First meeting with diabetic nurse

[Sam50]

Afternoon everyone,

Just back from accompanying Hubby to his first meeting with the diabetic nurse which went pretty much as I expected. She was running half an hour late then spoke at a hundred miles an hour going through her set 'spiel'.

We did succeed in getting his HBAIC result (only the third time of asking !) which back in the middle of June was 11. She wants him to get down to 4 but then said that 6 was 'normal'. Converting his latest BG reading from self testing he is at 10.2.
She then went through the expected talk on diet and exercise and printed off various diet sheets. At no point did she mention self checking of blood glucose levels and didn't seem particularly interested that he had his own monitor. He is to have another HBAIC test in 3 months.

Right at the end she said that she wanted to start him on Metaformin (no surprises there) beginning with one a day and going up to four so starting on 500mg and increasing to 2000mg. She said that the Metaformin would take 3 months to have any effects on his BG. Hubby does not intend to take any tablets all the time he can see that his BG is reducing via low carb dieting and exercise. If his BG levels start to stall or rise then he would of course take the meds.

Whilst talking about diet she said that you'must have carbs' in your diet ( no mention of how much) and to choose those with low GIs and to make sure that the diet was low calorie and that T2 was a lifetime condition. When I mentioned that people had reversed ( or well controlled) it by a low carb diet and got their levels back into the normal range I was ignored.

When I got home I read the diet sheets and I was gobsmacked how inaccurate they were. According to our practice it is perfectly okay to eat potatoes, rice is good and pasta is recommended. The nurse advocated eating bananas and biscuits (yes really !!) as long as they were oatmeal or Rich Tea.

I had to really, really bite my lip. There are people who would take those diet sheets away and follow them because a 'professional' had issued them and they still would not gain control of their blood glucose levels and just end up on more and more medication. We plan to carry on with the low carb diet and monitor the BG ourselves. We will soon know if it is working or not.

I'm very grateful to have found this forum and been able to do my own research before he had the appointment. Seems to me that the folk here are far better informed and better able to advise than our local surgery.

Thank you for reading !

 

[Guzzler]

Well done. Knowledge certainly is power.

 

[Bluetit1802]

We did succeed in getting his HBAIC result (only the third time of asking !) which back in the middle of June was 11. She wants him to get down to 4 but then said that 6 was 'normal'. Converting his latest BG reading from self testing he is at 10.2.

I'm not sure what the nurse actually said, but an HbA1c of 4% converts to an average finger prick check of 3.8mmol/l. I doubt any human ever achieves this. An HbA1c of 6% (42 in new money) is the highest point of non-diabetic. The NICE recommendation seems to be an HbA1c of 6.5% (48 in new money), which is the lowest point of the diabetic range.

We are all gobsmacked when we are given the NHS dietary advice. What you received is normal, and quite shocking. Personally I was told to cut out sugar (and I never did have much of a sweet tooth) but otherwise eat more or less normally making sure I ate plenty of wholemeal bread, and had a jacket spud with baked beans for lunch. I went away euphoric at the time because I didn't need to change a thing! I had a shock when I found this forum, but it is the best thing that could have happened.

It may help you to ask for a print out of your husband's test results. It should also include the results of any other tests he had, such as cholesterol, liver and kidney functions etc. GPs are too fond of filtering out information that could be useful, so seeing the results in black and white is the best way to go.

Well done for everything you are doing for your husband.

 

[Brunneria]

Well done.

When I was given a diet sheet by the nurse (this is several years ago now) it was quite astonishing.
Apparently I was supposed to eat brown carbs 3 times a day, up to 9 portions a day.
I hadn't been able to do that any day in the last 30 years, without indigestion, discomfort and feeling overloaded.

I threw the paper in the rubbish bin just outside the surgery door in the certain knowledge that I wasn't going to get any help there!

To be honest, if I included 3-9 portions of carbs in with my usual low carbing, I would have to reduce the vegetable portions just to fit the carb bulk in. There is only so much food I can eat in a day (one or two protein portions and 2-3 different types of salad/veg are the core of my daily diet). To subtract protein and veg to fit those carbs in would be detrimental to my blood glucose, my nutrition and my digestion.

What I find fascinating is the whole lala land these ideas come from.
enough protein
enough veg
all those carbs
and stay under the recommended daily calories? And fit it all in?
I just don't think it is possible, unless you are over 6 feet, athletic and an eating machine.

So people are filling up on nutrient poor processed carbs and skipping the important stuff, like protein, veg and healthy fats.
And then they get ill.

It ain't rocket science, is it?

 

[AM1874]

Hi @Sam50
Sadly, this is the usual experience of many people here. It continues to amaze me that this nonsense seems to go on .. and on ..
The Doc that I see is great but, in the main, I now learn from this forum (and my own research) and I employ a helpful little mantra when I am dealing with other HCPS ..
# Listen
# Nod
# Smile and say thankyou
# Ignore
.. works for me

 

[ringi]

I am 100% into low carb along with intermittent fasting, however I am taking Metaformin and am glad that I am. My view is that Metaformin is of great benefit as it reduces insulin resistance - but I stopped getting the **** side effects after 2 days. (If I got the side effects I would not take Metaformin)

 

[MikeTurin]

Just a curiosity: the sheet was a boilerplate sheet or was made after a personalized interview?
American Diabetes Association dietary advice endorses Mediterraean Diet

http://www.diabetes.org/mfa-recipes/tips/2011-09/the-basics-of.html
http://www.diabetes.org/mfa-recipes/about-our-meal-plans.html

(Take ADA guidelines as example - also Italian guidelines are different now)

 

[hh1]

Staggering & shocking, but also very sad. How many long term complications is the NHS setting people up for by dishing out this kind of nonsense? I wish someone somewhere with the power to make a difference would get hold of diabetes treatment by the scruff of the neck and sort it out. Even if HCPs don't want to endorse LCHF right now, at lease give people proper information about carbohydrate, how it affects BG and what options there are. I second everyone who says well done for what you're doing - keep it up and the people on this site'll be willing to help if you need it.

 

[dbr10]

Afternoon everyone,

Just back from accompanying Hubby to his first meeting with the diabetic nurse which went pretty much as I expected. She was running half an hour late then spoke at a hundred miles an hour going through her set 'spiel'.

We did succeed in getting his HBAIC result (only the third time of asking !) which back in the middle of June was 11. She wants him to get down to 4 but then said that 6 was 'normal'. Converting his latest BG reading from self testing he is at 10.2.
She then went through the expected talk on diet and exercise and printed off various diet sheets. At no point did she mention self checking of blood glucose levels and didn't seem particularly interested that he had his own monitor. He is to have another HBAIC test in 3 months.

Right at the end she said that she wanted to start him on Metaformin (no surprises there) beginning with one a day and going up to four so starting on 500mg and increasing to 2000mg. She said that the Metaformin would take 3 months to have any effects on his BG. Hubby does not intend to take any tablets all the time he can see that his BG is reducing via low carb dieting and exercise. If his BG levels start to stall or rise then he would of course take the meds.

Whilst talking about diet she said that you'must have carbs' in your diet ( no mention of how much) and to choose those with low GIs and to make sure that the diet was low calorie and that T2 was a lifetime condition. When I mentioned that people had reversed ( or well controlled) it by a low carb diet and got their levels back into the normal range I was ignored.

When I got home I read the diet sheets and I was gobsmacked how inaccurate they were. According to our practice it is perfectly okay to eat potatoes, rice is good and pasta is recommended. The nurse advocated eating bananas and biscuits (yes really !!) as long as they were oatmeal or Rich Tea.

I had to really, really bite my lip. There are people who would take those diet sheets away and follow them because a 'professional' had issued them and they still would not gain control of their blood glucose levels and just end up on more and more medication. We plan to carry on with the low carb diet and monitor the BG ourselves. We will soon know if it is working or not.

I'm very grateful to have found this forum and been able to do my own research before he had the appointment. Seems to me that the folk here are far better informed and better able to advise than our local surgery.

Thank you for reading !

Stick to your guns and throw those sheets away. That diet advice kills diabetics.

 

[dbr10]

I'm not sure what the nurse actually said, but an HbA1c of 4% converts to an average finger prick check of 3.8mmol/l. I doubt any human ever achieves this. An HbA1c of 6% (42 in new money) is the highest point of non-diabetic. The NICE recommendation seems to be an HbA1c of 6.5% (48 in new money), which is the lowest point of the diabetic range.

In my opinion, HCPs take the 48mmol number as a minimum. It should be a maximum!

 

[Jay-Marc]

In my opinion, HCPs take the 48mmol number as a minimum. It should be a maximum!

Indeed - mine just can't believe it when I keep getting round about 34 mmol/mol each time, when I was diagnosed at 107 mmol/mol. I can only imagine it isn't something they are used to.

 

[Sam50]

I'm not sure what the nurse actually said, but an HbA1c of 4% converts to an average finger prick check of 3.8mmol/l. I doubt any human ever achieves this. An HbA1c of 6% (42 in new money) is the highest point of non-diabetic. The NICE recommendation seems to be an HbA1c of 6.5% (48 in new money), which is the lowest point of the diabetic range.

We are all gobsmacked when we are given the NHS dietary advice. What you received is normal, and quite shocking. Personally I was told to cut out sugar (and I never did have much of a sweet tooth) but otherwise eat more or less normally making sure I ate plenty of wholemeal bread, and had a jacket spud with baked beans for lunch. I went away euphoric at the time because I didn't need to change a thing! I had a shock when I found this forum, but it is the best thing that could have happened.

It may help you to ask for a print out of your husband's test results. It should also include the results of any other tests he had, such as cholesterol, liver and kidney functions etc. GPs are too fond of filtering out information that could be useful, so seeing the results in black and white is the best way to go.

Well done for everything you are doing for your husband.

That's a good idea to ask for a print out of test results. He is having more blood tests on Thursday and back next week for the results so I will ask for that then. They forgot to check for kidney/thyroid and cholesterol when they tested in June......Still shaking my head over those diet sheets !!

Just before he went he read Dr Michael M

Just a curiosity: the sheet was a boilerplate sheet or was made after a personalized interview?
American Diabetes Association dietary advice endorses Mediterraean Diet

http://www.diabetes.org/mfa-recipes/tips/2011-09/the-basics-of.html
http://www.diabetes.org/mfa-recipes/about-our-meal-plans.html

(Take ADA guidelines as example - also Italian guidelines are different now)

the diet sheets were printed off the West Sussex Health Authority web page-same advice which is given out to everyone. One size fits all approach.Yes a Mediterranean diet with low carb seems the basis of the way to go x

 

[leslie10152]

Afternoon everyone,

Just back from accompanying Hubby to his first meeting with the diabetic nurse which went pretty much as I expected. She was running half an hour late then spoke at a hundred miles an hour going through her set 'spiel'.

We did succeed in getting his HBAIC result (only the third time of asking !) which back in the middle of June was 11. She wants him to get down to 4 but then said that 6 was 'normal'. Converting his latest BG reading from self testing he is at 10.2.
She then went through the expected talk on diet and exercise and printed off various diet sheets. At no point did she mention self checking of blood glucose levels and didn't seem particularly interested that he had his own monitor. He is to have another HBAIC test in 3 months.

Right at the end she said that she wanted to start him on Metaformin (no surprises there) beginning with one a day and going up to four so starting on 500mg and increasing to 2000mg. She said that the Metaformin would take 3 months to have any effects on his BG. Hubby does not intend to take any tablets all the time he can see that his BG is reducing via low carb dieting and exercise. If his BG levels start to stall or rise then he would of course take the meds.

Whilst talking about diet she said that you'must have carbs' in your diet ( no mention of how much) and to choose those with low GIs and to make sure that the diet was low calorie and that T2 was a lifetime condition. When I mentioned that people had reversed ( or well controlled) it by a low carb diet and got their levels back into the normal range I was ignored.

When I got home I read the diet sheets and I was gobsmacked how inaccurate they were. According to our practice it is perfectly okay to eat potatoes, rice is good and pasta is recommended. The nurse advocated eating bananas and biscuits (yes really !!) as long as they were oatmeal or Rich Tea.

I had to really, really bite my lip. There are people who would take those diet sheets away and follow them because a 'professional' had issued them and they still would not gain control of their blood glucose levels and just end up on more and more medication. We plan to carry on with the low carb diet and monitor the BG ourselves. We will soon know if it is working or not.

I'm very grateful to have found this forum and been able to do my own research before he had the appointment. Seems to me that the folk here are far better informed and better able to advise than our local surgery.

Thank you for reading !

HI @Sam50. I know what it is like to be innundated with contradictory information. The forum provides good information without hearsay or biased content, it takes the confusion out of how to manage diabetes.

 

[perry1960]

Gulp got my first meeting with a dietary/diabetes nurse tomorrow afternoon would have done what they advised but after reading this not so sure?. only 4 days in from diagnosis and I am confused enough as it is.

 

[Daibell]

Hi. I think many of us are appalled at the diet advice given by the NHS to diabetics. It remains incomprehensible that the NHS we fund can offer advice that will make your condition worse but sadly that's where we are. It makes you distrust any advice given by GPs/DNs. So, go for the low carb diet and aim for an HBa1C of 6.5% as a good target; a bit lower if you can.

 

[MikeTurin]

Gulp got my first meeting with a dietary/diabetes nurse tomorrow afternoon would have done what they advised but after reading this not so sure?. only 4 days in from diagnosis and I am confused enough as it is.

Maybe you can go prepared, with diet advices from reputable sistrs like american diabetes associatipn, diabetes Canada, this diabetes.co.uk and diabetes.org.uk.
I think if one arrives prepared to the appointment will at least get more precise infos or at least an amusing reaction.

 

[pleinster]

Gulp got my first meeting with a dietary/diabetes nurse tomorrow afternoon would have done what they advised but after reading this not so sure?. only 4 days in from diagnosis and I am confused enough as it is.

Hi Perry...don't worry. Everybody has to figure it out for themselves to some extent. If you haven't got a self-testing meter yet by all means ask for one but don't be surprised if you are hit with the usual rubbish about not needing to do that. Most type 2s on the site will tell you how important tool the meter is. Buy one if you have to...and you will soon see if you keep written notes on the levels you get and the food you eat just what works for you as an individual. Personally, if I could do things differently at first I would have spoken to the doctor about trying to control blood sugars through diet alone for a while before trying any meds. Hopefully, your nurse will be better than the usual...but whatever you are told, use the site for support and advice..lots of experience here.

 

[Sam50]

Gulp got my first meeting with a dietary/diabetes nurse tomorrow afternoon would have done what they advised but after reading this not so sure?. only 4 days in from diagnosis and I am confused enough as it is.

Hi Perry1960 good luck for your appointment but I would be guided by what other members here on the forum tell you. After all they are the ones living with the condition and the NHS seems to issue a lot of incorrect information. If you haven't already done so, buy yourself a BG monitor so that you can check your own levels. It's the only way to really know where you are at and a 3 month HBA1C test on it's own is not enough. Low carb diet as all carbs turn to glucose once they are digested.

Everyone on here is so kind and helpful so don't be shy about asking questions.

 

[Chook]

It makes me quite angry - I do know of several diabetics following the recommended dietary guidelines who are being prescribed more and more medication with no dietary advice that is likely to lower their BG.

There is only one medical centre in this village so the diabetics I know have got the same DN as me. This is the woman who looked at my HbA1C result (which was 29 / 4.9- lower than pre-diabetes level) and asked me how I had done it. I explained briefly about low carb and she did this really theatrical sigh and told me that we have to have carbs at every meal for our brains to work. I said mine seemed to be working fine despite two years of low carb..... she ignored that and said we need carbs at every meal and that if (if??) they raised my BG she would prescribe insulin for me. I said I've already been prescribed insulin but don't use it - and she asked me who had given me permission to come off the insulin. Permission??? Its my body! So she just carried on with her script - telling me I need to eat snacks - 3 meals and 3 snacks a day. I didn't like to mention about 24 hour fasting....

I think they lose sight of their role which is supposed to be SUPPORTING us with our T2.

 

[dbr10]

Indeed - mine just can't believe it when I keep getting round about 34 mmol/mol each time, when I was diagnosed at 107 mmol/mol. I can only imagine it isn't something they are used to.

It probably just does not compute. We do seem to be dealing with some people just following instructions robotically and without question. Mine's 34 too; but it wouldn't be if I took NHS advice.