Q&A With Dr. Richard Bernstein

Is there anything you can do to treat hypoglycemia unawareness?

Answer: Yes, very simple: You minimize the episodes of hypoglycemia.

There are two possible causes or likely causes for hypoglycemic unawareness. One is autonomic neuropathy, which maintaining normal blood sugars for a long period of time can reverse.

The other is frequent hypoglycemic episodes. Whenever you’re hypoglycemic, hopefully, you’re making epinephrine which is one of the mediators that raises blood sugar and also gives you the hypoglycemic tremors, and dry mouth, and so on.

However, the epinephrine down regulates* its own receptors, If you have hypoglycemia often enough, you’ll have down regulated the epinephrine receptors and they will no longer produce the signals–the tremors, racing heart and so on–that would normally warn you of hypoglycemia.

So the trick is to cut back on the episodes.

(* Down regulation is when the number of drug or chemical receptors on a cell surface decrease, usually from long-term exposure to the agents acting upon them.)

What’s your recommendation for the best colon preparation that will not affect blood sugars to use before a colonoscopy?

Answer: There are two problems here. One is what you eat during the previous 24 hours. The other is what colon prep solution you use.

What you eat should be very low in carbohydrates. They usually tell you to intake liquids, such as Jello and soup, and similar foods. What I tell my patients is you want a zero-carbohydrate soup like chicken broth. If they tell you to eat Jello, it should be sugar-free and conain no maltodextrin.

Also, the prep they give you should not be sweetened. How do you check the prep? You can look at the contents in the package insert. You don’t want a prep that has sorbitol in it because that’s a sugar, and will raise blood sugar. You also don’t want a prep that has any known sugar in it, such as sucrose, dextrose, or glucose.

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 will give you more information about his publications. To sign up for his free monthly tele-seminars, visit

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