Comment by jrtpup on June 9, 2012 at 8:35pm

Thanks for the blog David! Bernstein really is an eye-opener. Glad you're taking care of yourself ;)

Comment by David (dns) on June 10, 2012 at 1:32pm

Continuing the back story . . .

Ever since the dx (about 17 years), my A1c has hovered in the mid to high sixes. A couple of times it crept into the low sevens, but mostly it's stayed in the general vicinity of 6.5. Now some folks in my local support group would be thrilled to have those numbers, so I realize they're not terrible -- but they're not very good, either, and they're certainly not where I want them to be. (To say that something is "not bad" is not to say it's "good"!)

Up till now I seem to have avoided any noticeable complications, but control has been getting gradually more and more difficult with the passage of time; not an atypical experience at all. For the past three years or so my doctor had me on metformin, glyburide, and simvastatin. So, no serious problems (yet), but the long term picture wasn't encouraging.

Earlier this year I "discovered" Bernstein. I put that word in quotes because I had known about his book for a long time, even had a copy on my shelf gathering dust. A few months ago my Naturopath told me in no uncertain terms to take the book down and read it. What I actually did was order a new copy, because the one
I had was the 2nd edition and the 4th is now current. When the new one got here, I really did read it. Still am, actually, because one reading isn't anywhere near enough to really understand and retain everything he says.

Anyway, I now eat pretty much the way Bernstein recommends (still doing some fine tuning), and I have dropped the glyburide and the statin. My A1C is slowly inching down, and the lipids have improved so much it's almost a joke. Total cholesterol is now 128 and the other numbers are equally good, so bye bye statin . . . which is great because statins are really bad news. All drugs have side effects, of course, but statins have the ability to cause nearly as much mischief as they prevent. I'm glad to be rid of the stuff.

The A1c still isn't down where it ought to be, though it's better than it was. But the thing about A1c is that it's an average. Averages are useful, but they don't tell a complete story. An average, by definition, conceals the highs and lows; and the highs and lows are terribly important to a diabetic.

For the past month or so I have been monitoring eight times a day: fasting, pre and post prandial, and bedtime. Averaging the numbers for each event, the daily pattern looks like this:

Fasting 88
Pre breakfast 103
Post breakfast 119
Pre lunch 116
Post lunch 121
Pre dinner 118
Post dinner 145
Bedtime 107

(I just now checked the first three numbers for today, and they are 86, 102, and 117 -- right smack in the pattern.)

So, I'm seeing improvement, but not enough. Things are certainly looking up, but there's still a long way to go.

Next: What I Intend To Do About it

10 June 2012

Comment by David (dns) on June 11, 2012 at 1:58pm

Part 3 . . .

As mentioned earlier, for some time now I have been eating Bernstein's way, i.e., low carb, with very frequent monitoring. My numbers are relatively stable and pretty much follow the pattern shown above. So, I've come to the inescapable conclusion that if I am ever to have normal blood sugar, it's going to require some insulin.

I had this conversation with my doctor and he is willing to go along; partly because he is open minded enough to freely admit that he doesn't know all the answers, and, I suspect, partly because he can see how serious I am about achieving tight control and how thoroughly I am doing my homework. (I plotted the averages shown above on a chart and took it to my last appointment. I don't think he has very many patients who do that!)

He ordered some tests, mostly the usual suspects (A1c, liver function, lipids, etc.) and I requested a few of my own (Vitamin D and thyroid function to name a couple). I'll have the blood drawn tomorrow morning after fasting and once we get the results we'll meet again to discuss starting insulin therapy.

He also wants me to see a diabetes educator to learn the mechanics of insulin use (actually I think I know most of them already, but there's no such thing as "too much" knowledge), so I'll be seeing her the day after tomorrow.

My plan is to begin with a basal or long-term insulin, probably Levemir. I'll start small and inch upward, monitoring as I go, until I reach a point of equilibrium without any hypo episodes. Then we'll let that settle and stabilize for a while before deciding whether to add boluses to cover means. Slow and gradual, or, to use one of Bernstein's favorite phrases, "the law of small numbers."

As an off-topic aside, writing this down in this way is an interesting experience. As I mentioned in the beginning, I've never kept a diary or journal or blog or anything like that. Writing this stuff down and seeing it in black and while turns out to be very useful in helping to clarify my thought process, whether anyone else ever reads it or not. How about that?

Next: Test results and next steps

11 JUNE 2012

Comment by woodfairy2001@yahoo.com on June 12, 2012 at 11:19am

I am very glad you are here David. You have a clear and concise way of writing that I can really related to-I am a Type 1-but it is really all the same and we are in it together. I look forward to learning more about you and hearing about your experience.

Comment by David (dns) on June 12, 2012 at 11:56am

Thanks very much for the compliments. I'm glad that sharing where I am at is useful, or at least interesting. That's what this kind of networking is for.

Comment by Trudy on June 12, 2012 at 12:13pm

Hi David, I agree with woodfairy. I also enjoyed your conversation on the chat (guess I was just evesdropping!), but I don't type/think fast enough to get in on it. Maybe next time!

Comment by David (dns) on June 13, 2012 at 9:42am

Meeting with the educator today to learn the mechanics of insulin use. At least, that's what I'm going in for; she may have her own agenda. :)

Waiting for results from yesterday's tests.

13 June 2012

Comment by woodfairy2001@yahoo.com on June 13, 2012 at 11:56am

They usually do-but I feel sure you can steer the conversation in the direction you need-Hope those results are good. Let us know how it goes.

Comment by David (dns) on June 13, 2012 at 5:54pm

13 June 2012

Well, my luck seems to be holding. I got a diabetes educator with an open mind who was willing to listen and work with me instead of trying to force her own preset agenda. She had even heard good things about Dr. B's book but hadn't read it. I showed her my copy and opened it to a few places that I knew would get her attention. She says she's going to get the new edition and read it! How about that???

Comment by woodfairy2001@yahoo.com on June 13, 2012 at 7:56pm

How about that?? I knew you could handle it...Sounds like you are wll on your way.

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