Seeing a dietitian next month but on LCHF

[pshuttle]

Hey everyone,

I have an appointment with an NHS dietitian next month, in the quest for a pump (my first appointment under the specialist team). I haven't seen one since first diagnosed, and have struggled with control of my T1D for years. About 18 months ago, after reading an increasing number of posts and articles I decided to try the LCHF lifestyle and it has been incredibly successful. I have briefly slipped a couple of times during these 18 months, into occasionally eating higher carb meals, and when I do this, my BS readings suffer horribly. I am living proof that LCHF works (for me anyway) and I am not prepared to go back to the NHS Eat Well advice.

I have read Think Like a Pancreas and The Diabetes Solution as well as countless online articles, and although I have not done any diabetes education courses, I taught myself to carb count three or four years ago using Bournemouth's Diabetes and Endocronology Centre's online course.

The question I have is, am I going to have a battle on my hands with the dietitian, or are they now a little more clued up on alternative advice regarding fat and carbohydrates?

Thanks!

Pete

 

[SunnyExpat]

As with everyone, it mainly depends how you treat them.
If you go prepared for a battle, you'll probably manage to have one.
I found mine were always happy to discuss anything that worked with me.
It didn't meant that had to agree though, but were happy to have an intelligent exchange.

 

[pshuttle]

Oh no, don't get me wrong, I am not a confrontational or aggressive person. Far from it! I am prepared to listen to sensible advice, I am just dreading the person not being able to deviate from the old fashioned mantra!

 

[noblehead]

Hi @pshuttle

Did your diabetes team say why you needed to see dietitian if all is well with your bg control?

The usual pre-requisite for moving on to a pump is meeting the NICE criteria or ABCD recommendations, the ability to carb count (and work out your insulin-to-carb ratio) and the willingness to learn and adapt to life using a insulin pump, I can't see your diet being an issue tbh as your bg/HbA1c results should speak for themselves.

Good luck and hope you get approved.

 

[CarbsRok]

Be honest with the dietician listen to what s/he says say thanks very much for the advice it's very much appreciated. Don't start a battle with him/her and be done with it. S/he could be checking that you know what you are doing carb counting wise as well and know the effect that proteins and fats have your insulin levels (doubt it though)

 

[CarbsRok]

Oh no, don't get me wrong, I am not a confrontational or aggressive person. Far from it! I am prepared to listen to sensible advice, I am just dreading the person not being able to deviate from the old fashioned mantra!

Sounds as if you have prejudged the apt already. Go with an open mind then you wont be disappointed.

 

[pshuttle]

Hi @pshuttle

Did your diabetes team say why you needed to see dietitian if all is well with your bg control?

The usual pre-requisite for moving on to a pump is meeting the NICE criteria or ABCD recommendations, the ability to carb count (and work out your insulin-to-carb ratio) and the willingness to learn and adapt to life using a insulin pump, I can't see your diet being an issue tbh as your bg/HbA1c results should speak for themselves.

Good luck and hope you get approved.

Thanks. My DSN thinks that doing a course such as DAFNE is a requirement to be considered for a pump. No idea if this is true, but obviously I am going to do what I can to try and improve my chances.

 

[CarbsRok]

Thanks. My DSN thinks that doing a course such as DAFNE is a requirement to be considered for a pump. No idea if this is true, but obviously I am going to do what I can to try and improve my chances.

People always think you have to do a course, you do not. All you have to do is prove that you can carb count and adjust your insulin. Some HCP's tend to read and interpret the NICE guidelines to suit themselves.

 

[noblehead]

Thanks. My DSN thinks that doing a course such as DAFNE is a requirement to be considered for a pump. No idea if this is true, but obviously I am going to do what I can to try and improve my chances.

Yes some clinics do insist that a person has completed a carb counting course such as DAFNE, it's been mentioned on the forum numerous times over the years.

However if you can demonstrate that you can get by without doing the course then I can't see it being a obstacle to you getting approved for a pump.

 

[pshuttle]

I am thinking I will attend a DAFNE or equivalent course if offered. The more knowledge I have, the better right?

 

[noblehead]

I am thinking I will attend a DAPHNE or equivalent course if offered. The more knowledge I have, the better right?

Oh yes, we never stop learning with this condition.

 

[Daibell]

Hi. I wonder why you are bothering to see a dietician as you probably know as much now as the dietician?

 

[CarbsRok]

Hi. I wonder why you are bothering to see a dietician as you probably know as much now as the dietician?

The reason being it's all part of the process for getting a pump

 

[Daibell]

The reason being it's all part of the process for getting a pump

OK and thanks. Good point.

 

[Jaylee]

Two pumpers I know tagged in that can help with the insight... @Mrs Vimes @Diamattic

... & belay any fears from the OP.

 

[Osidge]

Thanks @Jaylee

Regards

Doug

 

[Mrs Vimes]

Woohoo, pumper here and a low carber. I think it all depends on your care trust. I had to go on a Dafne corse even though I'd carb counted for ever. I twiddled with my fast acting insulin for years to correct and whatever. I always tested more than they thought I should. But before low carb I had a serious pizza and ice cream habit to control.

I ended up getting my pump because of Dawn Phenomenom. I kept phoning the DSN for advice over a 6 month period. I made myself 'known'. They knew me by my first name in the end, probably with the prefix "oh god it's her again".
I tested religiously to get evidence and used it. You have to show willing to test. I certainly did and still do.
Diet wise, my DSN is a lovely person. I'm considered a complete and flippin oddity. We argued over carbs in broccoli once. The consultant was there and just laughed.
At the end of the day they know about diabetes. They don't know the ins and outs of yours. Their work load is huge. I don't know where they have times to up date themselves. I show respect.

They are certainly not perfect. Knowing what I know now I look back on past advice and think ***. BUT I find politeness and having the blood sugars as proof gets you what you want.

Practice your nice smiley face! (And deep breathing) Get remembered for the right reasons - trying to control sugars and listens to advice. Not for being argumentative. (STAY LOW CARB. SHHHHHHH!) You can always say you don't like bread and the rest. My dietitian on the other hand was horrified - again very professional and lovely. dietitician referral has always been optional though.

 

[Diamattic]

I am not located in the UK, but I hope I can help a bit anyway.

I think there are a couple ways you can handle this visit -

The first an obvious one is just to play dumb. Don't call it a 'diet' just listen to what they have to say to you and answer their questions when they ask what you eat and when. If they ask why you eat that way (they may notice the low carb trend) just say 'I dunno, I just eat what i want, and thats just what i like eating, i never want anything else...' without mentioning that you're following a specific program, and see what happens. I have found that most people will look at your numbers and tell you not to change what isn't broken and let you be on your way.

The other way would be to tell them that you are following a specific diet for a reason - the problem this raises is that you are basically telling a professional that you are better at their job then they are and they will either be interested to learn and grow, or fight you on it - in either case its best that you are prepared to defend your new diet choices. I would suggest truly understanding the HOW it works, and WHY its healthy. This involves some prep work beyond just telling them you read a couple books. I would look into the scientific papers those books are based on and try to understand the mechanism behind why LCHF works and why it is still a healthy diet. If you prove that you really understand what you're doing they likely won't intervene as long as your healthy and getting good results. It couldn't hurt to bring the books, or journal articles with you and leave them a copy incase they decide to check your work.

If you have a good dietician they should be up to date on these things, if you get resistance then perhaps thats a sign you should be looking into new ones...