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Dr. Bernstein and Erythritol?
- Thread starter kpa
- Start Date
Yes, I do. It's a good site to hear other stories but my main problem is knowing how to adjust the diet to me and how I react to insulin. I have a very outdated diabetes education, and I wonder if its a trial and error thing now (and due to the damage my kidneys have, I am a little reluctant to try myself). Also, it's a struggle to keep bloods at 4.7 when I don't know how much basal and bolus I need to take for protein. I've only just started the book but it's heavy reading and a lot of it isn't as simple to grasp. So I'm looking for any tips/sites to get an easier grasp.
kitedoc
Well-Known Member
Hi @kpa, From my reading , not professional advice or opinion, diabetes does not cause kidney stones. You would need to confirm this with a doctor but the threat to your kidneys sounds more like there might be back-pressure on your kidneys from the stones partly blocking the tubes (ureters) leading from your kidneys to your bladder plus the stress on the kidneys of your infections? Again just from reading about kidney stones. They are ways to remove kidney stones so a specialist (urologist) could give an opinion on that. see mayoclinic.org Kidney stones.
Before proceeding I need to let you know that some people when they really tighten up their diabetes control report that any complications like with their eyes get worse, before improving. That is why, ideally it is best to discuss with a doctor to see how best to manage this. ? aim for a less than perfect change to begin with ? brave out the consequences.
In regards to your question about how late is too late to reverse diabetic complications and how quickly might some improve, Dr Bernstein has some views on this.
For working out doses of insulin again I cannot advise. I can tell you what I did, but you may have quite a different readings and responses.
I divided my insulin up into bolus (before meals, shorting acting insulin) and basal - long-acting insulin.
First I did basal testing as it is called- see Home page - Treatment - insulin management - adjusting basal and bolus insulins.
12mn - 12md, BSLs every 2 hours, no eating but water as needed , skip breakfast and pre-breakfast short-acting insulin (bolus) any BSL > 7 mmol/l I considered adjust long acting insulin (that is working during that time, e.g. long-acting given that evening) up 10% and re-test in 2 days, any BSL , 4.5 mmol/l I adjusted long-acting insulin down 10% always watching for hypos (BSLs < 4 mmol/l), further 10% adjustments as needed.
I waited 2 days after final adjustment. if any, were made
12 md to 6 pm - skipped lunch and pre-lunch short-acting insulin and tested 2 hourly 12 md til 6 pm. Adjusted long acting insulin working during that time as above.
6 pm - 12 mn - as above.
Comments: I was prescribed Levemir insulin twice daily as my long acting insulin. That gave me the opportunity to change my evening dose without that change affecting my BSLs in much of the daytime, Similarly changing my morning dose of Levemir helped me to adjust regarding daytime BSLs without too much effect on the night/early morning BSLs. I imagine it is more difficult to make effective changes with longer-acting insulin than Levemir without perhaps running into problems with hypos.
Why not do a 24 hour fast and get the basal testing sorted more quickly? After about 16 hours of fasting I was getting ketones rising in my blood (some meters can test for ketones) and I was concerned that the ketones might interfere with my BSLs, and my doctor advised me that it would be better to split up the basal testing to ensure that ketones did not interfere in this way.
What is written below is from my discussions with my doctor and diabetes nurse:
Bolus doses
short-acting insulin: I use boluses for dosing before a meal to help keep BSLs from rising too high after the meal and sometimes as correction doses, to help bring a high BSL down to a more acceptable level.
Pre-meal boluses and testing: I would calculate how many carbs in the meal adding 50% of the grams of protein in the meal as carbs. That is how Dr Bernstein writes it in his book.
So for example my breakfast: egg -7 g protein --> 3 1/2 g of carbs, chia - 2 g, linseed meal 2 g, soy milk (sugar + protein)- 4 1/2 g grams = 12 g of carbs.
I check my BSL first to make sure it is < 7 mmol/l and > 4 mmol/l., otherwise the results after the meal will not be so helpful.
I inject my short-acting insulin Novorapid 30 t0 40 minutes before eating as I find that seems to better control BSLs afterwards.
I know of people whose BSLs would fall too much if they left their meal til that long afterwards, so it is trial and error !!
I check my BSL 2 hours and 3 hours after eating (not after the insulin dose) and just before the next meal is due.
Ideally my BSL is less than 9 mmol/l at the 2 and 3 hour marks, and > 4 mol/l before the next meal.
So --- if my BSls are all good, and I have injected say, 2 units of Novorapid: then my insulin to carb ratio is 1 unit to 6 g carb.
So if another day I am 'celebrating' and going to eat say 18 g carbs (allowing for protein at 50%) the Novorapid dose I use is 3 units. And if on starting out on low carb I was used to a 30 g carb breakfast, then by adjusting my insulin by my insulin to carb ratio there was less risk of hypos, and less guesswork !!
If the BSLs are not in range, then I check that I counted the carbs properly and if so, I use 10% adjustments and re-test.
On low carb meals like 8 to 15 g I found BSLs do not vary much afterwards.
Same procedure for pre-meal shorting-acting insulin doses for lunch and evening meals.
My Insulin carb ratio for evening meal is about 1 unit to 8 g, I find the pre-meal breakfast doses of short-acting have to be higher per g of carb than the later doses in the day. I find that I cannot quite achieve Dr Bernstien's meal carbs of 6g, 12g, 12g but I try to have less than 45 g carb per day.
Once on this diet regime I also found that my basal dose of insulin needed adjustment down. I was obtaining fasting readings in the morning of 3.8 mmol/l.
There are recipes for low carb meals in Dr Bernstein's book, on dietdoctor.com and on the Home page under Recipes.
Not being a dietitian, I was worried about how I was going to obtain enough vitamin C with a low carb diet, since fruit is so sweet, but things like brussel sprouts, broccoli and the like, even with light cooking and raw peppers, parsley seemed to meet my needs plus the fibre from chia/linseed and vegetables prevented constipation.
I was unwell for over a week when I started - the keto flu - to do with my body adapting to the new diet - I drank more water, had saltier food as advised by dietdoctor.com.
That is my low carb experience - as I say we are all different in the way we respond to such a regime.
Correction doses: I am now on an insulin pump so adjusting doses etc over the 24 hours is easier than with multiple injections.
If I had a higher than 9 mmol/l BSL I could give a bolus of short-acting insulin. But too much I would go hypo some hours later, then eat and go hyper, like a see-saw that kept tilting one way then the next !! So I try to be careful. Correction doses I was informed are units of insulin per change in BSL level above an ideal level. My ideal level was set as 5.5 mmol/l and my correction dose varies. I give a smaller correction dose of short-acting insulin per BSL reading at night than during the day. That is for safety, if I am sleeping I will not be able to detect a hypo as easily as during the day.
So for BSL of 11 mmol/l in the morning I might try 2 units of short-acting insulin and see how BSLs were in 2 hours time. I was told not to would expect a complete correcting to say 5./5 mmol/ but at least to half way and be prepared to correct a little further if need be. Of course I had to be aware that the correction dose of insulin would have an effect for the next 5 hours or so. I might need to ease back the next pre-meal dose a bit, otherwise the effect of one dose of short-acting insulin on the other (called insulin-stacking) would compound and and increase the risk of a hypo later.
If I had an unexpectedly high BSL , say 14 mmol/l, I was told to look for why. ? Cracked insulin vial in a pen or tubing --> leaking of insulin, injecting into scar tissue --> poor absorption, ? onset of an infection - to make sure about what other things were looked for and sorted out. I was told to also increase my long-acting dose ? 10 % or so with these high readings as at those levels insulin is not as effective compared to at lower levels. And if I was not 'winning' in getting BSLs down to ring my nurse or doctor.
A a general rule, if I am unwell with some infection or vaccination I put all doses basal (long-acting insulin and short-acting insulin up by at least 10% to begin with. After my annual flu injection I am 30% above normal doses for 4 days.
I hope you can find some understanding nurse and doctor to help you with what you wish to achieve!!
Before proceeding I need to let you know that some people when they really tighten up their diabetes control report that any complications like with their eyes get worse, before improving. That is why, ideally it is best to discuss with a doctor to see how best to manage this. ? aim for a less than perfect change to begin with ? brave out the consequences.
In regards to your question about how late is too late to reverse diabetic complications and how quickly might some improve, Dr Bernstein has some views on this.
For working out doses of insulin again I cannot advise. I can tell you what I did, but you may have quite a different readings and responses.
I divided my insulin up into bolus (before meals, shorting acting insulin) and basal - long-acting insulin.
First I did basal testing as it is called- see Home page - Treatment - insulin management - adjusting basal and bolus insulins.
12mn - 12md, BSLs every 2 hours, no eating but water as needed , skip breakfast and pre-breakfast short-acting insulin (bolus) any BSL > 7 mmol/l I considered adjust long acting insulin (that is working during that time, e.g. long-acting given that evening) up 10% and re-test in 2 days, any BSL , 4.5 mmol/l I adjusted long-acting insulin down 10% always watching for hypos (BSLs < 4 mmol/l), further 10% adjustments as needed.
I waited 2 days after final adjustment. if any, were made
12 md to 6 pm - skipped lunch and pre-lunch short-acting insulin and tested 2 hourly 12 md til 6 pm. Adjusted long acting insulin working during that time as above.
6 pm - 12 mn - as above.
Comments: I was prescribed Levemir insulin twice daily as my long acting insulin. That gave me the opportunity to change my evening dose without that change affecting my BSLs in much of the daytime, Similarly changing my morning dose of Levemir helped me to adjust regarding daytime BSLs without too much effect on the night/early morning BSLs. I imagine it is more difficult to make effective changes with longer-acting insulin than Levemir without perhaps running into problems with hypos.
Why not do a 24 hour fast and get the basal testing sorted more quickly? After about 16 hours of fasting I was getting ketones rising in my blood (some meters can test for ketones) and I was concerned that the ketones might interfere with my BSLs, and my doctor advised me that it would be better to split up the basal testing to ensure that ketones did not interfere in this way.
What is written below is from my discussions with my doctor and diabetes nurse:
Bolus doses
short-acting insulin: I use boluses for dosing before a meal to help keep BSLs from rising too high after the meal and sometimes as correction doses, to help bring a high BSL down to a more acceptable level.Pre-meal boluses and testing: I would calculate how many carbs in the meal adding 50% of the grams of protein in the meal as carbs. That is how Dr Bernstein writes it in his book.
So for example my breakfast: egg -7 g protein --> 3 1/2 g of carbs, chia - 2 g, linseed meal 2 g, soy milk (sugar + protein)- 4 1/2 g grams = 12 g of carbs.
I check my BSL first to make sure it is < 7 mmol/l and > 4 mmol/l., otherwise the results after the meal will not be so helpful.
I inject my short-acting insulin Novorapid 30 t0 40 minutes before eating as I find that seems to better control BSLs afterwards.
I know of people whose BSLs would fall too much if they left their meal til that long afterwards, so it is trial and error !!
I check my BSL 2 hours and 3 hours after eating (not after the insulin dose) and just before the next meal is due.
Ideally my BSL is less than 9 mmol/l at the 2 and 3 hour marks, and > 4 mol/l before the next meal.
So --- if my BSls are all good, and I have injected say, 2 units of Novorapid: then my insulin to carb ratio is 1 unit to 6 g carb.
So if another day I am 'celebrating' and going to eat say 18 g carbs (allowing for protein at 50%) the Novorapid dose I use is 3 units. And if on starting out on low carb I was used to a 30 g carb breakfast, then by adjusting my insulin by my insulin to carb ratio there was less risk of hypos, and less guesswork !!
If the BSLs are not in range, then I check that I counted the carbs properly and if so, I use 10% adjustments and re-test.
On low carb meals like 8 to 15 g I found BSLs do not vary much afterwards.
Same procedure for pre-meal shorting-acting insulin doses for lunch and evening meals.
My Insulin carb ratio for evening meal is about 1 unit to 8 g, I find the pre-meal breakfast doses of short-acting have to be higher per g of carb than the later doses in the day. I find that I cannot quite achieve Dr Bernstien's meal carbs of 6g, 12g, 12g but I try to have less than 45 g carb per day.
Once on this diet regime I also found that my basal dose of insulin needed adjustment down. I was obtaining fasting readings in the morning of 3.8 mmol/l.
There are recipes for low carb meals in Dr Bernstein's book, on dietdoctor.com and on the Home page under Recipes.
Not being a dietitian, I was worried about how I was going to obtain enough vitamin C with a low carb diet, since fruit is so sweet, but things like brussel sprouts, broccoli and the like, even with light cooking and raw peppers, parsley seemed to meet my needs plus the fibre from chia/linseed and vegetables prevented constipation.
I was unwell for over a week when I started - the keto flu - to do with my body adapting to the new diet - I drank more water, had saltier food as advised by dietdoctor.com.
That is my low carb experience - as I say we are all different in the way we respond to such a regime.
Correction doses: I am now on an insulin pump so adjusting doses etc over the 24 hours is easier than with multiple injections.
If I had a higher than 9 mmol/l BSL I could give a bolus of short-acting insulin. But too much I would go hypo some hours later, then eat and go hyper, like a see-saw that kept tilting one way then the next !! So I try to be careful. Correction doses I was informed are units of insulin per change in BSL level above an ideal level. My ideal level was set as 5.5 mmol/l and my correction dose varies. I give a smaller correction dose of short-acting insulin per BSL reading at night than during the day. That is for safety, if I am sleeping I will not be able to detect a hypo as easily as during the day.
So for BSL of 11 mmol/l in the morning I might try 2 units of short-acting insulin and see how BSLs were in 2 hours time. I was told not to would expect a complete correcting to say 5./5 mmol/ but at least to half way and be prepared to correct a little further if need be. Of course I had to be aware that the correction dose of insulin would have an effect for the next 5 hours or so. I might need to ease back the next pre-meal dose a bit, otherwise the effect of one dose of short-acting insulin on the other (called insulin-stacking) would compound and and increase the risk of a hypo later.
If I had an unexpectedly high BSL , say 14 mmol/l, I was told to look for why. ? Cracked insulin vial in a pen or tubing --> leaking of insulin, injecting into scar tissue --> poor absorption, ? onset of an infection - to make sure about what other things were looked for and sorted out. I was told to also increase my long-acting dose ? 10 % or so with these high readings as at those levels insulin is not as effective compared to at lower levels. And if I was not 'winning' in getting BSLs down to ring my nurse or doctor.
A a general rule, if I am unwell with some infection or vaccination I put all doses basal (long-acting insulin and short-acting insulin up by at least 10% to begin with. After my annual flu injection I am 30% above normal doses for 4 days.
I hope you can find some understanding nurse and doctor to help you with what you wish to achieve!!
