How irresposible are the current diet NHS guidelines for T2 and pre diabetics?

[Resurgam]

I was at 41 six months ago - the doctor lost all interest three months before that - when I was at 47 - I will have to wait for the time to pass and some routine test pinger to go off somewhere to try to get any further results.
I would think that Hba1c readings in the 30s would not be problematic for me, and I am hardly abstemious.

 

[derry60]

At the second diabetes education session I went to there was a couple there, and the man was really ill - I tried to get over the idea of low carb, but the 'educator' was constantly overriding what I said about eating low carb, and delayed me leaving to be weighed, so I could not speak to them on the way out.
They were not there on the third session, and I am not optimistic about the outcome for the man - I had taken along a book on the Atkins diet to give to the wife, in the hope of it being some help.
Where I go to band practice on Mondays is the communal room of an assisted living complex. One of the people there is a diabetic who has lost his legs and eyesight due to poor control - he happily eats the foods provided, all high carb but low sugar, as advised by the dietician. Sometimes he is brought down to listen to us, in his wheelchair.

: (

 

[Brewers23]

Please do not criticise your practice nurse for not following anything other than the official NICE guidelines for the simple reason to do anything else would mean that they would lose their professional registration with the Nursing and midwifery council as they’d be in breach of their code of professional conduct, with a subsequent loss of their job;however, a GP can go against such guidelines if they’re convinced there is a valid clinical justification for doing so. My GP is in favour of LCHF diets as she’s aware of the advantages and says that the NHS guidelines need to be updated.

 

[bruciebonus]

When my mother was diagnosed T2 about 40 years she was told to drastically reduce carb intake, I can clearly remember her saying how, potato, rice, bread etc. She could eat, and it was very little, so something's changed,

 

[woodywhippet61]

Please do not criticise your practice nurse for not following anything other than the official NICE guidelines for the simple reason to do anything else would mean that they would lose their professional registration with the Nursing and midwifery council as they’d be in breach of their code of professional conduct, with a subsequent loss of their job;however, a GP can go against such guidelines if they’re convinced there is a valid clinical justification for doing so. My GP is in favour of LCHF diets as she’s aware of the advantages and says that the NHS guidelines need to be updated.

They don't need to tell people to eat grapes or bananas. They don't need to shout at patients just because they've chosen to NOT listen / act on the advice that they (have) to give out.

They also do not have to tell T2's not to test.

 

[Sheila6960]

Thank you so much to all the posters in this thread. It has been SO helpful to read what you’ve all written! I am completely lost and bewildered by it all!! I am a 63 year old obese lady recently diagnosed a DT2 (three weeks ago) but with a level of 48. I was already completely convinced of the poison of sugar, so I gave it up and have been following advice from a Keto Facebook group where I have learnt SO much. I want to follow a LCHF diet and need to know and understand so much more But - I’ve now attended two diabetes education sessions and they are just unspeakably terrible and disempowering. I tried to say that high fat works, but, like someone else here, I was treated like a naughty child. In week 1 I refused to be weighed. I couldn’t see the point of it. Getting weight triggers me emotionally so not worth the following pain. Whether you’re 17 stone or 19 stone or whatever - why do they need to know?

I read somewhere that the brain can function well on fat, but was told today in the diabetes education session that the brain has to have carbs to function - this is just NOT true. I’ve been doing low carb for a couple of weeks, and I feel so much better. My sugar levels are low - I take my own readings - I tend to get my highest levels in the morning (!!) and they’re average 7.5mmol. I don’t know why they’re that high as I don’t eat after 8pm, and generally take my fasting reading about 10.00am next day.

So sorry this post is so disjointed but I am feeling so upset that I’ve been treated like an idiot at the Education session. Thanks for reading this, any advice greatly appreciated. Thank you.

 

[bulkbiker]

So sorry this post is so disjointed but I am feeling so upset that I’ve been treated like an idiot at the Education session. Thanks for reading this, any advice greatly appreciated. Thank you.

No need to apologise.. a lot of us have been treated exactly the same by HCP's.
However we are the one's living with and controlling our condition and as you rightly say we know better than them what helps. Sounds like you are well on the way to great control.
As for high morning readings check out "dawn phenomenon" in the search bar at the top of the forum page and prepre to be amazed.
It will all work out for you so keep calm and keto on!

 

[Sheila6960]

Thank you bulkbiker

 

[woodywhippet61]

So sorry this post is so disjointed but I am feeling so upset that I’ve been treated like an idiot at the Education session. Thanks for reading this, any advice greatly appreciated. Thank you.

It's appalling that you have ended up feeling like this. These are HCP's delivering these education sessions how does it help people if they are made to feel so upset. Reading your experiences I am glad that I didn't go to the education sessions that I was offered.

It's bad enough to be diagnosed because it really, really throws us. I am a 62 year old once was obese woman and I would have been horrified by being asked to weigh at one of these sessions. I can see no reason for it except to humiliate. I say once obese because I have lost lots of weight. I ate to my meter and changed my diet to low carb and the weight fell off me. This week I made it into the overweight category on the NHS BMI calculator.

Enjoy the diet, I am sure that you will.

 

[Brewers23]

Thank you so much to all the posters in this thread. It has been SO helpful to read what you’ve all written! I am completely lost and bewildered by it all!! I am a 63 year old obese lady recently diagnosed a DT2 (three weeks ago) but with a level of 48. I was already completely convinced of the poison of sugar, so I gave it up and have been following advice from a Keto Facebook group where I have learnt SO much. I want to follow a LCHF diet and need to know and understand so much more But - I’ve now attended two diabetes education sessions and they are just unspeakably terrible and disempowering. I tried to say that high fat works, but, like someone else here, I was treated like a naughty child. In week 1 I refused to be weighed. I couldn’t see the point of it. Getting weight triggers me emotionally so not worth the following pain. Whether you’re 17 stone or 19 stone or whatever - why do they need to know?

I read somewhere that the brain can function well on fat, but was told today in the diabetes education session that the brain has to have carbs to function - this is just NOT true. I’ve been doing low carb for a couple of weeks, and I feel so much better. My sugar levels are low - I take my own readings - I tend to get my highest levels in the morning (!!) and they’re average 7.5mmol. I don’t know why they’re that high as I don’t eat after 8pm, and generally take my fasting reading about 10.00am next day.

So sorry this post is so disjointed but I am feeling so upset that I’ve been treated like an idiot at the Education session. Thanks for reading this, any advice greatly appreciated. Thank you.

First of all I can only apologise for the attitude of my nursing colleagues, this is not true of all of us. I am a firm believer in the expert patient but I know what you mean, with regards to some education sessions.

With regards to the fuel required by the brain to function, the brain requires a blood glucose level of at least 3.5 mmol, below this brain starts to malfunction in a variety of ways, as the glucose level drops further it may lead to unconsciousness, a diabetic coma. Brain cells cannot store glucose therefore it can only come from the blood. M not sure but I seem to recall that brain cells cannot utilise fat as an alternative fuel source and neither do they use insulin, but I will stand corrected if I’m wrong.

Don’t forget that the body will try and maintain blood glucose at a level required by the brain. This does not mean that you have to ingest carbohydrates, the body is pretty good at synthesising everything for life, so high fat diets will work, but the brain has to have a ready supply of glucose available, so irrespective of what you eat you will always have a blood sugar level, either directly ingested or from the liver/ other tissues, not to do so would prove fatal very rapidly.

Having a too high a blood glucose level can make you feel really unwell, not only physically but mentally as well, I felt seriously depressed and sluggish in my thinking prior to diagnosis, not good for an A&E nurse on nights; I had a blood sugar of 24.8 mmol at the time without knowing it.

I found Michael Moseley’s books on sugar very informative and he and his wife are both physicians.

Please don’t lose faith, the system isn’t perfect and there’s a lot of inertia in the system to overcome, after all there’s around 40 years of misinformation and education to put right, along with the associated mindsets.

 

[Guzzler]

I wonder just how Dr. David Unwin's DNs get around the rules then? Is it that he leads every T2 educational session so that his DNs are not put into the position of losing their livelihoods? Flaunting the guidelines has made his practice almost a centre of excellence for T2 control, weight loss and a vastly reduced drugs bill. How does he do it and other practices fail so miserably?

Catch his youtubes videos which are usually about 15/20 mins long.

 

[Brewers23]

I wonder just how Dr. David Unwin's DNs get around the rules then? Is it that he leads every T2 educational session so that his DNs are not put into the position of losing their livelihoods? Flaunting the guidelines has made his practice almost a centre of excellence for T2 control, weight loss and a vastly reduced drugs bill. How does he do it and other practices fail so miserably?

Catch his youtubes videos which are usually about 15/20 mins long.

This is a good question. I’ll try and put forward a possible explanation, which is based on my understanding. In Dr. Unwin’s practice he has decided, as a physician, that in his clinical judgement the NICE guidelines can be safely ignored. He has then defined the scope of practice for all of his staff in their policies and procedures. Should anyone complain then his staff can say that they were working within to their policies and procedures and that the organisation is accepting vicarious liability; however if I were to do the same then I would not be covered as I am not part of that organisation and this is not within my organisation’s policies and procedures, and NICE guidelines should be followed. For example a GP can prescribe a medication for a condition for which it is not licensed, but a nurse prescriber cannot. I hope this makes sense.

 

[Guzzler]

This is a good question. I’ll try and put forward a possible explanation, which is based on my understanding. In Dr. Unwin’s practice he has decided, as a physician, that in his clinical judgement the NICE guidelines can be safely ignored. He has then defined the scope of practice for all of his staff in their policies and procedures. Should anyone complain then his staff can say that they were working within to their policies and procedures and that the organisation is accepting vicarious liability; however if I were to do the same then I would not be covered as I am not part of that organisation and this is not within my organisation’s policies and procedures, and NICE guidelines should be followed. For example a GP can prescribe a medication for a condition for which it is not licensed, but a nurse prescriber cannot. I hope this makes sense.

It makes perfect sense. But you are an individual. Why is it that more practices are not lining up for this? First line of defence, point of entry kinda thing?

 

[Brewers23]

It makes perfect sense. But you are an individual. Why is it that more practices are not lining up for this? First line of defence, point of entry kinda thing?

An even better question and one that I cannot answer! I know that one GP that I see is convinced of the benefits of a LCHF diet, and in fact she recommended it to me, but the practice is not just one GP, and so a change to the attitude of the practice is difficult. Also this particular GP is happy to work with the patient in a concordant relationship rather than the old paternal doctor/patient relationship, she raised an eyebrow when I said I was stopping my statin but accepted it.

 

[Guzzler]

An even better question and one that I cannot answer! I know that one GP that I see is convinced of the benefits of a LCHF diet, and in fact she recommended it to me, but the practice is not just one GP, and so a change to the attitude of the practice is difficult. Also this particular GP is happy to work with the patient in a concordant relationship rather than the old paternal doctor/patient relationship, she raised an eyebrow when I said I was stopping my statin but accepted it.

Aye, he recounts that it took a little persuasion to get his practice partners on side.

 

[MikeTurin]

I suppose that one could interpret the guidelines. My impression is that there is a lot of misunderstanding on what actually is written on NICE guidelines and the customs.

There is clearly stated on NICE guideline to eat whole grain foods not you have to eat bread and white pasta and that the dieting advice has to be personalized.

 

[Resurgam]

Don’t forget that the body will try and maintain blood glucose at a level required by the brain. This does not mean that you have to ingest carbohydrates, the body is pretty good at synthesising everything for life, so high fat diets will work, but the brain has to have a ready supply of glucose available, so irrespective of what you eat you will always have a blood sugar level, either directly ingested or from the liver/ other tissues, not to do so would prove fatal very rapidly.
.

Actually the brain works better on ketones than on glucose - that is why so many of us feel so much better on a low carb diet. You are quite right about the liver having the ability to release glucose when required, so eating carbs is not required - but for many people it is possible for them to eat some carbs and maintain their blood glucose at good levels, so they can obtain the nutrients required for good health.
One thing I notice about my trolley at the supermarket - there is far more plant life in there than in most others, lots of vitamin and mineral rich foods - and although I can't say that every bit gets eaten, only the last bits of cucumber or the last handful of salad might get thrown away because I have got some nice fresh stuff to put in its place.

 

[pollensa]

I recently had an annual HbA1c test that came back at 43 mmol/ml and a comment to 'See the nurse'. So arming myself with plenty of info gained from this site and others I have just returned from my appointment.
The nurse had a look of shock when this tall and slim 75 year old female walked in and immediately said that I didn't fit the usual patient that she sees. So when she started giving me the standard mantra about the 'Eatwell Plate' - there was even a poster on the wall illustrating it - I just said I thought it was irresponsible of the NHS dishing out that bad diet advice. I was also told to eat low GI foods, as I already eat brown bread where possible. I said even if low GI it was still carbohydrate and would have the same effect on the body in the end. All that carbohydrate had to be wrong.
At which point she realised I was not going to be convinced and said what I always suspected, that they have to dish out this advice as it's standard NHS practice: jobs on the line I suppose if they don't. I think that is truly shocking. Thank heaven for this site. I also gathered that Diabetes.uk.org is all part and parcel of the NHS too.

Strictly off the record she told me to get a copy of Michael Moseley's Blood Sugar Diet as the science in it is so interesting.

Well done YOU for raising your situation to awareness of others, but I am sure its not the first time.

This is why one should trust ones own body first and foremost, secondly, get 2nd and 3rd opinion also, as this meeting, indicates as I have always felt personally, whether the NHS, Diabetes associations which are connected to Pharmas, medic system, there is big business out there, and its in everyones best interest to keep diabetes ALIVE, rather than push and explain to people, it is not a chronic progressive disease, it can be reversed if one knows how, and I am sure, from gaining information from well reputable Doctors worldwide who are experts in this field, if the medical system worldwide starts to focus and treat the CAUSE of diabetes the Insulin Resistance, instead of the SYMPTOM, the higher sugars everyone with slightly or more higher sugars will benefit at the end of the day.

The Big question remains, what is the correct cut off, no one knows, at the end of the day. They are arbitrary set at whim and random chosen by the so called experts. One should not panic if their levels go up or down that seems to my understanding absolutely normal, and depending on this, one decides what to eat, so if the levels cannot be trusted, surely if one is
exercising more, eating low carb diet preferably Keto eating, wonderful delicious meals, exercising, and intermittent fasting as and when one feels like it, what better can one do, as these I feel are the basic elements that can help lower higher blood sugar levels, to lower and keep them consistent and stable, well, speaking from first hand experience, this is what I follow no medications and change of lifestyle only, and I am normal normal normal......

The SYSTEM, it seems and quite concerningly overall, can give confusion and only complicate a persons high sugar situation or insulin resistance situation simply due to the system following the system and not treating Diabetes in the correct way, treat the CAUSE and NOT the symptom, perhaps millions will have reversed diabetes, but then the problem with that, is big business drops, sales of monitors, stripes go down, insulin, and the pharmas crying because they have lost any clients.....

One should follow their own body and listen to their Docs, and take in cut off levels, but that does not mean the Doc system, or cut offs are correct, and make your own sound and sensible decisions, after all its our bodies not the Doctors or Pharmajs.

Well said, and well raised to attention how the system works...frightening really.

Mallorca

 

[Brewers23]

Actually the brain works better on ketones than on glucose - that is why so many of us feel so much better on a low carb diet. You are quite right about the liver having the ability to release glucose when required, so eating carbs is not required - but for many people it is possible for them to eat some carbs and maintain their blood glucose at good levels, so they can obtain the nutrients required for good health.
One thing I notice about my trolley at the supermarket - there is far more plant life in there than in most others, lots of vitamin and mineral rich foods - and although I can't say that every bit gets eaten, only the last bits of cucumber or the last handful of salad might get thrown away because I have got some nice fresh stuff to put in its place.

This extract from a book may be of interest, basically brain cells can use ketone bodies for energy when in long term starvation, but if your BM is above 3.5 mmol then glucose remains the energy source. https://www.ncbi.nlm.nih.gov/books/NBK22436/

 

[Bluetit1802]

This extract from a book may be of interest, basically brain cells can use ketone bodies for energy when in long term starvation, but if your BM is above 3.5 mmol then glucose remains the energy source. https://www.ncbi.nlm.nih.gov/books/NBK22436/

I believe the red blood cells also require a bit of glucose in order to operate correctly.