Sunday, November 9, 2014

Dr. Bernstein's Diabetes Solution

I am starting this post on October 26, 2014.  My intention is to list here each status update I post on Facebook, Google+, Twitter, TuDiabetes, and/or Tumblr that has anything to do with the book I am currently reading/studying, Dr. Bernstein's Diabetes Solution, 4th Edition.

Dr. Bernstein's book promises to teach diabetics how to properly regulate blood-sugar and live a much healthier, longer life.  I have decided to list my status updates and comments here as a way of keeping my thoughts/notes in order and keep me motivated to keep reading, studying, and working on my health.  If I don't have a way to keep myself in check, then no matter how good something is for me, I'll get bored with it and give up.  So, here we go!

By no means is this post meant to give away Dr. Bernstein's teachings.  What I have written here is a very basic overview of the book.  Dr. Bernstein's book is full of much more information and teachings, and much more detailed than what you will read here.  I have posted here only things I found especially interesting about each chapter.  All chapters contain much more than what I have listed.

I highly recommend all diabetics and their close loved ones purchase and read Dr. Bernstein's Diabetes Solution.  

Although I have carefully read the entire book once through (so far, I plan to study and use it for many years to come), I may have some mistakes here...I am only human after all. 

1. Just read the My Life With Diabetes section of Dr. Bernstein's book. He's type I diabetic and this chapter of this book is about his history. He suffered from all the same complications I have and managed to find a way to regulate his blood-sugar so well that all his complications went away. I can hardly wait to read on and learn how to do what he has done! In this chapter he also talks about the history of glucose monitors and how doctors used to think patients wouldn't and couldn't monitor their own blood-sugar, and how they didn't think blood-sugar regulation was all that important. Also they used to put diabetics on low fat/ high carb diets!!! My how things have changed, I'm glad I live today and not in the dark ages (pre 1980). So far a fascinating read and I am hopeful it will help me greatly.

2.  One thing I've always encountered with all the doctors I've ever had: endocrinologists, primary care... they never acknowledge or seem to understand that diabetes causes chronic fatigue. "Oh, when your BG is low, a symptom is tiredness", "well when you are real high it can make you tired". Yes, this is true; but they don't seem to get that we're tired ALL the time, CHRONIC fatigue. It blows me away that they don't understand this problem, almost all the diabetics I know and have read "life with diabetes" stories on, mention the issue of chronic fatigue, and not just when high or low, but ALL the time. Reading testimonials in Dr. Bernstein's book is no different. Almost every single testimonial included chronic fatigue. And every single one mentioned that his program remedied the issue. I'm liking this book, even if half the testimonials also mentioned that his program is strict and takes a lot of determination. I'm Ready!

3.  Just read another chapter of Dr. Bernstein's Diabetes Solution.  This chapter lays out in detail what diabetes is and how it works (or doesn't) in Type I and Type II diabetics.  He also explains how the pancreas and insulin work in a non-diabetic for obvious reasons.  Then he goes on to explain how eating an average meal mixed with protein and carbs works for a normal person, a type II, and a type I.  Very fascinating and frightening.  Here's a quote from this chapter:  "This is the central problem for type I diabetics - the carbohydrate and the drastic surge it causes in blood sugar. Because I know my body produces essentially no insulin, I have a shot of insulin before every meal. But I no longer eat meals with fast-acting or large amounts of carbohydrate, because the blood sugar swings they caused were what brought about my long-term complications. Even injection by means of an insulin pump cannot automatically fine-tune the level of glucose in my blood the way a nondiabetic's body does naturally."

4.  Chapter two of Dr. Bernstein's book covers all the tests a good diabetic doctor should run on every diabetic. He teaches what these tests are for and why they are important. At the end of the chapter he adds a little note that vitamin C is not so good for diabetics. Here's what he has to say about it. "Dietary vitamin C is important to good health. in doses above 500 mg/day, however, vitamin C supplements can destroy the enzymes on blood sugar test strips and can also raise blood sugars. Finally, in levels higher than about 400 mg/day, vitamin C becomes an oxidant rather than an antioxidant and can cause neuropathies. If you are already taking supplemental vitamin C, I urge you to taper it off or lower your dose to no more than 250 mg daily. Use only the timed-release form."

5.  Chapter three of Dr. Bernstein's book covers all the supplies every diabetic should have and why.  He also lists with them the average cost and whether or not they require a prescription.  For some he even lists where you can get them (if not readily available at local stores, etc.).  Most of the stuff I have always known about and use, but some items are new to me.  Like Frio, "This very clever product, a reusable wallet-style cooler activated by immersion in water, will keep insulin cool when you are traveling in hot climates.". Another thing he covers in this chapter is dehydration.  I have become very prone to dehydration in the past eight years or so and I thought it might be caused by my diabetes.  In this chapter he does not cover diabetes causing dehydration but he does have something to say about it. "Dehydrating illnesses, such as vomiting, diarrhea, or fever, are potentially fatal for diabetics. If you become dehydrated, salt substitutes can help you replace lost electrolytes. Look for potassium chloride on the list of ingredients. These should be available at the supermarket or grocery store.".

6.  Dr. Bernstein covers in chapter four of his book how and when to measure blood sugar.  This is a short chapter and virtually all of the information is stuff I already know quite well.  One thing he does mention that is something that contradicts what I was taught and retaught by many doctors is that he recommends NOT using alcohol to disinfect and clean your finger before pricking. "...this will dry out the skin and can eventually foster the formation of calluses. Neither I nor any of my patients have developed finger infections by not using alcohol, and I surely hold the world record for the number of self-inflicted finger sticks."  He simply recommends washing your hands before pricking.

7.  Dr. Bernstein discusses in chapter 5 how to create your own blood-sugar profile.  It is important to record all blood-sugar readings, food eaten (carb count, etc.), exercise and activities that raise or lower BG, and medications that raise or lower BG. This way you can see everything laid out and be able to learn what has an effect on your BG and how to correct it one way or the other and better regulate your blood-sugar. He also talks a little about other things that can mess with blood-sugar levels such as emotions, infection, illness, etc.

8.  Chapter 6 of Dr. Bernstein's book covers peculiar things that can affect blood-sugar. He covers a number of different things such as gastroperesis, stress, insulin resistance, etc..  The one that I found most interesting is The Chinese Restaurant Effect.  Basically this is the explanation for why a diabetics blood-sugar surges even when they haven't eaten something that has value..."why has my blood-sugar gone so high?  All I ate was celery!"  The reason isn't what you ate, but how much of it you ate.  When we fill our bellies, the body releases a hormone, glucagon, that raises blood-sugar. This is why it is important that diabetics not eat large meals...of anything! "The first lesson here is: Don't stuff yourself.  The second lesson is: There's no such thing as a freebie. Any solid food that you eat can raise your blood sugar."

9.  Chapter seven of Dr. Bernstein's book explains the laws of small numbers.  The best way to keep blood-sugars under control is to keep carbs and medications down to small amounts.  "Big inputs make big mistakes; small inputs make small mistakes.".  He goes on to explain that you can't trust the ADA's diet recommendations nor can you trust what you read on food labels.  The food packages are permitted a margin of error of 20%.  This can make for a huge increase or decrease in blood-sugar for a diabetic who is judging their medication dosage based on the carbs listed on food packages.  On top of that terror, is the fact that not all injected insulin gets used by the body, only part of it escapes the body's immune response.  How much gets used is based on dosage, body weight, and current blood-sugar level. Bernstein also discusses how "fast acting" insulins aren't fast enough to match how fast carbs raise blood-sugar. He then goes on to discuss when it is best to take your medications.

10.  Chapter eight of Dr. Bernstein's book gives an overview of his treatment program.  First he lists the four types of programs he has.  He has four different programs because there are many types of diabetics. He then lists and explains why he sets a blood-sugar goal of 83 mg/dl.  Yes, he wants your blood-sugar to stay at 83 ALL the time and stresses that it is possible. "The ADA recommendation for "tight control" of blood sugars, from its website, is as follows: 'Ideally, this means levels between 90 and 130 mg/dl before meals and less than 180 two hours after starting a meal, with a glycated hemoglobin level less than 7 percent.' The recommendations go on to state that tight control (what I advocate) 'isn't for everyone,' which I believe is nonsense. But the ADA's tight control as defined above isn't very tight at all. I would call it 'out of control'."

He finishes off the chapter with a list of goals for treatment which include such things as normalizing blood sugar, normalizing all the standard lab tests, reaching ideal weight, full or partial reversal of diabetic complications, relief of chronic fatigue, and other things...

11.  Chapter nine of Dr. Bernstein's book covers the basic three food groups, protein, fat, and carbohydrate.  He says at the beginning of the chapter that if you are diabetic, be ready to learn that everything you've been told about a healthy diet is wrong.  I found this to be half true for me. He starts with protein, explaining what it is and why it is so very important for everyone, especially diabetics. Proteins are made of amino acids which are essential for life.  It used to be believed that for diabetics, a diet rich in protein was the cause of kidney disease.  Nope, the cause of diabetic kidney disease is high blood sugar AND the large amounts of insulin taken to try to bring it down. Next he talks about fat.  Many people believe that eating fat makes you fat.  Nope, "The fallacy that eating fat will make you fat is about as scientifically logical as saying that eating tomatoes will turn you red.". Also, the belief that eating fat will cause bad cholesterol is wrong.  Both weight gain and bad cholesterol come, in part, from high carb diets. He explains how this works but for the sake of not taking up to much room here, you'll just have to read the book yourself! He then goes on to explain how insulin and fat are connected.  The more carbs you eat, the more insulin (fat building hormone) you require, and the more your body will turn some of that sugar (carb) into fat and store it (weight gain). He moves on to explain what carbs are and how they work and why they are so bad for everyone but especially for diabetics. Lastly he discusses alcohol and what types are actually OK for diabetics to consume and when and how much are OK.

12.  Dr. Bernstein discusses in chapter ten, foods that are acceptable in a healthy diabetic diet, and foods that are not. Obviously, carbohydrates are highly restricted and many foods high in carbs are out of the question. One thing I found very interesting is that artificial sweeteners often contain added sugar and will affect blood sugar as if you were using real sugar. He says to avoid powdered forms of artificial sweeteners and to use only liquid or tablet forms. Usually "diet foods" and "sugar-free" foods are high in carbs, so don't eat them! Whole fat milk has less sugar than low fat milk. Cheeses are acceptable except for cottage cheese. Absolutely no fruits of any kind! He then lists many foods that are good to eat, and I am happy with the list. Lastly he goes over vitamin and mineral supplements. He states that when following a healthy diet like the one's he teaches in his book, there really is no need for supplements except for vitamin D-3 and in some cases a couple of other supplements are needed if the individual person has a special need. 

13.  Started following what I've learned from Dr. Bernstein so far. Doing good, not feeling deprived or hungry at all. Only craving carbs a little which I find surprising since I'm so addicted to the carb lifestyle. But the high protein stave's the carb cravings, I think.

14.  Chapter eleven of Dr. Bernstein's book goes over how to create a meal plan. First he points out the obvious, changing your eating habits should be accompanied by a change in medication dosages as well.  He then talks about the amounts of carbs and protein you should eat per meal and gives examples. He throws in a discussion about timing your meals for blood sugar regulation and makes sure you know that the amounts of carbs and protein should remain consistent each day. He gives discussion and examples of breakfast, lunch, dinner, and snacks.

15.  Chapter twelve of Dr. Bernstein's book covers weight loss.  This chapter is mostly for type II diabetics who are also obese, but can be helpful for type I's as well. He discusses why and how one becomes obese and then moves on to give helpful advice on how to safely and permanently lose weight.  Of course he talks about how detrimental being over weight is to a persons health and also why diabetics gain weight so easily and find it hard to lose. The more insulin you have in your body, the more fat your body will store.

16.  Chapter thirteen of Dr. Bernstein's book covers solutions for carb cravings and overeating. First he covers self-hypnosis, a technique he says can be very helpful and doesn't require a prescription and doesn't come with side effects.  Then he covers incretin mimetics which are very good for curbing appetite and making you feel full.  The inability to feel satiated is a very common complication of diabetes, and this leads to overeating and weight gain. He explains what incretin mimetics are and how to use them properly for BG regulation and weight-loss. He talks briefly about gastric surgery, basically he does not advocate it because of the legion of complications that come with it. 
He adds in to this chapter a quote from a book one of his college professors wrote:

"Accept responsibility for Your Eating Behavior. It is very tempting to blame your eating behavior on your parents, your wife, the mayor, Watergate, the moon, the tides. As soon as you see the absurdity of that you will realize that of all the things you do in life, there is nothing in which you are more clearly 100 percent responsible than your eating behavior. Reflect on the fact that most of the things you do in life have to take into account other considerations or other people, but in your eating behavior you are in business for yourself." - Dr. Spiegel, Trance and Treatment

17.  Chapter fourteen of Dr. Bernstein's book covers exercise.  This chapter is mainly for using exercise to enhance insulin sensitivity. He first explains generally why people should, and do, exercise.  It makes us feel good and prolongs life.  If there is anything in this book that has shocked me, it is this chapter.  Everything I thought I knew about diabetes and exercise is mostly wrong. "Many type I diabetics have been ill for so long with the debilitating effects of roller-coaster blood sugars that they are often depressed about their physical health. Numerous studies have established a link between good health and a positive mental attitude. If you're a type I diabetic, as I am, strenuous exercise will not improve your blood sugar control as it will for type 2s,...".  Exercise improves insulin sensitivity which can help type 2s because most type 2s are insulin resistant, but won't do much for type Is. Exercise can both lower blood sugar, but can also cause it to rise, depending on what you do and for how long.  Exercising in the morning (within 3 hours of waking) may raise your blood sugar because of the Dawn Phenomenon. If you do have a low during exercise, use glucose tablets, not food, to treat it.  Glucose tablets will fix the low immediately and with no lasting raise later. Food is more unpredictable and usually will help now but also continue to raise your BG over hours. The best form of exercise for a diabetic is not aerobic but anaerobic exercise (strenuous muscle building exercise). In this chapter he also talks about making sure you work with your doctor and are healthy enough to exercise, and also goes over types of exercise, safety in exercise, and how to figure the effects of exercise on your BG and balance your glucose, exercise, and medication to keep your BG regulated.

18.  Chapter 15 of Dr. Bernstein's book is about oral diabetes medications. This chapter is primarily for type 2 diabetics.  There are three types, insulin-sensitizing agents, those that resemble insulin, and the kind that make your pancreas produce more insulin.  He only advocates the use of the first two, because the third can actually "burn out" your insulin production. He explains what each type of medication is used for, how to use it, and any side-effects. He also talks about some dietary supplements that can help to lower BG such as R-ALA in combination with biotin and evening primrose oil. He states that high iron in the blood can cause insulin resistance and diabetics who have a hard time keeping their BG down even with a proper diet and medication should have their iron checked.

19.  Chapter sixteen of Dr. Bernstein's book covers insulin injections. First he debunks the myth that once you go on insulin, you can never come off. Then he talks about the advantages of taking insulin if needed. Next he shows the sites best for injecting.  No, the thighs are not one of them.  Then he describes how to inject painlessly which is the same way I was taught; grab a hunk of skin and fat and "throw" the needle in fast, inject fast, and pull out fast. He spends a good amount of time talking about the best type of syringe to use. Then he talks about the proper way to fill a syringe and how to not get bubbles.  Also he talks about how to avoid causing a vacuum in your insulin bottle. He then says that it is not good to roll your cloudy insulin.  Shaking is better.  He says mixing types of insulin is bad because they often change when mixed, like N will slow the speed of R.  It is best to do two separate injections.  Do not reuse syringes because they can contaminate your entire vial.  You do not need to wipe with alcohol before injecting, it is highly unlikely to get an infection from injecting insulin. The scent of insulin is from a preservative called metacresol. He says using "painless" injector devices is a waste of money and don't really work.  He says jet injectors aren't really worth it either. He doesn't advocate using insulin pens either because they can not measure to precise quarter-units or even half-units (except one brand), so they aren't helpful in truly regulating BG.

One last thing: Look up on Amazon Disintegrator Plus.  So cool!

20.  Dr. Bernstein discusses in chapter 17 of his book types of insulin. There are four categories of insulin, most-rapid-acting, rapid-acting, intermediate-acting, and long-acting. The two insulins I currently use are N which is an intermediate-acting insulin and the only insulin left that is cloudy, and R which is a rapid-acting insulin.  I find it disturbing that the N I use is one of the two insulins he says never to use.  For N his reason is because it contains protamine which can cause the immune system to produce antibodies to insulin. The other insulin he prefers never to use is Lantus because it has a short shelf life and is linked to cancer. So he prefers Levimir over Lantus because Levimir is safer and has twice the shelf life. In this chapter he also goes over strengths of insulin, how to properly store your insulin, how each type of insulin affects your BG over time, when to use which type of insulin, diluting insulin, and other things regarding insulin.

21.  Chapter 18 of Dr. Bernstein's book covers simple insulin regimens. Mostly he talks about long-acting insulin. First, he talks about what you should do if you experience higher blood sugars in the morning than at night. then he goes over what to do if you experience blood sugar rises during the day even if you skip meals. He then goes over how to monitor your regimen.  I find it interesting that some people experience weather related changes in blood sugar.  Lower blood sugars when the weather is warm, higher when the weather is cold.  He then talks about how to adjust when traveling across time zones. Lastly he suggests splitting larger doses.

22.  Dr. Bernstein's chapter 19 is a long one.  This chapter covers intensive insulin regimens.  This chapter is mainly for type I's but can be helpful for type 2s.  This chapter also involves a lot of math, obviously. First he discusses taking insulin before every meal.  Some people need to, some don't, it really depends on individual health and needs. He prefers using regular insulin (R) for covering meals, but advocates the use of Humalog (most-rapid-acting) for when you are off schedule or are not sure of exactly when you will be eating. He goes over when is best to take which insulins and how long before eating they should be taken. He takes some time to discuss how to figure your dose needs and how long an insulin acts in your body and how much it brings your BG down, ect.. He then talks about snacking; for type I diabetics, he does not like the idea of snacks because they can greatly interfere with BG regulation and make it more difficult to figure meds and meals...they throw off the balance unless you eat the same snack everyday. He then talks about target blood sugars.  Basically the average non-diabetics blood sugar hovers around 83, and there is no reason a diabetic can not do the same, they just need to work harder at it and do things differently. He moves on to talk about how to rapidly correct a high blood sugar.  He then talks about when to cover (more insulin) a high. Then he discusses what might be the problem if your estimations don't work and you just can't seem to get things in line: bad insulin, insulin resistance and the dawn phenomenon, blood sugar above 200, infections. Then he covers when it is useful to take an intramuscular injection, when you absolutely shouldn't, and how to do it. Then he covers taking insulin in addition to oral diabetes meds. He covers how often you should check your blood sugar and when you should do it. Then he talks about insulin pumps; he lists their benefits and then their problems. Basically he says you are better off without a pump.

23.  Chapter 20 of Dr. Bernstein's book is How to Prevent and Correct Low Blood Sugars. This chapter is for type Is, 2s, and their family, friends, and co-workers. "Denial. As hypoglycemia becomes more severe, or if blood sugar has been dropping slowly, many patients will be certain that their blood sugars are fine. An observer suspecting hypoglycemia should insist on a blood sugar measurement before accepting the diabetic's denial." He first gives the basics on what hypoglycemia (low blood sugar) is, symptoms, how and why it effects the brain, and causes. He then moves on to how to properly treat mild, moderate, and severe lows properly ( without overshooting it or using dangerous methods). He teaches how to use glucose tablets, glucose gel, and glucagon injection. He goes over many what ifs that I won't discuss here but are very helpful. He then goes over what tools you should always have on hand to treat low blood sugar. He also discusses emergency ID tags, alarms, and CGM (continuous glucose monitor). He then discusses hypoglycemia unawareness and what can cause it. He also discusses autonomic neuropathy.

A side note of something I found very interesting: My dad was a type I and he often did the following; we never thought it was due to low blood sugar (we just thought he was upset or frustrated over something...short-tempered), but now I wonder.   "Pounding hands on tables and walls or kicking the floor or other objects"

24.  Chapter 21 of Dr. Bernstein's book covers dehydration. This chapter is for type Is, 2s, and their families. Dehydration in diabetics can kill us within hours, therefore it should not be ignored or taken lightly and must be treated immediately. "When you experience vomiting, nausea, fever, diarrhea, or any form of infection, you should immediately contact your physician.  I can't emphasize enough the importance of getting treatment and getting it fast." He first goes over what dehydration is and how it works.  He then describes what it does to a diabetic and the vicious cycle it creates that can easily and quickly lead to kidney failure and/or death. He then goes over what can cause dehydration and how a diabetic should treat dehydration based on the cause.  He goes over how to adjust your medication during illness, fasting, etc..

25.  Chapter 22 of Dr. Bernstein's book is all about gastroparesis. This condition is caused by damage to the vagus nerve caused from autonomic neuropathy which is caused from chronic high blood sugars. Gastroparisis can be cured by months or years of regulated blood sugars. This healing can possibly be sped up by large amounts of evening primrose oil combined with R-ALA.  He starts the chapter by explaining what gastroparesis is and what causes it. He then explains how the condition affects blood sugar and makes it more difficult to control. He moves on to discuss how gastroparesis is diagnosed. He then talks about treatments (not cures) for the condition: foods and products to avoid, medications (prescription and non), exercises, meal plan changes, foods and products that help, STS therapy, and electrical gastric stimulation. He moves on to discuss how to treat low BG and high BG when suffering gastroparesis, and how to use your diabetes medications properly.

26.  Dr. Bernstein talks in chapter 23 about routine Dr. visits.  It is good for a diabetic to see their doctor every two months. He goes over why you should see your doctor every two months and what you should bring with you.  He then goes over what each visit should entail, how often specific tests should be done, and other points about preventative, early detection, and ongoing care.

25.  Chapter 24 of Dr. Bernstein's book covers what you can expect from regulated blood sugars. Improved memory, neuropathies, vision, and many other wonderful things.  I highly recommend all diabetics read his book.

26.  Part three of Dr. Bernstein's book is a compilation of healthy diabetic recipes.  Each recipe lists servings, serving size, ingredients, and instructions.  Next to each individual ingredient is listed its carb and protein content.  Looking through the recipes I am eager to try them all!

27.  I have been following Dr. Bernstein's Diabetes Solution for a solid week now.  Well, not entirely, I have just made changes in my diet so far and will be adding other things very soon.  Here's what has happened in just one week:

- I have cut my insulin requirement by nearly 3/4!
- My BG's are still roller-coaster, but in a much closer to normal range
- My vision seems much clearer
- I "feel" good
- My shoulder is showing signs of faster improvement
- I have lost 9lbs.

In just one week!!!! And this isn't even doing everything, just some diet changes!

28.  In Appendix A of his book Dr. Bernstein discusses widely advocated dietary restrictions for diabetics and why they are not good.  He uses many studies, history itself, and his extensive medical knowledge and personal experience to prove his points. He discusses high-carb, protein restriction, salt restriction,and high fiber diets. In addition he also discusses risk factors for heart disease and kidney disease.  Also he discusses why the glycemic index poses problems.

29.  Appendix B of Dr. Bernstein's book covers ways of ensuring that you can keep your blood sugar normalized while in the hospital or undergoing outpatient procedures.  It is a terrible thing that most hospital staff are horribly under skilled in dealing with blood sugar control and live in terror of hypoglycemia, therefore diabetics end up with high blood sugars while in hospital care. He gives an outline for a letter you can personalize and provide to your admitting physician stating your concerns and requirements for your blood sugar control while in the hospital.  You can and should be allowed direct control of your diabetes medication and glucose monitoring.

30.  Appendix C of Dr. Bernstein's book are lists of drugs used for other conditions than diabetes that can raise, lower, and/or mask blood sugar levels/symptoms.

31. Appendix D of Dr. Bernstein's book covers foot care.  Diabetics are at extremely high risk for foot problems that can easily lead to amputation.  He covers how to avoid foot issues, examine your own feet, and what to do if you find an issue. 

32.  This is the last one, people!  Appendix E of Dr. Bernstein's book covers Polycystic Ovarian Syndrome (PCOS).  This condition is not strictly in diabetics, but is a very common complication of diabetes in both type I and type 2 female diabetics. He goes over what PCOS is and what it does to a woman's body, what the symptoms are, how it's diagnosed, and treatments. PCOS, he suspects is highly under diagnosed due to the difficulty in discovering it and the test required to positively diagnose.

After reading this book and already starting to follow some of his teachings and seeing immediate results, I fully intend to incorporate all of Dr. Bernstein's guidelines into my daily life. I intend to post regularly on how I am doing with this new lifestyle. 

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