Better Diabetes Management

For the last two weeks I have had conscious control of my diabetes for the first time since I became a Type 1 diabetic in December 1973. 35 years is a long time to have such a pernicious disease and some of my older readers will remember my battle against some of its complications.

I’ve had good hba1c results in the dim and distant past, but for the last few years, it has rarely dropped below 8.5% and has at times been over 10%. Simply not good enough. All of my prior good hba1cs were entirely unconscious. I don’t remember ever aggressively managing my diabetes. Sure, I made the odd attempt, but achieving regular balance was always like nailing jelly to a wall. I’d get my blood sugars under control for a day, then at night I’d get a crushing hypo, massively over-treat it and spend the rest of the following day bumping off the buffers of ketoacidosis.

Hypo after hypo weakened my resolve to manage my diabetes well, so I practically gave up trying to keep my blood sugar within a narrow range and decided to work on avoiding hypos. I got better at that over the last couple of years and consequently avoided readings of over 25mmol/l, which in the hypo-over-treating days were too frequent to reduce my chances of avoiding severe complications. Of course, I just buried my head in the sand whilst pretending that I was doing a better job than I was. Nobody seemed to be able to explain the basics of why I couldn’t get my blood sugars under any kind of control and I resigned myself to a life of brittle diabetes, continuing weight gain and hideous complications. Oh and of course, death. Then again, we all die of something, so I never really got too morbid about that.

So what changed? How did I manage to get to the point where I was waking up with blood sugars ranging from 4.2 to 6.8 on a regular basis? How did I manage to get to the point where even after a night-time hypo (last night as it happens), I could wake up with a blood sugar of just 5.3? (Never pulled that one off before)

The answer is very simple, and confirms my own suspicions about effective Type 1 Diabetes management. Richard K Bernstein.

By eliminating sugars, sweets and most fast-acting carbohydrates, which covers most starchy food, including pasta, potatoes, rice and bread, I reduce the amount of insulin required to treat the food that I eat. Insulin is of course a potent hunger-stimulator and the fat-storage hormone of choice for the human metabolism. So cutting down insulin helps reduce weight. Reducing weight lowers blood pressure (and therefore reduces the compounding effect that high blood pressure has on diabetic complications) and reduces the body’s requirement for insulin. Simply, an 11 stone man needs a lot less insulin than a 15 stone man. I have lost about a stone recently.

Diabetic complications are caused by high blood sugars. Other factors compound the damaging affect of high blood sugars, but Bernstein makes it very clear that he swears by the results of the DCCT. Bernstein also swears by frequent blood testing and keeping blood sugar aggressively managed. His thesis is that if you can keep your blood sugar in normal range for as long as you can, you stand every chance of not suffering the pernicious complications of diabetes. At 74 years of age, having been a Type 1 diabetic for 62 years, he is living testimony to his methods and ideals.

Avoiding high glycaemic index carbs (like starches and sugars) also means avoiding a blood sugar spike that cannot be covered by conventional injected insulin. Bernstein won’t allow that wooly nonsense you get taught at normal diabetic clinics – i.e. don’t test your blood sugar within two hours of a meal. He won’t have that. He proclaims that it’s possible to achieve good blood sugar around the clock. I’ve called him on this and bugger me if he isn’t right! Sticking to protein, vegetables and the odd low GI food means that the insulin I take, less than I normally need, is enough to cover me continuously. Now I can check my blood sugar at any time at all and it should be normal. I’ve hod the odd slip, but the highest I’ve read recently is around 10. Most of the time, it has been between 4.2 and 6.9. Just unbelievable. And unachievable using my old regime.

Having achieved near-normal blood sugars through aggressive monitoring, control and restraint for a few weeks, I’m delighted and plan on continuing Bernstein’s regime for a while. Insha’Allah, I should find some of my complications reversing and others not progressing.

(Update 17/12/8 – I forgot to say “alhamdulillah“)

Tagged as: diabetes, richard_k_bernstein