Consultant unhappy sending me to dietician again...

[Yeoc]

Dietician keeps telling me to eat more carbohydrates, says I need it for energy. I've disagreed with that and have been on a low carb diet (no tablets or other treatment).

HbA1c at diagnosis was 75nmol/mol

A year later on the diet I have chosen - HbA1c is 43/nmol/mol but this includes the Christmas period and 3 weeks of high carbs, so suspect my results might more normally be late 30s.

Thoughts?

Feeling a little frustrated.

 

[Bluetit1802]

Hello,

Why did the consultant send you to a dietician? Do you have other health problems that warrant a special diet? What sort of consultant is he? I am also type 2 and have never seen a consultant or a dietician.

 

[PepperTed]

That is frustrating, especially if you didn't say you were having problems with energy levels.

We have to remember that the consultant is part of the NHS and has to follow their guidelines, which are currently that carbs should make up about 1/3 of a meal and each meal should have 45-55g of carbs. The kind of diet the NHS promotes has been thought of as balanced and ideal for a long time, and it's what medical students are still being taught today. There is not enough proper, scientific research into nutrition and any kind of out-of-the-ordinary diets tend to be promoted by companies after a quick buck, or pseudo-scientists who talk about "toxins" and "natural eating" and other things that don't really mean anything, scientifically. It's easy to see where an educated doctor might feel you're doing the wrong thing.

Just keep smiling and nodding, play along, and prove them wrong with your excellent diabetic control and continued good health.

 

[Charles Robin]

Direct them to youtube and any of the videos of talks given by Dr Troy Stapleton. The man is a low carb hero, along with the great Dr Richard Bernstein. Why do these two healthcare professionals know so much about how to eat well as diabetics? Because they are both type 1 diabetics themselves. If a prerequisite of being a diabetic specialist was to have diabetes, our doctors would give very different advice to what they give today.

 

[Kat100]

Keep an open mind ...
You could discuss further with a GP if you wanted to ...
You can also ask to,see any letters written about your appointment ...they might give you some more details ...

But I would go,with the open mind attitude

I have seen a great dietiten for two years now ...says she should discharge me, from the db list but she helps with other problems ....for me it has been a good experience ....best wishes Kat

 

[Daibell]

Based on the many posts on this forum over the years many NHS dieticians don't seem to have a clue and often offer harmful advice which can lead to long-term damage. Much of what they say is not backed-up by scientific evidence. You don't need to be a rocket scientist to know that the body converts carbs into glucose. I have never been advised to see a dietician and am grateful for that and chose to ignore my local NHS diabetes booklet given to me that contains the 'eat plenty of carbs' nonsense. Yeoc, you're doing well so carry on doing what you're doing and feel good that you know more than the 'experts'!

 

[sanguine]

Get a copy of Trudi Deakin's new book (link below) to show your consultant and dietician (who typically seem to be clueless).

Have you been testing other than getting your HbA1c results (great improvement by the way, well done)? Maybe you could show them what happens when you eat high carbs over Christmas.

Otherwise just carry on what you're doing, trying to explain it to your HCPs seems pointless. How do they explain your improvement? Ask them to show you any similar improvements from their other diabetes patients who follow the NHS advice.

 

[Yeoc]

Thanks to everyone for the thoughtful replies. Interesting and a good bit to consider and read up on. My consultant keeps trying to tell me off for not exercising as well, which is a again, frustrating. I was formerly a professionally qualified tennis coach in another life, but now have osteoporosis in my lower spine and also have a damaged knee, so being lectured on sport by a very ill looking un-sporty looking consultant is a bit much. I used to run 20plus miles every week as well as being on the tennis courts 6 days a week. I loved and was obsessive about exercise. It kinda feels like a person with no legs now being mocked for not owning a pair of trainers.

Anyway I know a lot of the above is off track/digressing, but the consultant just seems very difficult/unreasonable.

I can't exercise unfortunately, which is why I have been very strict with the diet to come up with that very low HbA1c level. I thought i'd done a great job, so to be rebuffed, lectured and pretty much told I was doing **** was not what I expected to hear.

If I continue and manage to get my HbA1c level into the 30s, would that be good enough, despite the lack of exercise/inability in that regard? Would that be good enough long term?

Thx again.

 

[Daibell]

Hi. Anything near or below 45 (6.3%) is fine

 

[copepod]

Why not ask consultant to refer you to a specialist activity coach / physiotherapist, as I'm pretty sure there is some exercise you could do. Swimming, perhaps? Not weight bearing, I know, so not ideal for improving osteoporosis. When I had a knee injury, I had several individual sessions with a physio, then 6 physio gym sessions to build up strength with static bikes, step machines, weight lifting for legs, starting with low weights and a few reps, building up gradually etc.

 

[Bluetit1802]

Hi. Anything near or below 45 (6.3%) is fine

I can't agree with this as a long term aim. It equates to an average of 7.5mmol/l, meaning there are a lot of higher numbers in there that could cause damage over time. But that is off topic.

 

[sanguine]

I can't agree with this as a long term aim. It equates to an average of 7.5mmol/l, meaning there are a lot of higher numbers in there that could cause damage over time. But that is off topic.

I'd agree - it's good to aim for non-diabetic numbers, 30s is what I'm targeting.

 

[Kat100]

Thanks to everyone for the thoughtful replies. Interesting and a good bit to consider and read up on. My consultant keeps trying to tell me off for not exercising as well, which is a again, frustrating. I was formerly a professionally qualified tennis coach in another life, but now have osteoporosis in my lower spine and also have a damaged knee, so being lectured on sport by a very ill looking un-sporty looking consultant is a bit much. I used to run 20plus miles every week as well as being on the tennis courts 6 days a week. I loved and was obsessive about exercise. It kinda feels like a person with no legs now being mocked for not owning a pair of trainers.

Anyway I know a lot of the above is off track/digressing, but the consultant just seems very difficult/unreasonable.

I can't exercise unfortunately, which is why I have been very strict with the diet to come up with that very low HbA1c level. I thought i'd done a great job, so to be rebuffed, lectured and pretty much told I was doing **** was not what I expected to hear.

If I continue and manage to get my HbA1c level into the 30s, would that be good enough, despite the lack of exercise/inability in that regard? Would that be good enough long term?

Thx again.

Try to make your goals ones which are achievable and can be worked towards by you....think of your needs ...bestbwishes ...kat

 

[Yeoc]

Thx again. Is there any value in taking your own glucose levels with type 2 and should I look at other tests as well as the HbA1c, or is it the case, that as long as that is low/good, everything is ok?

Would love to exercise, but it's a non starter unfortunately, so just trying to do what I can via the diet and any other diagnostics that can help offer pointers as to whether i'm getting it right or not. Consultant seems unhappy about cholesterol too which is 6.6 with LDL 4.16 and triglycerides 3.11. No idea how to interpret that, though I know cholesterol has gone up eating low carb and more protein and fat.

Those tests were taken mid afternoon, no fasting or anything.

 

[AndBreathe]

I have never seen a consultant about my diabetes, and having dropped my HbA1c, as per my signature, I have never been asked what I eat, never mind if I routinely shake it all about. Indeed, there was a great disinterest from the practise nurse, although I can see that if they know you're going to talk about Low Carbing, it's easier for them not to get into the conversation.

My GP wants to talk about boats and sailing, and the GP I have spoken with a couple of times, seems fixated with my lipids, which are excellent, or dreadful depending whether you look carefully, or in massive summary.

It's all just such a mixed bag out there.

Why do you see a consultant (of course, you could be outside the UK), and aside from exercise, has he set any other goals? Do you have any weight to lose?

 

[AndBreathe]

Thx again. Is there any value in taking your own glucose levels with type 2 and should I look at other tests as well as the HbA1c, or is it the case, that as long as that is low/good, everything is ok?

Would love to exercise, but it's a non starter unfortunately, so just trying to do what I can via the diet and any other diagnostics that can help offer pointers as to whether i'm getting it right or not. Consultant seems unhappy about cholesterol too which is 6.6 with LDL 4.16 and triglycerides 3.11. No idea how to interpret that, though I know cholesterol has gone up eating low carb and more protein and fat.

A watch of Professor Sikaris' video would be worthwhile. It explains cholesterol extremely well:

It's time well spent.

 

[CollieBoy]

Thx again. Is there any value in taking your own glucose levels with type 2 and should I look at other tests as well as the HbA1c, or is it the case, that as long as that is low/good, everything is ok?

Would love to exercise, but it's a non starter unfortunately, so just trying to do what I can via the diet and any other diagnostics that can help offer pointers as to whether i'm getting it right or not. Consultant seems unhappy about cholesterol too which is 6.6 with LDL 4.16 and triglycerides 3.11. No idea how to interpret that, though I know cholesterol has gone up eating low carb and more protein and fat.

Those tests were taken mid afternoon, no fasting or anything.

WRT glucose levels, yes as a T2, taking them yourself has great value if you use them to target how foods/exercise/meds affect you!
The HbA1c is just an approximation of your average and will not show your peaks & troughs.
on the cholesterol, you need the full HDL/LDL/Triglyceride test which conventional wisdom says, should be fasting, as food can skew the Trig levels. Once we have these levels we can estimate the problem areas As an example my LDL is higher than recomended but the ratios are such that the LDL is likely the (good) fluffy type so my endo is not concerned.

 

[Daibell]

I can't agree with this as a long term aim. It equates to an average of 7.5mmol/l, meaning there are a lot of higher numbers in there that could cause damage over time. But that is off topic.

True and it's great if you can get nearer to 30 but I think many of us find that extremely difficult so I think reality comes into play. I know for insulin users if can be difficult getting down to 6%'ish due to the need to avoid hypos and many HCPs (wrongly?) set higher objectives

 

[Bluetit1802]

WRT glucose levels, yes as a T2, taking them yourself has great value if you use them to target how foods/exercise/meds affect you!
The HbA1c is just an approximation of your average and will not show your peaks & troughs.
on the cholesterol, you need the full HDL/LDL/Triglyceride test which conventional wisdom says, should be fasting, as food can skew the Trig levels. Once we have these levels we can estimate the problem areas As an example my LDL is higher than recomended but the ratios are such that the LDL is likely the (good) fluffy type so my endo is not concerned.

If your triglycerides are very low, it is most likely your LDL is the good big fluffy kind.

 

[jack412]

Thx again. Is there any value in taking your own glucose levels with type 2 and should I look at other tests as well as the HbA1c, or is it the case, that as long as that is low/good, everything is ok?

Would love to exercise, but it's a non starter unfortunately, so just trying to do what I can via the diet and any other diagnostics that can help offer pointers as to whether i'm getting it right or not. Consultant seems unhappy about cholesterol too which is 6.6 with LDL 4.16 and triglycerides 3.11. No idea how to interpret that, though I know cholesterol has gone up eating low carb and more protein and fat.

Those tests were taken mid afternoon, no fasting or anything.

the above video is a must watch..

then come back and ask questions and we will go through it with you

your triglycerides levels aren't good, do you have your HDL, I work it out to 1.1