My Take on Dr. Bernstein

Laddie_Head SquareI strongly believe that everyone with diabetes of any type should read Dr. Bernstein’s Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars.  I am neither advocating that you follow his teachings to the letter nor am I even suggesting that you try his WOE (way of eating).  But I believe that you should read the book.

Dr. Bernstein was diagnosed with diabetes in 1946 at the age of 12.  He indicates that for over two decades “I was an ‘ordinary’ diabetic, dutifully following doctor’s orders….”  In his twenties and thirties he began to experience significant complications including deteriorating vision, kidney disease, neuropathy, and cardiomyopathy.  During those years the medical community began to link high blood cholesterol to heart disease and it was a widespread belief that high amounts of dietary fat were the cause of this elevated cholesterol.  Therefore like many diabetics then and now, he was prescribed a low-fat, high-carbohydrate diet.

In 1969 Dr. Bernstein’s life changed dramatically when he saw an advertisement for a new device that hospital emergency rooms could use to test blood sugar levels to distinguish “unconscious diabetics” from “unconscious drunks.”  Although he was prohibited from buying the $650 device because he was not a doctor, his wife was a physician and she placed the order.  He began to use this device and went down in history as the first patient with diabetes to use a home blood glucose meter.  For a fascinating peak into the history of Blood Glucose meters, I encourage you to read David Mendoza’s interviews with four pioneers, including “Dick” Bernstein, who were instrumental in the development and ultimate widespread use of these meters.

Using his new meter, Dr. Bernstein quickly learned was that his blood sugars resembled a roller coaster with daily lows in the 40’s and highs in the 400’s.  Over the next four years he experimented with changes to his eating and insulin regimen that significantly improved his blood glucose levels and slowly eliminated many of the diabetic complications he had been experiencing.  Ultimately he developed a road-map to a destination that was “normal” blood sugars.  In order to have his ideas taken seriously, he attended medical school starting in 1979.  At almost 80 years of age, Dr. Bernstein continues to have a thriving medical practice and numerous publications describing his methods for controlling blood sugars.

Bernstein Book CoverThe foundation for Dr. Bernstein’s regimen is a strict diet with a limit of 30 grams of carbohydrates per day.  He has strong opinions about what types of insulins should be used and is a fervent opponent of insulin pumps.  The guiding principle in his teachings is “the law of small numbers” where if you eat small amounts of carbohydrates along with small amounts of insulin, you will have only small mistakes not big mistakes.  Dr. Bernstein sees the world in black and white with very few allowances for variance from his plan.  If you read his book, you will be given a detailed prescription for reaching the nirvana of “normal” blood sugars.

Dr. Bernstein has many followers who credit him with saving their lives and they follow his diet and other teachings to a tee.  There is an active forum with discussions about the Bernstein diet and philosophy.  There are also many people, and this probably includes me, who adopt some of his ideas with less stringent goals and see significant improvement in BG numbers.  Although he is still dismissed by much of the medical community as an extremist or even a quack, some of his ideas are becoming mainstream with the increased acceptance of low carb diets and lower A1c targets for people with diabetes.

Although few of us can live the Bernstein life perfectly and most of us don’t even want to try, why do I believe that everyone with diabetes should read this book?  The answer is  because the strongest message that comes out of the book is that you can successfully control your diabetes.  You are not a helpless victim destined for continual high and low bloods sugars along with a myriad of complications.  You have the power to make decisions that will improve your blood glucose numbers.  You can set goals and take steps to achieve those goals.  Some of the necessary changes will not be easy to incorporate into your life.  However, if improved blood sugars are a high priority, you can do it.

You are in control.  That is a powerful and inspiring message and that is why you should read the book.

Dr. Bernstein’s Diabetes Solution was first published in 1997.  The 4th and most current edition was released in 2011.

Strip Safely: Join the Campaign

Laddie_Head SquareLike many people with diabetes, I am frustrated by inaccurate readings from my blood glucose meters.  The FDA requires that 95% of our meter readings above 75 mg/dl be within +/- 20% of the actual blood glucose value.  Below 75 mg/dl 95% of the readings must be within +/- 15 points of the actual value.  That means that my meter reading of 200 could actually be 160 or 240 and be considered accurate.  Or my 60 could be a 45 or 75.  When you base your insulin doses on these numbers, it’s a scary proposition.

I have learned from the Strip Safely website that the FDA standards are only part of the problem.  Currently there is no further testing by the FDA once a meter and strips are on the market.  At the Diabetes Technology Society’s May conference, studies were presented showing that there are many BG systems on the market that do not meet current standards and that some are as much as 40% high or low.  That 200 meter reading can now be anything from 120-280.  Most of the non-compliant meters and strips are manufactured outside the USA and the FDA has trouble monitoring these companies.

It was suggested at this meeting that the CMS (Centers for Medicare & Medicaid Services) bidding process is creating an atmosphere where price alone is determining what will be available.  Quality is being sacrificed and patients are being put at risk.  If you want to see one of those patients at risk, look in the mirror.  I am close to Medicare age and I am terrified.  Because Medicare standards influence most insurance company decisions, everyone of any age is affected by this.

Bennet Dunlap of the YDMV blog is the driving force behind the Strip Safely campaign.   Only Bennet could have thought of such a titillating name:)  He is encouraging each of us to visit the website, take the quiz, and learn about the campaign.  Then we should follow through and write letters to our senators and representatives as well as members of the FDA.  There are instructions about how to do this on the website and many sample letters.  If you would like to listen to Bennet discussing the Strip Safely campaign, check out the 7/1/13 DSMA ‘Rents show.

Strip Safely_BANNERI spent the 4th of July writing letters to my senators, my representative, and the FDA.  I can’t think of a better way to have spent our national holiday than by exercising my right to influence my elected representatives.  The models for my letters were from the Strip Safely website along with Meri’s letter at Our Diabetic Life.  I wrote a longer letter to the FDA and if you would like a copy of it, please contact me through the link in my blog menu.  The one page letter to my elected reps is below.  This is the first time that I have ever written letters like this.  If I can do it, so can you!

My Sample Letter (please copy if you’d like):

I have had Type 1 diabetes since 1976.  I use an insulin pump to deliver the exogenous insulin that I cannot live without.  I test my blood sugar levels about ten times per day and this testing is a critical part of my diabetes care.  I need accurate meters and test strips to enable me to determine the correct amount of insulin required for meals, snacks, and corrections.  Inaccurate strips lead to inaccurate insulin dosages that can impact my short-term and long-term health with resulting blood glucose highs and lows.  Severe lows can be life-threatening.

The diabetes community in the United States needs your help.  Please help keep inaccurate meters out of the hands and off the fingers of people with diabetes.  At a recent meeting with the Diabetes Technology Society, the FDA acknowledged that there is a problem with test strips by certain manufacturers not delivering the level of accuracy for which they were approved.  Many of these manufacturers are from Asia and other offshore locations.  The FDA does not currently have a plan to do anything about the problem.

We need them to have one.  Please use your office to help keep Americans with diabetes safe.

Type 1 Diabetes is characterized by incredible variability and inaccurate strips make a difficult disease even more difficult to manage.  Please ask the FDA to implement a post-market program of ongoing random sampling of strips to insure that all brands consistently deliver the accuracy in the real world that they were approved to do.

We would also love to see the accuracy standard in the USA tightened to match the ISO standard of 15%.   But first things first.  Currently a lack of post-market quality control over manufacturers by the FDA degrades the existing standards to irrelevance.

The FDA has many responsibilities.  Please make Fixing Diabetes Testing Accuracy one of the things for which the FDA is known.

Very truly yours,