Dr Bernstein and the consequences

Let me start this post by saying that I am a recently (June 2009) diagnosed LADA diabetic who is currently only on 1500mg of Metformin (500mg per meal). Let me also say that Dr Bernstein clearly says that “if you use blood sugar-lowering medications…, the first rule of meal planning is don’t change your diet unless your physician first reviews your new meal plan and reduces your medication accordingly.” I have overlooked this warning at my own risk and started making the changes he suggested. Here is how it went:

Friday - the day the book arrived
07:44 - 82 this has been normal for the last month or so
10:45 - 140 yes, I was upset, that’s too high but I now I know I had way too much carbs for breakfast and did an almost workout by climbing a lot of stairs, which is bad if you do it within 3 hours of getting up
14:51 - 93 quite a good post-meal value, had my usual salad and cheese I think
23:03 - 82 two hours after dinner (probably already low carb, can’t remember now), happy with that, too
02:54 - 74 woke up at night, that hadn’t happened very often before…

Saturday - starting to make changes

07:03 - 71 a little lower than normal - had two scrambled eggs and berries for breakfast, liked it a lot
09:49 - 68 when I saw this, I started taking glucose tablets (several over the course of the morning)
12:24 - 86 happier with that, tablets work
15:29 - 86 two hours after my first low-carb lunch, that’s okay (see yesterday)
22:46 - 88 two hours after low-carb dinner, within the “normal blood sugar” range that Dr B. recommends
00:15 - 94 woke up at night again - nothing to worry about

Sunday - very proud of my achievements

08:47 - 63 got up late, so that’s okay
09:54 - 106 big yoghurt with berries for breakfast, and this is less than an hour after having it
12:09 - 78 fine, although a little low
15:31 - 78 roughly an hour after a huge steak and 1 cup of spinach
18:08 - 78 I have never had the same value three times in a row! but my stomach still says “full”, nice feeling
20:19 - 70 pre-dinner, on the low side
22:32 - 69 two hours after dinner… Dr Bernstein says that post-dinner values should be the same as pre-dinner values, so here we go - it’s just that I started off too low!
01:24 - 94 woke up at night again feeling weird
01:39 - 105 since I felt really weird, I tested again… very strange results

Monday - feeling this was all a horrible mistake

07:43 - 68 that’s a lot lower than last week…
08:06 - 73 I have never measured pre-breakfast before but since Dr B says that it’s higher, I wanted to see it with my own eyes
For breakfast, I had my two scrambled eggs with a double portion of berries (double the recommended dosis of carbs) AND took a glucose tablet so that I could walk my usual 5.5 km after breakfast (not really exercise, a leisurely walk to work)
08:40 - 112 less than an hour after breakfast - it felt like being 200!
09:47 - 77 at the end of the walk, all the accumulated carbs have evaporated, too bad, I ate a handful of nuts with no effect whatsoever
12:10 - 68 at this point, I took a glucose tablet…
13:01 - 83 …which got me exactly to where I wanted to be before lunch
15:59 - 68 2.5 hours after lunch (salad and cheese), and I am too low; ate a handful nuts with no effect…
16:41 - 63 at this point, I took another glucose tablet
I ended up eating another whole salad with a huge piece of cheese at 17:30 because I thought I might not make it home otherwise - it left me very satisfied; after all this measuring, I didn’t measure again before my real dinner at home but had a very good one (possibly more than the recommended dosis of carbs but also lots of protein)

Looking back over the last three days and especially over the day today, there are a few things that don’t work for me. First and foremost, even if they deliver predictable results, I do not want to feed myself glucose tablets to keep my sugars constant over the day. I seem to need snacks, and now I am really wondering what those could be (I can see myself downing several kilos of nuts per day…).
And I seem to need more carbs on the whole (at least while I’m still on metformin).
And… protein food is SO much more expensive than carbs!!!

Slow acting carbs are fine, I have been eating them for a while now - unrestricted amounts, really. Not having any carbs from grain or bread or pasta is fine. Not having any fruit is not great but I can handle it (especially after I went up to 128 from eating three mandarins recently). Eating lots of cheese, eggs and meat is very very unusual for me, but I think I can get used to it. I was a vegetarian for a while last year but I like the taste of meat, actually. I don’t like fish very much but I think I can get used to it. Luckily, I’m not “into food” and never have been (I hardly know how to cook) so I don’t mind very much how something tastes, as long as it suits my (now blood sugar driven) needs.

What I haven’t understood yet is this: even very few and slow-acting carbs will bring bloodsugar up at some point. And then back down again. How does one know how long this will take? For glucose tablets, it seems to take 40 minutes until their effect is over (and you need to take the next one). Dr B. says not to eat anything within 4 hours from the last meal in order not to have the bloodsugars overlap. But that’s just not enough food for me - I would be low all the time that way. So I guess my question is: how do I eat ENOUGH carbs at a meal so that they last me for 4 hours (as they should?) and I neither spike nor go low before the next meal? Is there a formula or something? Or is each food item different? I don’t think this is explained in the book.

[After writing the above, I went to bloodsugar101 and did some research. Here is the page that gave me almost all the answers: http://www.phlaunt.com/diabetes/14046989.php. Thank you, Jennifer, I come back to your site again and again and always find new stuff!]

The reasons why I really really want to do Dr B.'s diet, and be good at it, and put all my willpower into it, are these:
(1) If my beta cells are still producing insulin (as they do), they should get at much rest as possible to be able to do this for as long as possible. Low carb eating means they have to work less. I was on insulin for the first four months after my diagnosis and it gave them so much rest that they recovered really well and now I don’t need to take any insulin because they work - they deserve the best treatment possible!
(2) High blood sugar is toxic to my dear remaining beta cells, so anything to lower blood sugar under 100 will prevent me from killing them off (and I know I have done a lot of damage over the Christmas holidays - sorry guys!).
(3) The autoimmune attack that is going on in my pancreas focusses on anything that produces insulin, so it would be best to “shut down” the pancreas as much as possible with small doses of insulin. Second best is to “need” as little insulin as possible, which is why low carb may (may!) prolong the honeymoon period that I’m in for a good while.

And one last question: is the fact that my fasting blood sugar and also my levels during the day (post-prandial and not) are so low - way below the “normal” 83 mg/dl - entirely due to me taking metformin? Or could there be other reasons, like “just not enough food”?

I’m confused… lows on the 60’s don’t require aggressive treatment if you aren’t on insulin… popping glucose tabs is basically empty calories and could contribute to the problem, as your body gets used to “gearing up” to cover more and more carbs (as reflected in what you are consuming as tabs). A lot of normal people walk around in the 60’s and it’s not a huge deal… if you get there and stay there, I wouldn’t worry too much. If you were on a medicine that was making your body produce MORE insulin, or you were injecting some, then it would be a different issue. My gut feeling is that your body is quite capable of managing fine at that level without going lower.

However, met isn’t supposed to cause lows. If it is, I would suggest you talk to your doctor about what’s going on… maybe you could reduce your dosage.

And lastly, my advice is that Dr B’s method works for some… but it is by far not the ONLY solution for everyone… my guess would be that your lows are simply the product of “not enough food”.

Dear Sarah, thank you so much for your hugely helpful comment! In fact, it’s my doctor who thinks that 60s is low, not me, I feel mostly fine at those levels. At the beginning, I would start getting a panic attack (which has some of the same symptoms of low bs) whenever I went below 90 - until I read in on the bloodsugar101 website what truly normal blood sugars are. Nobody had told me this! Your information is even more comforting, and I will stop immediately taking those glucose tabs (I never thought that was a good idea). I will also talk to my doc to see if she might reduce the metformin. This morning, I ate two scrambled eggs with a grated apple (delicious!) and it got me to 105 after one hour. Not sure if I need to aim any lower than that - what confuses me is that after each meal I can feel my pancreas pounding and working and getting attacked right there by my stomach, and I feel sorry for the poor thing… The lower I can go, the less I can make it work, the longer it will resist the attack, I guess. Thanks again for your advice! Uta

Tuesday - working my way up to better results
7:32 - 66 not very happy
8:00 breakfast: 2 scrambled eggs with cinnamon, half a grated apple (loved it!)
9:00 - 105 okay…
10:00 - 113 hmm… (target was 90 after 2 hours)
10:45 coffee (bring bs down mysteriously every time - try to replace with green tea!)
11:00 - 84 see: bs down
12:41 - 62 feeling cold
lunch: salad (about the recommended 2 cups) with olive oil, vinegar & big chunk of cheese, and a tiny little part of a slice of bread; forgot my Metformin at home
14:03 - 74 panicked and ate 40g almonds (about 6g carbs)
15:08 - 81 seemed to have been a good idea, those almonds, or is this the delayed effect of the lunch?
16:00 ate even more almonds (50g), felt full until dinner
19:20 - 66 but I wasn’t hungry at all
started eating radishes with meaty spread, then a slice of raw ham, then salad made from half a (very small) fennel, nuts, olives, olive oil, some orange juice
21:30 - 76 after one hour, but still feeling quite full

Maybe Sarah is right and I am the type that is more “at home” around the upper 60s, lower 70s range… Or I need to come off that Metformin!