Carbohydrates

She sounds sensible to me. The number of carbs may after all be safe within you meter reading for blood sugar.
And hypos at night are something to worry about.

The teaching behind this, is very entrenched in medicine.
You need carbs because of energy, fibre, glucose, nutritient, and so on!

So how could you explain a diabetic being in ketosis, a diet that excludes carbs as much as possible!
It is a falicy that carbs are essential, they are not!
Again, .most medical practitioners would argue you need carbs for glucose for brain function, when with diabetics, it will make matters worse because of hyperglycaemia or hyperinsulinimia or both.
For me brain function improved when the carbs stopped
If you are prediabetic, you need to reduce your carbs, reduce your plate size, increase your exercise, to suit you!
Everyone is different, so your plan for better health should be tailored to you!

Best wishes

Janrad49 said:

Today I had a diabetic review with the diabetic facilitator . I have reduced my weight by 3 stone & my insulin from 28 units to 4 units . I have lower my carbohydrates considerably but the. Facilitator was not happy with this she stated I should be eating some carbohydrates at each meal . I know if I do my levels will shoot up . She has also asked me to test during the night in case my levels are too low . I am now totally confused as what I should be doing

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Because they are taught you should eat shed loads of carbs for energy. And are terrified you will be going hypo without them when on insulin, hence the request to test at night. And quite a few of them still know next to nothing about low carb eating in diabetes .

However if your insulin matches your glucose then hypos shouldn’t be a risk due to the lower carb. (Obviously that’s not the only factor but in a type 2 it is the main one). And as your insulin has lowered alongside your carbs it’s sounding like they are well matched. So long as you aren’t having hypos and you’re happy with your chosen way of eating, weight loss and reduced medication I say well done you and it’s a shame she didn’t too. There is CPD training available for hcp’s to update themselves and this https://bjgp.org/content/69/684/360 document that advises exactly what you’ve done, perhaps she needs to read it too.

Of course the point here is if you are on blood sugar reducing meds such as insulin you do have to treat low carb diets with a little caution as hypos can be dangerous.

For some health providers litigation is a concern. It is proven now that hypos cause low level brain damage. Hence the more hypos the more damage.
Everything in life has risk. Myself I used my risk to get rid of ALL of my insulin injected use. Slowly and steadily... to reduce my risk. Yes I had bariatric support to undo the hunger from all of the extra insulin I had slowly increased to a very dangerous point. So it was either stay mega obese or have an op and get rid of injected insulin.
Now how do you think carbohydrates figured in all this? How does carbohydrates figured in my maintaining my lower weight? Test test test. Money well spent and far cheaper than insulin cartridges/vials/ pens.
Carbohydrates are needed for digestion, even just a little. I don't respond without some carbs in my diet. Too much is just as bad as too little for me. However I must state most carbohydrates aren't any use in my diet so they hv gone.
Our own digestive system is based on our genes, variable sociology and psychological performance in life. Hence we are all different. We all need different levels of carbohydrates.
Find yours and don't get too worried about the quickly turned around mistake but health care providers will always be looking at the bigger picture. No brain damage where its avoidable.

ickihun said:

For some health providers litigation is a concern. It is proven now that hypos cause low level brain damage. Hence the more hypos the more damage.

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Have you got a link? While I can well believe that this might be the case for severe hypoglycemia, I have my doubts that blood sugars in the mid to high 3s have any effect at all. My issue with too many hypos is that it can reduce hypo awareness, certainly in my case, and hypo awareness is very important for insulin users.

Janrad49 said:

Today I had a diabetic review with the diabetic facilitator . I have reduced my weight by 3 stone & my insulin from 28 units to 4 units . I have lower my carbohydrates considerably but the. Facilitator was not happy with this she stated I should be eating some carbohydrates at each meal . I know if I do my levels will shoot up . She has also asked me to test during the night in case my levels are too low . I am now totally confused as what I should be doing

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Sounds like the mental gymnastics required by giving people the wrong treatment for their condition.
As a T2 you are over producing insulin already so chucking yet more into the mix is pretty unlikely to be useful.
You have sensibly decided to lower your carb intake so your insulin requirements have dropped.
Do you think the 4 units are now necessary or do you feel in control enough to drop the insulin completely?

Your weight loss (amazing whilst on insulin) is great news and can only help too.
To me the suggestion to add in more carbs looks like complete madness.. eating to your medication rather than amending the medication to suit your diet is crazy advice (in my opinion).