First meeting with diabetic nurse

[dbr10]

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.

That's completely understandable. Unfortunately you have to steer you way through the conflicting and contradictory advice. Look at Dr Bernsteins Diabetes Solution and Jenny Rhule's Bloodsugar 101.

 

[dbr10]

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.

Good advice.

 

[dbr10]

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.

So, the DN needed more carbs then. Her brain was clearly suffering a malfunction - so much so that she could completely ignore the evidence in front of her.

 

[MikeTurin]

So, the DN needed more carbs then. Her brain was clearly suffering a malfunction - so much so that she could completely ignore the evidence in front of her.

http://guidelines.diabetes.ca/app_themes/cdacpg/resources/cpg_2013_full_en.pdf
From page 546

The current recommended minimum intake for CHO is not less than 130 g/day, to provide glucose to the brain (32). A systematic review and meta-analysis of controlled feeding studies in people with type 2 diabetes found that CHO-restricted diets (mean CHO from 4% to 45% of total energy per day) improved A1C and triglycerides (TG), but not total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) or body weight compared with higher-CHO diets over the short term (33). The long-term sustainability and safety of these diets, however, remain uncertain. Very-low-CHO diets may not ensure sufficient vitamin, mineral and fibre intake. It is recommended that the percentage of total daily energy from CHO should be no less than 45% to prevent high intakes of fat, as this is associated with reduced risk of chronic disease for adults (32). If CHO is derived from low glycemic index (GI) and high-fibre foods, it may contribute up to 60% of total energy, with improvements in glycemic and lipid control in adults with type 2 diabetes (34).

From what I can understand it's acceptable by these official guidelines to have a daily CHO intake of either 130 g or 45-60%

So I suppose that a reduced-carb mediterranean diet (130 g of carbs are 100g of pasta, 150 g of bread and 400 of fruits) will nicely fit in these guidelines even if ones eats eggs and cheese. An Atkins diet on the other hand could be different.


Still feel amusing the boilerplate response. Are DN consultants willing to be replaced by a shell script and a printer?

 

[Chook]

http://guidelines.diabetes.ca/app_themes/cdacpg/resources/cpg_2013_full_en.pdf
From page 546

From what I can understand it's acceptable by these official guidelines to have a daily CHO intake of either 130 g or 45-60%

So I suppose that a reduced-carb mediterranean diet (130 g of carbs are 100g of pasta, 150 g of bread and 400 of fruits) will nicely fit in these guidelines even if ones eats eggs and cheese. An Atkins diet on the other hand could be different.


Still feel amusing the boilerplate response. Are DN consultants willing to be replaced by a shell script and a printer?

I suspect that in the future it will be a robot - which, to be honest, won't make much

I wonder if they ever realise the damage they do. How many millions of people are eating exactly as instructed yet wondering why their T2 is progressing. Its so sad. They have a real opportunity to help people yet won't listen when we tell them their way doesn't work and we can prove it.

 

[MikeTurin]

I suspect that in the future it will be a robot - which, to be honest, won't make much

If one prefer the old technology a good book will suffice.

I wonder if they ever realise the damage they do. How many millions of people are eating exactly as instructed yet wondering why their T2 is progressing. Its so sad. They have a real opportunity to help people yet won't listen when we tell them their way doesn't work and we can prove it.

From what I can read what they are saying is wrong also following the official guidelines, like they have misunderstood what was written or didn't follow the updates on guidelines. When NICE gudelines are stating:

Provide individualised and ongoing nutritional advice from a healthcare professional with specific expertise and competencies in nutrition.

a boilerplate diet is not what is expected to give.


It's the same problem is generating antivaxxers and people that goes to follow a "miracle" cure. Because people likes to be heard and explain their problems. Giving a standard response that could be right for some people but not for everybody means that the cure will not work and worsen the condition. People start to distrust doctors and put them at the same level of pseudoscientific claims.

 

[pleinster]

While the general guidelines are less than ideal (understatement), not all medical professionals (including DNs) are that poor...and more should be engaging in up to date training (which, to be fair, needs updating itself). If some are aware of developments in management through diet (specifically in relation to substantially reduced carbohydrate intake), why not most (indeed why not all). Management of both care facilities and of nursing in general should be ensuring that nurses are up to date with training (particularly in the field they are operating in every day). The Minister responsible should be ensuring that this is so. Sadly, that's a lot of people just not doing their job properly while the "clients" are herded along. Again - if some can do it..every one of them should. Time needs to be made for this to happen...not sure though where it is all coming from and how badly organised it all is! Bottom line - no leadership.

 

[perry1960]

Morning all
Just an update went to see the diabetic/dietary nurse yesterday afternoon he has put me on a low crab diet..... The usual examinations I gather were carried out ie weight, height, blood pressure, examination of my feet including pulse reading?
What annoyed me (not the nurse) was when I requested a print out of my blood results that had been initially been done at the hospital when first diagnosed they could not be found? that being the case the diabetic nurse requested urgent blood test and urine samples done and I will get the results of the readings in 3 days

 

[Brunneria]

You could try writing to the hospital, and requesting a copy of their test results that way.
I have never tried this myself, but don't see why they should refuse.

I have recently requested that copies of my endocrinology clinic correspondence be sent to me as well as my surgery, and they have been cheerfully complying. This was because I didn't have a copy what the clinic had said to the doctor in letters. On one occasion the doc stopped some medication that I had been on for about 20 years, due to a rather odd interpretation of a clinic letter. It all got sorted, but it took another endocrinology letter and an appointment, which was all a waste of everyone's time and NHS resources. So I learned the hard way how important it is to keep in on the loop and not just assume that things will happen as expected.

I'm impressed they have put you on a low carb diet. That seems like a step in the right direction.

 

[Bluetit1802]

Morning all
Just an update went to see the diabetic/dietary nurse yesterday afternoon he has put me on a low crab diet..... The usual examinations I gather were carried out ie weight, height, blood pressure, examination of my feet including pulse reading?
What annoyed me (not the nurse) was when I requested a print out of my blood results that had been initially been done at the hospital when first diagnosed they could not be found? that being the case the diabetic nurse requested urgent blood test and urine samples done and I will get the results of the readings in 3 days

Blimey, that is a nurse to keep hold of for the future! He did all the right things, and did right to order more tests as the hospital ones have been lost. Well done that nurse!

Are you in England? If so, your surgery may put test results on-line as they were supposed to do before May 2016. Some surgeries haven't done this. It is worth you asking, and asking how to register for these.