QNs from someone on the border

[RobLL]

I've ordered "Bernstein's book so will hold off on questions he may answer. You can see my first couple posts on "rise in BG while fasting" thread, just a few days before this one.

What sort of diagnosis do I need for Medicare to cover my testing stuff? The only BS out of normal range is FBS, which has been 105 the last few tests. But I also have had a session with retinopathy.

How important is it to see a specialist? I otherwise have confidence in my internist and ophthalmologist.

[dina1957]

I've ordered "Bernstein's book so will hold off on questions he may answer. You can see my first couple posts on "rise in BG while fasting" thread, just a few days before this one.

What sort of diagnosis do I need for Medicare to cover my testing stuff? The only BS out of normal range is FBS, which has been 105 the last few tests. But I also have had a session with retinopathy.

How important is it to see a specialist? I otherwise have confidence in my internist and ophthalmologist.
I doubt that FBG of 105 warrants glucometer and the strips, and insurance are very strict nowdays. You may try to convince your GP, but no endocrinologist will consider you a diabetic with FBg of 105, IMHO. They give me hard time strips wise, and my fasting on most days is in diabetic range or close. In general, insurance is against ppl monitoring blood glucose without being on OHA and/or insulin, and especially without being Dx with diabetes. Strips are expensive, around $90 for a 100, almost a buck each.
I would just go with GP, most Endos won't suggest anything esle, diet and exercise wise, and medication wise Metformin comes to mind.
it can be usefull to get antibodies and c-peptide tests done, to outrule late onset of T1.
HTH

[dina1957]

I've ordered "Bernstein's book so will hold off on questions he may answer. You can see my first couple posts on "rise in BG while fasting" thread, just a few days before this one.

What sort of diagnosis do I need for Medicare to cover my testing stuff? The only BS out of normal range is FBS, which has been 105 the last few tests. But I also have had a session with retinopathy.

How important is it to see a specialist? I otherwise have confidence in my internist and ophthalmologist.
You can read some chapters on Dr.Bernstein website
http://www.diabetes-normalsugars.com/

[RobLL]

Bernstein book arrived today. My annual appointment is coming up in a couple weeks and will check with him regarding how much monitoring I should do. All of your comments have been helpful. Thanks

[Cajunboy47]

[QUOTE] posted by RobLL:
How important is it to see a specialist? I otherwise have confidence in my internist and ophthalmologist.
[QUOTE]

I don't think you're diabetic either, unless you've had some BG readings above 120 and someone suggested at another post that there are other causes of retinopathy. You asked a question and my answer would be with a question to you.....

How important is your eyesight to you?

You may be justified in your concern of possibly having diabetes, but it sounds like your more imediate focus should be finding out for sure why you have retinopathy. I remember you saying you used to eat high carbs years ago and your doctor thinks the damage was done back then, but my thinking is, you didn't have any symptoms of diabetes back then, so it just doesn't sound like the most probable cause.

Cajunboy47

[ReginaW]

I've ordered "Bernstein's book so will hold off on questions he may answer. You can see my first couple posts on "rise in BG while fasting" thread, just a few days before this one.

What sort of diagnosis do I need for Medicare to cover my testing stuff? The only BS out of normal range is FBS, which has been 105 the last few tests. But I also have had a session with retinopathy.

How important is it to see a specialist? I otherwise have confidence in my internist and ophthalmologist.

An FBG over 100mg/dL does warrant a glucose tolerance test (GTT) - ask your doctor to order one for you AND have an HbA1c done too - so you'll know if you are diabetic at this point or still within the category of "pre-diabetes" which you doctor may feel is enough to have you test and monitor in an effort to prevent things from deteriorating.

[Cajunboy47]

An FBG over 100mg/dL does warrant a glucose tolerance test (GTT)

I didn't know that. I thought it was 120.......... Now, having said that, I think that any history in the family of diabetes would warrant the GTT even with lower numbers. Also, to err on the side of caution is always a wise thing whenever there is any concern. We are talking about a very serious disease and it can be prevented or delayed if attention is given soon enough...

Cajunboy47

[dina1957]

I didn't know that. I thought it was 120.......... Now, having said that, I think that any history in the family of diabetes would warrant the GTT even with lower numbers. Also, to err on the side of caution is always a wise thing whenever there is any concern. We are talking about a very serious disease and it can be prevented or delayed if attention is given soon enough...

Cajunboy47
I recall reading in RobLL other post that his Bg was 126 after GTT.

Opth. sent me back to Internest to get other blood check, A1C 5.7, very steady in testing, and drink the junk test 126.
I assumed the "junk" was glucose solution for GTT.;)

[RobLL]

I recall reading in RobLL other post that his Bg was 126 after GTT.

I assumed the "junk" was glucose solution for GTT.;)

Both my internist and opthomologist (Ph D) have said that they have had patients whose first presentation of diabetes was retinopathy. They both intend to see me fairly frequently. I'm sure opth. will want to track down what is happening if any more blood vessels appear amiss. It was only two, but they were in the critical part of the eye, center of the retina.

Dina1957, yes, your right, junk was the orange flavored glucose(?) - GTT. It was kind of interesting. I called internist after the ret. diagnosis and said I wanted A1C and the GTT, she said they didn't do those for men, only pregnant women. When I got up there the doc had already got supplies for the test.

I know more about weight lifting (still not much) than I do about diabetes, from my reading in Bernstein so far, he is pretty insightful about exercise. Found that impressive.

Cajun Boy - eyesight to me is life, I have watched my mother cope well with blindness from macular degeneration, don't know that I could match her coping ability. A session with cancer did not scare me as much.

Regina - I am a regular reader of your site. My weighlifting forum (jpfitness) holds you in high regard.

[Cajunboy47]

I have watched my mother cope well with blindness from macular degeneration, don't know that I could match her coping ability.

I have watched my 9 year old grand-daughter fight to keep her eyesight and lost the battle at age 5. Her lens had been removed prior to her first birthday to save her retinas, but she lost all vision in one eye and can see color when putting something against her cheek in a well lit room out of her "good" eye. Sad to see, but she copes fine, breaks my heart. Christmas time and buying something for her is very difficult to do....

Good luck to you with your health concerns....

Ron

[RobLL]

I finished reading Bernstein's book. Here is what I gathered. He does not directly address what a pre-diabetic diagnosis means. That is, no particular advice. But:

Reading between the lines, He asserts, with high confidence, that a normal non -diabetic person has an average FBG of 83. This corresponds to a A1C of under five. My A1C of 5.7 corresponds to an average blood glucose level of 120, technically that means I am not diabetic.

This seems to put a lie to the comments that 'you are either diabetic or non diabetic, there is no such thing as borderline diabetic'. Reading his book, looking at my tests and medical history borderline diabetic seems pretty accurate, in terms of logical language, if not in terms of the politics of diabetes.

So here is what I am going to do. My annual physical is next week. I will discuss all of this with my Internist. I will push for a prescription for testing equipment. If my insurance company demurs I will argue, but within a couple weeks I will have the equipment, and I will test. He seems to say that for those who don't need meds testing periodically, and also when you feel 'different', ill, eating differently is appropriate.

So my main question will be, What do I do to get an average blood glucose reading of 83? Or is that inappropriate. He is a type 1, and achieves it, why shouldn't I? And while I would like to do it without medications I have no philosophical objection to taking meds.

He also asserts, with a high degree of confidence, that high levels of blood glucose damage your pancreas/ insulin/glucose metabolism. So isn't the time to start addressing the problem now, while I still have a fairly decent metabolism in this regard? I am willing to make a lot of dietary sacrifices. Being healthy is a high value for me.

As always any comments will be given serious consideration and appreciated.

Rob

[RobLL]

I have watched my 9 year old grand-daughter fight to keep her eyesight and lost the battle at age 5. Her lens had been removed prior to her first birthday to save her retinas, but she lost all vision in one eye and can see color when putting something against her cheek in a well lit room out of her "good" eye. Sad to see, but she copes fine, breaks my heart. Christmas time and buying something for her is very difficult to do.... Good luck to you with your health concerns.... Ron

Cajunboy - that would be truly heartbreaking. I am sure you are a pillar of strength to her. Perhaps this is one of your calls in life now. Congratulations on getting below 200. For me being retired and having time to spend in the gym and weightlifting has been a boost. I really enjoyed Berstein's book. What little I know for sure were also things he knew. So I feel confident in all the other things he had to say.

[RobLL]

Well saw my doc. We had, relatively, a long conversation. He said, "no", "no", "no". On the other hand he does want to see me every 4 months instead of once a year. But no meds, no monitoring. However its OK if I want to take Alpha Lipoic Acid which is Dr. Bernstein's first choice for everyone practically, and Trader Joes has it fairly cheap. And he noted my last A1C was down. So I am happy, and so is he. Good Doc.

[Cajunboy47]

so, I'm confused Rob.......... what about your retinopathy?? Is there anything you're doing about it???

[dina1957]

so, I'm confused Rob.......... what about your retinopathy?? Is there anything you're doing about it???
This is my question too, I thought your main focus should be on retinopathy, not diabetes per se at this point. As I said, no Dr. will Dx you as a diabetic. It also would be produent to lift lighter weights or stop streneous exercise all together, this alone can exacerbate existing condition. My friend's DD had retinopathy since her teens, so she was not allotted even to cary heavy backpack to and from school.
JMHO

[RobLL]

This was annual physical with internist. Next ophthalmologists visit is February. He has no problem with weight lifting, my wife had asked me to bring the subject up at the very beginning.

aside: Bernstein lists some eye advantages for one of the diabetes oral meds, also the one my phar. dau. likes. Internist said no for diabetes, the opth. could prescribe it for eyes. They are both very proper about these things.

ps Got through big storm here in the Northwest, no damage to us, no power for six hours. Very noisy, like fourth of July with transformers exploding and doing their thing.

[Cajunboy47]

RobLL,

If there is an error, I would choose to err on the side of caution. I am not telling you how to go about doing anything in your life, or being argumentative, just expressing a deep concern.

I would err on the side of caution by using lighter weights, switch to perhaps more aeorobic type exercise, and reduce my exercise frequency just a bit until I find out with certainty the status of my retinopathy and its cause.

good luck to you and please use caution if you're not absolutely sure. An internist, as well informed as he may be is not the person with whom I would trust my eyesight to.......

Cajunboy47

[Mimya]

This was annual physical with internist. Next ophthalmologists visit is February. He has no problem with weight lifting, my wife had asked me to bring the subject up at the very beginning.

Hi Rob,

Do you use your internist to treat your diabetic needs or is he also treating your for other issues? I use an Endo doctor for my diabetic needs and wondered if I needed to do that.

[RobLL]

Opth. is the one who said weight lifting is OK. Internist is the one who keeps track of blood sugar. I should have my A1Cs in just a few days. If they are as low as he is expecting I will be pretty happy. He told me my last one's were 5.3, I thought it was 5.7. I'll post them when they come.

[Mimya]

Hey Rob,

I think 5.3 is pretty good. Are you now expecting to be lower then the 5.3?

My last A1c was 5.8 and I'm happy with that since it was 9.0 - 9 months ago.

Due to surgery I wasn't able to be as mobile as I should have been but now that I'm getting better I've started to walk daily. For me, exercise has made the difference. In the next few weeks I'll be starting some type of weight training - I hear that will help tremendously with bring down glucose levels.

Good Luck!

[RobLL]

Hey Rob,

I think 5.3 is pretty good. Are you now expecting to be lower then the 5.3?

My last A1c was 5.8 and I'm happy with that since it was 9.0 - 9 months ago.

Due to surgery I wasn't able to be as mobile as I should have been but now that I'm getting better I've started to walk daily. For me, exercise has made the difference. In the next few weeks I'll be starting some type of weight training - I hear that will help tremendously with bring down glucose levels.

Good Luck!

The Berstein book recommends stabilizing glucose levels at 85, and A1C between 4.3 and 4.7. I understand his rec. are radical, and not part of mainstream. I was visiting with someone yesterday who was happy with readings of 180 daytime after eating, and A1Cs of 8. He goes to a University endo guy.

Outside a couple Bernstein observations I listened, and did not say anything that could have been a challenge to his way. But this is a "Bernstein" forum, and would be interested in what others have to say about his BGL and A1C recommendations.

[Mimya]

------------

[Mimya]

----------

[RobLL]

Somehow I have a feeling my comments have some unstated assumption, and I read your answers as also assuming things most of you know, and that I don't know. That said, comments so far really have been helpful. They have answered a lot of questions, but not all. Hence a thank you.

Here is my unstated assumption: Dr. Bernstein asserts that a good sugar reading is 85, and that a good A1C is 4.3 to 4.7. From that I have assumed that my otherwise OK FBG of 105 is no longer close enough to be considered healthy? Ideal?. Likewise my 5.7 A1Cs (actually last one was 5.3) should no longer be considered good, indicating according to Bernstein that my average -BG was 120. So my assumption is that half the time it is over 120, and half the time below. Or perhaps some other combination. The upshot of this is that I considered that I might be a type 2 diabetic, not very, and with a lot of good insulin metabolism, but not ideal, and perhaps declining.

I am not positive that Dr. Bernstein would agree with my analysis, but I suspect he would. What is coming clear to me is that many (some?) of you do not agree with my analysis. I do not have a problem with that. I am searching for information. And taking it all in. It would be useful for me to know if this site generally does not think that Bernstein is right.

Some possibilities:
-Bernstein was the first to popularize going back to very low carb.
-Bernstein went too far in his recommendations.
-Bernstein is right, but his recommendations are too difficult for most people.
-Modern medicines are much better, and allow for more carbs than he recommends.
-I suspect all of us on this forum say far stricter carbs than ADA.

If Dr. Berstein is stricter than the science justifies that means that tomatoes, a little low carb fruit, carbier nuts, a little bread or other grains, legumes are OK. I would love to justify those sorts of additions to my diet. I have not excluded all of them, but I am considering it. My QN, where, ideally should be FBG and A1C be. I would enjoy reading the debate on the issue here or on another forum. I don't get emotional or enraged about differences of opinion.

Thanks for reading this convoluted and long post Rob

[dina1957]

Here is my unstated assumption: Dr. Bernstein asserts that a good sugar reading is 85, and that a good A1C is 4.3 to 4.7. From that I have assumed that my otherwise OK FBG of 105 is no longer close enough to be considered healthy? Ideal?.
Most labs don't even have 4.3 as low limit , and range starts with 4.5, at least, or 4.7! Few years back FBG < 140 was non-diabetic and H1C <6. Now,the trend is towards lower numbers, so FBG before was <110 and now is <100 to be consider normal.
But for Dr.B these number would be warranting eating almost no carbs and if diet alone does not get you in this range, then meds and/or insulin are in order. Personally, I have tried many times to follow the recommended diet 9qwithout meds), and every time my FBG will spike even higher.
For what I have read, as long as Bgs stay below 120-140 in general, the damage to eyes and kidneys is minimized. I got my best number as 5.2% and the higheest was 5.7% (upon diagnosis), so I am happy to be in this range and being able to eat some low GI fruit, some legumes, nuts, yougurt and in general, don't go crazy with my diet. Figured that it is not possible for me to achieve 83 or 85 around the clock, I can only get these numbers later in the afternoon and before dinner. I also don't think that T2 can accomplish the same tight level of control without meds or insulin as T1, but it is JMO.
Likewise my 5.7 A1Cs (actually last one was 5.3) should no longer be considered good, indicating according to Bernstein that my average -BG was 120. So my assumption is that half the time it is over 120, and half the time below. Or perhaps some other combination. The upshot of this is that I considered that I might be a type 2 diabetic, not very, and with a lot of good insulin metabolism, but not ideal, and perhaps declining.
Well, I think that H1C 5.3 is pretty good and many T2 would kill for this number, but there is also one factor as age, so despite the fact that there are some very insulin sensitive middle age and beyong folks, the majorityof population does become IR as they get older. Also, compare your H1C with recommended by ADA to be <7%;)
My take on this- do my best without driving myself insane over every single BG spike. H1C is not an average Bgs per se, but factor of BG and time as well, so if you do spike a little, but then Bgs return within 2 hours back to normal ( for me is <100), then it is not too bad in my book and won't impact H1C too much. BTW, normally everyone should see small spike after a meal, it is indication that you don't have huge amount of insulin circulating in your system at all times, "Life without bread" By Dr.Lutz explains it better. healso explains that older folks should not cut the carbs beyong 72 g a day, and I think it is pretty resonable, if you think it is a life time solution.
I am searching for information. And taking it all in. It would be useful for me to know if this site generally does not think that Bernstein is right.

Some possibilities:
-Bernstein was the first to popularize going back to very low carb.
-Bernstein went too far in his recommendations.
-Bernstein is right, but his recommendations are too difficult for most people.
-Modern medicines are much better, and allow for more carbs than he recommends.
-I suspect all of us on this forum say far stricter carbs than ADA.
#1- Bernstein definitely not a pioneer in treating diabetes with very low carb diet, it was known and used long before the insulin was discovered back in 1930s, and OHA avaialbe few decades. So it is old news... There is also a book by W.Bantingfrom mid 19th century, Letter of Corpulence, when low carb diet was used to treat diabetes and obesity.
http://www.supermarketguru.com/Downloads/Banting.pdf, Threr was also Dr.Atkins diet book back in 1970s, so there we go.
#2 - Couldn't agree more with this one, but it is a personal choice. Striving for better control is always a benefit, but trying to achieve constant BG of 83 is hardly possible even for non-diabetics, only to think that Dr.B states that BGs should be at this level before, during and after meal makes it hardly possible IMHO;
this leads us to #3, which is linked to #2, but again, ppl resort to using insulin just to get the magic #, which I think is a bit extreme;
#4-I won't say that modern medicine is much better, not sulfo-meds for sure, but certain recent medications already available and still in works, look very promissing. However, there is no free lunches, so every medication (even endorsed by Dr.B) has nasty side effects, and may pose problems on it's own.
IMO, there should be a balance between efforts to achieve good control and stressing and obsessing about BG numbers. Certainly, I won't deliberately compromize my control by eating starches, grains, God forbid regular sugar and sweets. But avoiding fruits in general, and even tomatoes and tomato products, spitting food to see if there is any glucose in it, using insulin injections to get from <100 to 83, does sound too extreme and rather too stressfull to me.
I still think if a person has only one leg, getting a prostatic leg may help to get around and look somewhat normal to other ppl, but he will never feel the same as when he had both his legs attached, yet achieve same level of fitness as normal person. Same with T2, we can achieve good control, may be better than those not yet Dx with diabetes and eating regular (high carb ) diet, but just the fact that this condition presents, chasing a magic number by eating practically no carb and using insulin and have super low H1C will still not be the same as being non-diabetic in general.
Again, I am not advocating ADA diet, but not a gang-ho with Dr.B plan either, at least, after almost 5 years of trying. I did not found it neither practical nor necessary to stay on 30 g carbs forever, and even when tried could not achieve his goal.

If Dr. Berstein is stricter than the science justifies that means that tomatoes, a little low carb fruit, carbier nuts, a little bread or other grains, legumes are OK. I would love to justify those sorts of additions to my diet. I have not excluded all of them, but I am considering it. My QN, where, ideally should be FBG and A1C be. I would enjoy reading the debate on the issue here or on another forum. I don't get emotional or enraged about differences of opinion.
I can't ditch tomatoes, those my favorite veggies (well I have learned for some bizare reasons they called fruit now days, LOL), same way I love yougurt, nuts, other low GI fruits, and eat them without huge spikes in my BGs. I can tell the difference between fruit and bread or cereal, so I manage to keep H1C in <6% club. Cosider, my diet was never too high in carbs even before, I am happy when I have certain variery in my food and have decent numbers. IMO, adding insulin to a very low carb regimen may make my numbers look good on paper, but in long term won't make me healthier. I think H1C <5,5% is good enough for helathy folks, and fasting BGs are most fo the time linked to DP and is by far the hardest number to control!
Frankly, I see similarities in using low fat diet and statins medications in treating high cholesterol , where trend is towards lower and lower numbers every day, while it is hardly achievable without meds, and in long term does more harm that higher CHO itself. For me it is the same as living life in ketosis and using insulin to achieve Bgs of 83 around the clock.
This is just my opinion on the subject, so good luck figuring what works for you.
Edited to correct some typos and add link

[RobLL]

Dina - good post. What is particularly informative is how your "philosophy" and experience interacted. It is important to me that I deal with reality. Models (i.e., Bernstein) of control are useful, but are not themselves reality. This is my one disagreement with my doctor, he doesn't think I need to do any testing. I think I should see what my readings are for about a week, and then do spot checking (one or two readings a week) after that.

Interestingly, this is what he wants me to do with blood pressure. Just before dr. visit I test BP three or four times a week. I sit down and immediately take it, then every few minutes until it stabilizes. He likes that system. (Dr. Berstein recommends the same). Otherwise I take it a couple times a month.

[dina1957]

It is important to me that I deal with reality. Models (i.e., Bernstein) of control are useful, but are not themselves reality.
I do think it is a reality for very few zealots, who dedicated their life to achieve magic number. But I used to participate in Dr.B's forum, and stopped posting after a year or so. But then I received e-mail from the forum administrator notifying that one member had passed away from a massive ischemic stroke. He was in his mid 50s, followed very low carb diet for almost 10 years living on sausages and shrimps with a small addition of green beans, used meticulous insulin injections. Poor Iceman, he lost more than 50 pounds, was doing great and still died at early age. His numbers were very good and H1C <5% I recall. Enough sad. There could be other factor than just diabetes per se, but indeed it shows that great number intself does not protect from an early death!
This is my one disagreement with my doctor, he doesn't think I need to do any testing. I think I should see what my readings are for about a week, and then do spot checking (one or two readings a week) after that.
I am kinda with your doctor, consider your numbers, but if the doctro objects, invest in a glucose meter (it last a life time) with enough strips for a couple of weeks, but trust me, checking Bgs is sort of addictive and is habit forming, LOL. ;)So you may find yourself on the hook after 2 weeks, and start buying more strips, LOL

Interestingly, this is what he wants me to do with blood pressure. Just before dr. visit I test BP three or four times a week. I sit down and immediately take it, then every few minutes until it stabilizes. He likes that system. (Dr. Berstein recommends the same). Otherwise I take it a couple times a month.
BP is something you need to monitor daily, and it is not cost effective. However, both Bg and BP change on horly basis, so makes sense to check it when you are at rest (upon arising) and later at night, before bed. My DH has inheritted tendency to higer BP, so he checkes it twice a day.
Again, with BP it used to be good enough for systolic :100+age, now everyone should be below 120/80 regardless of age.
I see trend with everything: lower the number, and get another patient.;) More business for doctors and more profitsto Big Pharma. But I prefer to stay away from medications as long as possible, since we know the cure can kill faster than desease itself.
Best regards and good luck with rethinopathy!

[ReginaW]

Here is my unstated assumption: Dr. Bernstein asserts that a good sugar reading is 85, and that a good A1C is 4.3 to 4.7.

From my understanding, those are "optimal" readings, targets to strive for if one can, since normal/optimal is associated with the least risk for complications and damage over time. If someone with type 2 can hit an A1c of 5.3 or 5.5 or even 6.0, and it's with diet and/or medication, I don't think anyone would be complaining or saying that's not good enough - the data clearly shows it's better to get an A1c at or below 6.0 than just to the ADA target of <7.0.

From that I have assumed that my otherwise OK FBG of 105 is no longer close enough to be considered healthy? Ideal?.

Your FBG is in the pre-diabetic range - ideal? No....ideal is "normal" and 105 is not normal blood sugars in the fasting state. Sorry if that's just blunt, but it is what it is.

Healthy? Probably not in the long-term since glycation is part of the problem with higher blood sugars and what leads to many of the long term complications associated with high blood sugars.

Likewise my 5.7 A1Cs (actually last one was 5.3) should no longer be considered good, indicating according to Bernstein that my average -BG was 120.

Hey, most T2 would kill for an A1c of 5.3 or 5.7 - that is good control whether it's with diet alone or diet with medication. Is it "optimal" or "ideal" - no, but it's way better than the target set by the ADA of <7.0 since lower levels are associated with less complications...so if your goal is long-term risk reduction, keeping your A1c at, or trying to get it lower, is the way to go.

Some possibilities:
-Bernstein was the first to popularize going back to very low carb.

For diabetics, he's probably the one who's been most vocal about returning to an effective dietary approach that was the treatment of choice before the discovery of insulin and various medications.

-Bernstein went too far in his recommendations.

I'd have to ask, how so? He advocates that diabetics be told the truth about high blood sugars, the damage they cause, and that they deserve normal blood sugars.

-Bernstein is right, but his recommendations are too difficult for most people.

Now we're talking about a whole 'nother issue - what works versus what one is willing to do to achieve blood sugars as close to normal as possible. Which leads directly to "Modern medicines are much better, and allow for more carbs than he recommends." which in some ways is kind of accurate - having modern medicine does indeed offer more options and somewhere to go if diet alone isn't having the same punch it used to in time....but I suspect the idea that they're "better" because they allow more carbs than Dr. B recommends is wishful thinking - if you look at the data from studies where carbohydrate is restricted and compare it to data where medication is the choice, the A1c and other risk parameters are lower (thus better) in the diet when the diet is followed properly. I think this tends to be because we want to believe the medication is solving the problem - but it's not, it's only aiding the body in a small way to deal with carbohydrate turning to glucose in a metabolism where glucose metabolism is impaired...the solution is to limit the carbohydrate, thus lower the glucose excursions, thus lower the potential for complications - medication doesn't do that.

That said, if someone absolutely finds they cannot adopt a carbohydrate restricted diet and faithfully follow it, medication is absolutely their next best option....but again, targets should be lower than the current ADA <7.0 (if you ask me).

-I suspect all of us on this forum say far stricter carbs than ADA.

Coming from the perspective of what does the data tell us? Well, carbohydrate restriction works and works better, faster and more consistently than anything the ADA is recommending right now.

If Dr. Berstein is stricter than the science justifies that means that tomatoes, a little low carb fruit, carbier nuts, a little bread or other grains, legumes are OK. I would love to justify those sorts of additions to my diet. I have not excluded all of them, but I am considering it. My QN, where, ideally should be FBG and A1C be. I would enjoy reading the debate on the issue here or on another forum. I don't get emotional or enraged about differences of opinion.

Probably, at this point, your best bet is to learn how various foods affect your blood glucose levels - as they say "eat to your meter" - good advice for anyone who feels they'd like to tweak their diet to fit their tastes and likes/dislikes. It's an effective way to measure how any food or combination of foods make your blood sugars rise, and how much. Low-GL fruits like berries are often included in diets for those with T2 - you can't go and eat cups of them, but a small amount is doable by most people if they include some fat/protein with them (think yogurt or some cheese).....same with tomatoes or legumes, although you'll be hard pressed for bread or other grains/grain foods, but options exist and it all comes down to testing to see what a food does to your blood sugars and how eating various foods in combination with something you like may allow you to have something.

Optimal numbers - from everything I read, I would say....

FBG....between 80-90mg/dL

A1c.....below 5.5 if at all possible, 6.0 being the high upper tolerable target to try for

1-hour post prandial....up to 140mg/dL

Hope this helps!

[dina1957]

To ReginaW:
Are you a diabetic?

[ReginaW]

To ReginaW:
Are you a diabetic?

No - does that matter?

[Lisa N]

No - does that matter?

Not at all, Regina. All informed posters are welcome to discuss topics here. :)

[dina1957]

No - does that matter?
I thought so. It does not matter in terms of posting but matters to me in terms of sharing experience and conseling. ;)
JMO

[RobLL]

Regina Your post is interesting, and seconds my suspicion that I do have a minor compromised glucose function.

ps - for me bread is a piece of 12 net grams usually with crust cut off, so likely 8 grams. About every other day.

Dina
It is interesting that the bottom line both from both of you is similar. Beings I'm in the middle (not quite diabetic, and not quite 'not diabetic) I read that medications are not in order, and that metering may be OK/probably should be done. As I mentioned my internist is ambiguous - no meds, monitoring not needed, but come in every 4 months.

General - fortunately I am not uncomfortable living with uncertainty. I think that in January I will do some monitoring. Still haven't got my last A1C from a week ago. I may consider Alpha Lipoic Acid, but not large doses. I will report again after I get some monitoring results.

[dina1957]

Dina
It is interesting that the bottom line both from both of you is similar. Beings I'm in the middle (not quite diabetic, and not quite 'not diabetic) I read that medications are not in order, and that metering may be OK/probably should be done. As I mentioned my internist is ambiguous - no meds, monitoring not needed, but come in every 4 months.

Rob,
This is just a common sense. IMHO, don't start monitoring now, better get H1C once in 3-4 months, it's a general tool used to asses overall control. testing your Bgs few times a day won't change your situation but will add unnecessary stress and anxiety over possible BG spikes, and this is least helpfull in BGs control.
Eat your bread, 8 g is nothing, consider your exercise regimen. Personally, I prefer bran -a crisp, high fiber rye crackers, or similar, I used GG crisp bread, but those really taste nothing like saw dust, LOL. Bran-a-crisp are very good with soups, work as cereal with unsweatened soy milk and plain yougurt, each has 6 g total carbs with 2 g fiber. Great for digestion also.;)
Your internist is right, no meds needed, you can try supplements and vitamins, may be shave off one or two decimals from H1C. Those who switch from a typical american (high sugar) diet to low carb see dramatic drop in H1c, while in your situation (and my own) there is not much room for improvement, unless meds and/or insulin.
General - fortunately I am not uncomfortable living with uncertainty. I think that in January I will do some monitoring. Still haven't got my last A1C from a week ago. I may consider Alpha Lipoic Acid, but not large doses. I will report again after I get some monitoring results.
Start monitoring if you plan to dedicate the rest of your life trying to obtain magic H1C number, otherwise, knowing that your Bgs may spike a little bit, will neither make you happier nor it will lower your Bgs. You know, I got through periods when I just don't test for 3-4 weeks, giving my fingertips time to heal, and just eating same way. I got best H1C during those periods, could it be because I eliminate stress of testing and obsessing about my numbers?
As for uncertainty, you are not diabetic, but it is prudent to keep an eye on your BGs. Get a comprehensive metabolic panel done once in 4 months, this should be enough without daily testing. If you see upward trend, then start monitoring.
JMO,
best of luck.
D,

[RobLL]

Dina - I am a pretty laid back person - more than my wife likes :D High blood pressure reading have not upset me ever, although I have decided it meant to slow down until I got to the doctor. Funny story, I was donating blood, at the gym, so would have BP taken after heavy swimming and lots of sauna. Getting about 105/65. FALSE READING. but I lowered my meds and went really high, like 165/100.

If I start metering after a week I know what will happen - I'll get bored with the whole thing, and subsequently have to force myself to test once or twice a week. I would like to know what of my normal eating causes any spikes, and I do not want to take supplements, ALA, evening primrose if it doesn't make any difference.

I really agree with your point that both BP and BG may be part of a larger constellation of of some sort of activity in the body, and that to SOME extent the meds may be treating a symptom as opposed to addressing the whole problem. Additionally as you have said, no free lunch, everything has side effects.

Rob

[Lisa N]

Rob, even if you are not yet diabetic, you are showing symptoms of something known as Metabolic Syndrome (http://www.medicinenet.com/metabolic_syndrome/article.htm) with elevated blood pressure, overweight, and probable insulin resistance. How are your cholesterol, specifially triglyceride, readings? If those are also elevated, you are wise to start thinking about ways to keep this from progressing now rather than later.
As for monitoring your blood sugar, that's up to you at this point but having the knowledge of what certain foods or types of foods do to your blood sugar could be valuable in deciding how you want to modify your diet. I don't think you need to test obsessively, but testing after you eat specific types of foods that you suspect you may have a problem with could be quite enlightening. That is what Regina was referring to when she said 'eat to your meeter'; you let your test results determine whether or not you can handle a specific food in your menus. It all depends on how much of a 'how does this work?' type of person you are.
If you do decide to purchase a monitor, make sure you ask how much the test strips cost because that is where the real cost of testing lies, not in the monitor itself. :)

[dina1957]

Dina - I am a pretty laid back person - more than my wife likes :D High blood pressure reading have not upset me ever, although I have decided it meant to slow down until I got to the doctor. Funny story, I was donating blood, at the gym, so would have BP taken after heavy swimming and lots of sauna. Getting about 105/65. FALSE READING. but I lowered my meds and went really high, like 165/100.
I did not know you take BP medications. BP is better taken at rest, and FWIW, testing after a phycial activities can give you rather high than low reading. If 165/100 is your resting BP and if it is on regular basis, it is a bit problematic, and medications are warranted. You do have some minor glucose intolerance, but you stated you are lean and muscular, so I don't think it is a problem. You are already low carbing, with probably ocational cheat. So, even if you monitor and see ocational spike in BGs within an hour post-meal, so what? Does it mean you sholuld stop eating carbs all together, can you live on protein and fat, and most importantly: would your get better control on it. Interesting observation. Last week I made a priome rib roast, and porbably indulged too much (ate a large slice of beef), and normally I don't do it. So I did not feel like eating meat an like since then, and ate lentil soup, beans, sauerkraut, low GI veggies, bran crackers, yougurt, and little fruit. My FBG dropped to below 110, which I haven't seen in months. before I have been eating lots of protein and fat, and even before being Dx, so I now want to conduct a little experiment and try to follow this semi-vegeterian plan for few weeks, to see if this will help with my FBG and overall control.
I would like to know what of my normal eating causes any spikes, and I do not want to take supplements, ALA, evening primrose if it doesn't make any difference.
In this case there is only way to tell: test 45-1 hour after a meal to catch the spike, and then after 2 hours. There is not way to if the supplements will or won't help, without trying.

I really agree with your point that both BP and BG may be part of a larger constellation of of some sort of activity in the body, and that to SOME extent the meds may be treating a symptom as opposed to addressing the whole problem. Additionally as you have said, no free lunch, everything has side effects.

Rob
I do think that no medication is side effects free, I doubt that your Bgs warranting any, monitoring BP is probably better idea especially if you take meds. Overall, take it easy and don't worry much about your blood sugar. I don't think your high BP is caused by diabetes, I personally have normal BP even I am a diabetic but my husband has elevated BP and his FBG is just slighly above 100.
Worrying too much about something that you don't have, will raise your BP.;)
Take care and enjoy it, life is too short anyway!

[Lisa N]

So, even if you monitor and see ocational spike in BGs within an hour post-meal, so what? Does it mean you sholuld stop eating carbs all together,

Dina, I don't think anyone is suggesting that Rob stop eating carb containing foods altogether. Even the most militant Dr. Bernstein follower doesn't go that far with carb restriction unless they have totally misunderstood what the man wrote.
What I'm suggesting is that since Rob is showing clear signs of metabolic syndrome that he do some testing to get a handle on what foods spike his blood sugars and which don't. Having that information will help him tailor menus that aid in keeping blood glucose as stable as possible. He may find, for example, that apples don't cause him a problem but pears do or that neither works well but small amounts of berries are fine. Low carbing is probably the best direction Rob can go, but how low does he need to be? His meeter can answer that question far better than the best guess of anyone here.
Since Rob is already suffering from retinopathy, I don't think it would be wise to play fast and loose with even borderline readings; better to get a handle on things now than wait until the problem becomes bigger, IMO. As the expression goes, "better safe than sorry". ;)

[RobLL]

Lisa - I see things about the way you suggest. My BP is under good control, cholesterol good, (minimal meds for these two), weight within ten pounds of goal. And I am intensely curious about what foods might be causing problems. I allow myself a little slack on carbs, have NEVER had a cheat day. A hamburger or a very small piece of cake every several months is my biggest carb cheat. After the first of the year I will do metering. I suspect that I will find some carbs I need to reduce, and that there are some I tolerate, and will make the adjustment to my diet. As I mentioned earlier tomatoes and berries are what I hope are not a problem, but the meter will tell.

To All: your comments have been a load of help.

[dina1957]

Dina, I don't think anyone is suggesting that Rob stop eating carb containing foods altogether. Even the most militant Dr. Bernstein follower doesn't go that far with carb restriction unless they have totally misunderstood what the man wrote.
First, Dr.benstein plan is 30g carbs, this level is practically not much different that Atkins Induction level. I think Rob stated that he has been low carbing, and that he eats a slice of bread once on a few days. He also stated that he is lean and muscular, with 14% body fat- how this resembles metabolic syndrome. His minor impairment of glucose metabolism does not justify for metabolic syndrome, many non-diabetic, lean men and women have high blood pressure, especially those after 50, and no one actually knows what causes it.;)
that he do some testing to get a handle on what foods spike his blood sugars and which don't. Having that information will help him tailor menus that aid in keeping blood glucose as stable as possible. He may find, for example, that apples don't cause him a problem but pears do or that neither works well but small amounts of berries are fine. Low carbing is probably the best direction Rob can go, but how low does he need to be? His meeter can answer that question far better than the best guess of anyone here.
Apples and pears are very close in GI/GL, and his H1C of 5.3% is a good indication of his good overall control. Consider his GTT was 120 after drinking glucose solution, apples and pears should not be a problem at all;)
Since Rob is already suffering from retinopathy, I don't think it would be wise to play fast and loose with even borderline readings; better to get a handle on things now than wait until the problem becomes bigger, IMO. As the expression goes, "better safe than sorry". ;)
I think he plays it as as safe as possible, low caring and exercising, pricking fingers 4 times a day won't make much difference. He also stated that he does not want to eliminate some legumes, fruit, ocational bread, etc. so I am not sure if what can make his control even better without restricting carbs to 30g or so.

[Lisa N]

As I mentioned earlier tomatoes and berries are what I hope are not a problem, but the meter will tell.

Rob, they aren't a problem for me as long as I'm sensible about the amounts. I've also found that it helps to not have them alone but to combine them with some fat (heavy cream or cheese) or some protein. As much as I love bread and bake it every week for my family, I can't manage even a little without a spike but you may be fine since your A1C clearly shows that you are still in normal range there.

I think Rob stated that he has been low carbing, and that he eats a slice of bread once on a few days. He also stated that he is lean and muscular, with 14% body fat- how this resembles metabolic syndrome.

Dina, Rob's stats show that he was overweight and by his posts, he has an elevated fasting glucose and high blood pressure; that's 3 out of 5 symptoms of metabolic syndrome right there. The fact that he has lost weight and his BP is controlled by meds doesn't change the picture. I asked about cholesterol (lowered HDL and elevated triglycerides) because those are the 2 remaining symptoms. Metabolic syndrome is not diabetes, but it definintely indicates carbohydrate intolerance.
Low carbing is probably the best thing he can do for himself but the real question, as I stated above, is how low does he need to be in carb intake? 30 grams may be lower than necessary since he is nearly at goal and his A1C is fine, but what range is good and what types of foods can he safely include?
For the life of me, Dina, I can't figure out why you are trying so hard to discourage Rob from satisfying what he has stated is his own curiosity about how his body responds to different foods.

[dina1957]

Dina, Rob's stats show that he was overweight and by his posts, he has an elevated fasting glucose and high blood pressure; that's 3 out of 5 symptoms of metabolic syndrome right there. The fact that he has lost weight and his BP is controlled by meds doesn't change the picture. I asked about cholesterol (lowered HDL and elevated triglycerides) because those are the 2 remaining symptoms. Metabolic syndrome is not diabetes, but it definintely indicates carbohydrate intolerance.

My BP is under good control, cholesterol good, (minimal meds for these two), weight within ten pounds of goal.
He stated his CHO is fine, and again, BP can be due to something esle rather than Syndrome X, and something to look into further especially in terms of rethinopathy. I would be worry more about this condition, than chasing BGs that are OK. I wonder also what is his waist measurements, for men Syndrome X is upper body obesity with waist >40 inches.

And I am intensely curious about what foods might be causing problems. I allow myself a little slack on carbs, have NEVER had a cheat day. A hamburger or a very small piece of cake every several months is my biggest carb cheat. After the first of the year I will do metering. I suspect that I will find some carbs I need to reduce, and that there are some I tolerate, and will make the adjustment to my diet. As I mentioned earlier tomatoes and berries are what I hope are not a problem, but the meter will tell.
It does sound that he is very strict with carbs already.

Low carbing is probably the best thing he can do for himself but the real question, as I stated above, is how low does he need to be in carb intake? 30 grams may be lower than necessary since he is nearly at goal and his A1C is fine, but what range is good and what types of foods can he safely include?
My experience tells me that no two diabetics are equal, but Rob passed GTT with Bgs 120 after drinking 75g of glucose is a sign that unrefined low GI carbs hardly impact his BG. A true diabetic and someone with IR will be way over 200, 2 h post GTT.
For the life of me, Dina, I can't figure out why you are trying so hard to discourage Rob from satisfying what he has stated is his own curiosity about how his body responds to different foods.
I am not trying to discourage Rob, I probably misunderstood him based on his earlier post...

If I start metering after a week I know what will happen - I'll get bored with the whole thing, and subsequently have to force myself to test once or twice a week.
I have changed my view of diabetes after 5 years of monitoring, I now see how and why drs are reluctant to Rx glucose strips ppl who are not diabetics or have good control. Meticulous monitoring does not change things much, after a diet and exercise routines are established. BGs fluctuate a lot: cold and flu, exercise, stress, weather, alcohol,time of the day, many variables are hard to fit into one equation. If one is on medications and/or insulin, then monitoring is a must.
When I tested 6-8 times a day, I was constantly stressed about not being able to meet perfect number, may be it is my personal problem. Rob can make this decision for himself, if he is willing to pick up the cost of glucose strips (I guess his insurance rejected his request), and can test few times a day, then - go for it. But monitoring without being commited to sacrifice most of the cabrs, does not make much sense. But each to his own!
JMO

[Lisa N]

Rob passed GTT with Bgs 120 after drinking 75g of glucose is a sign that unrefined low GI carbs hardly impact his BG. A true diabetic and someone with IR will be way over 200, 2 h post GTT.

That's not necessarily true, Dina. Even with a random blood glucose of 250, my highest reading on the GTT was 180 (Plain Cheerios, it seems, spike me far worse than straight glucose) but there was absolutely no doubt that I'm a T2. Unrefined, low GI carbs have very little impact on most people when eaten in reasonable quantities, even diabetics; that's why they're called low GI.

I'm sorry that frequent monitoring caused you such stress, Dina, but as to it making no difference, studies have shown that diabetics who test frequently (T1 and T2 alike) have better overall controll and better A1C readings than those who do not. Apparantly it does make a difference for the majority. 4 times a day? I tested that frequently when I was getting a handle on what I could handle and what I couldn't (for about the first year), but now I test every few days at varying times unless I'm adding something new to my diet. Do I think it's necessary for Rob to test? No. Do I think that he may find the information useful? Absolutely. BTW...you do not need a prescription to purchase a glucose monitor or test strips. You do need one for a lot of insurance plans for them to cover the expense. The good news is that often the monitors themselves are free after rebate; the test strips can be pricey, though, but I don't think Rob would need more than 1 container of 50 to get a good idea of what's going on with him.

monitoring without being commited to sacrifice most of the cabrs, does not make much sense.

Even if Rob finds that he doesn't handle some foods or types of foods well, it doesn't follow logically that he should then be required to give up most carbs. That would just be plain silly. It would make sense, however, for him to avoid the problem carb foods and replace them with those he doesn't have a problem with. :idea:

[RobLL]

Just a general comment, my perception of all of the differences of opinion on the diabetes threads, and actually on some of the others too, is that there is a lack of research and a lack of information coming out of the scientific, and more particularly out of the academic medical centers.

People on this site have had more information than I could garner elsewhere. But, and I am sure you won't consider this a criticism. It should not by my preference, it should not be your task, it should not even be my internist's job to produce a two or three page guide for someone with my numbers, and my medical history.

I have great doubts that I am one of the few in my position. There must be someone, actually many, in the research world who followed pre/borderline diabetes cases, and who assigned various treatment modes. And then should be offering guidance. If for no other reason than to say 'do nothing' save lose weight, go lower with sugar and grains.

I think there is a right for most of us to be angry at this lack of guidance from those in the business.

Prostate cancer was in similar circumstances five years ago: there was almost literally no guidance on what treatments worked best. Final answers still are not in, but enough research has been done that tests and results can be fit into a body of knowledge which give some guidance. Another note: five years ago a recurrence of PSA was considered a terminal sign. Now specialists are saying that until you have had two or three subsequent modes of treatment don't consider it terminal.

[AuntJoyce]

Hi Rob:

My goal is for an under 5 A1C. I stayed under 100 in October and stayed in the 80's for a few days. I eat well under 30g carbs daily and eat paleo by not eating grains or very much dairy. I eat about 3 cups or so of veggies a day but no fruit most of the time. It works well for me. I'm trying to have a good omega-3 balance (thanks to Regina's posts on that and then I read The Omega Rx Zone by Dr. Barry Sears). I'll get my checkup and bloodwork in March.

I've also been doing the intermittent fasting and that works wonders for me. Robb Wolf of the Performance Menu always talks about how it improves our insulin resistance and consequently a leaner body with more muscle.

Of course, between the holidays and the power outage (I was out for a week), I've backtracked. So I'm back on track now.

PS: I just read The New Rules of Lifting too and I'm all set to do the Fat Burning I workouts. I had tried his supersets out a few times in early December. Lou said not to worry about the 'dork factor' by having a clipboard at the gym so I typed up the workouts into a spreadsheet and printed them out.

[AuntJoyce]

I have great doubts that I am one of the few in my position. There must be someone, actually many, in the research world who followed pre/borderline diabetes cases, and who assigned various treatment modes.

I remember seeing a recent study in junior-high boys where resistance training did improve IR. I think this was studied in some native americans who have very rates of diabetes. They were expanding the study to a bigger group which includes girls.

I'm also seeing more information about waist measurements as an early-warning sign for diabetes. I always had a pot belly.

Dateline NBC reported that 1 in 3 kids will get type 2 diabetes. Is that a wake-up call or what?

[RobLL]

I remember seeing a recent study in junior-high boys where resistance training did improve IR. I think this was studied in some native americans who have very rates of diabetes. They were expanding the study to a bigger group which includes girls.

I'm also seeing more information about waist measurements as an early-warning sign for diabetes. I always had a pot belly.

Dateline NBC reported that 1 in 3 kids will get type 2 diabetes. Is that a wake-up call or what?

Hey - congrats on reading and starting NROL. I finished the three fatloss workouts about a month ago. That last two really were hard. Go light if you need to. On the Bulgarian Split Squats I once dropped my dumbbell weights three or four times before I could finish.

I am BG monitoring now. It would be boring to report, but after I have figured out what my baseline numbers are I will make an online report.

ps We were only without power down here (eighty miles from you?) for about seven hours. With a well we would have been up a creek after about twelve hours.

[RobLL]

Never very high - never very low (at first), out of the first 25 readings:
1~140, 137
5~ 120s
8~ 110s
2~ 100s
4~90s
1~88, 89
This is consistent with Dr. Bernstein's assessment that 1CA of 5.7(my last two original lab reports) equaling an average blood sugar of 120. Incidentally my last reading was 5.5, and they said it was a new scale - would that be a change at my lab, or a general change in calibrations. They showed new figures for my last three tests 5.3, 5.4, 5.5

It only takes a little carbs, maybe 20g to push me up, and 1 and 2 hour readings are 140 and 122, second 20 carb foray about the same. I will do some testing to this but I do not seem to clear that last bit of excess sugar out of my blood.

Next 25: You can't help but eat to the meter, One reading over 120, 3 under 90, one under 80.

My highs are not bad, the problem is that they stay up for a long time. I have not done a real carb load, i.e., a piece of pie, a hamburger, pasta. Tonight I plan on having salad and split pea soup.

For the first time in years I am getting FBG under 90, I mentioned before over the last 5 or 6 years 91 was the low, most in the 100-110

I am also suspicious that the more times I eat the more time I spend over 100. Hard - I like to snack.

[Lisa N]

I am also suspicious that the more times I eat the more time I spend over 100. Hard - I like to snack.

That's because you are starting out from a higher low each time you eat than you did before.
For example, first meal you go from 85 to 130 but at 3 hours are you are at 110. You eat again and then go from 110 to 140 or 150 and are still at 120 3 hours later when you have your next meal or snack. See how it works?
It's specifically for this reason that Dr. Bernstein recommends at least 5 hours between meals so that the effects of the last meal on your blood sugar have been dealt with by the body (hopefully....blood glucose shouldn't still be elevated 5 hours after your last meal in a normal person).

[AuntJoyce]

Tonight I plan on having salad and split pea soup.

Split pea soup is about 30g carbs per cup. If you would change that to a clear soup with meat and vegetables, you would have some carbs left over for a handful of almonds.

Hopefully, with some tweaks here and there and you will get your numbers down.

ps: didn't drop the db's on the bulgarian squats ;) , but was a little wobbly. I'm really feeling the barbell squats.

[RobLL]

"ps: didn't drop the db's on the bulgarian squats , but was a little wobbly. I'm really feeling the barbell squats." Aunt Joyce

Wait till you get to fatloss and do the Bulg. Sq. with overhead lift. :help: I had children, or at least young adults, coming to my rescue.

Oddly enough split pea soup, just before a workout, cleared fairly quickly. May be, per Lisa N, that if its not on top of a recent meal I'm OK. By the way, weighlifting nutritionists are in favor of 5-8 smaller meals a day, guess I will have to leave that particular to the young'ns.