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We are learning a lot about diabetes especially during

the past five to ten years. This accumulation of new


knowledge is both encouraging and at the same time very
challenging.
On the "challenging'' side:
Diabetes seems to be everywhere and steadily
increasing in its presence. Think about it 1 in 3 babies
born in 2000 will develop diabetes in their lifetimes. Every
day, about 1,400 people are diagnosed with diabetes in the
United States. And now no country in the world is free from
diabetes, and its growth.
We now do know how to prevent type 2 diabetes, but
today for type 1 diabetes, neither prevention nor a long-
lasting cure is available.
Once diabetes is present, good care based on solid
science now can prevent much of the devastation formerly
caused by elevated blood sugars. But there remains a
sizable gap between what we know to do and how well and
widely we are doing it. In other words, the "translation" of
diabetes science into daily practice still has a way to go.
Nonetheless, in spite of these and other important
challenges, we are all better prepared to deal with diabetes
in 2007 than we were even a few years earlier, let alone
decades ago. Remarkable progress has occurred. For
example, many people at high risk for type 2 diabetes do
not develop it. Modest weight loss and increased physical
activity have been shown to eliminate or at least delay the
development of this type of diabetes by 60-70 percent
regardless ofrace, ethnicity, or age.
In addition, for both types 1 and 2 diabetes, we now have
many more effective medications which, when taken
appropriately and in combination with proper nutrition and
activity, will result in controlled plasma glucose, blood
pressure, andblood fats with definite reduction in the
likelihood of eye, kidney, nerve, and heart problems. In
other words,while the goals of diabetes research still in
large part should be prevention or cure, even now the
devastation formerly caused by this condition does not
have tohappen!
Nowadays, too, we have better ways to follow and keep
track of diabetes with improved health care systems,
better educational programs, less painful self-monitoring of
blood sugars, more quickly available and accurate
glycosylated hemoglobin levels, ways to identify kidney
problems early, and so forth. We can know what is going
on!
So, in fact, we are actually seeing an improvement in
diabetes care in the United States, although not with all
people and not yet to an ad equate level or fast enough.
What does all this have to do with Dr. Bernstein and this
edition of Diabetes Solution 7. As mentioned earlier, the
rate of accumulation of new diabetes knowledge is quite
remarkable and daunting. Yet Dr. Bernstein stays on top of
it all. The care pattern for diabetes has be come much
more complex and demanding, and Dr. Bernstein and his
approach have proved equal to the challenge. In essence,
diabetes is in many ways "less easy" than in the past for
the patient or for his/her health care professional. There
are lots of nutritional approaches to consider, lots of
medications to be used in varying combination, and often
less time within a busy office practice to make all these
wonderful advances real and meaningful for people facing
diabetes. This newly revised edition presents the advances
in diabetes thinking and management with passion,
compassion, caring, and conviction. Certainly, for some
people, his approaches are not easy! But they do reflect
evolving medical science as well as his personal
experiences in managing his own diabetes. He does not ask
anyone to do anything that he himself would not do, and
for this I have respect and admiration. He is offering to
persons challenged by the presence or risk of diabetes a
way to be in charge of the disease. And he is ensuring that
important advances in diabetes science get out there now
to make a difference in people's lives. Take a look! Think
about the ideas and suggestions they can further our
mutual and ongoing effort to prevent, capture, and control
this disease called diabetes.
Estamos aprendendo muito sobre o diabetes -
especialmente durante os ltimos cinco a dez anos. Essa
acumulao de novos conhecimentos ao mesmo tempo
encorajadora e ao mesmo tempo muito desafiadora.
No lado "desafiador":
A diabetes parece estar em toda parte e cresce
constantemente em sua presena. Pense nisso - 1 em cada
3 bebs nascidos em 2000 desenvolvero diabetes em suas
vidas. Todos os dias, cerca de 1.400 pessoas so
diagnosticadas com diabetes nos Estados Unidos. E agora
nenhum pas do mundo est livre de diabetes e seu
crescimento.
Sabemos agora como prevenir a diabetes tipo 2, mas
hoje, para a diabetes tipo 1, nem a preveno nem uma
cura duradoura esto disponveis.
Uma vez que o diabetes est presente, o bom
atendimento baseado em cincia slida agora pode
prevenir grande parte da devastao causada
anteriormente por acares elevados no sangue. Mas
permanece uma grande diferena entre o que sabemos
fazer e quo bem e amplamente estamos fazendo isso. Em
outras palavras, a "traduo" da cincia do diabetes na
prtica diria ainda tem um caminho a percorrer.
No entanto, apesar destes e de outros desafios
importantes, estamos todos melhor preparados para lidar
com a diabetes em 2007 do que ramos at alguns anos
antes, muito menos dcadas atrs. Registaram-se
progressos notveis. Por exemplo, muitas pessoas em alto
risco de diabetes tipo 2 no desenvolv-lo. Perda de peso
modesta e aumento da atividade fsica foram mostrados
para eliminar ou pelo menos atrasar o desenvolvimento
deste tipo de diabetes em 60-70 por cento -
independentemente da raa, etnia ou idade.
Alm disso, para ambos os tipos 1 e 2 de diabetes, agora
temos muitos mais medicamentos eficazes que, quando
tomado adequadamente e em combinao com uma
nutrio adequada e atividade, resultar em glicose
plasmtica controlada, presso arterial e gordura sangunea
- com reduo definitiva na Probabilidade de problemas nos
olhos, rins, nervos e corao. Em outras palavras,
enquanto os objetivos da pesquisa de diabetes ainda em
grande parte deve ser preveno ou cura, mesmo agora a
devastao causada anteriormente por esta condio no
tem que acontecer!
Hoje em dia, tambm, temos melhores maneiras de
acompanhar e acompanhar o diabetes - com melhores
sistemas de sade, melhores programas educacionais,
menos auto-monitoramento doloroso de acares de
sangue, mais rapidamente disponveis e precisos nveis de
hemoglobina glicosilada, formas de identificar problemas
renais precoces , e assim por diante. Podemos saber o que
est acontecendo!
Assim, na verdade, estamos realmente vendo uma
melhora no cuidado do diabetes nos Estados Unidos,
embora no com todas as pessoas e ainda no a um nvel
ad equate ou rpido o suficiente.
O que tudo isso tem a ver com Dr. Bernstein e esta
edio de Diabetes Solution 7. Como mencionado
anteriormente, a taxa de acumulao de novos
conhecimentos de diabetes bastante notvel e
assustador. No entanto, o Dr. Bernstein permanece no topo
de tudo. O padro de cuidados para a diabetes tem sido
muito mais complexo e exigente, eo Dr. Bernstein e sua
abordagem tm se mostrado iguais ao desafio. Em
essncia, o diabetes , em muitos aspectos, "menos fcil"
do que no passado - para o paciente ou para o seu
profissional de sade. H muitas abordagens nutricionais a
considerar, muitos medicamentos a serem usados em
diferentes combinaes, e muitas vezes menos tempo
dentro de uma prtica de escritrio ocupado para fazer
todos esses avanos maravilhosos reais e significativos
para as pessoas que enfrentam diabetes. Esta edio
recm-revista apresenta os avanos no pensamento e
gesto do diabetes com paixo, compaixo, carinho e
convico. Certamente, para algumas pessoas, suas
abordagens no so fceis! Mas eles refletem a evoluo da
cincia mdica, bem como suas experincias pessoais no
controle de sua prpria diabetes. Ele no pede a ningum
para fazer qualquer coisa que ele prprio no faria, e por
isso tenho respeito e admirao. Ele est oferecendo a
pessoas desafiadas pela presena ou risco de diabetes uma
maneira de ser responsvel pela doena. E ele est
garantindo que os avanos importantes na cincia do
diabetes sair l agora para fazer a diferena na vida das
pessoas. D uma olhada! Pense sobre as idias e sugestes
- eles podem continuar o nosso esforo mtuo e contnuo
para prevenir, capturar e controlar esta doena chamada
diabetes.

I do not know of many diabeticswho developed the


illnessaround
the time I did, in 1946, who are still alive. I know of none
who do not suffer from active complications. The reality is,
had I not
taken charge of my diabetes, it's very unlikelythat I'd be
aliveand ac tivetoday.Many myths surround diet and
diabetes,and much of what is still considered by the
average physician to be sensible nutritional advicefor
diabeticscan, overthe long run, be fatal.
I know, because conventional "wisdom" about diabetes
almost
killed me.
I developed diabetesin 1946 at the ageof twelve, and for
more than
two decades I was an "ordinary" diabetic, dutifully
followingdoctor's orders and leading the most normal life I
could, giventhe limitations of my disease.
Over the years, the complications from my
diabetesbecame worse and worse, and like many
diabeticsin similar circumstances, I faced a
veryearlydeath.I was still alive, but the qualityof
mylifewasn'tpar
ticularly good. I have what is known as type 1, or insulin-
dependent, diabetes, which usually begins in childhood (it's
also called juvenile-onset diabetes). Type 1diabetics must
take daily insulin injections just to stay alive.
Backin the 1940s, whichwerevery much still the "dark
ages"of di abetes treatment, I had to sterilize my needles
and glass syringes by
boiling them every day, and sharpen my needles with an
abrasive stone. I used a test tube and an alcohol lamp
(flame) to test my urine for sugar. Many of the tools the
diabetic can take for granted today were scarcely dreamed
of back then there was no such thing as a rapid, finger-
stick blood sugar-measuring device, nor disposable in
sulinsyringes. Still, eventoday, parents of type 1diabetics
have to five with the same fear my parents lived with
that something could go disastrously wrong and they
couldtry to wakeup their childand discover him comatose,
or worse. For any parent of a type 1diabetic, this hs been
a real and constant possibility.
Because of my chronically elevated blood sugar levels,
and the inability to control them, my growth was stunted,
as it is for many juvenile-onset diabetics evento this day.
Back then, the medical community hadjustlearned
aboutthe rela tionship between high blood cholesterol and
vascular (blood vessel
and heart) disease. It was thenwidely believed thatthe
cause of high blood cholesterol was consumption of large
amounts of fat. Since many diabetics, even children, have
high cholesterol levels, physi cians were beginning to
assume that the vascular complications of
diabetes heart disease, kidney failure, blindness, et
cetera were caused by the fat thatdiabetics were eating.
Asaresult, I was put on a low-fat, high-carbohydrate diet
(45 percent of calories were to be carbohydrates) before
such diets were advocated by the American
Diabetes Association or the American Heart Association.
Because car bohydrate raises blood sugar, I had to
compensate with very large doses of insulin, which I
injected with a 10 cc"horse" syringe. These injections were
slowand painful, andeventually they destroyed all the fatty
tissue undertheskinof my thighs. Inspite of thelow-fat diet,
my blood cholesterol became veryhigh. I developed visible
signs of this state fatty growths on my eyelids andgray
deposits around the iris ofeach eye.
During my twenties andthirties, the primeof life for most
people, manyof my body's systems began to deteriorate. I
had excruciatingly painfulkidney stones,a stone in a
salivary duct,"frozen"shoulders, a progressive deformity
ofmy feet with impaired sensation, and more. I would point
theseout to my diabetologist (whowas then president of the
American Diabetes Association), but I was inevitably
told,"Don't worry, it hasnothingto do with yourdiabetes.
You're doing fine." But I wasn't doing fine. I now know
thatmost of these problems are com
monplace among those whose diabetes is
poorlycontrolled, but then I was forcedto acceptmy
condition as"normal."
By this time I wasmarried. I had gone to college and
trainedasan engineer. I had smallchildren, and eventhough
I wasnot much more than akid myself, I feltlike an old
man. I hadlost the hairon the lower parts of my legs, a sign
that I had developed peripheral arterial dis-