20 Pounds Overweight and Diabetic: How Neil Took His A1C From 8.3 to 5.8
A man who goes to the gym and carries only 20 extra pounds can still have type 2 diabetes. Neil was 45 when his A1C came back at 8.3. Here is the plan that brought it to 5.8.
Neil was 45 when his blood work showed an A1C of 8.3. He went to the gym and he was only about 20 pounds over his best weight. Six months on metformin brought his A1C to 7.5. Then he changed how he ate and how he trained, and over 100 days he lost 23 pounds and his A1C came down to 5.8.
Quick answer: can you be diabetic at only 20 pounds overweight?
Yes. Fat that builds up around your liver and pancreas gets in the way of insulin. Every man has a point where extra fat stops sitting under the skin and starts packing in around those organs. For some men that point is only 20 pounds above their best weight. Neil hit it at 45.
The Tuesday his lab results came in
Neil is a sales director. On a Tuesday morning he was running his weekly pipeline review with 50 reps watching him on Zoom. The team was having a strong quarter.
In the middle of the meeting his phone buzzed with his lab results. Between slides he checked them and saw an A1C of 8.3. Then he had to go back to presenting. He told me his brain froze.
Neil had been married 19 years and had two teenagers at home. He went to the gym and thought he ate pretty well. In his group of friends he still saw himself as the fit guy. Finding out he was diabetic shocked him.
What his doctor gave him
At his follow up his doctor told him he had type 2 diabetes. He walked out with a prescription for metformin and a plan to keep an eye on his numbers. Nobody talked to him about what to eat or how to train.
Metformin helps your body use insulin better. For Neil it also came with stomach trouble. In the middle of a sales review he would be sweating and working out how far he was from the nearest bathroom.
The afternoons were hard too. At 2:45 he had a forecast call with his vice president in 15 minutes and his brain felt like wet cement. He stood in his office so he would not fall asleep at his desk. He drank Diet Coke and grabbed almonds and candy from the office candy jar to stay awake.
On camera he looked confident. Off camera he was fighting to keep his eyes open.
Six months later he was at 7.5
His A1C came down from 8.3 to 7.5 in six months. His daily routine had not changed. He still ate hotel breakfasts on the road and client lunches with the bread basket, fries and dessert. He ate late at night while he answered emails, and he had a beer to unwind.
7.5 is still in the diabetic range. His doctor offered more medication and Neil said no. He got a trifold handout with a food pyramid on it that told him to eat less sugar and exercise.
Neil runs a sales team for a living. He would never tell a rep to sell more and call that a plan. A rep gets targets and a scorecard. His health had no targets and no scorecard.
The morning the suit did not button
On the outside his life looked successful. On the inside his afternoon crashes were getting worse. He read emails three times before the words stuck. He snapped at his kids over small things. When his wife asked if he was OK he told her he was tired from a big quarter.
Then one morning he went to put on his navy suit for his quarterly business review. To fasten the bottom button he had to suck in and hold his breath. He took the jacket off and hung it back up. That was the morning he decided he could not keep going this way.
He did not want to go from one pill to more pills and possibly insulin. His two teenagers were watching how he took care of himself.
He told me something later that I have never forgotten.
"I would never accept the 7.5 performance score in my business, my career, but I was doing it in my health."
Why 20 pounds was enough to make him diabetic
Your body can only store so much fat under the skin. Once that space fills up, the extra fat goes to your liver and pancreas. That fat around the organs blocks the insulin signal and your blood sugar climbs.
Some men can carry a lot of extra weight before that happens. Neil could not. His extra 15 to 20 pounds had gone straight to his belly and the organs under it.
So when a doctor tells a man like Neil to lose weight, the goal is to clear that fat away from his liver and pancreas. Then insulin can do its job again.
What the research says
A trial called DiRECT put people with type 2 diabetes on a structured weight loss program. The medical journal The Lancet published it in 2017. After 12 months, 46 percent of them were in remission and off their diabetes medication. On average they lost about 22 pounds.
A review of 47 trials in the journal JAMA in 2011 looked at exercise and A1C. People who did structured exercise for more than 150 minutes a week saw their A1C drop by close to 0.9 points on average.
Your habits and your weight can move your A1C as much as a prescription can.
How Neil changed his food
We started with food. Neil had two problems. He skipped meals during busy workdays and then he ate all night. The bread basket and fries kept his blood sugar spiking. So did dessert and the office candy.
He did not have to become a chef or eat different food from his family. He got a few clear rules.
- Protein first at every meal, with 30 to 40 grams as the minimum and 40 grams at breakfast.
- Vegetables and fruit before the starchy carbs, with smaller servings of rice, potatoes, beans and oatmeal.
- At least 20 to 30 grams of fiber a day from vegetables, beans and whole grains.
- One plate at dinner, with a quarter for protein and a quarter for starchy carbs and half for vegetables or fruit.
- A 12 hour break between his last meal of the night and his first meal of the morning.
The protein and fiber kept him full. That ended the grazing at night and the trips to the candy jar.
How Neil changed his training
Neil used to wander around the gym doing the same workouts he did in high school. We gave him full body strength sessions built on the big lifts, 45 to 60 minutes each. He lifted 3 days a week and added 2 longer cardio days.
He also hit 10,000 steps every day, whether he trained or not. Some days the 5 a.m. workout did not happen because he had to get his kids somewhere. On those days he walked on his lunch break so he still got his steps.
His goal was to lose about 20 pounds with a modest calorie deficit. He was never starving. The protein and the lifting protected his muscle while he lost the fat around his middle.
The four questions he answered every day
In sales a quarterly number is a lagging indicator. You watch the calls and meetings that lead to it. A1C works the same way. It is an average of your blood sugar over about three months, so we built daily questions he could check.
- Did I eat 40 grams of protein at breakfast?
- Did I get 10,000 steps?
- Did I lift 3 times this week?
- Did I order well at the client dinner or on the road?
Those four questions kept him honest with himself. He did not need me to tell him how his day went.
How he ate on the road
Travel was where his plan used to fall apart. So each place got its own rule.
- At the hotel he ate eggs, Greek yogurt, fruit and black coffee.
- At the airport he ordered a protein heavy meal and drank water before he boarded. He walked laps between flights to get his steps.
- In meetings he skipped the candy and the dessert tray.
- At home the family ate taco bowls, stir fries and sheet pan dinners. His kids added rice, wraps or chips to their own plates.
He also took a few minutes to breathe or walk between meetings. That way his family got the best version of him when he walked in the door.
What changed in 100 days
Neil lost 23 pounds and several inches off his waist. His energy stayed steady through the afternoon. The A1C came down from 7.5 to 5.8. At his next visit his doctor started talking with him about coming off the medication.
At his next quarterly business review he put on the navy suit. It buttoned without him holding his breath, and he walked in feeling confident.
Who this is for
This is for a man in his 40s or 50s who was told he has type 2 diabetes or prediabetes. He is busy, he travels and he does not want to spend the rest of his life adding prescriptions.
If you take diabetes or blood pressure medication, keep working with your doctor. Do not stop a medication on your own. As your weight comes down your doctor may need to change the dose.
Listen to the full story
Listen to Episode 66 to hear Neil's story in my own words.
More From Driven For Health
- Episode 89 covers what to do right after a type 2 diabetes diagnosis.
- Episode 102 explains how to read your own blood panel, including A1C and fasting glucose.
- Episode 60 tells the story of three men who went through the 100 day program together.
The Call To Rise
The Call To Rise is my 100 day group program for men over 40 who want to lose 20 to 30 pounds and improve their blood work. You get a food plan that fits your schedule and a strength plan. You also get a group of men doing it with you.
If Neil's story sounds like your last lab report, apply at thecalltorise.com and we will talk about whether it fits you.
Common Questions
Can you have type 2 diabetes if you are only 20 pounds overweight?
Yes. Extra fat that packs in around your liver and pancreas gets in the way of insulin. For some men that starts at only 20 pounds over their best weight. Neil was 45 and about 20 pounds over when his A1C came back at 8.3.
What A1C number means you have type 2 diabetes?
An A1C of 6.5 or higher is in the diabetic range. Prediabetes starts at 5.7. Ask your doctor to explain where your own number sits.
Can type 2 diabetes go into remission with weight loss?
For many people it can. In the DiRECT trial in The Lancet, 46 percent of people on a structured weight loss program were in remission after 12 months. They lost about 22 pounds on average.
How much did Neil's A1C drop?
Neil's A1C went from 8.3 to 7.5 in his first six months on metformin. After 100 days of changing his food and training it came down to 5.8.
How much exercise helps lower A1C?
A 2011 review of 47 trials in the journal JAMA found that people who did structured exercise for more than 150 minutes a week dropped their A1C by close to 0.9 points on average.
What should a man with high A1C eat for breakfast?
Start with protein. Neil's daily target was 40 grams at breakfast. On the road that meant eggs and Greek yogurt with fruit and black coffee.
Should I stop my diabetes medication once my numbers improve?
No. Keep working with your doctor and never stop a medication on your own. As your weight comes down your doctor may need to change the dose.
Who is The Call To Rise for?
It is a 100 day group program for men over 40 who want to lose 20 to 30 pounds and improve their blood work. You apply at thecalltorise.com.
