ho hum

Been riding regularly since June. I've put on about 1700 miles up to December. I've lost 35 pounds. My problem is that my Triglycerides are still 240 and my HDL is only 23 and my LDL is 94. Hg A1C is now down to 5.3 and fasting blood sugar is 104. Two hour post-prandial sugars are now 119 or so. Doctor suggested cutting back on carbs and to continue to exercise.

How can you determine amount of carbs to eat related to activity? What method do you use to determine what you need to eat to provide enough fuel without overloading the system of type II diabetic?

lillypad

Sounds like your HDL is low but so is your LDL as compared to most people. What is your total cholesterol level? Triglyceride level is something that is generally based on the amount of simple carbohydrates that you consume (sweet treats, sodas and the like) so your physician is probably right there. Fasting BSL is good for someone with Type II diabetes. I am assuming that you are taking some type of prescription med for your condition. Any type of exercise that you are doing will help to raise your HDL level and is good for someone with diabetes. If your total cholesterol is out of what is considered to be normal range (generally you want it to be below 200) then you may want to try a prescription med such as Lipitor at least for a little while until you get your cholesterol level under control. You say that you have lost 35 pounds, not to get too personal but, do you still need to lose some more? The more you lose, the better your chol level will tend to be. You can generally use the simple formula that your total caloric expenditure will be about 35 - 50 cals per mile depending on your body weight (the more you weigh, the more you will use per mile) and assuming you are actually riding outdoors. If you move indoors on a trainer, then obviously your weight does not factor in nearly as much because you are not actually moving your weight from point a to point b. 1 gram of carbohydrate provides 4 calories of energy, 1 gram of fat provides 9 calories. The faster you go, the higher the percentage of total energy expended will be carbohydrate and the less of the total percentage will be fat. Your body derives energy from carbos a lot easier (and a lot faster) than it does fat. Figuring out exactly how many carbos you used, therefore, is not an exact science (at least not without going to a laboratory and being hooked up to a bunch of fancy devices). As a rough estimate, your body will use about 60% carbo, 30% fat, and about 10% protein so if you burned 1000 calories during your workout, that would be 600 cals worth of carbohydrate or 150 grams. Being a person with Type II diabetes you will probably want to replace these cals with complex carbos rather than simple ones to help prevent a roller coaster effect on your blood sugar level. I hope this will help you in meeting your dietary needs for your exercise program.

lillypad

p.s. You have what is called a "two-hour window" in which your body will turn carbos consumed back into stored glycogen much easier, and with less insulin, than after this time so you will probably want to replace the used up glycogen (carbos) within this time frame unless you have consumed a very large amount of energy and will need to replace the amount lost in more than one sitting.

-Lillypad

geraldatwork

I've always had a low HDL although not quite as low as yours. Typically 26-28 been that way for 20 years or so. I've tried excersize and that hadn't helped. Same with Niacin up to 1500 mg. I've also tried fish oil up to 2000 mg per day. Same result. But I tried all of them one at a time to see which one would work. Not. So I tried all of them at the same time with the addition of grape see extract and within 6 months my HDL first went to 36 and a few months ago to 41. Kind of bombarded my liver into producing the HDL. During this period my triglicerides went from about 250 down to around 180.

ho hum

My total cholesterol is 163. I do need to loose some more weight. I haven't been able to do that even though I've upped my milage and tried to eat carefully. Been stalled out for about 8 weeks. No change in weight. I made it through the holidays without gaining any though!

I am not currently on any medications for my diabetes. I've brought my A1c down from 7 to 5.3 with exercise and diet. I'd been eating purely vegetarian for about 4 months and then went back to a little meat. I've been trying to eat the right kind of fats.

I've started chromium picolinate and garlic. I heard some radio program about alpha-lipoic acid and was going to research it a little. I tried the niacin and hated the side effects.

lillypad

Your total cholesterol is well within normal limits, glad to hear that. So what you need to focus on is getting the HDL up and the triglycerides down. There are a couple of ways of doing this and different methods work better for different people. The first, and probably the best, way is through diet and exercise. Try to cut your intake of simple carbohydrates to as low a level as possible. This may not only help your tri level but may also continue to help you to lower your long-term A1C values. You are correct about niacin. Therapeutic values for HDL increase far exceed RDA values and niacin at high levels is well-known to produce stomach upset.

If your physician feels that your values may require drug therapy, there is a relatively new class of drugs called CETP inhibitors that can be used alone or with traditional statin drugs. These have been shown to increase HDL levels while at the same time reducing triglyceride levels. If you want to do some research on your own, here are a couple of good websites you may want to try:

heartdisease.about.com
www.medscape.com

These provide a lot of useful information on the subject.

A totally vegetarian diet or lactovegetarian (milk added) or lacto-ovovegetarian (eggs also added) may definitely be of value if you are into this sort of thing. I, myself, was for many years. I would suggest that you use only the whites in cooking because the yolks are where the cholesterol in eggs is found.
(Two egg whites are equivalent to one whole egg).

This type of lifestyle, in itself, is naturally low in calories and may help you to lose some more weight.

Whatever method(s) you try, best of luck to you in your endeavor.

-Lillypad

Roody

Actually it sounds like you are doing real good. Great in fact. It sounds like you want to keep working on the weight loss. You know, as you lose weight your body requires fewer calories, so you might have to cut back on your intake a little more. You might not want to cut back on carbs too much if you are riding a lot. You really need the energy. (Check with your doctor again. Some doctors don't understand cyclists because they are used to working with couch potatoes who don't need much energy.) Since you're doing so well, maybe try cutting back on everything--fats, carbs, protein--about equally. You only have to cut back a tiny bit to lose weight, since you are already manitaining your weight. Just a few mouthfuls less of food every day--not too difficult!

Do you keep track of the intensity of your exercize? Maybe a gradual increase in intensity (more hills or intervals or just spinning faster) will help raise the HDL. It's worth a shot since it will also make you a better rider! And it's good to keep challenging your body instead of just coasting along.

Keep it up! You really are doing fantastic. BTW, I'm not a nutritionist. The only reason I would give you advice is because you are doing well and you probably only need minor changes.

Oh--you might want to read Andrew Weil's books or American Heart Association cookbook or even WebMD or similar websites. Make sure you're eating the right kinds of fats and carbs to help with the HDL and triglycerides. Are you using almost all olive oil? Are you eating enough fish? Soy products? Tree nuts?

ho hum

Thank you very much for your good advice. I will keep after it and report back.

ho hum

testmetest

I don't want to rehash what lillypad and others have said, but I want to chime in with:

1. Just as an FYI: For a diabetic patient, the goal LDL would be lower than your current level (think 70's).
2. A HgbA1c of 5.3 is excellent for a diabetic patient.
3. Your physician can not prescribe you a CETP inhibitor because it is not on the market.

Most importantly, as already mentioned: keep up the good job trying to eat healthier and exercising and also make sure ask your physician about your questions regarding medications, treatment goals, etc.

ho hum

I have some questions about intervals as I have no real hills to speak of that are on a close ride.

1. How long should they last?
2. How much time should be in between each one?
3. How many?
4. What percentage of max should be a reasonable heart rate goal?

I am assuming that the ride has a warm up period and a warm down period when intervals are done.

lillypad

I am assuming that you live in a location where you can still do outdoor training during this time of the year. If you are really serious about doing interval training, one of the best things that you can do first is to get your hands on a good heart rate monitor. Then there are different "training zones" that you can work out in. The simplest way to calculate what these zones are is to simply subtract your age from 220 and take different percentages of this value. 60-70% is low-level, 70-80% is mid-range and 80-90% is upper end.

Start out with just a few intervals during your regular training ride. Since you don't have many hills where you live, switch to higher gears (the effect is the same). If you are riding a trainer, you can do the same thing. Try to get into the 70-80% range for about one minute then take about one minute (or longer if needed) to recover and get back into the the 60-70% range. Repeat this four or five times to start. As you get into better shape you can increase the number and/or length of the intervals and increase the training intensity into the 80-90% range. A good warm-up time is about 5 minutes to get the blood flowing if you are not already out on the road and you will probably need about the same amount of time for a cool-down period after your ride. Also immediately after you get off the bike is the best time to do some stretching exercises. As usual, it is good to be consuming fluids during this time period.

Before doing any of this, though, it is always a good idea for your physician to tell you that you are in good cardiovascular health and it is OK to do this type of training. I hope this helps.

-Lillypad

cooker

Please insert paragraph breaks, credentials, and disclaimer.

DannoXYZ 

The first step should be to find out your true max-HR. Equations are off by +/-10% which will be completely out of range for target zones unless you know your true max-HR. Do the two common tests, the treadmill-running test and the biking test. They are short efforts of less than 5-minutes with increasing intensity until you hit max-HR. Most people can get 2-5bpm faster on the biking test.

Once your true max-HR is determined, you should then find your LT-lacate threshold. This too needs to be dertermined by testing. The 2x20 test outlined above is a good procedure. Be aware that LT is a muscular limit based upon exertion level and measuring HR is just a proxy indicator. Kinda like using the tachometer on your car to indicate speed, it depends upon the gear you're in. But, finding an approximate HR where LT occurs is good enough for your for now.

Once you've found max-HR and LT, we can move on to intervals. There are many varieties and different interval workouts. The ones I've found to give most benefits are defined as follows:

"An effort above LT, but below max-effort (sprint) of a fixed time-interval, such that HR maxes out by the end of the interval"

Obviously any effort above LT will result in a rising HR, if you can hold that HR, then it's below your LT. The most basic interval is a 1-minute interval. You'll be doing this at 95-98% of your max-effort (it'll be just below a 100% sprint effort). Something that you can hold for 1-minute at a steady constant pace, say... 25mph. During this minute, your HR will steadily increase until it hits max-HR by the end. The practice is to learn to pace yourself so that your HR maxes out at exactly the same time as the 1-minute interval is over. It may be 25mph, it may be 23mph, etc. depending upon your conditioning.

Then rest until HR recovers to 65-75% and repeat. Do 5 1-minute intervals, then go home.

Another type of interval workout is a pyramid set where you do 1-2-3-2-1 intervals. Start out with the 1-minute interval like before. After hitting max-HR, rest, spin-easy until you get down to 65-75% max-HR, then do the 2-minute interval. This will most likely be at 93-96% max-effort. Recover, then do 3-minute, which will be about 90-94% max-effort. Rest, then 2 then 1-minute intervals. Takes about 30-minutes, then go home.

There are other kinds of workouts above LT that are more appropriatedly called tempo or fartlek workouts. Those have different physiological goals such as recovery or stamina. Interval IMO, are to raise LT, the steady-state maximum you can hold for a long time that's the balance between muscular output and cardiovascular supply of oxygen.

BTW - do some research on various journal sites like NEJM, MedScape, JAP, etc. and you'll see that ingesting LDL has a much more direct correlation with cholesterol levels than eating straight cholesterol... It's really just a marker for LDLs and HDLs.

ho hum

Tough crowd... Doc. I'm a big boy and should be okay. I've been able to make my way through the flood of conflicting information everywhere to bring my A1c down on my own and will keep after it.

cooker

You aren't the only person reading the thread and possibly following advice gleaned here. Lillypad wrote very authoritatively but it was hard to read that humungous block of text with no white space, and personally, I'd like to know if (s)he is a trained expert, or self-educated. If the writer is a nutritionist or endocrinologist it adds at least a whiff of credibility, but at the same time they should not be dispensing such specific advice without a disclaimer.

Regards
RGC

Ritehsedad

Ho Hum,

I too am T2.

According to my Diabetic Educator, current goals are total l<160, HDL >45 (for men), LDL <100, & trig <150.

Generally speaking exercise will improve HDL, although I believe omega-3 (e.g. flax oil) will help.

Personally, I wouldn't worry about your PPG's, since they are in the pre-diabetes/non-diabetes range right now (<140 PPG is considered normal).

Concerning amount of carbs relative to activity, I don't really know, but you could either ask a CDE (especially if a nutricianist), or try asking a T1 or T2 who uses insulin (and therefore has to count carbs). Try diabetesforums.com.

Gotta go to Dos Amigos Burrito for a taco with my son. (yum)

ho hum

True, and that could apply to much of the information passed back and forth on this forum regarding advice on a multitude of things.

ho hum

Love that Mexican food! I've gotta be careful with it though.... Man, now I'm hungry and don't get away from work for awhile....

Ritehsedad

If you're ever in Portsmouth or Dover NH you gotta try the Dos. I actually had Mexican salad last night.

As for the comments concerning dispensing specific advice and disclaimers - this is a message board. I wouldn't act on medical advice given on this or any other message board without doing independent research. For questions on diabetes try diabetes.com (ADA web site), or Joslin.org (Joslin clinic).

Az B

I have no problems with the request for line breaks. And there's nothing wrong with letting people know whether or not you're a pro in the field you're speaking about...

But good grief. We're adults. Do we really need stupid disclaimers?

Az <-- Not a lawyer, do not respond to message with laptop while in shower. This could create a deadly electric shock.

cooker

Turns out lillypad is a high school teacher who happens to have a lot of health knowledge, so no, (s)he does not need to include a disclaimer. Had the poster actually been a health professional then a disclaimer would have been a very wise inclusion.
And we are certainly not all adults.

ho hum

Cooker,

Here you go, we can apply this to all of our postings.

BikeForums is an online open-content collaborative site, that is, a voluntary association of individuals who are developing a common resource of human knowledge regarding a variety of topics (not always bikes or bike related). The structure of the project allows anyone with an Internet connection and World Wide Web browser to participate. Please be advised that nothing found here has necessarily been reviewed by professionals with the expertise required to provide you with complete, competent, accurate or reliable information.

That is not to say that you will not find valuable and accurate information in BikeForums; much of the time you will. However, BikeForums cannot guarantee the validity of the information found here. The content of any given post may not correspond with the state of knowledge in the relevant fields.

Some people may even be lying, making things up, using sarcasm, screwing around, goofing off, killing time, trying to find a friend, stalking others, trying to start a scam, attempting to irritate others, committing acts of internet rebellion, and just not being nice.

If at any time you find that the advise you receive is not accurate (and you are still alive) please feel free to add to the body of knowledge here to assist others in identifying false, inaccurate, nasty, mean, malicious content and they will be dealt with in the severest manner possible. (Koffee will spank their hands and ban them from the site).

I think that this should cover it!

webist

Ho Hum

I think you've pretty well covered everything but the laptop in the shower thing. That should be OK if one is on battery though.

lillypad

Cooker,

You failed to mention what type of high school teacher I am (not English or social studies). If you are worried about breaking paragraphs in the correct places (and other English, compositon, and spelling problems) then you need to start reading every entry and correcting the poster's mistakes.

Also, you failed to mention your credentials and your source for determining my occupation.

I hope that I broke this entry to your satisfaction and you can check my spelling. It is all correct.

Best regards,

-Lillypad

cooker

Greetings.

Believe me, I have no interest in policing grammar or style on Bikeforums - I'll leave that to Raiyn et al. I commented on your lack of paragraph breaks, not to be a pedant, but because I found your post very informative, but extremely hard to read, all bunched into one big block.

I know (now) that you're a high school teacher because you said so in another thread, but what you teach is not relevant, except in a very general way (science) so I didn't mention it in my recent post. Some English teachers are likely very well informed about health and nutrition too.

As for asking for your credentials and disclaimer in an earlier post, you were giving such highly informed and specific advice that I thought you might be a health professional, in which case, you should have stated your credentials and included a disclaimer, to protect yourself from liability. Since you're not a health professional, that doesn't apply. I hope you didn't think I was implying that only certified experts should give opinions on bikeforums...I certainly don't believe that.

I took that comment as a friendly challenge, and here's my response: Were I indeed a pedant and an English teacher, I might criticize your use of the singular possessive in the phrase "poster's mistakes", since it relates to the earlier phrase "every entry" and thus implies multiple posters - so "posters' mistakes" would be more correct. However, I'm neither a pedant nor an English teacher...I'm a psychiatrist.

Oops - better fix that spellchecker: "compositon"?


Best wishes.

Robert