Thomas G. Watkins is a forty-year-old journalist. His diabetes was diagnosed twenty-three years ago. For the past nine years he’s been following one of the treatment protocols described in this book for people who require insulin.
“Following the instructions of several diabetologists over a period of years, I had the illness ‘under control.’ At least that’s what they told me. After all, I was taking two shots a day, and adjusting my insulin doses depending on urine test results, and later on blood sugar measurements. 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 blood sugar dropping too low. My meal schedule was inflexible. I still had to eat breakfast, lunch, and dinner even when I wasn’t hungry. Aware that recent research seemed to associate high blood 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 1986, I had 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 like he was doing something right. During his talk, I had to use the bathroom twice; he didn’t.
“I decided to spend a day at his office to gather material for an article to be published in the Medical Tribune. There, his independence of thought became clear. ‘Brittle’ diabetes [entailing an endless sequence of wide blood sugar fluctuations] was a misnomer that usually indicated 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 had been taught 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 easily correctable.
“By then, my interest had become more personal than journalistic. In early 1987, still wary, I decided to give it a try. The first thing I noticed was that this doctor visit was unlike any previous ones. Most had lasted about 15 minutes. This took 8 hours. Others said I had no complications; 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 approach blasted the theory espoused by my first doctor—that I should depend on him to dole out whatever information I needed. Dr. Bernstein made it clear that for diabetics to control their disease they needed to know as much as their doctors did about the disease.
“Two arguments commonly rendered against tight-control regimens are that they increase the incidence of low 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 sugar levels became 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 that mirror wide swings 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, spending an hour scuba diving, or hiking in the wilderness, without fear of being sidetracked 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 low blood sugars right after a meal followed by high blood sugars many hours later. My cardiac neuropathy, which is associated with an increased risk for early death, has reversed. Though I eat more fat and protein than before, my blood lipids have improved and are now well within normal ranges. My glycosylated hemoglobin measurements, used by life insurance companies to detect diabetics among applicants, would no longer give me away. Most important, I now feel well.
“Many doctors will not embrace Dr. Bernstein’s work, for the simple reason that Dr. Bernstein demands a commitment of time, energy, and knowledge not only from patients, but from physicians. Diabetics are the bread and butter of many practices. For decades, the usual treatment scenario has been a blood test, a short interview, a prescription for a one-month supply of needles, a handshake, and a bill. But that is changing. In the past few years, evidence has been amassing in support of Dr. Bernstein’s modus operandi. No longer is the old high-carbohydrate diet unquestioned; more and more doctors are espousing 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 system in the body. Dr. Bernstein’s scheme provided me with the tools not only to obtain normal blood sugars, but to regain a feeling of control I had not had since before I was diagnosed.”
