Law of Small Numbers and Diabetes

[Guest guest]

GREETINGS --

As an engineer by training and 40+ years of practice I learned (often

the hard way) that the Law of Small Numbers governs many actions and

events in our lives. However, until I read Dr Bernstein's Diabetes

Solution I completely ignored the affect on managing my diabetes. The

following is excerpted from his book and explains how a diabetic can

use this principle to better manage his/her blood sugars. If you have

not read this book I uirge all of you to do so. It is written by a 60

something year old endocrinologis who has been a Type I diabetic for

50 something years.

wambo1941

PS You can read the entire chapter at www.diabetes-normalsugars.com -

- going to the Read on Line section.

The Laws of Small Numbers

Big inputs make big mistakes; small inputs make small mistakes. "

That is the first thing my friend Kanji Ishikawa says to himself each

morning on arising. It is his mantra, the single most important thing

he knows about diabetes.

Kanji is the oldest surviving type 1 diabetic in Japan (he is, by the

way, younger than I, but afflicted with numerous long-term diabetic

complications because of many years of uncontrolled blood sugars).

Many biological and mechanical systems respond in a predictable way

to small inputs but in a chaotic and considerably less predictable

way to large inputs. Consider for a moment traffic. Put a small

number of automobiles on a given stretch of highway and traffic acts

in a predictable fashion: cars can maintain speed, enter and merge

into open spaces, and exit with a minimum of danger. There's room for

error. Double the number of cars and the risks don't just double,

they increase geometrically. Triple or quadruple the number of cars

and the unpredictability of a safe trip increases exponentially.

The name of the game for the diabetic in achieving blood sugar

normalization is predictability. It's very difficult to use

medications safely unless you can predict the effect they'll have.

Nor can you normalize blood sugar unless you can predict the effects

of what you're eating. If you can't accurately predict your blood

sugar levels, then you can't accurately predict your needs for

insulin or oral blood sugar–lowering agents. If the kinds of foods

you're eating give you consistently unpredictable blood sugar levels,

then it will be impossible to normalize blood sugars. One of the

prime intents of this book is to give you the information you need to

learn how to predict your blood sugar levels and how to ensure that

your predictions will be accurate. Here the Laws of Small Numbers are

exceedingly important.

Predictability. How do you achieve it?

THE LAW OF CARBOHYDRATE ESTIMATION

The old American Diabetes Association (ADA) dietary recommendations

allowed 150 grams of carbohydrate per meal. This, as you may know by

now, is grossly excessive for people trying to control their blood

sugars. Here is one reason why.

Typically, 150 grams of carbohydrate would be a good-sized bowl of

cooked pasta. You may think that by reading the ingredients label on

the package you can precisely compute how much of the dry pasta you

must weigh out to dispense exactly 150 grams of carbohydrate. Now, if

you're a nonobese type 1 diabetic who weighs 150 pounds (68

kilograms) and makes no insulin, 1 gram of carbohydrate will raise

your blood sugar by about 5 mg/dl. By using methods that we'll later

describe, you can calculate exactly how much insulin you must inject

to keep your blood sugar at the same point after the meal as it was

before the meal. This may sound elegant, but it will rarely work for

a high-carbohydrate meal.

What neither the ADA nor the package tells you is that food producers

are permitted a margin of error of plus or minus 20 percent in their

labeling of ingredients. Furthermore, many packaged products—for

example vegetable soup—cannot even match this error range, in spite

of federal labeling requirements. So even if you perform the

necessary calculations, your blood sugar after the meal can be off by

a carbohydrate error of 5 mg/dl multiplied by ± 30 grams (± 20

percent of 150 gm), or by a whopping ±150 mg/dl for just this one

meal. If your target blood sugar level is approximately 85 mg/ dl,

you've now got a blood glucose level anywhere between 235 mg/dl and 0

mg/dl. Either situation is clearly unacceptable.

Let's try another example. Say you're a type 2 diabetic, obese, and

make some insulin of your own but also inject insulin. You've found

that 1 gram of carbohydrate only raises your blood sugar by 3 mg/dl.

Your blood sugar would be off by ±90 mg/dl. If your target blood

sugar value is, say, 90 mg/dl, you're looking at a postmeal blood

sugar level of anywhere from 180 mg/dl to 0 mg/dl. That's one of the

many problems with the ADA guidelines. Big inputs and big

uncertainty.

But if you eat an amount of carbohydrate that will affect your blood

sugar by one-tenth of that margin of error, then you're going to have

a much simpler time of normalizing blood sugar levels. My diet plan,

which we will get into in Chapters 9–11, aims to keep these margins

in the realm of ±10–20 mg/dl. How do we accomplish this? Small

inputs. Eating only a tenth of a serving of pasta is not the answer.

Even small amounts of some carbohydrates can cause big swings in

blood sugar. And anyway, who would feel satisfied after such a small

serving of pasta? The key is to eat foods that will affect your blood

sugar in a very small way.

Small inputs, small mistakes. Sounds so simple and straightforward

that it may make you want to ask why no one has told you about it

before. Say that instead of eating pasta as the carbohydrate portion

of your meal, you eat salad. If you estimate 2 cups of salad to total

12 grams of carbohydrate and are off not by 20 percent but by 30

percent, that's still an uncertainty of only 4 grams of carbohydrate—

a maximum potential 20 mg/dl rise or fall in blood sugar. A big bowl

of pasta for a couple of cups of salad? Not much of a trade, you may

say. Well, we don't intend that you starve. As you decrease the

amount of fast-acting carbohydrate you eat, you can often

simultaneously increase the amount of protein you eat. Protein can,

as you may recall, also cause a blood sugar rise, but this takes

place much more slowly, to a much smaller degree, and is more easily

covered with medication.

In theory, you could weigh everything you eat right down to the last

gram and make your calculations based on information provided by the

manufacturer or derived from some of the books we use. This

information, as noted above, is only an estimate, with considerable

margin for error. You will have only a vague idea of what you're

actually consuming, and of the effect it will have on blood sugar.

The idea here is to stick with low levels of slow-acting, nutritious

carbohydrates. In addition, stick with foods that will make you feel

satisfied without causing huge swings in blood sugar. Simple.