Why Is It So Hard To Treat T1D With Insulin (Video)


#1

Dr. Jake Kushner, MD talks at UHCL - Low Carb Houston 2018 conference


#2

Thanks for the link. I’ve watched many videos from the 2018 Low Carb Houston meeting but had not seen this one yet. This video explains why the mainstream medical practitioners are so slow to recommend a low carb way of eating. But things are slowly changing.

I love the recognition of Dr. Bernstein’s pioneering work and the shout out to the Type One Grit community.

I’m attending the 2019 Low Carb Denver meeting starting next week and Dr. Jake Kushner will present. The list of speakers is a veritable who’s who of luminaries in the low carb world.

Changing to a low carb way of eating back in 2012 has certainly added years to my life but more importantly it has greatly enhanced the quality of my life. I tried for years to rein in the glucose roller coaster I rode for most of my diabetes life before 2012.

I resisted starting low carb for two years before I finally relented and gave up my “precious” carbs. The result was so dramatic and immediate, I have not looked back.

Nothing tastes better than an in-range blood glucose feels!


#3

I’m really envious of you Terry (attending LC Denver 2019). Excellent speakers every year, as evidenced by this video with Kushner.

Enjoyed watching him hammering home all the benefits of an ultra-low carb diet, from flatline BG’s to more enjoyable life as the worries about the daily glycemic rollercoaster become distant memories :hugs:


#4

I appreciate the honesty about “definitive therapies,” i.e., a cure. “A very long way off. Decades. I’d be surprised if I live long enough to see them.” And also the perceptive comment about our frustration around that, particularly the myriad reports, emails from friends & family etc touting them. Haven’t seen the whole thing yet but it feels like he’s on my wavelength.


#5

I’ve followed @JakeKushnerMD on Twitter for sometime and he always has been a straight shooter (which I appreciate).

I’d really like to have access to more doc’s like him!


#6

None of the six endos I’ve seen over my 35 years with T1D gave me any hint that they were aware of the dramatic positive metabolic benefit of adopting carb limits. I’d like to excuse that simply as ignorant but I think it’s more likely willful ignorance.

Even when I raised the issue in clinic visits and demonstrated quarter after quarter of stellar and sustainable results, I received next to zero recognition, much less the respect that it deserved. At least none of them argued against continuing my successful way of eating.

I needed the YouTube videos of doctors like Jake Kushner and Eric Westman to give me a more balanced view of the larger mainstream clinician demographic. I wish that clinicians would come to see and appreciate the depth of diabetes experience in their diabetes patients. The duration and heft of our experience deserve parity with the clinician’s credentials.

Some of us are paying attention and acting on our personal observations. Dismissal of our stories as merely anecdotal is a weak, arrogant, and incurious position.


#7

So, one of the things that’s not mentioned that is also a pretty standard part of the T1 orthodoxy nowadays is “You can eat what you want, just bolus for it!” I first encountered it when the big switch from R/N to basal-bolus MDI came along. I was pretty late to that party, and having been on R/N for 20 yrs in the exchange-diet era it felt very alien to me. Exchanges weren’t exactly a keto diet but self-discipline around carb/sugar avoidance was drilled into my brain pretty deeply. It was just part of the deal of having the disease. But that’s not at all the norm now. On the T1 groups I interact with people are generally aware that LCHF is a thing, but most of them are very resistant to it because they’ve been indoctrinated, pretty much from dx, that having T1 doesn’t mean having to give up cake and ice cream and pizza and soda and bread and pasta and all that other good stuff. Some of 'em are pretty adamant about it and they don’t want to hear otherwise.

I can see where it comes from. The tools now are better than they were back in the 80s and the medicos want to soften the blow. Just count carbs and shoot up! But I think inculcating that feel-good message stands in the way of what Kushner is advocating as much or even more than the misguided nutritional guidelines. I’m curious to what extent it may be responsible for the worsening trend in A1Cs at the start of his report.


#8

I was diagnosed in the same era as you and I remember medical professionals telling me that I didn’t have to deprive myself of almost any food; I just needed to dose for it. I think what this whole discussion boils down to is this. It’s human nature that we try to bargain with untoward realities. We want to strike a deal whereby we can meet the demands of the disease yet still be able to enjoy food like we did before diagnosis.

In other words, we really did think we could have our cake and eat it, too! I found that taking that position with my diabetes treatment sold me short and prevented me from taking full ownership of my disease.

When I finally promised myself in 2012, that I would do everything that diabetes demanded, that I would no longer try to bargain with it to salvage some sense of what I thought was my “real life.” It was at that time that I committed to the unappealing idea to limit carbs as much as needed to bring some sanity to my daily blood glucose line.

That mind shift I went through in 2012 was a key pivotal point that has made all the difference to me and the quality of my life. It’s as if I had to completely cave to diabetes’ demands in order to regain my life.

Once I made that philosophical concession, everything started getting better. I spent whatever time was needed to treat my blood glucose well. If it turned out I needed to go for 20-minute walk to pull down a hyper-trending glucose and my bedtime was near and it was dark and cold outside, I just did it.

I was relieved in a way since I knew deep down that I was honoring my highest sense of self. I was doing everything in my power to respect my future health and inject a better quality of life right now. This mindset, surrendering to the idea of fully owning my diabetes, was a relief and it energized me.

When I observed immediate results with losing weight without much effort, lowering my average glucose level, greatly reducing BG variability, and cutting my daily insulin dose by more than half, this all bolstered my motivation. All these positive indications told me that I was on the right path.

In the end, I discovered that this blank check I signed over to diabetes actually ended up taking much less time than my old diabetes regimen. Not only did I feel better and have more energy, it actually took less time than my old mindset.

In summary, I think trying to bargain with diabetes so that you can protect your “real life” will not deliver the fantasy you imagine as your real life and will likely undermine your quality of life. If you decide to own your diabetes, warts and all, you will necessarily accept the harsh realities of diabetes and your plan will be rooted in reality and not fantasy.

I only wish that I had come to this conclusion sooner than the 28-year mark. We have such incredible treatment tools to assist us. I think almost every person with diabetes has it within their reach to do better than they’re doing today. I know it’s hard and family, career, and other responsibilities complicate things, but reaching for better, not perfection, is the answer!


#9

Well, I just watched this … very interesting.

I’m shocked at how the ratio of carbs and fat was arrived at.

RE: Low Carb - I’m suddenly struck by a golf analogy (note, I don’t play golf).

The eat what what you want and bolus model seems like constantly being faced with long par 5 holes, narrow fairways, deep rough and plentiful hazards, playing from the pro tee boxes. You might do well on some holes, but there’s a lot of challenge. Your initial shots will always require a big club and a big swing.

The low carb approach is like being on the green with pretty reasonable birdie shots, certainly par is attainable if you miss the first putt. Your shots are almost always with the putter and an easy swing.

Now I don’t do low carb. I have had some no-hitter days, and I rarely have lengthy excursions above 180 mg/dl (10 mmol), but I could do better. Food for thought for sure.


#10

I’ve had and continue to have the same issues with my GP (general practitioner) and several of my recent endos (I’ve had 7 since being diagnosed).

More now than ever, I find their condescending demeanour not only ignorant but arrogant as well.

Every Edno should be made to spend 8 weeks at a camp with a 100+ T1D kids on pumps. It would be great experience for them and they’d have a slightly better idea of the challenges of matching glycemic change with insulin dosing.


#11

@YogaO - the recommending Carb / Fat ratio is just the tip of the iceberg.

A lot of honest, common sense talk in this video. I know how much I enjoyed it.

I should mention that whatever diet regime you’re on, whatever works for you is perfect. Not trying to force low-carb on anyone who isn’t ready to try it. I’d love to be eating 200-400 grams of carbs per day like I did until I was in my mid-50’s, however my metabolism doesn’t support it. Plus I really enjoy that I haven’t had a hypo event in over 8 months now.


#12

@DrBB - Not so funny but for the better part of 20 or 30 years I used to tell non-diabetics exactly that as I shoved cheeseburgers, pizza, pasta, Chinese food and cake into my mouth as fast as I could eat. Thought I was indestructible. I had some pretty EPIC blood sugar swings back then :kissing_smiling_eyes:


#13

I feel certain I will be cured one day.

My last day to take insulin will be the day the dig my grave. A permanent cure for certain.


#14

Thankyou for sharing this Jim, I really appreciate it and got a lot out of it, probably more so than anything in recent memory.


#15

Glad you enjoyed it @anon51000362 :+1:t3:

Once in a while you’ll run across something worthy of sharing, it’s nice knowing others get something out of it as well :hugs:


#16

Dr. Jake Kushner. I think I love this man! A speaker who is optimistic, yet realistic. A great combination for those of us who have struggled with T1D. Finally, a doctor who understands and can speak to the struggle. Thanks for the link. I may watch it again.


#17

This is true. Support is what’s needed in my opinion. Someone encouraging you. I believe in the simple single chain carb type of eating. That mostly means vegetables fruits, nuts, yogurt. It is tough to eliminate things like rice, bread, potatoes, pasta, but IMO those starchy foods cause a great deal of problems with blood sugars. Honey would be an alternative to sugar, because again it is a natural sugar. I have also had trouble eating the right foods , especially when I started living on my own.


#18

22 minutes into it and not a single new word or idea yet. What I’ve heard so far could have been given 5 years ago unchanged. I was hoping for more because I want to learn something new.


#19

After watching the Kushner video I decided to (at last) give a low-carb diet a try for several days. MAGIC, it significantly reduced my BG swings. So now I want to more permanently go low-carb. My question to all of you is which low-carb diet? Keto or Paleo or Atkins or Whole30 or something else? For me and right now, Dr. Bernstein’s is too much. And most importantly why that one?

Some background: a T1D for over 55 years, on a pump for about 20 years, requiring about 10 U/day, a BMI of just over 20, and absolutely no desire or need to lose any weight.


#20

@Larry_B_Church … there’s nothing to say you can’t do the #Keto style diet with 30-50 grams of carbs a day (depending on your size and metabolism, you may easily get away with eating more carbs than I do). I believe @Terry4 is on Keto with +/-30 grams carbs, and if I’m not mistaken @T2Tom maintains ketosis eating up to 50 grams of carbs a day (please correct me if I’m mistaken)

Once you’ve had a taste of lower carbs and magically reduced BG swings, it’s difficult to return to consuming carbs.

Somewhere between 20 - 50 grams of carbs a day lies the sweet spot for you, where you’ll reap the benefits while maintaining your desired weight loss.

While there’s no guarantee reducing carbs and BG swings will prevent you from experiencing the long term consequences of high blood sugars, at least you won’t be exposing your endothelial cells to any further damage.

Jim