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Doctor's Advice

B

BarbaraG

Well-Known Member
Messages
294
Type of diabetes
Type 2
Treatment type
Non-insulin injectable medication (incretin mimetics)
The Low Carb Programme tells you to discuss with your doctor how much to reduce your carbs by. Before you do it.

What I'd like to know is.... did anyone actually do that? Have you even told them about it after the fact? And given that the new NICE guidance about personal Carbohydrate recommendations appears to be largely news to most GP's, what's the chance of them coming up with a figure that is much under 150g anyway?

I just did it. (metformin only, so no hypo risk). 8 weeks later I went for annual review - at a new practice because had recently moved house. A1C was 62, but I told her I had recently reduced my carb intake and started losing weight, and asked for three months to see what I could do. I went for the follow up blood today - waiting with baited breath for the result.
 
I saw my GP last Tuesday and told him I was considering changing over to a LC diet, as I haven't fully committed to it yet. He said there had been a lot of research done on it recently and if I wanted to then give it a go. But he didn't suggest an amount to reduce it by that was down to me. He then moved on to my weight issue and was pleased I was loosing some of it. So although it was discussed briefly I took it that I had his support to try it.
Have you spoken to your GP?
Maggie/Magpie
 
BarbaraG said:
The Low Carb Programme tells you to discuss with your doctor how much to reduce your carbs by. Before you do it.

What I'd like to know is.... did anyone actually do that? Have you even told them about it after the fact? And given that the new NICE guidance about personal Carbohydrate recommendations appears to be largely news to most GP's, what's the chance of them coming up with a figure that is much under 150g anyway?

I just did it. (metformin only, so no hypo risk). 8 weeks later I went for annual review - at a new practice because had recently moved house. A1C was 62, but I told her I had recently reduced my carb intake and started losing weight, and asked for three months to see what I could do. I went for the follow up blood today - waiting with baited breath for the result.
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A few indicators you could do to gauge the carb levels you need is with finger prick tests and the ole' bathroom scales to monitor your weight loss (or gain). The HBA1C result is but one number which is the average BSL over a period. Regularly checking your blood sugars will show if you need to reduce your carb intake or not. Unfortunately, a lot of doctors and dieticians are stuck with the low calorie/low fat mindset and may give you outdated information like: your body NEEDS carbohydrates to function and he or she might even try to get you to take statin drugs as "your cholesterol is very high". The best thing you can do for your self is to do lots and lots of reseach on Diabetes, LCHF, medications and their side effects and things that affect your health and well being. As I found out later in life, doctors do not know everything:)
 
It was my GP who originally suggested the Atkins diet to me for weight loss when I was first diagnosed as type 2, but I actually ended up eating a "standard" LCHF diet instead. The only other advice I've has from him at my regular (non diabetic specific) 6 monthly checkups was "don't go too low", as an afterthought.

I'm on 1000mg metformin a day which I take in 2 doses. I've never actually gone too low by low carbing (down as low as 20g carbs a day initially) for nearly 3 years now - although I (believe I) used to get the occasional hypo from migraines years ago before they were under proper control and well before I was ever diabetic - I used feel really bad and had dreadful sugar cravings and sit and scoff spoonfuls of the stuff from the sugar bowl.

But I believe that advice to check with GPs is necessary as they have to cover all situations. There are certain meds that you may have to adjust (e.g. insulin!) if you cut the carbs right down.

Robbity
 
My DN is a low carber but has to push NHS dogma. I try not to discuss it openly with her since her job is on the line. What I do is to print out stuff from PHCUK and @Southport GP and when I open my patient care folder I leave it on her desk. She usually snaps it up. This Thursday she is going to get the PHCUK survey of 54 weight loss trials and Gary Fettke's statement to the Australian Senate.
 
I haven't actually met my GP yet - only moved to new area in July and practice in August, which was about when my annual review was due. So my only contact other than reception staff and phlebotomist has been with the practice nurse. I told her I had reduced my carb intake, without going into details.

I hadn't been testing for a couple of years, because I had lost a lot of weight (on low fat healthy eating) so came off meds, and therefore got no strips. I asked for them in August and was refused. So I bought an SD Codefree meter.... fasting BG mid 7's at the start of September, now regularly in the 5's.

Squire Fulwood - your DN might like to see the revised NICE guidance from December 2015 which talks about individualised care and a personal Carbohydrate recommendation, depending on patient's preferences...
 
BarbaraG said:
Squire Fulwood - your DN might like to see the revised NICE guidance from December 2015 which talks about individualised care and a personal Carbohydrate recommendation, depending on patient's preferences...
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I thought I read that once and quoted it but I shall read it again since I think there was second paragraph which I didn't like.
 
I have told my endocrinologist, doc and nurse that I 'self test so that I can see which foods raise my blood glucose, so that then I know to avoid those foods or eat smaller portions.' Carefully didn't use the words Low Carb.

My nurse told me 'only type 1s need to test' and my doc said 'but according to your latest hba1c you aren't even pre-diabetic'

Neither of them seemed to grasp the low carb message at all. Haha!

My endo's response was more interesting. He clearly accepted my D status - 'we knew it was going to happen, it was just a matter of when' but seemed totally chilled with the low carbing 'with your current blood glucose control and self-monitoring, I'm happy for you to carry on, but if things deteriorate you will need to see your doc ASAP, OK?'
 
Here is the paragraph that is still in the NICE recommendations which I am hoping will be deleted one day.

"1.3.3Emphasise advice on healthy balanced eating that is applicable to the general population when providing advice to adults with type 2 diabetes. Encourage high‑fibre, low‑glycaemic‑index sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include low‑fat dairy products and oily fish; and control the intake of foods containing saturated and trans fatty acids. [2009]"
 
I haven't seen my GP yet since before the blood test that led to my diagnosis though I have had two appts. with the diabetic nurse.

At the first appt. I was given the diagnosis (and the standard NHS advice sheets and told to go away and eat carefully and try to lose some weight) and the second appt. at three months, we didn't have a lot of time to discuss diet but I told her I was doing lower carbs. and she asked me a couple of questions, she was pleased with my weight loss and bg improvement. I'm going back to see the her again in a couple of weeks and I'll take my food diary and bg meter log along.
 
We don't seem encouraged by out practice to self test, in fact they refuse to hand out meters and strips. However the DN is very keen on low carbing so that's encouraging.
 
Squire Fulwood said:
Here is the paragraph that is still in the NICE recommendations which I am hoping will be deleted one day.

"1.3.3Emphasise advice on healthy balanced eating that is applicable to the general population when providing advice to adults with type 2 diabetes. Encourage high‑fibre, low‑glycaemic‑index sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include low‑fat dairy products and oily fish; and control the intake of foods containing saturated and trans fatty acids. [2009]"
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Diabetes Australia STILL give out similar advice as NICE however the Dieticians Association have slightly altered their stance with "there are some situations where reduced carbohydrate intake may be beneficial ... " My question will always be:"if low GI foods increase your BSL slowly, would it not be better to eat foods that DON'T increase your BSL at all?"
 
Doriand said:
Diabetes Australia STILL give out similar advice as NICE however the Dieticians Association have slightly altered their stance with "there are some situations where reduced carbohydrate intake may be beneficial ... " My question will always be:"if low GI foods increase your BSL slowly, would it not be better to eat foods that DON'T increase your BSL at all?"
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The Dietitians Association have put their ex Deputy Director on a public black list for saying that and have taken action against Gary Fettke for improving the health of his patients in Tasmania. "Reduced carbohydrate intake" is a bit extreme for them.
 
Isn't it sad that some of us are scared to tell our health care team what we're doing?
 
Squire Fulwood said:
Here is the paragraph that is still in the NICE recommendations which I am hoping will be deleted one day.

"1.3.3Emphasise advice on healthy balanced eating that is applicable to the general population when providing advice to adults with type 2 diabetes. Encourage high‑fibre, low‑glycaemic‑index sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include low‑fat dairy products and oily fish; and control the intake of foods containing saturated and trans fatty acids. [2009]"
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Yes, but look at these two:

1.1.1 Adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences

1.3.6 Individualise recommendations for Carbohydrate and alcohol intake and meal,patterns.
 
BarbaraG said:
Yes, but look at these two:

1.1.1 Adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences

1.3.6 Individualise recommendations for Carbohydrate and alcohol intake and meal,patterns.
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It seems you can pick and mix. I like 1.1.1. and 1.3.6. but they seem to be nullified by 1.3.3. I don't think the advice is consistent and allows an HCP to choose which path to follow.
 
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I don't discuss food with my DN and she has never told me to eat to the NHS guidelines of starchy carbs with every meal or to have low fat and as long as my HbA1c results are good she is happy for me to do whatever I do to keep them like that
 
There are a number of HCP's in the U.K. actively promoting low carb, both to their own patients and more widely - within the profession, to professional bodies, government and the public. A small number, I grant you, but growing. I suppose we may yet to have our own Noakes/Fettke trial here.... but until we do, the word is spreading.
 
I told my doctor exactly what I was doing and he watched the results over the following year and for that matter over the last 7 years, I dont suppose he entirely agreed with me to begin with but he didnt try to stop me, how could he?

I would never lie to my GP or any other HCP, why would I do that and possibly conpromise my own health, what if I became dangerously ill how could they possibly treat me correctly and diagnose any problems if they werent in possession of the full facts?

To my mind, anyone who doesnt tell their Doctor the whole truth and keep them in the picture is potentially making trouble for themselves, whats the worst that a doctor could do? Tell you that they didnt agree with you? Big deal. Tell them the truth, for the sake of your own future health.
 
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