The Practical Diabetic Solution: The Modern Guide To Achieving Normal Blood Sugars (or Pretty Good Blood Sugars, You Decide)

This week I underwent an experiment to see what would happen if I combined a very low carbohydrate meal replacement, a commercial looping system, and snacking to cover hunger pangs. The results were better than I expected and, over the four days, I was seeing normal, non-diabetic blood sugars. Unlike other regimens, I did it with:

  • No exercise
  • No bolusing
  • No hypo treatments
  • No meal plans
  • With insulin resistance and a daily insulin requirement of over 70 units per day

You can see the details of the setup here but, in this post, I thought I would go through the results and, now I am on the other side, reiterate why I believe it is a superior approach to Dr. Bernstein’s.

Before and After

So, before the four days, I had:

  • Average Glucose of 7.2 mmol/L (130mg/dL) (over 14 days)
  • Average Glucose of 6.5 mmol/L (117mg/dL) (over 2 days)
  • Standard Deviation 1.9 mmol/L (34 mg/dL) (over 14 days)
  • Standard Deviation 2.3 mmol/L (42 mg/dL) (over 2 days)
  • Median 6.2 mmol/L (112 mg/dL) (over 24 hours)
  • Coefficient of Variation 35% of Mean (over 2 days)
  • Time in Tight Range (3.9 – 7.8 mmol/L aka 70 – 140 mg/dL): 65%
  • Highs: 7 Lows: 11 (over 2 days)
  • GMI of 6.1% (over 2 days)

Let us now look at the results at the end of each day (screenshots taken just after midnight each night)

Day 1
Day 2
Day 3
Day 4

For the totals above, as can be read with a keen eye, all graphs are for 24 hours. The range is the Time in Tight Range (TITR) (3.9 – 7.8 mmol/L aka 70 – 140 mg/dL).

Comparing we see every measure (except the Median, especially on Day 3) has significantly improved. Highlights include:

  • Halving the Standard Deviation and Coefficient of Variation.
  • Taking my TITR from the mid-60s to the high 90s
  • Eliminating my lows (although I suspect they were calibration errors from a new sensor) and significantly reducing my highs (these were real).

For completeness, my weight stayed about the same, and my daily insulin requirement stayed about the same (84-79 units) as well. This second result genuinely surprised me as I assumed the sudden drop in dietary carbohydrate would lead to a much lower insulin need. I assume the difference in carb was offset by the increased protein and further amplified by the increased consumption of animal fats, raising my insulin resistance.

Did You Really Achieve Normal Blood Sugars?

Let us consider a study of the blood sugars of non-diabetics I mentioned in another recent post.

Lots of numbers here, so let me translate the key points for the average participant:

  • They had a mean value of 99 +/- 7 mg/dL (5.5 +/- 0.4 mmol/L)
  • Their standard deviation was 17 +/- 3 mg/dL (0.9 +/- 0.2 mmol/L)
  • Coefficient of Variation was 17 +/- 3 %
  • TITR was 93-98 %
  • Time in Super Tight Range (TISTR) (70 – 120 mg/dL aka 3.9 – 6.7 mmol/L) was 82-92%
  • Time below range was about 1.3% of the time

I only measured TISTR once during the four days which looked like this:

Where I measured 92% TISTR, beating the non-diabetic value of 90% and hit every range on the non-diabetic normal blood ranges.

The only measure I did not consistently hit was Mean Glucose on days two and three due to my morning coffee throwing out my values. By day four I had adjusted the coffee not to spike me so I think it is fair to say that, with improved experience managing the snacks and setting my pump to a more aggressive target (it was set to 5.4 mmol/L aka 98 mg/dL for the experiment but can be set as low as 4.4 mmol/L aka 80 mg/dL), given I had zero lows during the four days, it would not be hard to consistently hit this range as well.

Why Do You Say It Is Superior To Dr. Bernstein’s Approach?

In terms of the results I expect it is possible to get similar results with Bernstein but where I see this approach having the edge is:

  • Food management is MUCH simpler: Aussielent takes care of the main meals and you simply choose snacks which you like and which work for you. Compare this to Bernstein where you have to craft meal plans (he literally wrote a nearly 300-page book just on this topic alone), have no snacking, have to consider “forbidden” and “allowed” foods; it is a lot more work
  • Insulin management is MUCH simpler: Getting the looping pump to do the heavy lifting means I literally go for hours a day, not thinking about diabetes and I never need to “sugar surf” my way down. For the above results I did not even declare carbs or bolus; the loop took care of it. In the case of Bernstein, from Dave Dikeman’s video which I mentioned in my preparation blog, we learn he treats lows with glucose 1-2 times a day and, if he goes above 110 mg/dL (6.1 mmol/L) he uses an intramuscular shot of rapid acting Novolog. This is not including any R-insulin injections he does to cover meals, plus injections for basal and dawn phenomenon management.
  • Hormone fluctuation management is MUCH simpler. A good example of this is dawn phenomenon. For someone who is looping, the pump manages it overnight with no human intervention required. Here, Dr. Bernstein admits he and most of his Type 1 patients go up overnight and his solution is getting up, every night around 4am and doing multiple injections of different insulins which, to me, is a recipe for disaster.

The fact is the most recent edition of Dr. Bernstein’s book was written over ten years ago and a LOT has changed since then. It make sense the innovations which have come over the last decade, such as looping systems, can help us manage diabetes better and remove some of the mental burden of managing the disease.

The other big advantage of the Practical Diabetic Solution is there are still plenty of levers to pull for even better results e.g. the inclusion of exercise, bolusing and declaring if required, flexibility in snack strictness to suit the individual, augmentation of pump delivery with needle delivery etc. whereas, with Bernstein, it is so strict, there is, in my opinion, little room to move or to be creative.

Will I Be Continuing The Practical Diabetic Solution?

My position has not changed. To explain my position, I will again quote Dr. Bernstein adherent, Dave Dikeman: “I want to be normal…Not normal in that I can eat a birthday cake with everybody else but normal in that I want to have the same blood sugars as everyone else”. I respect this position but I simply do not share it. I see no reason why I cannot have a small slice of cake at the occasional birthday party, estimate the bolus and have the loop soak up the rest and my Solution allows for that. My goal is to minimise maintenance and maintain blood sugars enough to minimise the risk of complications, helped by regular check-ups.

Similarly, if I go to a restaurant, I do not want to pull out a meal plan meal and eat it while my family orders; I want to share in the experience with my family and experience the food as the chef intended. Food is an integral part of human social interaction, it is even in our language; the word “companion” comes from “someone who you break bread with”, “mate” comes from “someone you share your food (meat) with”, and to nurture comes from the concept “to feed”. To shun this link is to shun who we are.

Where I am likely to embrace the Solution is at breakfast, lunch and while travelling. Morning is a rushed affair in our house so a quick meal shake which I do not need to think too hard about is perfect. As I mostly work from home, I usually eat lunch alone so, again, a shake which will not spike me and make me a zombie in the afternoon, which is perfect. Conversely, if I go into work and my colleagues go out for lunch I will join them and leave the shake in the locker. Dinner is around a dinner table and shared with the family. This is sacrosanct for us and the Solution will not be part of it.

For travelling, the Solution is perfect. At conferences or, for example, all day workshops, there is often limited eating options and the options provided are often carby. A meal replacement shake is easy to carry with me and removes the issue.

What About You?

For someone looking for some stability in their numbers and piece of mind, consider the Solution. As mentioned here, the latest clinical thinking is an HbA1c below 6.5% or a TITR of greater than 50% is sufficient to avoid the risk of long term complications. Even if you just replace breakfast, you will likely be gluco-normal through the night (thanks to the loop) and up to lunchtime, which is already more than half the day i.e. more than 50% TITR. Anything above and beyond this is a bonus.

For the person aiming for normal blood sugars, the plan, as I followed it, is worth considering and the barrier to entry and exit are quite low as it does not require exercise, food plans, and kitchen overhauls (other than waiting a few days for the Aussielent or equivalent to turn up). If, like me, family dinner is important, you can “snack” on the elements which will not spike you which they are eating, while drinking your meal replacement (which is what I did this week). I literally saw stunning results by the first day so try it and, if you do not see improvement, move on.

Roadtesting An Approach “Better Than Bernstein”: The Preparation

Let me start by making it clear I am quite the fan of Dr. Bernstein. I have his books and have watched all of the Diabetes University videos on YouTube. If you are new to diabetes and want a foundation on the disease and how it works, his videos are a great place to begin. Dr. Bernstein took responsibility for his disease and came up with a solution which worked really well for him. He then published his method and a lot of people have success with it. However, the last version of his book published was over 10 years ago. A lot has happened in regards to technology, medications, and food options in that time so I thought it was worth exploring how to improve on his work for my own personal benefit and that of the diabetes community.

What Is Dr. Bernstein’s Diabetes Solution?

I had a quick browse through my copies of “Dr. Bernstein’s Diabetes Solution” and “The Diabetes Diet” but could not find a good summary of his approach. Diabetes Daily give some good context on the man and the solution which may be worth a read. In short, Dr. Bernstein’s goal is for people with diabetes to have “normal” blood sugars i.e. blood sugar levels indistinguishable from non-diabetics. His approach involves:

  • Low Carbohydrate (less than 30g/day) and high protein/moderate fats
  • Three meals per day, no/limited snacking, with each meal having effectively the same macronutrient profile each day
  • His starting suggesting is a breakfast with 6g carbohydrate, lunch with 12g carbohydrate, and dinner with 12g carbohydrate
  • He advocates regular exercise which promotes muscle growth, weight loss, and improves insulin sensitivity
  • “Insulin Hacking” i.e. intramuscular injections using rapid insulin
  • He is generally against the use of technology in his book, preferring multiple daily injections although concedes Continuous Glucose Monitors (CGMs) may have their uses (“If I were living alone, I’d use a CGM to protect from nighttime hypoglycemic episodes” – Diabetes Solution, p357). For pumps, Bernstein lists a range of advantages and problems on pages 330-332. Quotes include:
    • “Corrective injections are elegantly simple” – Diabetes Solution, p331
    • “Pumps can be set to automatically increase the basal delivery rate shortly before arising in the morning, thereby circumventing problems associated with the dawn phenomenon” – Diabetes Solution, p331
    • “Insulin pumps cannot be used to give intramuscular injections for more rapid lowering of elevated blood sugars” – Diabetes Solution, p331
    • “Contrary to a common misconception, they do not measure what your blood sugar is and correct it automatically” – Diabetes Solution, p332
    • If you have the book, check them out. For me, many of the criticisms of pumps equally apply to multiple daily injections over a prolonged period but decide for yourself

To see Dr. Bernstein’s Diabetes Solution in action, Dave Dikeman is a great example. He has been living with type 1 diabetes since the age of nine (he is now around 18 years old) and has worked closely with Dr. Bernstein, (I believe assisting with his YouTube channel) for many years. He presented his approach to Low Carb Down Under about a year ago. It is a great summary of how the solution works and shows someone achieving great success with it.

What Results Can We Expect From Dr. Bernstein’s Diabetes Solution?

Fortunately, Dr. Bernstein published the results of people dedicated to his approach five years ago. Key results were:

  • A survey was conducted on members of the Facebook “Typeonegrit” group with 316 respondents, a group of “type 1’s and parents who follow Dr. Bernstein”
  • Average time following Dr. Bernstein’s Diabetes Solution was 2.2 ± 3.9 years
  • Mean daily carbohydrate intake was 36 ± 15 g
  • Average HbA1c was 5.67% ± 0.66%
  • 2% of respondents reported diabetes-related hospitalizations in the past year

My Current Approach And How It Compares

Using the Bernstein summary as a prompt, here is my current approach:

  • “Low-ish” carbohydrate: I do not count carbs but estimate I eat maybe 100-150g per day
  • I generally have a white coffee for breakfast, nothing regular for lunch (sometimes food, sometimes snacks, sometimes nothing), and dinner with the family which usually has no more than 50g per serving, but this is not a hard rule
  • Snacking happens when I want. It is small and I do not give it too much consideration
  • Little to no exercise
  • I use a commercial looping pump/cgm. No injections, no finger pricks
  • I do not declare any carbohydrates, do not bolus or boost; the loop takes care of it

In terms of the results I am getting, I have been looping for close to 12 months and my last HbA1c was 5.5%. Given I am not following Dr. Bernstein’s Diabetes Solution at all and getting superior results to the average participant in the Typeonegrit survey, over a shorter period of time, perhaps there is value in assessing a hybrid approach for even better results.

Simplifying Food

A big part of any summary of Dr. Bernstein’s Diabetes Solution involves the listing of forbidden and allowed foods. In the Diabetes Daily summary mentioned above, of the 5,700 words, 4,500 describe which foods can and cannot be eaten. That is over 3/4 of the description. In Dr. Bernstein’s Diabetes Solution, chapters 9, 10, 11, and 25 (roughly 120 pages out of 460 pages or a quarter of the book) cover food and its management. I think it is fair to say food management is a big part of Dr. Bernstein’s Diabetes Solution.

Two years after the last version of Dr. Bernstein’s Diabetes Solution came out, a company called Soylent appeared offering nutritionally complete meal replacements for time-poor people who do not like cooking. Other companies offer similar products, including Aussielent which also offer a low carbohydrate alternative (shown below).

A serving provides about a quarter of the body’s micro-nutrients. For macro-nutrients a serving provides:

  • 1700kJ (406 Cal)
  • 30.4g Protein
  • 26.9g Fat
  • 7.1g Carbohydrate (excluding fibre)
  • 5.4g Fibre

So, in theory, four servings a day will provide all the micro-nutrients the body needs. It passes the “less than 30g of carb per day” test of Bernstein and gives a total energy of 6,800kJ (1,624 Cal). The average adult requires between 8,700kJ – 10,500 kJ (2,000 – 2,500 Cal) per day to maintain a healthy weight (, so we have a deficit of at least 2,100 kJ (500 Cal). Also, the packet is clear in saying “Not to be used as a sole source of nutrition”. So, we can embrace the energy deficit and lose some weight or use it for snacking. As long as the snacks do not spike us we are good to go. There are plenty of foods which, as people with diabetes, we know we can eat without spiking. For me, I will be eating things like:

  • Home made protein balls (about 735 kJ/175 Cal each)
  • Cheese and crackers (516 kJ/125 Cal)
  • Water Chestnuts and Soy Sauce (about 190 kJ/45 Cal)

Drinks will be sugar free so it will be diet soft drinks, mineral water (soda water), sugar free cordial, and tea/coffee.

I also only have enough Aussielent for four days so this will be the length of the experiment.


There is no doubt exercise is good for anyone. I will not be changing my routine for the next four days though. Clearly, if there was a desire to make this a long-term venture, introducing exercise would be good. Keeping this as=is also removes it as a confounding variable in the results.

Measuring and Administering Insulin

I have no doubt the use of a CGM and a Pump, with looping, have been a big part of my success to date. The pump is watching my blood sugars every five minutes and making adjustments to move my levels towards my target (currently 5.4 mmol/L or 97 mg/dL). Unlike Dr. Bernstein’s Diabetes Solution, which relies on basal insulin (sometimes delivered in the middle of the night to counter dawn phenomenon), and injecting insulin into muscles, my loop has no reliance on me being awake, or “insulin hacking”.

Looping was not available when the last edition of Dr. Bernstein’s Diabetes Solution came out which is why he says “they do not measure what your blood sugar is and correct it automatically”. Today, they can, and are very, very effective at managing overnight and hormonal fluctuations.

How Will I Measure Success?

My plan is to document my baseline in this blog and then review afterwards and see what has changed.

Current weight: 112kgs (246 lbs)

Last Daily Insulin Amount: 84 Units

Diasend (

  • Average glucose: 7.2 mmol/L (130 mg/dL)
  • Standard Deviation 1.9 mmol/L (34 mg/dL)
  • Time in Tight Range (3.9 – 7.8 mmol/L aka 70 – 140 mg/dL): 65%

Sugarmate (

  • % in Range (daily TIR 3.9 – 10 mmol/L aka 70 – 180 mg/dL): 69%
  • Time Below Range: 7% / Time In Range: 67% / Time Above Range 26% (TIR)
  • Average 6.5 mmol/L (117 mg/dL)
  • Standard Deviation 2.3 mmol/L (41 mg/dL)
  • Median 6.2 mmol/L (112 mg/dL)
  • Coefficient of Variation 35% of mean
  • Highs: 7 Lows: 11
  • GMI: 6.1%

Tidepool (

1 week values

  • Time In Range (4.0 – 10.0 mmol/L aka 72 – 180 mg/dL): 88%
  • Time Above Range: 9.3%
  • Time Below Range: 3%
  • Average Glucose: 7.2%
  • Standard Deviation: 1.9 mmol/L aka 34 mg/dL


  • The lows are due to poor readings of the CGM on insertion, as confirmed by finger pricks (the only time I do them). For me, the G6 sensor reads low for the first few days after insertion
  • Variation between the reports is generally due to differing periods of review. For Diasend it was the last week of data, for Sugarmate it is written on the measure (some say 2 days even though I specified 3, I am not sure why this is the case), and Tidepool was one week.

Are You Planning To Continue With This Approach?

Only so much can be demonstrated over four days. My primary reason for doing this is to see if Aussielent meals are a viable option when I am travelling for work as I have less control over what I eat when at conferences or onsite with clients. Carrying some powder and olive oil while travelling is a relatively simple solution. However, if I can also develop some preliminary data combining looping technology and a very-low carbohydrate diet, this may be worth more analysis later either by me or other people curious to try different approaches.

I actually have no interest in pursuing a very-low carbohydrate regimen long term. The primary goal of Dr. Bernstein’s Diabetes Solution is normal blood sugars. My goal is to minimise maintenance as much as possible to reduce the risk of burnout i.e. a sustainable approach, and to minimise the risk of long term complications (which is not quite the same as normal blood sugars). What I mean by this is maintaining a sufficiently low HbA1c that clinical evidence suggests I am close to the same risk of long term complications as a non-diabetic and getting regular check-ups is enough for me; I do not need to obsess about every spike or deviation.

Also, I like going out to restaurants and eating meals as the chef intended; I enjoy eating in moderation, rather than fixating on forbidden and approved foods; I enjoy spending literally hours a day not thinking about diabetes management. I see no compelling reason to change any of this.

Where To From Here?

For the next four days, I will be following the “Improved Solution” and writing about it next weekend. I will also be getting blood work done towards the end of this week as I am seeing my endocrinologist soon. This will give me additional results which I will publish later.