Introduction --- Now, I personally don't like the finger sticks. they hurt a little bit, and after a while, if you're doing this for, You're gonna be sticking your finger thousands and thousands of times. Even if you just do it, let's say three or four times a day, that's 1300 a year. if you're doing this for 20 years, that's almost 30,000 fingers sticks in your fingers. Hi, and welcome to the solving type two diabetes podcast. I'm Tom. And I'll be your host as I share what I'm doing in my daily life to solve my type two diabetes. Listen in, as I share the food, movement, and tools that I'm using each day. This podcast is intended for entertainment purposes only. For a full transcript or to follow the solving type two diabetes podcast on social media. Please head over to SolvingType2Diabetes.com for all those links and more now onto the show. My Week in Review --- I hope you are having a great week. I am having a fun week for sure. Here still on Royal Caribbean's Enchantment of the Seas. This is a 12 night cruise, so the past episode and this episode we're both recorded here on board. , we're in, day eight now of the cruise. We have four more days to go after today, and then the following morning we'll be back in Baltimore. I've had a real good time with my eating and walking and just enjoying myself here with my wife on the cruise ship. there's been a whole lot of good entertainment, great music. Musicians, singers, dancers, they have a few production shows. They have, I don't know, different things like jugglers and magicians as well. But all in all the entertainment's been great so far. We still have a few more shows to go, but we're having a good time. the weather's been really nice, breezy. In the low eighties, pretty much every day after we got, south of Florida. So it should be great weather for the next, I'm gonna say three days, but the last day probably be back in the sixties again. So we have to get used to that back in Baltimore. Now today it's only in the high forties, we'll experience that when we get back there. But I haven't had any problem, getting in my protein this time because I have brought the shakes and the. A Quest protein bars, and those are real good. I also wanna tell you about something I've had this week. I ordered it off of Amazon. They're the Quest Peanut butter cups. Now they are. for two of the peanut butter cups. They are 200 calories, almost 20 grams of protein, a little bit of, carbohydrates. Not much carbohydrates at all. they do have the sugar alcohol, and they have fiber. So as far as net carbs, they're very low. maybe. One gram of, sugar. and so it's a good treat. now I, I have those maybe every third day. So I have a Quest protein bar as a snack, or after lunch. And then I'll have, a peanut butter cups on the days that I don't have those. So it's been fun. It's been, yummy, food that I brought with me. very good food here in the ship. I've been getting different types of meats. and veg and things that are good for me. And of course my, espresso, cappuccino coffee in the morning up in the Diamond Lounge. I think that is one of the best benefits of being loyal to Royal, for me is that, coffee machine up in the Diamond Lounge, cuz of course it does, you know, grind the beans right before it makes the espresso. So it's very fresh, very good. They go through a bag of beans every three or four hours, so it's always fresh. It's only maybe 2, 3, 4 hours since the time they even opened the bag of beans, until you're making coffee, so you can't beat it. To me, it's just, very tasty and, I can have it every day and, I don't wanna overdo it, of course, but I really like it. yeah, good week here on board and Chapman of the Seas with a few more days. My Numbers --- for my numbers this week. I have managed to close my rings seven out of seven days. Like I say, I'm getting in good walks here in the cruise ship, lots and lots of stairs. Some days I checked and my Apple watch recorded me doing 19 flights of stairs. Usually, without hesitation, I'll go up to sometimes three flights and down two, three or four flights. Without even thinking about it. unintentionally I've been doing a lot of stair walking in addition to my regular walks. Some of my walks have been outside on the islands. I was able to, walk, on the ship even though it's docked here because on a few of the days we had, excursions. And so those take up, three hours outta the middle of the day. And I don't, walk around town as much as I do ride a bus around the island. . So today we're on St kits and it was another excursion day. So as soon as I'm done recording this, I'll get up on deck and walk around and, I find that enjoyable too cuz it's a great view. you're docked right up against the island and of course you get, great views of the ocean or of the island wherever you're walking on deck. So it's a fun time for me to, So good walks all week long. My glucose has been, super fabulous. seven day average, 24 hours, seven day average glucose reading has been 94. That equates to an a1c. If it were, extended out for three months, that would equate to an a1c. 4.8, 4.9, which is down into the optimal range. the chart I have only goes down to four, so it's the far cry from the elevens that I used to get. Just a couple years. . So I will, happily accept an A1C of 4.9 any day of the week. Now, for the body fat percentage, I don't know, I have not stepped on a scale now for about nine days. I have no measurement to give you for my body fat percentage. I can tell you that my clothes are continuing to be a little bit looser. So could I have lost a pound or so on this, past week in the cruise ship? Yeah, I think that's probably the case. That's typically what happens to me while I'm cruising, is I actually will lose about a pound, per week because, Well, no, especially with Mounjaro, but I don't have much snacking anything like that on the cruise ship. Although food's here all the time and everywhere, and maybe that's one of the reasons I'm not attracted to it is because it's just here everywhere. It's not like I'm feeling deprived or, restricted in any way. not with food on a cruise ship. that's for sure. So the macros this week I did average over the last seven days. I averaged 67 grams of carbohydrate, and that's right about where I have. My goal set at and 126 grams of protein, which, that's great. that hasn't happened on a cruise ship in forever. And again, it's this time I brought my protein shakes. I have one of those per day, and that gives me 30 grams. And then I have either a bar or one of those peanut butter cups, and that's 20 grams. , I'm supplementing on average about 50 grams of protein every day. And, I am, going outta my way to make sure I'm getting enough meat and things like that, to bring it up to that average of 126, grams of protein. And, that's more than you might. I have that's more than you might need. I go for the higher protein because although I don't do as much strength training as I should, I do get in the protein to, at least help myself to avoid losing muscle because 126 grams of protein on average, I am helping myself avoid, muscle loss. Although, like I say, I really do need to add in that strength training to get the maximum benefit of eating that extra protein Mounjaro Update --- for my Mounjaro update this week, I, did take my second dose while on board here at, the 7.5 milligram. So now that's nine full weeks of using Mounjaro. That's my 10th dose. I had the four doses at 2.5 milligrams, four doses at five milligrams, and each one of those doses is a week apart. And this was my second at 7.5. So nine full weeks, taking now my 10th dose and I really have to. these, especially now at these 7.5 milligram doses, my hunger is, gone. I'm gonna call it complete complete hunger suppression. I just don't really get hungry. In fact, there's sometimes when I, even though I haven't eaten anything in several hours, I still feel full and I am, encouraging myself to eat. I wanna make sure I get in enough protein and I do have to get in some fat and carbohydrates as well, so I do need to eat. I've been eating, unless you wanna count my cappuccino as a meal. I've been eating twice a day, plus, a little protein snack in the evening. And the shakes and the bars are certainly helping because they're compact and fairly dense sources of protein, so I don't have to eat a huge volume. Last night we had, chicken Parmesan and it was Italian night and it was a fairly good piece of chicken, a nice sized piece of chicken, maybe six ounces, maybe seven ounces. And I had to struggle to finish it. But I did finish it cuz it was very tasty. And, I wanted to get, the nutrition, I was full. So that's a little bit of a struggle. I've had very good A1C control, like I reported this week. my seven day average was 94. And, you can't beat that. that's great. I did have, I noticed it this time and I think I remember noticing it last time with this 7.5 milligram. About 24 hours after I took the medication, I did feel a little bit of nausea, not a lot, nothing that kept me from eating or nothing that made me feel like I had to run to the bathroom or anything. other people have reported this. And now I think I have finally at this 7.5 milligram dose. Experienced that a little bit now. It seemed to only last for a few hours. Just very few hours. And it was like, come and go. Fairly light. and it is gone. . So it certainly doesn't last all the time. Now, I don't have a weight update this week. I usually like to give you a weight update with my Mounjaro update because I know folks are interested in that. But, of course now I'm on board the cruise ship. I've been here for a little bit more than a week. So I have not stepped on a scale, clothing. Does seem to be a little looser. that's probably in my head. I doubt I've lost more than a pound in the last eight or nine days, but, we'll see when we're back on land. And, before the next episode, I will have weighed in again. . Challenge & Win --- So my challenge, and this is my challenge, whether I'm on board ship or not, it continues to be a recurring theme with me. My challenge is varying my movement, and as I just reported, my workouts this week have been all walks. I really have to figure out a better way. , get myself interested. I know I should be doing it because that's the intelligent thing to do. So my brain knows I should be doing it. But as each day rolls around, I find myself not doing it. And that's getting in strength training. I really need to do that. So I don't have a win for that challenge this week. It's something that I'm still working. when I was in the CrossFit community, living back in Maryland, before all this retirement travel, and I was getting there, I don't know, five days a week and loving it. I had no problem whatsoever getting my movement. So I'm not, totally unfamiliar with it. It's just right now I'm honestly having a difficult time. getting that in as part of my day. I, almost wish I didn't like my walks outside so much because that's where I spend my time, when I'm moving. News --- All right, let's take a look at the news. This first article, and it's a, sciency article, like I like to say. It's entitled, identification of a Previously Unknown Function of Adipose Tissue in Insulin Secretion. So Adipose tissue is, , most of you know that a f o tissue is fat, and it's saying here that they have uncovered a new, function of fat in releasing insulin. So what they found here is something called extracellular vesicles, that the, body fat cells use those and that signals the pancreas, to release more insulin. now, this is an article that you might want to really investigate and read over, several times because it is a little dense, but it is new research. So that is, very exciting. What it's saying is that if these extra cellular vesicles originated from healthy fat cells as if you had normal. , the insulin secretion was only slightly altered. However, if these extra cellular vesicles from obese tissue, so in other words, a large amount, then it actually transferred proteins and nucleic acids to the pancreas where it greatly increases the release of insulin. So they're thinking that, and again, Read this article yourself. it's a little dense, but what I found interesting is that they're saying that this increased release of insulin, so having a high level of insulin in your system, can impact what we call insulin resistance or insulin insensitivity. So the fat cells are actually behaving differently. On an obese person as they are in a person with, a normal, healthy amount of fat. exciting article, exciting research. But definitely I would say one here that, you need to read up on. It does link to the, actual study itself, and I'm not even gonna try and read the study itself, the title. It's, I'll try. Adipocyte derived extracellular vesicles, increased insulin secretion through transport of Insin Insulinotropic protein cargo. . Wow. Anyway, that was in Nature Communications of this year, 2023, and they do link to the full article and, it seems exciting. I'm not sure I understand all of it, but it does seem to point to a difference between what healthy fat cells do and what obese fat cells do. with regards to, insulin production. Extreme insulin production in the pancreas. wow, it's a heavy one, but it's interesting. Now, this one other one here is a little bit, easier to go through. it's entitled Women and Men shown to have different risk factors for Type two Diabetes. Now, that's not shocking, I'd say, because, type two diabetes involves, the, Hormone. And men and women certainly have different, hormones. And what they say here is that, while waist circumference was a strong, independent predictor of diabetes in women, they can also show that it's linked to the reduced production of a protein, produced by the fat tissue that can protect against cell stress. So that's for women. That is that, measure of the, abdominal waste circumference, can be a strong predictor. In men, what they're saying is that one of the significant, indicators or risk factors is if men reduce their physical activity and therefore reduce their muscle mass. That is a significant indicator of going on to develop type two diabetes. With women, what they're saying is that the, one of the biggest indicators is an increasing waste circumference or abdominal obesity. that increasing, waste circumference is a big indicator of developing type two diabetes. So again, with men, it has to do with, the amount of muscle mass and not necessarily the amount of, abdominal. But with women, muscle mass is not as big of a indicator as is this the, circumference of the waste itself, which, a waste becomes larger because of abdominal obesity. So I think that's interesting. men and women, different hormones, different indicators for what might show them going on to develop type two diabetes. So again, another interest. article here. They have cool charts. They link to the, studies itself, but I thought that was interesting. This third article, not science-y really at all. It's some common sense. It's called What to Do when your Diabetes Medication Isn't Working. . Most people when they've been diagnosed with either pre-diabetes or type two diabetes, they're initially put on Metformin. Now, not everybody, but most people now, medications can stop working according to this article. because your body changes your weight, your obesity level can. , your amount of insulin resistance can change and therefore a medication that might have been working for you when you were initially diagnosed. Maybe your disease had not progressed. Maybe it was just on the borderline of becoming an issue for you. that particular medication, let's say Metformin for example, might have worked, but it could be that years later and maybe during those years you did or did not meticulously follow your treatment plan, your eating plan, your movement plan, you know your lifestyle might have changed. That could be something that you know might also cause your medication to not work as well as it did. so hearing this article, they recommend talking to your healthcare provider. Now, normally you find out your medication isn't working by doing blood work, which you know, is in your doctor's office, so your doctor should know. But what they're saying here is that typically, if. The A1C goes up by more than 1.5, so let's say it was 6.5 and it goes up to eight or something like that. Then that's generally the, warning signal for when something has to change or something else has to be done, and it's not uncommon to add a second medication or to change medications or to double down on lifestyle change. We all know some of these recent, medications really make it, um, possible to follow through on a lot of these lifestyle changes. me, for example, I find it so much easier to not overeat when I'm not hungry. So that's a side effect of this, Mounjaro that I'm taking now. . They also go on to say that, you know, bariatric surgery can also be an option because again, with surgery you tend to eat a whole lot less. And it does, fix people with type two diabetes because just like these GLP one inhibitors, when you're not overeating, you tend to lose fat. And when you're losing fat, that tends to positively impact your type two diabetes. good reason to talk to your doctor, you find your, original medication is no longer working for. , that is definitely something that you should have a discussion. . All right. This last one here, it seems we went from very sciencey to more, light articles. this last one is called 14 Alternatives to Eggs for a Protein Rich Breakfast. Now, I have to admit that for myself, when I, eat breakfast, it's typically eggs and bacon. those are about, I don't know, 50 50 on protein and fat. eggs and bacon don't have any carbohydrates in them. so you know, if an egg. Five or six grams of fat. It's also gonna have five or six grams of protein. Now these other sources that they're gonna list here don't have maybe quite as much, protein, per serving, but they're pretty darn close. So a lot of these. Items they list here, and I'll read out a few of 'em, but a lot of these items they list have, five, six grams of protein per serving. So they're calling that high protein. your mileage may vary, depends on what you need to take in. You might need to eat quite a bit of these, for example. oatmeal here, it says that oatmeal, has five grams of protein, which is only a little bit less than an egg. An egg has, six, a half cup serving of oatmeal, contains those five grams of protein dairy. It says here, Cheese. it also lists cottage cheese. I'm not sure why it lists cottage cheese separately from dairy, but it does. but these types of things have a lot of, protein and in them actually, a glass of milk. maybe you have to realize, of course milk has, sugar in it. this article is really for any type. food that has some protein in it, even if it might also have a lot of carbs. So they go on to list things like seeds, certain grains, tree nuts like cashews and walnuts and pecans and almonds. those all have, protein now tree nuts, maybe average five or six grams of protein per quarter cup, but a quarter cup. Nuts is easily a couple hundred calories, so you sort of have to watch out for that. So an egg might have 90 calories in it for six grams of protein, whereas nuts might have 200 calories or 250 calories depending on what type you have. they got great fats, they have a lot of things going for them. So there's nothing wrong with, nuts. Keep in mind of what you're getting here. In addition to the protein, they go on to list peanut butter beans. And I found out myself, while I typically don't have them for breakfast, rice and beans, while having tons of carbohydrates really do not impact my blood sugar levels. And I think that's because of all the fiber that's in there as well. So they go on to list things like tofu or Tempe, which is just another type of tofu. , lentils, all kinds of things, even fish. And of course you might have had salmon on top of a bagel, but fish, they're even saying here, or chicken. Now I'm not sure that a, fried chicken biscuit might be the healthiest thing, but they listed here in the article. So Barbie beware. Read the article, look at these options, and just realize that, you don't always have to have just bacon and eggs, for your breakfast. Do I need to use a CGM? --- All right, so let's get into the main topic for today. Now, as I said last week, I wanted to talk about wearing this continuous glucose monitor, this cgm, do I need to wear this cgm? I've been wearing one now for about 2120 or 21 months, and I have one on constantly. only a couple times was I traveling away from the house where one would stop working or get knocked off accidentally when I didn't have a backup with me. And so that was only even then a few days of a break from wearing a cgm. But generally speaking, I'm wearing one constantly for the last 20 months. Now why do I wear it? data, I really am a data guy. I like to have information. I think information helps us make smart decision. , and that's why you wear a continuous glucose monitor. it gives you, the one I'm wearing right now gives you a reading every 15 minutes. the new Libre Freestyle three monitors that I'm moving to here in a couple weeks, those actually give you a reading every minute. Now that could be overkill, but for me, having this data always available, shows me the real. There's no way to hide it. and I publish my CGM readings every single day into my Instagram stories and my Facebook stories. So if you wanna see what my blood glucose levels are every single day, I post it there. You can find those links at the SolvingType2Diabetes.com website. So yeah, it's the real truth. you can't fake it. You can't hide it. now there are alternative. . You know, there are other things that I could do. For example, I could do traditional finger sticks. that's where you draw blood, little drop of blood, sometimes once a day, sometimes several times a day. And then you read it with a meter and that gives you your, blood glucose reading. Now, I personally don't like the finger sticks. they hurt a little bit, and after a while, if you're doing this for, You're gonna be sticking your finger thousands and thousands of times. Even if you just do it, let's say three or four times a day, that's 1300 a year. if you're doing this for 20 years, that's almost 30,000 fingers sticks in your fingers. so I don't like it. The other thing you can do is A1C blood. Now. Right now I get one of those at my doctor's office every six months. Used to be when my blood sugar readings were higher, I would get one every three months, but now we back down to once every six months. Now the A1C that you get at the doctor's office, that gives you a 90 day reading. So if you are getting them once every three months, that's about the same thing as wearing a continuous glucose monitor in. You are covering all your data points, but it's just an average for those three months, and if your eating is going off track or your medication stops working or whatever, you might not know about it until three or six months later because you know it's a 90 day rolling average. So whatever effects you say on January. you might not know about until April. now then you could have three months of very high or very low or wildly changing, blood sugar. And it's certainly not as real time as wearing a cgm. Now, if you wanna do it more often than that, let's say you wanna get an A1C test every single month, well, insurance probably won't pay for that. But if you do want that more frequent data, , you can actually get an over-the-counter A1C test at pharmacies. I've seen them in several pharmacies. And you send in your results, you take your blood draw at home, just like you do, sticking your finger, for a normal finger stick, and you send in your blood sample and you get the results of the a1c. Now, Doing it once a month even is actually cheaper than doing, your cgm. I've seen A1C tests at like Rite Aid, my local pharmacy, for under 50 bucks. and I, there are some that maybe go as high as a hundred, but still, it's not unreasonable compared to the cost of a cgm. Now I don't do that because even if I were doing it once a month, , it's just giving me a three month average still. So even every month I'm getting the previous 90 days seeing what a particular food did to my blood sugar or what, maybe a series of days of eating out in restaurants versus eating at home. Seeing what that does, that's gonna be impossible with even a monthly A1C test. It's just. Frequent enough for that. You need to be testing frequently, and there's really only two ways to test frequently, and that's with a CGM or a series of frequent, manual finger sticks. Now, there is another alternative, and it's just something I've seen recently. It's called, it's company name is January ai. Like the month, January, January, ai and what they sell you is an app. tries to learn your reaction to foods and movement. So for this app, they say you only have to wear a CGM for two weeks. Okay? So that's one single 14 day continuous glucose monitor. And during those 14 days, you have to meticulously enter everything you eat, the time you eat it, the amount you eat it. I. perfectly track your foods, your medications, your movement, and then supposedly in that two week period, it learns how your blood sugar reacts to what you eat, how you move and your medication. And then after two weeks it says you no longer have to use the CGM and that the artificial intelligence of the app will now tell. What your blood sugar in theory should be at any given moment based on what you're eating and how you're moving and the medications you're taking. Now, I think this is a little optimistic because just like we talked about in that earlier article, your body reacts differently as time progresses and while it can. the macros that you're consuming and what your blood sugar reading was two weeks ago or a month ago, or two months ago when you ate the same thing. For that to remain consistent over time, I think you would have to recalibrate. what if your medications aren't as effective as it used to be? What if your pancreas changes the production of insulin? What if, I don't know, a hundred different What? , the AI can only go back on what it knew before. And what I like to say is, past performance may not predict future results. I saw that on a mutual fund advertisement somewhere, but just because your AI recorded your blood sugar, being a certain level after eating certain foods months ago doesn't mean that's really what's still happening. So I, right now, I'm still not convinced that this January AI thing would work. I mean, try it. And another thing you can do if you really want to try it is wear their CGM for two. and then continue to wear a cgm. Just don't log it in the app. use a separate app to measure your CGM and see how they compare. Now you're gonna have to pay for the cgm. You're gonna have to pay for the app cuz there is a monthly subscription for this app. After even you stop using the cgm. But I don't know, you could test it out and see how that works for you. But I'm gonna leave that one to other people. , you could basically be your own AI if you wanna go that route. I don't see why you would necessarily have to pay for the app and the ai. I mean, if you aren't perfectly tracking your foods, your medications, and your movement, like I sort of do. I don't track 'em perfectly because I have the cgm, but I know that if I eat about this many carbs, about this much protein, that my average. blood glucose reading will be, you know, at a certain level. I'm thinking that if you kept your macros and your medications and your movement all the same, well then you would reasonably expect your blood glucose levels to stay the same. Now, I don't think that's a hundred percent true. , but if you just wanted to be generally speaking, say in the A1C of between five and six, and you don't really care if it's 5.4 or 5.7, you just wanted to say, oh, between five and six, then you probably could do that. If you did a really, really, really good job of tracking your food, your medications, and your movement, and then you kept it there. Reasonably, you would expect that if you were in fact wearing a cgm, it would continue to read about what it was reading before. So those are some alternatives. those are some reasons why you wear a cgm. Maybe things you can do instead of wearing a cgm. But for me, and right now out of pocket with my insurance, I pay $75 a month for my CGMs. I'm gonna keep wearing 'em. I just need that data. I need to feel, comfortable that what I'm doing is really, benefiting my health. Questions --- All right. So your questions, we do not have any questions this week, but that's, I do look forward to getting your questions though, because it does help me, do things like select topic ideas, make sure I'm addressing things that are helpful to you. And, feel free to send me in a question, a comment, feedback on the podcast. It's all really appreciated. Now, there's two ways to do that. There's two ways to contact me. First, simply send me an. tom@SolvingType2Diabetes.com That's my direct email address and I can make sure I cover your question. The second way, and this is honestly how most folks do it, is they go over to the website SolvingType2Diabetes.com and then click on feedback, and then there's a little form you can type in and send in your question or your comment or your podcast feedback. And I appreciate it. I look forward to it, and I'm really excited when I get those. So, uh, be bold, be brave this week and send in a question. What's Next? --- for next week, the podcast episode Next week, I wanna talk about my daily priorities in solving my type two diabetes. Now, there are things that I think, you know, I do, every day each week, but I wanna talk about my priorities, what things come first, what are the most important things I wanna make sure I do or don't do on a daily basis? And this is the nuts and bolts. This is, core of what I do to solve my type two diabetes. So that's up for next week, and I will talk to you all soon. Well, that wraps up another episode of the solving type 2 diabetes podcast. I hope you found it valuable. Please follow and leave a five star review, as it helps other people find the podcast. By subscribing you ensure you won't miss the next episode. You can always get a full transcript of the episode at SolvingType2Diabetes.com there you also find the links to leave feedback and links to follow on social media. I'm very interested in hearing from you with comments and suggestions. Thanks very much for listening. Please remember that everything I share is just from my own personal experience and should not be taken as medical or health advice. Please consult your own medical professionals. This podcast is intended for entertainment purposes only.