Diabetes and Mental Acuity/ Emotional Lability

noblehead

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Thanks for the clarification @Neemo, but try as we might it isn't always possible to keep bg levels consistently between 5-7mmol no matter how hard we try.
 
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Neemo

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I consider that within the range of 4-11 mmol/l has no affect on my cognitive ability or emotion. Above and below that range I acknowledge that I have a shorter fuse. What were you considering small fluctuations @Neemo?
Yep, for the most part if I maintain that 4-11 range I'm fairly satisfied. Although 4 will disrupt my analytical/cognitive abilities significantly for the short term (30-45 mins) any lower and it has more pronounced effect.

I think this topic can be somewhat subjective, as it depends on the individual and their lifestyle: I read A LOT, and my occupation is very analytical and requires a high degree of concentration; so therfore I'm acutely aware of the affects of Hypos/Hypers and brain function.

An earlier poster, JuicyJ also mentioned difficulty concentrating wit swings in BS (I can see from her profile that she works in a very analytical job; Excel spreadsheets :()

I've been at 1-2 mmol and been lucid in my thoughts and been able to have a conversation, however I was in a far from 'optimal' place, in terms of cognition.
 

Neemo

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Thanks for the clarification @Neemo, but try as we might it isn't always possible to keep bg levels consistently between 5-7mmol no matter how hard we try.
TOTALLY agree. But I believe these discussions can be a catalyst to spur Individuals to make positive changes.

I've had diabetes for 20 years now, when I was first diagnosed the Dieticians/Nurses/Doctors were adamant I should be on a high carb diet.

I think clinical guidelines are very generic, and some of the advise I received in my adolescence left a lot to be desired.

Personally I have made a number of ( sometimes difficult) lifestyle choices in recent years, which to a YOLO cynic may be considered extreme. This has afforded me a degree of freedom, vitality and mental wellbeing which I felt was lacking in my earlier years of inconsistent control.

I'm an strong advocate of;

1.low GI foods
2.Low/moderate carb
3.maximising Insulin sensitivity through resistance training and food choices
 
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Spiker

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4.Even when your body has adapted to using ketones to fuel neurons, there are still some parts of the brain that cannot use ketones and rely on glucose, hence protein gluconeogenisis Is required to find it (on ketogenic diet)
Actually on reflection this statement isn't just irrelevant in practice to the point - which is continued good function of the brain despite variable glucose - and not just irrelevant to real world ketogenic diets, which invariably contain carbs above this minimal level - it's also factually incorrect, because there is no specific part of the brain that requires exclusive glucose.
 

Spiker

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Rather strawmanish response
In what way a strawman? What are you supposing is the strawman?

You're saying good stable brain function depends on glucose levels not found in ketogenic diets, except perhaps via gluconeogenesis. That's your argument and that's what I am disagreeing with. No strawman.
 
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Neemo

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Not as long as that. Days.

I have found that readaptation is faster.

A number of assumptions being advanced, however nothing substantive. Where are the citations to authoritative studies. There are variations of the ketogenic diet, however they largely advocate less than 15 grams of carbs a day, and as per citation I've made in previous post, the brain DOES require at a minimum 30 grams of carbs a day, even when adaptations to ketones has occurred.
 

Neemo

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In what way a strawman? What are you supposing is the strawman?

You're saying good stable brain function depends on glucose levels not found in ketogenic diets, except perhaps via gluconeogenesis. That's your argument and that's what I am disagreeing with. No strawman.
Your conflating a number of points....

The strawman relates to your uncited assertion regarding BS of 1mmol with a concurrent suffusion/infusion (confusion) - resulting in supposed 'normal' cognitive function for humans - from this you've extrapolated/inferred that this will stop the deleterious effects of a hypo.

My point is that your responding with sparse details of a (link to your study please) supposed study that is artificial in the way you have articulated it, ie that a suffusion/infusion of ketones was delivered to the brain of an individual. please tell me how this is comparable to an individual on a ketogenic diet that is experiencing a blood sugar of 1mmol; how is this supposed magic infusion going to occur when required; time of hypo.

Now if you had said that the individuals in the study had been placed on a true ketogenic diet for 30 days, and then had their BS lowered to 1mmol, and then had laboratory tests conducted on brain marker function and mental function tests; with peer reviewed, documented findings to the positive. Then it would have been a valid argument.

Peace.
 
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TooMuchGlucose

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TOTALLY agree. But I believe these discussions can be a catalyst to spur Individuals to make positive changes.

I've had diabetes for 20 years now, when I was first diagnosed the Dieticians/Nurses/Doctors were adamant I should be on a high carb diet.

I think clinical guidelines are very generic, and some of the advise I received in my adolescence left a lot to be desired.

I'd agree with this, I've actually had conflicting advice by some HCPs on how to treat a hypo one said 50ml of lucozade another 180ml, I actually feel I need about 100ml so neither are correct. The longer I've had this and the more I read, the more I feel that the they really know nothing. I've also been told 'eat carbs with every meal' and this stuff. I am concerned about insulin resistance, but get the feeling that the HCPs opinion is: 'oh it just happens'. When it comes down to it, what do they actually know? They're still not sure on the cause of type 1.
 
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lizdeluz

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TOTALLY agree. But I believe these discussions can be a catalyst to spur Individuals to make positive changes.

I've had diabetes for 20 years now, when I was first diagnosed the Dieticians/Nurses/Doctors were adamant I should be on a high carb diet.

I think clinical guidelines are very generic, and some of the advise I received in my adolescence left a lot to be desired.

Personally I have made a number of ( sometimes difficult) lifestyle choices in recent years, which to a YOLO cynic may be considered extreme. This has afforded me a degree of freedom, vitality and mental wellbeing which I felt was lacking in my earlier years of inconsistent control.

I'm an strong advocate of;

1.low GI foods
2.Low/moderate carb
3.maximising Insulin sensitivity through resistance training and food choices


As diabetics, we're always striving to be as normal as non-diabetics, (whatever that might mean!). It's kind of natural, therefore, for us to be our own worst enemies and downplay the blood sugar fluctuation problems of mood, concentration, etc that you mention. The diabetic wants to work and play as well as anyone else and is in cahoots with the consultant who wants to believe that the treatments and medications he has chosen for his patients are effective. Consultant and diabetic being on the 'same side' in this respect may explain why we have been so slow to ditch the carbs and complain about the poor advice.
 
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Neemo

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I'd agree with this, I've actually had conflicting advice by some HCPs on how to treat a hypo one said 50ml of lucozade another 180ml, I actually feel I need about 100ml so neither are correct. The longer I've had this and the more I read, the more I feel that the they really know nothing. I've also been told 'eat carbs with every meal' and this stuff. I am concerned about insulin resistance, but get the feeling that the HCPs opinion is: 'oh it just happens'. When it comes down to it, what do they actually know? They're still not sure on the cause of type 1.

Yep, I agree - I would like to have a look at the training syllabus for Diabetes Nurses/Dieticians (Actually, I will request this tomorrow). The ignorance that is perpetuated is TOO **** high, I really get annoyed.

This high carb "myth" has/is leading to lots of premature complications and deaths...

The thing is, when they come up with these clinical guidelines they utilise data models stats and percentages and then extrapolate generic guidelines for a whole group.

For example the HBA1C ranges that the NHS recommends for TYPE 1's, below 7 is considered 'good'. However looking at studies and data, they really should be advising diabetics to try to safely achieve 6 and lower.

Scary study regarding HBA1C correlation with cardiovascular (stroke and heart attack mortality) (link below)...

I appreciate it can be difficult for some to even stay around seven, however I strongly believe excessive carbs are the primary reason. I am personally striving for a HBA1C if5.5, even if that means I never eat a packet of crisis again:(.

I'm stubborn, but more importantly determined. If the doctors had advised me the choice of the 3 below(I believe they should offer this kind of advise to all Type 1s), I would and do definitely take option 3;

1.Eat anything you like, take an injection/don't, take a test/or dont = u will live a short life, die an unpleasant death. Look on the upside u can binge to your hearts content; YOLO
2.Eat lots of starchy carbs, keep your HBA1C at 7 or below = you'll escape the first decade or 2 relatively unscathed, however the macrovascular/microvascular damage is being done; the retinopathy, neuropathy, atherosclerosis is nearly knocking at the door..and to top it off u will be middle aged, overweight with Insulin resistance - even if you want to change when problems start occurring it may be too late.
3.Carbs are the enemy. .You will have a lifetime of vegetables, Low GI carbs like lentils and good ol chicken breasts. No big bowls of pasta or pizza for you :/ = But you will be a LEAN, MEAN glucose busting machine, whose small sacrifices/food choices have paid massive dividends in later life. You'll be entering your later years with few or no complications, and you'll even be healthier then some of your non diabetic peers who chose to smoke, over indulge etc. :)

https://www.google.co.uk/url?sa=t&s...SY_DM4&usg=AFQjCNHR-Y0-ulqcG-apLh2t0vx4hhjb2Q
 

TooMuchGlucose

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Yep, I agree - I would like to have a look at the training syllabus for Diabetes Nurses/Dieticians (Actually, I will request this tomorrow). The ignorance that is perpetuated is TOO **** high, I really get annoyed.

This high carb "myth" has/is leading to lots of premature complications and deaths...




I appreciate it can be difficult for some to even stay around seven, however I strongly believe excessive carbs are the primary reason. I am personally striving for a HBA1C if5.5, even if that means I never eat a packet of crisis again:(.

I'm stubborn, but more importantly determined. If the doctors had advised me the choice of the 3 below(I believe they should offer this kind of advise to all Type 1s), I would and do definitely take option 3;

1.Eat anything you like, take an injection/don't, take a test/or dont = u will live a short life, die an unpleasant death. Look on the upside u can binge to your hearts content; YOLO
2.Eat lots of starchy carbs, keep your HBA1C at 7 or below = you'll escape the first decade or 2 relatively unscathed, however the macrovascular/microvascular damage is being done; the retinopathy, neuropathy, atherosclerosis is nearly knocking at the door..and to top it off u will be middle aged, overweight with Insulin resistance - even if you want to change when problems start occurring it may be too late.
3.Carbs are the enemy. .You will have a lifetime of vegetables, Low GI carbs like lentils and good ol chicken breasts. No big bowls of pasta or pizza for you :/ = But you will be a LEAN, MEAN glucose busting machine, whose small sacrifices/food choices have paid massive dividends in later life. You'll be entering your later years with few or no complications, and you'll even be healthier then some of your non diabetic peers who chose to smoke, over indulge etc. :)

https://www.google.co.uk/url?sa=t&s...SY_DM4&usg=AFQjCNHR-Y0-ulqcG-apLh2t0vx4hhjb2Q

I'm currently on a high carb diet because that's what I was told, but I can notice in my sugar level if I eat less then it doesn't rise as much, if at all. The consultant I saw said you will have 10 maybe 15 years before you get complications. I was told a mix between 1 and 2, eat what you want but mostly starchy stuff. Not sure where I heard/read this but rice is actually the biggest contributor towards type 2, and they want type 1s to eat this? The strangest thing is, I actually eat more now, because I was told three meals a day. I never used to eat breakfast either no time or would feel hungry after two hours anyway it just felt pointless. There have been days where I've missed breakfast because I've woken up late so only had two meals and felt much better in myself.
 

ButtterflyLady

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The thing is, when they come up with these clinical guidelines they utilise data models stats and percentages and then extrapolate generic guidelines for a whole group.

What other method would you suggest is more reliable?

Your 3-point advice to newly diagnosed patients is good, but I think if it was given at a population level, a good proportion of patients would never go back to a doctor. Medical practice has to be more nuanced than an extreme black and white view. Sure, doctors could improve on their knowledge of carbs in diabetes, but there is such a thing as going from one extreme to another.
 

LucySW

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Neemo, on a ketogenic diet the minimum amount of glucose you're talking about is manufactured by the liver from dietary protein.
 
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tim2000s

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Yep, I agree - I would like to have a look at the training syllabus for Diabetes Nurses/Dieticians (Actually, I will request this tomorrow). The ignorance that is perpetuated is TOO **** high, I really get annoyed.

This high carb "myth" has/is leading to lots of premature complications and deaths...

The thing is, when they come up with these clinical guidelines they utilise data models stats and percentages and then extrapolate generic guidelines for a whole group.

For example the HBA1C ranges that the NHS recommends for TYPE 1's, below 7 is considered 'good'. However looking at studies and data, they really should be advising diabetics to try to safely achieve 6 and lower.

Scary study regarding HBA1C correlation with cardiovascular (stroke and heart attack mortality) (link below)...

I appreciate it can be difficult for some to even stay around seven, however I strongly believe excessive carbs are the primary reason. I am personally striving for a HBA1C if5.5, even if that means I never eat a packet of crisis again:(.

I'm stubborn, but more importantly determined. If the doctors had advised me the choice of the 3 below(I believe they should offer this kind of advise to all Type 1s), I would and do definitely take option 3;

1.Eat anything you like, take an injection/don't, take a test/or dont = u will live a short life, die an unpleasant death. Look on the upside u can binge to your hearts content; YOLO
2.Eat lots of starchy carbs, keep your HBA1C at 7 or below = you'll escape the first decade or 2 relatively unscathed, however the macrovascular/microvascular damage is being done; the retinopathy, neuropathy, atherosclerosis is nearly knocking at the door..and to top it off u will be middle aged, overweight with Insulin resistance - even if you want to change when problems start occurring it may be too late.
3.Carbs are the enemy. .You will have a lifetime of vegetables, Low GI carbs like lentils and good ol chicken breasts. No big bowls of pasta or pizza for you :/ = But you will be a LEAN, MEAN glucose busting machine, whose small sacrifices/food choices have paid massive dividends in later life. You'll be entering your later years with few or no complications, and you'll even be healthier then some of your non diabetic peers who chose to smoke, over indulge etc. :)

https://www.google.co.uk/url?sa=t&s...SY_DM4&usg=AFQjCNHR-Y0-ulqcG-apLh2t0vx4hhjb2Q
However, you are disregarding the following:

Something like 95% of UK diabetics are unable to achieve an Hba1C below 6.5%, regardless of treatment/eating.

It is possible with intensive monitoring and insulin therapy for a T1 to eat what they like and achieve good bloods. It is not straightforward.

There are always concerns amongst health professionals that aiming for 6 or below results in increased hypoglycaemic episodes that have there own side effects and drain on resources.

Many of your points have been discussed many times on the forum. In general, a lower carb approach tends towards better control for the average person, however it depends on the individual as to whether that is a balanced low carb or LCHF type approach.

Ultimately too much of anything is bad, and if you really want control, the only way to do it is through intensive management.
 
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Neemo

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Neemo, on a ketogenic diet the minimum amount of glucose you're talking about is manufactured by the liver from dietary protein.
Hi Lucy,

As far as I have ascertained the majority of Ketogenic diets allow 5% carbs; derived from vegetables and or wholegrains.

Managing-Epilepsy-With-Modified-Atkins-Diet-Pie-Chart.jpg
 

Ladybirdy75

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Fascinating thread. So relevant, going through the wringer health wise and emotionally at the present time for these very reasons (plus a few others).
 
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Neemo

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However, you are disregarding the following:

Something like 95% of UK diabetics are unable to achieve an Hba1C below 6.5%, regardless of treatment/eating.

It is possible with intensive monitoring and insulin therapy for a T1 to eat what they like and achieve good bloods. It is not straightforward.

There are always concerns amongst health professionals that aiming for 6 or below results in increased hypoglycaemic episodes that have there own side effects and drain on resources.

Many of your points have been discussed many times on the forum. In general, a lower carb approach tends towards better control for the average person, however it depends on the individual as to whether that is a balanced low carb or LCHF type approach.

Ultimately too much of anything is bad, and if you really want control, the only way to do it is through intensive management.
Thanks for your input.
I appreciate the points your making; they are definitely salient.

Perhaps I didn't articulate my last post as well as I could/should have, but fundamentally, all the points I make are strong.

I'm going to create a post later regarding clinical guidelines issues. Ive sourced some excellent data to illustrate my points.

Would like to get your input once you have read the arguments I make backed up with primary this data.
 
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lizdeluz

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Fascinating thread. So relevant, going through the wringer health wise and emotionally at the present time for these very reasons (plus a few others).

Glad that it can be fascinating when you're going through the wringer. You're proving your strength to beat this! ;)
 
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Neemo

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What other method would you suggest is more reliable?

Your 3-point advice to newly diagnosed patients is good, but I think if it was given at a population level, a good proportion of patients would never go back to a doctor. Medical practice has to be more nuanced than an extreme black and white view. Sure, doctors could improve on their knowledge of carbs in diabetes, but there is such a thing as going from one extreme to another.
Thanks for your input.
The 3 point plan wasn't meant as a literal guide, i:e it's an oversimplification, I was just trying to make a point.

I'll have to politely disagree with your assertion that "a good proportion of patients wouldn't come back" if presented with stark facts as per above.

I do agree however that a holistic, nuanced approach is an important element of primary care.

I am creating a post later regarding clinical guidelines for Diabetes management, I think you will find some of the data that I have managed to acquire, very Informative.
 

ButtterflyLady

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Acceptance of health treatment claims that are not adequately supported by evidence. I dislike it when people sell ineffective and even harmful alternative health products to exploit the desperation of people with chronic illness.
Thanks for your input.
The 3 point plan wasn't meant as a literal guide, i:e it's an oversimplification, I was just trying to make a point.

I'll have to politely disagree with your assertion that "a good proportion of patients wouldn't come back" if presented with stark facts as per above.

I do agree however that a holistic, nuanced approach is an important element of primary care.

I am creating a post later regarding clinical guidelines for Diabetes management, I think you will find some of the data that I have managed to acquire, very Informative.
You didn't answer my question.