Managing the Bernstein eating plan

[LucySW]

To be honest I am totally freaked out and not sure of what to make of it all ... I went to bed and my BG was 76. I woke up this am and I was at 86.

Runner,

1) I think the point to focus on is what your target BG was and whether you were meeting it. If those BG levels are what you want, is there a problem? Beyond the stress.

2) you're still taking insulin - long-acting insulin? - once a day, 3u?

3) Those BG levels are beyond Bernstein's, aren't they? His are 4.6/83 fasting, 5.2/93 after meals. So do you want to stick as low as that using insulin, or should you consider stopping the insulin and seeing if you can keep inside the Bernstein targets with diet and ex alone?

4) I certainly and probably all of us feel with you about the stress load. Recently the BG thing has come to dominate my life. Every time I get a bad BG result I am worried and disturbed, and I can't wait till the next chance to do well (be teacher's pet, as it were). It's tiring and worrying. That's quite wrong, and I have to stop it. I have a life to live.

So - I have a feeling you're too close to all this. Try and back off for a couple of days. Do the stuff, but just record it and try not to react. It's all good.

Lucy

 

[LucySW]

Runner,

Maybe this is what's been happening to you (quoted from another thread):

Another new research finding found trawling while I should be starting some work. This study is by a Swiss team. They found that the pancreas can regenerate its beta cells (by alpha-cells converting themselves to beta-cells) even in adults. Letter to Nature here , and original reference on Science Daily here.

 

[LucySW]

http://insulinnation.com/treatment2/cure-insight/most-people-with-type-1-still-producing-insulin/

More on recent findings that many Type 1s go on producing insulin ...

and more on the immune system re-education vaccine:

http://www.bbc.com/news/health-23064897

 

[Ian DP]

Hi Lucy
The article / trial on T1s continuing to produce insulin is very interesting. Even more reason for us to keep BG levels low, so we can preserve for longer.

 

[LucySW]

Yes, we're definitely going after the right target and it's worth ALL the hassle.

(There is quite a lot of hassle though!)

Lucy

 

[smidge]

I think it's all too easy to become obsessed with your BGs, especially in the first couple of years - after all, being diagnosed with Type 1(ish) diabetes as an adult is a massive shock and , as adults, we're able to comprehend the seriousness of our condition in the way that children aren't. The complete obsession does wear off a bit after a couple of years but it never goes completely - how can it when our health depends on monitoring and managing our BGs?

After five years of it (five years next week actually!) I've come to the state whereby I monitor frequently although I often miss an after meal test or two and I always record food, insulin and test results. However, I now only allow myself to analyse my results once a week when I look for patterns and areas where I could improve my control. I think if you analyse your charts any more frequently you end up chasing anomolies rather than identifying patterns - and you drive yourself mad!

Smidge

 

[LucySW]

After five years of it (five years next week actually!) I've come to the state whereby I monitor frequently although I often miss an after meal test or two and I always record food, insulin and test results. However, I now only allow myself to analyse my results once a week when I look for patterns and areas where I could improve my control. I think if you analyse your charts any more frequently you end up chasing anomolies rather than identifying patterns - and you drive yourself mad!

Smidge

Thanks, Smidge, that helps a lot. Thanks for sharing. I'm going to follow you there.

Lucy

 

[LucySW]

@Ian DP and @robert72, what do you make of this?

http://www.diabetes.co.uk/forum/threads/official-tag-link.64531/

Lucy

 

[LucySW]

@Ian DP, How are your numbers going?

Mine are, I realise after much worrying and obsessing, basically fine, except when I snack before supper or eat supper late. Which I can fix. They're not yet down to my target Bernstein levels, being stuck at say 5.8 before and 6.4 or so after a meal, so extra effort is required to go that bit further. But they are stable, and recover within two hours of meals. And it's clearly meal-related rather than basal insulin where I'm challenged.

So that's all good.

OTOH, that's all very well, but my nice honeymoon may be short unless I pull my finger out and go further.

The result of much agonising and hyper-concentrating. !!!

Lucy

 

[Ian DP]

My pre-breakfast numbers are, very sadly, gradually increasing, when I first started Bernstein 3 months ago they were around 4.5, now they around 5.0..... Which was my original target.... But when I look at my 3 month pre breakfast graph, I can see that they are are,very gradually increasing. .... I am still able to get my 2hr after eating levels within his guidelines.... But no longer his fasting guidelines.... That said, we have been touring Cornwall, on holiday, for the last 4 weeks, so not been exercising as much..... But my all important pre breakfast BG trend is definitely up.... Indicating that my beta cells are not regenerating. .... Dr Bernstein does say he 'has seen' some regeneration in *some* patients......

I intend to keep to his recommendations until At least the new year.....we have ordered a new sub 3 ton campervan for the new year, trading in our 4.25ton motorhome. This will mean I will no longer need my C1 driving licence and thus all the complications that go with the C1 / heavy goods vehicle licence..... So going on insulin in January will not be such a problem driving wise...... But i will go on insulin before January if I feel I need / have to.... But hoping that I won't need to....Following Dr Bernstein solution has definitely made a difference, and I can see that his experience of food / carb intake exactly replicates mine..... The one cherry tomato and no fruit etc. certainly makes a difference.

Seeing my hospital diabetic consultant in a couple of days time, so will give a further update after this.

 

[LucySW]

My pre-breakfast numbers are, very sadly, gradually increasing, when I first started Bernstein 3 months ago they were around 4.5, now they around 5.0..... Which was my original target.... But when I look at my 3 month pre breakfast graph, I can see that they are are,very gradually increasing. .... I am still able to get my 2hr after eating levels within his guidelines.... But no longer his fasting guidelines.... That said, we have been touring Cornwall, on holiday, for the last 4 weeks, so not been exercising as much..... But my all important pre breakfast BG trend is definitely up.... Indicating that my beta cells are not regenerating. .... Dr Bernstein does say he 'has seen' some regeneration in *some* patients......

I intend to keep to his recommendations until At least the new year.....we have ordered a new sub 3 ton campervan for the new year, trading in our 4.25ton motorhome. This will mean I will no longer need my C1 driving licence and thus all the complications that go with the C1 / heavy goods vehicle licence..... So going on insulin in January will not be such a problem driving wise...... But i will go on insulin before January if I feel I need / have to.... But hoping that I won't need to....Following Dr Bernstein solution has definitely made a difference, and I can see that his experience of food / carb intake exactly replicates mine..... The one cherry tomato and no fruit etc. certainly makes a difference.

Seeing my hospital diabetic consultant in a couple of days time, so will give a further update after this.

Hmmmm. That's disappointing for you. Thinking of other explanations, if your fasting BG stays at that level, could it not be a long-term flattening out? ie, the level your metabolism sustains, after an initial reaction to a very fast fall?

 

[Ian DP]

If I can keep my fastings at 5.0 I will be very happy..... That's my aim.

 

[LucySW]

I saw the consultant today and he said two things I thought were interesting.

First, he said that as it's generally the bolus insulin function that goes first when people develop T1, with the basal aka residual insulin function hanging on longer, then logically new LADAs should really be given bolus insulin rather than basal - but that they get basal, because that's just what they do.

(That certainly fits with my pattern, viz., within two hours my BG recovers to within 0.5mmol of pre-meal for a lo-carb meal, and the only thing that really screws things is snacking or eating again within two hours. So I seem to be skating along on my basal-level insulin, while my bolus response does seem to have gone belly-up.)

Then he said that 4units of basal insulin (what I take at night) is such a small dose that it's practically homeopathic - a trace only. He said for my weight (72kg) a significant dose of basal insulin would start at 8 to 10.

This I have difficulty understanding, because Bernstein says that 1u will lower BG by ?? 1.6 mmol - too lazy to check it now. Perhaps he still isn't talking about basal. But these two statements don't seem to fit. I know that my experience is that 4u Insulatard lowers my BG about 1.5 mmol overnight.

Picking up my new HbA1c tomorrow, but hoping for great things.

Lucy

 

[Spiker]

The insulin response part is true but these are normally called primary and secondary insulin response. Primary response is a gush of insulin and secondary response is a continuous drip. People do lose the primary response first.

I don't agree 4u is a homeopathic dose. That's ridiculous. 4u is enough to give some people hypos, even as basal insulin. That's a clinical dose, admittedly on the low end.

All of these per kg dose calculations are just rules of thumb in the absence of any more concrete data. They are not prescriptive. There is way more variation in people than that.

 

[smidge]

Hi Lucy.

Your consultant 's observation on the bolus going first in LADA and the Basal remaining strong at first is spot on with my experience. I have always wondered why they don't provide early LADA's with rapid acting instead of basal to start with. It makes no sense to me to give us basal to try to control high post food spikes.

I disagree on his opinion concerning your small doses of insulin though. They started me on 6 units of Insuman Basal and after a couple of days I had to back track very quickly. For a while I was using 1 unit a day but it still made a big difference - without it my BG rose gradually over a period of a few days.

Good luck with the HbA1c. Let us know how it goes.

Smidge

 

[LucySW]

Hi Smidge and Spiker,

Yes, I agree with you both of course on insulin doses. 4u has a pronounced effect on me, and even 2u shows up, as with you, Smidge. It's the second time he's said it though, so I conclude that's what the medical establishment thinks. Useful to know and to disregard. Is this because still most T 1s aren't lo-carbing and so still they're not used to low insulin doses?

He supports lo-carb though.

Primary and secondary insulin response = bolus and basal. I think of them as that because it matches our treatment.

 

[LucySW]

Smidge,

Did you say they started you on insulin too late? It sounds as if small doses did work for you for a time.

Lucy

 

[Spiker]

Hi Smidge and Spiker,

Yes, I agree with you both of course on insulin doses. 4u has a pronounced effect on me, and even 2u shows up, as with you, Smidge. It's the second time he's said it though, so I conclude that's what the medical establishment thinks.

It's not what the medical establishment thinks. It's what one consultant thinks.

If he had experience even of pediatric T1s on normal, non low carb diets he would think differently.

 

[phoenix]

I suspect the reason they give basal first is simply because that is what is done in T2. In the case of someone who has a lot of insulin resistance, it makes sense, you may need a lot of insulin to stop the glucagon/glucose response from the liver. That isn't necessarily the case with someone with LADA.
I was going to say that I agreed about less need for basal. The reason I was given a pump so early on was to allow me to vary my basal according to activity, a long term basal just didn't stop .When I went out for a walk or run , I could drop by 6 mmol/l in 20 min The pump made tiny amounts possible.
. My basal is normally around 40% of my total insulin dose
Then something happens that makes you think what on earth is happening now ?
I came back from a walk yesterday afternoon, as normal; tiny basal of 0.1u hour for 3.5 hours but was still a bit low when I started dinner (3.3mmol/l). I was going to give myself a reduced bolus at the end of the meal which had about 45g of carbs I forgot completely. I woke up this morning with a fasting of 5.5mmol/l . So yesterday I used just 9.8units basal, 7.4 units bolus for 135g of carbohydrate . (obviously I don't follow Dr Bernstein!)
This is at almost 12 years since I realised I had diabetes, 9 years since I was officially diagnosed as T1 and started on a total daily dose of 34U
Who knows what the Diabetes 'Gods' have for us next.

 

[Spiker]

My basal is normally around 40% of my total insulin dose

Oh Noes. You have broken the 50/50 basal/bolus rule. Report to NHS High Command for compulsory re-education or immediate execution! ;-)