Type one on Dr. Bernstein diet

I am 76 y/o type one, trying to regulate my low carb diet
30 mg carb per day, like Dr. Bernstein; apparently gastroparesis is causing me problems.

that’s a really low daily carb intake, I’d lose my mind but that’s just me. what are you doing for basal insulin? when do you bolus for your carbs? the trick with delayed stomach emptying is guessing when the carbs get absorbed but at 30g/day total…you are probably just using basal insulin without any bolus? do you pump?

Hi; I do not pump. On this diet you do use much less insulin in general; instead of carbs you eat more protein; the low carb diet helps your cholesterol, and causes loss of excess weight.I still need basal and bolus insulin. Surprisingly, much of the bolus is needed to cover the protein because about 1/3 of protein grams are converted to glucose. I have to actually FOLLOW the diet, which I wasn’t doing for years. My last 3 aic’s were 5.8.and my test results are much more predictable, though not at all perfect. You could try it: Dr. Bernstein’s Diabetes Solution by Richard K Bernstein.

that’s an awesome a1c Rich. nice work.

I was diagnosed 7 years ago at age 56 and, after seeing a couple of completely clueless endos, I decided to spend the money and see Dr. Bernstein himself. Best money I ever spent. Since then I have more or less followed his diet, and my A1c has always been in the 5’s. When I saw him, he was somewhat anti-pump and anti-CGM, but I got both anyway, and they have made a world of difference to my quality of life.

I did not have gastroparesis, but I remember him telling me that certain things, including that, could get better over time as you followed his plan. So Rich, maybe that will happen for you.

Did I understand someone found this to be reversible?: I have had T1D for 47 years and have been fortunate enough and worked diligently enough to have made it this far with relatively good health. Now, at 57, I’m experiencing digestive problems which are also causing my bsg to be far less predictable at times. I have suspected that I’ve got early gastroparesis caused by mild neuropathy. My biggest fear is the worsening progression. I am an avid veggie/fiber eater, also have included Kombucha, kimchee (fermented foods) and the like in my diet and now take Linzess all to help my digestive system wake-up. My A1c’s are all between 5.9 and 6.9) I exercise 5-6 times a week. I did expect some complications, but delayed stomach emptying and resulting bsg predictability was not one. Any additional knowledge or helpful suggestions would be appreciated.

I don’t have personal experience with gastroparesis, but I do recall that Dr. B claimed it could improve if you followed his plan. There might be more about it in his Diabetes Solution book.

Hi Chickadee; why don’t you just get his book Dr. Bernstein’s DIABETES SOLUTION 4th edition; He has a whole chapter on gastroparesis; on his monthly seminar he says most of us that have gone about 15 years without perfect blood sugars will have it, and it took him about 13 years to get rid of his own gastroparesis.! you can diagnose it with a simple test done with an ekg machine, and get the test yearly to see if it is getting better or worse; Dr. Bernstein says the pump will eventually cause scarring in your injection sites(not good) and the cgm is not accurate enough.

Hi annsquire; I am jealous that you actually went to see Dr. Bernstein. He is now 81 years old, and I am 76 yrs old. He wants your blood sugar to be about 83, maybe 70 to 90 before during and after meals, all night, all the time with an aic in the 4’s; naturally the Amer Diabetes Assoc, does not recommend this, and with my gastroparesis I have never gotten below 5.8. For decades I was not careful enough about the diet (like all of us) but now I know I have better chance of staying alive if I mostly behave. I am also a retired internist.

Good luck with getting those readings! “maybe 70 to 90 before during and after meals, all night, all the time with an aic in the 4’s;” I was diagnosed with T1 in 1970 and I rarely if ever had such readings. Actually, with a 70 I’d feel hypo for sure, and as for the A1C, I can’t have it done because of a blood cell disorder called spherocytosis, which requires a fructosamine test instead. I searched this board and could find nothing on this. Why? Is it that uncommon? I’m upset because for too many years, doctors would prescribe the A1C and when my readings came in on the low side, I was congratulated for having great control! I protested that my glucose tests weren’t so great, but the A1C seemed to take precedence. I wonder what Dr. Bernstein would say about spherocytosis-affected T1D?

Hereditary spherocytosis I think is a rather rare inherited abnormality of the red blood cells, right? The hbaic is a test of glucose that is stuck to the hemoglobin inside your red blood cells; normally red blood cells only live 3 months (you keep making new ones) That’s why the test reflects how high your blood sugar has been in past 2-3 months. Your condition I believe, does not affect diabetes, it just makes the hbaic test inaccurate. Does that sound correct. I am having a hell of a time controlling my b.s.lately like everyone else. I have a bad tooth and that can screw up sugar control. Dentist appt not till week after next! also can not really control my freeking APPETITE. RICH

YES! , my blood sugar control has improved again. I think the ROOT CANAL on my bad tooth helped my blood sugars. The only problem is that I just saw my endo, and he thinks I am in danger of lows. Most endocrinologists do not like Dr. Bernstein. He asked me if I would like to apply for a CGM. I said yes, but he has to apply for it first, and I doubt I will qualify.
I have bought a new copy of Dr. Bernstein’s book, and when it comes I will send it to my doctor so He can understand what it is all about before he takes such a strong stand against low carb diet and Dr. Bernstein.

Hi Rich,

Did you have any luck getting your Endo to read Dr. Bernstein’s book?
Both of my Endo’s over the last 19 years would look at me like I was crazy if I mentioned his name. Neither acknowledged him or ever read hist book, or would ever. Maybe it’s some sort of control freak thing or the well known “God Complex” of many doctors.
In the end, I left both of them for a D.O. who works with me on my personal treatment plan that is based on Dr. Bernstein. She thinks I’m doing right by myself and should just keep-on, Keeping-on since my numbers are so good and my health is excellent.
My last A1c was 5.2 but I will be in the 4’s with my next A1C test. That is, according to my bg meter readings. Low carb is the way to go for us Type 1’s. I’ve been at it for the last 19.5 years and have never had a complication or an emergency situation I could not handle myself. Never been admitted to a hospital or emergency room for diabetes related issues.
Come to think of it, never been admitted for anything since being diagnosed. Type 1 sure does make you walk the straight and narrow.


Could you please tell me how you can achieve your levels without hypos? We are following Dr. Bernstein but are finding it risky. My son has type 1 and as on as he goes for a walk whilst in Bg range, his levels begin to drop rapidly. We can’t allow him to do much whilst he has a bolus on board. How do you avoid hypos??

Hi Elky,

I do have hypos occasionally but they are mild and I’ve learned to be ready with glucose tablets. I take them wherever I go.
Question is: How much of a bolus is he getting? That might explain his rapidly dropping BG. Remember what Dr. Bernstein says: Small numbers make small mistakes. When I’ve taken a bolus, it is only when I’m eating or to make a small correction. And usually my corrections are in the 1/2 to 1 unit range which will rarely make for a quick drop in BG.
How old is your son and what is his diet like. It’s very important, I’ve found, to try to stick to Dr Bernstein’s diet recommendations.
Low carb and small portions. After a while you might develop a pattern that’s easy to follow. Every person has to find their own way and make small adjustments as you go.

Thank you for your reply. My almost 18 yr old son is studying for his HSC this year (I think it’s like the SATs) so he is usually sedentary. However, he needs 2 units of insulin for the start of any meal for carbs followed by a second bolus of approx 2 units for protein about 40 minutes later. The trouble is, if he goes for a walk or is active in any way while there is a bolus, he drops fast. If he sits doing study, no problem. We have been following dr Bernstein’s diet since November last year and we are still trying to get the doses and timing right thanks to stress hormones that keep interfering due to frequent exams. He carries glucose also. Could you please tell me your bolus amounts for your meals and their timing? Also, how do you prepare yourself for exercise? Do you ensure your blood glucose is high first, what do you eat and what amount of insulin should you have on board? Currently, my husband stays up all night to check his blood glucose levels and makes adjustments. Each night requires a different treatment for high or low, too inconsistent! We would like to get it under control like you. Well done by the way!!

If your son is “within range” when leaving the house, I’d suggest he eat a glucose tab before taking his walk. This will prevent him going low. He should carry the tabs with him, just in case. And about 15-30 minutes after the walk, check his BG. He may need another tab. Just my thoughts.

I am T1. I do not follow Bernstein, nor do I count carbs. I do restrict carbs by food type, which is good enough to for me. I basal inject but usually (!!!) do not need to bolus.

I do not eat pasta, rice or starch veggie of any type. Ever.

I limit fruit, grain and legumes to maybe 1-2 single servings per week. Meaning 3/4 cup of berries. Or 1 slice of bread or 1 lower carb flat wrap. I had legumes, peanut butter, about 4-6 weeks ago in 4 ingredient cookies and not since. I had a 3/4 cup of raspberries maybe 2 weeks ago.

If I eat a restricted carb diet and don’t have to count the non-starch veggies that I eat in super abundant amounts every single day. I do eat meat, eggs, tree nuts, olives and olive oil and seeds a lot. Just a thought.

Hi Vhm1; Sounds like you are working hard on your program; how is it working for you; You have a good AIC? Do you recommend your program to others like me?

Richard, I am doing quite fine, I think.

Last week my AC1 was 5.5. Three months before it was 5.8. My AC1 typically runs in the mid to higher 5’s.

I have Dr. Bernstein’s book and enjoyed reading it. I have watched his YouTube videos on line and read blogs and articles about his plan. I just choose to kind of do my ‘own thing’ and it seems so far to be working for me. Hopefully it will continue.

Note I typically engage in modest exercise too, walking 3-6 miles most days. I also make sure to get adequate sleep most days, for me meaning 8-9 hours. Getting up to early or oversleeping more than 1/2 an hour can cause wonky numbers for a few hours.

Take Care!