Low Carbs versus NHS recommended diet.

walnut_face · Dec 13, 2016

Ailuj said:
Shocking!
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.

You don't!
Buy yourself a meter and eat to it, is the best advice that comes from this website.

2 Cliches

a) If it aint measured it aint managed
b) A failure to plan is a plan to fail

JohnEGreen · Dec 13, 2016

Ailuj said:
How do I know if I'm doing the right things if I have no way of testing.

You don't.

As walnut_face says get a meter it won't cost you an arm or a leg not getting one may.

serenity648 · Dec 13, 2016

3 months? I have 6 months between HbA1c tests. I am getting my results tomorrow (gulp)

noblehead · Dec 13, 2016

Oldvatr said:
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.

Like others have said the above doesn't make any sense, the RDA for carbs is 300g for a man so why would a diabetes consultant suggest 250g a meal? On a 1 unit to 10g of carbs ratio that would be 75u of insulin just for his meals plus any correction doses, that's not taking into account his basal dose which could be anything from 20-40u, so his TDD (Total Daily Dose of insulin delivered) would be 100+units, as the reservoir on pumps typically hold between 200-300u that advice doesn't seem plausible at all.

I've been diagnosed 35 years and never been told to bolus according to calories consumed and its always been carbs, however there are algorithm's available now where you can use bolus calculations according to calories but this has only been a recent development if I'm not mistaken, as its only in recent years that the experts are realising that its not only carbs that raise bg levels in type 1's but fat & protein too.

If your friend has been told all this then he is being poorly advised and the consultant/clinic needs reported, you should take up @tim2000s offer where he said he'll report them if your friend passes on their details.

Oldvatr · Dec 13, 2016

There used to be a team who provided dietary and pump clinic support, but they were disbanded due to cuts and only support the local hospital We have one Consultant, and two DCN in the county, but most local GP surgerues have trained healthcare workers who support the GP clinics.

I don't think my friend wants to count anything. I think he works like a bang - bang servo system in that he makes rough estimate when he sets up his basal in the pump, then he tests later and either eats biscuits or adds a correction dose on the pump based on his readings. He often says when I meet him for rehearsal or gig that he has just eaten high calorie meal and has given himself 20 units so he should last the gig. Sometimes he only gives himself 10 units, so it is very rough and ready. I have never heard him use the term bolus, but he does use basal. He understands how to deal with low bgl in his own way and only uses insulin correction when it is high. His target level seems to be 7 mmol/l since he is shocked when I get a 5 and don'r eat a biscuit immediately. I think high calorie in his eyes equates to high fat, so it is his way of compensating for the effect that has on him. I did copy him the report on T1 IR due to high fat intake, and he did read it, coz he mentioned that now he delays his readings and it helps stop him from over correcting/

I agree that his control is nothing like what it should be (as currently taught) but he is an obstinate old codger, and must do things his way. Its the same with his music, so learning a new song is a challenge. Having experienced disagreements with him, I can see why a Consultant has told him to revert to his old ways, rather than insisting that he do it correctly. When he was LC with me, he liked it since he did not have to count carbs, just avoid high carbs, and he did report needing less insulin, so he was clear that that was what would probably happen. So it was no more dangerous that his current bang-bang regime, where someone would regularly pick him up off the floor. I taught him my more relaxed way of using LC, and it suited him, And he was beginning to report finding LC meals at Asda that I could use, with glee. I hope I can get him back on the wagon,

kokhongw · Dec 13, 2016

Inchindown said:
So is there anyone on this forum that follows the NHS recommended diet and still controls their blood sugar?

As a rough guide, statistics from US ADA shows that it would be rare...very rare...

"Researchers found when they analyzed data from 122,781 adults enrolled in a health care delivery system. Seven years post-diagnosis, only 140 of them had ever achieved complete remission, defined as having an A1C (a measure of overall glucose control) of less than 5.7 percent on at least two visits without taking any diabetes medications. Only 6 people maintained remission for five years straight."

http://www.diabetesforecast.org/2015/jan-feb/remission-rare-possible-type-2-diabetes.html
http://care.diabetesjournals.org/content/early/2014/09/12/dc14-0874.abstract

pleinster · Dec 13, 2016

It wasn't intended to single out women...that's why I included the "gibbering circus clowns" (ie. men).

serenity648 · Dec 13, 2016

pleinster said:
It wasn't intended to single out women...that's why I included the "gibbering circus clowns" (ie. men).

you know clowns can be female too, right? ; )))))

azure · Dec 13, 2016

Oldvatr said:
There used to be a team who provided dietary and pump clinic support, but they were disbanded due to cuts and only support the local hospital We have one Consultant, and two DCN in the county, but most local GP surgerues have trained healthcare workers who support the GP clinics.

I don't think my friend wants to count anything. I think he works like a bang - bang servo system in that he makes rough estimate when he sets up his basal in the pump, then he tests later and either eats biscuits or adds a correction dose on the pump based on his readings. He often says when I meet him for rehearsal or gig that he has just eaten high calorie meal and has given himself 20 units so he should last the gig. Sometimes he only gives himself 10 units, so it is very rough and ready. I have never heard him use the term bolus, but he does use basal. He understands how to deal with low bgl in his own way and only uses insulin correction when it is high. His target level seems to be 7 mmol/l since he is shocked when I get a 5 and don'r eat a biscuit immediately. I think high calorie in his eyes equates to high fat, so it is his way of compensating for the effect that has on him. I did copy him the report on T1 IR due to high fat intake, and he did read it, coz he mentioned that now he delays his readings and it helps stop him from over correcting/

I agree that his control is nothing like what it should be (as currently taught) but he is an obstinate old codger, and must do things his way. Its the same with his music, so learning a new song is a challenge. Having experienced disagreements with him, I can see why a Consultant has told him to revert to his old ways, rather than insisting that he do it correctly. When he was LC with me, he liked it since he did not have to count carbs, just avoid high carbs, and he did report needing less insulin, so he was clear that that was what would probably happen. So it was no more dangerous that his current bang-bang regime, where someone would regularly pick him up off the floor. I taught him my more relaxed way of using LC, and it suited him, And he was beginning to report finding LC meals at Asda that I could use, with glee. I hope I can get him back on the wagon,

But what did he do on MDI? Surely he bolused then? If he can't or won't bolus correctly, and is 'misusing' his insulin, then LC is a dangerous suggestion which could,lead to severe hypoglycaemia or worse...

Rather than get him back on your wagon (LC for a Type 2) I strongly advise you try to gently persuade him to seek out help from a Pump Nurse, even if that means travelling a little further for his appointments or simply speaking to one on the phone, which would be less hassle. He would then, hopefully, be on the appropriate 'wagon' for a Type 1 who is using an insulin pump.

You don't estimate your food and adjust your basal. I find it hard to,believe he's doing that. However stubborn he is, if he's been a Type 1 that long he'd know how to bolus. And if he's correcting highs then why isn't he simply using the bolus system for his food?

As I and others have said - it makes no sense at all, and is very hard to understand and believe.

I know you don't use a pump,and aren't Type 1, but to me it sounds like the equivalent of taking Metformin by balancing it on your head, with the number of tablets corresponding to the number of degrees centigrade the temperature is that day.

I can't really think of any other adequate comparison. It simply doesn't make sense.

CherryAA · Dec 13, 2016

pleinster said:
It wasn't intended to single out women...that's why I included the "gibbering circus clowns" (ie. men).

I KNOW - I was teasing

JGLondon · Dec 13, 2016

Inchindown said:
Having only recently diagnosed with T2 I've been doing a low carb diet. Currently about 80 g per day. It seems to be working well and BG seems to be falling.

However, when I look at what the NHS recommends a T2 should eat, it seems almost opposite of what I'm currently eating for my low carbs diet.

So is there anyone on this forum that follows the NHS recommended diet and still controls their blood sugar?

It's not easy to totally go against my Doctor's advice on what I should eat.

Actually I think it is very easy to ignore your Doctor's advice, I have been ignoring mine for a decade and maintain good control. I won't say that I am on Atkins, but I certainly avoid Carbs as much as is possible. Fortunately I am also on Insulin and can dial up whatever units I need to cover the carbs I am eating, but Insulin increases the risk of weight gain, so I try to keep the units down. Best of luck!

Moosepig · Dec 13, 2016

bulkbiker said:
I very much doubt it... in my humble opinion that would be impossible and why so many of us get quite angry at NHS advice.
After my diagnosis (by practise nurse rather than GP) I went to see the GP in charge of diabetes care for the surgery. His ignorance about recent research into ways to treat Type 2 was, to me, completely amazing. Also he apparently had absolutely no interest in educating himself and was not even curious as to how I had brought my blood glucose down. After those 5 minutes I had no worries about completely ignoring his advice and following the way of eating I had been introduced to on this forum. I believe it has saved my eyes and feet. I worked out that diabetes was mine to control and not the doctors.. I would rather take advice from a well controlled Type 2 than someone with "qualifications" obtained 30 yeas ago.
All the best
Mark

I couldn't agree more Mark, if I just stuck with my gp and DN advice I would be out on a limb! Before I found this forum and the low carb lifestyle I felt isolated and confused. Sadly with the nhs cuts our surgery is reduced to a practice nurse covering everything - cardiac, COPD, diabetes, stroke, hrt, family planning etc so no time to support and advise on my diabetic nutrition and blood glucose levels. The low carb lifestyle has proved itself already, its a win win lifestyle and provided people get the confidence to tweak it to their particular needs (I cant cope with much fat) and get support and ideas from the great bunch on this forum it really is the way forward!

donnellysdogs · Dec 13, 2016

Please note that a GP in charge of diabetes care in a Practice does NOT mean he has any extra knowledge than other GPs in that Practice.
In my old Practice the GPs were just allotted their "speciality" by the core Partners. He had no extra knowledge than the day before he was allotted the diabetics to oversee.
The GPs are a business. They effectively get paid by results, qty patients, flu jbs given and the targets they hit for example the qty of hba1cs in range etc.
So, Practices are allocating "specialisms" to GPs. Ie baby clinics will go to x, diabetics to y, heart persons to z. Those GPs will look at targets and news, but do not even know sometimes about new treatments... ie tresiba as a new basal insulin a few years back.
Now, nurses- come of our nurses specialused and actually had two degrees!
My new Practice is taking on an uktra qualified nurse in preference to a GP, as she can prescribe.
Even a diabetes manager from my last hospital did not have any knowledge on diabetes at all when she visited me at home in July. She had been a nurse and a mental nurse. Not an ounce of diabetes training or speciality at all.

Yes. GPs do have to undertake some courses but the courses can be taught from watching a video and training for 90mins online in various different subjects that they can choose to select.

Nurses ysed to have to keep registered and pay to keep their qualifications. Not sure how this runs now..

Please dont expect GPs to know the ins and outs of everything.. even if they have been allocated "diabetics"... generally they have in my past 4 GP practices referred me to a nurse... or even recently for trseiba insulin referred my request from hospital to the in practice pharmacist who is sorting out the prescribing nowadays...

Japes · Dec 13, 2016

I had a very depressing conversation with a student nurse recently who was earnestly encouraging me to follow the NHS advice (after a 2 day training course) "As you NEED some carbs" and "There's no need to completely give up foods you like.". This was after seeing me refuse cake, biscuits, and chocolate. Also after telling me her mum was Type 2, with complications, and she herself was expecting to follow in her mum's footsteps in about 15 years time given her blood pressure, weight and BMI all of which, along with hereditary factors, put her as high risk.

I pointed out I preferred to keep my limbs and eyesight, if at all possible, and frankly, after years of eating a "healthy diet" of the current kind of recommendations, cutting carbs to an absolute minimum was working for me and I seemed to have lost my taste for sweet things along the way... She was still having none of it, so I terminated the conversation and will be making sure I do my lunch time checks out of her sight from now on.

fene48 · Dec 13, 2016

Stuart7152 said:
Up to last week I followed the NHS Doctor who confirmed my T2 back in March and have lost 40kg.

On joining this forum I've just started BG monitoring and have noticed a few spikes on this method which I'm now reducing by lowering my carbs over the whole day and individually meals.

My point is all diets work differently for every single person, but I focused on ensuring I was always in deficit from calories in to calories out. Find a life style that allows you to maintain a weight and a diet to reduce your weight by over 15%, may be more or less depending on your starting weight/BMI

We all need to work out our personal fat threshold point to reverse this T2 and remain long term below this weight by life style changes. I really recommend that you read Professor Roy Taylor - Newcastle University research as seems to be the UK expert in this field.

These are only my experiences to date with some success , but I'm very new to T2 and I'm sure I'm making a few mistakes

I am a fan of the good Professor too and almost a year down the track things are still working. At the end of the day it is your weight, condition, medication, research, experimenting, measuring etc etc that will do the trick for YOU. Roy Taylor is a good place to start, you seem to have an open mind and a positive attitude - great assets. The only piece of advice I have is do your own research and don't get locked into a particular mantra. Best of luck and success.

Trebor2516 · Dec 13, 2016

Inchindown said:
Thanks for all the replies.

I've no plans to abandon my low carbs diet. I just find it hard to understand why the official NHS dietary guidelines appear almost exactly the opposite of what seems to work for most people on this forum.

I have been following the '8week Blood Sugar' diet by Dr. Michael Moseley, which gives a good low carb diet and the recipes to go with it. He also explains the science and tests that were done by himself and Prof Rod Taylor. I was so appaled by the NHS advice when I saw it online I wrote to my MP to complain and ask him to take it to the Health Minister, which he has done. I think it is scandalous that the advice they are giving is at worst killing people, at best losing limbs. I suggest anyone who has been on a lowcarb diet also write to their MP.

Trebor2516 · Dec 13, 2016

Oldvatr said:
I have a guitar buddy who is T1D and on an insulin pump. He has had a terrible time trying to control his bgl going by NHS advice, amd we have even had him hypo halfway through a song. We have had to pull out of gigs because his bgl was either too high or too low.
Back to Topic. I recently introduced him to LCHF and gave him a copy of my 'rulebook' which he has used. He was reporting needing much less insulin, and was getting stable results at last. However a couple of weeks ago he had his annual checkup wih his consultant who immediately ordered him to stop his nonsense and start eating carbs again. He was recommended to eat a minimum of 250 g of carbs a day, and at least 2000 calories a day. He was told to stop carb counting and go back to bolus by calorie value, else face being dropped by the Consultant and his team.

Since then we have missed 3 rehearsals, and our next gig is this Thursday. He is in a terrible state, but is fearful of having his care being withdrawn, I have pointed out that his Consultant does not need to know how he eats etc, so don't tell him. Do what he now knows works for him. But the seeds of unease have been planted in his mind, and I dread this next gig.

I would advise him to carry on his low carb diet and find another consultant. It's his life and limbs after all.

Monty19 · Dec 13, 2016

Inchindown said:
Having only recently diagnosed with T2 I've been doing a low carb diet. Currently about 80 g per day. It seems to be working well and BG seems to be falling.

However, when I look at what the NHS recommends a T2 should eat, it seems almost opposite of what I'm currently eating for my low carbs diet.

So is there anyone on this forum that follows the NHS recommended diet and still controls their blood sugar?

It's not easy to totally go against my Doctor's advice on what I should eat.

Hi I have been type 2 since May and am now at normal levels on low carb diet with metformin. My GP has been really impressed by my scores . I have a blood test every 2-3 months .to keep on track. Low carb and exercise works. Read Dr Michael Mosley for more sensible info. NHS behind the times I think,

azure · Dec 13, 2016

Trebor2516 said:
I would advise him to carry on his low carb diet and find another consultant. It's his life and limbs after all.

If he's not using/understanding his pump properly it may be dangerous to go LC as explained above.

The needs of a Type 1 pumper are different to a Type 2

donnellysdogs · Dec 13, 2016

Totally agree with @azure..

Making any changes to diet and carbs on a pump needs a full
Understanding of how the pump etc works.
To me it is such a shame that this "friend" cannot really be bothered to change lifestyle or thinking when there are a lot of people that have to jump through hoops to get a pump....

I am absolutely shocked at reading details to be honest of this "friend".
I absolutely fear what could happen to him...

Low Carbs versus NHS recommended diet.

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