This sort of thing makes me very cross. Your "healthcare professionals" are giving you bad and potentially dangerous advice and doing so with an arrogant "we know best" attitude. Sadly, that is all too common - but I have never heard of quite so much rubbish being spouted as by your nurse.
Long Post Warning!
I am afraid that this is going to be a very long post - but honestly, this much rubbish needs to be thoroughly debunked. I am cross and in a debunking mood :evil: :evil: :evil:
popps said:
She was a different nurse to the one I saw first-time round three weeks after diagnosis, and told me that apparently the advise I was given by the first nurse was incorrect.
Given that this nurse was talking spectacular rubbish - I would give more credence to your first one!
popps said:
I was told initially that I would be referred to something called DESMOND (still waiting) who would be responsible for primary diabetic care, i.e. eyes, feet, etc. But not so! I should have signed a diebetics registry form.
I have never heard of a "diabetic registration form" - I have never signed such a thing. It might be something that your PCT does. DESMOND is a national training programme (
Diabetes Education and Self Management for Ongoing and Newly Diagnosed) - it is not directly responsible for any sort of healthcare. DESMOND are courses for T2 diabetics run by various (but not all) PCTs. I believe they can be quite hard to find, with long waiting lists (I have never been offered one). They are a very good idea, although I have heard mixed report of how useful they are.
popps said:
Was I on any medication for the condition ("no"), to which she replied "Not yet". Is it inevitable that everyone with the condition ends up on oral medication or insulin?
Absolutely not (although if you follow this woman's advice you will). Many T2 diabetics can control the diabetes quite effectively by diet and exercise alone. If it is diagnosed at an early stage, and if you adopt a really good lifestyle then there is every chance that you will be able to do this. Some people need help with medication, and there are now very good drugs available for doing this. It is probably a good idea to try diet alone initially, and only go onto medication if you need to. Far too many medics tend to put people straight on to drugs - I guess it is easier than trying to work with them on their lifestyle. As for insulin, yes some T2 diabetics do need it - but only if your pancreas is so badly damaged that it can no longer produce enough insulin yourself. This generally only happens if the diabetes has been uncontrolled for a long time (such as if it is undiagnosed - or if you follow the sort of idiotic advice you have been given here).
popps said:
When I mentioned about the low carbing she said it was the wrong thing to do and I could ear as much pasta, potatoes etc. as I wanted but I should watch what I "put on them", whatever that means. She also gave me a diabetic information pack which seems to reinforce this high carb mentality.
Now this is where the advice gets gobsmackingly awful! I know where your nurse is coming from (she is trying to explain to you a badly outdated approach to diabetes management), but she has garbled it badly - either she doesn't understand it herself, or she is communicating it incredibly badly. Where this comes from is the standard advice that is in many medical textbooks, and is promoted by organizations like Diabetes UK and the American Diabetes Association. This is what, on this board, is often referred to as the "high carb" approach. That is that you should eat modest quantities of complex carbohydrate (ideally low GI - things like brown rice, whole-meal bread and pulses) with every meal. The theory behind this is that these cause a slow release of glucose after eating, which minimizes the glucose spike and leads to stable blood sugar levels. However, this is a very far cry from saying that you should "as much pasta, potatoes etc." as you want. I suspect that what she is talking about with what you "put on them" is fat - but there is no evidence that fat is dangerous to diabetics (or anyone else for that matter - but that is another rant!). The problem with this high carb approach (the Diabetes UK original, rather than your nurses garbled version of it) is that it doesn't work! Actually, that is somewhat unfair. It can work for some people, and it does work if you combine it with drugs. However, most people find that reducing carbohydrates is vastly more effective and allows you to get by with fewer drugs or possibly no drugs at all. A lot of research, and a lot of highly respected diabetes specialists have in recent years come to the conclusion that carbohydrate restriction is absolutely key to good T2 diabetes control.
Now earlier on, I promised you references - so here goes... If you want to read up on diabetes yourself (and you should to counter this sort of nonsense) then I can strongly recommend
Dr. Bernstein's Diabetes Solution. Richard Bernstein is both a diabetic and a diabetes specialist, who has done a lot of research in this area and is one of the great proponents of low carb diabetes management. He is very highly respected in the diabetes world, both amongst researchers and patients. His book (which is non-technical advice for diabetics, and very readable) is the bible of many on these forums.
Now, I realize that you probably won't want to get into the research literature on this, but just in case you come against this sort of ignorance from the medical profession it doesn't do any harm to be aware of some of it. Here is a selection of papers that I am know of that provide good evidence that a low carb diet is the way to go. This is not by any means comprehensive, just a few papers that I know. They are by respectable clincal scientists and published in very respectable journals, though, so they should be taken very seriously by anyone who cares about evidence-based medicine.
Boden, G. et al. (2005). Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes. Annals of Internal Medicine 142(6) 403-411. Full paper available online.
Gannon, M.C. & Nuttall, F.Q. (2004). Effect of a High-Protein, Low-Carbohydrate Diet on Blood Glucose Control in People With Type 2 Diabetes. Diabetes 53, 2375-2382. Full paper available online.
Garg, A. et al. (1994). Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus. Journal of the American Medial Association 271(18) 1421-1428. Abstract available online.
Nielsen J.V.; Jonsson E. & Nilsson A.K. (2005). Lasting improvement of hyperglycaemia and body weight: low-carbohydrate diet in type 2 diabetes—a brief report. Upsala Journal of Medical Science 109 179-184. Full paper available onlne.
O'Neill D.F.; Westman E.C. & Bernstein R.K. (2003). The effects of a low-carbohydrate regimen on glycemic control and serum lipids in diabetes mellitus. Metabolic Syndromes Related Disorders 1(3) 291–8.
Vernon M.C. et al (2003). Clinical experience of a carbohydrate-restricted diet: effect on diabetes mellitus. Metabolic Syndrome and Related Disorders 1(3) 233–7.
Yancy W.S. Jr; Vernon M.C. & Westman E.C. (2003). A pilot trial of a low-carbohydrate, ketogenic diet in patients with Type 2 Diabetes. Metabolic Syndromes Related Disorders 1(3) 239–43.
popps said:
As well as asking me about weight and height she also wanted to know how many alcoholic units I consumed each week which was way above the recommended limit of 21.
This too annoys me. It is the UK government recommendation for England (bizarrely it is different for Wales!). However, this is not based upon any research or logic - it is a figure that was "plucked out of the air" by a committee of doctors 20 years ago. That phrase is not mine - it is a quote by someone who was present when that decision was made (this was
reported in the Times last year). Many different governments make this sort of recommendation (with different size units), but once you convert them they are wildly variable. If you convert these levels into British units Australia, for example, recommends that 35 units is the safe maximum for men. I will be spending a couple of months in Australia later in the year - do I need to increase my drinking by two thirds?? This is absurd. However, this Australian figure is based upon research and it is in line with the best guidelines available - those of the World Health Organisation (which are based upon a lot of research). These classify drinking behaviour as low, medium or high risk - for men, low risk being under 35 units (in terms of UK units), medium risk being 36-53 and high being above 53 (
Global Status Report on Alcohol, 2004). Now don't get me wrong - excessive alcohol consumption is a major health risk. However, it is going to vary wildly between individuals (it will depend upon things like your physical size, your metabolic rate, your general state of health and may other factors). The important thing is that you aren't in any way (psychologically or physiologically) dependent upon alcohol. If you must take an arbitrary figure as a limit, then the WHO figure of 35 units is at least based upon research rather than the UK figure of 21 units that was plucked out of the air 20 years ago.
popps said:
She says that my blood sugar readings (7.1 and 7.2) may be masked by my liver function (reducing blood glucose) and could well be much higher. But these are fasting tests where I ate nothing and drank only water for 14 hours prior to testing, so I don't quite get her logic.
Her logic - well I think we can see a theme now, there isn't a lot. It is true, that alcohol can lower blood glucose. However, if you are a moderate drinker then unless you were on a major binge the night before it will be well out of your system after 14 hours. If you are an alcoholic, particularly if your liver is in a very poor state, then she may have a good point. However, I suspect that you would have mentioned it if this was the case.
popps said:
Is exercise and diet merely a precurser to medication?
Not necessarily! Fasting figures of just over 7 aren't great - but it is early days yet. If you try following the Bernstein method, then there is every chance that you will be able to get them down a lot more without medication. If you can get it consistently well under 6 without drugs, then you will have the diabetes under control. Many T2s manage to do this. If you seriously low carb for a while and can't get it any lower than this, then you might need some medication.
popps said:
Are my fasting blood sugar levels (they would have been pre-diabetic on the scale used a few years ago) actually disguising levels which are far worse?
Unlikely. How much do you drink? If you have alcoholic hepatitis then this is a possibility, but if that is the case then, to be brutally honest, the diabetes is the least of your problems. If you are dependent upon alcohol, then the only solution is to give up completely - and you should contact Alcoholics Anonymous. If you were binge drinking the night before your test, then you should probably get another test. Otherwise, if your drinking was sensible then it won't be having any effect upon your BG after 14 hours. I suspect that it is this low, because your cutting back on carbs is starting to work. With effort you will be able to get it a lot lower.
popps said:
Maybe I should ask to see the GP next time I visit.
OK, here are things that you I think you should do.
- Complain to the practice about this nurse. She is giving dangerous advice, and should not be practicing (she most certainly should not be advising diabetics).
- Ask your GP about these issues. Unless he is sympathetic, and seems to know what he is talkig about, then ask to be referred to a specialist or else find a new GP.
- Read the Bernstein book, and try his low carb approach.
- Get a glucose meter and learn how to use it (I realise that your nurse won't approve - but, I think you can guess what I think about your nurses approval!).
Phew! End of rant. 8)
who put me on the right track.
