How irresposible are the current diet NHS guidelines for T2 and pre diabetics?

gardengnome42 · Nov 8, 2017

I recently had an annual HbA1c test that came back at 43 mmol/ml and a comment to 'See the nurse'. So arming myself with plenty of info gained from this site and others I have just returned from my appointment.
The nurse had a look of shock when this tall and slim 75 year old female walked in and immediately said that I didn't fit the usual patient that she sees. So when she started giving me the standard mantra about the 'Eatwell Plate' - there was even a poster on the wall illustrating it - I just said I thought it was irresponsible of the NHS dishing out that bad diet advice. I was also told to eat low GI foods, as I already eat brown bread where possible. I said even if low GI it was still carbohydrate and would have the same effect on the body in the end. All that carbohydrate had to be wrong.
At which point she realised I was not going to be convinced and said what I always suspected, that they have to dish out this advice as it's standard NHS practice: jobs on the line I suppose if they don't. I think that is truly shocking. Thank heaven for this site. I also gathered that Diabetes.uk.org is all part and parcel of the NHS too.

Strictly off the record she told me to get a copy of Michael Moseley's Blood Sugar Diet as the science in it is so interesting.

Guzzler · Nov 8, 2017

Well done. Spread the word. And well done to your DN, in private they let a few things slip that can make a difference.

kokhongw · Nov 8, 2017

gardengnome42 said:
that they have to dish out this advice as it's standard NHS practice

It is absolutely tragic.

Squire Fulwood · Nov 8, 2017

Here is the relevant paragraph of the N.I.C.E guidlines. They have been altered a bit so you can interpret them a bit but it is still bad.

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]

hankjam · Nov 8, 2017

I'm thinking Torrey Canyon (slow to turn) or maybe the Titanic (blind to danger)....

https://en.wikipedia.org/wiki/Torrey_Canyon_oil_spill

Deleted Account · Nov 8, 2017

Being t1, I do not fully understand the low carb/t2 thing. So please educate me before I write something (else) stupid.

This is the way I understand low GI and t2:
Low GI means the food takes longer to be digested so the glucose within the food appears in your blood a little bit at a time over a longer period.
If you do not have diabetes, your body can then slowly release insulin to cope with the slow release carbs. This puts less of a strain on your body. I think I read somewhere that eating high GI foods could put a strain on your heart forcing your body to release so much insulin so quickly.
If you have t2, your body produces insulin but struggles to use it which means it need to produce more. So, eating low carb means you need to produce less insulin. Likewise, eating low GI means your body has longer to produce the insulin it needs.
I thought this was the reason why many people recommend testing, eating and testing later. If your body can produce insulin at a similar rate to which you are digesting your carbs, your BG will not rise much.

So, my question is
Why is there not much discussion/attention to low GI on this forum?

(And, please correct my understanding if I am wrong. )

Guzzler · Nov 8, 2017

It may take another generation to see the end of such dietary advice. Thank heavens for the internet and sites like DCUK, eh?

Guzzler · Nov 8, 2017

helensaramay said:
Being t1, I do not fully understand the low carb/t2 thing. So please educate me before I write something (else) stupid.

This is the way I understand low GI and t2:
Low GI means the food takes longer to be digested so the glucose within the food appears in your blood a little bit at a time over a longer period.
If you do not have diabetes, your body can then slowly release insulin to cope with the slow release carbs. This puts less of a strain on your body. I think I read somewhere that eating high GI foods could put a strain on your heart forcing your body to release so much insulin so quickly.
If you have t2, your body produces insulin but struggles to use it which means it need to produce more. So, eating low carb means you need to produce less insulin. Likewise, eating low GI means your body has longer to produce the insulin it needs.
I thought this was the reason why many people recommend testing, eating and testing later. If your body can produce insulin at a similar rate to which you are digesting your carbs, your BG will not rise much.

So, my question is
Why is there not much discussion/attention to low GI on this forum?

(And, please correct my understanding if I am wrong. )

I think it has to do with glycaemic load rather than the glycaemic index. The GI throws up surprising stuff such as Wholemeal bread, check it out.

Mbaker · Nov 8, 2017

helensaramay said:
Being t1, I do not fully understand the low carb/t2 thing. So please educate me before I write something (else) stupid.

This is the way I understand low GI and t2:
Low GI means the food takes longer to be digested so the glucose within the food appears in your blood a little bit at a time over a longer period.
If you do not have diabetes, your body can then slowly release insulin to cope with the slow release carbs. This puts less of a strain on your body. I think I read somewhere that eating high GI foods could put a strain on your heart forcing your body to release so much insulin so quickly.
If you have t2, your body produces insulin but struggles to use it which means it need to produce more. So, eating low carb means you need to produce less insulin. Likewise, eating low GI means your body has longer to produce the insulin it needs.
I thought this was the reason why many people recommend testing, eating and testing later. If your body can produce insulin at a similar rate to which you are digesting your carbs, your BG will not rise much.

So, my question is
Why is there not much discussion/attention to low GI on this forum?

(And, please correct my understanding if I am wrong. )

Speaking generally low GI for a Type 2 implies the eating of grains and the like, insulin will be circulating in the body for a longer period of time. Some Type 2's also want weight loss so we want the minimal amount of insulin in the body, as insulin can promote weight gain and stall weight loss. Low GI also obviously still has a glucose hit which has to be dealt with and can / will causes blood sugar spikes (albeit not as large as high GI foods) when compared to LCHF foods. Another factor is the more insulin the increase in insulin resistance, and the cycle goes on.

In my case you can see in my signature that when I switched from low GI to LCHF my HbA1c went from 41 / 42 to 35 / 36 and I lost weight (whilst keeping muscle). Even if there is a "cure" for Type 2, I will never go back to high / low GI foods.

bulkbiker · Nov 8, 2017

helensaramay said:
Being t1, I do not fully understand the low carb/t2 thing. So please educate me before I write something (else) stupid.

This is the way I understand low GI and t2:
Low GI means the food takes longer to be digested so the glucose within the food appears in your blood a little bit at a time over a longer period.
If you do not have diabetes, your body can then slowly release insulin to cope with the slow release carbs. This puts less of a strain on your body. I think I read somewhere that eating high GI foods could put a strain on your heart forcing your body to release so much insulin so quickly.
If you have t2, your body produces insulin but struggles to use it which means it need to produce more. So, eating low carb means you need to produce less insulin. Likewise, eating low GI means your body has longer to produce the insulin it needs.
I thought this was the reason why many people recommend testing, eating and testing later. If your body can produce insulin at a similar rate to which you are digesting your carbs, your BG will not rise much.

So, my question is
Why is there not much discussion/attention to low GI on this forum?

(And, please correct my understanding if I am wrong. )

In a proverbial low carb nutshell...
Because most people find that Low GI raises BG s much as High GI. Wholemeal bread has a very similar effect to regular bread so its better not to have bread at all.

Edit to add this is what a lot of people find by eating to their meter.. carbs are carbs whatever the colour.

Bluetit1802 · Nov 8, 2017

The insulin index is also revealing. This is an index of foods and how much insulin is needed to respond.
Some of the foods that are lowish GI are quite high on the insulin index.

http://ajcn.nutrition.org/content/93/5/984/T1.expansion.html
https://public.tableau.com/profile/christoffer.green#!/vizhome/InsulinogenicFoodData/Dashboard1

Geordie_P · Nov 8, 2017

Bulkbiker, as usual, has it spot on. White rice is brown rice with a healthy husk on it. But it still has the same white rice inside. I regard it as being akin to mixing my whisky with water: it may be weaker, and it may be more of an immediate shock to the system, but the same damaging element is going into my body.

kokhongw · Nov 8, 2017

Low GI might work for T1D who have not yet developed significant insulin resistance...but for T2D, the insulin response being 2-3x higher than normal...will often result in a glucose roller coaster...

The key to T2D is really to understand the high insulin response and finding ways to modulate that. To have judicial use of the remaining beta cells and not squander them on grains...

Edited to add blog:-
http://www.diabetes.co.uk/forum/blog-entry/newbie-guide-to-t2d.1858/

Guzzler · Nov 8, 2017

It has occurred to me in the not so distant past how the successes of different approaches may be interpreted as to who might be credited with said success. If I go to my DN with a lowered A1c, weight loss, lowering or discontinuance of drugs/insulin but have done it all with disregard for the orthodox advice will she tick the boxes and have the credit go to the NICE guidelines? I think my coclusion is that there will not be a box that cites 'Other methods employed by patient' to tick. Which is very sad.

Bluetit1802 · Nov 8, 2017

Guzzler said:
It has occurred to me in the not so distant past how the successes of different approaches may be interpreted as to who might be credited with said success. If I go to my DN with a lowered A1c, weight loss, lowering or discontinuance of drugs/insulin but have done it all with disregard for the orthodox advice will she tick the boxes and have the credit go to the NICE guidelines? I think my coclusion is that there will not be a box that cites 'Other methods employed by patient' to tick. Which is very sad.

There is a tick box list they have to complete. There is no box for low carb. My nurse ticked "diet good" and "high fibre diet". She also ticked "patient advised about low fat diet" She is well aware of my LCHF diet and agrees with it. She did ask if I consume enough fibre, to which I replied yes. They are between a rock and a hard place.

MikeTurin · Nov 8, 2017

Guzzler said:
It has occurred to me in the not so distant past how the successes of different approaches may be interpreted as to who might be credited with said success. If I go to my DN with a lowered A1c, weight loss, lowering or discontinuance of drugs/insulin but have done it all with disregard for the orthodox advice will she tick the boxes and have the credit go to the NICE guidelines? I think my coclusion is that there will not be a box that cites 'Other methods employed by patient' to tick. Which is very sad.

I don't think so. If the article has to be published on a peer reviewed paper some basic guidelines has to be followed.
OTOH if this tick is used to make some number for politicians, the number they get have will be made public only if fits the politician agenda and hidden in a footnote otherwise.
For a railway here there were two options: one was to build outside the city area as a normal railway, following a river, or make a long gallery under an avenue. They asked what was the best option to a famous professor that was famous for his gallery projects. Guess what? Over the ground railway was dismissed in the report because "too costly"...
Or the sad story of the "swiss project", were a strong modification of tramways and bus routes was required and paid, the quietly put on a drawer. Or the fact that closing an hospital will make a better and mode comfy services for patients.

Guzzler · Nov 8, 2017

Bluetit1802 said:
There is a tick box list they have to complete. There is no box for low carb. My nurse ticked "diet good" and "high fibre diet". She also ticked "patient advised about low fat diet" She is well aware of my LCHF diet and agrees with it. She did ask if I consume enough fibre, to which I replied yes. They are between a rock and a hard place.

Some of them must be really frustrated but having said that, I did all the work and I want a Sticker!

Squire Fulwood · Nov 8, 2017

Guzzler said:
It has occurred to me in the not so distant past how the successes of different approaches may be interpreted as to who might be credited with said success. If I go to my DN with a lowered A1c, weight loss, lowering or discontinuance of drugs/insulin but have done it all with disregard for the orthodox advice will she tick the boxes and have the credit go to the NICE guidelines? I think my coclusion is that there will not be a box that cites 'Other methods employed by patient' to tick. Which is very sad.

Now there's a thinking person. You go to see DN and she gives you pills. You go home and eat sensibly and come back with improved numbers. What is your DN going to think?

The pills worked.

We have a responsibility to our DN's not to confuse them. (My DN is too fleet of foot to be confused). The "progressive" condition T2 diabetes is not supposed to have stable blood glucose levels.

Advice given out on this site some time ago is the best. If she knows better than you then smile and nod like Churchill the dog. Don't ever explain, just smile and nod.

Chook · Nov 8, 2017

Guzzler said:
It has occurred to me in the not so distant past how the successes of different approaches may be interpreted as to who might be credited with said success. If I go to my DN with a lowered A1c, weight loss, lowering or discontinuance of drugs/insulin but have done it all with disregard for the orthodox advice will she tick the boxes and have the credit go to the NICE guidelines? I think my coclusion is that there will not be a box that cites 'Other methods employed by patient' to tick. Which is very sad.

Nope - you are categorised as 'Non Compliant'. My argument (with the DN) was that 'Non Compliant' should be reserved for people who are making no effort whatsoever to deal with their T2 by whatever means. I suggested that people who are obviously dealing with their T2 satisfactorily on their own should be congratulated, not labelled as non compliant. When I came off of insulin (due to having reduced my BGs to below pre-diabetes level) I was treated like a small naughty child - and the same when I stopped taking Sitaglyptin (because of even lower BGs) - she actually asked who had given me 'permission' to stop taking them.

woodywhippet61 · Nov 8, 2017

Chook said:
Nope - you are categorised as 'Non Compliant'. My argument (with the DN) was that 'Non Compliant' should be reserved for people who are making no effort whatsoever to deal with their T2 by whatever means. I suggested that people who are obviously dealing with their T2 satisfactorily on their own should be congratulated, not labelled as non compliant. When I came off of insulin (due to having reduced my BGs to below pre-diabetes level) I was treated like a small naughty child - and the same when I stopped taking Sitaglyptin (because of even lower BGs) - she actually asked who had given me 'permission' to stop taking them.

This makes sense. To the NHS their representatives have given us advice and our role is to be grateful and accept it and act on it. If we then decide to ignore the advice and do something completely different then we are non compliant. After all they the HCP's have studied medicine. Non compliant I guess is a label that protects the NHS representatives from blame if things go wrong.

I am sure that your HCP's believed that you were risking your health and possibly your life by taking the action that you did Chook.

How irresposible are the current diet NHS guidelines for T2 and pre diabetics?

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