"Transitional Hyperglycemia"?

I guess I’m just lucky… or am I?

I read an article by an Italian professor, head of diabetology in one of the four university hospitals here in Rome, found his email address, wrote to him about the article, somehow managed to get his interest and got an appointment. Two things happened: one, like everybody else here in Italy, he told me I was crazy to follow the Bernstein diet and I would have to come off it immediately. Two, he sent me for another GAD test because he is not convinced I have LADA - he wrote “iperglicemie transitorie” on the prescription for the test…

Wow! Maybe I’m Type 2 now? No more worrying about auto-immune attack and destroying the remainder of my pancreas with every meal?? If the tests come back negative, that would indeed turn my young life as a diabetic (diagnosed in June 2009) around completely. We’ll see.

About the “crazy” Bernstein way of eating, well, I must admit that I may have overdone it a little. The last few weeks, I was so carb-aware that I ended up eating between 20 and 30g per day, although I think I can have a lot more. This is because without realising it, when I went lower and lower on the carb ladder, I never calculated the fibre (since Jenny Ruhl suggests you shouldn’t) so my carb intake was even lower than I calculated (most days, it was below 10% including fibre).

Less than 10% carbs meant that my fat intake rose to over 80% in order to get enough calories per day, while it really didn’t have to. So what I will try is to eat at least 15% of carbs per day, reduce the fat accordingly, use Jenny’s protein calculator to get the correct amounts of protein… and continue testing to see where my “cutoff” is on carbs per meal that I can have without spiking - which to be honest I have never tried. I admit that I may have gone a little paranoid in my spike-avoidance.

The professor will not treat me unless I eat at least 30% carbs per day. Okay, that’s a lot better than the 50% (ADA-style diet) that the people at my hospital wanted to force me to eat. I don’t know yet into how many grams of carbs that translates into and what the effect on my bloodsugars will be, but he suggested that I go back onto Metformin (500mg after lunch and dinner) to compensate for the carb intake, and I am actually happy to do that.

In the meantime, of course, I will try to convince him that it’s not the saturated fat that clogs up arteries and brings about heart trouble but the fat combined with carbs, as everybody knows :wink: (need to find the exact source of that information but I’m sure it’s somewhere on Jenny’s website). And that’s the very point I’m worried about - if I do up my carb intake to 30% (probably over 100g per day), and keep eating about 50% fat, what will happen to those arteries, and my poor heart? And all the other organs that have now gotten used to run on ketones? Let alone the weight gain that will follow when I “overdo” the carbs as per prescription? The solution may be a stringent weight-lifting program - the money for the gym could come from what I save by eating less protein (expensive) and more carbs (cheap)?!?! (just joking - I really don’t have the money to go to the gym!)

You already had the fattest diet in the world. You burn fat when you have ketones, so it’s like following a high fat diet. Your new one sounds a lot healthier.

I admit myself, I eat to Bernstein despite my doctors requests. I am on Byetta and I have specifically been asked to eat 20-30g of carbs per Byetta meal. But of course as you know, when you realize that you can consistently and directly control your blood sugar by following the diet, it becomes very easy to just do it. I argue with my doctors all the time.

But let me ask you. You contacted this doctor for a reason. If you are not prepared to follow his advice, then what is the point? If you want to explore whether this doctor, then just do it. Eat the carbs that he requests. Follow his instructions. If you don’t follow his recommendations, then you are doing an injustice to his advice.

But that being said, set specific expectations and timelines for things. Give him a month to show measurable progress in your blood sugar control (choose your time and definition (HbA1c)). If he cannot demonstrate his competence, then don’t waste your time.

You know in your heart that Dr. B gives you advice that works. There may well be other directions that also work. But don’t let yourself be mistaken that other directions work when they actually don’t control your blood sugar.

The ADA & doctors have been calling Dr. Bernstein crazy for decades. Thank heavens he hasn’t let them stop him!

I’ve followed Dr. B’s diet for almost 2 years & never have ketones, other than a few barely registering. My blood lipids improved greatly when I changed to low carb. My diet is low carb, moderate protein & fairly high fat. Sufficient protein is critical to health. To be honest, I haven’t calculated the percentages.

I’ve been slim my entire life. The only time I gained weight was on the evil ADA diet & even then I wasn’t eating as high carb as they recommended. I was reprimanded several times for not eating enough snacks. Couldn’t believe my ears on that one!

I haven’t allowed doctors to dictate what I eat when I found what works best. I argued with my first endos about low carb. Now, either I’m silent on the subject or tell them with such resolve they back off. You need to find what’s most effective for you & stick with it. Great if Metformin helps. If a doctor is not in accord with what’s successful for you, then get another.

Weight lifting does help. I don’t belong to a gym & do it on my own. Ok, I’m no power lifter:)

Thank you all for your helpful input, especially bsc for giving me some really good questions to ask myself. At the moment, I am dealing with the psychological fallout from the doctor’s appointment: as things keep milling around in my head, I am down with a big migraine, since yesterday. Interestingly, that’s the same psychosomatic symptom that I had after my horrible hospital appointment in February, but I just hope this migraine won’t last a week as it did then! For now, I have decided to stick with this doc and his advice, if not out of respect for his advice (he will still have to earn that respect) then at least out of curiosity.

Also, just to let you know that my problem are not ketones (as in DKA), I was just trying to say that this is a ketogenic diet, meaning that instead of glucose, my brain and body run mostly on ketones (and some of the glucose that comes from protein), which as far as I read is perfectly okay and healthy, nothing to worry about. Sorry for the misunderstanding and sorry if I misunderstood you again! It’s all still quite confusing to me.

In the meantime, I have started to try out if the doc’s suggestions might work for me. So I had 30g of carbs for lunch, just to see the effect: 120 after one hour, 103 after two hours, 107 after three hours… waiting for the next hour to pass. Most of the carbs came from pressed and soaked whole grains of rye, which is the closest to whole grain bread (his suggestion) that I had at home. I haven’t started taking Metformin yet, the numbers should be much better when I do that. I am actually surprised at how “good” they are without it! This was just a trial, since it’s the weekend and I have time to experiment. So far, for today, my intake has been 67% fat, 16% protein and 17% carbs. I will now try to do about 15% carbs for the next two weeks, and then see if I get a nutritionist to help me move up to 30% while keeping good blood sugar control (thanks for making that point, Gerri and bsc!). And then I’ll consider the weight lifting option…

Hi Uta,

Hope your migraine is short lived. The worst kind of pain.

Great lunch readings. What was BG before lunch?

You may feel more comfortable with a nutritionist increasing your carb intake, but you can do this on your own. My personal choice would be to increase carbs through eating more vegetables or nuts rather than grains. More nutrition in these than grains.

Sure you know this already from reading Dr. B, but tread slowly adding more carbs at breakfast. For many morning is the most carb sensitive/insulin resistant time.

Dear Gerri,

Thanks a lot for the helpful advice to eat vegetables and nuts rather than grain - I am very happy to go with that (after trying to go with grains/bread yesterday). At breakfast, in fact, I will stick to my 2 scrambled eggs with butter for now - even that sometimes gives me 120, no idea why.

Here is the full list of yesterday’s “trial” and the readings I got from it:

15g soaked rye (1Tbs) = 10.5 (-2.2 fibre)
200g green beans = 15.2 (-6.1 fibre)
Total: 17.4

before lunch - 84
1 hour - 120
2 hours - 103
3 hours - 107
4 hours - 80

2 slices wasa crispbread = 16.4 (-3.3 fibre)
200g greek yogurt = 7.0
1oz walnuts = 3.9 (-1.9 fibre)
Total: 22.1

before dinner - 93
1 hour - 150
2 hours - 135
3 hours - 128

next morning - 99

The immediate result was that my fasting numbers went from their normal 70s or 80s to almost 100. I will start taking Metformin in a few days and see what difference it makes.

Also, since the day before (and probably most days during the last few weeks), my carb intake for the whole day was about 30g, those almost 40g just for lunch and dinner, and 50g total yesterday must have been quite a shock for my body. I will now go more slowly - Jenny suggests adding carbs in 5g increments per meal, and that sounds more reasonable than what I did yesterday. The mantra here is: it’s a LOW SPIKE diet, not necessarily a low carb diet. More ideas on whatever prevents those spikes will be welcome!

Thanks again and all the best, Uta

Hi Uta,

Your readings are enviable. Adding more carbs slowly is the best route. You’ll know what level sends you high & which don’t. Same thing with adding more protein, if needed.

Morning is a tough for most of us. Even with insulin, I have to eat very soon after waking. The sooner I eat, the better the numbers (usually). Don’t let one morning reading of 99 bother you.

If you don’t mind me asking, why did the doctor suggest soaked rye seeds? For the fiber? Imagine these must be quite difficult to digest & they don’t taste like much.

Realize this is a trial diet, but it’s pretty low in protein & fat. Are you hungry after these meals? I eat a lot more than this, though it’s lower carb. Just doesn’t seem like enough to for you to eat. Vegetables are my choice for the healthiest carbs. I like color on my plate:) Salads, sauteed, baked, grilled, roasted–variety.

Hi Gerri,

No worries, I only put down the carbs in my list below, there was lots more in my diet, especially fat!
Fat: 155.8g
Carbohydrate: 68.4g
Dietary Fiber: 17.7g
Protein: 80.1

I realise that’s too much protein but it’s what makes me feel “satisfied” (as suggested by Dr Bernstein…). The soaked rye I invented for myself (crushed it and then soaked it) since I didn’t have any real wholegrain bread (which the doc suggested) at home, and yes, I thought it might be good for the amount of fibre, digesting more slowly, tastes okay actually, with lots of curry in the midst of green beans and cod fillet ;-).

Will definitely go for more veg and my fridge is stocked very well with salad ingredients these days. Looking forward to doing some more trying! Thanks for all your suggestions and support. The migraine is gone, by the way, talking about what I’m trying to do with you and my friends here has definitely helped.

Hi Uta,

Good! I was worried you were living on soaked rye, crackers & green beans. Concerned you’d starve eating such a restricted diet, even as a test.

That is quite a bit of protein depending how active you are & your weight. Protein effects BG also, though it doesn’t appear you need worry about this.

Happy for no migraine!

My PCP showed concern that I wasn’t getting enough fiber because I don’t eat grains. When I showed how many vegetables & nuts I eat, he backed down. They’ve all got in their heads that life without grains isn’t healthy. Not that I have data to support this, but I feel the fiber craze is excessive. People who spend their lives sitting & never eat a vegetable may need additional fiber, but it’s become just another thing to market. Really, how much fiber can a body process?