New NICE Diabetes Guidelines just out

[Southport GP]

We health care professionals are supposed to be guided by these - though they are not 'Rules that must be obeyed' This bit at the start caught my eye

'Treatment and care should take into account individual needs and preferences. Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals.'

Of course there was a lot of 'devil in the detail' later but it marks a significant movement towards partnership with patients which I thought the members of the forum should be alerted to. I hope in particular for those who find the low carb diet works it will mean the doctor or nurse should take more account of your wishes.

Cheers David

 

[Lamont D]

I must admit since my long talk with my GP after my diagnosis and following my endocrinologist to Manchester, he seems more receptive to low carbing and has told the wife (T2!) To lower her carbs significantly!

His understanding of my condition has alerted and awoke new interest in how to cope with diabetics within his surgery!
My dsn is also on board and can't believe the difference in my health because of low carb!

I don't think the guidelines go far enough, because the dietary advice is simply not applicable enough to most T2s! The report is still very conservative on its approach towards the role of carbs within a patient's particular problems and patients are being given meds where diet is an alternative and should be persuaded.

 

[Southport GP]

Speaking personally I like the idea of patients having a choice. I find that most folk prefer to try diet first rather than start lifelong medication and so often it works for them.

 

[SunnyExpat]

Mine was excellent in this respect, and indeed the advice given in the guidelines was followed to the letter.

'Dietary advice
Integrate dietary advice with a personalised diabetes management plan, including other
aspects of lifestyle modification, such as increasing physical activity and losing weight. [2009]'

I couldn't fault the NHS, and the individual HCP's I've met, so let's give a big 'thanks' to the partnership with patients we've received, it's definitely the way forward.

 

[mrspuddleduck]

I genuinely think it's a step in the right direction. My next wish is for 'joined up thinking' between the various specialists that my condition demands I see! (Sorry I've spent the last week on the phone between two health trusts, one if which is demanding a 12 hour fasting blood test and my local diabetes team who insist that as I'm a brittle Diabetic its too risky, they won't talk to each other, its left to me to act as go-between, they seem to forget I am a patient because I am ill! - and still no decision) Sue x

 

[donnellysdogs]

I've had one consultant in 30 years that believes in low carb and one DSN. They are fantastic and they lead by example.... Both are non overweight professionals ... So more believable when talking to them....

Sorry, The only other person interested in my eating habits was an overweight nurse telling me to eat carbs like porridge or toast... Affected me badly...

It will be great if consultants, gps' etc will consider that patients have a choice..and will offer different choices... Ie NOT just the eatwell plate.

I have great discussions with my Indian consultant regarding foods and also with my DSN regarding foods because she also has intolerances to pasta, bread etc. once in a while it is possible to come across such wonderful health care teams.

The difference with my health care team though (I believe) is because they can empathise from their own lives and experiences. That's what makes my hospital team special now. They know how grains adversely affect life.

 

[Daphne917]

For me it depends on what DSN I see - one was very interested in how different foods affected my BS and advised against eating too many carbs whilst another just advised against eating too much sugar and fat and suggested I eat low fat everything, brown bread, pasta, rice and jacket potatoes etc!

 

[SunnyExpat]

It's telling how little there is in the guidelines for those who successfully combat their diabetes.

'If adults with type 2 diabetes achieve an HbA1c level that is lower than their target and they are not experiencing hypoglycaemia, encourage them to maintain it. Be aware that there are other possible reasons for a low HbA1c level, for example, deteriorating renal function or sudden weight loss. [new 2015]'

I know the eatwell plate doesn't help, some HCP's attitudes don't help, but a lot must also be down to the group of patients that simply refuse to accept any change, and simply demand the NHS 'fix' them with no input from themselves.

 

[carol43]

Hope this information is given to my DN. She was shocked when I told her I was doing LCHF. I told her to look at my results but her answer was 'you must have carbs with every meal'. I gave up and don't think I'll see her next time my blood tests come around.

 

[tim2000s]

We health care professionals are supposed to be guided by these - though they are not 'Rules that must be obeyed' This bit at the start caught my eye

'Treatment and care should take into account individual needs and preferences. Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals.'

Of course there was a lot of 'devil in the detail' later but it marks a significant movement towards partnership with patients which I thought the members of the forum should be alerted to. I hope in particular for those who find the low carb diet works it will mean the doctor or nurse should take more account of your wishes.

Cheers David

This is just what Jonathan Valabhji was talking about when I spoke to him a couple of weeks back. Good to see in the guidance.

In summary, "listen to your patients"...

 

[Enclave]

To late for me .. I will never listen to trust my health team ever .. The new guide lines on testing and diet are still very wrong, so what else have they got wrong !

 

[Chook]

Hope this information is given to my DN. She was shocked when I told her I was doing LCHF. I told her to look at my results but her answer was 'you must have carbs with every meal'. I gave up and don't think I'll see her next time my blood tests come around.

That's what my GP says every time LC is mentioned.

 

[lindisfel]

Hi Dr.Unwin,
I believe your study is correct in saying LC diet reduces GGT.

In December 2014 I had already lost c 2stone in weight and my GGT had increased from 35 to 143. This was after a diagnosis of type 2 two years before, within a few months of diagnosis I got my Hba1c down from 50 to 45.

My GGT went up whilst I was dieting for those two years.... but I was not low carbing.
I thought the drug Warfarin had increased my GGT..I had to take a lot to get my INR correct..over 10mgs.
I stopped taking warfarin Jan 2015 and my GGT stabilised at 90-105 and was yo yo-ing up and down.
Since the novel anticoagulant Apixaban made me ill I went back on Warfarin in September this year and started on a LCHF diet. Since then my GGT has crept down and it recently went down from 83-79 in two weeks.
My weight has been stable for a few weeks at 90kg.. I'm very tall BMI c.23.

Interestingly since getting a meter I have realised I've got R.H. but not diagnosed by endo.
My Hba1c had been checked again recently and is still 45. ( In maths terms the area under the graph is the same but the peaks and troughs have gone by using an LCHF diet.

In my case it looks fairly obvious it is not weight causing high GGT but carbohydrates,

Theory: High Carb is proportional to insulin production, which is proportional to increased GGT.

Ironical for me and other R.H. people the insulin is also giving us hypos (mine occur during exercise) whilst loading our livers with fat.
regards
Derek

 

[lindisfel]

Hi,
It apparently takes a lot of evidence to correct an incorrect concept.
More evidence than is needed to establish a correct one in an open mind in the first place.

Given time things will change, I hope.

 

[ElyDave]

We health care professionals are supposed to be guided by these - though they are not 'Rules that must be obeyed' This bit at the start caught my eye

'Treatment and care should take into account individual needs and preferences. Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals.'

Of course there was a lot of 'devil in the detail' later but it marks a significant movement towards partnership with patients which I thought the members of the forum should be alerted to. I hope in particular for those who find the low carb diet works it will mean the doctor or nurse should take more account of your wishes.

Cheers David

Interesting but still does not seem to openly say low carb is a valid option.

I guess I'm lucky in that 1) I have zero interaction with my GP surgery Re T1 and 2) I have a very proactive, helpful DSN who has specialised in people like me who were athletic types pre diagnosis, want to keep that up and may also as a conseqence have a prolonged honeymoon, she recognises that each of us is experimenting but will give advice based on what she has seen work elsewhere, hence does not have a closed mind

 

[pmtbrew]

Just read the new guidelines and the statement 'quality of life' crops up very often.

Surely it's the job of the NHS to keep us healthy and should be telling us what our blood sugars should be to achieve no additional risk rather than giving us numbers which are likely to lead to complications?

 

[SunnyExpat]

Just read the new guidelines and the statement 'quality of life' crops up very often.

Surely it's the job of the NHS to keep us healthy and should be telling us what our blood sugars should be to achieve no additional risk rather than giving us numbers which are likely to lead to complications?

It's their job to help you keep you healthy.
They can do it only if you want to help them, because the main person that should care about your health is you.

 

[donnellysdogs]

Just read the new guidelines and the statement 'quality of life' crops up very often.

Surely it's the job of the NHS to keep us healthy and should be telling us what our blood sugars should be to achieve no additional risk rather than giving us numbers which are likely to lead to complications?

I read about quality of life a while back as it gets mentioned a lot in NICE statements.. Not just with diabetes.

It seems that it is expected that a patient with diabetes can only be say expected to achieve 80% quality of life compared to those without diabetes.... Same with other diseases. In orer to gain that 80% quality of life is it reasonable for an elderly person of 85 years with prediabetes to change their diet? To be honest I wouldn't if I was in that position.

These are just random figures and example but personally in older age I would agree.. Eg. A friends Mum ditched all her heart medications at 93 years of age. Saying she had had a good life and wasn't perpared to keep going through the side effects. Blow me down, she has just celebrated her 100th birthday!! With no meds for 7 years and a far better quality of life...for her and her family.

I think balance has to be gained...

 

[AndBreathe]

Quality of life is such a tricky thing.

Being devil's advocate; how many newly diagnosed folks (I'm considering mainly T2, as although I do read T1 threads, the majority of my interactions and my own experience is with T2) do we encounter who feel the diagnosis has already impacted upon their quality of life. Once one further overlays the concept of giving up carbs, they feel that will significantly degrade their quality of life.

The addictive nature of carbs can certainly influence how people feel about giving them up, never mind the challenges of living with in a family, and or just managing a busy life. Of course, once some of those folks experience the improved feelings of well being they often do, when their bloods moderate a bit, it's an easier concept to embrace.

I am not giving HCP's or anyone else a get out of jail free card, in terms of suggesting/promoting/encouraging a reduced carb diet, but at diagnosis, I am pretty sure they must encounter a fair bit of resistance - especially where testing isn't happening to provide the "in the moment" evidence of what's actually going on in the patient's system.

Interestingly, I had several enforced interactions with a new to me ANP at my surgery, for something non-diabetes related, but in the course of the 6-8 interactions we've talked about my diabetes experience, what I did, where I've ended up, and she is extremely interested. She was quite horrified, having watched the first "Dr in Your House" episode, by some of her personal misunderstanding of where carbs creep into notionally non-carb foods. Remember the carb content of the sausages he found the family were eating? As I met with her the very next day, she was then very keen to ask what resources I used for nutritional information of specific products, and so on.

Unfortunately, her interest was as much as a family woman, and how she manages her family diet, as she has no day-to-day role in the Practise management of diabetes. I've worked on her further since, and hope my personal diabetes education programme (going from me to my HCPs ) has made a tiny inroad. I think I'm probably going to drop off my remaining Trudi Deakin book for her, as I think it has a couple of nuggets in there.

Changing attitudes, actions and outcomes for diabetic care is no one act play. That's for sure, but we have to hold the line and keep the faith.

I've just booked in for my Crumblies NHS Health Check in a few weeks, I'm wondering what joys that will bring, but it's another educational opportunity, in both directions.

I'm also further developing how I communicate these things to both HCPs and just plain old other folks, so that I maximise the opportunities. I love a challenge.

 

[Southport GP]

Hi,
It apparently takes a lot of evidence to correct an incorrect concept.
More evidence than is needed to establish a correct one in an open mind in the first place.

Given time things will change, I hope.

Good point
I think its difficult as a health care professional to admit to being wrong , particularly when this involves going against 'guidelines'. But so often in science 'truth' will move on. Much of what today seems to be modern will be laughed at in 20 years time.

Steadily more and more doctors are contacting me to find out more about the low carb approach and give their patients the choice. The Royal College has just made me National Champion for Collaboration in Diabetes and Obesity -I hope to use this as an opportunity to encourage doctors to see a patient's priorities and choices are not always the same as the HCP but valid all the same.
Just last week i won 'NHS Innovator of the Year' for the North West. This would have been rather unlikely a few years ago!

Cheers