The premise that a 6.5% A1c is great for a type 1 diabetic is based on the widespread belief that we simply cannot expect better results than that and still maintain safety from low blood sugars. The truth is that a 6.5% A1c in a non-type 1 diabetic is medically diagnostic criteria for type 2 diabetes. It is well established that type 2 diabetes is detrimental to one’s health, especially in the long term, though probably also in the short-term, though that is more difficult to quantify due to comorbidities.
It’s possible that a type 1 with a 6.5% A1c is different from a type 2 with a 6.5% A1c because the type 1 might be having more blood sugar variability, which the body doesn’t like. The type 2 in many cases has additional metabolic distress in the form of insulin resistance, obesity, high blood pressure, and fatty liver disease which would also make a difference when comparing their 6.5% A1c to that same A1c in type 1. Therefore, there are factors making this a nuanced issue.
However, if you look at cardiovascular outcomes of people with A1c averaging in the lower normal A1c range and compare them with those whose A1c averages in the upper normal range, you’ll find that the former does much better than the latter. Many people with type 2 diabetes experience complications and most likely their diabetes started after they became adults. So imagine what may happen to the type 1 child who experiences an additional two or more decades of harmful blood sugar by the time they’re 50? If you’re thinking that’s not fair, I agree.
If you have type 1 diabetes and have a healthy weight (which is increasingly less common) and you have low blood sugar variability and you feel good and all other vitals are in optimal normal range and you’re not making visits to the emergency room, then you may be completely content with your management. Or you simply may not be willing to make certain changes for what you may deem a very minor improvement in the quality of your life. Or maybe you were diagnosed much later in life so you have a long and protective history of excellent blood sugar. Or perhaps you aren’t willing or ready to aim higher right now. We all have this freedom to choose what is right for us and I wouldn’t want it any other way.
As for children, ethics would dictate that our choices must reflect much higher standards on their behalf.
For those who want better than diabetic blood sugars and are willing to do what it takes, there is a way to manage diabetes so that you can achieve normal or near-normal blood sugars and see less severe hypoglycemia. I don’t know of another way to do this than to eat a diet that is comprised of very low carb, high protein, and fat to the degree you require. There is more to it than that, though. You may be tired of hearing this but if you read Dr. Bernstein’s Diabetes Solution, you’ll learn what you need to know to get on the road to optimally healthy blood sugar management.
Ultimately, I want you to know that if you want it, it’s possible. Regardless, I wish all diabetics the very best of health.
I knew quite a bit about type 1 diabetes before I diagnosed myself with it at age 11. My sister was diagnosed earlier the same year and I read up on it at the library in order to be useful to the family.
I still remember sitting in science class in 1994 when it hit me. I knew I had type 1 diabetes.
Days ago I got out the diary I wrote in between the ages of nine and 14. I read my early entries to my two nine-year-olds. They thought a day in February was hysterical which just said: “I’m SO bored!” I read to myself some of my age 10 entries, leading up to my diagnosis. Boy, was I moody…I couldn’t help but get a feeling of deja vu later that day when my daughter said something similar to what I had written on December 8th, 1995: “I just don’t know…” I wrote that so I know the feeling behind it and the way my daughter said it when I asked her if she was ok actually gave me the creeps. She sounded dazed and confused. I felt panic because it seemed that if I didn’t know what was wrong, and she didn’t know, then how could I help? She is an articulate child and generally knows herself so this kind of response was disturbing and abnormal.
Then on a typical Wednesday, my son comes up to me and says he is nervous because his vision is blurry. I stay calm and tell him that I’m going to check his blood sugar just to rule that one thing out. Type 1 diabetes in my children is a constant worry of mine.
I have two siblings with type 1 and an uncle with it, too. We definitely carry the genetic predisposition for it.
Alex is home from work now and he encourages our son to let me prick his finger.
He’s very nervous but he lets me do it. He’s 108. My stomach falls. I wish it was lower. That number is just good enough and just bad enough that I sit there dumbfounded. He looks worried and says, “that’s a little too high, isn’t it?” I have never lied to my kids so I tell him, “I think so…but it’s not too bad, we’re just going to keep an eye on your blood sugar going forward, ok? You don’t have to worry about it right now.” (His vision was back to normal after we checked him, turns out he had been pressing on his eyes, you know, things kids do).
Then suddenly, I decided I must check my daughter’s blood sugar. She is afraid of having her finger pricked so she runs away to her room. Alex has a chat with her and I am able to do it, though it’s no easy task. She has generally always been a very tough patient and I’m distracted by trying to keep her calm and keep her from pulling her finger away until the meter quickly counts down and beeps and the strangest number shows up on the screen: 245 mg/dL making my jaw fall open.
I’m speechless. I show Alex the meter and he looks just like me. He mouths the word “no…”. I tell our daughter there was a mistake and that I need to check her again. She’s upset by this and asks why. At this moment our son is looking at the result on the meter and says, “Was that her number? She’s really high…oh no, mom, I’m scared” And he starts to cry. She is on the other side of the room avoiding another finger prick. We check her again and confirm the high. She walks away to the couch and is upset about her bleeding finger and the slight throbbing. I accidentally pricked her too hard due to being unable to stop my shaking.
I check Alex’s blood sugar, for some strange reason. I don’t know what I was hoping for, the possibility of a screwy meter? He’s 100 mg/dL. I feel a rush of despair as I realize that our kids, who should have lower blood sugar than their dad, both have higher blood sugar than him.
Immediately I start thinking about research that shows what the chances are for a fraternal twin to get type 1 if one has it. I think the chance was about 22%, which is crazy high. For identical twins, I think it’s 50%.
I sit crying quietly with Alex at the dinner table for a few minutes. Then, while he’s holding our daughter in his arms, I ask him, “should we tell her?” Our daughter still doesn’t know what’s going on while the three of us are all mourning for her. Alex nods to my question. So I tell her that her blood sugar was high. She immediately knows she has type 1 as she covers her face to cry. She’s lived with it all her life by being my kid. Since she’s always been homeschooled, we’ve spent all our days together and she and her brother have not only seen all that I do to manage but have also heard me talk about it often. She even knows the risks and complications that can come with type 1.
I inform her with strong conviction that I have learned how to manage type 1 diabetes well and that we would take care of her. This is true. I have been a weird type 1 diabetic. I’ve talked and written about it much more than most type 1s would ever want to. Recently, I had told Alex that I still didn’t know why I have been obsessively compelled to learn so much about diabetes and to constantly read about it.
Sometimes you work hard and spend all your free time on something and you don’t understand why you’re driven to do it, you only know you must. I don’t enjoy learning about diabetes or talking about it or writing about it all the time. But now I know what I was training for, apparently.
A few years ago I imagined what I would feel if one of my children were diagnosed with this and I vividly saw myself on the floor, a puddle that no one could pull up and console–a pitiful shell of a person that couldn’t help anyone. I truly imagined that I would be so emotionally injured that I would die. But since my kids need me, I decided then that I had to toughen up. Because I can’t die on them.
Over the last few years, I have changed dramatically. My mindset is different now and many of my beliefs, too. I studied philosophy to learn how to determine was it real, true, and good and I started looking at everything more objectively. I was able to stop being mad at certain things and start being mad at things that deserved my wrath. I began to hold myself accountable and responsible for my life and my emotions. I stopped being fragile, honestly. I have been transmitting all this to my kids, teaching them how to think critically, be resilient, be righteous, and brave.
So I realized that night, standing in the kitchen with Alex’s arms around me, that I wasn’t a puddle on the floor. I was full of adrenaline of course, but I was standing tall and determined. If type 1 diabetes were a person, I’d be glaring at it, calculating just how I was going to beat it down.
Alex and I had a meeting with the kids the same evening about how we were all going to eat from now on. I eat a very low carb diet to manage my diabetes and now my entire family is going to do it. They are already used to a low carb diet but the step down to “very low carb” is not easy. I was surprised by how willing our son was to do this for his sister.
My daughter hasn’t cried again since…even after seeing me break down after the official diagnosis at the doctor’s office days later. She just took my hand and looked me in the eye and said firmly, “Everything is going to be alright.” I told her I was just so sorry and that I never wanted her to have what I have. She said, “I know, mom, it’s ok. Let’s go home.”
When did she grow up? Was it the day she was diagnosed with type 1 diabetes?
We caught the type 1 early so she doesn’t need insulin, yet. Her diet is keeping her mostly in the 70s and 80s. I check her during the day and in the middle of the night. She’s like a new kid when it comes to the finger pricking. She easily gives me her pinky, her favorite finger–mine, too coincidentally, turns her head away and covers her eyes with her free hand.
I’m still bursting into spontaneous tears at times but I don’t feel weak and hopeless. I am devastated. Yet, my love for my kids fuels me. I will take care of my daughter’s diabetes and teach her how to have excellent blood sugar management. I will keep an eye on my son’s blood sugars. I will make sure my husband knows what he needs to know to feel confident when I’m not around.
If there’s anything I’ve learned thanks to diabetes is that life is hard but much harder if you don’t learn to defer gratification and be stoic and use restraint and wisdom and curiosity. It feels good to avoid sweets in order to see better blood sugars. It feels good to check blood sugar in the middle of the night to stay safe. Everything you do that is wise but difficult will boost your self-confidence and self-respect and make you the person you always wanted to be: healthy as is possible, brave, and in some very meaningful ways–triumphant.
I strive to be humble, patient, empathetic, calm, and respectful with my daughter throughout this journey. I know that if I do these things, she’ll likely treat herself that way the rest of her life and she only deserves good things–including normal blood sugar.
The carnivore diet generally consists of eating only animal meat. For many, it includes other animal products that don’t raise blood sugar like cream and butter.
There are various reasons why people are doing this diet. Some are doing it because they’ve heard that it boosts physical performance and they want to see if it does that for them.
Some are doing it because it sounds appealingly primal. For these people, this sounds like a temporary fad diet.
Others, connected to Bitcoin, are doing it as a lifestyle statement of sorts protesting centralized banking and healthcare–or something like that. You’ll have to read more about it as I do not have an affiliation with this group.
One of the more common reasons I have found for people taking on such a limited diet is that they have ailments they are suffering from and are desperate to treat in a way that doesn’t include harsh drugs but rather work at the root of the problems. This is the camp I fall into.
I’ve been following this diet for several years out of curiosity as an objective observer. I’ve read claims of an all meat diet healing one’s gut and therefore being useful for those with multiple food allergies, sensitivities, and autoimmune conditions. The goal here is to heal and then reintroduce foods.
This past year I’ve had several months long bouts of fatigue and joint pain flares. These have happened over the last decade but the pain and duration of the flare-ups have been getting progressively worse. I’ve also developed some kind of dermatitis on my face and have psoriasis. Things get real when they happen to your face because you can’t hide it and you’re constantly reminded of it.
My doctor said that he could give me prescription non-steroidal anti-inflammatory drugs like Naproxen but those can damage kidneys over time. He said he could give me steroids but those would raise my blood sugars. Neither option seems like a solution to me. I’m only 35 years old.
My kids have my genes and another motivation for me to figure out what might help autoimmune problems is to know what may work in the case my kids were to develop something.
So anyway, I finally became fed up enough recently that I decided to find out if the diet could be tried without serious health consequences.
I did research on the topic of how bowel movements happen in the absence of dietary fiber, the need for vitamin C changing while not consuming carbohydrates, and what the latest science says about cholesterol. If you’re interested, I urge you to research these fascinating topics.
Sufficiently armed with a base level of confidence that I wasn’t going to kill myself by doing this for a few weeks, I plunged into the diet one week ago. I haven’t removed coffee because I don’t want to deal with caffeine withdrawal just yet. I’ve been eating beef, chicken, salmon, sardines, pork, eggs, butter, and cream.
Here’s what I’ve experienced so far:
The first two days I had cravings for everything except meat. I also started sweating a lot, which for me isn’t much, because I am not one to sweat, so just sweating period was a strange occurrence. I would sweat at each meal which wasn’t very appealing. I sweat a lot the first two or three nights, too. My weight, after 3 days, went down 3 pounds which may have been initial water weight loss.
On day 3 I noticed that my stomach has flattened. That’s weird, I thought my belly was just really pudgy. It appears I was bloated or retaining fluid there. My husband was surprised to see a little bit of a four pack of abs. He said, “Wow, your waist is actually really small, isn’t it?” Apparently so.
Another thing I noticed on day 3 was that I sprung out of bed so easily in the morning. For many, many years, since I was a teen, I’ve been trying to wake up while feeling happy and energized. I couldn’t do it. These last 10 years have been brutal. I have needed more than 8 hours of sleep each night and I have had such a hard time in the mornings that I had extended my waking hours into the night (since I feel pretty good then). So two years ago I was going to bed at 12-2 am most nights and getting up late. All this time I’ve been wanting to get my sleep schedule in sync with my husband’s–he gets up at 6 am, sometimes earlier. Well, since day 3 and each day since, I’ve been up at 5:30 or 6 am.
In the past 20 years, I’ve consistently struggled in the morning because when I wake up I feel like I’m dying and feel super depressed and stiff for about 30 minutes. Eventually, I feel better but it makes life hard when you don’t welcome the day. Maybe I’m just excited and these effects will wear off soon. We’ll see.
Another thing I’ve noticed is my coffee has started to taste much sweeter despite me drinking it the same way I have been having it for a long time.
As you can imagine, my blood sugars have been ridiculously stable. On the first three days, I had to treat a few low blood sugars with a glucose tablet or two but I’ve since lowered my basal and haven’t had any more lows. I am now taking 6 units of Tresiba in the morning and 3 units of Tresiba at night. I take about 6-8 total daily units of regular human insulin with my meals. I may take a unit or two of Humalog as a correction to stay below 100 mg/dl.
Speaking of meals, I’ve needed only two a day because the food is so filling.
My digestion is fine (I was worried I’d get constipated but that hasn’t happened). I take a magnesium supplement every day and Vit D3. I’m thinking of adding a little bit of Vitamin C.
The other thing I’ve noticed is I seem to be much more sensitive to the effects of alcohol this past week. Just the other night I had two shots of liquor (something I do only a few times a year with no problems) but this time I suffered the worst hangover of my life and the first one as a mother, which truly embarrasses me. I endured nearly 8 hours of vomiting–that was just yesterday.
I don’t know how that happened. I threw up bile for the first time since I was in the hospital with severe kidney stone pain 12 years ago and had to keep a hawk eye on my blood sugars while sipping water infused with electrolyte drops. Lesson learned the hard way. Take severe caution with alcohol.
Maybe I’ve hurt my liver in the last week and that’s what happened? Not likely. I’ve been eating mostly meat and veggies for a long time and my liver tests have been great. I do have high bilirubin levels but always have and providers have speculated that it’s a harmless genetic thing (possibly Gilbert’s Syndrome).
It’s still early for me so I will strive to be objective as I continue to note whatever positive and negative things pop up. I have no big hopes or expectations. I just want to find out if this helps. If not, I’d be very happy to go back to my beloved vegetables, nuts, and dark chocolate.
The good days of my monthly menstrual cycle are currently happening. The effects of rising estrogen and the oomph of extra testosterone make everything better. I’ll have to really test this out through my monthly week of low hormone hell which nothing–not even rainbows or ice cream can survive.
I do want to point out that I’ve never been a big meat lover. For the past decade, my favorite foods have been mostly vegetables, flavorful sauces, herbs, spices, and sweets. I joke that I like steak only because I get to have steak sauce. Or that I like shrimp because of that tomato-based cocktail dip. Wings dipped in blue cheese–you get the idea.
Eating only animal products has made meals so strangely satisfying. I can’t figure out why that is if I love veggies but am no longer eating them. I’m entirely weirded out. Since I’m feeling fine, I’m going to keep it up for a while to observe my symptoms.
Time will tell me more. If you think this sounds crazy, I’m with you, but I hope I am not judged harshly for trying to stop my widespread pain. It’s bothering me enough now that I’m willing to try anything. I don’t feel like I have anything to lose. I have other ideas to try to help rule out causes to my symptoms. I’m determined to somehow make things better for myself. Right now, it’s the carnivore diet.
For better or worse, I will update you soon.
Dr. Stephen Ponder, an endocrinologist living with type 1 diabetes, has been posting thought-provoking questions on Facebook. One of the latest questions was: “How often do you say “good” or “bad” when talking about blood sugar (or an A1C)? If not, then how do you describe them? Should kids use “good” and “bad” when talking about their sugar levels?”
I thought I’d answer in the form of a blog post since this sparked a whole long train of thought for me.
Confucious supposedly said, “The beginning of wisdom is to call things by their proper name.” If something causes you harm–for example, as high blood sugar does, then I hesitate NOT to call it a “bad” blood sugar because it simply is, whether we acknowledge it or not. I believe it would be bad for my health if I didn’t identify, accept, and name the truth on a regular basis. It’s hard to swallow but my reality needs to be very much imposed on me if I am to act in my best interest.
People email me all the time asking what the secret is to my pretty good diabetes management and how I have the discipline for it. Honestly, any good I derive from my actions begins with calling things by their proper name. That means that I admit that eating what I want and covering it with insulin doesn’t work well enough (for me). I openly say that low carb for type 1 diabetes is the only way I know of, to get close to achieving normal blood sugar levels, a healthy weight, and safety from severe hypoglycemia. And I say that not having normal blood sugar levels is physiologically harmful because we know it is. If it weren’t, no one would be diagnosed with pre-diabetes with a 6% A1c level but, they are every minute of every day. It is on that basis that I call a 6.5% harmful and deem it not good enough for me.
If I don’t acknowledge that something is “bad” or “not good” then I don’t follow with the appropriate response or actions which have to do with changing those blood sugars or anything else. We need to apply judgment in our daily lives. It’s necessary. I have to be able to admit to myself when I’ve mistreated a loved one or I’ll certainly continue to do it. I have to be able to admit when I’m overeating, or I’ll keep gaining weight. And I have to be able to say “no, that’s not good for me” or I will suffer various potentially unlimited consequences. What is it they say to those with an addiction? “You must first admit there is a problem.”
I understand parents of children with diabetes don’t want to use “good” and “bad” in relation to blood sugars or diabetes management in part because the child didn’t have anything to do with getting such a brutal condition and we don’t want them to feel bad about themselves due to diabetes. And I do support the effort many parents put into saying things like, “It’s not that you did anything bad, it’s that this isn’t working and we need to figure out what will work better.” There is still an acknowledgment that something isn’t working and the troubleshooting can begin and the child can feel better, physically, mentally, and emotionally.
I’ve recently put quite a bit of thought into why I struggle to do what I needed to as a kid with diabetes. There are several reasons but I think the main one is that doing what my parents and I were told to do didn’t ensure my success, at all, and made me feel sick and anxious anyhow and thus I acted out of hopelessness, by lying about my blood sugars, not always doing my blood sugar testing, and sneaking sugary foods to self-medicate my feelings of despair. I knew what my high blood sugars meant for my future, and in the immediate moment, my self-esteem took a hit. High blood sugars (especially really high blood sugars) make you extremely sluggish, make your saliva thick and foamy, your thinking slow, and make you not look and feel generally healthy (albeit subtly, at first).
Let’s face it, anything that is a detriment to health is a detriment to outwardly attractiveness, if not now, then later. I remember thinking as a teen that I was totally ok with my ears sticking out–there was nothing I could do, and they functioned properly, but I wasn’t ok with the weight gain I was experiencing from the way my diabetes was being managed. I wasn’t ok with becoming less attractive due to diabetes nor slower as I played sports which requires you to compete using your energy and speed. I couldn’t prove to myself or anyone else how just how good I could be as I couldn’t fully apply myself to anything. Within my capabilities, I tried SO hard, though. Not getting results for your efforts because of diabetes makes a person crazy. And successful diabetes management relies on the most effective efforts, not the most industrious ones so I lost out.
For those without diabetes, think of how you feel about yourself when you’ve been injured or come down with a bad cold–you’re knocked down a few pegs, right? Even if people are kind to you and don’t make you feel bad about any of it. Admit it, you feel less attractive, less productive, and you may feel motivated to do whatever it takes to get yourself back to feeling good, even doing things that you were not willing to do before that experience.
I believe many people with diabetes, including children, are in an impossibly precarious situation when their blood sugar management is less than ideal. This is particularly true once they learn what elevated blood sugars can do to them over time or once the negative effects stack up over the years. No, it’s not fair, or whatever, but all I know is my “good” diabetes management began when I admitted to myself that my diabetes management was “bad” and that if I were willing to make some sacrifices in the name of tight blood sugar management, I may have a ticket to health and happiness. It’s been more than worth it, which is why I keep annoyingly banging this tired drum.
I am partial to diabetes management for adults and children which makes it easier for them to be successful with their diabetes because the alternative leads to misery. No matter how much you tell a person they are “good,” if their blood sugar levels are often high, they are going to be feeling poorly much of the time, and that is going to make them feel “bad,” regardless. It’s very hard for us to separate how we feel, physically, from how we feel, mentally. One follows the other. Feeling unhealthy does not lend itself to feeling good and it never will.
Do some people who don’t feel healthy manage to feel good and happy? Yes, but this is a feat not accomplished by most, and while children amaze us with their resilience alas, they do grow up, and many will suffer the weight of high blood sugars and blood sugar variability and fear of hypoglycemia as evidenced by personal social media accounts and all the studies pointing out rates of anxiety and depression in adults with type 1 diabetes.
This is why I encourage the attempt at a low carb diet for anyone with type 1 diabetes. Thanks to those who do very low carb diets, we’ve learned that it is possible to do better with glycemic control. Did you know that for a long time no one did better than a 4-minute mile and experts said it was impossible and once Sir Roger Bannister did, many others followed suit soon after? That’s because we can only accomplish what we believe is possible. I’m telling you that I’m not special, I don’t have more discipline than you, and that it is possible to achieve very tight and safe, blood sugar control.
The repercussions of this are incredible. In my experience, it leads to better moods, better relationships, improved ability to work, less fear of highs and lows, less anxiety, less depression, better sleep, and on and on. The positive effects are hard to quantify but they are exponential and eventually make going back to another way of managing diabetes something I won’t consider.
You can’t easily feel good about yourself if you don’t feel good physically and you likely can’t feel your best physically if you don’t have blood sugars as close to normal as possible. For more: check out the Sir Roger Bannister of the type 1 diabetes world: Dr. Richard K. Bernstein.
To conclude, I don’t worry about good/bad and any similar terminology when I think to myself, I worry mostly about my outcomes and my actual experience. It’s surprising how happy I can be while honestly telling myself that something is “bad”. That’s because I then put my energy into finding what makes it “good” and focus on that, instead. What you focus on matters and makes all the difference.
(If you manage your blood sugars well without low carb and you’re happy and healthy, I’m not directing this to you, at all.)
My colleague at Diabetes Daily, Maria Muccioli, Ph.D., wrote an excellent and in-depth coverage of a remarkable study on very low-carb diets for treating type 1 diabetes in children.
The study found that a group of type 1 diabetic children following a very low-carb diet à la Dr. Bernstein style were not only experiencing normal blood glucose levels (this is nearly unheard of in type 1 diabetes) but also growing well (a top concern as macronutrient intake of carbs is widely believed to be essential for growth in children).
The researchers of the study looked at children from a Facebook group called Type1Grit. This group consists of adults with type 1 diabetes and parents of children with type 1 diabetes who all follow Dr. Bernstein’s regimen. This regimen includes very low-carbohydrate intake but so much more–put just any type 1 diabetic on a very low-carb eating plan, and I promise you’ll likely not get the results you are hoping for–though if you pay close attention to blood sugars you may notice some interesting things regarding the statistical range of error after giving smaller amounts of insulin. It’s about more than low-carb eating. Low-carb is essential to the plan but to do well, there are more things to do and understand. One must understand how to use and adjust insulin properly, understand how different physical activity impacts blood sugars, and so on. The Type1Grit group does so well because they utilize Dr. Bernstein’s decades’ long expertise to guide them (which is all in his book) and like any good support group, they help each other stay focused, informed, and motivated.
Some people on social media have voiced strong opinions against the group due to some of their outspoken members. It is my hope that we focus on content over delivery when it comes to important matters. After all, if fellow thinkers had rejected Issac Newton’s findings simply because he was a jerk (and according to the book I’m reading my kids about him he was) wouldn’t that be a shame? Personally, I strive to be gentle with others because I am quite sensitive. However, I also try not to put my feelings above critical thinking, and I think that serves me well. I also hope that the communication of a few doesn’t cause some to dismiss the whole group or worse–a promising idea. That said, I have not personally observed anyone from that group being rude to others, though some have been quite open and blunt with their opinions and I have observed a very strong response to that, in general. I do not consider an opinion shared in a straightforward manner to be rude.
I have followed a loose version of Dr. Bernstein’s protocol for about a decade, further lowering carbs and adding in more of his advice gradually over the years (I now follow his advice very closely). His logic struck me like lightning when I read his book, Dr. Bernstein’s Diabetes Solution. In particular, I was deeply moved by a line that said something about how people with type 1 diabetes “deserve normal blood sugars”. Dr. Bernstein’s protocol includes the use of Regular insulin to cover high protein meals versus faster analog insulin such as Humalog or Novolog. In fact, after using a CGM (continuous glucose monitor) for the first time recently, I quickly saw how my Humalog was a bit too quick and potent at mealtime and then a bit too short hours afterward, so I bought Novolin R at Walmart for $24 and have improved my blood sugar levels. This is to stress how following Dr. Bernstein’s protocol is about more than just reducing carbohydrate intake.
Many years ago, I found immense value in attempting just a little bit of Dr. Bernstein’s advice. Small changes like lowering my carbohydrates and understanding how to use my insulin better led my A1c to drop from 8-9% down to 6%. Before this, just covering high amounts of carbohydrates with insulin had mostly succeeded in making me fat, tired, depressed, and anxious (oh and with protein spilling into my urine as an 18-year-old in her “prime” of life). You have to understand how terrible this was for me–I was a bright-eyed kid who was intelligent, hopeful, hardworking, patient, and super determined. In a few short years, diabetes messed with my potential–I didn’t recognize myself anymore. It’s particularly sad to spend years recovering as a young adult when you’re supposed to be at peak performance and potential due to your youth and energy.
Dr. Bernstein, who many dare call a “quack” or “nutjob” saved my life just as he saved his own. My A1c hasn’t touched 6% in many years. I have a wonderful husband. We have twins who are about to turn 9. I’m still trying to reverse some of the consequences of very high blood sugars from my first 10-12 years with diabetes. What if I didn’t have to?
People tell me that eating low-carb will hurt my cognitive abilities. Do they know that studies indicate that typically managed type 1 diabetes may do that, anyway? Type 1 diabetes (with the average management of 8.2% A1c in the U.S.) has been shown to possibly lower intelligence and negatively affect memory and speed. Low-carb in the long-term may hurt my cognitive abilities (I haven’t seen anything to indicate this possibility though) but what if it just takes the place of what high blood sugars would have done to my cognition? And what if low-carb additionally helps protect my cardiovascular health and my kidneys and my eyes–oh and allow me to have healthy children! Do you know how fortunate I am that I turned things around when I did? I have children because of the information that turned my health around just in the nick-of-time. I can’t begin to describe the level of rage I might have had I never had children yet discovered that Dr. Bernstein has been trying to tell the world about his successful method for decades.
If you find Dr. Bernstein followers as angry or overly-passionate, this may help explain why: Unnecessary suffering is a tragedy. We’re in a country whose founders had been curious and open to acknowledging ideas that are worthy, pushing those ideas to the top where they can be put to the test and then accepted as the best ideas because they can create the best outcomes. This is the great thing about Western Civilization. The embracing of objective principles which allow the best ideas to rise because even if they come from someone we can’t stand, we know that ideas, critical thinking, and truth reign over all else and push us towards progress. Dr. Bernstein’s protocol isn’t an expensive training center and it’s not just for the elite of the world. He thrives using a cheap insulin in the same country where people die because they don’t know they can change their dietary habits and purchase cheap over-the-counter insulin in most states and survive.
From an economic and financial viewpoint, Bernstein’s protocol is also a stunning success. I don’t use an insulin pump or a CGM (I only got to test one out) and yet I can achieve my glycemic targets. I don’t need any apps, certified diabetes educators, or expensive technology. I don’t anxiously await a closed-loop hybrid insulin pump system because I don’t need it. I put all my energy into my simple but effective daily lifestyle. Providers who want to see healthier patients, please read Bernstein’s book. Your lower income patients may not want to follow the regimen in part or entirely but those who are willing deserve to know how to thrive with diabetes despite being poor or lower middle class, like me. I give myself excellent care for cheap–doesn’t that peak your interest?
People are justifiably angry over insulin prices but what about the medical community’s unwillingness to be curious about one doctor’s personal plan to keep himself at peak health and fitness well into his 80s? Without curiosity, what on earth then drives a doctor to investigate the issues in each patient as well as find the proper and least harmful solution? I tell my doctor how I managed a huge drop in A1c for the first time in my life and he has no questions regarding how I did it? I read doctor responses to research that shows a teeny tiny improvement in A1c and now they think “this shows wonderful promise and we should look into it further!”? I basically told my doctor I might have just saved my own life and drastically improved my quality of life, and he’s like “meh”. I told another how I did it and he said, “good for you.” Yes, good for me, but what about some of your patients who are as I was, struggling to get a halfway decent hold on their blood sugar and suffering? What about them? Don’t you have an obligation to check this out? This gives my doctor less work, by the way! For a decade now my doctor does nothing to manage my diabetes–he just orders labs. Aren’t doctors wanting more patients that can manage their blood sugars and don’t need them so desperately at all hours?
Nothing terrible ever happened by being disciplined. Think of all the amazing people out there and from history–what could they have accomplished without discipline? Probably nothing but a few moments of greatness. Discipline encompasses you within a realm of potential greatness. And if you create a system, discipline isn’t a show of willpower as much as you just loyally following your regular routine.
Much research backs up the potential of the ability to defer gratification. Who is more likely to become successful? The person who can restrict themselves from their impulses and short-lived desires, right? Let me put it this way: who would you rather marry? Someone who can keep their impulses in check or someone who can’t? Or who would you rather be? Someone who doesn’t overeat or someone who regularly does? I remember having hearts in my eyes when my husband told me “I never overeat”. I have long struggled with overeating, and when he said this, I was impressed by him and thought, “wow, I want to be like that.” I believe this is the empowered response. I could have given the common humorous response of “ugh, you make me sick” but where would that have gotten me? Instead, I tried to learn from my husband and improve myself.
I also think the healthy response is to admire someone like Dr. Bernstein for what he has accomplished against great odds. Dr. Bernstein is respected by so many because he created a well-functioning system to get himself thriving and generously shared his findings with others. In fact, as an engineer, he became an endocrinologist so that he could help others after he figured out how to save himself. He should be regarded as an American hero, whether you want to do what he recommends or not.
I believe in freedom and personal rights. I’m an immigrant who is incredibly happy to live in the U.S. Growing up when I found something challenging and I didn’t want to face it, my dad would say “Are you an American or an American’t?” I would often roll my eyes but, yes, I’m an American and believe I have the power to set my mind to improve myself if I want and I’m grateful for those who have set their minds to things and laid out paths before me. Thank you, Dr. Bernstein. I may never reach your astounding level of discipline but what I have been able to achieve with your advice has been most valuable to me and my family and I am forever grateful.
En fin, I’m certainly not saying you should do what he does or what I do. And I can respect wherever you are on your journey. I’m saying that Dr. Bernstein’s method has shown undeniably incredible potential and results and the general lack of curiosity and investigation on behalf of the global medical community makes absolutely no sense to me. There are now thousands of people doing it and doing it well.
Newton supposedly struggled with his ego and an inability to face criticism or questioning during his lifetime. Let’s have his overwhelming curiosity without the pride, his determination to dig and experiment properly without his emotionally unstable and anti-social ways.
I will leave you with one more thought:
Just a little bit less damage sustained is a great deal to the person enduring it, especially when they still have many decades ahead of them.
Years ago I suffered from a 9 millimeter kidney stone that had to be laser zapped into pieces. The procedure was deemed “successful” but left me with a torrential avalanche of small kidney stone pieces that sent me right back to the hospital in extreme pain later that same day. It was the type of pain that makes you lose the will to live because in the moment, you need anything to come between you and that pain.
Luckily, after a few hellish hours, my nightmare was over. I was sent home with strong pain medicine to take over the next few weeks while more kidney stone fragments made their way down my ureter.
I kept feeling twinges of pain so each day I took one of my pain pills. I knew that if the pain got too bad before I took medication, that the medication would be almost useless at that point and since I was traumatized from the pain I took my precautions against it.
I took the daily doses for about two weeks before I decided to chuck the remainder of the pills in the garbage.
I did this because those two weeks were among the best of my entire life. Let me explain.
During this time, I was coming out of a period of poor diabetes management so I was healing from some diabetic nerve damage in my feet, healing my depression and was also in the process of working on improving my issues with anxiety surrounding my diabetes.
The strong pain medication didn’t allow me to feel my foot nerve pain and it seemed to completely remove my anxiety about my diabetes. I lived temporarily as someone who, about half of the time, forgot she had diabetes in the first place.
This was wonderful to experience (though I don’t and can’t recommend it to anyone, of course). I became the opposite of my uptight self who was always paying attention to symptoms and was worried about blood sugars. I dare say I was the most pleasant version of myself I’ve ever witnessed. This isn’t to say that people with diabetes are uptight–but some of us are because it is the only way we have come to cope with trying to manage our condition. I truly admire those who can take good care of themselves without becoming a little neurotic. It is true too, that I may have been feeling so great partially due to not being in pain after being in tons of pain and the stark contrast left me in a type of momentary heaven.
My mind felt free to interact fully with those around me because I wasn’t stuck in my internal dialogue regarding my worries about insulin, blood sugar, complications and carb counts.
So how did I manage my diabetes during those two weeks? Really well, actually, because I was in the habit of checking my blood sugar levels and so that still continued like clock-work. I kept giving insulin like before and I kept eating low carb foods as usual. I was aware that I may not feel highs and lows on a strong pain medication so I threw in more blood sugar checks and even these were easier because I didn’t feel apprehension about the results. I am pretty sure I also did less anxiety eating and made better food choices, too.
I realized that my feeling so wonderful about life had everything to do with an illusion however, so I knew that before I became addicted to the pills, I needed to get rid of them for good. It hurt but I threw them in the trash, felt an impulse to rescue them and then threw the trash out in the garbage can.
It was a major bummer but my lesson here was that my goal would be to continue doing what I needed to do to manage my diabetes while somehow managing to turn off the perfectionistic and unhelpful demands and worries I was living with. Those two weeks proved that I didn’t need all that to manage my diabetes well.
It has been 11 years and I don’t think I’ve had a happier consecutive two weeks since. I’m still working on toning down my bouts of negativity and anxiety. I may not have achieved what I would have liked to but I’m hanging in there and am regularly picking myself off the ground and I suppose that counts for something.
I can live with myself as long as I keep trying.
Click for the Favorites and Motivations – Saturday 5/16 Link List.
If you have been blogging for a while, what is your favorite sentence or blog post that you have ever written? Is it diabetes related or just life related? If you are a new blogger and don’t have a favorite yet, tell us what motivated you to start sharing your story by writing a blog? (Thank you Laddie of Test Guess and Go for suggesting this topic.)
My favorite blog post: (Because getting this info down took forever and it’s one of the biggest things that helps me…)
I really believe carb counting alone is insufficient when it comes to my diabetes management. At least the simple way it’s taught. It’s just my opinion and I’ll explain why:
I’ve found that for ME, there are adjustments I make for different types of carbs. These are adjustments beyond just subtracting grams of fiber. A carb is not a carb. They vary spectacularly and learning their differences helps me keep my blood sugars in range and helps me decide which carbs to avoid.
I classify my carbs:
-Sugar/sucrose/plain fructose (no fiber)
-HFCS (High Fructose Corn Syrup)
-Chocolate, ice cream, and other high fat desserts
-Fruits and vegetables
When I eat anything with processed grains like white rice sushi or pizza or cookies, cake, or crackers, I have to watch out for a post meal blood sugar skyrocket. It doesn’t happen right away which is why it’s often confusing to dose for these kinds of foods. For example, last time you had pizza you were high afterwards so this time around you give more insulin, only to get low in the middle-towards the end of your meal.
I find that about 30 minutes after eating anything with refined or processed grains, I have to give another dose of insulin. An insulin pump option on a dual or square wave bolus works well for a lot of people, but from what I gather, people with and without pumps have a hard time keeping blood sugars in range with processed grains.
Eating something like candy made from glucose or sugar or drinking plain 100% juice or sugar sweetened beverage is a bit different. I find that if I’m going to consume this within a reasonably fast amount time (as opposed to snacking over a period of 30 minutes) then I count carbs and using my 1:15 scale, I give just that amount of insulin. Then I wait 15 minutes for the insulin to start working (more if I’m not in range). I find that the insulin cancels out the sugar carbs pretty well and there is no shocking aftermath.
High Fructose Corn Syrup (HFCS)
This one is interesting. At least for me (remember, this is just what happens in MY body). I find that candy or beverages made with HFCS works like when I eat refined grains. But that makes sense to me when I think about corn being a grain! It’s easy to forget because people serve it to kids and say “eat your veggies”.
High fat desserts
This gets it’s own category because of the large amount of fat (and because they’re my favorite!) I try to stick with dark chocolate for a low dose of sugar. I also make sure to buy desserts that do not have HFCS in it as a sweetener. I try to get the gourmet kind with minimal ingredients and then I count carbs and give insulin in the middle of eating since the fat content really slows down the absorption of most of these foods. If there is a lot of sugar I give insulin prior to eating as usual. I’m referring to a dessert like high fat truffles, mostly.
I count carbs and then add a tiny extra amount of insulin to my carb count depending on how much I eat. I don’t have to do this unless I’m really filling up on this protein source. I love how these foods fill me up and do very little to my blood sugars.
Vegetables and Fruits
I’m a fan of these, especially in terms of carbs. As you are well aware, the high antioxidant, vitamin, mineral, fiber, and water content of these foods makes them wonderful for our health. I definitely don’t need as much insulin for these foods. I count the carbs and then omit for fiber content. Fruit is something I stick to consuming in it’s natural state and in small quantities. The sugar in fruit is fructose and too much overloads the liver, causing fatty liver problems. Oh and it definitely affects blood sugars. My favorite are cherries, they are very low glycemic. Have you tried them for a low? It takes so many!
I know I didn’t talk about legumes or nuts. I don’t eat legumes anymore. I think I ate too many as a kid. I treat legumes like vegetables and I treat nuts like meat.
With any food: If I eat a lot, I need to give a little extra insulin for the full stomach effect that Dr. Bernstein has talked about in his books.
I adjust for a few other things. I’ve mentioned them before but here we go again:
–BM status. Eww, I know. But being backed up might make a person anticipate a need for more insulin. The opposite of that issue= less insulin. So watch out for major lows if you get food poisoning!
–Stress. If I’m stressed, I have to give a little bit extra insulin to combat the stress hormones and their affects on my blood sugars.
–Exercise. Different types of exercise require different diabetes management approaches. Read Ginger Vieira’s book for that info and so much more-even worksheets for getting all these changes right!
–PMS. Days before I start, I need to up my basal insulin.
–Sleep. If I stay up late (past midnight), I have to give some extra insulin (unless I’m active).
–Sedentary. If I’m being sedentary more than two days in a row due to sickness or diabetes burnout or whatever, I definitely have to up my basal insulin substantially (by 30-40%).
–Too much artificial sweeteners. Certain artificial sweeteners in high doses do contain carbs (it’s a small amount per serving so they’re legally allowed to round down to 0) so if you’re binging on diet coke, check your blood sugar and stay alert to a sneaky increase.
That’s all I can think of. It’s just an example of how you want to be aware of how your body reacts to different types of food and activity. You can see why I stick with meat/poultry/seafood, vegetables, and fruits. Much better blood sugar stability and less variability for me. But when I do splurge, at least being aware of how those foods act differently help me manage them for those occasions.
I write all this out because you can have tighter blood sugar management. It helps to learn yourself and the foods you’re eating. Again, get Ginger’s book or ebook and discover how to improve your blood sugars. I highly recommend it.
If successful diabetes management is based upon a multitude of decisions we make during the day, why is technology often regarded as the number one asset in our diabetes management arsenal?
It can’t possibly be. Take some important daily decisions that all impact diabetes:
-what to eat
-when to eat
-how much to eat
-how much insulin to give
-when to give insulin
-when to exercise
-what type of exercise to do
-how much to exercise
-when to test blood sugar
-how often to test blood sugar
And on and on!
Now basic technology like a meter is huge. But, only if we choose to use it. And a pump, for many of us, makes it easier to eat and deliver insulin as needed and to do a wide variety of exercises, as long as we choose to use it properly. A CGM gives us information about trends and helps us catch highs and lows before they get too high or low. Not to mention it can help save our lives by alerting us to dramatic blood sugar levels.
So technology is awesome!
It would seem that those using all of this technology would always have better diabetes management than those who only use a meter and syringes, right? And yet, in my personal experience, I’ve met many people who use a meter and syringes and do very well and people who use all the technology available and don’t do very well.
There are other important variables that always need to be considered. So when a person is struggling with their diabetes management, often times more questions need to be asked than what is often asked. Most likely, a person who can do well with a pump, can do well without one. And CGM’s are most dramatically beneficial to those who can’t feel their lows or have young children with diabetes.
My cautioning is really about avoiding the conclusion that, “If I had a pump, my diabetes would be controlled” or “I probably just need a CGM to have controlled blood sugars” without considering other factors. This isn’t to say these tools won’t dramatically help one’s management. There is no guarantee and the decisions a person takes throughout the day is a better indicator of how a person will do with diabetes technology.
So if you’re struggling with your diabetes management, assess the root of your individual struggle. Some people’s issues are best addressed with technology, but many issues are addressed outside of technology and skipping this facet of diabetes management can prove extremely frustrating and detrimental.
I know because I’ve been there, done that. Address your personal needs and let your blood sugars be your guide. What technology can’t begin to replace is you and your knowledgeable decisions, which require knowledge about your diabetes. Make sure your bases are covered before relying on gadgets.