Opinion on Diabetes Control

How many think like Dr. Bernstein's that diabetes control should be about having non diabetic numbers fasting below at least (100/5.5) and postprandial numbers that move very little even if you have to use insulin to get there, if his low carb 6/12/12 and oral meds don't achieve it. Do you think that is best to have that tight control? Or being meds free is more important to you even if not that tight control is achieved?

I'm T1 so maybe not really qualifies to answer accurately as I can't go meds free but my opinion is that I try to maintain BG levels around non-diabetic levels if poss. I do fall off the wagon occasionally but my last HbA1C was 41 ( 5.9% ). I've mentioned this before but even though I was very happy with this, my consultant pretty much accused me of having to hypo regularly to achieve this. I don't. Just a fine line I guess.

yoly wrote:How many think like Dr. Bernstein's that diabetes control should be about having non diabetic numbers fasting below at least (100/5.5) and postprandial numbers that move very little even if you have to use insulin to get there, if his low carb 6/12/12 and oral meds don't achieve it. Do you think that is best to have that tight control? Or being meds free is more important to you even if not that tight control is achieved?

From my perspective-It depends on whether someone is Type 1 or Type 2-I'm somewhere in the middle as a Type 1.5 but through low carbing below 50 grams of carbohydrates a day I still need insulin but manage so far on a Basal (Background) insulin only currently so I'm keen to keep it that way for as long as possible.
A lot of type 2's {but not all} may have plenty of natural insulin of their own on board but their cells are resistant to it so IMO injecting synthetic insulin on top is not a 'Get out of jail free card' as very large daily doses are often required with unpredictable blood glucose readings,weight gain which leads to more resistance and then more insulin required plus more weight gain and so starts the vicious cycle.
Much more better to look at the long term and with the aid of your meter,reduce your carbs to the level where your BG readings are at a near as possible non diabetic levels 2 hours after a meal,exercise and weight loss if needed which combined will reduce insulin resistance...Sometimes a type 2 whose pancreatic function is at a level where natural insulin production is confirmed via specialist blood tests as being at a very low level,will require insulin injections and this shouldn't be feared but even then keeping your carb intake down will enable you to keep your daily dose low with far less errors,erratic blood glucose swings and more predictability.

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I've been diagnosed a Type II for 10 years and have been on insulin for the last nine of them.  Following Bernstein's advice has allowed me to reduce my insulin intake from 50 units a day to 15 units a day and I've lost 30 pounds and my HbA1c is 5.1  I am beginning to wonder if I may be able to get off insulin altogether and have started taking metformin again.  Next week I'll have my insulin and C-peptide tested as part of evaluating this.  So I appreciate the wish to be on minimal or no medication.  But I would rather have normal blood sugar and use low doses of medication than risk the long-term micro- and macro-vascular complications of higher than normal blood sugars, even if those blood sugars lead to HbA1cs of only the upper 5s or low 6s.

I'm still learning about what my body is doing in relation to T2.  I know I can burn off blood glucose from eating by short bursts of exercise (10 minutes on the rower) and also that I've never had too much trouble keeping my 2 hour postprandial levels below 7.  This suggests to me that I'm neither strongly insulin resistant nor have a severely reduced-function pancreas, but that I have some of both (I'd welcome comment from anyone who's been longer in this game than me).

Given that, I'm aiming to get my BGs consistently into non-diabetic territory with LCHF, and also minimise the spikes so as not to upset my pancreas (or kidneys) too much.  Whether this will enable any self-repair I've no idea but I'm happy at the moment with the regime and how it will help to stave off any complications for as long as possible (hopefully for as long as I live).

I also want to have my body treat itself as far as possible on the simple grounds that it knows me better than any pharma company and is a lot more sophisticated in its processes. I've never liked taking pills - more than 1 paracetamol a month is a lot to me, although I will admit to taking more ibuprofen as I get older!

Seth wrote:I've been diagnosed a Type II for 10 years and have been on insulin for the last nine of them.  Following Bernstein's advice has allowed me to reduce my insulin intake from 50 units a day to 15 units a day and I've lost 30 pounds and my HbA1c is 5.1  I am beginning to wonder if I may be able to get off insulin altogether and have started taking metformin again.  Next week I'll have my insulin and C-peptide tested as part of evaluating this.  So I appreciate the wish to be on minimal or no medication.  But I would rather have normal blood sugar and use low doses of medication than risk the long-term micro- and macro-vascular complications of higher than normal blood sugars, even if those blood sugars lead to HbA1cs of only the upper 5s or low 6s.

Great progress Seth. Be good to eventually come off the insulin but I think I agree with you, good control should be priority, even if it means taking meds. My concern is when some take meds in ever increasing amounts to allow them to eat a very poor diet.

Speaking as a total noob to all this....

I would rather have normal blood glucose, even if that means taking insulin. Why? Because I don't want to have diabetic complications and I honestly don't think it's acceptable to have different (higher) limits for diabetics. We all know damage can be done before you get into the diabetic zone, otherwise I wouldn't be getting recurrent abscesses which don't heal! I'm currently pushing for metformin, but I'm struggling to get it because I'm only prediabetic. I think they think I just want meds for the sake of it, but I've seriously considered this, I know the risks of long term drugs and I think it's worth having a go. I'm going to keep asking anyway...at 39, I have too many years to develop complications.

I will do anything to stay off any meds. I had 12 months of being poisoned directly into my jugular vein every 3 weeks last year. My body needs a break. There may come a time when I need some help with controlling my levels, but I am hoping not for a long time. I currently aim for under 6 fasting, under 5.5 before meals and under 7 at 2hrs after meals. I am seeing a lot of 4's before evening meal and am happy with this for the moment.

Bluetit wrote:I will do anything to stay off any meds. I had 12 months of being poisoned directly into my jugular vein every 3 weeks last year. My body needs a break. There may come a time when I need some help with controlling my levels, but I am hoping not for a long time. I currently aim for under 6 fasting, under 5.5 before meals and under 7 at 2hrs after meals.  I am seeing a lot of 4's before evening meal and am happy with this for the moment.

You're doing really well and I hope to get those figures at some point soon. Only had one 4.9 but I'm hoping for more, especially as I lose more weight.

Some will want drugs earlier than others, but it would be good if we as patients genuinely had a choice when that happens. Sadly it doesn't feel like we do.

you will both get where you want to be i know, i didnt realise there was a choice when i was given meds, maybe for me there wasnt, but then i had smoked so much weed and popped so many acid in my life i figured how bad can they be lol

Andy12345 wrote:you will both get where you want to be i know, i didnt realise there was a choice when i was given meds, maybe for me there wasnt, but then i had smoked so much weed and popped so many acid in my life i figured how bad can they be lol

Edit, other drugs other than weed and acid are available too ;-)

nowadays my only mind bending experiences are trying to pay the mortgage

Andy12345 wrote:nowadays my only mind bending experiences are trying to pay the mortgage

or open a Pot Noodle ?

lol yes its apparently a good method of control and keeps life worth living, and apparently ya have to respect it, i dont think i was the only one taking acid

Pot noodles!!!!  The last time I ate one of those many moons ago I fell asleep on the job whilst fitting a bathroom

when i knew nothing about nutrition and ate crap 24/7 pot noodles where too unhealthy for me lol

I once looked at a pot noodle while under the influence. It was the only food I ever saw that looked like puke before I thru up. Each to their own eh !

Kind regards Eddie

I've never eaten a pot noodle in my life. They look like cat sick.   

With all the latest research about what exogenous insulin can do to Type 2's, I'm very much on the side of avoiding it as long as possible. If you believe Dr Jason Fung, the problem is really the excess insulin rather than the BG levels - the outcome for people on long term insulin and/or pancreas-stimulating drugs seems to "prove" the progressive label for Type 2.

Well done for reducing your medications so significantly, Seth! 

For anyone who hasn't watched his videos, they are well worth the time and effort:

https://www.youtube.com/channel/UCoyL4iGArWn5Hu0V_sAhK2w

The problem I have is that I am not obese or overweight and have some insulin deficiency or insulin signaling problem. Never had very high glucose so I don't think is beta cell damage from glucotoxicity. I am not insulin resistant and metformin does very little. I probably have some type of MODY or some other beta cell genetic defect my father was diabetic. I get no help from the doctors since they don't care for modest elevation of blood glucose and because I am not overweight they really have no advice to give. With low carb I can have almost non-diabetic numbers and A1c but fasting will not get under 100. I will like to preserve my beta cells as long as possible Dr. Bernstein's believe having normal non-diabetic numbers is key for beta cell preservation. Increased carbohydrates just produce less control and higher A1c. I have used very small dosage of NPH insulin on my own and get near around 85 fasting average but I don't if it worth the trouble. That why I wanted others opinion.

yoly wrote:The problem I have is that I am not obese or overweight and have some insulin deficiency or insulin signaling problem. Never had very high glucose so I don't think is beta cell damage from glucotoxicity. I am not insulin resistant and metformin does very little. I probably have some type of MODY or some other beta cell genetic defect my father was diabetic. I get no help from the doctors since they don't care for modest elevation of blood glucose and because I am not overweight they really have no advice to give. With low carb I can have almost non-diabetic numbers and A1c but fasting will not get under 100. I will like to preserve my beta cells as long as possible Dr. Bernstein's believe having normal non-diabetic numbers is key for beta cell preservation. Increased carbohydrates just produce less control and higher A1c. I have used very small dosage of NPH insulin on my own and get near around 85 fasting average but I don't if it worth the trouble. That why I wanted others opinion.

Hi yoly,

Sorry, I should have put a disclaimer on my post that the video referred to insulin resistant Type 2's. They are probably the bulk of Type 2's (even thin Type 2's can have problems with visceral fat deposits and insulin resistance).

Can you get more tests to establish exactly which type you are? There are outliers on any spectrum of disease processes and it sounds like you are one.

If you have an excellent A1c and follow a low carb diet, you may have "physiological insulin resistance" which can cause rises in fasting BG, but according to Peter Hyperlipid, the A1c is more important marker. He has a series of posts about the phenomenon that you might find interesting. Here's the one specifically related to Fasting BG levels:
http://high-fat-nutrition.blogspot.co.uk/search/label/Physiological%20insulin%20resistance%20%283%29%3B%20Clarification%20of%20FBG

Edited to add: re-read that link and it's possibly not the one to start with, so adding the series he has posted on the subject:

http://high-fat-nutrition.blogspot.co.uk/search/label/Physiological%20insulin%20resistance%20%281%29
http://high-fat-nutrition.blogspot.co.uk/search/label/Physiological%20insulin%20resistance%20%282%29%3B%20Dawn%20Phenomenon
http://high-fat-nutrition.blogspot.co.uk/search/label/Physiological%20insulin%20resistance%20%284%29%3B%20Alzheimers
http://high-fat-nutrition.blogspot.co.uk/search/label/Physiological%20insulin%20resistance%20%285%29%20The%20wild%20type%20mice
http://high-fat-nutrition.blogspot.co.uk/search/label/Physiological%20insulin%20resistance%20%286%29%20The%20Terminator
http://high-fat-nutrition.blogspot.co.uk/search/label/Physiological%20insulin%20resistance%20%287%29%20and%20palmitic%20acid%20again
http://high-fat-nutrition.blogspot.co.uk/search/label/Physiological%20insulin%20resistance%20%288%29%20Chewing%20the%20FAT
http://high-fat-nutrition.blogspot.co.uk/search/label/Physiological%20insulin%20restisance%20%288%29%20Guess%20what%3F
http://high-fat-nutrition.blogspot.co.uk/search/label/Physiological%20insulin%20resistance%20%289%29%20Dolphins

I keep promising myself that one day I'll read and understand all of these posts     

Indy51 wrote:

yoly wrote:The problem I have ...

Hi yoly,

Sorry, I should have put a disclaimer on my post that the video referred to insulin resistant Type 2's.   

Fantastic links @indy51

I've only read 3 so far, and they've totally addressed my high fasting glucose levels AND DP - so THANK YOU

Will slowly work my way through them.  Who knows what other gems they contain! 

The video has great diet advice but not the most current views on diabetes. There is more than insulin resistance in diabetes. I think Dr. Bernstein's had it correct all the time on focusing on beta cell preservation.

http://www.nature.com/nrendo/journal/v9/n10/full/nrendo.2013.157.html

Introduction

Insulin resistance and impaired β-cell function are hallmarks of type 2 diabetes mellitus (T2DM). The concept of insulin resistance emerged in the 1980s and 1990s and has been recognized as the most fundamental pathological state of T2DM, with less attention given to β-cell failure. However, insulin resistance does not cause T2DM unless β-cell failure also occurs. Many more people have insulin resistance than have T2DM, suggesting that insulin resistance is necessary but not sufficient to induce the onset of diabetes mellitus.1 Genome-wide association studies have identified many susceptibility genes linked to diabetes mellitus, most of which are expressed in pancreatic β cells and are thought to have roles in their function and growth.2, 3, 4, 5 Furthermore, studies of postmortem and surgical pancreas specimens describe a 63% loss of β-cell mass in obese patients with T2DM, and a 41% loss in lean patients with T2DM, compared with weight-matched healthy individuals.6 β-cell dysfunction is, therefore, thought to have a primary role in the pathogenesis of T2DM.