Joe Simpson - Type 2 Diabetes
Joe Simpson BEFORE his weight loss and glucose control
The new Joe Simpson, 70 lbs. lighter!
Joe Simpson had been diagnosed with type 2 diabetes for approximately 20 years when he came to the U-M Metabolism, Endocrinology & Diabetes (MEND) Clinic. The path Joe took to get to where he is today reads like part detective story and part health soap opera.
Joe was first diagnosed in his 20’s, around 1991. When Joe got up in the middle of the night to eat ice cream and had to drink a gallon of water with it, he knew that something was wrong. His dad and his brother had diabetes too, so it was not really a surprise.
After he was diagnosed, Joe took nutrition classes and at first followed a strict diabetic diet. This allowed him to trim down and, for awhile, he weighed under 300 lbs.
Eventually, Joe started cheating on his diet. Before long, his weight crept up over 300 again. During the next 10 years, he put on 35 or 40 more pounds.
Being 6’5” tall, he could hide some of that extra weight. Plus he had an active job as an iron worker, so he was in better shape than he had been in when he was younger.
But over time, the disease and Joe’s bad habits took their toll. His health started to catch up with his habits after he got promoted to an office job in 2003. He was not as active day-to-day on the job any more, and he had a lot more stress. Joe jokes, “I didn’t eat much — just constantly!”
Up until this point, Joe’s diabetes care was being handled by his primary care physician. By 2005, Joe realized that he was feeling tired all the time. But his hemoglobin A1c test (the average of his blood sugar readings over a period of weeks or months) would always read normal, even though he knew that his individual sugar readings could be quite high.
His doctor’s office wondered if he had low points while sleeping. So Joe investigated this by testing his blood sugar when he’d wake up in the middle of the night. Sure enough, his glucose was still high, in the 200 range. It was a mystery!
Joe’s doctor referred him to the University of Michigan’s MEND Clinic and he started seeing Dr. Elif Oral. “She figured it out pretty quick,” says Joe. “I’ve got so much respect for that lady! She’s the reason for my success.”
Dr. Oral explains, “It turns out that Joe had a rare genetic variation in his hemoglobin. So, his hemoglobin A1c test would always read normal, when actually his sugars were running in the 300 to 400 range! That’s the reason why the doctors never understood how bad his diabetes was.”
That’s where the mystery ended, but the story doesn’t stop there. Finding out about his hemoglobin abnormality didn’t solve Joe's diabetes problem, it just made it easier to see how bad it really was. Joe admits that, even with this knowledge, he was slow to change his ways. “I had to hit rock bottom first.”
Around this time, Joe got married. His wife, Vivian, isn’t diabetic and “she’s always been the healthiest eater of the two of us,” Joe says. They were enjoying life together, spending winter here in southeast Michigan. During the summers, Joe’s wife runs a motel that they own in the northern Lower Peninsula, so they only see each other on the weekends. “My wife walks in the state park with the dog each morning, and she bikes too. I’m busier in the winter when my wife’s back.”
In other words, Joe wasn’t doing much exercise when his wife wasn’t around, and his eating habits weren’t improving, either. “You think you’re tired because you’re getting old, but that isn’t it. You’re slowly killing yourself!” Joe reflects. “I had gym memberships before, but it didn’t go nowhere. Before, I was pretty active at work, so that made up for it.” But now it was catching up to him.
In 2007, Joe tore one of the meniscus discs in his knee and needed to have surgery. But he had to have his blood sugar properly regulated first, before they would operate. Joe remembers Dr. Oral telling him, “I know you can get your blood sugar under control, because you’ve done it before” [when he was first diagnosed]. So he buckled down long enough to be able to have the surgery.
A year later, Joe’s toe got ulcerated after he trimmed a callous himself and cut too deep. It got infected and, because he has some neuropathy (nerve damage) in his feet, he didn’t feel it at first. Once he realized it, he wore a cushioning pad and was trying to take care of it himself. But when on vacation in Philadelphia, he went on a walking tour with the pad rubbing on the wound. “I probably overdid it,” Joe admits, but he couldn’t feel it at the time.
After the wound got infected with the dangerous, antibiotic-resistant MRSA staph bacteria, he almost lost his toe and his foot. “When your sugar’s out of control, things won’t heal,” Joe explains. “I was lucky; we were referred to a really great podiatrist who specializes in wound care. He was able to save my toe and my foot.”
The final straw in this story fell at the end of 2009, when Joe had to cut a hunting trip short “because I was beat. I was sick and tired of being sick and tired.” He consulted with Dr. Oral, who suggested that Joe consider bariatric surgery, but he wasn’t interested. She told Joe, “I could increase your insulin, but it wouldn’t do any good. You need to turn your habits around.” He already was taking the slow-acting insulin, Lantis, twice a day and fast-acting insulin, Humalog, on a sliding scale, depending on his sugar readings. He was also on the medication Metformin (which slows the release of sugar from the liver and decreases the amount of glucose absorbed from food).
Joe now says, “You don’t realize, you can have a couple of candy bars now, but it affects you later. It’s a gradual change, like slowly losing your eyesight. All of a sudden you can sleep twelve hours and still feel tired."
Joe’s wife was worried that he might be ready to have a heart attack if he started exercising again. She insisted that he get his heart evaluated. So in January 2010 Joe had a cardiac perfusion scan, a special type of stress test using nuclear dye to look for blockages and problems.
Luckily, the results of the stress test showed that Joe, at age 45, had low risk for heart problems! So he began slowly working out. He joined a gym with “no pressure and no egos” and began regular workouts. “When I first started working out, thirty minutes slow drained me. Now forty minutes fast energizes me!”
Joe worked up to having regular workouts five days a week, one hour a day. Sometimes he’ll even work out twice a day. He also uses a treadmill at home in the basement and he bought a mountain bike this past summer, so he can ride with his wife.
In February 2010, Dr. Oral sent Joe to the four-week series of type 2 diabetes classes offered by the MEND Adult Diabetes Education Program. His wife went with him, since attendees are encouraged to bring a support person. “I’d had nutrition counseling many times before, but this time it was easy,” Joe relates. “They really showed me what I was doing wrong.”
Kim Sperlbaum, R.N., led the classes. “I learned how to calculate the net carbs in food by looking up the fiber grams and subtracting them from the carbohydrate grams,” Joe relates. “You can eat anything you want, but you have to watch it” with portion control, label reading, and noticing the serving sizes given on those labels.
“Once I learned what to eat and how to eat, it was much easier to adjust my diet,” Joe enthuses. “Kim and the intern who helped run the class were great.” Because most of the people in the class were newly diagnosed, he felt like the authority on living with diabetes.
Joe started making a variety of changes to his eating habits. First, every couple of days, he took a little away from the amount he was used to eating, to reduce his calorie count. “I don’t eat near as much as I used to,” says Joe. He also doesn’t go out to eat very much, and he’s learned to make substitutions for what he used to eat.
For instance, he’ll have a piece of fruit at every meal. (“They’re good carbs, but you can’t overdo it.”) He’ll have yams instead of the starchy potatoes. For bread, he likes Aunt Millie’s light wheat: two slices have 12 net carbs. “Now that I’ve got my blood sugar under control, it doesn’t bother me when they have candy and stuff in the office,” Joe says. “I’ll just have a snack of pecans or cashews.”
Joe’s wife also introduced him to turkey versions of beef products. “Turkey sausage is good, but you have to watch the fat content still,” Joe cautions. “Turkey bacon is great! But even with eggs and bacon, which have no carbs really, you need to control the calories as well as controlling your carb intake.”
It’s been about a year since Joe got serious about turning his health – and his life – around. “I love the heck out of fruits and vegetables! But when your sugar’s high, you crave sugar. You eat sugars and they create more sugar – you feel hungry constantly,” Joe says.
His improved statistics also tell the story: Joe’s down to 280 lbs., having lost 70 lbs. over the past year. With Dr. Oral’s blessing, he hopes to lose at least 30 more. He’s down to a 1x size shirt and has given away all his 3x shirts as he slowly acquires a new wardrobe. He lost 8 inches in his jeans size, “And I can even pull ‘em up now!”
Joe is down to one dose of Lantis insulin a day and can probably decrease the amount when he loses more weight. He’s no longer taking the fast-acting insulin, Humalog. His triglycerides are down and his HDL (good cholesterol) is up.
Best of all, Joe’s blood sugar is under control. “I feel so gosh-darn good now! I’m awake and alive, not a zombie,” Joe finishes. “I thank Dr. Oral and everybody from the U of M Health System. I owe a lot to them.”