Q&A With Dr. Richard Bernstein
Is it important to determine the exact type of diabetes you have if you’re already on insulin and maintaining very good blood sugar control, and if so, why?
Answer: I would say that the main reason would be to know if you have a substantial percentage of your beta cells remaining. If you’re a type 2 or a very mild type 1 and are making insulin, you want to preserve those beta cells because it’s so much easier to treat diabetes if you’re making insulin.
By the way, I see this every day: the people who are making insulin are a breeze to treat, and there’s no excuse for them not having round-the-clock normal blood sugars, even if they have gastroparesis. However, if you’re not making insulin, it’s a much harder job to treat your diabetes. So, it pays to know if you’re making insulin so that you can preserve your beta cells.
On the other hand diabetes has a spectrum of severity for both type 1 and type 2 so giving it a special name really doesn’t tell you where you are on the spectrum. The disease should be treated based on blood sugars, not based on a name.
What do you consider to be the most important tests that you order or routinely perform on diabetic patients?
1. Multiple daily blood glucose (BG) measurements.
2. Hemoglobin A1c every few months as a double check on accuracy of BG records. This is especially necessary for patients who do not awaken in the middle of the night to check BG. It is also a check on the accuracy of your BG meter.
3. Free T-3 (serum liothronine), as nearly 100 percent of diabetics are hypothyroid and this is the most important thyroid test.
4. R-R interval study every 1.5 years. This is a test for autonomic neuropathy. It is a reproducible quantitative measure. It gets better when BG’s are normal for extended periods and worse when they are elevated. It therefore is the gold standard for determining if we are winning the battle against diabetic complications.
It is also the gold standard for diagnosing diabetic gastroparesis (unpredictable stomach emptying). It therefore should be performed on new patients before negotiating a meal plan as people with gastroparesis may require special foods or medications in order to achieve predictable blood sugars.
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
