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Frustrated by advice

xiries wrote, "My last little rant is this, it is ok the nurse checking feet, weight, BMI and ticking boxes for the GP contract payments but the harm being done giving wrong, or little dietary advice is totally unacceptable. Furthermore, how the hell can anyone know how diet is affecting them if BG monitoring is "not necessary"!!! The problems my husband is having now have largely been caused by following the "advice" given in diabetic review clinic at home. I cannot understand why opposite advice is being given to that he was given in Europe!!"
I doubt if there is anyone on this forum who will disagree with you! Keep up the good work.
Sally
 
According to my GP diabetics just get fatty liver eventually..... Nobody actually knows the true extent of how fatty your liver is unless he's had scans of his who abdomen.

Alchohol contributes to a fatty liver.

Spanish health service is excellent, my step sis lived in Madrid for 30+ years and receives excellent care and advice regarding her anal and stomach cancer...very much different to the advice she would get here.

UK diabetes advice is awful. End of.

I am lean and slways a low carber for majority of my 50+ years. when I added extra fat in to my diet it caused me to lose another 10lb.... And I really didn't need to. However if this is case with hubby starting to lose more then get him to eat more walnuts and a couple squares of dark choc....its just finding a balance with bg's and keeping weight on. It could take a few weeks as trying to keep weight on when eating lower carbs and higher fat can be a strugglebut it is achievable.
 
I have found that both here in Spain and also in Tuscany the GP's seem to "tell it as it is", give the advice necessary and expect that you will follow it and keep them informed of progress. They are not overly sympathetic when you say "but it's very hard" A friend of mine in UK is married to a GP and when we were at a dinner party together a couple of years ago her husband said that it wasn't realistic to expect diabetics to stick to a diet anymore so they were generally now allowing higher BG readings as acceptable. He said that UK diet of convenience foods etc wouldn't change so if patients kept their HbA1c to around 7 to 7.5 that was fine and that as diabetics had been "running on higher sugar levels for years" it wasn't a good idea to try to get their levels down to none diabetic ones.
It seems that he felt they were "flogging a dead horse" and that it wasn't helpful to be too firm with patients as they would just be antagonised so not follow advice anyway. I am sure there is a little truth in that but it almost seems to condone patients not taking responsibility for their health (assuming they have been given correct diet advice)?
It can be a bit of a culture shock here to be told very matter of fact what the problem is, what you must do and the consequences of ignoring the advice! Our GP here said he wanted HbA1c down to 6.1. My husband had a result of 6.4 at that time and he said "can do better".
 
It is so frustrating isn't it but you are doing the right thing, stuff the UK advice and go with the Spanish!! I would definitely be pushing for a CPEP and GAD test too, to rule out Type1 or LADA. Have a great winter in Spain and avoid that pasta on Italy! Have you seen cauliflower rice and courgette pasta strips? If not, have a google, the rice is lovely and easy to do and you use a spiraliser or julienne peeler on the courgettes.

Ali
 
Thanks Ali, Could you explain what the CPEP and GAD tests are then I can discuss them with our GP here?
 
The fact that you have adopted the lifestyle you describe (I bet you even speak Spanish instead of speaking English loudly and slowly) sets you apart from most people back home. I went on a diabetes course in which the men's greatest worry was whether they could carry on drinking by cutting back on beer and adding whisky chasers. I'm sure you'll take this in your stride.
 
xirles said:
Thanks Ali, Could you explain what the CPEP and GAD tests are then I can discuss them with our GP here?
Click to expand...
GAD I think it is an antibody to something pancreatic. There are also the islet something antibodies, both can be tested for in pursuit of autoimmune diabetes.
C-peptide is something that pro-insulin leaves behind and is measurable so sometimes used to evaluate insulin production in order to see if you are type two or type one,
 
Thanks again, we will speak to GP about the tests. Going back to previous post about diabetes "course". The practice nurse asked my husband to attend a one day course (cant remember the daft acronym name of it). It was just before we were going to Tuscany so he asked if she could give him the info (and perhaps the power point presentations). Of course the answer was no, "we dont do that because we want you to attend the course and meet other diabetics to discuss your condition in a "safe environment"?? The PCT are paying for this course and venue"
My husband is a very private kind of individual and discussing his "condition" with complete strangers just would not happen. Why he couldn't have the info to read in private (own safe environment) I will never know!!
We do enjoy our lifestyle here and in Tuscany and still enjoy UK with our family too. Just find the slower pace and less emphasis on what you wear and what your "profession" is, a refreshing change here after busy careers (and awful traffic) at home! Not much in the way of "convenience foods" in supermarkets here either though I suspect "ready meals" will appear eventually. Macdonalds and Burger King are always virtually empty here apart from British Tourists that is!!
 

Ha Deejay, you never told me about the jet, you can always fly me. Lol
 
after years of low fat, the amount of fat you need to eat may seem huge..think back to how your mum ate and add a bit more. you could be 70-80% fat energy..the protein could be between 15-20% of total and 5-10% carb.
I think the fat won't put on weight, but will give energy
if you want to put on weight, make sure there is enough fat/calories and then add a bit more protein
it's best not to overdo the protein
www.youtube.com/watch?v=2KYYnEAYCGk
 
Welcome & things will be fine sooner than later.
The DN is going to get a shock sooner than later I feel, about diet advice, it's looking like there is going to be a big turn around. Can I suggest you go look at X-pert health website & maybe purchase Dr Trudi Deakin's book, EAT FAT. It's full of useful info on diabetic diet. Then go stick it under the DN's nose & tell her to stick her advice where the sun don't shine.(well maybe not quite that way, but you know what I mean)
 

I think most of us are given the incorrect advice initially and then find out for ourselves (mainly through the forums on this site). I have never actually seen a doctor! I went for my free NHS health check and was gobsmacked to find that my HbA1c and glucose levels were really high. I had no symptoms at all; diabetic nurse was amazed that I hadn't. I was told I was T2 and given the usual advice; 40% carbs (low GI ones eg wholemeal bread, porridge etc.). I didn't eat much bread anyway and always had the granary seeded bread and bran flakes with seed sprinkle and fresh fruit for breakfast. I wasted months getting nowhere until I put myself on the very LCHF diet. I was a healthy 8 and a half stones and now weigh 7 but I seem to have stabilised there. I am going to start the ND diet and have arranged to see the DN next week to tell her. Reading this thread I may ask for a GAD test as I really want to sort out my diet as it is so restrictive at the moment and if I am type two with fatty liver and pancreas it should help.

Any advice/tips greatly appreciated.
 
I had my annual "well woman" check a few months ago with practice nurse. She did my weight, waist measurement B/P etc then took blood for cholesterol levels. She said that as my BMI was in normal range and I am not overweight she would not ask for bood glucose levels checking. I can see her point but as my husband (and you) were clearly not overweight and had no symptoms then I guess many "type 2's" get missed for a long, long time. I understand that the NHS has to draw a line somewhere but there is so much emphasis on number of diabetics in UK and worldwide and the cost long term to the NHS, maybe the BG test should be routine, like the cholesterol one is?
On a postive note for my husband today, pre-breakfast level 10, two hours after bacon, eggs and mushrooms (and metformin) 7.1. Cant get our heads around why his morning levels always seem the highest. BG 8.5 just before bed last night and that was at least 4 hours since he had eaten anything so why 10 this morning is a mystery!! However, that's still much better than a couple of days ago. We are going to cut out all wine for a while (shame) and see if any difference as we tend to drink it in the evening.
 
Hi,

The higher morning readings are natural. Most people experience them, including non diabetics. It's called the Dawn Phenomenon or Liver Dump - have a google round and search this forum as there are loads of threads about it. When we are fasting our livers dump glucose in our blood stream to keep us going, it also happens during exercise. A few people are lucky that it doesn't happen for them, but most people experience it.

As for wine, if it is red or dry white there is no problem as there are very few (if any) carbs. Spirits without mixers are the same. Beers and cider etc are liquid sugar. Alcohol tends to lower BS levels whilst the liver is busy dealing with it. Once it is out of the system, higher levels return. So unless you are calorie counting to lose weight, wine is fine!
 
"On a postive note for my husband today, pre-breakfast level 10, two hours after bacon, eggs and mushrooms (and metformin) 7.1. Cant get our heads around why his morning levels always seem the highest."

Does he test as soon as he gets up? Does he get up to go to the loo in the night?

I never get up in the night but I always see to my horses as soon as I get up (hard work) and then come in and have breakfast; I was testing when I came in before I had my breakfast. My levels were always high so I tested when I got up and then when I came in and found the early one was quite a bit lower than the pre breakfast one so I now have my breakfast before I see to my horses and my levels are much better..
 
Thank you Bluetit, will go back to "plan A" and shop for some nice red tomorrow (not difficult here in Spain, and cheap too). We are aiming for 50 carbs a day as when our Spanish doctor originally helped sort hubby out I think it was even lower than that, basically meat, green veg, fish and sparkling water!
I say "we" as I am the cook and have decided that it will not do me any harm to low carb too and it makes mealtimes easier and is a bit of support. At least I do not have to do the testing several times a day so no downside for me (especially if I can have my wine). Thanks again for all the advice and support, it has been enlightening and so helpful so far.
 
Hi,

Testing as soon as he gets up, sometimes up for loo in the night but not always. Just looked back on spreadsheet readings we kept when he was high before and morning readings were always the highest. After about 3 weeks on metformin and v.low carb diet his levels were averaging 7 in the morning, down from around 10 to 11 where he is again now.
 
If he has gone back up from 7's to 10's in the mornings, something else in his routine may have changed. Maybe slightly bigger portions without realising? Failing that, maybe his medication needs reviewing.

I find that testing at bedtime and in the morning immediately after getting up and washing hands will tell you if he is having liver dumps. If there is negligible difference, then no liver dumps. If he is noticeably higher in the mornings, either liver dump or possibly too much protein the previous evening meal as that kicks in later than carbs.
 
I have another question:
Why are the "spikes" so dangerous. I have been reading around the forum and some people seem to have a pretty reasonable HbA1c, I understand that it is an average over a couple of months but our UK nurse always says that "everything" is fine as long as the HbA1c is not high? Hubby cant remember what the last one was but says the nurse said it was good......will phone the surgery tomorrow and ask so that I can add it to my "new" spreadsheet
 
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