Dr. Bernstein, insulin, and T2 patients

[Whited]

Hi. Dennis here. I was watching some of Dr. Bernstein's videos and I was surprised that the Dr. said he had only 3 T2 patients that could use low carb alone to get acceptable blood sugars. Now I know that Dr. Berstein defines acceptable BG as 83 before, during and after a meal He shoots for an A1C of 4.2 or 4.3 tops. He seemed to advocate low levels of insulin along with his program of around 30 to 40 grams of carbs a day for T2 patients.

I'll bet it would be really difficult to find a doctor that knows enough to guide a patient with low enough insulin to be successful. Also this is a little bit of a bummer as I would really like to avoid medication if possible.

Do any of you (that are diabetic that is) never go over 83 2 hours after eating? I go right now up into the lower 90s 2 hours after. Do any of you supplement your low carb eating with very low does of insulin? I kind of am shooting for keeping by BG under 100 2 hours after eating if I can but I do know Dr. B. stresses 83 at all times.

Forgive me if this has already been covered on the forum. Any thoughts or commets about this subject are welcome.

Dennis

[irishred15]

Dennis, I came off of all my medications just this past month so it is still too early to know long term results but currently I still have variation. I shoot for less than 100 with all testing. My am fasting bg is still usually my highest of the day and usually is 85 to 92. That is down from a consistently high that was more than 130 in the am in January. My 2hr post meal bg are between 80 and 90 usually if I keep my carbs very low. I honestly question the 83 is normal at all times that Dr B reports. He has worked with large numbers of type 1 diabetics that are artifically manipulated with drugs to try and achieve those results. But I have not read anything that supports that supports that tight of a range even in non-diabetics. Maybe Teaser or JEY will know if there is studies available. For me, I want fasting day bg around 80. I want my am bg 90ish or below. And I am happy with a 2hr post meal bg low 90 or below. Do I always hit it? No, because sometimes my supper has more carbs then I can handle at this point (I am very low carb). Hopefully with time my bg will settle consistently in the low 80s. Patience is not my long suit but I have certainly been practicing it as I make these changes a permanent commitment to a healthier life.

[cotonpal]

That's been my goal too, to keep my bg level at 83 as Dr Bernstein suggests. I can't quite manage to do it, often being over 90 at the 2 hr mark and beyond and occasionally a little over 100. If we go by what Dr Fung says, that insulin resistance is the problem and bg level just a symptom, adding insulin to get the bg down a small amount is the wrong approach. It's just feeding the problem, insulin resistance, by addressing the symptom, elevated bg levels. When you add to this that you are talking about a relatively small increase in bg, it seems wiser to just stick with the lchf diet.

Jean

[teaser]

I'd love to see a debate between Dr. Fung and Dr. Bernstein about the issue of blood glucose. There's sort of a choice between a rock and a hard place--excess glucose and excess insulin both being harmful. Is it better to have ideal blood glucose, and near-ideal insulin, or ideal insulin, and near-ideal blood glucose?

He seemed to advocate low levels of insulin along with his program of around 30 to 40 grams of carbs a day for T2 patients.

Maybe this is the key--we are talking about getting things to where it only takes small amounts of insulin to get at that 83 target. If a person had a fasting blood glucose of 100, and wanted to have a blood glucose of 83, how much insulin would they have to inject? Probably precious little. If we take somebody like Liz, who's been tested at an insulin level of 3--if she were to start an insulin program to bring her blood glucose down to 83, she'd likely still be miles and miles away from anything that could be called hyperinsulinemic.

There's another issue in that injected insulin doesn't necessarily make for elevated insulin levels, at least at the low end. Inject insulin, blood glucose goes down--and blood glucose is the main impetus for endogenous insulin secretion, so injected insulin may displace secreted insulin to some degree. There's also the potential that by mimicking the first phase insulin response that tends to be deficient in a type II diabetic, a person could have an insulin exposure pattern closer to that of a non-diabetic--and that could reduce the amount of insulin, endogenous and supplemented, that it takes to do the job.

I think we don't really have the studies to show what a blood glucose of 100 in a person eating a low carbohydrate diet means. If I'm eating 300 grams of carbohydrate a day--that hundred may signal hyperinsulinemia, tissues all over the body are taking in glucose, but it's being driven in with a sledge-hammer, their sort of being force-fed. If I'm eating 20 grams of carbohydrate a day, and 80 grams of protein, and my blood glucose is 100, my insulin levels very low--that force-feeding isn't happening, that number doesn't mean that there's a glut of glucose in the system, it means that glucose is being spared for those tissues that most need it. Maybe even then, a blood glucose of 83 would be better than 100. But it's clearly a very different scenario.

I think that's the crux. In a non-diabetic, does the glucose resistance that comes with a low carbohydrate diet do any damage? I don't say insulin resistance, and this is a little pet peeve of mine that I try not to be to uptight about. If insulin is low normal, and glucose a bit elevated--probably you're fairly insulin sensitive, the amount of insulin it would take to normalize your blood glucose is small, if you injected it or somehow convinced your pancreas to secrete slightly more insulin, you'd still be at the low side of normal for insulin. Being able to achieve normal blood glucose at low levels of insulin is the definition of insulin sensitive--this is true whether the pancreas secretes sufficient amounts of insulin to do this or not. There, the question isn't one of insulin resistance--but of why the pancreas isn't secreting the slight bit more insulin that would give a normal blood glucose.

If it's safe for a non-diabetic like Peter at Hyperlipid to have a fasting blood glucose of 104, as he reported five or six years ago--then, would this be a reasonable number, for a type II diabetic to be satisfied with?

[GRB5111]

I think we don't really have the studies to show what a blood glucose of 100 in a person eating a low carbohydrate diet means. If I'm eating 300 grams of carbohydrate a day--that hundred may signal hyperinsulinemia, tissues all over the body are taking in glucose, but it's being driven in with a sledge-hammer, their sort of being force-fed. If I'm eating 20 grams of carbohydrate a day, and 80 grams of protein, and my blood glucose is 100, my insulin levels very low--that force-feeding isn't happening, that number doesn't mean that there's a glut of glucose in the system, it means that glucose is being spared for those tissues that most need it. Maybe even then, a blood glucose of 83 would be better than 100. But it's clearly a very different scenario.

I think that's the crux. In a non-diabetic, does the glucose resistance that comes with a low carbohydrate diet do any damage? I don't say insulin resistance, and this is a little pet peeve of mine that I try not to be to uptight about. If insulin is low normal, and glucose a bit elevated--probably you're fairly insulin sensitive, the amount of insulin it would take to normalize your blood glucose is small, if you injected it or somehow convinced your pancreas to secrete slightly more insulin, you'd still be at the low side of normal for insulin. Being able to achieve normal blood glucose at low levels of insulin is the definition of insulin sensitive--this is true whether the pancreas secretes sufficient amounts of insulin to do this or not. There, the question isn't one of insulin resistance--but of why the pancreas isn't secreting the slight bit more insulin that would give a normal blood glucose.

If it's safe for a non-diabetic like Peter at Hyperlipid to have a fasting blood glucose of 104, as he reported five or six years ago--then, would this be a reasonable number, for a type II diabetic to be satisfied with?
That's the real question here. While Fung and Bernstein take different approaches to manage diabetes albeit with some similarities, we still have no information on how BG readings relate to insulin activity and related insulin sensitivity in T2 and non-T2 people. In a normal person if BG gets north of 100, at what point and why does the pancreas release enough insulin to lower BG?

[Whited]

Thanks for your responses Teaser thanks for your comprehensive analysis -- much to chew on (pun intended).

Jean and Irishred my BG seems to mirror both of yours very closley except so far my lowest of the day is when I wake (fasting) which is usually mid 70s (although for some reason sometimes in the 80s or very occasionlly higher) or when I do a 24 hour fast (often lower 70s) but as the day goes on mine are just like both of yours. I guess we're in this together. :thup: I actually go higher as the day goes on -- my highest readings are always after the evening meals. I usually only go in the 80s after lunch but evening when I go higher (90s or occasionally higher). I suppose I should eat less at night but its also the first meal after fasting (on those 24 hour days). I suppose i could schedule moderate excercies after an evening meal. I do wonder sometimes if its detrimental after a 24 hour fast if mine goes from 69 lets say to 94 so quickly. I do know its better than eating like I did before.
I suppose its kind of moot anyway as I would probably never have the resources to get a doctor the caliber of doctor B. I could do distance training with Dr. Fung though but I probably won't. I suppose the best course a action is to keep on doing low carb and try to stay off medication as long as possible and shoot for keeping BG under 100 after meals.

GRB -- Wow! A debate between Dr. Berstein and Dr. Fung. I would watch that one.

Update --I also have been eating more oil and vinegar with meals latley. (I tried taking ACV alone with water and sometimes I get IBS or acid reflux). I think there might be something to that though as today I had a piece of bacon, cheese, and mushroom quiche, salsa, sour cream, a couple extra pieces of cheese and a salad (with a little avacado) along with strawberries (2 of them) and creme and two squares of 86% Giralldeli chocolate. I suspected my BG would be high but after two hours it was 83 and the major change I made was putting plenty of ACV and extra virgin olive oil on the salad.

[irishred15]

Dennis, I have found ACV helpful so I am betting your salad dressing made a difference. I do drink it each evening trying to modify my morning bg. If you try evening exercise test after. Each time I try adding in walking I have gotten a bg spike. So now I walk if I want to but I avoid testing so I don't get frustrated.

[irishred15]

I went back to look at Blood Sugar 101 again and it gives the blood glucose range for "normal" people as 70-92 for fasting bg, <120 at 1 hour post meal, and <100 at 2 hours post meal. It feels appropriate for me to strive for those goals that are "normal" ranges if I can do them without medications. Not that I am opposed to my body hitting the low 80s, but I can only control so much of all the variables. Need to not perseverate on what I cannot change overnight.

[Whited]

Agreed -- We can be too attached to the numbers. Easier said than done (I am the worst offender here for panic) but we should look at longer term patterns as Teaser I believe has stressed. Our bodies are complex and many variables affect it that we might not even be aware of.

I do know that even if my bood sugar creeps up some its 10 times better for than a year ago when I was 85 pounds heavier and eating a lot of sugar.

Excercise is weird for me -- sometimes the numbers go up some, other times it lowers my BG. But again I think it is a very good long term practice.

[Whited]

You know what Irishred said makes a lot of sense. That is about Dr. Bernstein using insulin to get those perfect 83 readings. It would seem that it would be somewhat natural for our BG to go up a little after eating, even if meat and vegatables were the only thing consumed.

Also Dr. B is basing his goal of a perfect 83 on mortality statistics. I would guess that it is correct that the higher the BG the higher the risk but he also doesn't want anyone below 83. I am betting that those mortality statistics that that 83 number is based on average in damage from diabetics (like type 1) that go extremely hypoglycemic. My BG has gone back to a low level lately. FBG abound 70-75 and 2 hours after eating 80s (that of course doesn't do that if I eat any grains or other carbs -- I did an experiment last week where I ate two bites of a small chesse enchilada, two tortilla chips and two bites of a Wendy's child's cheese burger with bread -- my BG went to 106 after 2 hours)-- tonight BG was 81 1 hour after eating & 87 2 hours after but it was pretty low carb except for strawberries and a slice of tomato. Now those low numbers probably won't stay that way as its probably a phase or a rythum but I'm wondering why below 83 would be any problem unless you go so low you pass out etc. It would seem to me that people who go too low might alter the statistics -- the way child deaths altered the mortality statistics 150 years ago. There were plenty of 80 and 90 year old people (check the old graveyards) but women dying with complications from childbirth, child moratlity from disease, and infant mortality made it seem nobody lived past 45.

Of course I don't know this but it would seem that lower BG would be ok unless those low numbers would cause hypo symptoms in predisposed people. As Teaser posted before -- many healthy people have lower than average numbers.

[deirdra]

I wonder if Dr. B. picked 83 to take into account the inaccuracies of BG meters, so that people would remain safe if their meter reads high or if it reads low.

[SilverEm]

Deirdra, I seem to remember Dr. B saying that, in one of his monthly internet podcasts.

[SilverEm]

delete, duplicate

[Turtle2003]

I thought Dr. B said that years ago he tested lots of young, healthy people and found that 83 seemed to be the usual BG for non-diabetic, non-overweight people.

[Whited]

Here is a podcast where Dr. B explains his descision to set BG at 83 as a standard for optimum health. He based it on the young healthy salesman population he came accross (and non diabetic siblings of patients) as well as the mortality statistics, using FBG and A1cs as the statistical evidence in the mortality readings.

https://www.youtube.com/watch?v=zJGAbZIvRh8

I still don't understand why having BG in the 70s would be worse (in the overall mortality sense) than the 80s if there isn't a likelyhood of a hypoglycemic episode. In other words why would the lower than 83 BG be in a greater than normal mortality range unless severe hypoglycemic people who die in comas etc. are averaged in and alter the statistics?

We do have to take into account the inaccuracies of both home meters and A1Cs. As many others have said we probably should look at overall trends.
My fasting BG has been in the mid 70s for a while but my latest A1C was 5.1 (previous one was 4.9). That gives a higher average BG. So one should view broad trends I suppose instead of looking for the perfect number unless one has access to a clinic like Dr. Berstein's.