How do you work with patients who are happy to achieve an A1c of 6%, even though you know that is too high to reverse diabetes complications?
Answer: We let everyone know in advance what our goals are. We try to discourage people from wasting their time and money if they are not interested in normal blood sugars.
Does it really matter where blood is obtained, such as the arm, fingers, or buttocks, for blood glucose testing?
Answer: Yes, it does matter. The fingers lag behind the central blood sugar that you’d get if you puncture a vein. The arms and legs, and even parts of the hand lag behind the fingers by about 20 minutes. If your blood sugar is steady, it doesn’t matter where on the body you make the puncture. But, if your blood sugar is dropping, or increasing rapidly, it will make a difference.
How do you–or do you–track the degree of beta cell loss over time in a type 2?
Answer: Usually, if anything, we get beta cell recovery. If I have a person who has not been able to control overeating, I just notice from A1cs climbing up, that we have to use more medication. So I haven’t deliberately for research purposes been trying to track what happens to beta cell function. If they are taking insulin, and we see that their insulin doses are dropping, we know they are getting beta cell recovery. If their insulin doses are going up, without known causes we assume they are getting beta cell loss. I haven’t tried to do any special measurements.
Richard K. Bernstein, MD is one of the most knowledgeable, committed, and successful pioneers in the field of diabetes today. He invented blood sugar self-monitoring and basal/bolus insulin dosing when he was an engineer.
Dr. Bernstein is Director Emeritus of the Peripheral Vascular Disease Clinic of the Albert Einstein College of Medicine in Bronx, NY. His private medical practice in Mamaroneck, NY, specializes in treating diabetes and obesity.
He is a physician, research scientist, thriving type 1 for 67 years, and best-selling author of nine diabetes books including Diabetes Solution, The Diabetes Diet and several e-books. This link diabetes-book.com will give you more information about his publications. To sign up for his free monthly tele-seminars, visit askdrbernstein.net