How to be diplomatic with DN/Doctor

@MPH lol I get on very well with my diabetic nurse. She talks about eat well plates and I talk about lchf . We both smile and nod but it's like parallel lines. Lol

I listen...( to their bs, ignorance and bad advice ) and then go home and eat LCHF ....I get results....doing it their way I wouldn't

The first thing is to turn up with results she never dreamed of achieving when she handed out the pills. At this point she may assume that she is doing well. You can just sit there with a smug grin on your face. If she intimates that she has heard of low carbing then you may tentatively talk of same in the full knowledge that she is being insubordinate to her governing body and could get into trouble.

If she has only ever heard of the Eatwell Plate and does not want to discuss other ways of managing then this is the time to smile and nod, or if you prefer, smile and nod and keep saying "Oh yes" like Churchill the dog in the adverts.

If you think you are going to convert her to lchf then you could be in for an argument since NICE still don't think it exists and she has to do what NICE say. Currently NICE says that Type 2's should be encouraged to eat as a normal healthy person.

I got most satisfaction by dropping my Hba1c by 25 points and watching the puzzled look on her face and not explaining how I did it. My DN is particularly clever and she has tried pumping me to see what is going on and I think she knows really but we both enjoy the game.

I'm fortunate to have a great relationship with both my DN and GP and both know that I've been LCHF 'ing for almost 2 years now. Initially there was some sucking of air through their teeth and head shaking but after 2 years they can see the results for themselves and have no argument against the effect my lifestyle changes have made to 2 health conditions, one of which is T2, and the fact that I have been able to reduce or come off a lot of nasty meds since converting to LCHF.

Not knowing your particular practice or their policies, I would recommend standing your ground, having the courage of your convictions and letting your results speak for themselves.

As an aside, the last time I had my DN review, she confessed that she too had now given up carbs and was feeling much better for doing so!

The tide is definitely turning

Having a rare blood glucose order has certainly confounded my dsn.
Having had a lot of visits to her office, is always a pleasure for me, as I smile and answer her positively about eating a very low carb diet and the positive effects it has had on my well being.
She gets that look in her eyes, as if that, what I'm doing is totally alien to her way of thinking. She keeps muttering to herself, that she can't believe her eyes, when my vital life signs are taken and all are normal.
However, it does seem that my influence on my GPs and dsn have been good in that my doctor has come on the low carb advice to all his patients, that's what he's told me, when my wife (T2) went awhile ago, and my OH was told to lower her carbs!

Little steps!

The easy way out is simply to listen, nod, smile, and ignore. I personally don't do that but talk about my low car/high fat way of eating. Last year I was gobsmacked when she pulled Trudi Deakins "Eat Fat" book from her drawer and agreed with what I was saying!. That was one big turn around from my initial appointment when she told me to eat baked potatoes with baked beans for lunch. So ... I do think the tide is turning, but it will only progress if we bang on about it.

I tried talking to my dietician about my LCHF. I got the usual "we only recommend the well plate diet as its be proven". I wanted to scream how you going to prove anything else works if you only recommend one way. Instead we played the what did you eat yesterday game. I could visibly see the shock on her face when she saw there were absolutely no complex carbs on my normal foods. So much so she wanted me to come off the plan. I just smiled and said no I still wanted to see her and I would come back once a month for her to see my weight. If they are not forced into seeing it works they will never believe it.

Kyi said:

I tried talking to my dietician about my LCHF. I got the usual "we only recommend the well plate diet as its be proven". I wanted to scream how you going to prove anything else works if you only recommend one way. Instead we played the what did you eat yesterday game. I could visibly see the shock on her face when she saw there were absolutely no complex carbs on my normal foods. So much so she wanted me to come off the plan. I just smiled and said no I still wanted to see her and I would come back once a month for her to see my weight. If they are not forced into seeing it works they will never believe it.

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Complex carbs, refined carbs, good carbs, whole grains, whole wheat.

They are still all carbs! No matter how they are labelled!

It's how we ingest, digest, react to them that is the decision to how many we eat.

nosher8355 said:

Complex carbs, refined carbs, good carbs, whole grains, whole wheat.

They are still all carbs! No matter how they are labelled!

It's how we ingest, digest, react to them that is the decision to how many we eat.

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I may have mistakely given you the impression I ate any carbs lol. My carb intake is usually about 50g per day. It was just how she reacted blurting out "what no complex carbs"

My DSN was delighted when I lost weight and lowered my BG. She looked at the notebook I use to record my monitor test results and marvelled at how they had come down from 30+ to the 5s. She asked me the sort of things that I eat - typical day's menu - and she said she thought it sounded and I obviously am thriving on it. She told me she wished all her patients would be so interested in helping themselves. That, as she is herself, in the pre-diabetic range she will lower her carb intake. TWO DAYS LATER she told a newly diagnosed co-worker of mine that the ONLY diet suitable for diabetics is one with plenty of low GI carbs.

There is no point in trying to change the way either DSNs or GPs advise us, it's further up the hierarchy that need to be educated.

MPH said:

As I've only recently been diagnosed as type 2 with a HbA1c of 53 I've started on LCHF diet
dropped 18pounds or 8.16 kilo in three weeks
bp dropped from 140/90 to 128/77
bg 14 day average 4.9 from home testing

When diagnosed had the usual info from Doc and DN about carbs, then looked on here and ignored what they said I should do.

If I try to explain the reasons for this as " Just because you've got anti venom for snake bites would you suggest playing with snakes" does this indicate I should eat carbs because you've got medication to counteract them?

Although this is meant as a bit of humour I can't help feeling the response may be to follow the guidelines. This is not doing anything to help people with T2 in my circumstances when controlled by diet but told you will end up on medication.

I appreciate I'm only new to dealing with being T2 but as a control to this point of view when following DN advise on porridge in morning three days after diagnosis tested FBg was 6.9 , two hours later Bg was 14.6 and head was pounding.

So when my next appointment comes through is it worth trying the above analogy or just nod , smile and ignore or state the facts and suggest they leave me to stand or fall by my own results.

M

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I think if you use the analogous tactic you describe, you run the risk of setting up a confrontational situation that really needn't arise and could be unhelpful in your ongoing relationship with your practise. The reality of our lives is we all need the support of our medics from time to time, and I would rather not be known as a troublemaker or a difficult patient, if I can avoid it.

I would tend to take a summary of my results, but careful to include the starting point and various staging points, showing reduction along the way, including weight, BP and anything else you know has improved.

When the discussion about "plenty of carbs" comes up, you can readily show your hard evidence that these things didn't agree with your diabetes, and in fact appear to have been fuelling some of the high blood scores you were seeing. Matching those blood results with a food diary helps illustrate exactly what you mean.

It is very difficult for any HCP to argue against factual evidence, and few would then reiterate you should be eating high carbs, plus medicating to the hilt. It is more likely they may feel a little uncomfortable and move swiftly on.

When I was challenged as to why I was testing myself, I explained it gave me immediate feedback on my condition, that day at that time, and allowed me to learn what I needed to do. When I had previously asked my nurse if she were diagnosed herself, if she would take her own advice not to test at home. It went deafeningly quiet, and after a few uncomfortable (for her) seconds, I allowed her to "move swiftly on".

I can be minxy in my own way, but I don't need enemies I may need at any juncture for something I don't foresee. I just reckon they'll catch up in the end.

I can only echo what everyone else has said and I had the same initial reaction from GP and DN when I told them I was starting LCHF. DN said she'd keep an eye on my cholesterol but didn't actively try to stop me. I went to GP this week to talk about latest HbA1c result and they agreed that I can come off Metformin as the results were so good. He did say it was all down to the weight I've lost rather than LCHF, but as far as I can see it, if it's the cause or effect which has got me off my meds, I'm happy! I've just got to prove it when I go back in four months for the next HbA1c otherwise it's back on the meds for me!

So, to sum up, they both know how it happened but aren't yet quite willing to admit it. I'll keep waving the LCHF flag until people start to take notice.

Good luck, @MPH, you're doing really well!

If your nurse is at all sensible she'll be delighted with your results and tell you to keep doing what you do. Sadly, my diabetes nurse lacks sense. She is happy for me but think I was misdiagnosed as in her book no diabetic can ever achieve a HbA1c of 32.
Well, no they can't if they follow her advice.

I'm so lucky I don't have a Diabetes Nurse.

I've only seen my GP once since diagnosis, and he didn't ask me how I'd dropped my HbA1c from 88 to 32 because he knew I'd not followed the "rules". We just had the Statins chat, but as he knew he'd lose that argument too he didn't try too hard.

Have you ever wondered where the eat well plate came from. Apart from it being promoted in the 2007s I can find nothing on any medical reports from Drs that supported it via testing and getting results. I can see it was used as a consumer feedback that it worked but nothing medical other than the nutritionists recommending it. Its weird because I can find example of low carb dieting from the 1800s that work. It surprises me that the information about the eat well plate just doesnt exist (atleast that I can find) that most NHS nutritionals say its a proven diet. As far as I can see there are more reports of the Low carb diets working than the NHS recommended diet and for a whole lot longer than the NHS guide. Anyone have any supporting documentation for the NHS plate?

Just smile and nod until you start to get non-diabetic blood test results. Then tell them what you have been eating.

I must admit I quite enjoy telling my diabetes nurse that I only eat bacon, eggs, ribeye, and cheese.

MPH said:

So when my next appointment comes through is it worth trying the above analogy or just nod , smile and ignore or state the facts and suggest they leave me to stand or fall by my own results.

M

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Yes. I've had the try porridge to help stabilise BG nonsense. I did point out that it might be fibre but it's also 60g/100g carbs.

poshtotty said:

As an aside, the last time I had my DN review, she confessed that she too had now given up carbs and was feeling much better for doing so!

The tide is definitely turning

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It will take a while to overcome years of programming I think.