A Gentle Nudge

Terry Adams, 69, has more energy and feels better than he has in a long time. “He’s found the fountain of youth,” says his wife Helene. His type 2 diabetes diagnosis provided the incentive to help this Ames, Iowa man turn his health around.

Terry’s journey started at a routine physical in October 2001. His doctor told him he had type 2 diabetes. His fasting blood glucose was 160 and his A1C was 6.9. He could either control his diabetes, his doctor said, or watch it get worse as the disease progressed unchecked. Terry’s doctor immediately referred him to a diabetes center for nutrition and diabetes counseling.

His doctor’s stern warning was followed by a gentle, yet firm nudge from Helene. “If you don’t take care of yourself, you could lose your eyesight,” said his wife of 41 years. “I’ll take care of you whatever happens, but I’d hate to see you not be able to enjoy things you love, such as reading and playing music.” Terry decided to take care of his diabetes and signed on for diabetes counseling.

A Turning Point

When I became Terry’s diabetes educator, he was at a pivotal point in his life. He was turning 65 and was selling his funeral home, a business that had been in his family for three generations — more than 100 years. “Terry doesn’t usually show stress,” Helene says, but both admitted it had been a stressful year.

Terry didn’t let the stressors hold him back. I outlined the basics on diabetes and how to manage it; then I worked up a personalized, 1,800-calorie-a-day meal plan based on his likes and dislikes. In addition, I advised him to start walking 20 to 30 minutes a day three to five times a week. Then I gave him a blood glucose monitor and recommended he test his blood twice a day. “I can do this,” Terry told me. And he did by learning to follow the three basic rules that put him in control: follow a meal plan, exercise regularly, and monitor blood glucose levels often.

Work with a Diabetes Educator

Understand that controlling diabetes can enhance your life.
See a dietitian and follow through with a positive attitude.
Realize that you can feel better and prevent complications from diabetes.
Follow your meal plan and exercise regularly. You’ll feel so much better that you’ll wonder why you didn’t do it before.
See your diabetes educator and doctor regularly for lab results, support, and reassurance.

Watching Portions

Terry’s struggle with weight started in his 40s. His story was typical of many people — he weighed 132 pounds in high school, then gained an average of 2 to 3 pounds a year. Twenty-five years later, he’d put on 40 extra pounds. A few years before Terry’s diagnosis, his doctor had handed him a sheet of paper with a meal plan and told him he was too fat and needed to lose weight. He did but then gained it back. “It was hard to stick to a rigid plan,” Terry says.

This time, though, it was different. “The key,” Terry says, “is that [my dietitian] emphasized healthy eating as a lifestyle, not a crash diet. [My dietitian] told me to cut back, but not too fast, and not to miss a meal. I also learned that I can eat anything in moderation.” For example, Terry loves pie — he just limits himself to two slices a year. “You can’t snitch or play games with yourself,” he says.

It helped Terry to see how proper portion sizes look. “I’m a visual learner,” he says. “The food models helped the portion size stick in my head.” After embarking on his new healthful eating plan, Terry lost 25 pounds in the first six months. It was an accomplishment to celebrate.

“I always remember, when I lost 25 pounds, I was told to walk around with five bags of 5-pound flour in a backpack to appreciate how much I’d lost,” Terry says. “That was a very positive message. And now I’ve lost the equivalent of eight of those bags!”

Walking the Neighborhood

Terry learned his solution wasn’t choosing between diet and exercise — it had to be both. Initially, he had all the classic excuses for not exercising. “Walking at the gym was a challenge,” he says. Then he discovered headphones, and soon marching music made the time slip away.

“Walking opened my life to what’s around me,” says Terry, who now walks around the neighborhood for an hour on most days. He’ll often even go for a second walk. He’s become quite an outdoorsman — he simply dresses for the weather and heads out.

Checking Gives Control
Terry initially checked his blood glucose twice a day, but he now checks it three times a week at different times of the day.

His blood glucose is in the near-normal range most of the time — less than 110 mg/dL when fasting and less than 150 mg/dL two hours after a meal. Terry recognizes the importance of reacting to a blood glucose pattern rather than an individual reading. For instance, he’s not alarmed if one fasting glucose reading is 130 because his usual range is 80 to 105. Terry also has his A1C checked twice a year. He’s maintained it below 6.0 percent for the past three years.

Keeping a Diary

Terry keeps his food and activity diary in his pocket. When he eats something or takes a walk, he writes it down. To some, that may sound compulsive, but to Terry it’s vital. “With diabetes, it’s a slippery slope,” Helene says. “If something works, I don’t touch it.”

Terry also records his blood glucose levels. With these records, it’s easier for him to understand why they go up or down. He also uses his glucose results as a motivator to balance his meals and go for those walks. “It’s helped me stay on track,” he says.

Finding Support

Helene’s support is visible in many small things she does. She reinforces the behaviors that have become important to Terry. She’s become diligent about serving healthful, balanced meals and keeping temptations out of the house.

“It’s a lifestyle,” she says. “We never diet around here; we plan meals.” And most important, she recognizes that Terry needs to make his own decisions regarding food choices. After all, in the long run, he’s responsible. The entire family appreciates Terry’s commitment to taking care of his diabetes. “He makes an effort every day to stay healthy,” Helene says.

Terry has found regular visits to see his dietitian are also very motivating and supportive. The sessions empower him, validate his efforts, and help him stay on track. Terry is very proud of himself, as he should be. “I feel better than I have in a long time,” he says. The “fountain of youth” — in the form of eating right, exercising, and monitoring blood glucose — has definitely let Terry live the life he loves.

10 Keys to Success

Terry Adams adapted his dietitian’s advice to create his own set of rules.

Follow a meal plan — it takes away the guesswork.

Measure and weigh foods — estimate when eating out or on special occasions.

Limit starches and balance meals with nonstarchy vegetables.

Eat vegetables and fruits daily — three to four servings of each.

Eat most anything, but watch your portion sizes.

Avoid munching throughout the day.

Bake, broil, or grill — avoid fried foods.

Cut down on desserts overall — have a small serving on special occasions.

Split a meal when eating out and order an extra side salad.

Keep food, exercise, and blood glucose records.