Introducing a new About.com Diabetes feature...
Meet Jim, a registered nurse who was recently diagnosed with type 2 diabetes. Jim has graciously agreed to be interviewed once a month for a year, so we can follow his progress as he copes with diabetes.
Jim is 61 years old and a registered nurse. He is married with 2 grown sons, and will celebrate his 40th wedding anniversary in June 2008. Jim was diagnosed with type 2 diabetes in August of 2007. His wife Connie was diagnosed with the disease in 2003.
Jim's May 2008 Stats
- Height: 5 feet 8 inches
- Weight: 230 lbs.
- Smoking Status: 2 and a half packs a day
- Medication: Metformin
- Current A1c: 7
- Current Average Blood Pressure: 150/90
Health Overview
While Jim smokes, he recently quit for several months, but then restarted. Besides diabetes, he also has been diagnosed with hypertension, with his blood pressures hovering around 150/90.After talking with his doctor, he is trying to manage his blood pressure with diet and weight loss, rather than medication. Jim feels his blood pressure is borderline, and comments that when he was in nursing school many years ago, borderline hypertension was 140/90. These days doctors recommend keeping blood pressures at 130/80 or lower.
Diabetes Diagnosis and Management Approach
Jim was diagnosed with type 2 diabetes as a result of a routine physical. A fasting blood glucose level came back at 350 mg/dl. He was prescribed Metformin (500 mg twice a day). A repeat fasting blood sugar showed that although his blood sugar had come down on the Metformin, it was still 280 mg/dl.He changed his diet somewhat and realized that he was taking the evening dose of Metformin at the wrong time. When he started taking the drug before dinner instead of after, his blood sugars went down to a fasting 140 mg/dl and a dinnertime 180 mg/dl postprandial.
A follow-up doctor visit revealed an A1c of 9, so his Metformin was increased. His most recent A1c was 7.
Jim is intent on starting a diet and exercise program to further help manage his diabetes and hypertension. He has started to substitute olive oil for other fats in his cooking, and he has cut down on salt. He has been doing some cardio classes at the gym, including occasional classes in Zumba, which is a cardio/fitness program based on Latin dance moves.
He is intending to start a home fitness program very soon. It is comprised of an exercise program that combines weights and cardio, a low-carb nutrition plan, other support tools to track progress, and online peer support. It is not designed specifically for diabetes management, but it offers overall weight loss and fitness benefits. It might be a little rigid and intense, but Jim feels optimistic about his choice of fitness plan.
Complications From Diabetes
"I have some numbness and tingling in my hand, but that might be from an old injury," he says. "Although, I first noticed the tingling a few months ago." When asked how he feels about having diabetes, he says, "It doesn't bother me too much. Subconsciously, I think that there are things I shouldn't eat. I haven't had a milkshake in a long time."
Challenges
What does he consider his biggest challenge? "The shift I work. It screws up when I [am able] to exercise. If I could eat a regular supper, that would help too," says Jim. He works the second shift at his job, 3:00 pm to 11:00 pm, full time.He feels that second shift throws his eating schedule off. Getting up late in the morning, having a late breakfast, and then laying down in the early afternoon to rest before work means that he doesn't have time for a proper lunch before work. Consequently, he eats most of his calories later in the day. He often brings snacks to work to tide him over until his dinner break.
Dinner time is difficult at work because, as a nurse, he is often busy and doesn't have time to take a full dinner break. He is also dependent on what he brings from home, or ordering take-out. Eating quick can mean grabbing unhealthy snack food on the run, instead of having time to eat a healthy meal. Because his dinner time is so sporadic and the shift is so busy, he frequently forgets to take his evening dose of Metformin until a few hours later.
Notable Successes
What does Jim feel he is doing right? Jim has lost 13 pounds so far, just by making some adjustments to his diet. He is trying to stay away from snack foods, such as chips and candy. He still drinks cola, but plans to switch to water when he starts his fitness program. He brings a lot of his own food to work, rather than relying on what's handy.There are often a lot of snack foods -- doughnuts, muffins, cake -- laying around the nurse's station, and they can be a real temptation to someone who is busy and hungry. Jim admits that although he can resist most of the snacks, he has a fondness for doughnuts.
