"Dr.
Bernstein isa truepioneer indeveloping practical approaches to controlling
a devastating disease that isgrowing at epidemic proportions in thiscountry."
—Barry Sears, PhD, author of The Zone
DR. BERNSTEIN'S
Diabetes
Solution
NEWLY REVISED
&
M' UPDATED
THE COMPLETE GUIDE
TO ACHIEVING
NORMAL BLOOD SUGARS
LkkAA
r r? "
Richard K. Bernstein, MD
Dr. Bernstein's
Diabetes Solution
Theories, no matter how pertinent,
Cannot eradicate the existence of facts.
—Jean Martin Charcot
Dedicated to the Memory of My Dear Friends
Heinz I. Lippmann, MD,
and
Samuel M. Rosen, MD,
Who fervently believed that people with diabetes are
entitled to the same blood sugars as nondiabetics
Dr. Bernstein's
Diabetes Solution
Newly Revised and Updated
The Complete Guide
to Achieving Normal Blood Sugars
Richard K. Bernstein, MD,
FACE, FACN, FCCWS
Foreword by FrankVinicor, MD, MPH
Recipesby Karen A. Weinstock and Timothy J. Aubert, CWC
m
i 837
LITTLE, BROWN AND COMPANY
New York Boston London
Copyright©1997,2003,2007 by Richard K. Bernstein, MD
Glucograf* is a registered trademarkof Richard K. Bernstein, MD
All rightsreserved. Exceptas permittedunder the U.S.CopyrightAct of 1976,
no partof this publication may be reproduced, distributed, or transmitted in
any form or by anymeans,or storedin a database or retrieval system,without
the prior written permission of the publisher.
Little, Brown and Company
Hachette Book Group
237 Park Avenue, New York, NY 10017
Visit our Web site at www.HachetteBookGroup.com
Originally published in hardcover by Little, Brown andCompany, 1997
Newly revisedand updatededition, March 2007
Little,Brown and Company is a division of Hachette Book Group, Inc.
The Little, Brown name and logo are trademarksof Hachette Book Group, Inc.
Illustrations by Terry Eppridge
Author's Note
This book is not intended as a substitute for professional medical care.
The reader should regularly consult a physician for all health-related
problems and routine care.
The author is grateful for permission to include the following previously
copyrighted material:
Figure 1-3. Reproduced from the Journal of Clinical Investigation, 1967;
46:1549-1557. By permission of The American Society for Clinical Investi
gation.
Figure 9-1. Reproduced from Journal of theAmerican Dietetic Association,
1995; 45:417-420. Copyright © by The American Dietetic Association.
Reprintedby permissionof The AmericanDietetic Association.
Figure 19-1. Reproduced from Humalog PI.Reprinted by permission of Eli
Lilly and Company.
Library ofCongress Cataloging-in-Publication Data
Bernstein, Richard K.
Dr. Bernstein's diabetes solution: the complete guide to achieving normal
blood sugars / Richard K. Bernstein; foreword by FrankVinicor; recipes by
Karen A. Weinstock and Timothy J. Aubert.— Newly rev. and updated,
p. cm.
Doctor Bernstein's diabetes solution
Diabetes solution
Includes index.
ISBN 978-0-316-16716-1
1. Diabetes— Popular works. 2. Blood sugar monitoring — Popular
works. I. Title. II. Title: Doctor Bernstein's diabetes solution. III. Tide:
Diabetes solution.
RC660.4B464 2007
616.4'62 —dc22 2006026483
10 9 8 7 6 5
RRD-VA
Printed in the United States of America
Contents
Forewordby Frank Vinicor,MD,MPH vii
Prefaceto the NewlyRevised and Updated Edition ix
MyLife with Diabetes: Well Beyond a HalfCentury and Counting xii
Acknowledgments xxi
Before and After: Fourteen Patients Share Their Experiences 3
PART ONE
Before You Start
1. Diabetes: The Basics 33
2. Tests: Baseline Measures of Your Disease and Risk Profile 52
3. Your Diabetic Tool Kit: Supplies YouWill Need and Where
to Get Them 66
4. How and When to Measure BloodSugar 75
5. Recording Blood Sugar Data: Using the Glucograf III Data Sheet 83
6. Strange Biology: Phenomena Peculiar to DiabetesThat
Can Affect BloodSugar 91
7. The Laws of Small Numbers 102
8. Establishinga Treatment Plan: The Basic Treatment Plans
and How We Structure Them 109
PART TWO
Treatment
9. The BasicFood Groups, or Much of What You've Been
Taught About Diet Is Probably Wrong 123
10. Diet Guidelines Essential to the Treatment ofAll Diabetics 138
11. Creating a Customized Meal Plan 167
12. Weight Loss — If You're Overweight 184
13. How to Curb Carbohydrate Craving or Overeating
Using Self-Hypnosis or Low-Risk Medications 196
14. UsingExercise to Enhance InsulinSensitivity 211
15. Oral Insulin-SensitizingAgents,Insulin-Mimetic Agents,
and Other Options 235
16. Insulin: The Basics of Self-Injection 249
17. Important InformationAboutVarious Insulins 264
18. SimpleInsulin Regimens 276
19. Intensive Insulin Regimens 284
20. How to Preventand CorrectLow BloodSugars 317
21. How to Cope with Dehydration, DehydratingIllness, and Infection 344
22. DelayedStomach-Emptying: Gastroparesis 357
23. Routine Follow-upVisitsto YourPhysician 381
24. What You Can Expectfrom VirtuallyNormal Blood Sugars 385
PART THREE
Your Diabetic Cookbook
25. Recipes for Low-Carbohydrate Meals 391
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.
