Type 2 'education' clinic - decidedly un-educational

[CathyN]

Just attended the second of three education sessions. Felt as if I had gone back to primary school - such was the level of the education. It felt as if their target age group was 8 -10, rather than a room full of adults. I felt patronised and talked down to - all very well meaning but really hard to take seriously. Of course, until I have attended the third session I should withhold my judgement but I don't hold out much hope.

Unsurprisingly, a month of random urine stick testing had produced few positive results, as these sticks don't read positive until 10 mmol/L. This was greeted with more patronising enthusiasm and I'm sure a slightly confusing message that we were all well under control. So I just had to raise the question - if you're officially diabetic at 7mmo/L or over, you could have been 9.9mmol/L for the entire month, but the sticks would not inform you of this worrying fact. Suddenly the patronising charm was replaced by a more business like attitude. The nurse actually said " If you are not using insulin, and you get a test result of, say, 8.7 - what are you gonna do about it? You can't DO anything about it"

I said possibly you could look at the food you had eaten to try to understand the result. You could definitely go for a brisk walk or do some exercise. And that was the end of that. She ended the discussion then and there. So it is very obvious that self testing is completely ignored as a help to control type 2.

Going onto diet. This was depressingly puerile. Arranging plastic food into the correct groups on a plastic pie chart - and then being instructed to eat healthily is primary school stuff. That would have been ok if followed up with some grown up advice. I could not tell what the message was except to eat healthily ..... well it is a start but I don't call it diabetic education. We did not even touch upon the sort of food that will raise levels in the diabetic person.

I await lesson three.......

What I'm deducing here though, is that if you are unequipped to help yourself ie. you don't read about type 2, you don't test, you have negative urine sticks and have been told it's excellent - then your chances of really managing your diabetes are slim.

It just isn't enough.

 

[MaryJ]

Hi Cathy

I guess there may well have been some members of the audience who don't get the basics so maybe that's why they pitch it where they have???

The rest totally goes along the same ways as many (not all to be fair) members experiences - **** advice. Cringeworthy, it really is.

I've not been offered a 'education' course and I hope I never do. I realise they have a place but I'm lucky, like you are to have found this forum

Mary x

 

[CathyN]

Hi Mary

Yes, absolutely agree that not everyone is informed of the basics - and it's right and proper that the basics are in there. I just hoped that the basics would be followed up with some specifics. It became pretty obvious that wasn't going to happen. I think also that lots of the advice was about losing weight - which is obviously very important and would give those that need to lose weight something to aim for. I just happen to be a sensible weight for my height .... as a consequence I got no advice or help at all.

Cath

 

[izzzi]

Hi,
I am with you all the way on this topic, I just hope these so called expert advisers have learned something from you.

I was told to sign the form to prove to the Doctor I did attend the coarse ,

Roy (A 64 year old child)

 

[CathyN]

Yes - I felt like a 48 year old child in there!! Now I think of it, I really should have said something about how they made me feel. I bet I wasn't alone.

 

[oakdaledave]

Where did you go for your meetings Cathy? I went to Littledown. I live in Oakdale, but the friday meetings were better for me. I attended the 3rd meeting two weeks ago. The two ladies taking the 'course' were very nice, but I have to say I have learnt more from this forum and having a general nosey on the web. You will get a couple of bits of paper and a letter to take to your Dr and that's your lot!

 

[Paul_c]

what happens if you decide not to take the course after being offered it?

 

[sallylondon]

When I went on the introduction course combined with 'a little talk' by the dietician at King's hospital here in London with a group of about 20 women I felt like I was being talked down to. I was fed the most basic information and seemed to be on some sort of conveyor belt. I came away feeling the need for rebellion just like a teenager. :shock:

I was so scared when I first found out about the diabetes I would have attended anything anyone sent me on and believed everything because, after all, they are the experts. :evil: :evil: If only I knew then what I know now. :lol: If you don't take the course aren't you regarded as non-compliant?

 

[xyzzy]

On non compliance. A lot of people seem to get asked "if you would find the course useful" I said "no" and my DSN and GP were fine with my decision.

If it's the DSN who is insisting you do something against your will then be aware the ultimate responsibility lies with your GP who has effectively delegated their role. From the GMC Patient Consent guidesline

http://www.gmc-uk.org/static/documents/content/Consent_0510.pdf

26. If you are the doctor undertaking an investigation or providing treatment, it is your responsibility to discuss it with the patient. If this is not practical, you can delegate the responsibility to someone else, provided you make sure that the person you delegate to:

a. is suitably trained and qualified
b. has sufficient knowledge of the proposed investigation or treatment, and understands the risks involved
c. understands, and agrees to act in accordance with, the guidance in this booklet.

27. If you delegate, you are still responsible for making sure that the patient has been given enough time and information to make an informed decision, and has given their consent, before you start any investigation or treatment.

As it's the GP's responsibility then the following would seem to cover it but I haven't looked for examples of people putting it to the test.

43. You must respect a patient’s decision to refuse an investigation or treatment, even if you think their decision is wrong or irrational. You should explain your concerns clearly to the patient and outline the possible consequences of their decision. You must not, however, put pressure on a patient to accept your advice. If you are unsure about the patient’s capacity to make a decision, you must follow the guidance in Part 3.

 

[hanadr]

I think there are a lot of people here who have uncovered the real reason why the medical profession tries to warn patients off the internet for information.
They don't want us to uncover how lacking their advice is. However they do also have to deal with the least well educated as well as the knowledgeable patients. Many folks haven't a clue about food groups. Some of the elderly, because they never learned it at school and others who were present in class, but didn't bother to learn. Some people are so far from their days of educaion, that they don't any more know how to learn. School leaving age for my generation was 15,[ I went on to University! ] for my mother's 14. and many people think ALL education happens in school.
So even if the "Educators" know good and helpful information, they are well and truly up against it before they start and think about how they were trained!. The intelligent and motivated patients will research the subject, but what about the others?

 

[IanD]

The nurse actually said " If you are not using insulin, and you get a test result of, say, 8.7 - what are you gonna do about it? You can't DO anything about it"

I said possibly you could look at the food you had eaten to try to understand the result. You could definitely go for a brisk walk or do some exercise. And that was the end of that. She ended the discussion then and there. So it is very obvious that self testing is completely ignored as a help to control type 2.

I was at an X-PERT refresher course where one participant said he had had heart trouble as well as diabetes - the Dr was monitoring his diab by regular HbA1c - ANNUALLY.

If we have a spot reading of 8.7, we know it will come down if we don't eat, or go up if we snack. If we don't have any spot reading, ever, we just follow the diet advice & find our condition progress, as they expect. In that case, obviously they are RIGHT.

The problem IS education - they train as youngsters & have no personal knowledge of T2. ALL their T2 diab education is second hand. T1 is encountered & is controlled by testing & insulin. Therefore, when we develop T2 at 50+ we will not meet an HP who has real personal knowledge of T2, or if we do, they are still likely to be at a relatively early stage & not have the complications resulting from the NHS/DUK "healthy" diet.

We are, frankly, suffering from medical disinformation - false education that sees T2 as a progressive condition that will need ever-increasing medication, & ultimately insulin. The sad truth is that that attitude is vindicated whenever a T2 runs into trouble. Further, those of us who have learned how to take control, particularly by carb reduction, & report our experience, are dismissed as "anecdotal." As if real patient experience can teach them NOTHING. How can MY experience cast doubt on years of professional practice?

Somehow we have to get through to the HPs - but we rarely meet one prepared to listen - or if we do, they are still likely bound by their profession & simply say - "if it works for YOU, do it, but I can't change what I tell my other patients."

I get a hearing at the Hounslow cardio/diabetes support group, but I am still waiting for positive feed back.

 

[izzzi]

Hi Again,

Thanks Hanadr, :thumbup:

Hanadr has made a very good point,
regarding many people that do not use electronic education systems, for what ever reasons.

Then surly these education sessions should be arranged only for the people without knowledge of computers etc; that are in need good healthy advice.
( Or even on the coarse make clear that knowledge can be gained from the web, evev show a small demonstration ).

Actually my doctor advised me to go on a DESMOND coarse and also if I understood the web of which I did.
The Doctor then told me to look into Diabetes.co.uk .
How much would NHS save if my doctor or many doctors, just recommended this so helpful Diabetes.co.uk
to patients that were computer literate.

I also take on board Hanadr's comment "what about the others" Now that's got me thinking.

roy

 

[cheesesoup]

Cathy I so heartily agree with what you have said. Getting told what a healthy diet is was patronising in the extreme. However they do have to deal with X cases a day some will be like me degree educated and some will be like my F-I-L barely able to read and pretty much lacking in any education at all (usual story left school early as parents had died ,brought up family on his own etc etc etc) the "education" has to be one size fits all . Hence really patronising for anyone with any education at all. Got to agree with the doctor who gave the advice 'look it up yourself' , if only all GPs/Diabetic education courses did that.

 

[Paul_c]

Unsurprisingly, a month of random urine stick testing had produced few positive results, as these sticks don't read positive until 10 mmol/L. This was greeted with more patronising enthusiasm and I'm sure a slightly confusing message that we were all well under control. So I just had to raise the question - if you're officially diabetic at 7mmo/L or over, you could have been 9.9mmol/L for the entire month, but the sticks would not inform you of this worrying fact. Suddenly the patronising charm was replaced by a more business like attitude. The nurse actually said " If you are not using insulin, and you get a test result of, say, 8.7 - what are you gonna do about it? You can't DO anything about it"

I said possibly you could look at the food you had eaten to try to understand the result. You could definitely go for a brisk walk or do some exercise. And that was the end of that. She ended the discussion then and there. So it is very obvious that self testing is completely ignored as a help to control type 2.

That's exactly the reply I got yesterday about why they say no testing for T2's on diet control.

I countered that it would tell me that I'd got the carb count wrong or else to avoid that particular foodstuff from then on.

They kept going on and on about how you needed to eat their "healthy" diet with 1 third of the plate made up from carbs so you could get glucose for your brain and other energy needs.

Sadly, I didn't counter at the time. I've since come up with a possible counter. That supposedly "healthy" diet is really a "healthy" diet for a normal non-diabetic person. We're damaged and that diet is no good for us as it will result in raised BS levels or spikes that will inexorable kill off whatever beta cells we have left working. So in order to preserve beta cell function, we have to reduce our carb load. If we're not allowed to test ourselves and we're following that diet, then we don't know what damage is being done by the spikes so we will inexorable progress to needing medication followed by insulin. The HBA1c won't show the spikes as they're too short for the glucose to become attached to the haemoglobin. The HBA1c will only show the result of the inexorable damage to our beta cells in the long term raised glucose levels.

They were seriously obsessed with saturated fats being the cause of insulin resistance in gumming up the "locks". They got quite upset with my diet and insisted it wasn't safe. They did concede on my point that supposedly healthy "Low-fat" options were not as healthy as they really claimed when I showed them some evidence with labels of normal and "lite" versions of the same products.

I have a possible convert who was interested in what I was doing, so I pointed him to this website so he could follow things up.

 

[jansmith7]

I have had the same experience. Having been newly diagnosed with Type 2 I was anxious to get information and asked to attend a 6 week course. This was to find out what I didnt know. The course level was pitched horriifyingly low- I think two attendees could not read. I learnt very little and some of the "information" was plain wrong.
The conclusions I have reached is that most of the information given out (particularly for Type 2) is wrong. Being told to eat "a healthy diet" is of no help and can do positive harm. When I had my diabetes under control I was rewarded by the removal of Test Strips from my prescription. Cost saving for the NHS although they wont admit it.
I have been Type 2 for 5 years and control it by diet without diabetic medication.
Having reluctantly decided that all the official advice is simplistic and often wrong I decided to make my own way.
I wanted to take a scientific and logical approach.
A good place to start is the GI diet. I always go for the lowest GI component available- eg stone ground flour in bread and pastry,
basmati rice instead of ordinary rice, new potatoes the only form of potatoes. Use Splenda(or more cheaply Aldis version).
Add some pulses to savoury meals to pull down the average GI. I simply do not eat high GI foods.
When you are doing all this then think of a healthy diet eg fresh vegetables and fruit, variety of food etc
I buy my own Test Strips as it is important to check the day to day workings of a diet.
I do not believe in "the occasional treat"- this will cause a blood sugar spike and will be harmful-but will not show up on the long term blood sugar test.
You can contrast this with the ridiculous (for Type 2) recipes in the Diabetes magazine.
My advice is that everybody should make their own reasoned approach and disregard the low quality advice available.

 

[susanmanley]

I have been enrolled on a DESMOND course but am now worried. I have got a s/h meter from this site and have worked hard to find the best information I can [again from this site mainly] I am concerned I will get negative responses to my way even though it is obviously working.
I have a range of problems [CHD, Kidney removed, diverticulitus, pancreatitus,chronic asthma, etc] and need to juggle the needs of each which can be difficult and will not respond well too brainless trotting out of government guidelines. I was hoping it would help/support me as an individual.

 

[izzzi]

Hi,

People that make you feel negative, have a serious problem within themselves.

Your ways are important, respond in whatever way you feel necessary.

There will be a few people attending the coarse that will need their kind of help and advice.

"Mind you I have a negative view towards the DESMOND coarse, I must have a inward problem".

Your comments indicate that you will be a great help to many of us on this Forum.


Best of Luck.

Roy.

 

[CollieBoy]

I have been enrolled on a DESMOND course but am now worried. I have got a s/h meter from this site and have worked hard to find the best information I can [again from this site mainly] I am concerned I will get negative responses to my way even though it is obviously working.
I have a range of problems [CHD, Kidney removed, diverticulitus, pancreatitus,chronic asthma, etc] and need to juggle the needs of each which can be difficult and will not respond well too brainless trotting out of government guidelines. I was hoping it would help/support me as an individual.

Firstly good luck with the course.
I too have a number of problems: CKD4 , bleed stroke survivor as well as Diabetes so they can seem as trying to come at you from all sides.
What I do when they try to push something I'm not sure about, I just say "Thanks, I'll take that under advisement" and go off and build my case and come back to them later!
If they stick to dogma over science I just retreat.
Remember they can't force you to do anything :twisted:

 

[hanadr]

I was a teacher for about 35 years and I noted that many yyoungsters of "average" ability were just plain dim! As , unfortunately, were some teachers.
Your experience would confirm that
Hana

 

[Paul_c]

Just had part deux of the Desmond course this morning... boy are they obsessed with cutting fats out, especially saturated fats... all part of a supposedly "Heart Healthy" diet... meh...