Teleseminar 59: December 2020. 0:00:00 - Hello, Dec 2020 Teleseminar. Last one of the year. 0:00:12 - ARTICLE: Before we go through questions. I want to cover one article that came out in the past month. Found in the journal Diabetes. It is another one of these articles that shows damage to the brain caused by elevated BGLs. These articles are appearing at the rate of 1 or 2, per month. Each appears to be dealing with a different aspect of brain damage. This particular one looked at people who have had T1D for an average of 21 years. The average age of cohort was 36 years. Their brains were imaged with a special form of MRI and compared with that of non-D matched for age, sex, etc. The T1D had changes not found in the non-D. Interestingly, these changes were not related to impaired blood flow, they were strictly neurologic changes (i.e., neuropathies of the brain). Summary: No cerebral blood flow differences between groups was found in any of the structures that were examined. This suggests nonvascular ideologies (causes) of these changes. Findings implicate a marked non-vascular disruption in T1D of several essential neural modes engaged in both cognitive (thinking) and motor (movement) processing. So, control of motion e.g., balance, touching your nose with your finger, etc. Here we have the ADA, and most endocrinologists, still claiming that if kids have normal BGL and LC diets their brains will not develop. We see what is happening with people who are not on our regimen. Article: Structural Alterations in Deep Brain Structures in Type 1 Diabetes. Diabetes 2020 Nov; 69(11): 2458-2466.doi.org/10.2337/db19-1100
0:03:18 - WARNING. Before answering Q, a reminder that answers are strictly generic. They are earmarked for the entire listening audience. They may not really solve the problem of the individual. Recent experience for Dr B. A diabetic lady - not a patient - phoned the office and asked for medical advice with regard to her eyes. He was unable to answer her because it would be illegal for him to give advice without examining her and getting a full medical history, family history etc, etc. She c/o bleeding in one eye. Her first eye was already blind, she had bleeding in the other eye and now she was totally blind. She wanted to know what she could do. He was only able to recommend she see a Retinologist. She replied that she had seen one, but he failed to tell her anything. [More details relating to this as a general situation given to this YT audience]. He was unable to give specifics because she was not his patient. The same goes for advice given in these teleseminars, it is generic, Dr B. will never claim he has a solution to a particular individual’s problem. 0:06:05 - T2D for 30 yrs. On insulin for 20 yrs. Wanting to reduce amount of insulin. Finding it difficult to lose weight. Following the 6-12-12 LC plan person has reduced basal to 7 units. How can they reduce the amount of insulin further and hopefully lose weight? 0:07:45 - Person gets restless leg syndrome but only when BGL are out of control. Recently received a Cortisone shot for a rotator cuff tear. BGLs were awful and still are high even though basal has been increased. In the past used Neurontin (Gabapentin) but this makes person ravenous like a seven-headed caterpillar. Is there another remedy? 0:12:20 - Parent has a 2-year-old, fairly new onset T1D. Using 0.5 unit of Levemir (Insulin Detemir) in the morning. Started lower carb diet. Now AM BGL looks great, but he is having low BGL overnight and on rising. Can Levemir be diluted? Are there any other long-acting insulins that you can dilute? 0:13:35 - Parent has a T1D child at home for two months. Is it safe to return to church services during this part of the Covid-19 outbreak? 0:15:00 - Person has A1c of 5.3%. Sugar spikes up to 190 mg/dL (~10 mmol/L) after eating any kind of carbohydrate. Is this person diabetic? Person’s doctor says this is fine. Person is not sure?
0:16:52 - Person has inconsistent eating. T1D at age 32 and a BMI of 21. Person is 37 y.o. now and healthy. Eating changes on the weekends and person tends to eat a lot more calories. They use more insulin and don’t allow BGLs to run high. The following day, after consuming a lot of calories, they need 200-300% more insulin for meals and more long-acting insulin. This situation continues unless a two-day fast is undertaken. Is this normal for T1D? 0:19:30 - Person has diabetes for ~20 yrs. BGL usually stays under 200 mg/dL (~11 mmol/L). They are constantly dehydrated despite drinking 64 ounces (~1.9L) a day. Also drinks sugar-free Gatorade on occasions. Potassium stays low despite daily Potassium supplement. How to stay hydrated?
0:21:05 - Parent living in Georgia (USA). The State is reopening (re Covid-19). Daughter is 12 years old T1D. At home since March 13. Should they continue to stay at home? 0:23:42 - Person takes 6 units of Novolog (Insulin Aspart) following a sliding scale for breakfast, lunch, and dinner. Still finding BGL are high. Frustrating situation.
0:25:11 - 33 y.o. Female told she is pre-diabetic. 125 pounds (~56 kg). Recent A1c was 5.3%. BGLs monitored at home. Has noticed recently, an hour or so after eating blueberries with unsweetened plain yoghurt followed by a bowl of LC chicken stew, levels at 170 mg/dL (~ 9.4 mmol/L). Do these numbers indicate that she is now diabetic? 0:26:33 - 48 y.o. male with T1D for 24 years. Eats high fat, medium protein, and practices intermittent fasting. A1c is 4.8%. Has noticed an increased sensitivity to protein that causes a BGL spike roughly 4.5 hours after consumption. Foods such as chicken breast causes BGL to rise from stable 75 mg/dL (~4 mmol/L) to >180 mg/dL (>10 mmol/L). This is a new phenomenon for person. Wondering what causes an increase in protein sensitivity like this and what can be done? 0:29:13 - 42 y.o. T1D for 22 years. Working as builder, wears boots all day in all types of weather. Has severe toenail fungus that has spread to fingernails. Is this related to diabetes and is there a remedy for this?
0:32:05 - 19 y.o. Male. T1D. Following Dr B diet. LDL became very high up to 300 mg/dL. What could be causing this and what could be done to lower it, besides medication? 0:34:08 - Is a LCHF diet ok for T2D? What if the fat is olive oil, coconut oil, and other good fats?
0:35:06 - Is it possible to do away with insulin resistance?
0:36:19 - Is it safe for an 83 y.o. man with stage II - III chronic kidney disease, and an A1c of 5.3-5.4%, to take small doses of Metformin for its many benefits?
0:38:50 - Is there a link between rising cholesterol LDL and increased BGLs?
0:39:22 - Patient told by their doctor to go back on a statin due to high LDL. Patient is unsure. Triglyceride and HDL are well within normal levels? 0:39:58 - Is there a risk of atrial fibrillation with a LC diet?
0:40:46 - Is there a vegetarian diet that does not use soy for BGL control? 0:41:56 - Is T1D reversible?
0:43:34 - A 60 y.o. female patient presented with a random BGL of 706 mg/dL (~39 mmol/L), polyuria, mild blurred vision. She was placed on a strict 6-12-12 LC diet 5 days ago. Education given over 2 hours via videoconference. Given daily encouragement (phone call). She has been compliant and feels fine. Yesterday, her BGL was 470 mg/dL (~26 mmol/L) at 9 am; two (sic) hours after a breakfast of eggs, sausage, and water. At 7:30 pm, two hours after a dinner of pork and broccoli, she was 343 mg/dL (~19 mmol/L). Her BGLs remain better overall down from 706 mg/dL but still remains high. Would you add an oral medication at this point or continue with the strict diet for now? Is her current high BGL coming from stored liver and muscle glycogen? If so, do we expect BGL to normalise after stored glycogen is depleted? 0:46:04 - 40 y.o. female. Very athletic and healthy. Has BMI of 24.9. She wants to lose a pinch of fat around her belly, hips, and thighs. Started on a LC diet, one month ago. She has been very compliant and most days her total carb intake is 10-20 g. However, despite the strict LC diet and daily exercise, she had not lost a single pound. She is v. disappointed. Can you explain and/or review the physiology as to why she has not been able to lose weight? LC diets reportedly help people lose weight, what could be happening here?
0:48:16 - 2 y.o. daughter diagnosed with T1D 6 months ago. What is the best lifestyle approach to avoid any complications and maintain stable BGLs? 0:49:35 - Male T2D. Now takes insulin. Since taking insulin he has begun shaking at night. This was not the case when taking Metformin. Is this related to his T2D and what can we do?
0:50:18 - 11 y.o. son. Diagnosed T1D a year ago. He had very few antibodies, only slightly positive. We started to give 1 unit only of basal insulin at night for 2 months. He suffered low BGL then we stopped the insulin. BGL was normally a bit high and sometimes low. He has been on a ketogenic diet for two weeks. Now BGL are normal all the time. Should we keep keto without insulin or start insulin and suffer the low BGLs?
0:51:56 - Son 11 y.o. has just been diagnosed as T1D. He seems to be in the honeymoon period and does not need any insulin on a LC diet. Is there anything we can do - food or drugs - to extend this honeymoon period for as long as possible? Parents speculate that with a LC diet and no insulin, the chances of hypos or other complications are greatly reduced?
0:54:03 - Some people in T1D community are now saying “time in range” is better than A1c to assess how good a T1D patient is doing with regard to BGL. Could you share your perspective on this? Please note that statements seem to come from people marketing CGMs and CGM pump systems. 0:55:36 - Female T1D for 25 years. Current age is 56 y.o. Has trigger finger on left thumb. Now the middle finger is starting to lock up on the same hand. 0:59:04 - That is it for the year 2020. We will see you in the next decade on Wednesday January 27th. Have a good month. Stay well. Stay out of trouble. Good Luck.
Teleseminar 59: December 2020.
0:00:00 - Hello, Dec 2020 Teleseminar. Last one of the year.
0:00:12 - ARTICLE: Before we go through questions. I want to cover one article that came out in the past month. Found in the journal Diabetes. It is another one of these articles that shows damage to the brain caused by elevated BGLs. These articles are appearing at the rate of 1 or 2, per month. Each appears to be dealing with a different aspect of brain damage. This particular one looked at people who have had T1D for an average of 21 years. The average age of cohort was 36 years. Their brains were imaged with a special form of MRI and compared with that of non-D matched for age, sex, etc. The T1D had changes not found in the non-D. Interestingly, these changes were not related to impaired blood flow, they were strictly neurologic changes (i.e., neuropathies of the brain). Summary: No cerebral blood flow differences between groups was found in any of the structures that were examined. This suggests nonvascular ideologies (causes) of these changes. Findings implicate a marked non-vascular disruption in T1D of several essential neural modes engaged in both cognitive (thinking) and motor (movement) processing. So, control of motion e.g., balance, touching your nose with your finger, etc. Here we have the ADA, and most endocrinologists, still claiming that if kids have normal BGL and LC diets their brains will not develop. We see what is happening with people who are not on our regimen.
Article: Structural Alterations in Deep Brain Structures in Type 1 Diabetes. Diabetes 2020 Nov; 69(11): 2458-2466.doi.org/10.2337/db19-1100
0:03:18 - WARNING. Before answering Q, a reminder that answers are strictly generic. They are earmarked for the entire listening audience. They may not really solve the problem of the individual. Recent experience for Dr B. A diabetic lady - not a patient - phoned the office and asked for medical advice with regard to her eyes. He was unable to answer her because it would be illegal for him to give advice without examining her and getting a full medical history, family history etc, etc. She c/o bleeding in one eye. Her first eye was already blind, she had bleeding in the other eye and now she was totally blind. She wanted to know what she could do. He was only able to recommend she see a Retinologist. She replied that she had seen one, but he failed to tell her anything. [More details relating to this as a general situation given to this YT audience]. He was unable to give specifics because she was not his patient. The same goes for advice given in these teleseminars, it is generic, Dr B. will never claim he has a solution to a particular individual’s problem.
0:06:05 - T2D for 30 yrs. On insulin for 20 yrs. Wanting to reduce amount of insulin. Finding it difficult to lose weight. Following the 6-12-12 LC plan person has reduced basal to 7 units. How can they reduce the amount of insulin further and hopefully lose weight?
0:07:45 - Person gets restless leg syndrome but only when BGL are out of control. Recently received a Cortisone shot for a rotator cuff tear. BGLs were awful and still are high even though basal has been increased. In the past used Neurontin (Gabapentin) but this makes person ravenous like a seven-headed caterpillar. Is there another remedy?
0:12:20 - Parent has a 2-year-old, fairly new onset T1D. Using 0.5 unit of Levemir (Insulin Detemir) in the morning. Started lower carb diet. Now AM BGL looks great, but he is having low BGL overnight and on rising. Can Levemir be diluted? Are there any other long-acting insulins that you can dilute?
0:13:35 - Parent has a T1D child at home for two months. Is it safe to return to church services during this part of the Covid-19 outbreak?
0:15:00 - Person has A1c of 5.3%. Sugar spikes up to 190 mg/dL (~10 mmol/L) after eating any kind of carbohydrate. Is this person diabetic? Person’s doctor says this is fine. Person is not sure?
0:16:52 - Person has inconsistent eating. T1D at age 32 and a BMI of 21. Person is 37 y.o. now and healthy. Eating changes on the weekends and person tends to eat a lot more calories. They use more insulin and don’t allow BGLs to run high. The following day, after consuming a lot of calories, they need 200-300% more insulin for meals and more long-acting insulin. This situation continues unless a two-day fast is undertaken. Is this normal for T1D?
0:19:30 - Person has diabetes for ~20 yrs. BGL usually stays under 200 mg/dL (~11 mmol/L). They are constantly dehydrated despite drinking 64 ounces (~1.9L) a day. Also drinks sugar-free Gatorade on occasions. Potassium stays low despite daily Potassium supplement. How to stay hydrated?
0:21:05 - Parent living in Georgia (USA). The State is reopening (re Covid-19). Daughter is 12 years old T1D. At home since March 13. Should they continue to stay at home?
0:23:42 - Person takes 6 units of Novolog (Insulin Aspart) following a sliding scale for breakfast, lunch, and dinner. Still finding BGL are high. Frustrating situation.
0:25:11 - 33 y.o. Female told she is pre-diabetic. 125 pounds (~56 kg). Recent A1c was 5.3%. BGLs monitored at home. Has noticed recently, an hour or so after eating blueberries with unsweetened plain yoghurt followed by a bowl of LC chicken stew, levels at 170 mg/dL (~ 9.4 mmol/L). Do these numbers indicate that she is now diabetic?
0:26:33 - 48 y.o. male with T1D for 24 years. Eats high fat, medium protein, and practices intermittent fasting. A1c is 4.8%. Has noticed an increased sensitivity to protein that causes a BGL spike roughly 4.5 hours after consumption. Foods such as chicken breast causes BGL to rise from stable 75 mg/dL (~4 mmol/L) to >180 mg/dL (>10 mmol/L). This is a new phenomenon for person. Wondering what causes an increase in protein sensitivity like this and what can be done?
0:29:13 - 42 y.o. T1D for 22 years. Working as builder, wears boots all day in all types of weather. Has severe toenail fungus that has spread to fingernails. Is this related to diabetes and is there a remedy for this?
0:32:05 - 19 y.o. Male. T1D. Following Dr B diet. LDL became very high up to 300 mg/dL. What could be causing this and what could be done to lower it, besides medication?
0:34:08 - Is a LCHF diet ok for T2D? What if the fat is olive oil, coconut oil, and other good fats?
0:35:06 - Is it possible to do away with insulin resistance?
0:36:19 - Is it safe for an 83 y.o. man with stage II - III chronic kidney disease, and an A1c of 5.3-5.4%, to take small doses of Metformin for its many benefits?
0:37:00 - Is your book ever going to be updated?
0:38:50 - Is there a link between rising cholesterol LDL and increased BGLs?
0:39:22 - Patient told by their doctor to go back on a statin due to high LDL. Patient is unsure. Triglyceride and HDL are well within normal levels?
0:39:58 - Is there a risk of atrial fibrillation with a LC diet?
0:40:46 - Is there a vegetarian diet that does not use soy for BGL control?
0:41:56 - Is T1D reversible?
0:43:34 - A 60 y.o. female patient presented with a random BGL of 706 mg/dL (~39 mmol/L), polyuria, mild blurred vision. She was placed on a strict 6-12-12 LC diet 5 days ago. Education given over 2 hours via videoconference. Given daily encouragement (phone call). She has been compliant and feels fine. Yesterday, her BGL was 470 mg/dL (~26 mmol/L) at 9 am; two (sic) hours after a breakfast of eggs, sausage, and water. At 7:30 pm, two hours after a dinner of pork and broccoli, she was 343 mg/dL (~19 mmol/L). Her BGLs remain better overall down from 706 mg/dL but still remains high. Would you add an oral medication at this point or continue with the strict diet for now? Is her current high BGL coming from stored liver and muscle glycogen? If so, do we expect BGL to normalise after stored glycogen is depleted?
0:46:04 - 40 y.o. female. Very athletic and healthy. Has BMI of 24.9. She wants to lose a pinch of fat around her belly, hips, and thighs. Started on a LC diet, one month ago. She has been very compliant and most days her total carb intake is 10-20 g. However, despite the strict LC diet and daily exercise, she had not lost a single pound. She is v. disappointed. Can you explain and/or review the physiology as to why she has not been able to lose weight? LC diets reportedly help people lose weight, what could be happening here?
0:48:16 - 2 y.o. daughter diagnosed with T1D 6 months ago. What is the best lifestyle approach to avoid any complications and maintain stable BGLs?
0:49:35 - Male T2D. Now takes insulin. Since taking insulin he has begun shaking at night. This was not the case when taking Metformin. Is this related to his T2D and what can we do?
0:50:18 - 11 y.o. son. Diagnosed T1D a year ago. He had very few antibodies, only slightly positive. We started to give 1 unit only of basal insulin at night for 2 months. He suffered low BGL then we stopped the insulin. BGL was normally a bit high and sometimes low. He has been on a ketogenic diet for two weeks. Now BGL are normal all the time. Should we keep keto without insulin or start insulin and suffer the low BGLs?
0:51:56 - Son 11 y.o. has just been diagnosed as T1D. He seems to be in the honeymoon period and does not need any insulin on a LC diet. Is there anything we can do - food or drugs - to extend this honeymoon period for as long as possible? Parents speculate that with a LC diet and no insulin, the chances of hypos or other complications are greatly reduced?
0:54:03 - Some people in T1D community are now saying “time in range” is better than A1c to assess how good a T1D patient is doing with regard to BGL. Could you share your perspective on this? Please note that statements seem to come from people marketing CGMs and CGM pump systems.
0:55:36 - Female T1D for 25 years. Current age is 56 y.o. Has trigger finger on left thumb. Now the middle finger is starting to lock up on the same hand.
0:59:04 - That is it for the year 2020. We will see you in the next decade on Wednesday January 27th. Have a good month. Stay well. Stay out of trouble. Good Luck.