Diabetes UK recipe

[))Denise((]

Why would you want sugar on fruit (with the exception of rhubarb - I'm not even sure if that's a fruit)? No need in my book ...

 

[borofergie]

Borofergie - what did you mean by disgraceful dietitian - please explain!

When I was first diagnosed (T2, 24.4 mmol/L, HbA1C=10.2%), all I wanted to do was talk to a dietician so that I could get some help in putting together a new diet. Unfortunately, it took 8 weeks before my referal came through, by which stage I had read Bernstein, and cut my carbs to the extent that I had my BG under control (never over 7mmol/L).

By this stage, I had read around the subject enough, that I was looking forward to an intelligent consultation, where we reviewed my DIY diet and used her professional experience to work out what was missing and what I could do better. The referall letter had a two-hour appointment, so I took the morning off work and went to my appointment armed with a folder full of graphs, charting my BG levels, my weight, and detailed information about my diet (I had logged every single piece of food that I had eaten in the past 8 weeks).

The dietician was 20 minutes late for the appointment (the first of the day), and the consultation lasted less than 10 minutes. She weighed me, asked me what I ate, and after listening to my "typical diet" said "you need to eat starchy carbohydrates with every meal", and you "shouldn't eat cheese because it is high in fat" (I don't even really like cheese, but she had seen it listed once in my food log).

I tried to explain to her that carbohydrates would put my blood sugars up, and she shook her head, thrusted me a badly photocopied copy of the ridiculous "NHS Diabetes Diet Guide" and asked me to complete a discharge questionaire.

I am still disgusted. Not only did she give me wrong, potentially dangerous advice, but she treated me with a level of contempt I have not experienced in 20 years of professional life.

As I said before, I am educated enough to read around the subject and form my own opinion. If I had blindly followed her "professional" advice, I'd be sitting here with a HbA1C of 8 or 9, rather than 5.2%.

 

[ally5555]

Thank you for explaining that - no excuse at all. You should have complained - when I was a Chief Dietitian I would not have tolerated lateness although it can happen but poor photocopies are not acceptable.

I am amazed you had a 2 hour appointment - was it on your own or as a group?

I use a moderate approach and have many pts with HBAs in the 5s and low 6s without having to low carb - I should copyright this as it will appear on a blog by 9.

The awful thing is that hospital dietetic depts do not see diabetes as a priority - there is so much else to deal with. Often diabetics are referred to overun clinics in the primary care setting - not ideal.

 

[borofergie]

It's not the lateness or the photocopies that bother me, but the complete lack of constructive advice or understanding of the issues surrounding diabetes.

(In my opinion) a HCP might not agree with low-carbing, but they should at least have some knowledge of it, and be able to discuss it intelligently. It's obvious that she was "reading from the script". I could have taken all the information that she gave me from glancing through the poorly photocopied leaflet (which most of us agree gives almost criminally bad advice to new diabetics).

I presume the two hour appointment was an administrative mistake but, having waited for two months, I certainly deserved more than 10 minutes.

 

[Grazer]

I agree completely with borofergie. My appointment with the dietician was almost identical. She was late, and the "consultation" consisted of showing me pretty pictures of plates of food piled high with spuds. She told me I didn't eat nearly enough potatos (and that was BEFORE I went on a reduced carb diet) Notably, she was quite obese herself, so not a great role model. My meeting with her was just before christmas, and she ended with "If you want a few mince pies, you have some. You need to enjoy yourself" I'm glad I wasn't testing over Christmas. When I did test on her diet I was often at 13+ with my BG, and nearly always in double figures. Now I've worked it out for myself, and eat well but properly, I rarely go over 8, and am normally below 7. I'm on diet only. HbA1c now 5.5. I'm sure there are some properly trained dieticians out there who understand the effects of different food types on different med or no-med regimes, but it would be nice to have been told more than "eat lots of fruit and veg and you'll be fine"

 

[jopar]

It's not the lateness or the photocopies that bother me, but the complete lack of constructive advice or understanding of the issues surrounding diabetes.

(In my opinion) although a HCP might not agree with low-carbing, but they should at least have some knowledge of it, and be able to discuss it intelligently. It's obvious that she was "reading from the script". I could have taken all the information that she gave me from glancing through the poorly photocopied leaflet (which most of us agree gives almost criminally bad advice to new diabetics).

Sorry I don't think that from your discription of your 10 minutes, gives you the right to judge let alone condem in the manner you do..

So you've determined in 10 minutes, the level of understanding of issues surrounding diabetes, lack of constructive advice, that she was reading from a script! no knwoldege of low carbering etc etc...

Sorry but yet again, you can not determine all this in 10 mintues it's impossible..

The leaflet isn't criminal or even near criminal, what is criminal is how people lack to understand it, that it's only a basic information that tells you some basic information about diet and you as an individual need to find out a lot more..

 

[borofergie]

She told me I didn't eat nearly enough potatos (and that was BEFORE I went on a reduced carb diet)

No matter where you stand on the low-carb issue, telling a newly diagnosed diabetic that they don't eat enough potatoes is like telling an alcoholic that they need to drink more vodka.

I forgot to say that my dietician told me off for testing too. Her advice was bascially "more carbs with every meal, less fat, no testing".

Which brings me back to my original point. Not all Type 2 Diabetics that suffer complications do so because they fail to act on the advice that they are given. Many (if not most) are given bad advice.

 

[borofergie]

Sorry I don't think that from your discription of your 10 minutes, gives you the right to judge let alone condem in the manner you do..

So you've determined in 10 minutes, the level of understanding of issues surrounding diabetes, lack of constructive advice, that she was reading from a script! no knwoldege of low carbering etc etc...

Sorry but yet again, you can not determine all this in 10 mintues it's impossible..

The appointment was for 2 hours (according to the referall letter). The dietician discharged me after 10 minutes, after offering no constructive advice. How am I supposed to judge her level of knowledge?

And of course I have the right to criticise any HCP that doesn't treat me properly. I waited 2 months for the appointment, prepared extensively for it, and went with an open mind expecting an objective review of my diet. Where was my tailored diet plan?

 

[RussG]

I'm largely not commenting on the quality of the advice as I don't have a barge pole with me today.

However all of my previous clinic style appointments in the NHS other than GP have never had a specific, actual appointment time. It's always just been the time of the start of the clinic or the length of time the clinic ran for and you wait your turn.

I sincerely doubt you were actually offered a 2hr appointment as that would simply not be practical. I would have thought a poorly worded letter was a much more likely turn of events. If their allowance per person is 20 mins and you got 10, for example, that's a quite different perception from thinking you should get 120 mins and only got 10.

I had maybe15-20 mins with my dietician, and whilst she was perhaps slightly uncomfortable with some of my plans, she went with them and gave me some suggestions that helped me manage my BS readings a bit better (which were going too low at points). I did not need her approval, and neither did I feel the need to win an argument with her about the best way of managing my diabetes.

borofergie - only you will know how much discharging you with 'no constructive advice' was actually with 'no constructive advice that you agreed with'. I know I didn't agree with some of what my dietician said and entered it with quite a bit of journal info behind me, but no dietetic qualifications. I chose to listen and accept some of what she said, agreed to disagree on other bits and simply chose to quietly ignore some others. We parted company amicably enough. As I say, only you and your dietician know what your experience was like.

Just my $0.02.

 

[CollieBoy]

Jopar,
If 10 minutes is all the time you are given, Then that's all the time you have to judge her. You may not like it but LIVE WITH IT. If you make a horrendous impression then you have to live with it or work to improve it!!

 

[anna29]

Hi, would just like to let you know after a bad start with first 2 appointments with a dietician that clearly wasnt listening to my medical conditions and facts , I made an appointment with the clinic manager and presented my issues and complaints, I was allowed to be seen by the most experienced staff manager and now have brilliant support and advice, she even says remember dont eat too much carbs or fibre as you cant take/tollerate it, remembering my 2 bowel diseases coeliac and diverticulitis. If you have a HCP that ignores your medical history or reasons for your own choices/needs ,you CAN request a change of staff member. It worked for me and I certainly successfully created progress for myself. Just wanted to let you know you can do too! Anna.x

 

[jopar]

You have the right to make an opinion concerning the length of time spent in the appointment, you have a right to moan that you had to wait 2 months for an appointment.. And you have the right to say you felt you didn't get enough informtion..

But what it doesn't give you the right to say what knowledge she did or didn't have, and it certainly doesn't give you the right to tarnish every HCP with the same brush..

See the problem is whether a patient had got a validation to make a comment, some patients just don't listen to a word what's being said to them!

I use my sugery dsn for an example..

I have a total different opinion of her to my friend..

Our DSN has been involved with my diabetic care for over 10 years now and we make a good working team, shared information and is always interested what is working for me and at times when I've not been able to see the woods through the tree's she has..

How ever my friend or should I say her husband as he's the diabetic, doesn't have the same working relationship that I have and yes this does have an impact on her husbands control.. It's not what our DSN is or isn't saying, it really doesn't matter what she did or didn't advise because my friend will not listen to a word that is being said.. She will do what she thinks for her husband!

I will add at this point, my friend controls every aspect of her husbands life, always has done in the case the phrase 'being under the thumb' is pretty much an understatement :shock:

Strangely if you looked at how she attempts to control her husband diabetes, you would know that no medical professional has ever advised her to do what she does! But yet she slates them for advice that hasn't been given!

 

[Sid Bonkers]

Firstly no one get a 2 hour slot with a consultant a doctor or a dietician. Edit to remove personal comment.

It's obvious that she was "reading from the script".

[mod edit -too close to 'carb' politics]

 

[Grazer]

Methinks Jopar protests too much in defending his own proffession.
Methinks also that Sid is getting a little personal rather than scientific in his criticism.

 

[Patch]

It's obvious that she was "reading from the script".

Seems to me its you who is 'reading from the script' the extremist low carb script [/quote]

Welcome back, (to the old) Sid. :lol:

 

[ClaireG 06]

Can we please keep this thread on topic and not use it to attack people personally or their line of work.

 

[ally5555]

I must admit I did not think anyone would get a 2 hour slot unless seen as a group.
The problem is that for the dietitians they are completely overrun with referrals and in England there have also been quite serious cuts - no recruitment etc. So if you are lucky then 20 minutes is what you will get!
It takes 10 minutes to look at the relevant notes etc and just ask a few questions. It is really not the dietitians fault - management!!
As far as the carb question is concerned then they can help with ensuring your diet is nutritionally complete - I find in practice that this is often not the case. The very basic analysis I did on here showed exactly that!
There was only one that really did have enough fat and he had seen a dietitian! Many were low in various micro nutrients but the interesting thing was that actually many had a lower intake of fat than the DRV in the UK.

I have to say that as a profession Dietitians are generally very dedicated , very busy and do a lot more than just dole out diet sheets. They are involved in very technical and specialist work - special care babies, ITU, metabolic disorders that require very complicated diets, tube feeding etc! So actually seeing outpatients is not very appealing to many younger dietitians !
I have found it a great profession to be in.

Ally

 

[ShyGirl]

If you can be bothered enugh to read such sites and publications then you probably already know how to treat such foods- a one off treat.

 

[ally5555]

Shy girl - dietitians are specialists and contrary to what you may read here they are able to advice people especially if things are complicated . They spend 4 years studying the subject by the way! However it is getting the right referral to the right specialist.
Please pm me if you want some advice on the right person to see.

Ally

 

[noblehead]

The only fruit I BBQ is bananas, apart from that it's meat all the way! :wink:

As for Dietitians, well I've never had a problem and have seen one twice in the last 2 years, overall I find them very informative and are more than willing to listen and learn from your own personal experiences, I just ask them to analyse my diet and point to where I may be going wrong or if something is missing in my diet. They are really busy people and very much in demand as I tried to book my son to see one at the beginnig of 2011, at the time I was told the waiting list was 2-3 months, I am lucky as I get to see mine during my diabetes check.

Nigel