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Not following health care providers recommendations

Wurst

Wurst

Well-Known Member
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1,128
Location
Germany
Type of diabetes
Type 1
Treatment type
Insulin
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During my diabetic mandatory health care lessons last night , the nurse had a fit because i haven't been following their guidelines. This was the first lesson on what to eat so i was a little suprised. I've been following the Bernstein guidelines of 6g,12g,12g carbs (breakfast, Lunch , Dinner) and my BS levels have been relatively good around < 5.2 fasting and some 4.5's in the afternoon. They recommendened i eat whatever i want and test accordingly , based on this i can get some fast acting insulin to cover meals. Currently i'm only on basal insulin therapy at night 2 units. I've already proved to them that eating museli in the morning sends me into the 9's so i declined their offer.

Has anyone else experienced this? What did you do ? I live in Germany and most likely they have differing practices to other countries but what could be the repercussions of not following healthcare providers recommendations however bizarre.
 
Just tell them what they want to hear ! Then carry on with your regime, it obviously works !
I've been doing this for 10 years, have good stable BG's and they are none the wiser, The point is they have a fixed immovable old fashion attitude that will not be shifted.Don't waste your time with them.

Carry on and keep calm !
 
Greetings Cblake843,

All I can say on this one is that I have been diabetic for 31 yrs now, never had a HBA1C above 6.8 so far and rarely if ever stick to the advice of nurses or doctors (actually these days I tend to tell them what should be done). Although I would not recommend running at 4.5 for a diabetic it is considered to be a hypo at that level and can have a negative effect on brain function (since it needs glucose to function correctly). I usually try to keep mind in between 5.5 and 8.5 max seems to do the trick.

Frankie
 
Still getting harassed by the diabetic nurse about my low carb diet. She informs i should be eating a minmum of 20 BE's a day (around 240 g of Carbs) and take fast acting insulin accordingly. I'm eating > 30g a day, only night time Basal insulin , weight is perferct (BMI) & i can run 11 km in under an hour (not bad for me).

240g of carbs a day would send my levels through the roof. Even if i took fast acting insulin to counter it, my levels would still go above 10 MMOL temporarily which to my understanding is 'dangerous' and could still lead to diabetic related complications.
 
Superchip said:
Just tell them what they want to hear ! Then carry on with your regime, it obviously works !
I've been doing this for 10 years, have good stable BG's and they are none the wiser, The point is they have a fixed immovable old fashion attitude that will not be shifted.Don't waste your time with them.

Carry on and keep calm !
Click to expand...

the problem with that is that it reinforces their belief that their advice is correct.
 
I see that you live in Germany... So may be different than the UK..

But I am surprised that your German nurse is saying this, as the UK DAFNE course is based around German methods which is based around carb counting, you get to choose the amount of carbs you want to eat and adjust your dose accordantly..

As to telling a HPC what they want to hear, only a fools does this... You tell the HCP the truth as to lie to them means information recorded in your medical records is incorrect, incorrect information can lead to another HCP providing incorrect medical treatment, which can kill...
 
Riesenburg said:
Although I would not recommend running at 4.5 for a diabetic it is considered to be a hypo at that level and can have a negative effect on brain function (since it needs glucose to function correctly).
Click to expand...

This not correct. I have copied and pasted the following from the DiabetesUK website. As you can see, 4.5mmol/l is NOT considered a hypo for someone with or without diabetes of any type. It may be a lower level than YOU personally feel comfortable with but it is considered a normal blood glucose level for a human being.
I visited several website (including this one) as well as Lilly Diabetes etc and some of them actually suggested LOWER targets than the ones below. NONE of them stated that 4.5mmol/l was hypo.

It is important that the blood glucose levels being aimed for are as near normal as possible (that is in the range of those of a person who does not have diabetes).

These are:

3.5–5.5mmol/l* before meals
less than 8mmol/l, 2 hours after meals.

Children with Type 1 diabetes (NICE 2004)
Before meals: 4-8mmol/l
Two hours after meals: less than 10mmol/l
Adults with Type 1 diabetes (NICE 2004)
Before meals: 4- 7mmol/l
2 hours after meals: less than 9mmol/l
Type 2 diabetes (NICE 2008)
Before meals: 4-7mmol/l
Two hours after meals: less than 8.5mmol/l
 
You just stole the toys from them.
They genuinely seem to believe they are right. Neverthelesws, your regime is obviously doin the right thing for you.
Hana
 
The 'recommended' regime does include carb counting but 240 g a day seems extreme (i.e. 12g carb = 1 BE, 20 BE's a day). At the moment with my > 30g carbs a day (6g breakfast, 12g Lunch , 12g Dinner and an evening snack) i don't need any insulin to cover these meals. I am going to refuse their kind offer tomorrow and advise i am following the Bernstein diet which surely it is my right to do.

As for hypo's at n4.5 normally i start to get irritatable / tired when my BS hits this level. Is this normal or is it simply because my body is not used to going this low
 
Cblake843 said:
The 'recommended' regime does include carb counting but 240 g a day seems extreme (i.e. 12g carb = 1 BE, 20 BE's a day). At the moment with my > 30g carbs a day (6g breakfast, 12g Lunch , 12g Dinner and an evening snack) i don't need any insulin to cover these meals. I am going to refuse their kind offer tomorrow and advise i am following the Bernstein diet which surely it is my right to do.
Click to expand...



It's your diabetes and it's up to you how you control it, if you are happy on the Bernstein diet and feel it is in your best interests long-term then stick with it, tell the nurse this is your choice and ask that he/she respects your decision.
 
Just to drag this topic on a bit longer:-

At the diabetic course this evening the 'head diabetes doctor' of the practice was called in to confront my about my low carb diet. I was informed that my diet was 'no carb' versus 'low carb' and that vegetables have no carbohydrates in them. I was quite puzzled by this as to my knowledge vegetables such as broccoli (my main ingredient) have around 5g carbs per 50g. Also the topic of kidney damage was raised due to the high protein intake to deter me.

I'm possibly one of the first low carber's they've had to deal with .

Anyway I'm still sticking to low carb !
 
You're right. Vegetables DO have carbs. I always count them and take insulin for them if necessary. I think though, that according to the ridiculous DAFNE guidelines (which seemed to have been designed to make people run high) they shouldn't be counted and therefore"don't have carbs".
 
glucosegirl have you actually attended a DAFNE course at all?

As it seems that you are getting confused, DAFNE recommendations for good blood glucose control is as followes

5.5-7.5mmol/l before breakfast
4.4-7.5mmol/l before other meals
6.5-8.0mmol/l before bed

As you can see slightly lower than the ones recommended, but if you attend the course you will know that you can if you've got enough stable control lower these slightly..

And DAFNE does count the carbs in vegetables, they discuss when perhaps the amount of carbs being consumed may be considered to negligible amount... Also they discuss about how accurate one needs to be about carb counting, rounding up/down for your dose adjustment etc... So that you find your level and how accurate you need to be as this can be slightly different for different people.

Going back to cblake..

I think it might be wise for you to do some basal testing, as if you are eating and not needing any quick acting insulin then it sounds like your basal (background) insulin is too high...

The problem with controlling your blood glucose like this, is that if you miss a meal/snack then you increase the risk of a hypo, and if for any reason you eat more or decide to treat yourself with something containing carbs, you won't have a clue how much quick acting insulin you might need, and a danger of not having any or what you have is out of date etc..

As to your hypo symptoms kicking in at 4.5mmol/l

Technically/clinically a hypo is blood glucose reading of below 3.7mmol/l (if I remember it rightly) but for practical and legally for UK driving licences purposes, it's classed as anything below 4mmol/l (humans work better using a whole number or an half a number i,e 0.5 or 1 etc)

Hypo symptoms start at 4.5mmol/l isn't a bad thing and could be a life saver, as it shows your hypo awareness is intact so will keep the paramedics away.. As the problem is if you are running your level at normal the lower line of 4mmol/l can diminish your hypo warning, and the less of a window you will have to treat a hypo before it becomes a medical emergency....

I know that you are following Bernstein guidelines, but do you have his book as it's one thing following his guidelines, but their is a lot to understand about control, so you need the book to get the rest of the information...
 
jopar said:
As it seems that you are getting confused, DAFNE recommendations for good blood glucose control is as followes

5.5-7.5mmol/l before breakfast
4.4-7.5mmol/l before other meals
6.5-8.0mmol/l before bed

As you can see slightly lower than the ones recommended, but if you attend the course you will know that you can if you've got enough stable control lower these slightly..

In what way is this LOWER than the ones recommended?

Adults with Type 1 diabetes (NICE 2004)
Before meals: 4- 7mmol/l

DAFNE guidelines are set higher than this.eg According to NICE guidelines 2004 a bg of 4.6mmol/l in the morning would be in range but according to DAFNE would be too low.
Click to expand...
 
@ jopar. Thanks for the reply you make some useful points which i'll look into. I've read Bernstein's 'Diabetes solution' at least 5 times now but still have lot to understand:-)

If i understand correctly, basal insulin works for only approx 12 hours which i inject only 2 units before bed. This dosage shouldn't affect my daytime readings or have i the wrong end of the stick? I am still in the 'honeymoon period' after diagnosis but as Bernstein states this period can be prolonged indefinately by a low carb diet and not overworking the pancreas. This is what i am attempting.
 
It depends what insulin you'll using, if you using an older isophane insulin such humilin I, Insulated yes you would be injecting 12 a day, the profile for these insulins, is 2 hours to begin to work, 4-6 hours to peak, then 8-12 hours drop off,

Long acting Analouges insulin's Lanuts and Levlmer (if I remember rightly Bernstein doesn't like Lantus) are 24 hours, but can be spilt..

What aspects are you struggling with?

Is his theory or timing of injections ect?

I wouldn't pin too much hope on Bernstein's theory of being able to stay in honeymoon period, as it's only a theoretical theory on paper! The honeymoon period is different for different people, it's not unknown for a newly diagnosed T1 either reduce insulin to very low levels, or even be able to stop insulin for a short period of time...

Bernstein's book is written for an American audience who seem to like, reasons why to be included, so a far bulk of Mr Caveman and evolution...

Perhaps investing in John Walsh's 'Using Insulin' might be worth while, as understanding how the Bolus/Basal regime works within a traditional diet you better understand's what Bernstein theory is coming from...

Bernstein not only writes his book for an american audience (hence the Mr Caveman underpinning reasoning) but he's basically prescribing the regime which the downside of that, he doesn't always get the necessary underpinning knowledge so that you understand what you'll doing, and without full understanding you'll tend to struggle...

Also, having all the information, if you find that Bernstein is too restrictive to maintain, you know how to work out your control, find your own working balance of carbs and carb types so you build your own personal 'regime' that specifically works for you... Less likely to fall off the wagon that way..

But do ask questions, perhaps google for Bernstein forum best source of information for his regime, asking the ones who are following it...
 
paul-c

Superchip wrote:Just tell them what they want to hear ! Then carry on with your regime, it obviously works !
I've been doing this for 10 years, have good stable BG's and they are none the wiser, The point is they have a fixed immovable old fashion attitude that will not be shifted.Don't waste your time with them.

Carry on and keep calm !

paul-c wrote 'the problem with that is that it reinforces their belief that their advice is correct.'


Well, yes, I agree with what you say but The point is they have a fixed immovable old fashion attitude that will not be shifted. !
Don't waste your time with these idiots !

Do what works for you, THEY will eventually realise the truth when they stop getting kickbacks.
 
I saw a Swedish documentary or TV-spot on LCHF and diabetes.
They interviewed pro-LCHF-professors, diabetics, anti-LCHF, and the ones giving todays recommendations to diabetics (eat everything except candy basically).
They did a test for type 1 diabetics to go on LCHF-diet, everyone who followed through where amazed - and when they showed the graphs of their sugar levels before and after it was a huge difference.
But the anti-LCHF and the ones giving recommendations to diabetic just refused to even consider their position even when they got a look at these graphs.

It's weird, because it's so logical, you got a decease where carbs make you sick in the long run. Generally, it's a good idea to stay away from what makes you sick.
 
Instead of telling them what they want to hear, I have now told them I will not be following their recommendations and will reconsider when my 'honeymoon' period is over. I can't recall where i read it (probably Bernstein) but the American diabetes association has around a 10% success rate of avoiding long complications using their high carb methods, same for the German assoication!

I asked for a 'background' insulin i could take in the day similar to the Basal which I take at night and was advised there is no such thing. From what i've read on this forum people take 'background' insulin in the day or have i totally got the wrong end of the stick here again?
 
Background and basal insulin are the same thing. The basal or background insulin that you are probably referring to is Levemir as this is taken twice a day- once in the morning and once in the evening. Whereas Lantus (which is also a background or basal insulin) is usually only taken once a day. It is normally taken in the evening although it can be in the morning instead and some people even take a spilt dose (once in the morning and once in the evening) although Lantus suggest that once a day is best.
 
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