Low Carbs versus NHS recommended diet.

[Brianiacsleep]

My health coach is the same, telling me that I must cut down on fat and only slightly limit my carbohydrate intake. Although much modern research shows a link between insulin use and dietary fat. So lowering your blood sugar, by reducing your carbohydrate intake will significantly lower your cholesterol level.

 

[Oldvatr]

I suggest he gets Think Like A Pancreas and Pumping Insulin. They're both fantastic books for a Type 1 pumper

I'm surprised he was told to,eat a set amount of carbs. Also, I'm very confused that you say he was told to stop carb counting. Do you mean in the general,way that people refer to carb counting here (ie watching how many they eat per day)? Because carb counting in relation to Type 1 means assessing carbs and adjusting bolus insulin. One of the things you have to do before going on a pump is show that you can do that.

As for the NHS diet, I've never had a problem with it or dieticians. I've always been told to adjust it according to my needs and have never been told I have to eat a certain amount of carbs, protein or fat. Type 1s usually have more leeway than many Type 2s due to insulin and the lack of insulin resistance (usually).

I may be wrong since I am guessing on this, but I think the values the consultant recommended werw actually MIN values, and because it was a correction dose approach on the pump, then it was actually probably a per meal value, not per day as I originally said. In practice he makes a guess on x units insulin per y calories, and this may be why he has been getting problems. He then corrects later when his post prandial shows low bgl by adding a fixed amount normally 8 or 10 units. There seems to be no calculation in this correction dose, and is based on previous experience.
As I am a T2D not using insulin, I cannot advise him. He is set in his ways, and even his DCN has tried to change his control method, but only his Consultant can do that. Rock and a hard place.

Or Chicken and Egg ! It seems he is being taught to adjust his carb intake to feed his insulin habit, rather than doing things properly. With LC you can reduce the need for insulin, so need fewer carbs, but the NHS does not want to take that concept on board at all. Presume it is not a good idea to take insulin without giving it glucose to work on. I think that is called an overdose So make sure there are loads of carbs to tame the insulin - NUTS!

 

[Oldvatr]

I'm confused. Do,you mean calories or carbs @Oldvatr ?

Calories.

 

[azure]

Calories.

Thanks

I agree with @tim2000s I can't understand how he got a pump if he's not demonstrated he's able to count carbs. Calories are nothing to do with it.

And why would he be having to feed his insulin?? That's not how pumps work. He'll have a bolus ratio for the carbs.

It does sound rather muddled.

 

[azure]

I may be wrong since I am guessing on this, but I think the values the consultant recommended werw actually MIN values, and because it was a correction dose approach on the pump, then it was actually probably a per meal value, not per day as I originally said. In practice he makes a guess on x units insulin per y calories, and this may be why he has been getting problems. He then corrects later when his post prandial shows low bgl by adding a fixed amount normally 8 or 10 units. There seems to be no calculation in this correction dose, and is based on previous experience.
As I am a T2D not using insulin, I cannot advise him. He is set in his ways, and even his DCN has tried to change his control method, but only his Consultant can do that. Rock and a hard place.

Or Chicken and Egg ! It seems he is being taught to adjust his carb intake to feed his insulin habit, rather than doing things properly. With LC you can reduce the need for insulin, so need fewer carbs, but the NHS does not want to take that concept on board at all. Presume it is not a good idea to take insulin without giving it glucose to work on. I think that is called an overdose So make sure there are loads of carbs to tame the insulin - NUTS!

Sorry but none of that makes sense. Why's he correcting a low blood sugar with insulin?? No wonder he's having hypos! How does he use the pump if he's unable to count carbs? And how did he get it in the first place? And surely he knew calories were nothing to do with it when he was on MDI?

You don't use correction doses like that, which surely he'd know from MDI.

And if, as you say, the consultant told him to bolus by calorie value, then something is seriously wrong and he/she should be reported.

 

[kittypoker]

My health coach is the same, telling me that I must cut down on fat and only slightly limit my carbohydrate intake. Although much modern research shows a link between insulin use and dietary fat. So lowering your blood sugar, by reducing your carbohydrate intake will significantly lower your cholesterol level.

I'd drop the health coach. You are clearly intelligent and aware, and we have the greatest information resource known to man at our fingertips, the Internet. Granted, there's a lot of rubbish there but you can sift it out.

 

[Oldvatr]

Sorry but none of that makes sense. Why's he correcting a low blood sugar with insulin?? No wonder he's having hypos! How does he use the pump if he's unable to count carbs? And how did he get it in the first place? And surely he knew calories were nothing to do with it when he was on MDI?

You don't use correction doses like that, which surely he'd know from MDI.

And if, as you say, the consultant told him to bolus by calorie value, then something is seriously wrong and he/she should be reported.

I cannot answer your questions myself. However, I suspect that my friend who is vey stubborm, was originally taught to control his condition (some 40 years ago) and has refused to learn new tricks. I suspect either his Consultant is of similar vintage, or is taking the line of least resistance. All I know is that my colleague had difficulty understanding LC, and kept wanting to go back to calorific value. The concept of sugar being a carb was new to my colleague, and also the concept that protein becomes glucose. Likewise he is still not able to counteract the effects of high fat intake.

I will not see my friend until the gig, and then we will not have much time to discuss this. It will have to wait till our next 'scheduled' rehearsal in about 3 weeks time.

 

[Juicyj]

I cannot answer your questions myself. However, I suspect that my friend who is vey stubborm, was originally taught to control his condition (some 40 years ago) and has refused to learn new tricks. I suspect either his Consultant is of similar vintage, or is taking the line of least resistance. All I know is that my colleague had difficulty understanding LC, and kept wanting to go back to calorific value. The concept of sugar being a carb was new to my colleague, and also the concept that protein becomes glucose. Likewise he is still not able to counteract the effects of high fat intake.

I will not see my friend until the gig, and then we will not have much time to discuss this. It will have to wait till our next 'scheduled' rehearsal in about 3 weeks time.

Sorry but to me none of this makes sense, he cannot use a pump without understanding carb counting, they do not compute with calories so he would have to be carb counting to even use one. If a specialist consultant is advising him to count calories then again this is completely wrong, this is not how a type 1 would manage their condition, I think there's a few crossed wires here..

 

[tim2000s]

Yes, but this is part of the problem... consultants never ask how good people get good results... they are too wrapped up in giving more uncontrolled people more bad advice...

This isn't strictly true. I had a very long conversation with Anna Brackenridge at Guys who runs the Diabetes clinic there. We were discussing my CGM output and she asked me whether I ate reduced carbs, as "in her experience, those with the lowest Hba1Cs tended to".

So it's not like they don't know. They do. What they know is one thing. What they can share in an NHS clinic is rather different.

Add in to that, getting people who are struggling to reduce carb intake is rather like teaching those pigs how to fly. The issues are far more around people not testing or taking insulin, than about whether what they eat helps. So in Type 1 land, many HCPs are well aware of the benefits of reducing carb intake (they aren't stupid and it IS logical) but trying to get carbs lowered when there are much bigger issues just isn't a fight worth undertaking.

 

[Tabbyjoolz]

LCHF is an open secret in the NHS - my doctor is delighted with my Hba1c reduction, told me he was happy for me to carry on - but did not record it in my medical notes. The DSN at my education course - herself diabetic - said to cut down on carbs if sugars were high, but the dietician continued spouting the same old stuff.

People generally have been so brainwashed by the low-fat, high-carb edict over the past 40 years that they cannot get their heads around doing the exact opposite. I've lost count the number of times friends and acquaintances have asked me "are you sure that's a good idea?".

 

[pleinster]

We must all bear in mind that there is a very clear reason why the general NHS "healthy food" diet is not as effective for us; it's simply because it is pure nonsense put together by three dozen non-diabetic,well-meaning, badly educated, old women, a few retired and gibbering circus clowns, a very overweight, blind cat and a cute, three-legged Labrador puppy which writes its views on toilet paper with its ****. Seen in this light, we should not really be surprised.

 

[catapillar]

I'm so confused by @Oldvatr posts about t1 and pumping. You have to be able to carb count to use a pump. Literally. In order to deliver a bolus, the pump asks you how many grams of carbs you are eating. Then it uses your entered insulin to carb ratio, your BG value and any correction factor to calculate your insulin dose. You have to be carb counting to use a pump. To know what your insulin to carb ratio is to set up the pump, you must have been carb counting on mdi before starting pump therapy. The pump doesn't ask for calories, calories really don't have anything to do with it.

The NHS advice for a type 1 is eat whatever you want (including all the carb/ reduced carbs/ low carb if you choose), count the carbs and know how to adjust your insulin dose for the carbs you are eating. I have never recieved any advice on what to eat as a type 1, nor do I want any. When low carb has been mentioned in my appointments HCPs have been not keen, but not bothered.

It does sound like your friend is recieving advice that is out of step with usual NHS approach for type 1s on a pump, or that the advice has been misinterpreted by several crossed wires.

 

[azure]

@Oldvatr All I can think is maybe your friend used the wrong word when explaining to you (calories when he meant carbs). No one can get a pump unless they can carb count and it would be impossible to use one without carb counting.

Moreover, if your friend is somehow just whacking in insulin, then recommending he change to a LC diet would be even more dangerous.

Even if he was diagnosed 40 years ago, he'd have learnt carb exchanges and would certainly know that you don't 'correct' a low blood sugar with insulin!

I also noticed that you said his consultant had told him that the 250g carbs was a per meal amount!!! I find that very hard to believe, as with all the other things you've mentioned. People with pumps go to pump clinics. Are you saying he goes to a pump clinic where nobody knows how pumps work? If so, I think that's a very important matter that you should take further.

 

[donnellysdogs]

I had a chap in Wales that was given a pump straight from being on mixed insulin and did not carb count! He had ate the same food for 50 years from a child whendiagnosed. Ie only cornflakes. He got a pump. He had no idea on carb counting. He and his wife came to our bungalow onSundays initially and he phoned me once on the way home saying he was for the first time having a Macdonalds -how many carbs should he bolus!!

There are a few people that seem to get a pump. He showed willing... he wanted to change but was still given a pump without good understanding.

I do not know how he got on...

 

[azure]

Was he told to count calories to calculate his bolus @donnellysdogs ?

 

[donnellysdogs]

No, he was told carbs.. he knew he didn't know how many carbs in a macdonalds so his first thought was I would!
I had to look it up. Not printed on the. Ack of trays at the time!

His nurse said he wouldbe a danger to himself on pump, his consultant over rode the nurse. He was the person that phoned me at 3am and asked what he should do for a hypo... he had accidentally given himself extra bolus through pump for the carbs he ate!!

 

[MartinK9]

Here's the latest comment notes from my DN on my 6 monthly review:

" MartinK9 has achieved an HbA1c of 5.1%, he is extremely motivated with his lifestyle management, achieving weight loss of 16kgs by virtually cutting out CHO from his food intake and making very healthy choices. Feels his weight is levelling out now. He is happy with his food choices and resistant to re-introducing CHO."

So the evidence is there but she wonders why I'm resistant to eating carbs again? ***

 

[serenity648]

We must all bear in mind that there is a very clear reason why the general NHS "healthy food" diet is not as effective for us; it's simply because it is pure nonsense put together by three dozen non-diabetic,well-meaning, badly educated, old women, a few retired and gibbering circus clowns, a very overweight, blind cat and a cute, three-legged Labrador puppy which writes its views on toilet paper with its ****. Seen in this light, we should not really be surprised.

so they would be the CAT scan and the LAB report - right?

 

[CherryAA]

We must all bear in mind that there is a very clear reason why the general NHS "healthy food" diet is not as effective for us; it's simply because it is pure nonsense put together by three dozen non-diabetic,well-meaning, badly educated, old women, a few retired and gibbering circus clowns, a very overweight, blind cat and a cute, three-legged Labrador puppy which writes its views on toilet paper with its ****. Seen in this light, we should not really be surprised.[/QUOTE

Not completely sure why you would lump us "Old women" into that particular diatribe badly educated or not. The one thing that comes shining through on the research is that its easy to find woman researching the benefits of the low carb way of life and apart from the much vaunted benefits of the Mediterranean diet - whether substantiated or not, in general MEN (possibly old) appear to be the prime cause of much of this dietary muddle.

 

[Ailuj]

until I found low carbing I was accused of all sorts by medical professionals who gave me diet sheets and then blamed me for putting on weight on high carb regimes. I have been shouted at called a liar, lazy, greedy - and for a long time I thought it was my fault I was fat. Then I found that I could lose weight on a low carb diet and was instantly berated and told that my thinking was wrong and the diet was dangerous. A few years later I found Dr Atkins New Diet Revolution, and found that he was treated in just the same way, but that he had got lots of patients who were alive when standard medical treatments would most likely have killed them. The medical establishment really needs a good shake up.

Shocking! All very confusing for a newly diagnosed type 2. I told my nurse straight out that I was going to try low carb eating. She didn't argue. She also didn't give me any diet sheets. She was keen for me to self-refer to the Diabetes2gether course, which I will do. However, I suspect I will be given the NHS party line on diet there. The nurse told me not to get a glucose meter at the moment. How do I know if I'm doing the right things if I have no way of testing. Wait till you come back in 3 months seems like stupid advice.