Dr. Bernstein

I am listening to Dr. Bernstein at this moment and man o man he is so against pumps. His biggest concern is accurate delivery of insulin and he feels after 7 years, people will have much scar tissue which will further make insulin dosages very inaccurate. He also feels that the body thinks the tubing is a foreign body and infection will develop making further issues with pump usage. Pumping for 4.5 years and not sure I agree, as after 35 years of shots, I have a lot of issues with sites and skin problems as well.

If you rotate your sites well, wouldn’t this solve the problem? I use my stomach, legs, and arms for sites, same as I did for shots. I don’t see how it would be different …

I think it is the length of time it stays under your skin. I have never heard him have a positive thing to say about pumps. I do not have issues with my pump and scarring and even with shots I sometimes had absorption problems. He stated if you are having good control with a pump, more power to you, he is very negative, but…
… he is super intelligent about diabetes in every other way. He is just very matter of fact and no messing around, and ooooo he stated if you can follow his routine and no more than 30 carbs a day coming from veggies your bgs would and should be always around 80. Don’t think I could do it, but I know he is right.

He writes about this in the book, and what he says is that in the body of patients he has seen, he has seen this problem where over time there is significant scarring.

I have also read online discussions where people suggest that the pumps of today aren’t like the pumps of 10 years ago, so it is possible that the problem is one that has been significant in his patients but occurred because they were using older pumps with thicker infusion sets .

There are people on the bulletin board associated with his site who use his diet and pumps and have incredibly good A1cs (mid 4%). So people do it.

WOA… 4% would mean there’s a hefty number of lows, anyway…

One thing I wonder would be (and this was one of the reasons that made me decided for a pump back in 2005):
I currently do one “shot” (change of sites) once every three days vs. 24 or so shots every three days, if I count the Lantus (split into two shots at night and two shots in the morning) and the Novolog shots before each meal. Wouldn’t that many more shots in the same period of time create far more scar tissue?

It is the long term (3 days) of tubing in one spot, I believe he said caused increased white blood cells, infection, scarring, and with the increased white blood cells, iffy absorption and inaccurate insulin delivery.

What does he have to say about things like variable activity levels and hormones (for us ladies), and infection/illness? I find those are the three biggest factors that prevent me from getting super tight control, rather than carbs. I somehow think that even if I did eat really low carb these factors would make my blood sugar go up and down … but then, I haven’t tried it so don’t know.

I had this discussion once with my internist about my high numbers when I was hormonal, this was prepumping and she said are you sure it is not because you are eating more, because of your cravings. I still know that it is my hormones that made me soar, but I think she was half right in that I craved high carb and fatty meals, just adding to my increased numbers. If I really try during my pms and really low carb I can have better numbers, but still like the flexability of my pump to increase my basal for this timeframe. Bottom line low carbing is the best for diabetics and really most diets and better eating lifestyles stress carbs coming from veggies and low carbing it.

He(Dr.Bernstein) is correct. Anytime a cannula stays for an extended duration, there is risk of infections. Even if the cannula is inserted subdermally, there is a risk of infection, sp. in patients with impaired/vulnerable immune systems. Besides, extended use (24 to 48/72 hours) will result in scarring, which in turn impedes insulin perfusion. The same reasoning is used for peripherally inserted veinous cannulas during hospital stays, although those tend to be higher risks of infection. A subdermal injection, on the other hand, lasts for a minute at most, so there is no risk of infection.

Disclaimer: I am not a doctor, nor do i play one on television. And no, I did not stay in a Holiday Inn.




Bernstein’s diet keeps a very flat blood sugar so done right there are no lows. The people I know with Type 1 who use it use it precisely because they could not avoid dangerous hypos with a higher carb input. They get those 4% A1cs without hypos. It takes a lot of discipline, but for someone who can find no other way, it is an option.


He may seem like an extremist, but his techniques work. I don’t know where I’d have been without his book, because I could not get a diagnosis for years since my diabetes is a weird combination of normal basal (and near normal fasting) and extremely high post-meal numbers. For 5 years the only way I could keep my blood sugars out of the 250+ range was to eat the way he describes. If I had done what my doctors told me to do, I would have ended up 250 lbs (I was packing on 20 lbs a year until I started eating his way) and continually battling infections.

His book also taught me how to find the correct doses of insulin for me, which my doctors were completely clueless about (again, because I have an unusual form of genetic diabetes.) If I hadn’t read him, I probably would have ended up in the ER as my doctor prescribed a starting dose of Lantus that turned out to be more than 3 times the correct dose for me!

A lot of what he wrote that was considered “extreme” in 1998 when I first read him, is now what everyone here knows and follows. It’s hard to believe that back then many people with Type 1 were NOT on basal/bolus regimens and that most people with Type 2 were on sulfonylurea drugs that burn out the remaining beta cells.

I personally do not believe it is necessary to maintain as low an A1c as he says, but whether that is true or not, only my future will tell. OTOH, I feel very strongly that every person with diabetes deserves a NORMAL blood sugar. I just differ with Bernstein on what normal is.

People who don’t have diabetes have BG that go higher than 80. Can you image your energy level…I would have none and I would pass out while exercising!!!

I’m curious why you dislike Dr. Bernstein so.

Although he can be a little dogmatic, I don’t find him annoying or preachy. It’s admirable the way he took control of his own condition and shared his knowledge so freely. I don’t use his methods or advice strictly but he taught me two concepts that I keep to heart:

Diabetics are entitled to the same blood sugars as non-diabetics, and

The Law of Small Numbers (or something like that).

Like anything else with this disease, his book and methods are a tool. Use it for what it can do for you, discard the rest and use other tools as well.

But, I’m still curious about the level of dislike - I’ve never heard that about him before.

I have been on a pump for more than 12 years and still going strong. I do not have issues with infections or scar tissue. I do know this, there are many diabetics that say they are taking care of themselves and are not. I know because at one time I was one of those in the tribe.

In a nutshell, here is one doctor, who I am sure is credentialed, that acts like the cop, prosecutor, or lawyer who has become cynical due to the legal ystem they work in.

Frankly, this doctor is under the same spell…I know plenty of pumpers, from 4 years old to well over 60 that do not experience these problems as discribed by this doctor.

I have said and I stand by it that ther is no doctor that can truly treat you as a diabetic. They can suggest and help you attain a level of success. You must become friends with your disease and I know becaase I have been a T1 for 24.5 years and almost half of it on a pump.

Would I return to 8 needles a day…HELL NO!


At 24 years using 8 needles a day that would be approximately 71,540 shots. Using a pump for that period of time would be approximately 2,920 infusion sets (changing every 3 days). There is really no comparison and I do realize you said you have been pumping for only 12 of those years but I have to disagree with Dr. Bernstein as well being a pumper myself.

I start pump training Monday. I have talked to a few people that have been on the pump for 10-15 years with no issues. Also listened to countless people that have been on pumps for even long and have not heard a mention of scaring. They did talk about crimped tubes, blood in the infusion set, but not the scaring. I also see better control with the pump than multiple shots. But may be my research is slanted.

Ok. I keep hearing about this guy. Who is Dr. Bernstein??

Dr. Bernstein may be correct about scar tissue and inflammation on the pump. Only time will tell. I have noticed that often, not always, her numbers will go up in the middle of the second afternoon. Next time that happens, I will be on alert, apply a temp basal and see if that holds her; otherwise will pull the site early. I have also noticed emergency shots in the arm bring her blood sugar down pronto, whereas, bolus through pump is slower. This is most likely due to the absorption at the particular site (arm vs. buttocks). Many, if not most, patients with Type 1 diabetes contract it in childhood. His advice cannot be applied to children. I respect his point of view regarding greatly limiting carbs, yes, of course that would work. But his carb reduction technique is unsafe to use with children. Likewise, many young children balk at four or five shots a day and pumping is more practical for them. The drastic carb reductions Dr. Bernstein advocates would be difficult to follow even for adults, but one could certainly learn much from him and use his low carb limits for out-of-control periods. I think it is very important to keep an open mind and seek any and all advice that may help. Carb reduction is just another tool adults can use. I don’t think the carb reduction technique is anything new, however; in fact, it is one of the oldest techniques.