Dr Bernstein on Insulin Pump Therapy

Diabetes Health online magazine has an Interview with Dr Bernstein about his views on Insulin Pump Therapy. I couldn't believe what he said, basically that all those he interviewed had worse A1C results on the pump than off it. Mainly due to scar tissue build up. This has not been my experience, my A1C is way better (5.9 to 6.3) in my 6 years on the pump than it was pre-pump (7.0 to 8.0). Who on did he interview?

The link is:

http://diabeteshealth.com/read/2013/05/15/7867/what-are-your-thoughts-on-insulin-pumps/

My experience is like yours, Annabella. This is likely why we don't get interviewed by the doc, he is not interested in speaking about success with pumping.

You know what? I would like to know where this "major insulin pump center" he spent a month in is located. I wonder if it is Joslin (and I wonder what they think of his view).

Here's a similar link to the 2010 'interview'. It clearly states his 'normal' range:

"We have both A1C and blood sugar targets. The A1C target for most people is 4.2 to 4.6. This is a non-diabetic range. The target blood sugar we seek is 83. "

I've used a pump for 15+ years, and I have not noticed any scar tissue. And I would never have 4.2 - 4.6 as my goal.

link-berstein-interview2010

Does anyone know which meter dr B is currently recommending?

Gosh, I'd better get rid of my pump!

This attitude towards pumps is a big reason I don't really like the guy, actually. And also why I don't trust "evidence" he bases on his patients or personal experience as a doctor. Obviously he hasn't interviewed all (or even most!) representative pump users, because many have a lower A1c on the pump than off—regardless of whether they actually achieve his recommended level of control. So then why, when he says things like ALL people with diabetes can achieve non-diabetic level control (based on his patience/experience), or any of the other stuff he says based only on his or his patients' experience, should people actually believe that these statements are accurate? He may restrict his patients to people who have "straightforward" diabetes and who his program works for, and/or who agree with his philosophy completely, and so on.

I think he really needs to publish some proper data. The fact that he had so much trouble before he was in the medical field isn't really an excuse anymore.

Sorry if that got off topic and into a bit of a rant. :) Do not mean to start any kind of debate/argument! I try to give the guy second or third chances, I even bought his book! But whatever I try, I just can't make myself like him or agree with much of what he says.

I'm with Jen on this and I don't rate the guy. I know many on here seem to think he's amazing, but frankly I don't see it and personally think the guys a quack more interested in selling books.

Well, understand I am a big fan of Bernstein, but I don't always agree with him. In this case, he argues against pump therapy because he saw worsened control in a population of users. This one experience flys in the face of most research which seems to find that it will improve the control of most patients by reducing their A1c 0.5-1% (altho most of these people start with poor control). This argument is different than what he usually states, which is the argument that pumps cause scarring. That being said, I have one friend who just started as his patient and moved from pump to MDI after more than a decade and her control has improved even though her A1c was already 5.3%.

I think what he doesn't say, but probably believes is that a pump may lead people to believe they can eat whatever they want and just bolus.

ps. And sometimes, I think diabeteshealth "recycles" columns that may be more than a decade old and it isn't always clear when they do this.

The meter he recommended this fall when I called his clinic was the Accu Check Aviva. Not the nano, but the big one.

Much research that is so freely bandied about on the internet these days confuses correlational relationships between variables with causational relationships between those variables. In other words, two things can occur together without one thing being the cause of the other, which can be something entirely different.

Brian's friend did two things at the same time: She switched from pump to MDI and she started working with Dr. B. Dr. B is known for getting his patients' A1C's down through diet and other principals - it's what he does. So if her A1C came down it is more likely due to working with Dr. B than changing to MDI. Given that Dr. B hates pumps he probably urges all his patients on pumps to switch to MDI. When their A1C comes down he can say, "Patients who switch from pump to MDI have lower A1C" which may be true but it is misleading as it's not the switch to MDI that caused the lower A1C. Correlation vs Causation.

The issue of scarring from long term pump use is another subject, one we'll probably hear more of as people are on pumps longer and maybe that view of Dr. B's will prove prophetic. As for the belief that using a pump may lead people to believe they can eat whatever they want and just bolus, there are many people who, unfortunately, believe that. But there are people who believe that about insulin in general and doctors often foster that idiotic idea. But neither insulin nor pumps cause that behavior. Doctors, on the other hand.....ok, time for me to back off of teacher's mode!

I wonder if by "control" in "his patients" Dr. Bernstein is measuring his ability to control them as much as their ability to control their blood sugar...

Why I agree with some of his concepts (low carb-lower insulin requirements-less chance of mistake) his whole concept of your BG shouldn't elevate after eating is one of those ideas that seem a little on the quack side. It's a proven fact that even non diabetics BG will elevate after eating.

Are you saying there is something Machavellian in the man? I think there is in all true healers. What I don't believe Dr. B for a moment to be is someone just in it for the money or the books. I think he is a true believer. True believers are often very effective at what they do and at influencing others. They also can be sort of scary!

There are lots of good ideas in his book along with many that don't fit recent evidence.
I adopt the tools in it that are useful for me in improving my control.

With regards to his comments on pumps and CGMs, I will speculate that at his age, despite being an engineer, he is starting to fossilize his ideas on technology, like so many people do.

Moving to the pump improved my A1c by nearly 1%. A big part of this was the ability to have many different basal rates by time of day. Even splitting and changing the timing of my long acting insulin dose was not able to get me good control both day and night.

Thanks MegaMinxX for the interview link. There is also a thread about that on DD from 2010. The bit about where he came up with his number for "normal" cracked me up! It's not a bad number for sure but all the folks he tested had that number? What are the odds?? I know that was (who really knows when it was) some years ago. Maybe it was the first meter and it only had 4 numbers, and they were range driven (ie. 83 is normal, 45 is low, 126 is borderline, 145 is high). Just for kicks, folks!

As for the pump stuff, I just can't help but laugh. But then I am not a fan of the diet, so even without my pump I would eat my fruit every single day. And the scar tissue warning is valid but MDI causes the same thing.

I see that there are others like me who agree that the pump has changed our lives. In fact the pump has saved my life including the education which I'll give first credit to. I now have Gastroparesis (sp) I don't know if I could manage with GP on MIDI and wouldn't like to find out. After 40 years of MIDI when I learned to pump it has helped me to make it to 54 years for which I'm thankful.

Full disclosure: I am a Bernstein follower in many (not all) respects. I don't pump, but like many here, I believe his pump arguments to be deeply flawed. I have my own reasons for staying with MDI and they owe nothing to him.

I don't want to rehash what others have said, other than to attempt one very small clarification. Zoe, I don't think Brian was saying that people on pumps feel they can eat more, only that Dr. B himself might believe that, and therefore take the position he does.

But fundamentally, I think this very discussion itself highlights a key requirement when receiving advice from any expert, anywhere: take what you can use, and leave the rest. Applying many (not all) of Dr. B's methods has given me the best numbers I have had at any time since dx -- roughly 20 years. So, as I said -- use what's useful and discard what isn't.

Thanks, David. I actually wasn't attributing that view to Brian (or even Dr. B as I don't know if he believes that), just saying that some people do, in fact hold that view, and are encouraged by their doctors which could in turn be an influence on how they do on the pump.

I totally agree with the "take what you need and leave the rest" approach!

I will say one thing I do NOT loose weight with low carb/high protein high fat diets. I actually gain. And I maintain very good control BY including some carbs in my diet. While I keep those serving sizes small, I just try for me to eat a balanced healthy diet..and that does include some fruit and some carbs. I think like many of us have stated we have to find what works best for US. We are not all going to respond to the same treatment in the same way. And Zoe I agree with your earlier statement regarding research. Very well said.

i don't know if i even buy into 'low carb = lower insulin requirements', eventually the body will start turning everything into glucose, one will become extremely 'carb sensitive' and will start having to bolus for protein - veggies, everything, etc...I know, I've done it and when low carbing I have to bolus a ton for protein etc..so, what's the point, you end up taking the same or more insulin at a meal. these analog insulins were designed to work with carbs, they work better with carbs.