Appendices
AppendixA:What About the Widely Advocated DietaryRestrictions on Fat,Protein, and Salt,and the Current High-FiberFad? 443 Appendbc B: Don't Permit Hospitalization or Lengthy Outpatient Procedures to ImpairYour Blood SugarControl 462 Appendix C: Drugs That MayAffect BloodGlucoseLevels 465 Appendix D: Foot Care for Diabetics 473 Appendix E: Polycystic Ovarian Syndrome 477
Glossary 482 RecipeIndex 493 General Index 495
Foreword by FrankVinicor, MD, MPH Director, Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta, Georgia
W e are learning a lot about diabetes , especially during the past five to ten years.
This accumulation of new knowledge is both encouraging and at the same time verychallenging.
On the "challenging'' side: • Diabetes seems to be everywhere and steadily increasing in its presence.
Think about it , 1 in 3 babies born in 2000 will de velop diabetes in their lifetimes.
Every day, about 1,400 people are diagnosed with diabetes in the United States.
And now no country in the world is free from diabetes, and its growth. • We now do know how to prevent type 2 diabetes, but today for type 1 diabetes, neither prevention nor a long-lasting cure is available. • Once diabetes is present, good care based on solid science now can prevent much of the devastation formerly caused by elevated blood sugars.
But there remains a sizable gap between what we know to do and how well and widely we are doing it.
In other words, the "translation" of diabetes science into daily practice still has a way to go.
Nonetheless, in spite of these and other important challenges, we areallbetter preparedto dealwith diabetes in 2007than we were even a few years earlier, let alone decades ago.
Remarkable progress has oc curred.
For example, many people at high risk for type 2 diabetes do not develop it.
Modest weight lossand increased physical activity have been shown to eliminateor at least delay the development of this type of diabetes by 60-70 percent , regardless of race, ethnicity, or age.
In addition, for both types 1 and 2 diabetes, we now have many
viii Foreword
more effective medications which, when taken appropriately and in combination with proper nutrition and activity, will result in con trolled plasma glucose, blood pressure, and blood fats , with definite reduction in the likelihood of eye, kidney, nerve, and heart problems.
In other words,while the goals of diabetes research still in large part should be prevention or cure, even now the devastation formerly caused by this condition does nothave to happen!
Nowadays, too, we have better ways to follow and keep track of diabetes , with improved health care systems, better educational programs, less painful self-monitoring of blood sugars, more quickly available and accurate glycosylated hemoglobin levels, waysto identify kidney problemsearly, and so forth.
We canknow what is goingon!
So, in fact, we are actually seeing an improvement in diabetes care in the United States, although not with allpeople and not yet to an ad equatelevelor fast enough.
What does all this have to do with Dr.
Bernstein and this edition of Diabetes Solution7.
As mentioned earlier, the rate of accumulation of new diabetes knowledge is quite remarkable and daunting.
Yet Dr.
Bernstein stays on top of it all.
The care pattern for diabetes has be come much more complex and demanding, and Dr.
Bernstein and his approach have proved equalto the challenge.
In essence, diabetes is in many ways"lesseasy" than in the past, forthe patient or for his/her health care professional.
There are lots of nutritional approaches to consider, lots of medications to be used in varying combination, and often less time within a busy office practice to make all these wonder ful advances real and meaningful for people facing diabetes.
This newly revised edition presents the advances in diabetes thinking and management with passion, compassion, caring, and conviction.
Cer tainly, forsome people, hisapproaches are not easy!
But they do reflect evolving medicalscience aswell ashis personal experiences in manag ing his own diabetes.
He does not ask anyone to do anything that he himself would not do, and for this I have respect and admiration.
He is offering to persons challenged by the presence or risk of diabetes a way to be in charge of the disease.
And he is ensuring that important advances in diabetes scienceget out there now to make a difference in people's lives.
Take a look!
Think about the ideas and suggestions , they can further our mutual and ongoing effort to prevent, capture, and control this disease called diabetes.
Preface to the Newly Revised and Updated Edition
Since the publication of the revised edition of Dr.
Bernstein's Diabetes Solution in 2003, many new developments have oc curred in the field of diabetes research, and as each significant one has come along,I have further refinedmy techniques for normal izing blood sugars.
This newly revised and updated edition discusses new oral medications, new insulins, new dietary supplements, new hardware (tools for the diabetic), and other new products.
It also ex plores new methods that I havedeveloped for more elegantly control ling blood sugars.
Exciting new approaches to weightlosswill be found here, includ ing the use of a new, injectablemedication (an amylin analog) that is wonderfully effective for alleviating carbohydrate craving and over eating.
This newly revised and updated edition builds upon the prior two editions of this book and upon my two earlierbooks about diabetes.
It is designed asa tool for patientsto be used under the guidance oftheir physicians or diabetes educators.
It covers, in a step-by-step fashion, virtually everything that must be done to keep blood sugars in the normal range.
In these pages I attempt to present nearly everything I know about blood sugar normalization, how it can be accomplished and main tained.With this book, and with the help of your physicianor diabetes educator, I hope that you will learn to take control of your diabetes, whether it's type 1 (juvenile-onset), as mine is, or the much more common type 2 (maturity-onset) diabetes.
To my knowledge, there is no other book in print addressed strictly to blood sugar control for both types of diabetes.
x Preface to theNewlyRevisedand UpdatedEdition
This volume contains much material that may be new to many physicians treating diabetes.
It ismy hopethat doctors andhealthcare professionals will use it, learn from it, and do their best to help their patients take control of this potentially deadly but controllable disease.
Although this book contains considerable backgroundinformation on diet and nutrition, it is intended primarily as a comprehensive how-to guide to blood sugar control, including detailed instructions on techniques for painless insulin injection and so on.
It must, there fore, leave out other related issues (such as pregnancy), some of which require their own volumes.
My officetelephone number is listed sev eral times in this book, and we are always happy to hear from readers who seek our latest recommendation for a blood sugar meter, other equipment, or new medications.
I urgeyou to visittheWeb site for thisbook,www.diabetes-book.com.
The site contains some of my recent articles, a history of blood sugar self-monitoring, links to other sites, testimonials from readers who havetried the program, an opportunity to share your own experiences in an ongoingchatgroup for diabetics and theirloved ones,and more.
The site also permits you to forward information by e-mail to anyone you think could benefit from this book.
Recent news releases and advertisements have described "develop ments" and products that are not mentioned here, and you may be curious about them.
If a medication is not discussed here, then it is likely I have deliberately omitted it as either useless or potentially harmful, or it was not available when this volume was written.
There are many drugs, old and new,usedin the treatmentof diabetes.
Some, like metformin, or Glucophage, are truly wonderful, but others, such as the sulfonylureas, are insidious and can destroy your body's re maining insulin-producing capability, if it hasany.
I haveomitted any thing I think is either too far into the future to be of near-term consequence or is simply not going to be effective at getting you on track.
I have neither the time nor the space to attempt to debunk every "miracle cure" that comes along, most of which are neither miracu lous nor cures.
Should you become pregnant while on this program, of all the medications mentioned in this book, metformin, aspirin, and insulin are the only ones that have been tested in pregnant women.
Never theless, check out all your medications with your obstetrician and pharmacist , ideally beforeyou become pregnant.
Preface to the Newly Revised andUpdated Edition xi
Many thousands of diabetics have successfully used this program.
Like them, if you, with your physician's help, seriously follow these guidelines, you should be able to avoid the discomfort of inappropri atebloodsugar swings.
You may evenbe able to prevent or reverse the development of manyof the grave complications long associated with chronically high blood sugars.
Finally, much of what I will cover in this book is in direct opposi tion to the recommendations of the American Diabetes Association (ADA) andothernational diabetes associations.
Why?
Because if I had followed those guidelines, theywould have killed me long ago.
Such conflicts include the low-carbohydrate diet I recommend; the avoid ance of oral agents (such as sulfonylureas) that burn out surviving insulin-producing betacells in type 2 diabetics; my utilization of cer tain nutrients to lower insulin resistance; my preference for certain insulins over others, which I avoid; my desire to preserve remaining beta cells (an alien concept to traditional practice); andmy insistence that diabetics are entitled to the same, normal bloodsugars that non diabetics enjoy, rather than the ADA's current insistence upon higher levels.
Most important, unlike the ADA guidelines, ours work.