Thomas G.
Watkins is aforty-year-old journalist.
His diabetes was diag nosed twenty-three years ago.
For the past nine years he's been following one ofthe treatment protocob described in this book for people who re quire insulin. "Following the instructions of several diabetologists over a period of years, I hadthe illness 'under control' At least that's what theytold me.
After all, I was taking two shots a day, and adjusting my insulin doses depending on urine testresults, and later on blood sugar mea surements.
I was also following the common recommendation that carbohydrates fill at least 60 percent of my caloric intake. "But something was not right; my life was not 'relatively normal' enough.
I was avoiding heavy exercise for fear of my bloodsugar drop ping too low.
My meal schedulewas inflexible.
I still had to eat break fast, lunch, and dinner even when I wasn't hungry.
Aware that recent research seemed to associate highblood sugars with an increased risk of long-term complications, I tried to keep blood sugars normal,but wound up seesawing daily between lows and highs.
By the end of
4 Before andAfter
1986,1had ballooned to 189 pounds and was at a loss for how to lose weight.
My'good control' regimen had left me feeling out of control.
Clearly, something had to be done. "In that year, I attended a meeting of medical writers at which Dr.
Bernstein spoke.
It became clear that his credentials were impressive.
He himself at that time had lived with the disease for four decades and was nearly free of complications.
His approach had been formulated largely through self-experimentation.
His knowledge of the medical literature was encyclopedic.
Some of his proposals were heretical; he attacked the usual dietary recommendation and challenged dogma surrounding such basics as how insulin ought to be injected.
But it seemed likehewas doing something right.
During histalk, I hadto use the bathroom twice; he didn't.* "I decided to spend aday athisoffice to gather material for anarti cle to be published intheMedical Tribune.
There, hisindependence of thought became clear. 'Brittle' diabetes [entailing anendless sequence of wide blood sugar fluctuations] was a misnomer that usually indi cated an inadequate treatment plan or poor training, more than any inherent physical deficit, he said.
Normal blood sugars round-the- clock were not just an elusive goal but were frequently achievable, if the diabetic hadbeentaught the proper techniques.
Beyond treatment goals, he armed his patients with straightforward methods to attain them.
His secret: small doses of medication resulted in small mistakes that were easilycorrectable. "Bythen, my interest had become more personal than journalistic.
In early 1987, still wary, I decided to give it atry.
The first thingI no ticedwas that this doctor visitwas unlikeanyprevious ones.Most had lasted about 15 minutes.
This took 8 hours.
Others said I had no com plications; Dr.
Bernstein found several.
Most said my blood sugars were just fine; Dr.
Bernstein recommended I make changes to flatten them out and to lower my weight.
Those hours were spent detailing the intricacies involved in controlling blood sugar.
His whole ap proach blasted thetheory espoused bymy first doctor , thatI should depend on him to dole out whatever information I needed.
Dr.
Bern stein made it clear that for diabetics to control their disease they needed to know as much as their doctors did about the disease.
Very highbloodsugars cause frequent urination.
Beforeand After 5
"Two arguments commonly rendered against tight-control regi mens arethat they increase the incidence oflow blood sugar reactions and that they cause subjects to gain weight.
I have found the opposite to be true: I shed about 9 pounds within four months after my first visit,and, years later, I have kept them off.
And once the guesswork of how much to inject was replaced by simple calculations, my blood sugarlevelsbecame more predictable. "For the first time since I was diagnosed, I felt truly in control.
I no longer am at the mercy of wide mood swings thatmirror wideswings in blood sugar.
Though I remain dependent on insulin and all the paraphernalia that accompany its use, I feel more independent than ever.
I am comfortable traveling to isolated areas of the world, spend ing an hour scuba diving, or hiking in the wilderness, without fear of beingsidetracked by diabetes.
Now if I feel like skipping breakfast, or lunch, or dinner, I do so without hesitation. "I no longer have delayed stomach-emptying, which can cause very lowblood sugars right after ameal followed byhigh blood sugars many hours later.
My cardiac neuropathy, which is associated with an in creased risk for early death, has reversed.
Though I eat more fat and protein than before,my blood lipidshaveimproved and are now well within normal ranges.
My glycosylated hemoglobin measurements, used bylife insurance companies to detect diabetics among applicants, would no longer give me away.
Mostimportant, I now feel well. "Many doctors will not embrace Dr.
Bernstein's work, for the sim ple reason thatDr.
Bernstein demands acommitment of time, energy, andknowledge not only from patients, but from physicians.
Diabetics are the bread and butter of many practices.
For decades, the usual treatment scenario hasbeen ablood test,a short interview, a prescrip tion for a one-month supply of needles, a handshake, and a bill.
But thatis changing.
In the past few years, evidence has been amassing in support of Dr.
Bernstein's modusoperandi.
No longer isthe oldhigh- carbohydrate diet unquestioned; more and more doctors are espous ing a multiple-shot regimen controlled by the patients themselves.
Most important, though, tight control is being associated with fewer of the diabetic complications that can ravage every major organ sys tem in the body.
Dr.
Bernstein's scheme provided me with the tools not onlyto obtain normal bloodsugars, but to regain a feeling of con trol I had not had sincebefore I was diagnosed."
6 Before and After
Frank Purcell isa seventy-six-year-old retiree who, like many ofmy mar ried patients, works closely with his wife to keep his diabetes on track.
Eileen, who goes by the nickname Ike, tells the first part ofhis story.
Ike: "Frank had been treated for many years for diabetes, and had beentreated orally because he was atype 2.As far as we were aware, he had a functioning pancreas.
The thing was, as a younger man, he'd been told that he had high blood sugar, but it was ignored.
This was going back to hisarmy days, in 1953 or so.
No onesuggested medica tion, no one called it diabetes, and nothing more was done.
They just said he had high blood sugar.
They called it 'chemical' diabetes.
It showed up on bloodtests, but not on urinalysis.
I guess in thosedays, having it show up on a urinalysis was some sort of determinant.
He did modify his diet, he stopped eating so much candy, andhe took off weight , he lostabout 30 pounds in those days. "In about 1983, Frank had a mild heart attack.
He began to see a cardiologist, who has been monitoring his health care very carefully since then.
For about two to three years, he took beta blockers and maybe one or two heart medications.
As far as we could tell, his heart problems were verymuchin resolution , I mean he'dhadaheart at tack, he'd had no surgery, and seemed to be doing okay.
But when he started working with the cardiologist, the doctor notedthathisblood sugar thing was ongoing, and he began to feel it was of concern.
He prescribed Diabinese, which was the oral medication of choice of the time, I guess, and he monitored Frank's blood sugar about every four months. "I mightsay thatI never even knewwhat anormal bloodsugar was.
No one ever talked about it.
I had no idea whether it was 1,000 or 12.
The onlything wewere ever toldwas thatit was high or wasn't high.
This went on and on forcloseto sevenor eightyears.
If he had seen Dr.
Bernstein back then, who knows what could have been different?
But eventually, the cardiologist said he thought Frank ought to see an en docrinologist.
He didn't feel hewas able to control Frank's blood sugar well enough himself with medication, and so he felt the condition warranted closer attention. "Wewent to see a gentleman who was chiefof the diabetes clinic at a major hospital here in upstate New York, where welive.
Now, this is averywell thoughtof medical facility.
The doctor met with us,andhe kept Frank on the Diabinese, and monitored him every three months or so.
Hisblood sugars were 253,240, andhe would say, 'Let's try an other pill.' It was always medication.
Glyburide, Glucophage , the
Before and After 7
whole bit.
But trying to gethis blood sugar down wasvery difficult.No one evermentioned diet, really.
And rarely wasit everbelow 200when we went in.
Rarely.
When I finally found out what the numbers meant, I said to the doctor, 'Don't you think we ought to see a dietitian?
I mean,we'reeatingthe same foodwe always have.'We wereon the nor mal diet that anybody'son.
I had friends who are diabetics who watch certain things that they eat,and so I thought it made a certain amount of sense.
He said, 'Sure.
That's a really goodidea.' "He gave us the name of a young woman, and we saw her three times.
She said, 'Eat eleven carbohydrates every day,' and she gave us the food pyramid , we didn't need her for that , and nothing changed, except Frank stopped eating dessert.
He would have the oc casional bowl of ice cream, or a piece of cake when he felt like it, or a cookie.
I always bought the newest foods that came out , low- fat, low-sugar.
I was more concerned about fat during that stage, as I recall. "This went on until God intervened.
I mean that.
What happened was, Frank had anattack of serious hypoglycemia [low blood sugar].
No one had warned us that this could happen.
No one had told us what hypoglycemia looked like.
I thought it was a stroke.
He was out of hishead.
He couldn't answer questions.
The only thing that gave me some smidgen of doubt was that he got up and walked to the bath room and put on histrousers.
I called 911.
When the medic gothere, hehooked him up to some glucose, puthim onagurney and trundled him out of here, and headed for the medical center.
In the middle of the ride, Frank woke up and said, 'What the hell am I doing here?' The young man said he certainly seemed to be coming out of his stroke well.
Bythetimewegot to thehospital, hewas virtually himself.When they decided to do a finger stick, his blood sugar was 26, 26 mg/dl.
I didn't have the education in diabetes that I've gotten with Dr.
Bern stein, but I knewenough to knowthat this was not good.
Who knows what it wasbeforehe got the intravenous? "Now, we'll never know if he accidentally took his oral medication twice thenightbefore , it's very possible , but I tell you, however it happened, it was the Lord who was watching over Frank and said, 'Now it's time todo something.' As scary as itwas, itwas also ablessing. "I have a doctor friend who's a close colleague of Dick Bernstein's.
My friend had had an uncle who'd beenveryill with diabetes and its complications, but hislife hadbeen prolonged in a much more com fortable fashion by Dick Bernstein.
I would talk to my friend about
8 Beforeand After