Replies to This Discussion

Permalink Reply by David (dns) on June 4, 2012 at 9:38am

You know, I've been wondering about this too. I am relatively new to Bernstein (and thank God he exists), and am a T2 who is just preparing to start using insulin, so I am very interested in this question also. I look forward keenly to the discussion.

Permalink Reply by Gerri on June 4, 2012 at 10:15am

It's a goal that's impossible to achieve. As close as you can get, is great. I've tested my husband when he'll let me & his BG isn't in the 80's after meals. It comes down quickly, but he doesn't maintain a consistent level.

In his May web cast, Dr. B stated that people can get a small deviation if they don't have gastroparesis. So, that means that no one is hitting a completely flat BG line. I'm thrilled to have postprandials of 120 or slightly under.

I've been following Dr. B's guidelines for going on 4 years. Some of it can be done with timing of bolus, for those on insulin. I've tweaked & tweaked timing. The general guideline of bolus 15 minutes before eating isn't helpful for everyone. Another method that helps, again for using insulin, is splitting bolus doses by taking some before meals & another 1-2 hours or more later to prevent a spike from protein.

Permalink Reply by Hana Rous on June 4, 2012 at 10:49am

I use low carb and minimal metformin only and I can keep quie close to that More like 85, but I never go over 115[6.4 to me]. I think the point is that this number is a TARGET. Even the best marksmen miss targets, but they all aim for them.
I find I do best if I eat very low carb and SMALL meals. One of the big problems in Uk diabetic health is the relaxed targets which make people think numbers up to 8 [144] are acceptable[look at the Diabetes UK website!!!]. Thus often they will see 180 as Ok since it's not much above target. If however your target is 83 at all times, You know 180 is badly off. I talk to MANY diabetics and I know this to be the case
Hana

Permalink Reply by GlacierLily on June 4, 2012 at 10:54am

No, it is not possible and Dr. B would not claim it is. But depending on how extremely anal you want to be, it is possible to stay relatively close, say less than about 100 most of the time. I am type 1 and I do not achieve that, but I try.

Permalink Reply by onesaint on June 4, 2012 at 11:07am

What Gerri said is spot on.

My experience: I'm T1, on a pump, Dexcom CGM, and have been on a Bernstein diet going on 2 years. The majority of my PPs are around 110-130, starting with a flat trend of 80ish before a meal. Trying to hit a completely flat day is really tough and requires a lot of micro boluses (10-14 a day) and small glucose additions. It's pretty much one bolus every 1.5 hours that I'm awake and some of those are extended over 2-4 hours (think R insulin).

So, when my body switched over to getting glucose from protein/fat I noticed my PPs changed to a 3-4 hour stretch as opposed to the old 2 hour trend. Also, only large boluses will effect my PPs. Meaning if I go up to 120, 20 minutes (to 3 hours) post meal, it will take about 5u of insulin to bring me back down. What a fascinating digestive system!

So, can I hit 83 1 hour after a meal? Yes, I call it flatlining. Does it happen all the time? No, not by any means! Plus, it requires a lot of effort to do so depending on regularity of food and dose timing.

Still, it's a great standard to try to reach and my BGs have never (in 27 years), been better.

Permalink Reply by BadMoonT2 on June 4, 2012 at 12:42pm

My understanding is that a normal person will top out around 130 for a carby meal and then go back to 83 at 2. I would test at 2 to see how you are doing. My personal goal is to never go over 140 and this is do able for me.

Permalink Reply by HomeSchoolMom on June 4, 2012 at 5:02pm

Did he really say it should not go up "at all"? I thought 83 was the average for a non-diabetic, and that the goal was that we should try to eat in a way that our blood sugar "does not go up by much, if at all". I don't know if my memory here is accurate.....I do know that my adopted Korean son is the only one in our family who matches that 83 average, and can eat anything he wants and hardly go up. I would be willing to bet there are just not many like him.......There is always the goal....but I would think anything under 120 an hour after eating is ok? I know that as a type2 if I eat extreme low carb, I can do it....but that takes extreme will power too!

Permalink Reply by Gerri on June 4, 2012 at 7:29pm

Bernstein's motto is that diabetics have a right to normal BG. Normal BG does veer from the 80's, just not for long. Impossible for BG to never budge from 80's. We'd spend our lives with insulin in one hand & glucose in the other:)

Under 120 one hour postprandial is excellent.

Permalink Reply by Judith on June 4, 2012 at 8:56pm

One of a gazillion things I learned here from folks like Gerri and bsc and others, is that there's also a "spike" as the protein hits later. So at 1 hour, I may very well be at say 85-90, but at 2 hours, I will be more like 115, depending on a lot of different variables.

I've also, after about 5 years doing Bernstein, started playing around with when I have the most carbs. I always do 30-35 carbs/day and usually lunch is my carb-heaviest meal. But maybe I will have a 1-2 carb breakfast and have more carbs later for lunch or dinner out with a friend. It averages out okay and gives me a feeling of having treats and oh, you know, spontaneity!

I'm still diet and exercise only, for the moment......Judith in Portland

Permalink Reply by Ralph on June 5, 2012 at 12:00pm

I think he is trying to say that before the advent of grain / processed food / fast carbs, all humans ran at (roughly) 83 most of the time. (If you were a non diabetic caveman only eating roasted meat you had caught and some scavenged greens you probably pretty much stayed totally flat). (Obviously nothing stays totally flat e.g. your body temp flucuates through out the day and night - but not by much. Similarly glucose will fluctuate a little when you eat and exercise etc - but on a caveman diet, probably not by much). THe advent of readily available fast carbs (and large amounts of easy to get food) overrides even non diabetic pancreases (briefly) so even non diabetics on a modern diet will spike (but recover fast). So if you want to run your sugar the same as a non diabetic you have to define what diet your non-diabetic is on! A non-diabetic on a modern diet (often the diet that gives people type 2 disease to follow!) will have spikes post meals (but recover the spikes back to normal levels later as their pancreas catches up). I think Dr B is comparing to a non-diabetic on a very low carb / paleo type diet in which case it is possible to be flat most of the time. As glacierlily says, it is possible to remain extremely flat even as a diabetic if you are anal enough about it. Some days I am extremely anal and can stay between 75 and <90 for 24 hours but as onesaint says it takes lots of work (or being too busy to eat - not eating all day works very well!) plus lots of tiny boluses of insulin etc. (See some of the pictures on the flatliners group to see 24 hour traces of what levels are possible). Other days things are rather more rocky mountain than flatline! Either way I think it is possible to maintain a pretty flat trace but it involves extremely strict diet (for me less than 20 cars per day) careful bolusing and regular testing (I test 8-12 times a day depending on how well my continuous monitor is working!) plus regular exercise to keep your insulin resistance down - If I don't cycle to work for 3 days I notice a definite change in my insulin resistance and insulin dosing required.
The real answer i wanted to give to your question (as Dr B's advice that you should be 83 all the time confused me too when i read it as I thought "but even non-diabetics don't get that level without spiking higher") is that I think he means you should be the same levels as non-diabetic humans IF they are eating a paleo or extremely low carb diet (who will hence probably remain extremely flat around 83) NOT the same levels as non-diabetic humans on a modern diet (who will probably spike quite high repeatedly after meals despite great beta cells!). It seems therefore, the more beta cells you have working and the lower carb you can manage, the flatter you can keep your line.
(HbA1c levels will test how flat and low you are keeping on average. The lower your HbA1c the better as it reduces your risk of complications. Some trials show a low HbA1c INCREASES mortality(!) but it is likley that is if you are trying to keep your HbA1c low whilst eating lots of carbs and taking big doses of drugs etc to counteract those carbs. I believe keeping your HbA1c low by reducing carbs instead (hence using small amounts of medication) is beneficial despite the trials I mentioned).

Permalink Reply by Judith on June 5, 2012 at 12:31pm

Wild swings are most dangerous. Aic is only an average and can disguise those swings. So, as usual, the best we can do is test a lot! And eat to our meters......

Permalink Reply by David (dns) on June 5, 2012 at 11:53pm

Amen! HgA1C is a useful barometer but it is indeed an average. An average, by its very definition, conceals the peaks and valleys. And the peaks and valleys are critically important to us. Those severe back-and-forth oscillations are just a form of very slow Russian Roulette. There is no effective substitute for frequent monitoring and feedback. There just isn't.

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