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Permalink Reply by acidrock23 on July 25, 2012 at 8:11pm

I am too much of a junk food junkie and slacker to Bernstein all the time. At the same time, I've gotten things very much in line and have always found that if I can cut carbs out here and there, it makes diabetes less work, which is a ***HUGE*** win in my book. The ketones from Bernsteinism (ketosis...) are different from damaging ketoacidosis from hyperglycemia. I've tasted them a few times but, any time I drop 5 lbs behaving myself, I go find them in the potato chip aisle.

To me, the biggest advantage of going low carb is that it reduces the margin of error for calibrating your basal rates and ratios. If you are bolusing 10G of carbs/U and eat 20G, there's 2 units floating around so, if you're off by 25% either way, the "oops" isn't as much as if you eat 70U and are bolusing 7U? Once I have my rates nd ratios set, I feel more comfortable saying "ok, this is 9U...". As I'm horrible, I use this to inform my "burrito blasts" but I think that if you have other goals and want to try it it may work very well for you. I like eating less carbs in the summer as I can come home from work and fire up the grill and it's a piece of cake. Oh wait...

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Permalink Reply by Judith on July 25, 2012 at 8:47pm

Bernstein saved my life. We have a group here with a diverse range of adherence to his plan. Check it out. I'm an old lady T2, diet and exercise only, so you can definitely plug in a lot of differentials. But you will find it is a very mixed group with a lot of variations, as AR said. You just have to find your own way with a lot of testing and study. We are each our own guinea pig.....You'll find over time, with experimentation and study---you don't have to "go nuts". You just have to pay attention to what your meter says. And that will vary for each of us!.....Judith in Portland....

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Permalink Reply by smartblnde on October 26, 2012 at 10:29am

Judith, you are SO right. I believe there are something like 7 billion people in the world. If all 7B had DM, there would be 7B ways to treat it. We DO experiment on ourselves. I just took myself off the ACEi (lisinopril) and Lasix only to have my blood pressure come down, my kidney function and ALL other tests come back to the normal range.
It IS that paying attention to what the meter says that makes all the difference. Thank you for sharing! (We SO need a 'like' button)

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Permalink Reply by Brian (bsc) on July 26, 2012 at 4:50am

I have followed Bernstein for years. I've owned like 5 copies of his book, having given away copies to others. I am also quite familiar with Atkins. After years, I have no trouble eat a low carb diet, usually less than 50g/day. I eat like a king. People love coming to my house for dinner. But I don't really eat carbs. And I don't miss them.

Some people reject Bernstein, arguing that his 30g/day diet is way too extreme. And it can be hard. But we are all intelligent adults. We should read the information and consider the evidence and adapt advice to meet our own personal needs and goals. And make no mistake, Bernstein's dietary advice is not that you should eat 30g/day. His advice is the "Law of Small Numbers."

The Law of Small Numbers is based on the observation that normalizing blood sugar is achieved by controlling the inputs (food and insulin) so that you can bring down your average blood sugar and reduce the varation so that you can avoid hypos. It is that second part that is the killer, if you don't reduce the swings, you cannot achieve tighten control. And hence, the Law of Small Numbers. If you reduce the rise in blood sugar by reducing the carbs, you reduce the blood sugar variation. You can achieve a benefit by simply reducing carbs, it doesn't have to be 30g/day. I eat about 50g/day of carbs.

And the "Low Carb Wars" have resulted in a lot of disinformation. When you eat low carb, your body naturally shifts to burning fat. This process happens in everyone, even a "carb addict" overnight will shift to burning fat. And when you burn fat, fat is mobilized from your stores and your liver converts them to ketones. These ketones are then taken up by your cells and burned for energy. It happens all the time. In a low fat diet, it can happen around the clock. But that is not DKA. And low carb diets and burning body fat does not cause DKA. That is just part of the misinformation.

I have to tell you. Maybe some other diets will enable you to tighten your control. Maybe you will be "lucky" like some of us who can eat a high carb diet, run a marathon and bolus precisely and achieve good control. But, chances are, you are like most of us. This diabetes thing is a real struggle. If you eat a meal and do "everything" right, counting the carbs, calculating the insulin dose and taking it at the right time, stuff will happen and you will often be over 200 mg/dl 2hrs later or stuffing glucose tabs with a hypo. I never have that happen. I don't eat enough carbs to ever go over 200 mg/dl and I never bolus enough insulin to cause a harsh hypo. That is the Law of Small Numbers.

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Permalink Reply by KCCO on July 26, 2012 at 8:34am

This is helpful information for me too. I have Dr. Bernstein's book, but haven't made it but a quarter of the way through. There's so much information! I've been T1 for 13 years and I find his advice amazing, but very hard to do in my "real" life.

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Permalink Reply by Randy on July 26, 2012 at 11:26am

I have not read Bernstien, but I do understand the concepts. I also agree with BSC. We are all different and you will need to experiment and test a lot to find what works best for you, but the small numbers concept is a winner.

Here is what I do and how it works for me. First of all, not all carbs are the same. Some will spike badly and some will not. How they are prepared will make a difference as well. For instance, sweet potatoes work much better than regular. I eat about 100 carbs per day more or less. I limit my intake of high glycemic foods in both frequency and quantity, but I do "treat" myself from time to time. I test before I eat, take my activity level into consideration and ear foods that will require the least insulin and provide the meal I want. What these meals and snacks consist of is determined by experimenting, which I do continually. Following this method I have reduced my basal by 12U and have gone for as long as a week without any fast acting. I rarely go below 65 or over 140. I am able to be more active than before without going hypo. For the last 6 weeks My fasting numbers have been almost entirely between 70 and 100. It has amazed me. It may not last and I may just be lucky, but I;m sticking with it because what they had me doing before, well frankly it sucked.

It IS working for me and I do not feel deprived. It takes some planning and preparation, but the way I now feel and my long term health make any so called sacrifice more than worth it.

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Permalink Reply by Don on July 26, 2012 at 6:33am

I find the Bernstein/low carb diet to be very valid but it isn't mainstream and you have to be a bit independent. If I were to go that low carb, my biggest challenge as a vegetarian is getting enough protein and not becoming totally sick of eating eggs!

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Permalink Reply by BadMoonT2 on July 26, 2012 at 8:52am

Here's a few links you might find useful:

The Bernstein Group here on tuD.

A discussion about the difference between ketosis and Ketoacidosis.

A link to a video discussing metabolic changes when adopting a low carb diet.

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Permalink Reply by Laddie on July 26, 2012 at 11:50am

My diet is not nearly as strict as Dr. Bernstein would recommend, but I think he's definitely on the right track when it comes to trying to control BG both in Type 1 and Type 2.

Although there are tons of people who claim they can eat anything and match it up with insulin, the fact of the matter for me is I can't match the timing of my insulin to eating large numbers of carbs. People who are able to eat lots of carbs and keep post-meal spikes under 120 are living in a different world than I do. But at the same time, I find it difficult to get my basals so perfect that I am flatlining all of the time when eating low carb. Type 1 is just plain hard to be "perfect" at.

I am a big fan of Bernstein's book. His philosophy that everyone can take control of their diabetes is very empowering. Even if you don't follow his advice exactly, I think all of us can improve our BG numbers by adopting at least some of his recommendations. When eating low carb, I still get highs but I actually get a lot fewer lows, especially severe lows. So my life becomes much easier.

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Permalink Reply by Jonah on July 26, 2012 at 2:13pm

For me, eating lower carb means I have even bigger problems with basal issues because the protein and fat causes blood sugar spikes later on down the road and is much harder to dose for. Also I have pancreatitis and can't tolerate a lot of fat, prefer eating vegan, and really can't afford to lose weight (am already too skinny).

I have found using CGM and waiting to eat until I see a drop in blood sugar, and switching to Novolin R (from Novolog) and eating lots of small meals, to be the most useful changes for me.

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Permalink Reply by Lady Moon Rise on July 26, 2012 at 6:39pm

This is absolutely wonderful, helpful information. I am very grateful.

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Permalink Reply by Lab Mouse on July 26, 2012 at 8:55pm

I was dx'ed T1 in Oct 2011, early stage, a1c 5.7 fasting BG 130 GAD positive. Found Dr.Bernstien and implemented his program on November 1st. I am still enjoying my honeymoon and taking no insulin, max BG 130 only when I treat myself to a small portion of fruit and or low carb chocolate, otherwise rarely over 110. Fasting BG's from 90 to 105 depending on previous evening carb intake. I am 5'7'' and weighed 212lb at dx, dropped to 172lb in five months and have stayed that weight for 4 months now. Had blood work a couple months ago and tryglicerite went from something like 135 to 55, LDL from 109 to 128 and HDL from 40 to 55. I eat tons of high fat beef (ribs, serloin, filet), fish, bacon, sausage, dark meat chicken with skin, pork rhines, tree nuts, eggs, letuce, asparagas, saturating all meats and veggies cooked at home with butter. I treat myself occasionally (maybe once a week) with low sugar chocolate and or a small portion of fruit and whip cream from a can. I drink coffe in the morning, then lots of water, and red wine or scotch and soda in the evening. I have a good sense of my carb to BG spike ratio (1gm carb = 1.5 BG increase) so as my pancreas deteriorates to the point of having to take insulin I will be one step ahead of the learning curve as to dosage and will be in the realm of small numbers. Dr. Bernstien makes total sense to me and frankly I miss carbs but no longer crave them. I feel fantastic, I have a very stressful sometimes physical job and never feel burned out. I am regular way more often than before and my urology symptoms have dramatically improved. Thank you Dr. Bernstien.

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