Robert Gholston - Type 2 Diabetes
By any external measure, Robert Gholston’s journey is a health success story:
- He went from 429 lbs. to 350 lbs. — a loss of almost 80 lbs.
- His percentage of body fat went from 57% to 42%
- He had type 2 diabetes; his glucose is now near-normal
- He took medications to stabilize his blood sugar; now being weaned off
- He never exercised; worked up to walking several hours a night
- Never lifted weights; now goes to the gym five times a week and has a trainer
- Food was a coping mechanism; now he has other outlets for handling stress, including a counselor and a life coach
- Used to indulge in whatever food he wanted; now limits himself to better choices and smaller portions
But this is really a story of success from the inside out.
In 2008, Robert Gholston was in denial. He had grown up as the tallest, heaviest kid in the class and in his family. Even though he is 6’3” tall, 429 lbs. was way too much for anyone to carry. He was off work and receiving disability payments for injuring his arm and for experiencing severe arthritis, reflex sympathetic dystrophy (RSD), and all-over joint pain, which of course the extra weight made worse.
Robert also was the sole caretaker of his invalid mother, who lives 30 minutes away. He was under severe stress with no one to talk to, having lost many friends because he was so busy taking care of his mom.
One evening, while Robert was at his mom’s house getting her ready for bed, he popped a piece of candy into his mouth. “It felt like my head was going to explode,” Robert recounts. His mom noticed that something wasn’t right and urged him to sit down. But he passed out on the floor instead.
“I could hear, but I couldn’t move,” he remembers. An ambulance was called, but the paramedics couldn’t wake him up. He was taken to a hospital near his mom’s home, where he awoke several hours later. The doctors were never sure exactly why he passed out, but his blood pressure and glucose were sky-high. He hadn’t been sleeping well and was under a lot of stress.
Robert had been diagnosed with type 2 diabetes about a year earlier, through another health system, but had been in denial about it. He had a glucose meter, but didn’t use it much.
His primary care doctor tried to get him to exercise. He was given passes to the County Recreation Building on Washtenaw Road. He and a small group of fellow patients also were provided with a trainer, but Robert wasn’t seeing any results. The trainer focused on stretches, and most people just walked around the track. “It wasn’t for me,” said Robert. “There was no one to challenge me.”
Robert also knew he was supposed to change his eating habits, but had trouble adapting the food he was used to eating.The nutritionists didn't seem to understand where he was coming from. For instance, he grew up with eating Maltomeal for breakfast, heavily fortified with evaporated milk, butter, and sugar; how do you substitute that? For while, he went on the Atkins Diet, but the medical professionals weren’t supportive of it.
This was the point at which Robert had his "wake-up call."
Things began to change for the better for Robert, though he still resisted it at first. His primary care doctor at the other health system was retiring, so she referred him to a diabetes specialist, Dr. Palak Choksi, M.D., M.B.B.S., an endocrinologist at the U-M Metabolism, Endocrinology & Diabetes (MEND) Clinic.
Robert was put on two medications: Metformin, which slows the release of sugar from the liver and decreases the amount of glucose absorbed from food; and Byetta, an injection drug that helps control blood sugar levels and aids the pancreas in producing insulin more efficiently.
The medications were making a difference, but Robert didn’t like taking them at first. He didn’t like giving himself Byetta injections. His sugar would drop a lot when taking the medication, but he also wasn’t eating right then, either.
It also seemed to him that the medications were the main focus of his clinical visits. He thought he needed another kind of help. "I kept saying, ‘If you want to help me, help me deal with my mom!’ "
He was counseled to eat no more than 3,400 calories a day. But he didn’t like counting calories. Luckily, the Byetta helped him control his appetite.
When Dr. Choksi went on maternity leave, Robert decided to become more proactive. He started going on walks at night alone, when it started getting warmer in the spring. It was peaceful and the price was right! Often he would take a nap, then wake up at 11:00 p.m. or even later, and go walking for several hours around the city, accompanied by the music on his iPod. The weight started dropping off.
After going on and off with his medications, Robert realized the difference they make, especially the Byetta. "When I stopped taking it for a month and it finally got out of my system, I was ravenous!" Now he's used to the pen-style injections and doesn't mind giving them to himself.
Slowly, more help starting coming Robert’s way. He was referred to a counselor to help him deal with the strain of taking care of his mom, whose services are covered by his insurance. On his own, he acquired a life coach, who is also a spiritual mentor.
Robert also benefitted from diabetes education sessions with the Director of Adult Diabetes Education in the MEND Division, Sacha Uelmen. Sacha told Robert, “Don’t diet — just cut back on portions.”
Sacha also taught Robert how to eat “regular food” by modifying dishes. For instance, he’ll make pizza himself instead of having greasy, calorie-laden, fast-food pizza. He uses whole wheat flat bread for the crust, low-fat mozzarella cheese, organic tomato sauce, and spicy ground turkey sausage.
“It’s not the same as Pizza Hut, but I’ve gotten used to less fatty food. I think my body prefers it.” One time, he unknowingly bought regular Kraft cheese singles instead of the low-fat variety. It was so distasteful to him, he looked at the package to see if there was something wrong with the product and realized his mistake. Another time, after he hadn’t had potato chips in months, he had a craving and bought the full-fat variety. He ate a few and actually felt sick, so he tossed out the rest.
Sacha also got Robert to join the Fitness Center at the Cardiovascular Medicine Department at Domino’s Farms. For $50 a month, he learned how to use the workout equipment and goes every day they’re open. There he also gets his blood pressure and weight checked, including the use of a special BMI scale that measures his body’s fat and water composition.
Best of all, the gym membership includes the use of a trainer. “The trainers push me to work harder,” Robert says. “It makes a big difference. Working out has to be fun or I won’t do it." He especially credits exercise physiologist Kristin Edrozo, whom he sees twice a week.
He uses his iPod at the gym too. Now that the weather's gotten cold, Robert has swapped walking outdoors for indoor workouts. “I want a body like Tyson — model Tyson Beckford, not the boxer Mike Tyson!” Robert jokes.
Robert had inquired unsuccessfully in the past about getting help in caring for his mother, who has multiple sclerosis. He wouldn’t put her into a nursing home. But the insurance company and Medicare “gave me the runaround and told me it wasn’t covered.” Taking a big step, he went to court in September 2009 to sue Blue Cross and Medicare to cover in-home help for his mother, and he won. Now his mom has helpers and Robert has relief from the caregiver stress he used to suffer.
Robert now has a new outlook on life, to go along with his new lifestyle and his new physique. It starts with gratitude for this team of helpers that he has been able to surround himself with. “I would have thought that you gotta be Oprah to get this kind of help,” Robert says — but he’s manifested it himself.
"I want people to understand, this is not easy," Robert cautions. But he realizes that his health and quality of life are worth the extra effort. Sometimes he gets tired and has to rest in the middle of the day. Other times, he doesn't feel like going to the gym, but he pushes himself — and feels good once he's there.
Robert had a friend who died of diabetes complications, and another who’s facing leg amputation. All but one of his friends has type 2 diabetes, which heavily affects minority populations such as African Americans. “I’m trying to be an example,” he says, by modeling the behaviors it takes to overcome the disease and its obstacles.
Dr. Choksi’s target weight for Robert is 250 lbs., but he’d like to go even lower. And he wants to lose at least half of the weight over this winter. Whether he does it that soon or not, one thing is certain: Robert is already a model (of diabetes success!).