Dr. Bernstein

I am listening to Dr. Bernstein at this moment and man o man he is so against pumps. His biggest concern is accurate delivery of insulin and he feels after 7 years, people will have much scar tissue which will further make insulin dosages very inaccurate. He also feels that the body thinks the tubing is a foreign body and infection will develop making further issues with pump usage. Pumping for 4.5 years and not sure I agree, as after 35 years of shots, I have a lot of issues with sites and skin problems as well.

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Permalink Reply by Lara on September 21, 2007 at 9:31am: Katrina, the book is not just about the diet. It also gives you tips about managing D in general. I would suggest you pick it up... I am a long-time T1 and even I learned some things!

Lara
Not a low-carber; ▶ Reply to This

Permalink Reply by Jan on September 20, 2007 at 1:26pm: Dr. Bernstein may be correct about scar tissue and inflammation on the pump. Only time will tell. I have noticed that often, not always, her numbers will go up in the middle of the second afternoon. Next time that happens, I will be on alert, apply a temp basal and see if that holds her; otherwise will pull the site early. I have also noticed emergency shots in the arm bring her blood sugar down pronto, whereas, bolus through pump is slower. This is most likely due to the absorption at the particular site (arm vs. buttocks). Many, if not most, patients with Type 1 diabetes contract it in childhood. His advice cannot be applied to children. I respect his point of view regarding greatly limiting carbs, yes, of course that would work. But his carb reduction technique is unsafe to use with children. Likewise, many young children balk at four or five shots a day and pumping is more practical for them. The drastic carb reductions Dr. Bernstein advocates would be difficult to follow even for adults, but one could certainly learn much from him and use his low carb limits for out-of-control periods. I think it is very important to keep an open mind and seek any and all advice that may help. Carb reduction is just another tool adults can use. I don't think the carb reduction technique is anything new, however; in fact, it is one of the oldest techniques.; ▶ Reply to This

Permalink Reply by Tim on September 20, 2007 at 5:38pm: Disclaimer: I don't know anything about this Dr's program beyond what has been said in this post, but...

I think what it comes down to is quality vs. quantity of health. If restricting your carb intake as much as this program requires lowers your quality of life, making it impossible to get through the day happy and awake, or go cycling for more than 10 minutes, or enjoy a friends birthday party while everyone is eating cake, then this is not the program for you. If, on the other hand, "treating your numbers" (as I would call it -- aiming for the lowest A1c, rationing vs. counting carbs, etc.) is the important thing, then more power to you.

As for me, I'd rather take a moderate approach of mindful carb consumption and counting and not be miserable every time I walk by a bake shop, or restaurant or not be able to enjoy a social gathering with food. If my A1c is 5.5% and not 4.2%, I can be happy with that. Dr. Bernstein's mantra, as I understand it, is that diabetics can have the same blood sugars as non-diabetics. But my question would be can they also enjoy life as much?; ▶ Reply to This

Permalink Reply by Jenny on September 20, 2007 at 6:32pm: Tim,

If my A1c is 5.5% I'm thrilled. I only got one of those in the past 5 years.

One major thing to remember, though, if you are a Type 1 is that most Type 2s get offered no treatment except for oral drugs that only drop A1c about 1%. And many are over 10% at diagnosis. If they don't cut carbs, they will have A1cs of well over 8% and most do--even while taking the expensive oral drugs. Most doctors won't give people with Type 2 insulin until they have neuropathy, retinopathy and nephropathy. Then they give them Lantus only and about 5 minutes of instruction and set Lantus doses that guarantee they'll always be high even though they're using insulin.

So for type 2s treated by family doctors (as most are) Dr. Bernstein's diet can be the difference between going blind or not. It certainly was for me. It took me 7 years to get an accurate diagnosis and permission to use the insulin I needed. Before that, "enjoying" a piece of birthday cake meant going up to 275 -300 mg/dl and feeling sick as a dog for 3 hours afterwards. And having infections all the time. And having doctors tell me that I was doing great because my fasting bg was only 110 so I didn't need any other treatment!

My form of diabetes comes with normal basal secretion and, at this point, NO post-meal secretion.; ▶ Reply to This

Permalink Reply by Tim on September 20, 2007 at 6:49pm: Jenny, you make an important distinction that I neglected to make myself. Thank you for correcting me.

Hopefully, as the tide changes and more T2 diabetics begin treatment with insulin, management of the disease will become easier. The current AACE guidelines do now recommend the use of insulin, in addition to the normal pharmacologic regimens, in T2 diabetics with exaggerated postprandial hyperglycemia or fasting hyperglycemia even when A1c values are below 8% (ref: AACE Diabetes Mellitus Guidelines, Endocr Pract. 2007; 13 (Suppl 1) 2007, p.18).; ▶ Reply to This

Permalink Reply by Jenny on September 21, 2007 at 9:22am: Tim,

Unfortunately, the AACE's recommendations are known only to its members. Most family doctors don't seem to have ever even heard of them. They follow the ADA recommendations which are that the target is 7% and that after a YEAR above that level they should start metformin. Then a year later add another drug, and then another.

Most family doctors and many endos (including the 2 I saw) are convinced that giving a Type 2 insulin will only make them gain weight so they delay it as much as possible.

Now with Byetta on the market doctors are delaying insulin even further though Byetta only works for a small percentage of those who use it. The rest just burn out the rest of their beta cells.

I still hear from a lot of type 2s who believe that it is eating fat that raises their blood sugars. That's why they believe the doctor told them to eat the low fat diet. Needless to say, they report "I tried the diabetes diet but it didn't work."

For those people, just reading Bernstein is a huge eye-opener. Most people WON'T eat his diet, but if they drop from 100 grams per meal to 40 it's going to make a huge difference in their long term health.; ▶ Reply to This

Permalink Reply by David Wendel on September 21, 2007 at 9:42am: Unfortunately, most doctors are very poor nutritionists. Even when you go see a nutritionist it is often hard to listen to what they are saying because so many have eating disorders.

Here is my approach for dealing with my diabetes for what is is worth. Extremes in any situation are bad and are not good for you. Too much exercise--bad, no exercise--bad, eating hardly any carbs--bad, avoiding fruits all together--bad. If people would do things in moderation they would have a much better life and a much easier time controlling their diabetes.

Dr. Bernstein seems to take the treatment of diabetes to an extreme. However, some people may need an extreme to get them back in line with where they should be. Many may just give up because his plans are extreme and fit poorly into their lives. Hopefully for the more average person they will fall somewhere in the middle.; ▶ Reply to This

Permalink Reply by Karen Doering on September 21, 2007 at 8:11pm: I read Dr. Bernstein when I started pumping and knew I could not follow his strict control. The reason Dr. Bernstein developed this strict diet and insulin dosaging is because he himself had many complications and now has reversed/stopped most of his complications. It worked for him so he wanted to share his ideas. He is very very strict and if you see him as a doctor he expects the same out of his patients if they are there to stop further complication. It surely is not a plan for everyone, but he has a multitude of good ideas. I am probably the worst offender of his plan.; ▶ Reply to This

Permalink Reply by Kathy on September 20, 2007 at 6:58pm: What a great bunch of input! These are the kind of discussions I love.

I don't have anything to add except that I feel Dr. B. is simply offering his own plan for success to others, should they choose to check it out.; ▶ Reply to This

Permalink Reply by Progress Trumps Perfection on September 21, 2007 at 1:55pm: I'm glad I kept reading because David summed up what I think better than I could have.; ▶ Reply to This

Permalink Reply by Sherrie E on September 21, 2007 at 4:59pm: I bought Dr. Bernstein's book and read the entire thing. Frankly, it was like wading through a boring textbook. Also, by the time I finished the book, I was sorely depressed. If his ways are the solution to Diabetes, I might as well give up. I wouldn't recommend a newly diagnosed diabetic, who tends towards depression, read this book. (My conclusion is based on my experience only and I'm a Type 2, btw.); ▶ Reply to This

Permalink Reply by Sherrie E on September 21, 2007 at 5:16pm: It was a tough book to read. I cried a lot when I read it. Seemed like diabetes was a hopeless illness with quick death or, at the least, early life debilitating side-effects, if you couldn't get your blood sugar readings down to 83. Very depressing stuff for me.; ▶ Reply to This