High profile praise for Dr. Bernstein's methods

Of course, it's heart-warming to read about how this semi-famous fellow lived a life of adventure with photography (one of my vocations and hobbies) AND Type 1 diabetes. Clearly, even diabetics have lived extraordinary lives...

I suppose we can all survive, but we don't always thrive. What always gets my attention is the story of how someone, after years of struggling with the disease had a breakthrough, and was able to tangibly improve their life with diabetes.  In this case, the pivotal point in his diabetic control came from meeting Dr. Richard Bernstein. Through Bernstein, Roger Ressmeyer was introduced to the "rule of small numbers" and began partly controlling his diabetes by eating a limited carbohydrate diet. Ressmeyer also uses an insulin pump and CGMS. I feel like my best results have been possible once I had that trinity working for me. I relate to this man's "pivotal breakthrough" in his diabetes journey.

While Dr. Bernstein is critical of insulin pumps, I feel that using one has really helped me to take my control further. Dr. Bernstein's methods usually require simplifying things and eliminating variables. The pump might bring more variables that sabotage your results, but, with some diligence, and careful fine-tuning, it can be a tool for better control and flexibility.

Anyway, I'm glad to see Dr. Bernstein getting mentioned in the media. I know he's a well-known (and sometimes controversial) figure in the diabetes community, but I wish that his extensive personal knowledge about managing diabetes could help more people who struggle with getting the best results, and recovering health. His insistence that all diabetics can achieve normal blood sugars is bold. But, it's these kind of high standards of medical care that we need in a world that has been talking for decades about an "imminent cure".

My Most Useful Book List

Some of my favorite books about managing diabetes, and strategies for eating with diabetes:

1. Diabetes Solution by Richard K. Bernstein
2. Think Like a Pancreas by Gary Scheiner
3. Your Diabetes Science Experiment by Ginger Vieira
4. Pumping Insulin by John Walsh
5. Nourishing Traditions by Sally Fallon
6. The Rosedale Diet by Ron Rosedale
7. Primal Blueprint Cookbook by Mark Sisson and Jennifer Meier
8. Paleo Solution by Robb Wolf
9. Why We Get Fat, and What to Do About It by Gary Taubes

I plan to review some of these resources and describe the ways I have found them useful. I have been impressed with the most recent updates to many well known books. The developments, research, and understanding of metabolism has moved forward and the latest versions are worth checking out.

Surviving the Feast Days

I am pretty disciplined with my diabetes.
But, there are always times when you allow yourself to "go off the reservation" a bit and embrace a little chaos. In fact, in my last few relapses of poor control, it was really just a stringing together of these kinds of justifications that led to an extended hiatus. "Oh, birthdays and ice cream only come around once a year..." "Well, we are out for dinner".

I do really well with my daily routine, but when there is a "feast day" of some kind, extended family, booze... it all gets kind of whacky, and no matter what, I end up with an evening and overnight of high blood sugar, even without serious missteps. Here's the thing... I eat too much of whatever I eat. Low-carb, no-carb, I just eat too much because it's a celebration and it's fun. This eating too much thing is really my problem. My stomach gets stretched, glucagon is released (read about Dr. Bernstein's "Chinese restaurant effect" theory), and now I have insulin that is outmatched and useless.

Let's look over today, our family's Easter feast day. I started by eating some deviled eggs and some smoked salmon and some olives for appetizer. Quality food. I was already full. Of course, I bolused. Next up, ham, salad and grilled veggies. All good stuff. So, all together, not to much in the carb realm... but, I was beyond full.

I saw my sensor BG level hitting 140 mg/dl post meal.

I got out my secret weapon. Walking. I took two brisk laps around the block and during that time I saw my BG hit 160 mg/dl and then change direction and return to 130 mg/dl. Then it started creeping up again...

When I got home I tested and found that my sensor had it wrong. I was 200 mg/dl. I took our dog for a brisk 20 min. walk and saw my post walk BG at 111 mg/dl. Okay, so hopefully I'm stable enough to go to bed and not see any more rises.

My insulin seems to work slowly, unless I exercise. When I do, I find that it accelerates everything. For me a correction has become a bolus and a walk. Done.

Hopefully, someday...  I will figure out how to approach a celebration without consuming more food than usual. Or, I will just plan to walk a lot.

CGMS accuracy hiccups

It's a bumpy ride... or not.

I find that my CGMS is rarely accurate during the first 24-48 hours. At first I thought it was because it was getting calibrated, and it took a while. But, then, sometimes it would calibrate perfectly by the 2nd reading and then be spot-on till it ran out of battery 6-7 days later. I just want to give props to my last one that was accurate the whole time, 24x7. It took 7 days for the battery to run out, or I would have kept it going longer. Hope there's a few more like that in my future...

I think that when I hit a blood vessel there is some bleeding around the sensor. Since it's meant to read BG from interstitial fluid, and not blood, it's not accurate. I believe when the blood gets reabsorbed and the bleeding stops, it gets more accurate. I have had results that go along with this idea. I always leave them in, even if I notice bleeding or accuracy problems early on. They seem to eventually get sorted out, but it's not immediate.

Today, I turned it off and am going to give it some time before I actually depend on it for real useful data. So far, I've been pretty flat at 90 mg/dl this AM and my sensor has had me at 69 mg/dl with a single down arrow and low predicted, and then a double arrow up at 129 mg/dl predicting an ascent out of range. During the night it showed me going from 81-130 every hour like an ECG. All false...

Anybody else out there have these quirky problems with their CGMS?

I have heard that Medtronic has improved their sensor technology, a lot. That will make a huge difference, when the FDA approves them and we get them. Dexcom seems to be ahead on the development, but I'm pretty hooked on the pump integration, so am willing to wait/suffer a bit.

Great videos that show what's up with total cholesterol...

diabetic jewelry

I enjoyed looking at these diabetic tattoos. I read that the reasons many of the owners got them was because they didn't want to wear a medical alert bracelet. I think if that's your reason, you have to be honest and say that you really want a tattoo. If I don't want to wear a bracelet or necklace, I just... don't.

Part of me wonders... maybe I'm wrong in my decision on this, but, from my experience it isn't necessary. I guess I've always felt that it's my job to protect myself by being really careful with insulin.

What do you think about them? (not tattoos, medical alert jewelry)
What do I do? I have a card in my wallet that says that I'm a diabetic. Is that enough? So far no one has ever seen it.

If I were to ever get a tattoo, it would be a conversation starter. I love to have conversations about diabetes, so I guess it's pretty likely that I might get one like that. But, I'm not really a tattoo person.

Ahh... blood.

I received my labwork on my phone. I had the patience to wait until they pinged me and said it was ready. It was hard to wait... it took 5 days to reach my phone, but only 24 hours to get to my docs.

It was exciting because I was seeing a lot more blue ink, indicating more/new numbers that were out of normal range. Even my blood glucose of 105 mg/dl was marked as "high". Did Dr. Bernstein get to them?

I don't have to do an at home A1C this month because I did an "official" one in the last few days of March. This time it was 6.3. I had guessed that it would be that number, because I had looked at my recent sensor/meter readings. I don't really regard the A1C as a suspenseful data point anymore, I can see the trend and pretty much guess it. I would venture to say, our sensor/meter data is more useful than an A1C these days.

Other things I was looking forward to seeing:
1) Thyroid Function- I asked my doctor to order a TSH test to see where I was with that. I had been fine in Sept., but during the last 6 months I felt that I was showing signs of slower metabolism. I wasn't eating very much, still maintaining weight, etc.  As it turns out, it was high, which means it's likely that I have some sort of low thyroid issue. Possibly low-iodine intake. I understand that there are various reasons why Type 1 diabetics also have hypothyroid issues. I'll see what route my doc wants to take to correct it.
2) For the same reasons pondered above- I wanted to have my testosterone checked. I figured the metabolism question might be related to one of the two hormones. It was not the problem, it was a tad higher than normal, which could be the reason why I have felt pretty decent despite low thyroid function. I've never come across as a high-test kind of guy, but, I like knowing it's on the high-side for health/aging reasons. Insulin sensitivity goes up with testosterone levels.

Other interesting data: 

• There was low creatinine in my urine, which would only be interesting if I had an abnormally high number in my blood. Since I don't, it likely just means my kidneys are working well. 
• The bloodwork also showed a high-ish ratio of albumin/globulin. This ratio was 2.1(the upper edge) last time and now it's 2.3. Seems like a marginal change. The things I read didn't make it seem like a sole indicator of anything in particular, but if other things were out of whack, it might help shed some light. It is usually related to liver and kidney issues.
• My cholesterol is higher than last time, but I have read that hypothyroidism can have an impact on cholesterol, so that may be tied in together. I had expected my improvements in my glucose control to impact my cholesterol positively, but, I guess there's always multiple factors at play. My triglycerides: HDL ratio is still solid, so I'm not worried about any of the lipids right now.

So, that's all the excitement for now. It will be interesting to see if my doctor orders any more lab work to clarify my results at all. I will see him in mid-April, so that will be when I might get some more info on it.