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THE THREE FIRST’S in DIABETES CARE, 21 YEARS BEFORE DCCTArticles - Dr. Bernstein Shares His Insights “First to advocate and perform blood glucose self monitoring” “First to use a blood glucose self monitoring and bolus/basal insulin dosing to achieve tight control” “First to publish a paper on reversing complications by tight control”
We are proud to be friends with Dick would like to thank him for providing us with the materials to write this feature. We know you will find it interesting and informative. We have made it a 3-week series, discussing the 3 first’s. Included is the actual article on how tight control can prevent complications, that was finally accepted by Diabetes Care and also the rejection letters from NEJM, ADA, AMA and Lancet which stated that: “No physician or patient would ever be interested in such a time consuming program of using a device to check blood glucose multiple times a day and adjusting insulin doses” Part 1 will be, “First to advocate and perform blood glucose self monitoring” Part 1: First to advocate and perform blood glucose self monitoring Part 2 will be, “First to use a blood glucose self monitoring and bolus/basal insulin dosing to achieve tight control” (See below for part 2) Next Week: Part 3 will be, “First to publish a paper on reversing complications by tight control”
Part 2 “First to use a blood glucose self monitoring and bolus/basal insulin dosing to achieve tight control” I spent the next year checking my blood sugars 5-8 times each day. Every few days, I’d make a small, experimental change in my diet or insulin regimen to see what the effect would be on my blood sugar. If a change brought an improvement, I’d retain it. If it made the blood sugar worse, I’d discard it. I discovered that 1 gram of carbohydrate raised my blood sugar by 5 mg/dl, and ‘A unit of the old beef/pork insulin lowered it by 15 mg/dl. Within a year, I had refined my insulin and diet regimen to the point that I had essentially normal blood sugars around the clock. After years of chronic fatigue and debilitating complications, almost overnight I was no longer continually tired or washed out:’ After years of sky-high readings, my serum cholesterol and triglyceride levels had now not only dropped, but were at the low end of the normal ranges. I started to gain weight, and at last I was able to build muscle as readily as nondiabetics. My insulin requirements dropped by about two-thirds of what they had been a year earlier. With the subsequent development of human insulin, my dosage dropped to one-fifth of the original. The painful, slow-healing lumps the injections of large doses of insulin left under my skin disappeared. The fatty growths on my eyelids vanished. My digestive problems (chronic burning in my chest and belching after meals) and the proteinuria that had so worried me eventually vanished. Today, my results from even the most sensitive kidney function tests are all normal. My deformed feet, the calcified walls of arteries in my legs, and the cystoid macular edema of my eyes are not reversible and still remain. I had the new sensation of being the boss of my own metabolic state, and began to feel the same sense of accomplishment and reward I had in engineering when I solved a difficult problem. I had taught myself how to make my blood sugar levels whatever I wanted them to be and was no longer on the roller coaster. Things were under my control Back in 1973, I felt quite exhilarated with my success, and I felt that I was on to something big. Since getting the results of my computer search, I had been a subscriber to all of the English-language diabetes journals, and none of them had mentioned the need for normalizing blood sugars in humans. In fact, every few months I’d read another article saying that blood sugar normalization wasn’t even remotely possible. How was it that I, an engineer, had figured out how to do what was impossible for medical professionals? I was deeply grateful for the fortuitous combination of events that had turned my life, my health, and my family around and put me on the right path. At the very least, I felt, I was obliged to share my newfound knowledge with others. There were no doubt millions of ordinary diabetics like me suffering needlessly. I was sure that all physicians treating diabetes would be thrilled to learn how to prevent and possibly reverse the grave complications of this disease. I hoped that if I could tell the world about the techniques I had stumbled upon, physicians would adopt them for their patients. So I wrote an article detailing my discoveries. I sent a copy to Charles Suther, who was then in charge of marketing diabetes products for Ames Division of Miles Laboratories, the company that made my blood glucose meter. He gave me the only encouragement I received in this new venture, and arranged for one of his company’s medical writers to edit the articles for me. Next week we will have copies of the rejection letters and the complete paper that was finally accepted for publication. Richard K. Bernstein, M.D., F.A.C.N., F.A.C.E.
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Being
the first for anything in the medical field is not the easiest. As you will
see, it took a great commitment and a desire to help others to achieve what
Dr. Bernstein achieved. 
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