Before you continue… You really need to see THIS if you have diabetes(will open in new window)
Looking for something special ? Find The Lowest Price Right Here
[Editor’s note: This article was originally published in 2019. Dr. Bernstein is now about to turn 88 years old, and still going strong! His own longevity is surely a testament to his diabetes management philosophy.]
Dr. Richard K. Bernstein has lived with type 1 diabetes since age 11. At nearly 85 years old he remains busy treating women and men with diabetes, which he has done since 1983. Did you be aware of Dr. Bernstein invented blood sugar self-monitoring and the use of a basal-bolus insulin dosing?
Dr. Bernstein not only lives with and specializes in diabetes, he has sought to uncover the details regarding what damage it can do, how that damage manifests, and more importantly, how it may be treated.
He has kindly taken the time to answer questions about diabetes complications thoroughly so I encourage you to bookmark the link, get comfortable, and remember you’re not alone in facing this potentially intimidating information. Dr. Bernstein answered in a video that you can view here.
The entire length has been transcribed below if you prefer to read.
What is the cause of diabetes complications?
Simple answer: lofty blood sugars. The secondary answer is that some studies have shown that wide swings in blood sugars can also be a cause of diabetic complications. There have, over the years, been a number of so-called authorities, including organizations claiming that the complications of diabetes are triggered by the affliction diabetes and are unrelated to blood sugar. This is false and it’s been promoted mostly because many physicians do not realize how to keep blood sugars ordinary.
Elevated blood sugars can affect almost every tissue in the body. Eyes, nerves, tissues, skin, liver, you name it, it can probably be adversely affected by high blood sugars. There are many mechanisms by which lofty blood sugars can cause the complications of diabetes. Some of these mechanisms have been intensively studied and others, less intensively.
For example, there are tissues in the body named aldose reductase producers, they produce an enzyme in the presence of high blood sugars that converts glucose to sorbitol. Sorbitol is an osmotic agent that attracts water. So if there is a lot of sorbitol in the cell, water will be attracted to the cell and the cell will swell up, its functions will be impaired and it can eventually blow up–explode, from being so swollen with water. The aldose reductase tissues include the lens of the eye (can get cataracts), nerves throughout the body and be part of neuropathies (damage to nerves), the Schwann cells, which are cells that insulate axons that come out of nerves, long spidery arms that come out of nerves named axons, and they are, let’s call it electrically insulated with cells named Schwann cells–these are aldose reductase cells; cells from the kidney named mesangial cells, these likewise are aldose reductase cells; cells that line the outside of the capillaries, little blood capillaries, these are aldose reductase cells.
There’s one other typical cause of diabetic complications, these are named advanced glycation end products. This is where glucose sticks to proteins in a cell and causes the proteins to either lose their role or do things that are inappropriate.
I’ll give an example: the connective tissue adjacent to our joints, connected to muscles and bones. Connective tissue is high in a protein called collagen. Collagen is probably the most longest-lived protein in a human body. In a young healthy person, it’s turnover, it’s half-life, is about 15 years. In older men and women or a fully controlled diabetic, the collagen might be around much longer. And collagen gets glycated; that means glucose sticks to the proteins, to the amino acids in the collagen. When the fibers of collagen have glucose stuck to them, they get glued together by the glucose and no longer position smoothly so you try to move the joint where all the connective tissue in close proximity the joint (frequently in the shoulder) is glycated, you’ll tear the fibers and you might have pain, limited range of motion in the shoulder, etc.
This is also a cause of carpal tunnel syndrome which is witnessed in the wrist with discomfort in the functions that involve the wrist.
There’s Dupuytren’s contracture which is a flexing of the fingers caused by glycation of collagen in the tendons that flex the fingers.
There is one other ailment that you could look up on the internet called Peyronie’s disease, that according to the newspapers, affected one of our presidents. So there are many biochemical reasons why glucose is destructive and causes many issues. It causes heart disease, and I said kidney failure before. So that’s sort of a summary, a long answer to a short question.
What are some typical diabetes complications?
Well, I already mentioned a few of them but I’ll give you some examples of some others.
Let’s take blindness. Blindness most commonly occurs in diabetics either by macular edema which is the outflow of fluid from the blood vessels near the center of the eye (the center of the eye is where we concentrate when we’re reading or looking at an object), the macula can be damaged by leakage of proteins from the bloodstream into the macula, damaging the cells in the macula. So macular edema is one cause of diabetic complications. And I might add, that I have seen patients with macular edema who had chronically elevated blood sugars and when we normalized their blood sugars for many months, the macular edema reverses. And when retinologists, which are ophthalmologists who heal the retina, when they see these cases they can’t believe it, because in their experience, macular edema doesn’t reverse, but in my experience, it does.
Another cause of blindness is proliferative retinopathy. This involves proliferation of microscopic capillaries or blood vessels in the retina, might be in the center of vision or in the periphery, could be anywhere in the retina. These vessels that proliferate are fragile, they can be easily broken. One of the mechanisms that causes these proliferative vessels involves aldose reductase cells, the cells that line the outside of these tiny capillaries act as an exoskeleton (outside skeleton) are called pericytes. The pericytes, when exposed to glucose, will quickly absorb the glucose from the bloodstream. One characteristic of aldose reductase cells is that they do not need insulin for the entry of glucose. So these are the 1st cells to be bombarded with glucose when blood sugars are elevated. So here we have these pericytes getting loaded with glucose and eventually bursting. The pericytes will rapidly expand due to the inflow of water. First glucose comes in, gets converted to sorbitol, that causes an inflow of water, pericytes bursts.
Let’s say my finger is a capillary. Here are the pericytes all around the surface of the capillary. One of them bursts, the endothelial cell underneath it will balloon out, it’ll look like a little bubble. below a magnifying ophthalmoscope they’re called microaneurysms, it’s a little bubble of the blood vessel called an aneurysm. That bubble can burst and cause blood to be released into the retina and even more important, the pericytes produce an anti-proliferation factor, a factor that prevents proliferative retinopathy, but when you lose pericytes, there is no longer a pericyte to make that factor, that area will permit the proliferation of capillaries and you’ll now get proliferative retinopathy. So, you can get problems from these proliferative cells, the proliferative vessels that can burst, or you can also get retinopathy from the bursting of the microaneurysms. I believe that the microaneurysms are more of a warning sign but the proliferation is a much more serious condition.
I mentioned the Frozen Shoulder. We also have something called Iliotibial Band Tensor Fasciae Latae Syndrome. The iliotibial band of fibers, connective tissue that is going from the hip down the outside of the leg and it connects to another band of tissue that gets all the way to the knee from halfway up the thigh down to the knee, called the iliotibial band. The collagen fibers in this structure can get glycated, causing discomfort and can even cripple men and women so that they cannot walk. That reminds me of another complication called Charcot Foot where there’s loss of discomfort sensation in the feet and loss of proprioception which is the ability to sense the position of the joint or the position of the foot. These women and men who can’t feel their feet smash their feet against the ground when they take steps. The high blood sugars also cause bone loss so you have bone thinning in the feet combined with banging the feet repeatedly and the feet end up looking like a bag of bones. It could be extremely painful, although if you have intense and serious neuropathy you might not feel it. That is not reversible because the bones are already fractured into little pieces.
There are infections. Elevated blood sugars force the growth of bacteria so you can have all kinds of infections. Common ones and uncommon ones. They are a lot of the time bacterial but they can also be viral.
Very common are infections in the mouth such as gum infections, nerve root infections; in fact, the huge bulk of long-term diabetics will have procedures on their teeth where the endodontist destroys the nerve root in a tooth. These women and men with endodontal infections also develop infections of the jaw bone adjacent to the tooth called osteomyelitis. Osteomyelitis reminds me of infections that diabetics regularly have in the feet where a podiatrist or a family member will try to remove a callus, they may buy one of these little machines that the ADA [American Diabetes Association] advertises in their magazines for patients, a little machine to grind down calluses or they’ll use a pumice stone to grind down a callus and if you grind down enough calluses eventually you’ll get one that ground down too far, the skin will get infected and eventually it’ll spread to the bone. We have here in the USA 500,000 known amputations a year due to these infections. They’re commonly called salami surgery where first a toe is amputated but that doesn’t stop the spread of the contamination and the forefoot is amputated, then the entire foot is amputated. Then there may be below the knee amputation and then above the knee amputation. Usually, by the time they get to the above the knee amputation, the contamination is gone. I could probably go for hours, there are so many complications of diabetes and they’re all caused by elevated blood sugars and in most of the cases, the underlying mechanism is understood.
Now for many years it was claimed that offspring do not get diabetic complications but I have performed a thorough exam on each new patient to my office. I just examined a young lady two days ago and she had about 15 different diabetic complications. She had lost a reflex in her eyes called hippus. She had double vision in one direction of the gaze. She was only diagnosed two months ago so this was a brand new diabetic but her blood sugars were probably elevated for a few years before the diagnosis. They weren’t high enough to cause the ketoacidosis that she had but they were high enough to slowly cause complications. She had another complication called Monckeberg’s arteriosclerosis, I won’t go into the details, it’s sort of complicated. As I said she had about 15 complications. People who have had diabetes for a longer period of time usually have double vision in multiple directions of gaze, sometimes in all 9 directions that I examination. Now, they don’t realize it until I examination them because I put a red glass over one eye and a clear glass over the other eye and shine a light and they’re capable to distinguish the two lights–they look separate, you see a segregate red and white light. And when they report that, we know they have double vision.
As I said, it would take me hours to list all of the ones I see.
What is your experience treating and having diabetes complications?
Well, I had diabetic kidney sickness where every time I tested my urine for protein in those days I would use a dipstick, this is before I became a physician, I read that a sign of kidney disease is protein in the urine. I would get a dipstick for protein and every time I peed on it, it would turn the darkest color–it was, I believe a dark green that looked like black. Subsequently, years later read that if you have what we call 4+ proteinuria every time you urinate you’re producing at least 1500 mg of protein in your urine per day. Normal, depending upon what authority you consult is usually under 300 mg so I had five instances the higher end of ordinary and that totally reversed after a number of years of ordinary blood sugars. And standard by the way, for an adult is around 83 mg/dL and for kids, let’s say, under 16 or 17 years of age, ordinary is around 65, 70, or 75 mg/dL. The younger ones and non-diabetics tend to have lower blood sugars.
I also had intense and serious gastroparesis which is a failure of the stomach to empty predictably. I had bloating, burning, belching after meals and I would have constant burning almost all day long. I would be consuming two bottles of Rolaids which is calcium carbonate, an antacid, I would consume two bottles of Rolaids a week, that’s about 200 tablets a week. And they didn’t do a hell of a lot of good. And it took 13 years of ordinary blood sugars before I had the endure of my burning attacks. The gastroparesis also makes it extremely hard to keep blood sugars standard. How I managed to do that, I just don’t know. I did develop night blindness extremely early on, I guess when I was about 25, maybe earlier, and that hasn’t cleared up. I don’t know why. I don’t have proliferative retinopathy, I don’t have diabetic macular edema but I still have my night blindness.
I have a extremely interesting condition called Monckeberg’s arteriosclerosis. I was tested for it in 1983 when I first got out of medical school. We tested with something called an oscillometer. I also had x-rays of my ankles that showed calcified arteries in the ankles which is a sign of this Monckeberg’s arteriosclerosis. I was tested by a extremely famous doctor, who at that time the world’s authority on the diabetic foot. And I ended up working in his clinic so I’d learn how to heal diabetic foot ulcers and I ended up becoming the director of the clinic, I worked in the clinic for 29 years. He told me that this is not reversible. Well, why did he tell me that? Because he had never seen a diabetic with standard blood sugars. Well, I had already had normal blood sugars, let’s say, for about 10 or 12 years by the time he saw me but it was still very abnormal.
About 20 years later I was teaching the residents in my clinic about this condition. We were out of patients and most of the patients in the foot care clinic are diabetics–they’re the ones with foot problems and we had no patients. So I’m teaching the residents and I said “ok, I’ll show you a good example of Monckeberg’s Atherosclerosis” and I taught them how to make oscillometric measurements of my lower extremities and low and behold, all of the measurements were absolutely normal so apparently this condition is reversible, I didn’t realize it. I’ve seen it reverse in a few other patients but it takes a long, long time to reverse it.
I never reported it in the scientific literature for two reasons: One, it was hard for me to get published in the diabetes journals because I was considered an enemy by virtue of my insistence upon normal blood sugars. And secondly, when it comes to papers in the field of medicine you usually need such things as large-scale double-blind studies and a report on one case is rarely published. It’s interesting that in psychiatry, single case reports are frequently published but a report–especially a report about the author doesn’t stand a chance of getting published so I’ve never published this but when I lecture I do talk about it.
I did have an early diagnosis of a cardiac disease but about 5 years ago I got tested for what is called the coronary artery calcium score which measures the amount of plaque in coronary arteries. Normal is zero, having absolutely no plaque and the score goes up to let’s say, 15,000, where a computer can count 15,000 pieces of plaque. I had a score of one after I guess it was 65 years with diabetes, maybe with 70 years. So whatever coronary artery disease I had when I was young apparently reversed.
I didn’t answer the question about treating other people’s complications. I’ll give you some examples.
Painful neuropathy in the feet. That usually gets superior over the course of a few months, doesn’t totally get better in a few months, but improves. It takes years for it to fully get better. What we see initially with normal blood sugars after a few months is renewed sensitivity to pain where the foot previously felt nothing, it now feels pain from the resprouting of nerves. And that can be very severe pain. But patients usually can tolerate it because they know that a few more months of normal blood sugars the severe pain will go away. And that’s the sort of thing that we see.
There’s erectile dysfunction that we constantly pay attention on television called ED. Sometimes it’s so far advanced that I’ve not seen it reversed but with other people that say “I still have penile erections but they don’t last long enough for action” but again, after a few months, they start lasting long enough. But it takes years for a total recovery.
When I examination someone for double vision I find, let’s say a new patient, new to me but a long-time diabetic has double vision in all 9 directions of gaze that I test, comes back in two years with normal blood sugars (for two years), he might have double vision in 7 directions. Another two years he might only have double vision in 5 directions. Eventually the double vision will vanish altogether.
I’ve seen people with microaneurysms that have disappeared over time. I’ve seen people with early proliferative retinopathy that disappeared over time. Severe proliferative retinopathy probably gets treated so that doesn’t get a chance to go away on its own unless you prevent the treatments that are being rendered. Nowadays you don’t always need laser treatments, there are other treatments that are more benign that can sometimes restore vision rapidly.
There’s the R-R Interval learn about which is a study of the autonomic nervous system that I do on every new patient and then I try to repeat it on patients after every year, year and a half. It involves the use of the electrocardiograph machine and deep breathing while you’re looking at intervals between heartbeats. This thing is frequently abnormal in people with long-term diabetes and it’s not just a sign of a cardiac abnormality and autonomic neuropathy. It can cause gastroparesis, and that’s what we’re mostly worried about. So we the truth is have seen the R-R study amend and the gastroparesis reverse over many years.
If I wrack my brain I can probably think of other complications that will reverse but most of the complications reverse.
Things that involve the glycation of collagen like Dupuytren’s contracture, frozen shoulder, iliotibial band syndrome, carpal tunnel syndrome–these things don’t reverse on their own, they require cure. The treatment is variable.
For example, for frozen shoulder, sometimes trigger-point massage by a physiotherapist can do the job but has to be repeated every couple of weeks for maybe a year or two.
Iliotibial band tensor fasciae latae syndrome responds to what’s called vacuum stretching over the length of the structure.
Dupuytren’s Contracture responds to a little invention of mine which is the mixture of collagenase, an enzyme that dissolves collagen, with a solvent called DMSO, we have maybe a 6 to 1 ratio of the collagenase and have the patient apply it maybe with a little applicator glass to the Dupuytren’s–to the swollen tendon, and that goes down over a period of a year or two. There are doctors who inject collagenase into the Dupuytren’s but the procedure is very costly, frequently has to be repeated, and the doctors usually don’t guarantee their work because it’s uncertain. Likewise, the application of the collagenase and DMSO, I haven’t done it that often that I can guarantee it but what I did do for example, people frequently have this in both hands so I’ll heal the more severe hand. I had a friend who had a lump on the flexor tendon of his fourth finger that was the size of a walnut and he had one on the other hand that was half the size. So, I had him apply it only to the walnut-sized one for a year and it came down to be smaller than the other one. He got tired of doing it and let it stay after it got down to a smaller size but I would imagine that it would have disappeared altogether. And I’ve done this for other people also.
I guess that’s all the special reversal of complications that I’d like to talk about right now.
Is there a way to entirely avoid diabetes complications?
Yeah. Normal blood sugars. I guarantee it.
Now, there is a question about who says “normal”. The scientific studies or endocrinologists who don’t know how to achieve normal blood sugars and say that high blood sugars are normal. Also, there are certain associations like the American Diabetes Associations and probably some foreign associations that pick high numbers for the hemoglobin A1c and call them normal. So the ADA I think says, that an A1c of 6.5% is normal, well that’s an average blood sugar of about 160 mg/dL which is about double normal for an adult and more than double normal for a child. I’m talking about real normal, not about these fanciful normal.
What A1c is good enough?
An A1c I would speculate between 4.2% and 4.6% is probably what you’ll see in a non-diabetic who is not obese, does not have a family history of diabetes, and is not overeating sweets as many people are doing today. And by sweets, I include grains, so whole grain bread is going to raise blood sugars–is going to raise A1c. I wouldn’t expect someone who eats several slices of whole grain bread a day to have an A1c of 4.2% to 4.6%.
What do you say to someone who says there is no risk at 6.5% or less?
Well that’s the American Diabetes Association and of course I see–and all doctors see, diabetic complications in people with A1c under 6.5% but not under 5%.
Now, of course it’s true that most doctors do not really examine their patients. They may not even check the blood pressure. They’ll have someone check the patient’s blood pressure and they won’t do any other part of a physical exam. My physical exam for diabetes, which is separate from my general physical exam, although done on the same day, the diabetes exam is 8 pages long and takes me four hours to perform. There are very few doctors who actually have seen the complications of diabetes first hand, unless they’re looking at gross ones like amputations or a patient who says he’s blind. They don’t look in the eyes, necessarily, to see what’s in there, if the man or woman says he’s blind, they’ve seen a complication.
I had a physician in my office yesterday, who was in as an observer and she saw all the tests that I did on a new patient and she saw all the complications I found and she said “I didn’t know most of these complications existed”.
Can most diabetes complications be reversed? Which cannot, in your experience?
Well I just answered that, those that involve glycation of collagen require treatment. Now, collagen has a half-life in a healthy person–non-diabetic, of 15 years. So in five half-lives, there’s no more collagen left. So if you can keep someone’s blood sugar normal for 75 years, and if he lives that long, there won’t be anymore glycated collagen–that’s my guess, so his carpal tunnel syndrome might get better, and his Dupuytren’s contracture and frozen shoulder might all get better if he survives 75 years of normal blood sugars.
When someone has endured decades of hyperglycemia (high blood sugar), ought to they hope that normalizing the blood sugar can still make a difference or is it too late?
Well, if they’re totally blind it’s too late. If their kidney function, as estimated by creatinine clearance or glomerular filtration pace (GFR), which is the pace at which kidneys perform their job. If the GFR is under 10, the kidney destruction proceeds on its own, you’re overworking the kidney and it’s going to self-destruct. There have been articles that claim that under 30, it will self-destruct. I’ve seen people with GFRs of 30, where we keep their blood sugar normal for years, and they last for a long time, their GFR slowly comes down. I’ve had a patient who, I believe saw me initially with a GFR of 30 about 20 years ago, and I think his GFR is around 20 right now so if you have normal blood sugars, there is a good chance that you can slow down even advanced kidney disease. When it gets down below 15, it’s a big question mark how long you can keep the kidneys alive. Below 10 is worse than below 15 and below 5 is worse than below 10.
Now the neurological complications after many years of diabetes, of uncontrolled or high blood sugar diabetes can still be reversed because I’ve seen it. I’ve seen people with great pain in their feet, where that reverses. Where numbness in the feet, is very common, I’ve seen that reverse. So certain of the complications, usually the neurologic ones reverse.
Other complications don’t reverse for example, there’s a complication that I have, which you could look up on the internet, it’s called the Intrinsic Minus Foot, that’s a foot deformity that’s common to diabetes with hammertoes or so called “claw foot”–and this does not reverse. People have asked me, “is there an exercise that you can do to reverse it?” Well, due to the lack of motor innervation in these toes, you can’t straighten them out, so there’s no exercise they can do to straighten out these deformed toes. It also involves the shape of the whole foot. The forefoot rotates relative to the hind foot, there are prominent metatarsals that have many features that increase the likelihood of too much pressure at certain sites, tempting podiatrists to file down the calluses, thereby causing infections and amputations. I have Intrinsic Minus Foot milder than many more severe of a few of the patients coming in here and that is not going to reverse. So I have slight hammertoes and I have channels between the metatarsal bones on the top of my foot where muscles have wasted.
Has the pace of diabetes complications in people with type 1 diabetes improved in recent times? Has technology helped people avoid complications?
I doubt it. I’m not sure. Some years we get notifications in the literature that amputations are down a little, some years we get notifications that they’re up a little. Whether there’s any information on other complications, I don’t know. I suspect that since the advent of blood sugar self monitoring and bolus/basal insulin dosing–both of which I introduced, I suspect that the range of blood sugars is narrower than it used to be because people can correct a blood sugar of 400 mg/dL and bring it down to 200 mg/dL. Back in the old days when I first started measuring my own blood sugars, in a typical day, my blood sugar would go from 40 mg/dL to 600 mg/dL. In those days it was possible to measure high blood sugar directly. And that’s the way it was going for everyone so I think there has been an improvement since then.
By the way, when it comes to type 1 diabetics, there are some new things that we’re seeing, we’re seeing obesity or type 2 diabetes caused by obesity in type 1 diabetes, caused by the common prescription of high carbohydrate diets and very high doses of insulin for type 1 diabetics. This is likely universal in the U.S.A and it’s common in Australia. I’m not sure of the situation in European countries but here we’re now turning little kids into fatties and giving them type 2 diabetes.
Another thing that is sort of new is that there have been many studies of the brains of growing diabetic children and all of these children that are studied have elevated blood sugars and brain development is significantly impaired in kids with high blood sugars. Cognition is impaired and other functions are impaired. In adults, there is likewise impairment of short-term memory and impairment of cognition, even impairment of motor function due to damage to the brain from high blood sugars.
Recently, research has shown that depression in people with diabetes may be due in part to physical changes in the brain and not just related to the strain of living with a chronic condition. What do you think about this?
Well, it may well be the case. I don’t know that it’s been demonstrated but I did a study on depression and diabetes in two places, at the Rockefeller University–Rockefeller Institute in those days, now it’s the Rockefeller University. This was before I went to medical school, when I discovered how to normalize blood sugar, it happened that Rockefeller University was one of the few institutions measuring hemoglobin A1c, so I said to myself, “hey, this is a way to see if we improve blood sugars, I’ll see if I can get them to use my method to normalize blood sugars and attempt to normalize diabetic complications”. So we picked complications that were early like the leakage of protein into the vitreous humor of the eye and a few other early complications and we were able to reverse them all. But we had to recruit the patients from somewhere and I, strangely enough, was one of two non-physician members of the Board of Trustees of the New York Chapter of the American Diabetes Association.
So I knew the handful of diabetes specialists back in those days which was around 1970. And I asked the doctors to give us their worst patients, the ones they couldn’t stand–that were uncooperative, that had bad complications, etc. To me they were very nice people. I trained them in what to do and a physician at Rockefeller adjusted their insulin doses, we put them on very low carbohydrate diets.
The doctors who gave me the patients said “you’re going to make them crazy”. They were glad to get rid of these patients but they said, “such compulsive behavior is going to make them crazy.” I knew that I felt much relieved after I got my blood sugars straightened out, there was no longer a sword hanging over my head. I found a type 2 diabetic psychiatrist who is the office partner of my wife, who is a psychiatrist, and he examined each of the patients throughout the training–before the training and at the tail end and he administered a test called the Hamilton Depression Score, which is still used today. Severe depression was above a score of 20, mild depression was over a score of 6 and these people were all over 20 at the initial tests. After they got their blood sugars controlled, all but one lady came under six, that’s not depressed. And she never adhered to the diet or really participated the way she was supposed to and she did not normalize her blood sugars.
So if we got the blood sugars normalized the depression went away and I don’t think it’s from the normal blood sugars, I think it’s from the removal of the threat to your life–a daily threat. Just remember, these people never knew what their blood sugars were except once a month when they went to their doctor’s office and he checked their blood sugar. We repeated the same study at Down State University in Brooklyn which was also measuring hemoglobin A1c. It was actually at Down State that we did the study with the leakage of protein into the vitreous humor and we again got reversal of other complications. And here we had a psychologist administering the Hamilton Depression Score with similar results.
Developing diabetes complications can bring great emotional stress and frustration. How did you manage to channel your energy and focus into learning how exactly to manage your blood sugar levels in the midst of complications?
Well, the only disturbing, really interfering complication that I had was constant pain from gastroparesis and the method that I developed for normalizing my blood sugars was really simple and straightforward and obvious. I was an engineer and it happens that my specialty was systems engineering, I don’t know that they had that word in those days but that’s what I had spent my professional career doing so I knew how to work out a system that would do something and I was able to accomplish this very rapidly. Why did I do it against all obstacles? The only obstacles were that my wife, as a physician, thought that I would get an contamination from sticking my fingers, and she didn’t like me sticking them.
But, I was frightened. I knew that I was doomed to have a very short life, and doomed to have a painful life and many disabilities. I was desperate to get out of this bind, easy enough. And since I had the know-how to work on systems, that was the thing to do and I was able to do it pretty rapidly.