Replies to This Discussion

Permalink Reply by Gerri on January 19, 2011 at 7:20am

Honestly, I think this is quite unrealistic. Perhaps Dr. B achieves this, but the rest of us mere mortals aren't able to. To take enough insulin to have 83 after meals would pretty much guarantee a low later. (This is utterly impossible for me because of gastroparesis.)

Actually, I'm surprised Dr. B advocates for strenuous exercise after meals for T1s because strenuous exercise tends to send T1s highs because of cortisol hormones. Heard members here talk about bringing postprandial down with exercise after meals, but they are T2s.

How many people have time to exercise after every meal? After breakfast will exacerbate dawn phenonmenon. Strenous exercise after dinner can cause T1 lows overnight. Anyone out there able to exercise after lunch every day?

Very few people can live as controlled & precise a life as Dr. B. Perhaps he can eat at the same time every day & all the other things he does, but I can't.

Permalink Reply by FHS on January 19, 2011 at 7:52am

Gerri, it's actually quite easy, for me as a T1 anyway, to control my postprandials using exercise. I don't know how many people have time to exercise post meal, but for me I've made it a part of my diabetes managment. Fortunately for me, at work, I get 30 minutes for lunch and a one hour conference period around an hour after lunch, so the windows to exercise are there for me even at work. At home and on weekends, it's no problem at all.

I find it easier to control postprandial because of the insulin on board results in a predictable pattern of BG in response to exercise. I test 30 minutes and 1 hour after a meal. My upper target is 140. If I'm anywhere near that limit, I exercise accordingly. With IOB, 10 minutes of moderate jogging in place will drop my BG 10 to 20 points. Increasing the intensity of cardio type work drops my BG faster. At a BG of near 140, I'll rarely have to exercise for longer than 15 minutes at moderate pace to bring my postmeal BG into my target range of 80 to 100, 90 minutes postmeal. On rare occasions where my postmeal Bg spikes above 180, up to a recorded high of 220, I've managed to bring my BG back to my target range with 25-30 minutes of high intensity cardio type exercise.

YMMMV of course, but I believe the difficulty with post-exercise highs comes withe the type of exercise rather than the intensity. A lot of T1s say that weightlifting, as opposed to cardio type exercise, will raise BGs. That''s what I've experienced, but over at the new Weightlifting and Powerlifting Forum, members have talked about post exercise hypos as a result of lifting, so I think it really is variable for T1s.

All that being said, I'm not following Bernstein and I find it impossible to maintain my BG with any kind of precision that allows me to keep my BG at a number as tight as 83 all the time. The best I can do is keep my BG within a 60 point range, 80 to 140, about 75%, with the rest of the time split equally between lows and highs.

Permalink Reply by Gerri on January 19, 2011 at 8:12am

You're fortunate. Anything but moderate exercise sends me soaring & then crashing hours later & this seems to happen to many from discussions here. Interesting about the discussions in the Weightlifting group. There are no set rules for us:) Heart pumping cardio sends me way high. Weights do also, unless it's of short duration. Exercise like gardening or long walks brings down my BG, but not dramatically.

Permalink Reply by FHS on January 19, 2011 at 9:37am

Yeah, absolutely and I really do count my blessings in this regard. =)

But also, along with just dumb luck of the genetic draw, it is something that I've put a lot of time and effort into over the past 25 years of having T1 because I'm strongly motivated to do so. =)

Permalink Reply by Pauly on January 19, 2011 at 7:38am

Frankly Geri I have yet to see a Type 1 on TU with a A1C in the 4's and likewise a handful of T-2's The A1C target along with BG rise is confusing for what he is advocating for us mortals out here.


That is one area I question with Dr B. I know he is an engineer in his former life and approaches his control with engineering precision.

Permalink Reply by Gerri on January 19, 2011 at 7:52am

Even non-diabetics don't always have BG in the 80's after meals. Of course, their BG comes back to normal quickly. Dr. B is saying that it's possible to have an almost zero standard deviation. That's not possible from my experience. If rapid acting insulin lasted 2-3 hours in the body, if a person had a perfect insulin:carb ratio, if carbs could be counted perfectly every time, if timing of insulin was also perfect, if there was no stress, no hormones, no allergies, no other meds impacting BG, no other auto-immune or medical problems, along with the ability & time to exercise after every meal, then MAYBE this could be achieved:)

Permalink Reply by FHS on January 19, 2011 at 9:27am

[edit]

Oops.

Just realized that you're probably referring back to Dr. B.

Sorry Pauly.

Permalink Reply by LaGuitariste on January 19, 2011 at 10:09am

Pauly - I think one factor that sets Dr. B apart from the rest of the unwashed masses could be genetics.

I'd love to compare his genetic factors to mine.

I read somewhere recently (?) that researchers have identified fifteen genes so far that relate to diabetes. If Dr. B has (for example) two faulty genes and I have seven different faulty genes, he may be T1 -- which "on paper" seems more serious than T2 -- but nevertheless, I have issues he doesn't have.

We're both diabetic, but have very different diseases.

I wonder what kind of book he would have written if he were a mensturating female with thyroid disease, PCOS, severe insulin resistance and adrenal hyperplasia? I think it would be a somewhat different book.

Nonetheless, I think his core genius is "The Magic of Small Numbers". I think that's what he'll be remembered for in the future: teaching us to bring our numbers down as small as we safely can -- number of carbs, bg's readings, insulin injections -- in order to have better control, fewer wild swings in BG's and fewer long-term complications.

My crazy doctor told me that I was "doing great" compared to her other patients when I was getting fasting readings in the low 300's!!! I think that kind of mentality is much more dangerous than Dr. B's idealistic view that we can all hover at 83 night and day. ;0)

Permalink Reply by Pauly on January 19, 2011 at 10:17am

Hi Jean. I follow him about 95%. I posted this because this encompasses part of the 5% I have problems with him on.

Yes small numbers are the way to go for either type. And yes females often have additional issues that males dont have to deal with.

Most GP Dr's dont have a clue and you enter the big world of self care. No one is here holding your hand monitoring blood sugars for sure. I have many issues with my Dr but that would be another post.
Best of luck to you too. I have lost over 100 pounds now, dropped 10 pant sizes, but still have a pooped out pancreas. I am thinking maybe of a personal trainer now to get me motivated to increase my insulin sensitivity... I hate all these damm pills

Permalink Reply by LaGuitariste on January 19, 2011 at 11:30am

Wow, good for you! How inspiring. ;0)

Have you heard of Team in Training? It's a program of the Leukemia and Lymphoma Society.

I've been working out with them since July -- they have great coaches and very supportive members and mentors. It really is a team of people helping you towards your personal fitness goals as everyone also raises money for leukemia research.

They helped me get to my first fitness goal this past November: walking a 10 K. Younger, thinner and healthier people ran their first half-marathon or marathon with the Team. It was quite an experience to work out with what I call "The Gazelles" every week. No one treated me any differently even though my speed/distance was about 1/4th to 1/8th of theirs.

I still can't quite believe that I walked a 10 K without keeling over. I tested my BG's every half hour, drank only water, and my blood glucose didn't start dropping until HOUR THREE, and I was doing hills for most of it -- so much for exercising to lower post-prandials. ;0)

Permalink Reply by LaGuitariste on January 19, 2011 at 7:44am

I've only been transitioning to Dr. B's program for a few weeks -- with a BIG detour during the holidays, gah! I've only been back on track for a couple of weeks. I honestly don't know if I can do his program or not. I have so much weight to lose (approx. 200 lbs.) that eating strictly the way he recommends feels almost like anorexia to me -- a starvation diet.

However, I am trying to eat <= 15 gm of carbs at each meal (3 or 4 meals per day) and space my meals out at least four hours apart, so I'm never throwing more than 15 gm of carbs at my body at once.

I've seen a dramatic improvement in my numbers (of course) but nothing like 83 yet. More like 183 average (225 in the morning, 150 before dinner).

Of course, remember that Dr. B is type one and he doesn't have my horrific insulin resistance. He's also very, VERY slim and getting on in years, so he needs less food than someone who is still younger and more vigorously active (e.g. a construction worker, a letter-carrier, a coach -- someone who is on their feet and moving constantly throughout the day.)

I look at his approach as being perfect for a retired type 1, difficult for a retired type 2 (due to insulin resistance) and a shining but perhaps unattainable goal for people who work full-time and have insulin resistance. I am not even trying to do his 7/13/13 because I'd be a raging witch at work and probably get fired in a week. Not kidding.

If I can get through the day on 35 to 45 gm of carbs (total) and get in a good, long walk five days a week and do some resistance exercise two days per week (crunches, bands, hand weights) and adjust my medication so it gets me close to normal but doesn't kill me with hypos, then I'll take what I can get. Whatever it is, it will be 150% better than what I was getting when I was trying (and failing miserably) at following the ADA (ahem) nonsense, injecting HUGE amounts of Lantus, gaining weight like crazy and STILL going dangerously hypo "for no reason" from time to time.

To me the KEY to Dr. B's program is "The Magic of Small Numbers" as a principle, not a particular target number.

Permalink Reply by Brian (bsc) on January 19, 2011 at 4:13pm

Ok, so I know other people not on this board who have been successful at the Dr. B targets. As many of you know, I've never been able to get my A1c below 6% long-term. I do weight lifting, not dinky little pink dumbells on a bosu ball but aggressive weightlifting. I've made good progress on becoming insulin sensitive, but it never enabled me to normalize my blood sugars. Performing weight lifting as Dr. B suggests can double (or more) your insulin sensitivity. But that alone may not be suffiicient, and Dr. B never meant to suggest it would be enough. He is clearly very strict, but he is also pretty clear, if you follow all his advice and still your blood sugar won't normalize, then you need insulin.

ps. That being said, Dr. B actually likes metformin and surprisingly (as many people consider him a dinosaur) he likes byetta and victoza. Pauly can probably confirm that from the MNS lectures.

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