Carbohydrates

[Pneu]

It's part of the old NHS Diabetes Apartheid. Most of us T2s don't get anywhere near a Hospital Diabets Team or a DSN (let alone an Endocronologist or a Podiatrist or a Dietician that knows anything about diabetes).

My only encounter with a proper DSN was when (in my first few weeks post-diagnosis) I got dragged into hospital because my GP mistook Ketosis for Ketoacidosis. I was very impressed, they talked to me knowledgably about low-carbing and gave me encouragement on my great progress with BG readings. It was a tantalising glimpse into "how the other half live" and made me realise how much better off most T2s would be with proper diabetic care.

I've not had a positive experience with a HCP before or since. My GP has since taken my metformin away, knocked back my HbA1c to once a year, and never even bothered to look at my feet during the yearly review.

As with everything I guess it comes down to cost.. I do know they see some insulin dependant type II at my local centre but the majority are hospital diagnosed individuals or community type I's.

I also know however that my local hospital team have a DSN that has specialised in 'carb control' and is active in visiting local GP's to promote this approach..

As with everything NHS I think there are those that mean well and do a good job.. but don't have the resources to concentrate on anything but primary care.. its going to take a long time (or someone to show politicians that they can save money in the short term!) to get the message out and about amongst most GP.

 

[GraceK]

I am involved with my local PCT and the hospital diabetes team and most of them would advise based on what works for the patient.. if its working for you and you aren't endangering yourself.. i.e. your blood pressure and cholesterol are also good and you have no other relevant medical conditions then keep doing it.. you would just get described as 'un-orthodox'.. better that than dead hey!

It's part of the old NHS Diabetes Apartheid. Most of us T2s don't get anywhere near a Hospital Diabets Team or a DSN (let alone an Endocronologist or a Podiatrist or a Dietician that knows anything about diabetes).

My only encounter with a proper DSN was when (in my first few weeks post-diagnosis) I got dragged into hospital because my GP mistook Ketosis for Ketoacidosis. I was very impressed, they talked to me knowledgably about low-carbing and gave me encouragement on my great progress with BG readings. It was a tantalising glimpse into "how the other half live" and made me realise how much better off most T2s would be with proper diabetic care.

I've not had a positive experience with a HCP before or since. My GP has since taken my metformin away, knocked back my HbA1c to once a year, and never even bothered to look at my feet during the yearly review.

When I read things like this it really concerns me. My GP supports my low carb diet, he supported me doing the Newcastle diet, I do get a small amount of strips on prescription (I used to have unlimited until I pulled out a 4.9 HbA1c :lol: ). Recently I have had retinopathy screening and been seen by a podiatrist. Why is the care I receive not available to all?

My GP only had my bloods tested because I REMINDED her that a PS in tiny print at the bottom of a letter from a hospital Consultant I had seen about another health problem, advised that I should have my bloods regularly checked. Otherwise my diabetes would still be undiagnosed. When she gave me the diagnosis, she gave me a prescription for Metformin, NO dietary advice whatsoever, diet wasn't even mentioned. She told me the DN would be in touch soon and I should make another appointment to see her, my GP, in a month's time. When I saw the DN, she lowered the dose of Metformin and told me I need statins and BP meds at which point I TOLD HER that in yet ANOTHER LETTER FROM A HOSPITAL CONSULTANT I am told that it is VITAL that I am never given ACE INHIBITORS, PROTON PUMP INHIBITORS or NSAIDS because I have life threatening allergic reactions to them. Her response was "Oh, OK. We'll leave it then." After that she handed me a lovely spiral bound booklet called 'Diabetes' which I haven't found at all helpful, and a scruffy sheet of photocopied paper with an example of a daily diet on it, which I found absolutely ridiculous.

I've worked in the NHS for many years until this year. Nuff said. :|

 

[RoyG]

Me too all the above, my DN told me she would not need to see me for another 12 months, Now here is the two edged sword. when I asked shouldn't you be checking my hba1c every 6 months the retort came back "why you are doing an excellent job yourself" I cannot answer that one because I am to a greater extent, and I am responsible for my own welfare and health.But she knows full well I am not going straight to the sweet shop after seeing her for a 1/4 of chocolate limes (oh how I miss them) so kinda shot myself in the foot, But normally I just ring them anyway to get my blood tested, so I shall wait and see what transpires in 4 months when I ask.
Meanwhile today I had a very interesting conversation with my Doctor after a visit for a persistent rash on my hand. I gave him some information on my diet and cholesterol that I had got from various sources on internet a while ago, during my visit he happened to mention my cholesterol was high and the fact I had said to him, I am not that bothered about that just yet. He said well I have read your information and it had intrigued him, any way to cut a long story short he has a friend who happens to be a specialist in the field at Manchester Uni and he is going to ask him about me and what are all the latest findings regarding cholesterol. Now if nothing else he is being very open minded and inquisitive, he already agrees that my diet is good and working and has no problem with it. Incipiently the rash has him stumped ? So he put me on antibiotics after all the steroid creams have failed, If this fails it's off to the dermatologist. Keep chipping away is my mantra :thumbup:

 

[borofergie]

Me too all the above, my DN told me she would not need to see me for another 12 months, Now here is the two edged sword. when I asked shouldn't you be checking my hba1c every 6 months the retort came back "why you are doing an excellent job yourself" I cannot answer that one because I am to a greater extent, and I am responsible for my own welfare and health.

The problem is that my HbA1c is my prime motivation for keeping on the waggon. I'm an analytical kind of guy (a recovering engineer), I don't like making decisions without data. Unlike BG testing, your HbA1c doesn't lie. But the truth is that I could eat whatever I wanted for the next 9 months, and it wouldn't make a jot of difference. I'd also like to address my low-cholesterol, but what's the point when I won't be able to see the results for another year?

Hopefully we'll be moving house in the next few months, which means a new GP and another spin on the NHS postcode lottery.

 

[RoyG]

Me too all the above, my DN told me she would not need to see me for another 12 months, Now here is the two edged sword. when I asked shouldn't you be checking my hba1c every 6 months the retort came back "why you are doing an excellent job yourself" I cannot answer that one because I am to a greater extent, and I am responsible for my own welfare and health.

The problem is that my HbA1c is my prime motivation for keeping on the waggon. I'm an analytical kind of guy (a recovering engineer), I don't like making decisions without data. Unlike BG testing, your HbA1c doesn't lie. But the truth is that I could eat whatever I wanted for the next 9 months, and it wouldn't make a jot of difference. I'd also like to address my low-cholesterol, but what's the point when I won't be able to see the results for another year?

Hopefully we'll be moving house in the next few months, which means a new GP and another spin on the NHS postcode lottery.

I kinda know what you mean, I am the same. I need consistent data to show a proven pattern and make sense, yet I sometimes do all the right things and get spurious numbers and readings, like my cholesterol, by all rights and information it should be going down, yet for some reason it's shot up, it don't make sense ! I can make assumptions as to why and guess it will go to normal because of X and Y, but mine has always been high even before Diabetes so what's the "normal" I have a week off work relax and don't have stress and my BG goes whacky, not high but jumps all over the place, it don't make sense ! But what can you do but give it your best effort. Do we know for sure what is too high or too low? re-cholesterol I think not. My Doctor asked me have I looked at both sides of the argument regarding cholesterol, I said yes I have and come to my "conclusion" Am I right? Is today's theory right? The jury is still out for me, but I have my conviction and the coins still in the Air.

 

[borofergie]

Do we know for sure what is too high or too low? re-cholesterol I think not. My Doctor asked me have I looked at both sides of the argument regarding cholesterol, I said yes I have and come to my "conclusion" Am I right? Is today's theory right? The jury is still out for me, but I have my conviction and the coins still in the Air.

I think that the jury on cholesterol delivered their verdict some time ago. The problem is that inertia means that it is taking a long time for that verdict to penetrate a medical establishment that has been forcibly pushing the false "lipid-hypothesis" down our throats for the last 30 odd years.

 

[librarising]

RoyG wrote
My Doctor asked me have I looked at both sides of the argument regarding cholesterol, I said yes I have and come to my "conclusion" Am I right? Is today's theory right? The jury is still out for me, but I have my conviction and the coins still in the Air.

The observant will have noticed me recommending The Great Cholesterol Con by Malcolm Kendrick before on this forum.
Well yesterday I took another step towards investigating this side of the argument (other than trying to read whatever the internet has to offer :lol: )
I discovered that Uffe Ravnskov had brought out another book

Ignore The awkward ! How the Cholesterol Myths Are Kept Alive.
http://www.amazon.co.uk/Ignore-awkward- ... 774&sr=8-3

For £5.13 I took the Kindle edition. Only half 'skimmed' it so far.

For more reviews see Amazon.com :

http://www.amazon.com/Ignore-Awkward-Ch ... e+ravnskov

Geoff

 

[hanadr]

Django
there is no need for carbohydrates in the diet at all. Just ask your nurse to quote you the evidence that you need to eat any at all. She won't be able to. There isn't any. The whole healthy eating food pyramid thing was invented in the USA by sheer guesswork. there's NO science behind it. In fact in the USa, they are ditching it it favour of something else, also developed by guesswork!
If we had a dietary need for carbs, there'd be a set of specific deficiency symptoms, as there are for protein and the essential vitamins and there isn't.
I've been researching this myth for years. and Myth it is.It's just that if you repeat something often enough, people get to believe it's true.
Yes carbs provide energy and we need energy, but we run perfectly well on energy from fats, including animal fats! in fact most of what the dietqary experts tell us is garbage.
they know what is in foods, but don't seem to understand at all what happens to them in the human body. More real research has been done on rat chow and dog food.
Hana
Ps read Gary Taubes

 

[borofergie]

I discovered that Uffe Ravnskov had brought out another book

http://www.amazon.com/Ignore-Awkward-Ch ... e+ravnskov

Geoff

Interesting Geoff, let me know how you get on with it. This is a nice summary of the problems with the lipid-hypothesis by Ravnskov:
http://www.spacedoc.com/saturated_fat_is_good_for_you_2

 

[catherinecherub]

"Prevention is much more complex than just throwing statins at patients with high cholesterol. There are other ways to lower cholesterol, including weight loss. It makes a difference whether you are aiming for primary prevention (preventing disease in the first place) or secondary prevention (preventing further harm to someone who already has cardiovascular disease). A high LDL may not be as significant in a patient whose HDL (“good” cholesterol) is also high. Before prescribing, a good doctor looks at the whole patient: all the other risk factors, such as age, sex, weight, diet, exercise, family history, smoking, blood pressure, and past history. He looks at the risk/benefit ratio of statins in the patient’s particular situation. He considers the NNT (number needed to treat) to prevent one death or heart attack (which may vary from 5 to 333 depending on the situation). He looks at what other medications the patient is on, at the cost and convenience, at the patient’s personal philosophy and preferences. Ideally, the decision to use statins should be a joint decision of the patient and the doctor based on all the information available."
http://www.sciencebasedmedicine.org/ind ... -skeptics/

I think if every G.P. adopted the above statement it would make sense as statins are not for everyone.

 

[GraceK]

Django
there is no need for carbohydrates in the diet at all. Just ask your nurse to quote you the evidence that you need to eat any at all. She won't be able to. There isn't any. The whole healthy eating food pyramid thing was invented in the USA by sheer guesswork. there's NO science behind it. In fact in the USa, they are ditching it it favour of something else, also developed by guesswork!
If we had a dietary need for carbs, there'd be a set of specific deficiency symptoms, as there are for protein and the essential vitamins and there isn't.
I've been researching this myth for years. and Myth it is.It's just that if you repeat something often enough, people get to believe it's true.
Yes carbs provide energy and we need energy, but we run perfectly well on energy from fats, including animal fats! in fact most of what the dietqary experts tell us is garbage.
they know what is in foods, but don't seem to understand at all what happens to them in the human body. More real research has been done on rat chow and dog food.
Hana
Ps read Gary Taubes

Have you noticed how many overweight nurses there are in the NHS? And have you ever noticed the foods served in NHS hospital cafes and restaurants? I had a real struggle when I worked in one hospital to get anything like a decent meal from the staff restaurant. And in one other hospital where I worked the portion size was INCREDIBLY ENORMOUS and I had to regularly ask for a half portion please. But I was told I HAD to have the portion they were told to dole out and if I didn't want it I could leave it on my plate. Wow! That astounded me because not only do I feel sick when I look at a plateful of food overflowing round the edges and mounded up like a hill, but I also DO think about the homeless and the hungry who could be helped if that food were diverted their way instead of killing half the population with it. There was no middle ground, you eather had a meagre snack of cheese and 2 crackers or a plateful of stodge that you didn't want and would need to be a 45st sumo wrestler to be able to eat. Shocking waste of resources. :x

 

[Pneu]

Moved into discussion area as I think more appropriate

 

[AMBrennan]

Have you noticed how many overweight nurses there are in the NHS?

Even if that was true it should not surprise you:

The latest Health Survey for England (HSE) data shows that in England in 2010:

62.8% of adults (aged 16 or over) were overweight or obese

Curiously, none of the NHS staff I've met (triage nurse, A&E doctors, endo, DSN, GP or dietician) are obviously overweight. If anything, I'd conclude that NHS staff are healthier than the national average (obviously, given the massive size of the NHS, my sample of 20 is waaaaay to small to make any deductions)

 

[GraceK]

Have you noticed how many overweight nurses there are in the NHS?

Even if that was true it should not surprise you:

The latest Health Survey for England (HSE) data shows that in England in 2010:

62.8% of adults (aged 16 or over) were overweight or obese

Curiously, none of the NHS staff I've met (triage nurse, A&E doctors, endo, DSN, GP or dietician) are obviously overweight. If anything, I'd conclude that NHS staff are healthier than the national average (obviously, given the massive size of the NHS, my sample of 20 is waaaaay to small to make any deductions)

I must admit my GP and my DN are both very slim, but having worked in several hospitals I've seen obesity rising amongst the nursing staff too and I think its generally down to the same thing as has happened to most people since technology became so prevalent - we don't move about as much as we used to, we don't need to exert ourselves as much as we used to - eg, even secretarial staff nowadays rarely move from their desks, they don't need to get up and dow to filing cabinets anymore, everything is on screen. Nurses aren't as hands on as they used to be, they don't do as many physical jobs as before, it's becoming very cerebral. So are brains are getting plenty of exercise but our backsides aren't!!! :lol:

 

[Pneu]

I am pretty certain that the staff in the NHS on average will follow the weight trend of the UK as a whole.. back on topic please people

 

[Defren]

Me too all the above, my DN told me she would not need to see me for another 12 months, Now here is the two edged sword. when I asked shouldn't you be checking my hba1c every 6 months the retort came back "why you are doing an excellent job yourself" I cannot answer that one because I am to a greater extent, and I am responsible for my own welfare and health.

The problem is that my HbA1c is my prime motivation for keeping on the waggon. I'm an analytical kind of guy (a recovering engineer), I don't like making decisions without data. Unlike BG testing, your HbA1c doesn't lie. But the truth is that I could eat whatever I wanted for the next 9 months, and it wouldn't make a jot of difference. I'd also like to address my low-cholesterol, but what's the point when I won't be able to see the results for another year?

Hopefully we'll be moving house in the next few months, which means a new GP and another spin on the NHS postcode lottery.

I kinda know what you mean, I am the same. I need consistent data to show a proven pattern and make sense, yet I sometimes do all the right things and get spurious numbers and readings, like my cholesterol, by all rights and information it should be going down, yet for some reason it's shot up, it don't make sense ! I can make assumptions as to why and guess it will go to normal because of X and Y, but mine has always been high even before Diabetes so what's the "normal" I have a week off work relax and don't have stress and my BG goes whacky, not high but jumps all over the place, it don't make sense ! But what can you do but give it your best effort. Do we know for sure what is too high or too low? re-cholesterol I think not. My Doctor asked me have I looked at both sides of the argument regarding cholesterol, I said yes I have and come to my "conclusion" Am I right? Is today's theory right? The jury is still out for me, but I have my conviction and the coins still in the Air.

I agree with you both. I like to see the data, mainly in the form of meter readings. I tend to now take them sporadically rather than the obsessive I once was. I know exactly what Stephen means by the HbA1c being the prime motivator, it is for me too.

Keeping a reign on carbs is the main way most of us T2's can control our condition. Then, the mantra many of us carry as our signature 'eating to our meter'. So many people have been told they 'must' eat starchy carbs with every meal. If the OP is concerned, then let me throw down a bit of gauntlet. Take one week and eat a normal diet with the carbs you have always eaten. Test before the meal, then +1 and +2 hours (I know it's a bit pricey on the old strips, but it's a valuable way to learn about this yourself). Week 2 eat a diet of say 100g of carbs a day (or less (just a ball park figure guy's don't jump on me)) Again, test before the meal then again +1 and +2 hours and then tell us your results. I can however save you the test strip dosh and tell you the results. Your reduced carb week will give you lower figures.

Which ever way you decide to go, I wish you lots of luck. (Low carbs is the best option. Shhhhhh :lol:

 

[gazzerg]

Why test after 1 hour? I haven't even read a cereal pack, but i would imagine there is a certain amount of sugar in it... injection of energy and so on... not a expert on the subject, but any breakfast cereal is a no no on my behalf.

 

[Defren]

Why test after 1 hour? I haven't even read a cereal pack, but i would imagine there is a certain amount of sugar in it... injection of energy and so on... not a expert on the subject, but any breakfast cereal is a no no on my behalf.

Breakfast cereal is a no-no for me too. Depending on the GI of any given cereal it will depend how quickly the sugar hits your blood. If you have a high GI cereal and as some people also add sugar to it, it's going to hit your blood fast. A two hour test is likely to miss the peak so at two hours it could well be coming down and appear to be safer than it is. If you do (or recommend) a +1 and +2 then you are letting people see the whole picture, rather than just the ending.

Hope that helps.

 

[bonzodog]

Django
there is no need for carbohydrates in the diet at all. Just ask your nurse to quote you the evidence that you need to eat any at all. She won't be able to. There isn't any. The whole healthy eating food pyramid thing was invented in the USA by sheer guesswork. there's NO science behind it. In fact in the USa, they are ditching it it favour of something else, also developed by guesswork!
If we had a dietary need for carbs, there'd be a set of specific deficiency symptoms, as there are for protein and the essential vitamins and there isn't.
I've been researching this myth for years. and Myth it is.It's just that if you repeat something often enough, people get to believe it's true.
Yes carbs provide energy and we need energy, but we run perfectly well on energy from fats, including animal fats! in fact most of what the dietqary experts tell us is garbage.
they know what is in foods, but don't seem to understand at all what happens to them in the human body. More real research has been done on rat chow and dog food.
Hana
Ps read Gary Taubes

Do you reallywant to go ketogenic? Do you really want to play with fire with hypoglycaemia? Want muscle wastage? Bad breath? There is PLENTY of evidence that some carbs are needed in the diet.

 

[borofergie]

Do you reallywant to go ketogenic? Do you really want to play with fire with hypoglycaemia? Want muscle wastage? Bad breath? There is PLENTY of evidence that some carbs are needed in the diet.

If you want to make inflammatory statements bonzo, you should probably back them up with "PLENTY" of evidence (all of which I'll shoot down in flames without even blinking).

1. Keto breath - I brush my teeth, you should too...
2. Hypoglycemia - unless you are taking insulin (or insulin production promoting medecine) ketosis will preven hypoglycemia, that's what it evolved for, it's a glucose starvation protection mechanism.
3. Muscle Wastage - Ketosis is protein sparing. It is ridiculous to suggest that it wastes muscles.
4. Carbohydrates are not an essential macronutrient, although it's probably to sensible or practical to eat zero carbs.

I've been eating <50g a day for the past 18 months, and <25g a day since February. I ran a half-marathon last week. Please don't make me send you a picture of my leg muscles to show you that ketosis doesn't cause wastage.

Keto and proud. HbA1c = 4.9%