Frustrated by advice

[xirles]

Hello,

I have joined the forum as my husband is Type 2 (diagnosed 5 years ago) and I am increasingly frustrated by the lack of advice and information from his "diabetes clinic" at GP surgery in UK. Just over a year ago he became very unwell, virtually urinary incontinent, tired, irritable and understandably worried. At this point he was still diet controlled though had been going through a period of anger/denial and ignoring his diagnosis despite my trying to help. We were in Spain as we spend the winter here so went to spanish GP and he checked his BG with the surgery monitor and was 396 (dont use UK measure here). He immediately put him on metformin 850 three times daily and explained he must go on a very low carb diet, get a BG monitor ASAP and see him every two weeks until BG improved considerably or he would have to prescribe insulin therapy.
My husband did as he was told (unusually) and within a few weeks he was much better and far more controlled although he lost a great deal of weight (was not overweight to start with) and has had ongoing issues with diarrhoea at least once a week since.
Anyway, when back home in UK he went to see GP who just said he was doing ok and to see diabetes nurse once a year. He saw the nurse and as usual she checked his feet (ok), weight (ok), BMI (ok), blood pressure (145/78), then the usual advice about exercise (he walks at least an hour daily and works out in gym 3 times a week). Then came the diet advice..........wholemeal bread, brown rice, pasta, veg, fruit, red meat only twice a week, fish, low fat yoghurts, weetabix or porridge for breakfast etc, etc.
When I said about low carb, high fat, she was not amused and basically said that was not the guideline diet he should follow. When I asked what might be the reason for his BG always being high in the morning (?liver dump) she said she didnt know why but carry on with meds as prescribed. When I asked about the diarrhoea she said it was probably just the medication. When I asked about a BG monitor and test strips (she didnt know we had bought them) she said they arent necessary for type 2 and would only "do your head in worrying about the readings" !!!!
So, fast forward to this week (we are in Spain for the winter)......my husband has been increasingly tired and irritable and the diarrhoea seems to be worse than usual. As he chose to follow the "UK" advice, he hasnt been checking his BG and has gone back to the diet of low fat/more carbs. After strong words last night, he checked his BG and it was 276 (around 15 I think). This morning it was 11.9 fasting so he has had a big wake up and so we go back to the low carb diet.
His biggest concern is the weight loss associated with the low carb lifestyle. He isnt overweight and never really has been, has always exercised regularly, doesn't smoke, doesn't drink much (a glass of wine with dinner,a bit more if we are out with friends) and is frankly already a bit down at how much weight he will lose again. Can anyone suggest a low carb option that wont knock his weight down so much as before??
Apologies for this "war and peace" length post, any advice would be gratefully received.

 

[noblehead]

Hi and a warm welcome to the forum.

Hopefully Daisy will be along shortly with her advice to new members of the forum.

 

[donnellysdogs]

He's achieved the high figures from eating too many carbs.

I suggest he foliws the spanush advice and totally ignore the UK advice.

Cut the carbs now totally. And get him to have full fat milk and cream and cheese etc for initially a week... But certainly long term too.

If this was me I would eat 50 or less a day. And fill up with fat.

 

[Bluetit1802]

Hi and a warm welcome from me.

The advice you had in the UK is typical of the advice given by the NHS and to be frank is total rubbish, and in my opinion, dangerous. The Spanish doctor was correct. Low carb. Carbs convert to glucose once in the system and glucose is what we don't want, so cutting carbs is the only way to go.

Because we cut carbs we also cut calories, so we need to replace those calories with extra fat and/or protein. As he was losing weight when he went low carb, he probably did not eat enough fat. I lost 31% of my weight on low carb to reach my desired weight, and then struggled to maintain as I just kept losing. I had already increased my fats but had to increase them even more, and then even more. I am now more or less stable. He needs to eat loads of cheese, eggs, butter (on veggies and for cooking), olive oil, oily fish, full fat Greek yogurts, double cream, meat and fish, nuts, avocados, bacon and egg fry ups etc. Plus of course veggies and salads etc. It is a fine balance, but he really needs to up those calories from fats and maybe a little more protein.

 

[Daibell]

Hi and welcome. Your husband musn't follow the UK diet advice he has been given unless he wants to make his diabetes worse. The Spanish advice was spot-on. If he is not on Metformin SR (Slow Release) he should ask for this as it will probably stop the bowel problems. If your husband is not overweight and continues to lose weight abnormally then you need to query the diagnosis. Continual or sudden weight loss around diagnosis is one indicator of Late onset T1 (LADA). The low-carb diet is still the right advice but if he is a LADA then the Metformin may need to be changed or supplemented. Metformin SR still helps a little regardless but LADA needs action to replace lost insulin from the pancreas either by other tablets or insulin. I don't want to worry you unnecessarily but quite a few of us have been wrongly diagnosed when low weight as GPs can be relatively ignorant of diabetes variants. Come back for more advice if needed.

 

[xirles]

Thanks for your advice. I wasn't too sure what level of carbs he should be aiming for but today so far, he (we) have had around 30 tops and planned for steak and salad for dinner tonight. Is the white wine ok or should we cut that out too for a while?

 

[noblehead]

Thanks for your advice. I wasn't too sure what level of carbs he should be aiming for but today so far, he (we) have had around 30 tops and planned for steak and salad for dinner tonight. Is the white wine ok or should we cut that out too for a while?

From a bg point of view red wine is better than white.

 

[DeejayR]

Hello and welcome. You story just about sums up what's wrong with the UK advice on diabetes and how damaging it can be. I have never been overweight and lost far too much to start with until like @Bluetit1802 I realised that truly fat is my friend.
Steak and salad is fine and what time do you eat? I could just make it on my executive jet haha
Your test meter will decide about the wine but wouldn't you prefer red?

 

[xirles]

Thanks also for the advice regarding LADA, I must admit I have wondered about the Type2 diagnosis as he didn't seem to fit the "profile" and he gets annoyed when all the publicity in the news is around losing weight , taking more exercise etc......that has never been his "problem". His younger sister was diagnosed Type 1 after glandular fever at age 42. She was always poorly managed both by GP and hospital, never understood her condition at all! Sadly she developed pancreatic cancer and died last year but before she died she was very worried that my husband would "end up the same".
My husband had checked his BG using his sister's monitor as a bit of a joke but found he had a reading of 12.9 before a meal! Diagnosis confirmed here in Spain after blood tests but back in UK they wouldn't accept diagnosis until GTT done 6 months later. I have more faith in GP here in Spain, how would we find out if he doesn't have Type 2 but something else?

 

[donnellysdogs]

Dry white wine is better than sweet for diabetes but red is better than the dry white for blood results.

I think he needs to ask for a GAD test to be done to find out if he T1 or T2

 

[xirles]

Sorry for my ignorance, what is a GAD test? very happy to ask for it here before we come back to UK middle of March

 

[daisy1]

@xirles

Hello xirles and welcome to the forum Here is the information we give to new members which I hope you will find useful. Keep on asking questions and someone will be able to help.


BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you’ll find over 130,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.
There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes-and-whole-grains.html

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to bloodglucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic

Note: This post has been edited from Sue/Ken's post to include up to date information.

 

[Bluetit1802]

You asked how many carbs a day. This is very personal as we all have different tolerances. His meter will tell him. Test before and 2 hours after a meal. The rise should be less than 2mmol/l preferably less than 1.5mmol/l. More than that and there are too many carbs in that meal for that time of day. Many people say the fewer carbs at breakfast the better, and none for supper (bedtime supper).

 

[xirles]

Thank you all so much.....so helpful, just a shame my husband wont actually ask himself though ha! Anyway, its nearly two hours since we had a meal (mealtimes a bit different times here in Spain) and despite 2 glasses of wine (watching the rugby) he has just checked his BG and it is 7.7

 

[Bluetit1802]

Did he test before he started? Just testing afterwards tells you nothing.

His wine will lower his bs levels whilst his liver is busy dealing with the alcohol! Once out of his system it will be back to normal.

 

[xirles]

Thanks, guess we wont read too much into that much improved reading yet then and go buy some nice RED Rioja tomorrow! Told him about increasing the fat as much as possible to try to balance out any weight loss and he has a question. An ultrasound liver scan here last winter showed his liver to be "fatty". GP said this was to be expected due to diabetes. Will vastly increasing fat intake cause this to be worse?

 

[Bluetit1802]

Carbs cause non-alcohol related fatty livers, and lack of exercise. Fats only make you fat if eaten in conjunction with carbs. Does he exercise? I don't mean half killing himself in a gym, I mean walking a bit more perhaps.

 

[xirles]

He has always exercised, walks at least an hour a day, not just on the flat as we are in a mountain area in Spain which he loves. Does cardio and weight training at gym or with own gear on our roof terrace every other day. I really think that looking back, he was diabetic for many years before diagnosis and the damage may have been done long ago. We had a typical UK diet of "meat and 2 veg", potatoes, yorkshire pudding, takeaways, fish and chips etc although his weight was never much of a problem probably due to the gym as he had a sedentary job in an office. We have a far healthier diet now we have semi-retired as we work on a campsite in Tuscany for a few months in the summer so outdoors all the time and eating more fresh veg and unprocessed food (except the pizza and pasta can cause issues if not careful) and as the weather is so much better here in winter, we can be out and about walking most days and eating in Spanish restaurants where carbs dont seem to figure much on the "menu del dia".

 

[Brunneria]

Strict low carbing and (I hesitate to say this in view of his reluctance to lose weight) losing some weight may help with the fatty liver.

Short term very low carb diets (e.g. the Newcastle Diet) are becoming popular to 'reverse' type 2 diabetes because they reduce the amount of visceral/liver fat. This may enable the liver to function better and reduce or eliminate type 2 symptoms.

It may be worth your husband reading up on this.

But there are a few things to bear in mind:
You say your husband really doesn't want to lose more weight
He may have been diabetic for years (the Newcastle diet seems to work better for people diagnosed within the last few years)
Not all type 2 diabetes is caused/worsened by a fatty liver (mine isn't)
You don't seem absolutely sure that he is type 2.

Low carbing and eating the right kind of fats will help with nearly everything you have mentioned, but I have no idea if it will reduce the fat in a liver without significant weight loss too.

But whatever happens, stick with your Spanish doc. They talk a lot more sense than you UK one!

 

[xirles]

Again, thanks for all the replies. So, I will make appointment with GP and ask for Metformin SR and hope that helps with the bowel issues. Will ditch the white wine fro a nice red (in moderation) and stock up on full fat milk, cheese and cream as "snacks" so my husband isn't so worried about weight loss with the low carb diet!
He is going to test before and after each meal and write down his results so he can see the progress being made and also what works best for him food wise (then I know what to cook!).
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!! End of rant....onwards and upwards........