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Eat to your meter and Controlled Carb Regimes


I'll try and make that a bit clearer. So...

New T2 member arrives with their first post. In my head it then goes likes this...

1) Am I sure they really sound like a correctly diagnosed T2 if so...
2) Must warn them off 50% total carbs of which 33% must be starchy ones as that will hurt them
3) Tell them to cut out sugar and at least half starchy carbs as a simple portion control method to get them going.
4) Tell them to replace the difference with list of food stuffs the Swedes recommend (i.e a trustworthy source)
5) Point out advice in 3) & 4) is what would be given by another modern health service (i.e a trustworthy source)
6) Point out everyone is different and they may need to go up or down from half starchy carbs.
7) Mention 130g as a good start as 130g is the latest American recommendation so again is a trustworthy source.
8 ) Nod to GI by mentioning swap to "brown" rice, pasta etc but secondary advice to cut carbs.
9 ) Nod to VLC by mentioning some people can give up meds and "the trustworthy source" doesn't say no
10) Introduce carb counting as a concept.
11) Introduce importance of testing and meters.
12) Introduce importance of safe levels ( 8.5, 7.8 ) and why those numbers are trustworthy.

My aim is to get the new member to swap diet as quickly as possible as that will get their levels down the fastest. As I've said previously to me safe levels take priority over any diet and to do that a simple "cut carbs" message is by far the most effective one and all of us should not have a problem in pushing that message.

So again relating that back to the Daisy text. If it were to change to me it should not be quite so shy in pushing the "cut carbs if you're a T2" message as nowadays it doesn't need to be shy as there are trustworthy sources it could refer to that back up that standpoint IF you look at the treatment of T2D in global terms not just UK terms.

Finally if the answer in my head to 1) is "I'm am not sure" or what they say in their post doesn't match the details they say about themselves on their account then will say "Can't offer any dietary advice but talk to your gp cos it sounds like.... ... c-peptide, GAD, ketones, urine test etc, age, not overweight"
 
One more thing on the 8.5 or 7.8 debate

This site does actually officially recommend the 7.8 safe limit.

Although the table that shows safe levels

http://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

still shows 8.5. It states and refers to IDF guidelines not NICE. The refrence link [19] on that page takes you to this document

http://www.idf.org/webdata/docs/Guideline_PMG_final.pdf

Inside which on Page 20 which are the conclusions there is a table that says 2 hours should be 7.8 and the following statement


So come on Benedict get your act together and have the site reflect what the reference material you give actually says :lol:
 
Xyzzy, I don't disagree with anything that you say, but for some people at least I think your post is best as a 'second stage'. In my opinion, for some it's too much, too soon, as a welcoming post.

Many people are ready for it straight away, but I've noticed that at least some 'newbies' don't even understand the different food groups, and don't seem to have any sort of a scientific background - aren't ready yet to check sources, etc.

The Introductory Post as we have it now is gentle, and offers a welcoming hand. It gives enough info for the newly-diagnosed, maybe frightened person to think about. It was revised last year by the mods and the admin team, and has had a great deal of thought put into it.

Your post, following on the same thread, shows that there's more to it, when people are ready to take it further. It also shows, as you say, that the 'controlled carb' approach has a good, solid, official background, so can be tried safely.

Anyone who is told, as I was, by the diabetes specialist GP, that I would inevitably go blind and lose my feet, and that if I ate low carb/high fat I'd probably die of DKA before I had chance to have the heart attack, needs soothing and reassuring first. Except me ! :lol: :evil:

The point is that we don't know how people are reacting to the news, when they first join. We need to be a little cautious at first in how much detailed info we face people with. I do favour the 'softly, softly' approach to begin with.

Just my opinion, of course - others may differ!

Viv 8)

And I'm sorry to say it, but your post immediately above would make my eyes glaze over, if I didn't already know what you are talking about. The language in the article you quote is far too technical for many people. Let's keep it simple, huh? I'm sure the Admin team will take on board what you say and have a good think about it, but don't forget we're dealing with the lowest common denominator.
 
please don't flame my thread its been good up to now...
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I have not flamed your thread

I have asked questions and asked for clarification in case my understanding has been flawed.

I think I am owed an apology for your post. I ask questions and get and give advice all over this forum. No-one has said I am flaming by asking.

I am very hurt and sad and dont feel it is helpful to my confidence in asking questions anymore
 

If I thought you were flaming my thread then I would have said "Lucy please don't flame my thread" which is what you are doing now. Why? Is this your attempt to stop the discussions being raised Lucy?

What I meant and I suspect most others interpreted as such was:

"I am about to talk about sensitive things which may make people react strongly. I recognise that these are my views only"

Sorry I wont be around to see your reply as I am now going out for meetings until later. I hope this thread can continue in the rational way it has up until your last post.
 

that is what you wrote. So you are addressing my comment. I am not stopping discussion, I am asking questions. Why is this being turned into my fault? I am being helpful by stepping out, as a newbie, to give my honest personal appraisal of the changes and additions you want to make to newbie information.

I am helping you. So please dont dismiss my posts as irrational, or flaming, or disruptive just because I am questioning not just you, but others on this thread and asking for clarification. I find your tone extraordinary under the circumstances.
 
I for one am glad you are asking questions Lucy, how else are you going to learn?


I agree with Viv, if this had been presented to me when newly diagnosed I would have asked someone to decipher it for me I think. This is a lifelong condition and people need to be eased in gently IMHO. The post that Daisy offers is a general explanation of what needs doing as a starter. The more questions that newbies ask when they read Daisy's post means the more they begin to understand. Technical stuff can come later IMHO.

It is a pity that some more newbies do not add to this thread.
 

I'm going to counter debate here..

1) you aren't medically qualified to determine if somebody is correctly diagnosed, even if you were you it's illegal to make a diagnosed without being privy to the patients medical records etc..

2) Again you don't know if the 50% carbohydrate ratio, will hurt that individual at all, again the individual requires assessment to what their individual needs are by a qualified persons, who needs to be privy to the individuals medical records.

3) Yes I would agree that suggesting the cutting out of sugars, such sweets, sugar in coffee, cakes etc is good advice and one that will give a good reduction of carb intake.. (my sister who's not a diabetic, lost 4 stone just by doing this and made no other adjustments to her main diet)

4) Sorry you don't tell people what they may or may not eat, or able to determine what is or isn't a trustworthy source of information...

5) Yep, point people into what other modern health service is saying, but we all need to remember 'that' modern health service might be different to ours, so their polices might be based on different criteria than ours, such as in America Health Care Service is purely based on the patients ability to pay for treatment and may be dealing with different factors within their own society.

6) So Far you've neglected that everybody is different, as you are telling what they have to do, based on your own opinion and what you suggest to us works for you... You are also pointing people in one directions and classing only the information that agree with your personal opinion... Not what I call an 'we all different' approach.

7) Again you telling somebody what to do... Problem is that without a medical history, and a assessment of the individual actual needs, such as activity levels do they have weight issues to address, what sort of appetite they have in general etc...

8 Again, you'll telling somebody what they must do, yes the GI diet often can improve control for an individual without having to faff with changing their carb intake..

9) Again you are giving misinformation, VLC diets do come with problems and doesn't always mean that the individual can stop taking or reduce meds hence why even the Swedish and American's don't mention it...

Again problems surrounding this type of diet, is adherence to the diet, having to have an in-depth knowledge to nutrition to ensure that your nutritional needs are being met... And several others as well

10 and 11), Yes carb counting is a must, what ever regime you decide on with the backing of a meter and testing is a must, as it's a lot easier to make any necessary lifestyle changes when you can see an impact it having on your control..

12) The figures given are based on continuing data collection and research and is based on WHO recommendations, where the patient can reasonably expected to achieve with or without medication... And studies has shown to attempt to drive these figures lower with high dosages of medication may be detrimental to the individual rather than help.. And again they are a guideline and each individual needs to be assessed to what...

There is one important thing you are leaving out with your message...

And that's the individual :shock:


Which means you are instructing them, and not educating them!

See I don't inform people how many carbs they shouldn't or shouldn't be eating... What I prefer to do is actually educate them about carbs and there probably reaction, and what options are open them to change that reaction, and when needs be give them the pro's and con's of various different options...

This way I'm treating the person as an individual, giving them information so that they can make their own choice what is right for them, the advantage is that they not only have full information to make a justified choice but it's more likely to lead to long term better control because they've are happy with what they are doing and how they got to what they are doing...
 
jopar said:
1) you aren't medically qualified to determine if somebody is correctly diagnosed, even if you were you it's illegal to make a diagnosed without being privy to the patients medical records etc..
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He didn't say he was diagnosing anyone. He was asking himself the question "is this person really a T2?", which is a perfectly legitimate question. There are people that roll up here not understanding what type of diabetic they are, and others who are half way through being properly diagnosed as Type1.5 or LADA or whatever.

jopar said:
2) Again you don't know if the 50% carbohydrate ratio, will hurt that individual at all, again the individual requires assessment to what their individual needs are by a qualified persons, who needs to be privy to the individuals medical records.
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Given that we are explicitly only talking about diet and metformin T2s here we know, almost for sure, that a 50% carbohydrate diet is going to be bad for almost all of them. 50% is 312g on a 2500kcal a day diet, or 250g on a 2000kcal a day diet.

I am not aware of any T2 Diabetics (on diet+met) that claim to achieve good control on above 200g a day. Telling people that "reducing their carbohydrate intake a bit" will help them doesn't require access to their medical records.


I don't understand this. He qualified at the start that we are talking about T2s on diet and/or metformin. We all have at least that in common. I think that we all agree on this forum that some level of carbohydrate management is absolutely necessary for good control within this group.

The method you choose to achieve that control (GI, low-carbing, portion control) is up to the individual, and the amount of restriction necessary depends on the individual and their metabolism, but xyzzy deals with this explicitly in his discussion.


xyzzy isn't dealing with any medication apart from metformin. Medication levels are irrelevant to this discussion.


I disagree. Giving people a ball-park estimate for how many carbs they might be able to eat, and a practial methodology for working out exactly how many carbs they can eat, is a much better approach than the entirely theortical one that you are suggesting.

For this specific group of people there are only two options:
1) To what level do I need to reduce my carbohydrate intake (or glycemic load)?
2) What method do I need to employ to do this (low-carb/very-low-carb/GI/GL/portion control etc)?

all other options are in the hands of the HCP.
 


I am a newby, so shall add

The information given by Daisy is very good and extremely helpful. The only real issue I have with it now, is that as has been said on this thread, many people are not even aware of what constitutes a carbohydrate. People will read "bread, potato, pasta and rice" then go off and have steak and kidney pie with baked beans for dinner, thinking they are doing well. I would strongly advise/ request the information also includes wheat, beans and pulses. A 220g can of Heinz baked beans contains 30g of carbs and 10g of sugar - eek!!

While as a newby I was upset, lost, scared, and helpless, I would have appreciated knowing about wheat and beans. These are most family staples and as such MUST be addressed. I am lucky that I read this forum and learned what exactly a carb was, initially I still made mistakes, beetroot was one. So as much as the information is a very gentle introduction to diabetes, it is not as comprehensive as it could be.

I sound thoroughly ungrateful but I truly am not. I was very appreciative of the advice, but with a little more knowledge now, I can see where it could be improved a little, but make a huge change, and possible lack of mistakes in the newly diagnosed.
 
I agree 100% with what Borofergie has said

I would add Jopar that by advising people to restrict carbs I do no more than Daisy's text which also suggests that T2's might want to look to reduce carbs. All I do by adding 130g is to clarify what "reduce" might mean based on what the American Diabetic Association now recommends. Perhaps you want to tear up Daisy's text as well as mine?

As Borofergie may have been somewhat shy in defending VLC then I'll do it for him even though I'm not a VLC follower myself. The Swedes DO mention VLC and give examples of VLC diets. They conclude with if a PATIENT CHOOSES TO GO ON A VLC DIET then monitor them closely to make sure no problems happen.

On 3 ) Don't quite get your point here Jopar. We are supposed to be helping people with T2D not non diabetics. You seem to be confusing the concept of a diet for weight loss against a restricted carb regime to help with blood sugar levels.

On 6 ) I've made it clear that all I want is for this kind of diet to be added as an option that should be explained to T2D's at diagnosis. The keyword is option. We had the same debate in another thread the other day Jopar or don't you remember? I said to you then my emphasis is safe levels, not diets. People can eat what they want. The key thing is their 2 hour after meter reading. If they are safe whatever they eat great. Even if they are not safe I have no issue unless they say they are safe. Again you try and make out I say things that I don't and paint me as some fanatic.

On 8 ) you are just assuming the Swedish diet is a GI diet that has been "faffed around with". Your premise is entirely false as it is not primarily a GI based diet. The moderately carb restricted Swedish diet is essentially low carb high "safe" fat where carbs come first and GI is secondary. That's the whole point and why it works and has been proven to work.

Jopar rather than keep trying to paint every post that involves me as "the dictator xyzzy say this" why don't you find everyone some evidence that says the moderately restricted 30% total carb diet recommended in Sweden does not give better outcomes than the current UK high carb approach for T2D's or that the 130g ADA recommendation does not give better outcomes for T2D's than the UK high carb approach.

Maybe you should present why you think a 50% total carbohydrate diet of which 33% should be starchy carbs works for T2D's who just take Metformin and will keep their levels under 8.5.
 
I would argue that with respect as Jopar is an insulin user, their need to keep carbs restricted is not quite as vital as a T2 on either medication or diet alone.
 
May I extend your explanation of "eating to your meter.
I think it's been said, by Jenny Ruhl, that you should introduce a food and check bg before and after. Thus you know the effect of that food.
I agree on V low carb and have done for years. which is, I think, why 10 years after diagnosis, I have an HbA1c in the 5% range and use 2 x 500mg Metformin per day, most days and sometimes only 1. I'm also complication free, despite being told a few years ago by my, now retired GP that I'd end up on insulin by 10 years and that complications are unavoidable, but that we might be able to delay them.
I also read some of the work on VLHF diets done in Sweden.
Why must our diabetes "Experts" be so wooden headed? Not just the medics but Diabetes UK too.
Our local Consultant tried to get round my achievement by telling me I probably have a rare form of T2, which doesn't progress.
I gave some blood to the UKPDS, and was told I have a COMMON monogenic form of T2. I can't remember the name of the gene unfortunately.
I have never seen the consultant as a patient. We were talking at another venue.
As far as I'm concerned VLC diets WORK. I've never met anyone who tried seriously, for at least a few weeks, and didn't get improved control. I have met people who gave up, because they couldn't give up some food or other.
Hana
 
I'm all for the international brotherhood (and sisterhood) of Diabetics, but I don't understand why T1s seem to be the most vocal critics of low-carbing as an intervention for T2 diabetes.

For those of us on diet and/or metformin, we really don't have a choice: managing our carbohydrate intake (by whatever means) is our only method of controlling our blood glucose levels, that doesn't involve resorting to increased medication.

That's also why adherence isn't a factor. Ever you choose to follow a diet that helps to control your diabetes, or you accept the consequences of future complications and/or increased medication.

I'm also very interested to hear how anyone thinks that a 50% carbohydrate diet is suitable for a T2 (at any realistic level of energy expenditure).
 
T2 Diet controlled and Met only+Diet consisting of 50% carbs(Enzymes convert carbs to glucose)= sustained High blood glucose levels,symptoms and future risks of life changing complications. I'm sorry Nurse practicioner but it's as simple as that despite what you tell your patients.
 
borofergie said:
I'm all for the international brotherhood (and sisterhood) of Diabetics, but I don't understand why T1s seem to be the most vocal critics of low-carbing as an intervention for T2 diabetes.
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Jopar, I had assumed you were T2 like me but no. You appear to be a T1 with a pump. Great, good luck to you mate. Go eat your high carb or GI based diet to your hearts content and pump the insulin to cover it with my full blessing.

I would never ever ever ever presume I could tell a T1 about diet in the detail you just tried to prescribe to me. I would expect and deserve ever single consequence of that action including being warned not to do such a thing by admin or a moderator.

So as a matter of interest what is your expertise in stating what a T2 on Met diet should be?
 
hanadr said:
May I extend your explanation of "eating to your meter".
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Hana you can extend my definition of eat to your meter anyway you like. You are the undisputed champion of that art and you have inspired me since I first arrived here. Thank you for showing me the way.
 

On 3) Around 80% of T2 diabetic at diagnoses are overweight, and probably consuming more than the RDA of carbs per day, this is more likely if they have either a sweat tooth or very poor diet choices.. But I've know people who eat what is considered to be healthy balanced diet...

My example of my sister experience, was to show how much carbs etc can be found in certain types of foods, and what can be achieved just by cutting these out...

6) But all diets are an option, because if you see a diabetic dietitian, they work out individual needs with weight loss and control in consideration.. Fair play not everybody has easy access to a dietitian let alone a diabetic dietitian but that's another debate all together..

8) I haven't made any assumption that the Swedish diet is a GI diet...


You give one message I'm entitled to give another point of view or don't you like others debating the merits of what you've said or implied?

Concerning the Swedish recommendations, only time will tell if and what impact this will have of improving outcomes and I reckon there's going to be a wait of over 10 years before we get a clear picture if that's possible to get as Statistics are often skewed in many ways..

For the diabetic two main area's that can skew the statistic, that the data is backed dated and covers all diabetics whether they have been diabetic 1 year or 60 years, regimes and available treatments has changed so the prospect for a diabetic being diagnosed today is a lot different than it was 20 years ago.. It also uses the assumption that all diabetics follow ALL advices as given, and we all know that some people will heed advice on their dietary needs, take medication as prescribed and other won't!

Maybe you should present why you think a 50% total carbohydrate diet of which 33% should be starchy carbs works for T2D's who just take Metformin and will keep their levels under 8.5.
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Simples it does work...

But the more complex answer to this one is, You need to know what your actual needs are that maintains your bodyweight at a healthy level, and enables your body to repair itself and match your food intake to this.. Plus match your energy levels etc..

Problem is, that most peoples actual appetite is bigger than their actual needs... It this that causes all the problems for a lot of people... The calculations says that they only need 150g's of carbs yet their eyes and bellies want to eat 250g's of carbs...

So as you can see I'm not telling people that they can stuff their faces with carbs, but the carb they are taking on board has to fit their needs..

I do need to point out as well, your calorie needs also needs to be considered, as these needs actually differ for different people, it's often linked to diets and assumptions made...

Oh, how do I know this information to work, because I've seen it in actions I used to work in the care field and dealt with many T2 diabetics, some did very well and these tended to be those who's appetites fitted well with their needs, so just needed little tweaks... Others would need some major readjustments and a lot of encouragement to cut back on their starchy carbs, and encourage to bulk out if needs with more no carby friendly foods, such as vegetables and meat sources so that they ate the same quantity of foods just in a better balance..

Others well they weren't going to listen to any advice what's so ever and nor were they going to take medication as prescribed one chap is unforgettable on this score, he exasperated us all... Totally convinced that he only needed to take his metformin if his blood sugars were normal :shock: Which wasn't going to be happening as he wouldn't listen to any dietary advice either...
 

It seems you'll making assumptions about my diet and my knowledge...

Again making assumption I see..

See I don't eat a high carb diet, yes I do eat normal starchy carbs but because I have a small appetite I be hard pushed to eat 100g's a day...

Strangely even though yes I am fortunate to have an insulin pump, it's not shunting hurdles of insulin into my body far from it my TDD of insulin is betwen 16-20 units per day...

And what is my expertise to T2 and metformin, Well I've explained that I worked in the care field, and dealing with T2's and many other medical conditions and dietary needs were all part of my Job over a 15 year period..

But due to how and when I was diagnosed, but to cut a complex and long story short I was misdiagnosed as a T2 and took metformin... Oh and suffered the side effects of this as well...

So I think that I'm pretty well versed in both regime's to be able to comment and/or debate...
 

Simples not it doesn't. Show me an example of just one T2 diabetic here that achieves good control on a sustainable diet of 200g-250g of carb a day. Lots of people look in awe at Grazer because he can manage 180g - which is far less than 50% of his energy from carbohydrate.

Your total energy requirement is irrelevant - as you can easily make up the energy with fat and protein.



The first point is irrelevant. You can see from this forum that various people are prescribed insulin and choose not to take it (for whatever reason). Their non-adherance isn't a justification for never prescribing insulin "because some people won't take it".

On the second point, your actual metabolic requirement for carbohydrate is precisely zero.


So your answer is that you should prescrive a 50% carbohydrate diet because, even though it is completely unsuitable for all T2s, some people won't adhere to a diet of less that 50%.

The answer to that Jopar, is better education, and access to testing equipment.
 
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