth for the electrolytes.

The main reasons for doing this are summarized in Dr. Jason Fung's recent book called The Diabetes Code. His previous book, The Obesity Code, was what got me to try it at least. Given fasting costs nothing and everything else I was doing wasn't working to control my diabetes, much less my weight, why not?

A year in, I'd say it's been successful. My stats from May 2017:

  • Weight: 311 pounds or 141 kilos, which is about 15 pounds below my high water mark from 2016
  • Blood Glucose (30-day average): 137 mg/dL or 8 mmol/L
  • A1C (based on a blood test): 7.1 (highest was 7.9%)
  • Waist: 54 inches or 137 centimeters (about 2 inches lower than my largest)

As of May 2018, here's where I'm at:

  • Weight: 230 pounds or 104kg
  • Blood Glucose (30-day average): 105 mg/dL or 5.8 mmol/L
  • A1C: 5.6%
  • Waist: 39 inches or 99 centimeters

The more important bit of this: My A1C is in the normal range. Granted, I am still taking Metformin, but that means I no longer fit the diagnostic criteria for even pre-diabetes! However, there has been no change in my medications. My doctor wants me to continue taking Metformin until my A1C drops to at least 5.0%. My blood pressure, while definitely a lot better than it was a few years ago, is still mildly elevated.

When I was diagnosed with Type 2 Diabetes, I was also diagnosed with onset sleep apnea. The good news is, from the sleep study I did a few weeks ago, it looks like my apnea has improved: from 8 events an hour to 6. I do, however, still meet the diagnostic criteria. That said, given all the other changes that have taken place, and the relative mildness of my condition, my pulmonologist and I agreed that I should try sleeping without my CPAP for a few weeks, monitoring my blood pressure and symptoms along the way to ensure I don't develop any issues. That's progress!

The one frustrating bit is my weight has been more or less the same for the last few months, plus or minus a few pounds. That said, given the amount of travel I've been doing lately, keeping my weight fairly steady is a positive achievement in and of itself.

Despite the stall, I am slowly but surely shrinking around my middle and other parts of my body. Even if the scale isn't moving, progress is still being made.

Waist Progress While Weight Progress...Waits

I thought I was making progress on the weight loss front...until I wasn't.

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Basically, I've bounced around the same 10 pounds / 4.5 kilos for the last few months. That's what the blue line shows, whereas the green and red curves show where the "floating average weight" is (as calculated by HappyScale).

I suppose I can blame the fact that I haven't done a fast longer than 24 hours in a while. Also, I've been in many different timezones over the last few months, meaning my sleep is all over the map. With that as context, keeping my weight more or less stable is an achievement.

What is definitely an achievement is another notch being punched in my belt. That puts my waist loss at 15 inches (or 38 centimeters). That is definitely an achievement.

Meanwhile, the doctor tells me to keep making progress. The A1C is at a 5.6% and my blood pressure is still mildly elevated, but way better than it was when I started. Hopefully, those will all trend downward along with my weight and I can get off the meds. That would be serious progress.

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).

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