Hi,
I am a T2 for 2 years, and pretty much follow Dr B's solution to the letter, but seems there is no way to maintain a constant blood sugar at 83 before, during and after a meal. I tried same thing on my none-diabetic wife and son, they can't maintain 83 after one hour either, even after a low-carb meal.
So my question: how many of you can actually maintain your blood sugar at 83, one hour after a meal ? Is it actually possible? with/without the help of insulin ?
thanks!
Otter
You know, I've been wondering about this too. I am relatively new to Bernstein (and thank God he exists), and am a T2 who is just preparing to start using insulin, so I am very interested in this question also. I look forward keenly to the discussion.
It's a goal that's impossible to achieve. As close as you can get, is great. I've tested my husband when he'll let me & his BG isn't in the 80's after meals. It comes down quickly, but he doesn't maintain a consistent level.
In his May web cast, Dr. B stated that people can get a small deviation if they don't have gastroparesis. So, that means that no one is hitting a completely flat BG line. I'm thrilled to have postprandials of 120 or slightly under.
I've been following Dr. B's guidelines for going on 4 years. Some of it can be done with timing of bolus, for those on insulin. I've tweaked & tweaked timing. The general guideline of bolus 15 minutes before eating isn't helpful for everyone. Another method that helps, again for using insulin, is splitting bolus doses by taking some before meals & another 1-2 hours or more later to prevent a spike from protein.
I use low carb and minimal metformin only and I can keep quie close to that More like 85, but I never go over 115[6.4 to me]. I think the point is that this number is a TARGET. Even the best marksmen miss targets, but they all aim for them.
I find I do best if I eat very low carb and SMALL meals. One of the big problems in Uk diabetic health is the relaxed targets which make people think numbers up to 8 [144] are acceptable[look at the Diabetes UK website!!!]. Thus often they will see 180 as Ok since it's not much above target. If however your target is 83 at all times, You know 180 is badly off. I talk to MANY diabetics and I know this to be the case
Hana
No, it is not possible and Dr. B would not claim it is. But depending on how extremely anal you want to be, it is possible to stay relatively close, say less than about 100 most of the time. I am type 1 and I do not achieve that, but I try.
What Gerri said is spot on.
My experience: I'm T1, on a pump, Dexcom CGM, and have been on a Bernstein diet going on 2 years. The majority of my PPs are around 110-130, starting with a flat trend of 80ish before a meal. Trying to hit a completely flat day is really tough and requires a lot of micro boluses (10-14 a day) and small glucose additions. It's pretty much one bolus every 1.5 hours that I'm awake and some of those are extended over 2-4 hours (think R insulin).
So, when my body switched over to getting glucose from protein/fat I noticed my PPs changed to a 3-4 hour stretch as opposed to the old 2 hour trend. Also, only large boluses will effect my PPs. Meaning if I go up to 120, 20 minutes (to 3 hours) post meal, it will take about 5u of insulin to bring me back down. What a fascinating digestive system!
So, can I hit 83 1 hour after a meal? Yes, I call it flatlining. Does it happen all the time? No, not by any means! Plus, it requires a lot of effort to do so depending on regularity of food and dose timing.
Still, it's a great standard to try to reach and my BGs have never (in 27 years), been better.
My understanding is that a normal person will top out around 130 for a carby meal and then go back to 83 at 2. I would test at 2 to see how you are doing. My personal goal is to never go over 140 and this is do able for me.
Did he really say it should not go up "at all"? I thought 83 was the average for a non-diabetic, and that the goal was that we should try to eat in a way that our blood sugar "does not go up by much, if at all". I don't know if my memory here is accurate.....I do know that my adopted Korean son is the only one in our family who matches that 83 average, and can eat anything he wants and hardly go up. I would be willing to bet there are just not many like him.......There is always the goal....but I would think anything under 120 an hour after eating is ok? I know that as a type2 if I eat extreme low carb, I can do it....but that takes extreme will power too!
Bernstein's motto is that diabetics have a right to normal BG. Normal BG does veer from the 80's, just not for long. Impossible for BG to never budge from 80's. We'd spend our lives with insulin in one hand & glucose in the other:)
Under 120 one hour postprandial is excellent.
I think he is trying to say that before the advent of grain / processed food / fast carbs, all humans ran at (roughly) 83 most of the time. (If you were a non diabetic caveman only eating roasted meat you had caught and some scavenged greens you probably pretty much stayed totally flat). (Obviously nothing stays totally flat e.g. your body temp flucuates through out the day and night - but not by much. Similarly glucose will fluctuate a little when you eat and exercise etc - but on a caveman diet, probably not by much). THe advent of readily available fast carbs (and large amounts of easy to get food) overrides even non diabetic pancreases (briefly) so even non diabetics on a modern diet will spike (but recover fast). So if you want to run your sugar the same as a non diabetic you have to define what diet your non-diabetic is on! A non-diabetic on a modern diet (often the diet that gives people type 2 disease to follow!) will have spikes post meals (but recover the spikes back to normal levels later as their pancreas catches up). I think Dr B is comparing to a non-diabetic on a very low carb / paleo type diet in which case it is possible to be flat most of the time. As glacierlily says, it is possible to remain extremely flat even as a diabetic if you are anal enough about it. Some days I am extremely anal and can stay between 75 and <90 for 24 hours but as onesaint says it takes lots of work (or being too busy to eat - not eating all day works very well!) plus lots of tiny boluses of insulin etc. (See some of the pictures on the flatliners group to see 24 hour traces of what levels are possible). Other days things are rather more rocky mountain than flatline! Either way I think it is possible to maintain a pretty flat trace but it involves extremely strict diet (for me less than 20 cars per day) careful bolusing and regular testing (I test 8-12 times a day depending on how well my continuous monitor is working!) plus regular exercise to keep your insulin resistance down - If I don't cycle to work for 3 days I notice a definite change in my insulin resistance and insulin dosing required.
The real answer i wanted to give to your question (as Dr B's advice that you should be 83 all the time confused me too when i read it as I thought "but even non-diabetics don't get that level without spiking higher") is that I think he means you should be the same levels as non-diabetic humans IF they are eating a paleo or extremely low carb diet (who will hence probably remain extremely flat around 83) NOT the same levels as non-diabetic humans on a modern diet (who will probably spike quite high repeatedly after meals despite great beta cells!). It seems therefore, the more beta cells you have working and the lower carb you can manage, the flatter you can keep your line.
(HbA1c levels will test how flat and low you are keeping on average. The lower your HbA1c the better as it reduces your risk of complications. Some trials show a low HbA1c INCREASES mortality(!) but it is likley that is if you are trying to keep your HbA1c low whilst eating lots of carbs and taking big doses of drugs etc to counteract those carbs. I believe keeping your HbA1c low by reducing carbs instead (hence using small amounts of medication) is beneficial despite the trials I mentioned).
Amen! HgA1C is a useful barometer but it is indeed an average. An average, by its very definition, conceals the peaks and valleys. And the peaks and valleys are critically important to us. Those severe back-and-forth oscillations are just a form of very slow Russian Roulette. There is no effective substitute for frequent monitoring and feedback. There just isn't.
Not sure if the reasons for increased mortality in the trials of tight control are due to increased levels of medication (they help control sugar levels but do cause other problems) or due to the high peaks and troughs that automatically result from attempting tight control on a high carb diet but either way completely agree that HbA1c just an average and lots of fingerstick testing to avoid peaks and troughs is also very important (as well as the low carb / Dr B approach).
The study that i've read on tight contr5ol and Mortality was a shocker. The massive and frequent doses of multiple medicines would kill an elephant!
No-one has yet done a large study on low carb eating leading to tight control. There have been some smaller scale ones in Sweden. All of these show that low carb eating is beneficial and a couple of these studies have been done on periods of 4 years. However. Most research is funded by pharmaceutical companies, which won't make much money if EVERYONE tries the NATURAL route to tight control.
Hana