My Dietician Appointment

[AM1874]

Had first appointment with Dietician today. She's a lovely young lady and seems to be keen and knowledgable. Just a shame that her knowledge was not particularly relevant to me. She spent about 20 minutes, with a beautiful coloured diagram, explaining all the do's and dont's of the "Eat Well Plate" and then asked me if I had any issues with it. I said - "Yes - the starchy carbohydrates". She then explained (another 20 minutes) that I should have no more than a "fist-sized" portion of rice, potatoes, pasta etc and maybe only 2 slices of bread - with low fat spead, of course. Then I told her that I don't eat bread (for several years), or rice or pasta (don't like them) or potatoes (given them up since diagnosis). I also told her that I have given up my 2 (sometimes 3) pints of lager a day, at which point she asked .. "well where do you get your carbs from"? So I showed her my food diary and my spreadsheets detailing my daily carb intake of around 40 grams. "That's a bit low .." she said, ".. we recommend between 130 - 150 grams" Then, to my surprise, she added a little pearl of wisdom .. "But don't worry, I won't be round checking your cupboards and, at the end of the day, it's all about what works best for you" .. WoW

Finally, we spoke about testing and I asked her why there was no support for strips or lancets from the Surgery. She then gave me what I assumed were the stock answers that she is told to churn out ...
# no need to test if you're on Metformin
# people test but don't really understand what they're doing or the results that they are getting (patronising ??)
# some people beome very upset by their high (?) readings and some even have to be treated for depression
And then she said "that's why we have stopped giving out meters and strips .. but the real reason is because it costs too much" Wow again ..

As I said, a lovely young lady doing a pretty pointless job .. but with a refreshing touch of realism and honesty

 

[kokhongw]

And they then insist that T2D is chronic and progressive...one can only wonder why that is so...

 

[Nicksu]

Had first appointment with Dietician today. She's a lovely young lady and seems to be keen and knowledgable. Just a shame that her knowledge was not particularly relevant to me. She spent about 20 minutes, with a beautiful coloured diagram, explaining all the do's and dont's of the "Eat Well Plate" and then asked me if I had any issues with it. I said - "Yes - the starchy carbohydrates". She then explained (another 20 minutes) that I should have no more than a "fist-sized" portion of rice, potatoes, pasta etc and maybe only 2 slices of bread - with low fat spead, of course. Then I told her that I don't eat bread (for several years), or rice or pasta (don't like them) or potatoes (given them up since diagnosis). I also told her that I have given up my 2 (sometimes 3) pints of lager a day, at which point she asked .. "well where do you get your carbs from"? So I showed her my food diary and my spreadsheets detailing my daily carb intake of around 40 grams. "That's a bit low .." she said, ".. we recommend between 130 - 150 grams" Then, to my surprise, she added a little pearl of wisdom .. "But don't worry, I won't be round checking your cupboards and, at the end of the day, it's all about what works best for you" .. WoW

Finally, we spoke about testing and I asked her why there was no support for strips or lancets from the Surgery. She then gave me what I assumed were the stock answers that she is told to churn out ...
# no need to test if you're on Metformin
# people test but don't really understand what they're doing or the results that they are getting (patronising ??)
# some people beome very upset by their high (?) readings and some even have to be treated for depression
And then she said "that's why we have stopped giving out meters and strips .. but the real reason is because it costs too much" Wow again ..

As I said, a lovely young lady doing a pretty pointless job .. but with a refreshing touch of realism and honesty

At which point we all fall off our chairs in laughter! You couldn't make it up!

 

[Chook]

Priceless! But it's great she was open to you low carbing and testing and didn't tell you off for being 'non compliant '.

Apparently the reason they use the metformin excuse is because they say you can't hypo while taking it so you don't need a meter. That is rubbish because I had several hypos in the first four years of taking it but, interestingly, none while I've been on this VLC / ketogenic way of eating even though I've had some quite low finger prick tests.

 

[Debzz_]

She sounded quite patronising - think I will avoid .... if ever ever it happens !

 

[Buttons11]

My DN offered to make me an appt with a dietician and I said no thanks. She said maybe next time I'll want to do it - don't think so

 

[Brunneria]

For a first appt, I think that is really quite good.

Will you be seeing her again? If so, there is plenty of room for you to show how WELL you are doing and allow for a bit more open discussion.

Although, to be frank, if anyone ever offers me an appt with a dietician, I don't think I will take them up on it.

 

[Mr_Pot]

I don't know why you would decline a consultation with a dietitian, after all you don't have to follow their advice. Even if you only learn one thing it would have been worth while. For example I found out that the tinned tuna I was eating didn't contain omega3 and I switched to mackerel. Also your record will probably show you declined and mark you as someone not trying to help themselves.

 

[carty]

I got sacked by a dietician because I was too skinny.!!!
CAROL

 

[Brunneria]

I don't know why you would decline a consultation with a dietitian, after all you don't have to follow their advice. Even if you only learn one thing it would have been worth while. For example I found out that the tinned tuna I was eating didn't contain omega3 and I switched to mackerel. Also your record will probably show you declined and mark you as someone not trying to help themselves.

I would probably decline because it would be a waste of my time and theirs. And maybe someone else could benefit from the appt who might need it more.

I had a routine blood pressure check at the surgery at few days ago. They had a sign up saying '517 missed appointments in the last 3 months - PLEASE cancel your appointment if you are unable to attend.'
This is a group surgery of 6 doctors.

I bet people would be a little more considerate if they were being charged for absenteeism.

And just imagine how many more appointments were wasted because they were attended, but served no useful purpose (like a dietician's appt where I just smiled and nodded, or they were unable to contribute suggestions for my less than 20g carbs a day ketogenic diet because it lies outside their official guidelines).

 

[DavidGrahamJones]

As I said, a lovely young lady doing a pretty pointless job ..

Only true when confronted by somebody whose body has different needs, and is pretty knowledgeable with it. Her job becomes more challenging when confronted by people who literally have absolutely no idea. Having said that, I wasn't taught anything about diet at school, I learned that myself because dietary advice was failing me 50 years ago, especially as I was a left prop for the school rugby team and people thought I should have a "healthy" appetite. I was always being brought extra pudding which is probably why, since leaving school, I have never been keen on puddings in any shape or form. Even 40 year ago (64 now) friends thought I was weird because I didn't eat pudding, cake, biscuits, not even chocolate.

I have long come to the conclusion that if insulin resistance was non existent then the "Eatwell plate" might be OK. From personal experience I can add that although I don't eat the carbs to convert to glucose for energy, my body does a pretty good job of converting protein and for all I know fats to do exactly the same thing

They have a one size fits all mentality and as we know, it doesn't work. At least she listened and didn't give you any grief, she sounds so nice it's probably not in her to give grief to clients (is that the word these days?)

 

[Chook]

I thought I was pretty knowledgeable about diet and nutrition (having dieted almost constantly based on the Eatwell Plate and calories in/calories out since I was 20 - without much success) so I think after I was cross questioned by my original DN she thought it wasn't necessary for me to go to a dietitian.

I suppose neither of us were to know that the best way for me to treat my diabetes is with a VLC / keto diet - and that Eatwell Plate diet was making me much worse. The VLC / keto way of eating is something I'd not really heard of before apart, of course, from the Atkins diet (which just about everyone medical that I've known has rubbished).

I'm so glad that I found this website and, like @Brunneria I'm pleased to have saved the NHS the cost and time of my dietitian appointment(s).

 

[walnut_face]

@AM1874 if I had known you had so much time on your hands last friday I wouldve asked you to cut my grass

 

[AM1874]

They have a one size fits all mentality and as we know, it doesn't work. At least she listened and didn't give you any grief, she sounds so nice it's probably not in her to give grief to clients (is that the word these days?)

Hi David ... I agree that advice to people who "know nothing" is more likely to be effective .. but it is the "one size fits all mentality" that I have difficulty with .. and my experience of being ignored and treated as a child .. all a bit patronising, in my opinion. And it's not just the Dietician .. when I told my Doc at a previous appointment that I had given up beer, stopped eating chips and potatoes and no longer ate any bread, her answer was (literal) "Well don't eat too many cream cakes" .. I didn't even bother telling her that I have not eaten any cake or biscuits for years. This is why I used the term "pointless" .. at least for me

 

[AM1874]

@AM1874 if I had known you had so much time on your hands last friday I wouldve asked you to cut my grass

And I'd have been happy to do it ..

 

[DavidGrahamJones]

Well don't eat too many cream cakes

Some might say that the cream is fine, just the cake. Like you I was never a "cake" person.

I think our relationship with our doctors can be very difficult because they don't know us and use their "people are all the same" attitude. We probably don't know them either, maybe it comes with time.

I was able to make it very clear to my doctors that I did not appreciate any "fat" innuendo, daft sayings like "enjoy your food" are "verboten". Suggestions of bariatric surgery have been met with laughter because I eat less than they have to anyway. I've been lucky with my 3 Drs. It might be because of the seven weeks it took to diagnose what turned out to be a burst appendix and peritonitis that I get a bit of slack, they're always nice to me. At Christmas I do wish the welsh doctor merry christmas and happy new year in welsh if I see her. Seems to work well.

 

[AM1874]

Some might say that the cream is fine, just the cake. Like you I was never a "cake" person.

I think our relationship with our doctors can be very difficult because they don't know us and use their "people are all the same" attitude. We probably don't know them either, maybe it comes with time.

I was able to make it very clear to my doctors that I did not appreciate any "fat" innuendo, daft sayings like "enjoy your food" are "verboten". Suggestions of bariatric surgery have been met with laughter because I eat less than they have to anyway. I've been lucky with my 3 Drs. It might be because of the seven weeks it took to diagnose what turned out to be a burst appendix and peritonitis that I get a bit of slack, they're always nice to me. At Christmas I do wish the welsh doctor merry christmas and happy new year in welsh if I see her. Seems to work well.

I am all for respecting and being nice to doctors (and most other people for that matter) and I agree with you that our relationship with our Doc can be difficult. Nevertheless it is a professional-client relationship that, in my case, is unlikely to be made any less difficult when the professional ignores what you say, treats you like a child and comes up with throwaway comments that have little to do with what has been discussed .. or tells you that there is no time left (after just 7 minutes) to discuss anything else because of "my duty to other patients that are waiting"
Don't get me wrong, though, I am quite prepared to go along with all of this and I am generally positive about what has happened since my diagnosis. But that's much more to do with the love of my family, my general attitude to life and the incredible support that I get from this forum, than it is to do with what I get from my Doc and other HCps at my surgery

 

[SueNSW]

or tells you that there is no time left (after just 7 minutes) to discuss anything else because of "my duty to other patients that are waiting"

Crikey sounds like we are very lucky with our public health system here in my part of Australia at least - despite the doom and gloom merchants who are suggesting it's in serious trouble!!

I've had two 1 hour sessions with the same dietician since diagnosis - and with massively improved levels have currently agreed not to continue regularly, but to know she is there if I have any questions. I'm not sure what the "official" line is here - but she immediately agreed with me on lowering carbs to be the way to go, and when at the second appointment, figures hadn't come down as low as I'd hoped made a number of suggestions for lowering the carb intake even further.

She did make the comment that it made a change to have a client who was actively taking control of things - and, it's hard to say this without sounding awful - but having seen the size of the ladies before and after me at the last appointment - could see the point she was making!!

 

[DavidGrahamJones]

Don't get me wrong,

Nor me, I'm not having a go, honest. I'm lucky with my GPs. I used to go to my local surgery 1/2 mile away, they sounded very much like yours, I "sacked them" LOL I have to drive for 20 minutes to get to my present surgery but worth it. I forgot to mention, my surgery have won awards for being the best in Bucks, probably why I like them.

 

[AM1874]

You have it sorted .. I'm pleased for you