Dietitian talks of Carbohydrate Management!!!!!

[wallycorker]

Last night I attended the monthly meeting of the Rotherham Support Group knowing that the guest speaker was a dietitian. I fully expected to be coming home wound up and fuming after listening to more of the quite appalling "do not test" and "eat plenty of starchy carbohydrate" advice that has been given to me as a Type 2 in the nine years since I was diagnosed.

However, I was amazed that the entire talk related to carbohydrate management as a way to sort out a diabetic's problems of blood glucose control. Hallelujah!

I'm still not certain as to where this change of tack has come from but I certainly welcome it.

The dietitian brought along a lady patient who had been Type 1 diabetic for around 25 years. This lady had seen her weight balloon through using the conventional insulin injection techniques that are traditionally used to treat her condition. However, over the last 5 months after attending sessions on carbohydrate management she had attained a magnificent HbA1c of 5.6 - down from readings in near to - or in - double figures. What's more by following the techniques explained to her she had lost a massive five stones in weight in the same period of time. Yes five stones in five months - I am certain that is what she said - just through carbohydrate management or carb counting as it is sometimes known.

I hope this change of approach is something that is taking place nationwide and not just something that is happening in Rotherham. Moreover, I hope that it is because of pressures brought about through the power of forums such as this one.

Maybe, in the words of the song - "The times they are a changing!". I certainly hope they are!

 

[ally5555]

Wally - this post has caught my eye !!

I have never known anything but this approach - have always used carb counting if patients can grasp it and so have all my colleagues. I have often found it is the patients who do not see a Dietitian do not get this info! I have said this so many times on here!! that is the way dietitians are taught - it is nothing to do with forums I hate to tell you!

 

[cugila]

Hi Ally.

I know that info is given to Type 1's.
Is the same info given to Type 2's. Reason I ask is that one of my friends recently was diagnosed with T2 and was given the usual, 'eat plenty of starchy carbs advice etc....? Then sent on their way with loads of info just like I had 12 years ago ?

That was from one of your dietician chum's BTW.

Ken x

 

[wallycorker]

Wally - this post has caught my eye !!

I have never known anything but this approach - have always used carb counting if patients can grasp it and so have all my colleagues. I have often found it is the patients who do not see a Dietitian do not get this info! I have said this so many times on here!! that is the way dietitians are taught - it is nothing to do with forums I hate to tell you!

Hi ally,

That is certainly not the way diabetics have been educated in Rotherham over the last nine years - and even less so in Barnsley the PCT that I am covered by. I've attended a Desmond course in Rotherham and a similar course in Barnsley and neither of those courses included anything about carbohydrate counting or management.

I've seen loads of dietitians over the years and still do so on a regular basis - nearly all of them different from one meeting to another. In fact, in my experience, I've never understood the reason for such a big turnover - perhaps, it's me they don't like meeting.

Certainly, none of the dietitians ever answer my question as to why, as a Type 2, I am always - and have always been - advised to "eat plenty of starchy carbohydrate".

 

[gbtyke]

I can second that John, the dietician I saw at the Diabetic clinic in Barnsley Hospital gave me the carbs thing, then when I explained my diet she said "That sounds like Atkins" which it clearly was not as it was mostly vegetable based. I get grief now from my diabetic nurse for refusing to see the dieticians.

 

[AliB]

Yeah me too. The one and only time I ever saw a dietician put me off ever seeing one again. I don't need their advice - I know what is best for my body - why do they treat us as if we are all idiots?

Who says they are right anyhow? Everything is based on opinion. What gives them the right to say that their opinion is any better than yours? I don't have any letters after my name, or have spent any years going through University or Medical School - I was educated at the school of 'hard knocks'. I reckon that makes me just as qualified as the next person.

I am perfectly intelligent enough to have done all those things if I wanted and acquired all those bits of paper but for what? So I could be 'qualified' to dish out stupid - and even damaging, advice? (and believe me I've been given enough of that over the years)

My University is called common sense - and there ain't many who qualify from that one................

 

[jopar]

wallywonker

It's been around for a very long time...

Carb managment ws one of the first treatments with insulin avaiable, the problem was it was retricted and your quot work out for you... One of the biggest problems was, that the consultants when faced with some facing regular hypo's would automatically increase the carbs instead of which we see more common sense decreasing the insuline.. Leaving the poor diabetic gaining weight has they fed there insulin intake!

But now they've sussed this and giving the actual control to the diabetic, and training with cause such as DAFNE so we do the calculations has made so much difference for many people, not only with better control but also flexibility and being able to avoid or tackle weight issuse that one might be faced with...

The information for T2's is sort of there if you dig deep enough for it in the DUK lituture... But they don't take advantage of how we process information...

The first thing a T2 sees or hears, is plenty of carbs every meal... Which is so missleading, and in many cases the T2 doesn't follow through and see or hear, what comes next.. The carb amount required is based and calculated on your height, weight, age, sex and activity levels... Which has you all agree does actually make a lot of differece to the meaning 'plenty of carbs'

In truth it would be a lot better to deal with the amount of carbs that is suitable for the individuals requirements, then encourage that this is spread out over there meals to help with a steady blood. surgar level!!

And I know of no better way, to give some-one the motivation to make lifestyle changes than the good old BG meter, Even though weight loss is a motivator due not only due to a feel better aspect but achievement as well, but it tends to be slow and hiccups a long the way can effect motivation... The HbA1c is not only too far apart, but isn't reflective enough in many ways, but to be able to eat a meal, look at what your BG is doing.. So the nice tuna salad you had with only a couple of new potatoes does little to your BG, then you wyne a little give into tempation, on your next meal and decide to have fish and chips! Seeing your BG's rocket will sort of give you nudge to say, eh.. I don't want that to happen so I'm sticking to my tuna salad etc...

 

[catherinecherub]

I am a type 2 and have never seen a Dietitian or been offered an appointment. It is not something that I have ever needed.

I have a good G.P. and when I was diagnosed he explained about carbs and their relation to blood sugars. He suggested that G.I. management might be the way to go but he also explained about portion control. Just because a carb food has a low G.I. does not mean that you can eat vast amounts of it. He also recommended a book to buy that explains this method in great detail.

Seven years on and my control is good and I hope this continues. I know that my G.P. would help me if my control declined.

I think this thread highlights that diabetes education for the recipient is patchy and depends on where you live. I think the same can be said for all types of chronic illnesses.

Catherine.

 

[wallycorker]

Catherine - You certainly do seem to have been very lucky with your GP. You should be sure to take good care of him/her. Actually, I like mine too but I certainly never received that sort of attention. However, mine seems to have learnt something from what I have achieved by self-management over the last twelve months - he certainly seemed very surprised.

 

[wallycorker]

Jopar - very sensible all that!

 

[kegstore]

My health status is in the footer of this post. I am acutely aware of the need for diabetics to closely manage their carbohydrate intake, but as I have done this from first diagnosis, I've never had to make any drastic diet changes. On the very few occasions I've seen a dietician in the last 10 years I've gleaned some useful information that I wasn't already aware of, with one or two significant gems that were crucial in transforming my overall control. I was certainly glad of the opportunity to discuss my diet with a professional to ensure I wasn't making any terrible mistakes.

I have more respect for a professional with letters after their name than the opinion of someone without appropriate qualifications every time, and certainly acknowledge the years of study they have undertaken. But personal experience is also vital, and I don't necessarily think a professional is always right - I'm intelligent enough to form a balanced view based on information from a variety of sources. Assuming you know it all and don't need anyone's help seems a rather bizarre notion.

 

[hanadr]

I have been diagnosed 6 years and thank heavens I have a biology degree. I saw a dietician once who showed me a portion of rice about the size of my fist andd told me that was the guideline to use. I have never been offered any kind of course, because my PCT doesn't run them. It's me that has taught my GP and my Angel DSN about reducing/controlling carbs.
The PCT has a diabetes educator( in fact 2), but as far as I can find out, they don't educate patients.
My PCT( in the supposedly affluent Thames Valley) has the care of 14,000 diabetics of whom fewer than 50% achieve an Hb A1c of 7.5% or lower.
What are they going to do with the latest Quality and Outcome framework target of 6.5%?
They also don't allow routine strip prescription for non-insulin users. I buy my own, which I think is VERY UNFAIR> if I were a smoker or a drug addict, I could get treatment free.

And Keg I have a genuine B.Sc. Which I worked 4 years for and didn' buy on-line

 

[kegstore]

And Keg I have a genuine B.Sc. Which I worked 4 years for and didn' buy on-line

Glad to hear it Hana, although I never suspected otherwise! :wink:

 

[hanadr]

Unfortunately too many well known people including Gillian Mc keith got their degrees by the "easy" route. I think Barry Groves's Ph. D is "iffy" too. Bernstein is genuine, or he wouldn't have a license to practise.
Hana

 

[AliB]

I have more respect for a professional with letters after their name than the opinion of someone without appropriate qualifications every time, and certainly acknowledge the years of study they have undertaken. But personal experience is also vital, and I don't necessarily think a professional is always right - I'm intelligent enough to form a balanced view based on information from a variety of sources. Assuming you know it all and don't need anyone's help seems a rather bizarre notion.

I never meant to infer that I 'know it all', simply that I can't assume that so-called 'professionals' always do. Over my lifetime I have heard and read far more sensible stuff from people who don't have letters after their name. A student is only as good as his teacher, and many only follow what they themselves were taught without ever questioning it. They also may be tied by the constraints of the NHS or whoever they work for too, that even if they may think their advice is ****, they still have to give it! Those not under those constraints have far more freedom.

I think that whether you are 'professional' or not, common sense has a huge part to play in the dispensing of that advice. I like common sense.

As I have mentioned before, I had to educate my own Doctor about Coeliac Disease. She knew worse than nothing. I say worse, because what knowledge she, and probably more than half of those in the Medical Profession know about it is so limited and outdated, that is why it is estimated that only 1% of those with Coeliac Disease ever get diagnosed. Thousands of people are suffering because it has never been picked up.

I learned about it because 1) I have a vested interest in finding out, and 2) because I took the time and trouble to do copious research. Doctors get sent something in the region of 10,000 or more pieces of research every year. Do you think they read it all? Of course not, and to be quite honest, much of it is probably a waste of time anyway. What one piece will support another will negate much of the time. But I have taken the time and trouble to become an 'expert patient' for my own benefit.

There are good 'professionals' out there and if you have found one then you have a great support, but they are not gods and don't always get it right - sometimes they get it very very wrong. I wouldn't like to put an estimate on the amount of people who have lived a horrible life and died a needlessly early death because of wrong advice from professionals, or even worse, as so often happens, no advice at all. I can start the list with my parents, both of them.

I have spent the last 40 years dragging myself around. Doctors don't know why and they are not very interested in finding out either. There are thousands like me who are getting no answers from the 'professionals'. Is it any wonder that the Alternative Therapy business is doing so well?

At the end of the day, who better is there to trust than yourself (apart from God, if you believe in him!)? If Doctors always got it right then we would have such tremendous faith in them, but you know, and I know that doesn't happen. It's more like a game of Russian roulette as to whether you end up with the right treatment/diagnosis/support, etc.

Granted, not everyone is going to have the mental capacity to work things out for themselves and sadly they are then at the mercy of those who may or may not give them the help and support they need.

But for those who can, it is our life, and ultimately our responsibility. We only have one chance to get it right. Why completely absolve ourself of that precious responsibility and hand it over to someone else who doesn't know us and to whom we are just a number on a patient list, and a bit more money in the Health Trust coffers?

PS. After 4 months I'm still waiting for the Ultrasound. By the time I get the appointment I'll either be better, or dead. :|

 

[catherinecherub]

Ali.

You cannot blame the medics all the time.
We are diabetics and we want the best from our Dr's in controlling this disease. So does the cancer sufferer, the asthmatic, the mentally ill, the Aids or HIV sufferer, the arthritis sufferer,.... the list is endless. No Dr. can specialise in all subjects because then he wouldn't need to refer people on. Specialists don't know much about diseases and conditions that they don't specialise in so cut Dr's some slack.
Educating them about how we manage to gain control can only be a good thing for them and other diabetics and if your Dr. doesn't want to listen then it is time to move on.

Catherine.

 

[graham64]

The advice for T2s regarding carbs and BG control is virtually nil, the only information I got was to cut the sugars, reduce sat fats and eat plenty of starchy carbs. T1s are taught to carb count so the relationship between carbs and BG is recognised, but it seems this doesn't apply to T2s. Compare the advice given on this American diabetes education site to DUK/NHS dietary advice.

http://www.deo.ucsf.edu/type2/health-ma ... rates.html

Perhaps if this advice was given on the Desmonds course, it would result in a better understanding of the effects of carbs on BG control, this link shows that as far as HbA1c goes Desmonds does not deliver.

Conclusion A structured group education programme for patients with newly diagnosed type 2 diabetes resulted in greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but no difference in haemoglobin A1c levels up to 12 months after diagnosis

http://www.bmj.com/cgi/content/abstract/336/7642/491


Graham

 

[IanS]

Hi folks, I'm new to this forum and new to diabetes having been diagnosed T2 just over a month ago.

I seem to be luckier than most becasue my diabetes was picked up in a blood test before I had any symptoms (I had mentioned to my GP that virtually the whole of my mother's family was now diabetic). I also seem to have a fairly good PCT as I was given a blood glucose meter and my GP is happy to prescribe the lancets and test strips (which because I have a pre payment certificate, don't actually cost me anything extra).

However, to the point of this post. My first appointment with our practice diabetic nurse gave me (what I now understand to be) the traditional advice about reducing sugar intake but to eat starchy foods etc etc.

I was having problems getting my blood glucose under control (with record low of 5.6). For a day or two I would get good readings, but for it to go high a day or two later (with a record high of 12.6 ). I was having terrible trouble working out where the sugar came from (especially as I had discovered that half a tin of pears and a scoop of ice cream didn't even register). My diabetic nurse only gave me a target range of 4-8 mmol/l without qualifying it further than that.

It was on this forum that I discovered the truth regarding carbohydrates (actually 2 days ago) :idea: , so I put it into practice. In just 2 days my blood glucose has returned to 6.4 (morning fast). Now hopefully as I can now regulate the carbohydrate intake my blood glucose will take on some stability and I can achieve a sensible target (I'm aiming for the middle of that 4-8 range).

So my gratitude to this forum for solving a puzzle and showing me the way.

 

[wallycorker]

Hi Ian - It's good to meet you!

A great story that!. It's wonderful to read about someone diagnosed so early and on track right from the beginning. Also, for having a PCT that encourages Type 2s to test. I'm confident that you will soon have great control of you blood glucose levels and that will keep you away from the quite horrible diabetic complications that can come a diabetic's way.

Read my story - it is very different to your experience:

viewtopic.php?f=20&t=10512

However, I got there in the end once I decided to buy my strips and start testing.

Best wishes - John

 

[cugila]

It was on this forum that I discovered the truth regarding carbohydrates (actually 2 days ago) :idea: , so I put it into practice. In just 2 days my blood glucose has returned to 6.4 (morning fast). Now hopefully as I can now regulate the carbohydrate intake my blood glucose will take on some stability and I can achieve a sensible target (I'm aiming for the middle of that 4-8 range).

So my gratitude to this forum for solving a puzzle and showing me the way.

Hi Ian.

Excellent tale.

Spread the word about this forum to anybody you know who is a Diabetic. Take every opportunity to tell others about the good advice you have had from everybody on here. Advice that often goes against mainstream medical and dietary opinions - but that we Diabetic's know works.