Dietician

[Cinderella]

Have had my first appointment with dietician today. Was diagnosed T2 in December 2012. Am on 1 x 30mg gliclazide tablet a day at breakfast. Dietician went through my typical day's diet and she doesn't think I eat enough and also thought I ate too healthily (can you actually do that??). As I have lost quite a lot of weight (from 8st 40z down to 6st 12oz) she asked me what weight I would like to be (told her 7st 4oz don,t know why, question took me a bit by surprise) She thought that sounded OK. I only eat 1 small slice of wholemeal bread at lunchtime but she said I should eat 2. Explained had tried this but BG level at 11.2 two hours after eating. She suggested I should eat the level of food I wanted to (within reason of course!) and then show my BG levels to the nurse and ask her to give me medication to allow me to eat that level of food. I may not have correct understanding but from comments on this forum I thought medication only lowered BG by a small amount and it is what we eat that has the biggest effect on BG control. She wants me to do this for a month. I really can't cope with the thought of allowing my BG levels to go wild for a whole month. She is going to write a letter to my GP and practice nurse to explain all this but I really can't do it. I am willing to have meds reviewed and then try changing diet but not the other way round. Is there really a pill that can allow a diabetic to eat normally and still maintain good BG control? If so where do I sign up! I find this quite difficult to understand. Not sure what GP/nurse will make of it. Any one got any suggestions please?

Cinders

 

[Daibell]

Hi. Confusing isn't it. I suspect the dietician doesn't really understand diabetes very well and really does assume there are magic pills that can match any diabetes need; I wish (which is why I'm now on insulin). First, are you quite young as well as not being overweight; let us know if so. It may that your very low Gliclazide dose could be increased to match higher carb intake but that would not last forever as Gliclazide works by stimulating a pancreas that isn't performing at 100%. Some say, but there isn't hard evidence, that Gliclazide can accelerate pancreatic decline so best not to have more than needed. Yes, you must control you blood sugars within the NICE range, hence to increase your carbs you would need to try increasing the Gliclazide following discussion with the GP and checking levels with a meter 2 hours after a meal. So, in summary, I think you have a better understanding of diabetes than the dietician.

 

[Cinderella]

Thanks Daibell for your response. No, i am not young, am 59 but i am petite 4ft 10 (well almost!!). My concern about an increase in my gliclazide is whether it would cause me to have hypos, which I haven't had so far (thankfully). Have also heard about stimulating the pancreas and wearing it out quicker but as you say there doesn't appear to be any hard evidence as such as far as I know but I am fairly new to this so i wouldn't like to comment either way. I think i will wait to see if the GP surgery contact me after receiving the letter and if not I'll just carry on as I am. My hba1c result was 7.2 which is still a little high really but the nurse thought it was very good as my original one was 10.9 so I can see why she thinks it is a good improvement. I would like to get it a bit lower but I don't know if i can achieve it, will do my best.

Cinders

 

[Cinderella]

Thanks Daibell for your response. No, i am not young, am 59 but i am petite 4ft 10 (well almost!!). My concern about an increase in my gliclazide is whether it would cause me to have hypos, which I haven't had so far (thankfully). Have also heard about stimulating the pancreas and wearing it out quicker but as you say there doesn't appear to be any hard evidence as such as far as I know but I am fairly new to this so i wouldn't like to comment either way. I think i will wait to see if the GP surgery contact me after receiving the letter and if not I'll just carry on as I am. My hba1c result was 7.2 which is still a little high really but the nurse thought it was very good as my original one was 10.9 so I can see why she thinks it is a good improvement. I would like to get it a bit lower but I don't know if i can achieve it, will do my best.

Cinders

 

[DocBinChat]

Cinderella I feel that you have got it right. If you eat more you will need higher dose of Gliclazide, you will then put on weight. Eat less, move more, maintain your lower weight. If you eat more carbohydrate, you post meal sugar will shoot up.


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[Sketcher]

Hello Cinderella. Why eat more carb? Why not eat more cheese, nuts, oily fish and other good fatty stuff? That will give you more calories without spiking your blood glucose. I was on Gliclazide but through low carbing I am now off it, and maintaining normal-ish BG levels.


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[Cinderella]

Thanks for your responses. I do eat cheese and quite a lot of nuts and most of my carbs are in the form of vegetables. I just struggle a bit with what to eat for lunch at work so usually have a sandwich made with one small slice of wholemeal bread with meat or fish filling BG is usually OK with this. Wud just like to increase weight a little to make it easier to find clothes that fit. It's never been easy being so small but now is even more difficult. However prefer to keep BG as good as possible even if it means more difficulty in finding clothes!

Cinders