7 Risks of Prolonged Insulin Resistance

Insulin resistance refers to a condition in which cells in the body no longer respond properly to insulin. This has a huge impact on health because of the role that this anabolic hormone plays in glucose metabolism. With insulin resistance, cells, including those in the liver and body fat, begin to ‘resist’ signals sent by insulin. This means that they stop absorbing glucose from the blood to use it as the main fuel source. As a result, blood sugar levels start to rise, causing a variety of health risks, the best known of which is diabetes. However, failing to manage the condition effectively can do more damage than you realize. Here are some of the major risks of prolonged insulin resistance.

  1. Type 2 Diabetes

The pancreas which produces insulin, respond to resistance by increasing production of the hormone. With prolonged insulin resistance, the amount of insulin needed to regulate blood sugar levels keeps rising. In time, the pancreas suffers from fatigue and cannot meet the demands for insulin. This leads to the onset of prediabetes and diabetes. Insulin resistance is regarded as a major predictor of type-2 diabetes, with most patients going on to develop the condition within the next 10-20 years.

  1. High Cholesterol

In many cases, prolonged insulin resistance makes you more likely to develop high cholesterol levels. More specifically, it alters systemic lipid metabolism, resulting in higher than normal levels of plasma triglycerides, while levels of high-density lipoprotein (the good cholesterol) start to fall. The increase in blood cholesterol levels that is commonly observed with insulin resistance may be caused by increased synthesis of very-low-density lipoprotein in the liver.

  1. Non-alcoholic fatty liver disease

Although the non-alcoholic fatty liver disease can have various causes, such as a high-fat diet and obesity, insulin resistance is regarded as an important contributor. The condition can increase fat accumulation in the liver by increasing the delivery of free fatty acid and through hyperinsulinemia – increased insulin production. In fact, insulin resistance is observed in almost all cases of fatty liver disease. In some cases, this can even lead to the development of steatohepatitis.

  1. You develop dark skin patches

Prolonged insulin resistance leads to an increase in insulin production over time and this can cause an accumulation of insulin within skin cells themselves. This manifests in visible skin changes, with darkened patches of skin towards the back of the neck, elbows, knees, groins, knuckles, and armpits. This skin condition is described as acanthosis nigricans. There is no known cure for the condition, but the management of insulin resistance can help to prevent it or reduce the severity of discoloration and darkening.

  1. Heart Attack & Stroke

When not managed in a timely manner, insulin resistance can significantly raise the risk of heart failure and strokes. Aside from the fact that reduced insulin sensitivity and increased blood sugar damages cells, including blood vessels, insulin resistance also adversely affects lipid levels. All of this encourages the buildup of arterial plaque, restricting or even obstructing blood flow. In time, this damages the heart itself. Not surprisingly, insulin resistance is associated with a 50% higher risk of heart failure and strokes.

  1. Cancerous Tumors

Cancer is not something that most of us associated with insulin resistance, but research suggests that there may be a connection. Prolonged insulin resistance and metabolic syndrome may increase the risk of various types of cancer, including breast, bladder, colon, pancreatic, and uterine cancers. It is believed that high insulin levels facilitate tumor growth and also impair the body’s natural defense against malignant cells.

  1. Early Onset Dementia

Although the connection between prolonged insulin resistance and dementia is not clearly understood, studies do suggest that insulin resistance raises the risk. One mechanism is vascular dementia, in which blood vessel damage from insulin resistance leads to reduced blood flow to the brain. Researchers are still investigating the role of insulin resistance in memory function decline and the increased risk of conditions such as Alzheimer’s disease.

 

How to Cope with Insulin Resistance

In addition to the risks highlighted above, insulin resistance is also connected to a higher risk of kidney disease, high uric acid levels or gout, and PCOS. Fortunately, effective and early management of insulin resistance can counter these risks. Dietary and lifestyle changes to lose weight and get better sleep can help improve insulin sensitivity significantly. In fact, a study that appeared in the International Journal of Obesity, found that 10% of weight loss through diet and exercise could improve insulin sensitivity by 80%. Similarly, sleep deprivation has also been shown to raise insulin resistance. Findings like these highlight the importance of comprehensive lifestyle changes to tackle insulin resistance.

Insulin Resistance

Breaking the insulin resistance cycle involves a number of things, including reducing simple carbohydrate-rich foods, like grains, juices, processed foods, etc, in our diet. Below are 5 guidelines that will help slash insulin resistance and improve blood sugar control overall. This is useful advice with people who have diabetes, PCOS, metabolic syndrome and for those who just need assistance to lose weight. 

  • No naked carbs. What? Since carb-rich foods (legumes, fruit, starchy vegetables, grains, and sugar) give us quick energy and have the greatest effect on raising blood sugar levels, it is ideal to have a source of protein or fat with this food to buffer the absorption of sugar going into the bloodstream. For example, an apple (carb) with peanut butter is far more favorable than eating an apple alone.
  • Reduce snacking and eliminate grazing. Be sure to eat enough at each meal (review plate visual) by cueing into your satiety and hunger levels, so you do not need to eat more than three-four times a day. When we have smaller, more frequent meals, we cause our body to produce more insulin, creating higher circulating levels of insulin. High insulin levels cause insulin resistance. Transition to 3 meals and an optional snack each day.
  • Hydrate. Drink 20 ounces of water first thing in morning. I play a game by making myself drink my water before I am allowed to enjoy my coffee. Do what motivates you. Overall, aim to drink half of your weight in ounces every day. For example, if I weigh 200 pounds, I need 100 ounces of water or herbal tea per day. Drinking water is one of the simplest ways to improve your hormone (including insulin) functionality, hunger, and fat-loss.
  • Forecast meals. No need to make a formal meal plan, but spend five minutes a week reviewing which meals you will be eating out or at home. Sketch out at least 3 meals (doubling some of the recipes can save you time) and reflect these meals onto a grocery list. This can help you get in front of your health by making healthy food the obvious choice. It can also help reduce food waste. Win-win.
  • Eat with the sun. Eating during daylight hours supports our natural body clock, and therefore our hormone functioning. The more in sync we are with our circadian rhythm by eating with the sun, we support hormone balance, improving insulin resistance. Doing this also improves sleep and high-quality sleep is the “secret sauce” for health. Additional motives to eat earlier? Data suggests when we eat past 7 PM we increase our insulin secretion by 50 to 70%. High insulin leads to insulin resistance. If you find yourself eating late, make it a smaller, lighter meal.

Nut Milk Does a Body Good

Not too long ago, there were limited milk alternative options for people looking to remove dairy from their diet or just try out something new. Soy milk was one of the first milk alternative options available, but those with sensitive digestive systems often found that the soy can be too harsh to ingest and perhaps unfavorable for thyroid health (and more). But because of the rise in eco-friendly diets in recent years, a hub of new plant-based milk alternatives have come onto the scene, offering people new ways to enjoy their favorite baked goods, cereals, and other traditionally dairy-filled recipes.
Those suffering from diabetes, in particular, know the struggle of being able to find food that both tastes good and keeps their body functioning at an optimal level. The team at Snap Kitchen is on a mission to help those with diabetes find delicious milk varieties, so they put together this infographic that breaks down the 8 most popular plant-based milk options on the market today. They provide expert tips on how to implement these alternatives into your daily snacks and recipes as well as a taste and texture comparison chart to help you find the milk that best suits your preferences.
Did you know that cashew milk only has 1-2 grams of carbs and is ideal for those who monitor their blood sugar levels on a daily basis? Or that rice milk, because of its high carbohydrate levels (33g per serving!), is best avoided by diabetes patients as it can cause a blood sugar spike and subsequent crash. Learn more about these popular options and see which one is right for you in the infographic below.

 

Milk Alternatives

My Forever Love for Juice Boxes

I write to you today with a frog in my throat, feeling humble, scared and grateful.

Last week, immediately after my Endo appointment, we headed to FL to have a reunion with 2 other families. I felt like a badass driving down because my A1c returned to a territory I want to stay in, reading at 5.6 (a non-diabetic range). Yet, just when I think I have a routine, a plan, momentum, I realize I am at a loss.

Days into the trip I woke up with a blood sugar of 383 mg/dL. “Wtf?!” I haven’t seen a high like this in years.

Is it bc we ate a late dinner? I always have a high fasting when I eat late; but not this high. Was it the Prosecco I drank last night?? Maybe the alcohol made me low, I didn’t wake up, and glucagon shunted into my bloodstream??

Maybe it’s because I’m not sleeping enough? I was often the first to go to bed because I know less than 6 hours of sleep makes blood sugar control hard, but I’ve had 2 newborn babies and my blood sugar never behaved this bad.

Was it because I was less active than being at home? I was still running and swimming. Was I dehydrated severely? No.

What’s going on? Is the insulin bad? It worked fine yesterday and the day before and since then I haven’t stored it differently. I had it on the bathroom counter; maybe the room got too hot when we had our showers?

I take action – I’m aggressive with my basal/Tresiba for the day, upping my dose from 8 units to 12, then layer on another 2 units, making it 14. I take an intramuscular injection to correct the high.

Is it the heat? I always go really high with high humidity and temps above 80F. But I’ve lived in Australia with 100-degree temps and no a/c and it never got this bad.

Two hours later I’m only at 220 mg/dL, arrow across. Blood sugar goes up 2 points. I take more insulin.

Trying my best to keep my fears and frustrations to myself, I head to the beach with everyone.

I see diagonal down on my CGM. “Yay, the insulin is working.”

I have some dried mango in my beach bag in case the insulin begins working too well.

I’m in the water and run back to our things, aka my phone to read my blood sugar via my continuous glucose monitor (CGM) and grab my daughter her floaty.

Double arrow down reading 45 mg/dL. Where is the mango??? I eat it.

Five/ten minutes pass and my friend comes back to get her son a snack.

I actually start feeling really scared. I started praying. The mango isn’t doing a thing, still 2 arrows down (this means my blood sugar is dropping 4 points per minute).

My friend pulls out a cooler with juice boxes for the kids. Amen! Juice will help.

I chug the juice.

I’m so low my CGM can’t read my blood sugar. CGM reads, “LOW” double arrow down.

My friend has no idea I’m scared for my life at the moment. Am I going to go into a seizure?

I ask my friend to get my husband. I start crying. Am I going to die because of this damn high blood sugar, now firing back?

Thirty minutes in, I level out, head back to our house and over-analyze everything for the next 2 days with 1 more similar low blood sugar scenario. The second time I used maple syrup to bring my sugar up, followed by a juice. I asked my husband to hold me until the carbs kick in. 

I threw out my current pen of Fiasp for fresh insulin starting day 2, but I robotically took the same Tresiba day 2, and I was hesitant to take another full dose of a new bottle. So now day 3, it’s confirmed on what the problem was…

Spoiled Tresiba/basal insulin.

Sometimes I think I’ve got this disease, but it can be mean, scary, horrific. Diabetes teaches me day in and day out to make my time count and I’m so grateful for my insulin, my CGM, my juice box, my life.

I had a great trip overall, diabetes won’t taint it, and I’m happy to be home to ground myself and make a difference in this world. 

This scary event was a gentle reminder of what it may feel like to be newly diagnosed with type 1 diabetes or going through a confusing time of diabetes management. There is always something to learn, and I should have been more bold with changing out my insulin sooner.

Variables that Play Into Blood Sugar Control

When I help my clients with diabetes understand how to best manage their blood sugars, of course, I mention nutrition and insulin, but there is a large emphasis on a number of other variables, including, but not limited to the following…

  • Hydration – being well hydrated can help your insulin work most efficiently
  • Allergies – seasonal, food, medication
  • Food sensitivities – if the gut is inflamed, the body is, hence poorer insulin sensitivity
  • Stress – good and bad stress can impact blood sugars.
  • Movement – move every 30min and exercise every other day
  • Hormones – male hormones fluctuate as do females
  • Puberty 
  • Pregnancy
  • Excitement
  • Public speaking (a form of stress)
  • Mood
  • Outdoor temps – heat makes some type 1s high (me!), but others it runs blood sugars down.
  • Breakdown of the meal fat, protein and carbs
  • Activity, bad insulin (this happens), 
  • sleep duration and quality, 
  • Altitude and this includes flights. I will go high shortly after takeoff and my blood sugar drops ~30-40 pts after landing.
  • the timing of meal the night before (if it was later than the norm, that can throw blood sugars the next day), 
  • lack of exercise, over-exercising, 
  • supplements,  
  • gut health, 
  • time change, jet lag, 
  • alcohol, esp if alcohol was drunken the day before
  • period, ovulation, 
  • insulin resistance, 
  • overeating, 
  • overdoing carbs, etc.

We Made History May 18th 2019

It is with great pride and gratitude to announce that this year’s JDRF Gala on May 18th broke an all-time fundraising record! Your generosity resulted in over $660,000 raised for the mission that ties us all together.

The gala was a result of so many hands and I am so thankful for your support…and we couldn’t have done it without our family, friends and JDRF community.

Below I have captured the script of my speech and some of the pictures I snapped from this AMAZING evening. As well, here is a video from the live event.

How many presents does an 8 yo girl get when she is diagnosed with diabetes the day before her birthday? (long pause) 

A lot. 

Looking back, on my earliest memories, they all begin in second grade. No matter how hard I try, I can’t recall much before then. It starts with my diagnosis.

But as I drift through that memory on, I remember more of the hard ones than the happy. In those first few years, I had several seizures – a few at school and some in my sleep. 

I remember writing a letter in crayon to my mom and putting it in her bathroom drawer – saying “I don’t want to try anymore. It isn’t fair that I am the only kid in the family who has diabetes. I hate it (stomp foot) and I don’t want it.”

My siblings
My siblings

When my mom found it, I was waiting for her to yell at me, but she surprised me instead.  She pulled me aside, sat down with me and told me to never take life for granted and that I was capable of overcoming this.

I AM capable, but it’s a heavy burden. There are so many layers to Type1 that are invisible. There is no limp or mark to distinguish us. We often look perfectly healthy until you see the tubing from a pump poke out from our waistband, or a little white pod stuck to our arm. Then you wonder – what is that? 

Meanwhile, we wonder if we dosed enough insulin. If I should’ve eaten more before walking my kids to school, if that 30 grams of carb is going to kick in at Teagans soccer practice or if I need to tell a stranger I need help. We wonder if this is the high that is going to tip the scales to a complication.  

It’s not just about nutrition and insulin, there are dozens of variables that affect our diabetes management. As a dietitian, I help my type 1 clients with what’s on their plate but also looking beyond. We need more options to manage this disease. Thankfully JDRF is racing to find a cure for tomorrow while striving to improve the lives of those with T1D today through advocacy and outreach. 

We have studies being funded focusing on beta cell regeneration, research, screening individuals at risk of developing T1, vaccines that might prevent it, and work underway for Open Protocol, taking the closed loop system one step further. 

JDRF is also working to improve the odds for expectant mothers with their closed-loop insulin pump research – some of this research is here at OSU. I was on shots nearly the whole time I was pregnant with my daughter (we didn’t do the best family planning!). And pregnancy means fluctuating hormones, fluctuating hormones mean fluctuating insulin needs and there were days I would take 17 shots. Not finger pricks – shots. 

Can you fathom what it’s like to fear you are hurting your baby because your insulin isn’t working nor absorbing as you’d predicted? 

Type one is scary. But when we come together, we make it a little less lonely, and with perseverance we build hope. We have events like tonight where we can make a tangible difference.   

My family and I are grateful for all of you being here and I am going to be bold, as bold as I am with my insulin, and ask each of you to do all you can to help us make a difference. Your generosity and support this evening will 100% go towards JDRF mission of finding a cure, better treatment options and to prevent it in the first place.

Tonight, please help:

  • build the hope all of us need, 

  • fund research that can resolve some of the hardships and the mental burden this chronic disease carries, and 

  • break a record on the generosity a room in Central Ohio can create. 

5 Ways To Workout Your Mind & Body

Do you workout for your mind or your body? Do you do it to lose weight, be stronger, or just have more energy? Yes, I’d love to have a 6-pack, but I personally do it to be a better mom, for my blood sugars and for my mood.

Exercise invigorates our minds and is a form of self-love and stress management. It seems far-fetched to say that your workout will be spiritual, but it can leave you feeling mentally refreshed! Try one of these 5 workouts to see what fits you best, mind and body. 

#1: Running

If you’re looking to clear your head, then running or jogging is a great option. Hit 2 birds with one stone and phone a friend to come with you. I do this weekly with my friend Cindy.

Forget the treadmill, and head to a park or beach. Sure, you can do this in the city, but nature is good for your stress hormones. Push yourself to a level of attaining that ‘runner’s high’ that people talk about so often.

#2: Martial arts

Whilst martial arts isn’t perceived as very ‘zen’, there’s something to be said for taking all of your stress out on a punchbag. If you’re having a difficult week, or you just feel like things are building up, try a session like martial arts and come out of the other side on the positive.

#3: Pilates

Pilates is so good for a stressed HPA-axis (aka stressed adrenals, chronic stress). Not only is it wholly dependent upon good mental and physical control, but many people report that it helps them to feel grounded, too. As those at c2b state, ‘when you’re truly connected, you really are the best you can be.’ If you want to experience this interconnectedness, then pilates should be on your list.

#4: Yoga

Holler! This girl just signed up for a 13-month contract at a yoga studio less than 2 blocks from my house. Yoga has taken the world by storm recently, and whilst it’s not really the most energetic of workouts, it really is a test of strength, flexibility, and mental prowess. Whether you’re taking part in a hot yoga class, or you’re just trying it out at home, there is no reason not to give this a try if you’re really looking to regain some control over your mind. There are plenty of yoga options out there! PS, stay-tuned as I share the progress I’ve made in my mind, business, relationships, and body after investing months of a solid yoga practice. 

#5: Walking

Walking is the secret sauce of blood sugar control. A slightly brisk stroll will lower blood sugar in type 1 diabetics by 1-2 mg/dL per minute. Many cultures (Italy) who engage in an after-dinner stroll have a lower BMI and I am sure the bonding over the leisure exercise enhances relationships.  However, going for a long walk will help you to burn fat for energy, and it’s great for your fitness levels. On top of this, it allows you to reconnect with nature and it can really give you a chance to clear your head. Go for a walk, and think about all of the things that you appreciate!

Let me know which movement speaks to you the most. 

Have a healthy and fit day!

Kelly, your Diabetic Dietitian

My Daily Health Hacks

What Hacks Do You Use?
A study examining the various things Americans do to feel healthy found the average person attempts six “hacks” a week to boost their health and save time.

  • As a type 1, I supplement strategically with methylated B vitamins, CBD, probiotics, turmeric, fish oil, to name a few.
  • I drink ACV water before bed to improve my fasting blood sugar/gut health
  • I keep monthly notes on my phone for my cycle so I can best prepare for insulin changes and cravings.
  • Morning routine – I wake up before my kids.
  • I use a standup working desk
  • I bounce on a trampoline 3-5 minutes, most days – good for lymph, detox, immunity, and stress.
  • I eat 4-6 cups of vegetables a day.
  • I practice gratitude nightly before I fall asleep.
  • I eat mindfully, paying close attention to what (real food) my body wants and when it starts to feel satisfied.
  • I minimize snacking.
  • I pack my meals for road trips.
  • We use blackout curtains, low temperatures, and an eye mask for high-quality sleep.
  • I have and keep an organized kitchen.
  • I drink decaf coffee and matcha to keep my caffeine in check
  • I pamper myself monthly – from nails, girl night’s out, massage.
  • I read ~3 books a month.
  • I sleep with my phone in airplane mode (but I keep my Bluetooth on to stay connected to my Dexcom)
  • I immediately chop after I grocery shop – to have large salads and roasted veggies ready to go for future meals.
  • I do some form of a detox 4x a year
  • I keep the healthiest food options at eye level in the pantry and fridge.
  • I eat chocolate.
  • I schedule my workouts like a meeting; always showing up.
  • I time block projects to be more efficient with my time, aka stress level.
  • I shop on Thrive Market to save time (esp researching products) and money.
  • I have a water intake goal every day to improve my insulin efficiency, blood sugar control, and appetite.
  • I intermittent fast nearly every day. The summer my fasts are shorter.
  • We go camping multiple times a year. I certainly prefer glamping, but the grounding and gratitude that comes from nature are undeniable.
  • I periodically (depending on the season I am in) track my food to make sure I have tabs on my portions. I have the appetite of a teenage boy.
  • I get outside every day, no matter what.
  • If you are not cheating, you are not trying. I am kinda kidding, kinda not. But I will buy pre-riced cauliflower, salad kits, a premade meal when time is a priority over cost.
  • I throw money at the problem. I have this awesome workout app – and I may use it 1x a week. I purchase a year membership to the local yoga studio, I workout 500% more. I am a fan of throwing money at the problem of whatever hurdle I am trying to overcome.
  • I (try to) eat without distractions to ensure I am eating the amounts my appetite calls for.
  • I use a low carb diet to control my appetite and diabetes.
  • I walk/bike EVERY time I need to go somewhere and it’s within walking or biking distance.
  • I batch and prep meals ahead of time for the week. I also pack my kids lunches the night before to make the mornings go more smoothly.
  • I moderate my alcohol by only enjoying it on the weekends. I love being productive and wine during the week slows me down. Well, all wine with the exception of Dry Farm Wine.
  • drink mixed greens every afternoon to increase my nutrient intake.

Low-Carb Mug Muffins & Cakes

Going low carb isn’t always the easy thing to do, but when we can whip together something that mimics a muffin or cake, it makes the journey easier and more enjoyable. Here are a few recipes I like throwing together while I round out my daily meals.

Keto Mug Muffin

This simple, low carb recipe is easy to make and pair with a dinner, where bread would traditionally be served. 
Prep Time5 mins
Cook Time2 mins
Total Time7 mins
Course: Side
Keyword: Keto, Low carb
Servings: 1

Ingredients

  • 1/3 cup almond flour
  • 1/2 tsp baking soda
  • 1 pinch sea salt
  • 3 seconds avocado spray

Instructions

  • Spray the mug with avocado spray. 
  • Add all remaining ingredients and whisk together in the mug.
  • Microwave for 90 seconds, or until set.
  • Let cool 1-2 minutes before slicing. Slice into 3-4 pieces. 

Nutty Mug Muffin

Add a little comfort to a traditional keto muffin by adding your favorite nut butter. 
Course: Side
Keyword: Bread, Keto, Low carb, Low sugar, Side, Snack
Servings: 1
Author: Kelly, Diabetic Dietitian

Ingredients

  • 1 tbsp favorite nut butter, like macadamia nut butter
  • 1 egg large
  • 1 tbsp coconut flour
  • 1 pinch sea salt
  • 1/4 tsp baking soda
  • 2 drops liquid stevia (optional)

Instructions

  • Spray the lining of a mug with avocado spray. 
  • Mix together the dry ingredients with a fork. 
  • Mix in the wet. 
  • Cook for 45 seconds to 1 minute. 

Chocolate Mug Cake

Made with almonds and cocoa, combining a good taste and texture for a single treat. 
Prep Time2 mins
Cook Time1 min
Total Time3 mins
Course: Dessert
Keyword: Low carb
Servings: 1
Author: Kelly, Diabetic Dietitian

Ingredients

  • 2 tbsp almond flour
  • 1 tbsp cocoa powder
  • 1 tbsp Swerve (or 2-3 drops of stevia)
  • 1/4 tsp baking powder
  • 1 tbsp mayonnaise avocado oil based
  • 1 large egg yolk
  • 1 tsp water

Instructions

  • Spray the lining of a mug with avocado oil.
  • Mix dry ingredients in a mug with a fork.
  • Mix in all the wet ingredients and let sit for a minute or 2.
  • Heat in microwave for 50 seconds. Temp may vary depending on the microwave. 

How I Hack My G6 Dexcom CGM

Hack Your 6 Dexcom Sensor - KSW - #insulinpump #diabetic #type1diabetes #diabetes #diabeticnutrition #diabetichacks #diabeteshacks #diabetictips #diabeticinfo #dexcom #g6dexcom
Infographic designed and made by Tayler Silfverduk, DTR

Thanks to the awesome DOC (diabetes online community) I seamlessly hacked my G6 Dexcom and am currently on day 34 of my first sensor. I hope I don’t jinx it!

So this is how I went about it: Make sure you write down or keep the paper off of the sensor that has the code on it. You’ll need it to do a restart.

To restart:
1) Once the session ends, start new session with NO CODE.
2) Let it warm up for 5 minutes.
3) Go into the settings in the Dexcom app on your phone and stop session (towards the bottom, you will need to scroll).

4) Start a “new sensor” with the code you used when you first put on the sensor. I keep the little paper in a specific spot in my nightstand.
5) 2-hour warm up and done!

I LOVE the G6. I am so excited about it, I got a smaller wristlet that doesn’t have to carry around my meter and supplies 24/7.

Let me know if you have any questions.

When I hack my G6, I will often have to change out the extra adhesive on the site every 10 days or so. This is a 2 person job (thank you for the help husband!) and here is a link to the Simpatch adhesive I like.