Frustrated after my recent visit to the diabetic nurse

[amandajane]

When I saw the diabetic nurse in August 2012 she was worried about my hba1c - as it had risen to 8.6. She wanted me to go on one of two new drugs but I refused saying I wanted time to think about it. I wrote to her asking for 2 months to do my own thing before I made the decision about the drugs. I am already on the full dose of Metformin so there was nowhere to go with this. She also, for the first time, told me that I would soon be on insulin. The advice she gave me was, "eat more oily fish." She told me that it would probably not be possible for me to improve my results as the damage was done. I have turned down Statins, and she always refers to that, asking if I have changed my mind (no!)

I found the book, "Say no to diabetes," and followed Patrick Holford's diet and supplement advice - I joined a gym, I learnt to meditate and have been seeing a herbalist whose knowledge about diabetes is better than the specialist nurse.

I went back this week and she told me how well I looked.... she looked at my results and was pleased because the hba1c has now gone down to 6.5 and I have lost 11 kg and my cholestrol had dropped to 3.5. She told me the blood sugars had reduced because my weight had dropped - I responded that it was the low GI diet and that I had given up bread, rice, potatoes and wheat. She wasn't very happy about this - and thought I wasn't eating a healthy diet (not that she asked me what I was eating!) I showed her PH's book - showed her what supplements I was taking - and it all seemed to make her very uncomfortable and said she didn't want to know about the supplements. (hmm.... which is the scariest, cinnamon or statins?) I also refused her flu vaccine which upset her too.

It worries me that with her advice I have got steadily worse, but that after 12 years of being diagnosed I can start seeing improvements within 2 months. Do other people feel like this? I have come away from the appointment feeling as though I have been disrespectful...and when I asked if I could have a blood testing monitor it was as though I had asked to be a member of a coven - as "type 2's don't need monitors". I responded that I had found it useful to see which foods had caused my blood sugar to be raised (in my case berries) - but she as good as said I was talking nonsense.

Despite my good results I am feeling a bit battered by this appointment. I am also concerned about waiting 6 months for another blood test. I feel I have to take charge of my health and need to know what my hba1c is to do this. Or am I being stupid?!

 

[Fraddycat]

Hi Amanda Jane, you are not being stupid, you are just going through the same thing the vast majority of us on the forum have also been through. The standard NHS advise is eat a balanced diet which includes starchy carbs with every meal - wrong, I followed this and was put on more and more meds, now I am following a low carb diet I have reduced my meds and got my BG under control - at last! I was told there is no need to test your BG, what are you going to do if the reading is high?? Obvious isn't it, eat less of that food next time, but they cannot see that.

If the nurse will not give you a monitor then you can buy your own. Be careful when you buy as you can get them very cheaply or infact free but the testing strips are expensive.

Don't let you under educated Diabetic Nurse undermine your great achievements! Keep up the good work, after all its you that is benefitting isn't it!!

 

[ladybird64]

Amanda, your post saddens me. I have seen so many like this since I joined this forum, it isn't a rare occurence, it is a frequent failing of those who are supposed to help manage our diabetes that they are unable to acknowledge when we are making improvements.

I have no real axe to grind with the NHS. I have had treatment for non-diabetes related conditons that has saved my life (literally) and I know I am not the only one, I have noticed quite a few on here who obviously have/have had other conditions apart from their diabetes who must use the NHS, for operations and so forth, yet they appear to be vehement in their hatred of the organisation as a whole. I have to be honest and say I find this a more than a bit hypocritical but that is OMHP.

Coming back to the subject of Diabetes and the NHS, I do feel they are doing us a disservice generally and yes, I think they have got their dietary advice totally wrong. The proof of the pudding is in the eating (couldn't resist! :lol: ) and if your A1c has come down Amanda, then you are doing the right thing, no question about it. As far as I am aware, this is the landmark by which the NHS wants to use to monitor our diabetes (seeing as, on the whole, they tell us we don't need to self monitor) and if it is lowering, they should be encouraging and supportive, anything less than this is inexcusable.

This is like the last doctor I saw about an unrelated issue, he assumed I wasn't diabetic because of my HbA1c (6.5, not too bad). We briefly did the backwards and forwards "why you don't need to monitor/why I DO need to monitor" convo, he then said, "well, whatever you are doing works for you, so keep doing it". Not enough of a statement to agree with me but nice not to have condemnation as so many of you seem to have to endure.

I attend no appts for my diabetes because I made it clear at the beginning I didn't want to and it is working out ok for me. I feel nothing but sympathy for those who are put through the wringer every time they go and in those instances, criticism of the NHS approach is more than justified. I believe somebody recently said that those on the forum are just a few, I would beg to differ and say we are the start of many and that the word is spreading that things need to change..they are changing.

Let our results speak for themselves.

 

[izzzi]

Hi Amanda,

Well done,

I have a lovely diabetic nurse, however she has not got clue. Her guide is the NHS computer.

This forum has been my tool for good advice and help.

Good luck and continue with your good results.

Roy.

 

[amandajane]

Thank you for responding to my post/rant.

It seems so very wrong that the NHS continues to be giving incorrect advice regarding the best diet for diabetic control. It also beggar's belief that they can hand out drugs but refuse to give out monitors to help us take control of our own bodies and health,

I have been told that Patrick Holford is going into politics to try and change the mind set regarding this. I hope he does.

Thanks again,

Amanda

 

[lizmartin]

I was so interested in your letter Amanda, I can never understand why diabetics are told to include carbs in every meal! They are the bad boys of a diabetic diet, granted they possibly help not to eat too much fat, but they do raise the glucose level in the blood tremendously.

I am going to try to take up your diet and am sure I will be able to get my hba1c down a point or two, Many thanks Amanda! By the way I cannot get sticks to test so have to buy them and have only managed to get the vat back on one occasion so far.

All my good wishes to you.

Liz Martin

 

[Squire Fulwood]

I believe somebody recently said that those on the forum are just a few, I would beg to differ and say we are the start of many and that the word is spreading that things need to change..they are changing.

Let our results speak for themselves.

We few, we happy few, we band of brothers;
For he to-day that sheds his blood with me
Shall be my brother; be he ne'er so vile,
This day shall gentle his condition:
And gentlemen in England now a-bed
Shall think themselves accursed they were not here,
And hold their manhoods cheap whiles any speaks
That fought with us upon Saint Crispin's day.


I wish It was me that said all that.

 

[robertwt]

Oh Squire Fulwood,
So poetic, so relevant. Can't read those lines without thinking of Larry Olivier...

But enough, that wasn't what I came to say.

Here in Ireland I get excellent support from my DDC. They have three ('cracking') Sisters who are sympathetic when they need to be and stern when I have let my HbA1c slide a bit (6.3 at the last count, thanks for asking). We [b]DISCUSS[/b] my BG results (I have two testers - one at home and one for on the move. - and all the testing strips I can use (thanks to my sympatico GPs). I make decisions about my insulin levels - if I am low, or high, before a meal two or three days in a row, I can tweak the dose.

I also have a couple (it might be three, come to think about it) spare insulin pens.

The only area where consistently we disagree is in the treatment of hypos. The advocate glucose tablets whereas I am in the 3 spoonsful of honey and a banana (and a bowl of ice cream, and another banana and perhaps another spoonful of honey) school of treatment. I am beginning to come round to their way of thinking. Perhaps I'm getting conditioned, or getting old!

I hear stories about the HSE (Irish equivalent to the NHS) being firmly placed in the 1950s. NOT SO. They are under funded but they make the very most of what they have.

I sympathise with anyone who does not have a good working relationship with their clinic. It took me a number of years to achieve what we have. But there must be some trust by both sides.

Keep at it AmandaJane. You can make a difference. :?:

Robert

 

[Geezer654]

I would just like to ask the question what does a low carb diet do to your body over a long period? We need carbs for energy if we have no glucose in our blood we have no energy. It may well be dropping BG levels but it's not a healthy balanced diet it's eating to serve the diabetes not treating what you eat which should be a healthy balanced diet. Nurses know about being healthy that has to count for something. I would recomend anybody who has type 1 or 2 to do a DAFNE ( Dose Adjustment For Normal Eating ) it is geared more for insulin dependant but it has quite rightly pointed out that for type 2 adjusting the diet is just as helpfull.
Anyway just a thought.
Stay strong and all the best

 

[Hobs]

I sympathise with you amandajane and I fully understand why you are fed up with your DN.
It all comes down to payments to the surgery from the NHS. The more patients they see, the more the money rolls in. Which is why they want you to make frequent appointments for clinic attendances.
However, I would urge you to get a flu vaccination as diabetics usually have a harder time fighting off infections and symptoms all too often lay us low for far longer.

 

[Fraddycat]

Hi Geezer,

I have been on a low carb diet now for 4 months - I have about 50g of carbs a day from veggies and dairy. I don't eat any starchy carbs. I go spinning twice a week, to the gym twice a week and play badminton for two hours on a Wed. I have bags of energy. My body uses fat for energy, not carbs.

I would just like to ask the question what does a low carb diet do to your body over a long period? We need carbs for energy if we have no glucose in our blood we have no energy. It may well be dropping BG levels but it's not a healthy balanced diet it's eating to serve the diabetes not treating what you eat which should be a healthy balanced diet.

What many of us firmly believe on this forum is that the myth that starchy carbs form part of a healthy diet is not true and is not proven. Have a look at the book 'Gary Taubes - why we get fat ...' and the Mark Sissons website about the Paleo diet.

I was just like you when I was first diagnosed and followed the advice of the NHS eatwell plate, but its wrong I got sicker and now I feel better than I have in years.

 

[the east man]

Oh Squire Fulwood,
So poetic, so relevant. Can't read those lines without thinking of Larry Olivier...

But enough, that wasn't what I came to say.

Here in Ireland I get excellent support from my DDC. They have three ('cracking') Sisters who are sympathetic when they need to be and stern when I have let my HbA1c slide a bit (6.3 at the last count, thanks for asking). We [b]DISCUSS[/b] my BG results (I have two testers - one at home and one for on the move. - and all the testing strips I can use (thanks to my sympatico GPs). I make decisions about my insulin levels - if I am low, or high, before a meal two or three days in a row, I can tweak the dose. I also have a couple (it might be three, come to think about it) spare insulin pens.

The only area where consistently we disagree is in the treatment of hypos. The advocate glucose tablets whereas I am in the 3 spoonsful of honey and a banana (and a bowl of ice cream, and another banana and perhaps another spoonful of honey) school of treatment. I am beginning to come round to their way of thinking. Perhaps I'm getting conditioned, or getting old!

I hear stories about the HSE (Irish equivalent to the NHS) being firmly placed in the 1950s. NOT SO. They are under funded but they make the very most of what they have.

I sympathise with anyone who does not have a good working relationship with their clinic. It took me a number of years to achieve what we have. But there must be some trust by both sides.

Keep at it AmandaJane. You can make a difference. :?:

Robert

To be fair to the NHS, any patient on insulin will get strips on prescription. It's only non insulin users that are refused strips

 

[the east man]

I would just like to ask the question what does a low carb diet do to your body over a long period? We need carbs for energy if we have no glucose in our blood we have no energy. It may well be dropping BG levels but it's not a healthy balanced diet it's eating to serve the diabetes not treating what you eat which should be a healthy balanced diet. Nurses know about being healthy that has to count for something. I would recomend anybody who has type 1 or 2 to do a DAFNE ( Dose Adjustment For Normal Eating ) it is geared more for insulin dependant but it has quite rightly pointed out that for type 2 adjusting the diet is just as helpfull.
Anyway just a thought.
Stay strong and all the best

So far I havent heard of anyone on a LCHF diet having any problems over a period of time, I ve been doing it for the last 2 years:? Lke Fraddycat I excercise regulary, 5 days a week of high intensity training, and Ive had no problems getting the engery to do this. in fact for the last 4 weeks I have stopped taking my statins, and the muscle pains I was getting have totally gone away, and I have even more engery. If i had stuck to the NHS advice, and ate a high carb diet for the last 2 and a half years, I'm positive I would now be on medication, or even insulin. I know what diet I will take my chances on

 

[Sid Bonkers]

Oh dear, Patrick Holford :roll:

http://www.badscience.net/2007/09/patri ... ntruthful/

And Taubes is no better have you listened to Carbsanes interview with Jimmy Moore were she defrocks him as a fraud who cherry picked information to back up his theories and even quoted sources incorrectly.

http://www.thelivinlowcarbshow.com/show ... pisode-436
This is an hour long interview to hear the Taubes fraud bit fast forward to 30.00 minutes.

But of course if you want to believe these - then that is of course your prerogative.

 

[Geezer654]

I would just like to ask the question what does a low carb diet do to your body over a long period? We need carbs for energy if we have no glucose in our blood we have no energy. It may well be dropping BG levels but it's not a healthy balanced diet it's eating to serve the diabetes not treating what you eat which should be a healthy balanced diet. Nurses know about being healthy that has to count for something. I would recomend anybody who has type 1 or 2 to do a DAFNE ( Dose Adjustment For Normal Eating ) it is geared more for insulin dependant but it has quite rightly pointed out that for type 2 adjusting the diet is just as helpfull.
Anyway just a thought.
Stay strong and all the best

So far I havent heard of anyone on a LCHF diet having any problems over a period of time, I ve been doing it for the last 2 years:? Lke Fraddycat I excercise regulary, 5 days a week of high intensity training, and Ive had no problems getting the engery to do this. in fact for the last 4 weeks I have stopped taking my statins, and the muscle pains I was getting have totally gone away, and I have even more engery. If i had stuck to the NHS advice, and ate a high carb diet for the last 2 and a half years, I'm positive I would now be on medication, or even insulin. I know what diet I will take my chances on

I take your point about the carbs if that's your thing then that's grand. But to stop your statin I think is Not very good. My mum has just a stroke and it is a scary thing so if I am at a higher risk of stroke and have a chance to reduce the risk I will take it. There are alot of statins out there finding one that suits you is the key. I believe the benefit of taking them out weighs the side affects.

 

[Squire Fulwood]

I take your point about the carbs if that's your thing then that's grand. But to stop your statin I think is Not very good. My mum has just a stroke and it is a scary thing so if I am at a higher risk of stroke and have a chance to reduce the risk I will take it. There are alot of statins out there finding one that suits you is the key. I believe the benefit of taking them out weighs the side affects.

It's horses for courses I suppose. A fellow type 2 who lives down the road was taken into hospital with a stroke. Once in there he was re-diagnosed as having had a statin seizure which caused him to go numb down one side.j

I am now considered intolerant of statins since the first type crippled me for a month, the second did the same and the third made me go rigid for which I was sent to the physio. Once the tablets wore off I was fine again.

Statins are not good for everyone.

 

[xyzzy]

I would just like to ask the question what does a low carb diet do to your body over a long period? We need carbs for energy if we have no glucose in our blood we have no energy. It may well be dropping BG levels but it's not a healthy balanced diet it's eating to serve the diabetes not treating what you eat which should be a healthy balanced diet. Nurses know about being healthy that has to count for something. I would recomend anybody who has type 1 or 2 to do a DAFNE ( Dose Adjustment For Normal Eating ) it is geared more for insulin dependant but it has quite rightly pointed out that for type 2 adjusting the diet is just as helpfull.
Anyway just a thought.
Stay strong and all the best

So far I havent heard of anyone on a LCHF diet having any problems over a period of time, I ve been doing it for the last 2 years:? Lke Fraddycat I excercise regulary, 5 days a week of high intensity training, and Ive had no problems getting the engery to do this. in fact for the last 4 weeks I have stopped taking my statins, and the muscle pains I was getting have totally gone away, and I have even more engery. If i had stuck to the NHS advice, and ate a high carb diet for the last 2 and a half years, I'm positive I would now be on medication, or even insulin. I know what diet I will take my chances on

I take your point about the carbs if that's your thing then that's grand. But to stop your statin I think is Not very good. My mum has just a stroke and it is a scary thing so if I am at a higher risk of stroke and have a chance to reduce the risk I will take it. There are alot of statins out there finding one that suits you is the key. I believe the benefit of taking them out weighs the side affects.

Another LCHF success here. A couple of points Geezer. Firstly Type 2's are normally not allowed to do DAPHNE courses as the NHS says that even insulin using T2's don't need to in most cases let alone those of us who are just diet only or diet only plus meds.

Secondly, effectively an insulin using diabetic gets the option to eat what you describe as a healthy diet containing carbs because you can calculate the grams of carbs and cover them with the correct dose of insulin. Diet only and low med T2's often don't have that ability. If we eat too many carbs our levels just rise and there is no way to bring them down quickly enough to prevent damage. Hence many of us reduce our carbs to the point our meters say our 2 hour post prandial readings are safe using the NICE guidelines to define "safe". In my own case I have to reduce my daily carb intake to around 60g / day or else I start to see a day by day rise in levels which within a few days would have me back above those all important NICE guideline values.

When I swapped to my new regime post diagnosis which is low carb but quite high in saturated fats my cholesterol levels actually came down to normal levels within 6 months and further based on those results my gp agreed that coming off statins was fine. To many of us it seems to have been that supposedly healthy low fat high carb diet that caused the cholesterol problem in the first place and cutting back on the carbs and upping the fat has actually sorted the problem out. Again in my case at diagnosis I had spent years eating the supposedly safe low fat high carb diet recommended in this country. We cooked all foods mostly from fresh and I exercise and still do with a 3 - 5km walk most days. In the 15 years prior to diagnosis that healthy diet made me gain 4 stone in excess weight. I have lost all that weight within 9 months of swapping to a low carb high fat regime.

Of course I agree that wherever possible things should be done with the backing of your gp or dsn. In my case that hasn't been a problem as both, although a bit suspicious of my methods, have had the intelligence to support and encourage how I control my T2 as they can see it works brilliantly for me. Many other T2's like the OP don't get that support because of that "one size fits all" approach to diet in this country.

 

[xyzzy]

I understand exactly what your saying but however you look at it a high fat diet is not good for you and a doctor should not just let you get on with it watching those arteries fur up. If you can't control your type 2 by meds and a healthy balanced diet and what I mean by that is a bit of everything not a hi carb diet but balanced not high in anything. Then if that is not achievable because BG goes up then you should be re- diagnosed with type 1 and get better control of it not let it control you by eating in my opinion an unhealthy diet then the DAFNE course would apply to you. But I do agree we are put into one category and treat for that category and not as a individual.

But I am not T1 am I. I am T2 just like hundred and hundreds of other T2's on this forum who over the years have done what I've done and successfully controlled their condition.

Surely if my arteries were furring up then those 3 monthly lipid tests I take would be showing a rise in cholesterol not a fall?

Cholesterol just after diagnosis when following what you describe as a healthy diet for most of my adult life.

HDL 1.0, LDL 3.08, Trigs 1.97, Total 4.9

Cholesterol just 3 months later after swapping to the diet you claim will fur up my arteries .

HDL 1.36, LDL 1.89, Trigs 1.19, Total 3.8

Patently it isn't.

BP at diagnosis was regularly 160/95, nowadays on the my high fat diet its 115/75.

HBA1c at diagnosis was 11.3% now its 4.9%

So you want me stop my LCHF diet and go on insulin so I can go back to regime which gave me high cholesterol requiring statins, and a BP that was through the roof? Don't you realise how silly that sounds?

 

[lucylocket61]

I think Geezer is under the mistaken impression that T2's on insulin become T1's.

Then if that is not achievable because BG goes up then you should be re- diagnosed with type 1 and get better control of it not let it control you by eating in my opinion an unhealthy diet then the DAFNE course would apply to you

as an aside, a balanced diet for a T2 diet only is not the same as a balanced diet for a non-diabetic.

Its like the difference between cars who run on Diesel and those who run on Petrol.

A car which needs Petrol (LCHF) will become unable to function if we insisted on putting Diesel (traditional NHS diet) in it. Its the same for a T2 diet only. We become unbalanced and unable to function of many carbs. The carbs make our blood sugars out of balance. So for us, low carbs produces a balanced diet.

 

[xyzzy]

So tell me this! Why is it that every health official and the government and anyone watching what they eat is adviced to keep the fat intake low. Now they don't tell you that for nothing.

They don't. Go download "Kost Vid Diabetes" the official Swedish government guide for T2 diabetics. You'll see it recommends a range of low carb high fat regimes. So there you go, the country with the worlds leading state run healthcare service says low carb high fat is fine. Similarly even the Americans via the ADA recommend a carbohydrate intake level of half that of the UK if you read their 2011 & 2012 T2 position statements. The recommendations in the UK stem back to 1991 so over 20 years ago. Other countries at least recommend T2's regimes based on findings in the 21st century.

An example of a low carb high fat diet as recommended by the doctor that the Swedish Health Service follows can be seen here.

http://blogg.passagen.se/dahlqvistannika/?anchor=my_lowcarb_dietary_programe_in

It is also of interest to note that the top 3 industrialised countries that have the lowest rates of T2 diabetes have populations that have historically followed low carb high fat regimes. 1st is Iceland, 2nd is Sweden, 3rd is Norway.

Please try and have an open mind. Over the years this forum has seen hundreds of T2 diabetics follow that low carb advice and the vast majority have successfully controlled their conditions without furring up their arteries or having to go on insulin just because some out of date dogma says you need to eat a load of starchy carbohydrate.