Mark Wade, MD, is one of many physicians with diabetes.
He is board certified inpediatric medicine.
His lovely wife notlong ago gave birth to their third child.
His story has a number ofparallels with my own. "Dr.
Bernstein's program turned my life around.
Prior to meeting Dick Bernstein at age thirty-four, I had spent twenty-two years of my fife as what I then considered a well-controlled insulin-dependent, juvenile-onset diabetic.
I'd never been hospitalized for ketoacidosis [a serious condition caused by high blood sugar in combination with dehydration] or severe hypoglycemia, hadwhatI considered good cir culation and nerve function, exercised daily, and ate pretty much what ever I felt like eating. "However,cuts and lacerations took months or years to heal instead of days, andalways leftugly scars.
Once ortwice each year, I would de velop pneumonia that typically lasted four months andhad me, with out fail, out of school or work for two and a half months per episode.
My mood swings went from kind andlovable to short-tempered, hot headed, and uncaring fourto five times daily, congruent with my rou tine blood sugar swings from high blood sugars (300 to 500) after mealsto hypoglycemia (less than 50)beforemeals.
This Dr.
Jekyll/Mr.
Hyde personality made me very unpredictable and unpleasant to be around, and came closeto causing me to lose my wife and the close nessof family and friends.
I was forced to eat my meals at exactly the same times each dayin order to avoid life-threatening episodes of low blood sugar.
Even so, I had to adjust my life aroundthe inevitable pe riods of hypoglycemia.
If I didn't eat, my life was in trouble, and un fortunately so werethe people who had to interactwith me when I was hypoglycemic.
Most of the times those werethe ones I loved most. "My trainingasa physician, asan intern and resident, averaging 110 hours a week of work, was at times a nightmare, though I did it, trying to balance rounds, clinics, emergencyroom and ICU schedules, screen-
Before andAfter 29
ing patients, long hours of reading, and an unreal demand on physical tolerance, emotionalstability, andconsistency that almostdrove me to the breaking point.
My mission was to be an excellent doctor, and I was, with a calm, cooldemeanor whichI presented externally.
But in side I was a mess, and my interactions with my loved ones and close friends were horrible.
I was an avid basketball player, jogger, and weight lifter, but despite doing these activities daily, I found my perfor mance and endurance were usually modulated by my blood sugar , and was never really sure whether I would be able to perform for 10 minutes or 2 hours.
In addition, despite my high level of exercise, 1to \Vihours daily for twelve years, I was never able to develop a muscu lar or athletic body type, eventhough I worked hardat it. "I was always extremely conscientious about testing andexercising andeating anddoctor visits, to the pointthatmy friends thoughtI was neurotic.
I wasconsistently following the conventional guidelines rec ommended to diabetics, and I thought I was a rather model patient.
The problems that I described above, I had been led to believe, were a natural part of life for adiabetic.
No oneshowed me that my lifecould be better, that I could control my diabetes rather than let my diabetes control me,thatwith recognition of a few principles thatare really just common sense, a few extra finger sticks and a few extrainjections and better control of my dietary intake , I could be in charge for real! "Nine years ago, I met Dick Bernstein.
Dr.
Bernstein not only gave me the most complete, comprehensive, logical, reasonable, and infor mative teaching on diabetes that I have ever encountered, but his uniquely expert and comprehensive physical examination and testing illuminated for me the most accurate picture of my overall health and the subtle tolls thatthe previous management of my diabetes hadper mitted.
Then with a personalized, comprehensive, tightly controlled but reasonable diet, exercise, and a blood sugar-monitoring plan, he put me in control of my diabetes for the first time.
Sure, the diet plan, finger sticks, and 5 to 8 painless insulin injections a day for my pro gram require a high degree of discipline and self-control, but it's doable, it works, and this comparatively small sacrifice brings me the freedom of lifestyle, quality of life, and longevity thatnondiabetics take for granted. "The results have been as follows: I can eat or fast whenever I choose.
I plan my day around my activities rather than around my meals, have the ability to be much more flexible in my schedule and participation in activities, and now have the ability to adjust my
30 Beforeand After
daily activities easily to accommodate 'emergencies' or suddenchanges in schedule, activities and adjustments that nondiabetics take for granted. Best of all, the wild mood swings have been eliminated and I'm sick much less often and lessseriously."
All of these people have been patients of mine and have seen wonderful improvements in their health.
Ifyou're curious about howpeople have fared using the prior two editions ofthis book, I urge you to look at the testimonials on the Web site for this book at www.diabetes-book.com/ testimonials/testimonials.shtml and those in reader reviews of the prior editions on www.amazon.com to see similar reactions from people who have tried the program but have never been under my direct care.
For somereason, readers in the United Kingdom presentmore com plete and more impassioned reviews.
Many of these can be seen at www.amazon.co.uk.
It is wellworth a visit.
These people havebeen suc cessful in spite of the major obstacles imposed by their National Health Service.
PART ONE
Before You Start
Diabetes THE BASICS
Diabetes is so common in this country that it touches nearly everyone's fife , or will.
The statistics on diabetes are stag gering, and a diagnosis can be frightening: diabetes is the third leading cause of death in the United States.
According to the most recent statistics compiled by the National Institutes of Health (NIH), as of 2005, a staggering 7 percent of the U.S. population, or nearly 21 million people, have diabetes, with 14.6 million diagnosed and6.2 millionwho have not yetbeendiagnosed.
This number willno doubt increase.
Most death certificates of diabetics do not fist diabetes as the underlying cause of their heart attacks, strokes, or fatal infec tions.
If it were included, it mightwell be the leading cause of death in the United States.
Recent reports predict that 95 percent of people borntoday in the United States will eventually develop diabetes.
Even more alarming, the incidence of type 2 , or what was once known as maturity-onset diabetes , among children eighteen years old and younger has skyrocketed.
A Yale University study of obese children between ages four and eighteen appeared in the March 14, 2002, issue of the New England Journal ofMedicine.
The study found that nearly a quarter had a condition that's often a precursor to dia betes.
According to USA Today's story on the report the same day, "The incidence of type 2 diabetes, the form that usually occurs in adults, has increased in young people, especially Hispanics, blacks, andNative Americans.
Some regional studies suggest the incidence of type2 in children has jumped from less than 5%, before 1994, to up to 50%." That children are increasingly getting a disease that once tar geted fifty- to sixty-year-olds presents anewand frightening potential public health disaster.
34 BeforeYou Start
Each year, tens of thousands of Americans lose their eyesight be cause of diabetes, the leading cause of new blindness for people ages twenty-five to seventy-four.
Ninety-five percent of diabetics have type2 diabetes.
Because 80 percent of type2 diabetics are overweight, manyinappropriately feel thatthedisease istheir own fault, the result of some failure of character.
Since you are reading this book, you or a loved one mayhave been diagnosed recently withdiabetes.
Perhaps youhave long-standing di abetes and are not satisfied with treatment that has left you plagued with complications such as encroaching blindness, foot pain, frozen shoulder, inabilityto achieve or maintain a penileerection, restrictive lung disease, hip andleg pain, or heart or kidney disease.
Although diabetes is still an incurable, chronic disease, it is very treatable, and the long-term "complications" are fully preventable.
For more than sixtyyears, I'vehadtype 1diabetes, also called juvenile- onset or insulin-dependent diabetes mellitus (IDDM).
This form of diabetes is generally far more serious than type 2, or non-insulin- dependent diabetes mellitus (NIDDM), although both have the po tential to be fatal.* Most type 1 diabetics who were diagnosed back about the same time I was are now dead from one or more of the seri ous complications of the disease.
Yet after living with diabetes for more than sixty years, instead of being bedridden or out sick from work (or dead, the most likely scenario), I am more fit than many nondiabetics who are considerably younger than 1.1 regularly work 12-hour days, travel, sail, and pursue a vigorous exercise routine.
I am not special in this regard.
If I can take control of my disease, you can take control of yours.
In the next several pages I'll give you a general overviewof diabetes, how the body's system for controlling blood sugar (glucose) works in the nondiabetic, and how it works , and doesn't work , for diabet-
Fora period of time,manypeople considered the designations type 1 and type 2 out of date, replacing them with the terms IDDM and NIDDM, which are slighdy misleading and are losingcredence.
While it is true that most of those with type 2 can stay alive without injecting insulin, many patients who suffer from type 2, or so-called NIDDM,do inject insulin to preservetheir health.
The terms "autoimmune diabetes" for type 1and "insulin-resistantdiabetes"for type 2 are more precise, but are unlikely to take overfor the much-easier-to-say type 1 and type 2.
The situation is further complicated by the recent discovery that most type 2 diabetesalso has an autoimmune component.
Diabetes: TheBasics 35
ics.
In subsequent chapters we'll discuss diet,exercise, and medication, and how you can use them to controlyour diabetes.
If discussion of diet and exercise sounds like "the same old thing" you've heard again and again, read on, because you'll find that what I've observed is al most exactly theopposite of"the same oldthing," which iswhat you've probably been taught.
The tricks you'll learn can help you arrest the diabetic complications you may now be suffering, may reverse many of them, andshould prevent theonset of new ones.
We'll also explore new medical treatments andnew drugs thatare now available to help manage bloodsugar levels and curtail obesity.
THE BODY IN AND OPT OF BALANCE
Diabetes is the breakdown or partial breakdown of one of the more important of the body's autonomic(self-regulating) mechanisms, and its breakdown throws many other self-regulating systems into imbal ance. Thereisprobably not a tissue in the bodythat escapes the effects of the high blood sugars of diabetes. People with high blood sugars tend to have osteoporosis, or fragile bones; they tend to have tight skin; they tendto have inflammation andtightness at theirjoints; they tend to have many other complications that affect every part of their body, including the brain, with impaired short-term memory and even depression.