Should I do what the specialist nurse says.

[xyzzy]

So this morning I have been in a discussion with the specialist diabetic nurse I was referred to. I took along my printouts. These show my BG readings, what I eat, carb count, average carb count, calories and average calories. What I wanted to discuss with her was the following.

"Look my BG's are really good and now mostly between 4.5 and 6.0 at all times. However to get that I can only eat around 60g carb per day and my calorie intake is around 1300 per day. What can you do so that I can actually eat MORE carbs as I would like to do so. The trouble is if I try my BG's spike widly on anything more than 25g of rice, pasta etc etc."

Her initially quite angry responses.

- You're not eating enough carbs eat 200g a day now.

- Stop all your testing it will make you anxious and depressed. Eat 200g of carbs and don't worry.

- You could go on insulin

It took me a while to convince her that

- She had as much chance of getting me to stop testing as a brick flying so that wasn't going to happen as I suffer from anxiety so stopping would make me depressed as I'd feel out of control.

- I really do want to eat more carbs (not 200g though) and that I am not a low carb nutter.

- All I wanted her to do was suggest and discuss a course of medication that would allow me to eat more carbs. I did not want to go on insulin.

Her response

- You're not eating enough carbs eat 200g a day now.

- Showed me the piles of rice piccies in the carb / cal book and asked me to point to the portion size I eat. I pointed to the smallest portion and said about half of that or else my BG would be in double figures.

- Eat 200g of carbs a day for the next few weeks and prove to me you spike as you say.

- You really sure you don't want to go on insulin.

My response.

- No I don't want to go on insulin. I want to control with diet and Met and a minimum of other drugs. Please prescribe me something so that I can get a better balance of fat / protien / carbs. I agree with you I want to eat more carbs.

- I would rather not go back to 200g carbs per day without help because that's exactly what I was doing all of last year and my HbA1c went from 7.3 to 9.9.

Her Reply

- No we'll review when you've gone back to eating 200g carbs per day. Then I'll reconsider prescribing other meds to help you to stop spiking.

- Your meter readings show you're better now so if you eat 200g carbs a day you will be fine.

- By the way when you start eating 200g of carbs expect to put back on some of the weight you've lost.


Comments please. Should I take her advice?

 

[Patch]

Absolutely forking not.

I encountered the exact same attitude wrt going onto insulin.

The truth is, if you want to eat more carbs, you probably SHOULD go onto insulin. Insulin will most likely make you gain weight, and increase your insulin resistance. Wanting to eat more carbs so that you are not a "low carb nutter" sounds "nutty" to me.

Conspiracy Theory: They WANT you to be afraid of being seen as a "low carb nutter". (Better a low carb nutter with a good HbA1c than heavy (portion size) carb eater with out of control BG!)

Insulin + Carbs + T2 Diabetes + Weight gain = Recipe for disaster.

Good luck to you, though. Sounds like you've got a text book (literally) specialist nurse there.

 

[catherinecherub]

No, no, no. She hasn't answered your queries has she?

When you go back, if you decide to, ask her where she gets her information from and can you see her Certificates. :wink:

 

[xyzzy]

Patch I should make it really clear.

I don't think even the most ardent zero carber is a "low carb nutter". It was her attitude I was trying to put over.

...and you're right maybe I shouldn't expect too much from standard meds carb wise unless I'm prepared for the jump to insulin.

 

[CollieBoy]

Well I can't tell you what to do but I wouldn't walk away from Nursie Nightshade ,
I would RUN :shock: :shock:
sounds like she is not a thinking professional, just an automaton spouting phrases like a parrot. :thumbdown:
Isnt there anyone else that you could talk this over with.

 

[xyzzy]

Isnt there anyone else that you could talk this over with.

er yes - you lot!

I honestly respect everyone's opinion on the forum even if I disagree with some of you. :lol:

...and at least I've got my son expertise to fall back on.

So I'm not that concerned just a bit shocked. :shock: It's all very well making posts getting angry when it happens to other people but I was actually convinced my specialist wouldn't be one of them. Well you live and learn as they say.

 

[Grazer]

Can't BELIEVE she went straight to discussions about insulin with someone with your BG levels, or even the levels you WOULD get to if you ate more carbs. I do wonder if perhaps you fixate on getting TOO low at +2 hours all the time. Don't mean to be rude so please don't be offended but even a non-diabetic doesn't get under 6 all the time. I know you don't want to return to high HbA1cs but a slightly higher set of BGs wouldn't take you back to the levels you quoted. Couldn't you eke the carbs up so you're always under 7 at +2 - that would probably give you a lot more leeway on carb quantities, and still give you a really low HbA1c. Remember, even an OVERALL 24 hour average of 7.6ish on BG only equates to an HbA1c of 6, providing you're an average glycator, and you're miles under that BG average.
Oh, and of course, you'll ignore the dotty nurse!

 

[ladybird64]

Comment? Sure thing Zizzy.

Words **** well fail me.

 

[smidge]

Hi Xyzzy!

:lol: - sorry for laughing but I had many similar experiences. No-one could believe that even 10g carb spikes my BG into double figures. I argued and argued with the DSN at my doctor's. She kept insisting I was bringing it all on myself by refusing to eat carbs. In the end, I was so ill that I took her Glic tablets even though I knew they wouldn't work for me and I ate a stew with barley in it - the Glic made me violently ill and barley sent my BG to 22. I rang the doctor - insisted I wanted to speak to a doctor, not the nurse and I finally got a whole series of blood tests done and a referral to the hospital. Eventually, I was diagnosed with LADA and put on insulin. On the insistence of the nurse, I'd been trying to control Type 1 diabetes on diet and exercise for about a year with no testing and increasing carbs :evil: So, no, don't do as your DSN says! Insist on seeing a doctor to talk over your options with someone who is medically-qualified to have an intelligent discussion with you. If your doctor isn't up to it, insist on seeing someone who is!

Smidge

 

[xyzzy]

Grazer, yes I concede your point on the BG level fixation. Trouble is I'm still less than 3 months into this and like I tried to explain to the woman this morning I will have no problem reducing testing and slackenning off a bit but only when I feel I've got the balance between BG's and diet right.

I know with my experiences over the years with giving up smoking I can very easily lapse. I gave up smoking 3 times so far in my life for years at a time and then BANG back I was puffing away, not because I didn't realise that smoking harmed me but because I ENJOY smoking. I also ENJOY rice and pasta and especially Cornish Pasties.

So yes I am really hard on myself at the moment and go for really low levels that I know if I relaxed a bit wouldn't be all that bad but it really is like smidge says. I really do have that level of intolerance to carbs. I can be at 4.something eat more than 50g of rice and be at 10+ 2 hours later.

Another way of looking at it Grazer is I have reduced my carbs to the point I don't spike. The fact they are now in a really good range is a somewhat secondary aspect of that. At the weekends I DO release my iron grip somewhat but not all in one meal. So for lunch at the weekends we're normally at a friends who insists on giving me mini sausage rolls or cheese straws etc. I eat a couple or so to please her and me! Main meals at the weekend are usually my specially constructed low carb Indian takeaway on Saturday and some weeks a low - moderate carb Sunday main evening meal at my Type 1 sons, usually around 60g i.e in one meal I eat my normal daily average. Even his diabetic friendly dinners consistently spike me into the high 8's and 9's at two hours but like you say its 1 or 2 meals a week which is why I always say my levels are in a normal range 95% of the time and not 100%

Which is why with all the Type 1 and LADA in my family I would like to be tested. The damned woman came out this morning and said straight to my face it was too expensive to do the tests so she wouldn't.

I have my sister-in-law here this week and (with other behind the scenes help from forum members) have been advising her on her Type 2 which isn't horribly out of control but just a bit high. Like me she is just on Met but she can eat loads more carbs than me. I am positively jealous :mrgreen:

So the decision to make is whether to make the fuss now like smidge did. I am not by along way yet in the same position as smidge found himself in that I don't particularly mind the 60g diet and I feel its doing me good, I feel better and with by BG averages in the 5's my concentration is coming back and I'm feeling far more alert so I can continue to earn a crust.

I went to the appointment today looking towards getting an answer to the 60g / 1350 cals is ok while I losing weight, what do I do when I've lost the weight issue. At the moment the answer seems to be eat even more cheese or begin a long process of shouting at people which at the moment I don't think I'm ready to do.

 

[xyzzy]

Nursie Nightshade

That one has gone into the memory cells and will get pulled out and used in future battles I suspect. :clap:

 

[Grazer]

Just a small point:-

same position as smidge found himself

Smidge is a girl, and I'm sure a very pretty one! :wave:
On a more serrious note, :-

60g / 1350 cals is ok while I losing weight, what do I do when I've lost the weight

That's obviously less than I have, but I did find that my weight came off to a degree where I was thinking "how do I stop this?" then it just slowed and stopped. I seemed to get an exponential curve to my current BMI of 22, so maybe the weight loss won't require as much adjustment as you think. And you DO have a bit in hand carbs wise it seems - even if you only do what I do and graze on nuts! :thumbup:

 

[anna29]

Hi Xyzzy.
Get more assertive ? and reorganised ?
You do have the right to ask n have a 2nd opinion . . .
I did this, after being told by a DSN and a dietician to INCREASE my carb intake.
Despite the facts I cant even TOLLERATE or DIGEST these easily or well. [like YOU]
I went 'mental' at the practice manager and " insisted " to be allocated a new DSN who 'knew' what she
was talking about !!!!
I ended up with the top team leader of ALL the DSN's....
Saw her every 2 weeks for 6months, now I am sorted out, very low carbs, high protein, plenty salad n veg etc...
Must mention here, PORTION sizes are relevant and as important too, if large portions eating then will still push n spike the BG's.
Combined therapy of victoza and hypurin porcine isophane insulin split dosed, 24/24 units suits me well.
It HAS been bl***y HARD WORK, taken time,effort, focus and stressful at times I admit - but am finally there now!
Results in just YESTERDAY HbA1c is down 1% more to 7.1% [54]
I would ask to speak to the practice manager and explain all this to them....
Ask to be reallocated a new DSN and 'start afresh' .... !
Please do let me know how you go on, as the stress from all this will still effect you.
Anna.x

 

[xyzzy]

Just a small point:-

same position as smidge found himself

Smidge is a girl, and I'm sure a very pretty one! :wave:

Oh b*****ks I've only gone a done it AGAIN! Did it to Phoenix last week. I

REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY REALLY
SORRY smidge.

You get the same "With Cherries On Top" as Phoenix as well.

... and some flowers

 

[xyzzy]

Hi Xyzzy.
Get more assertive ? and reorganised ?

Yep you're right Anna. I am usually one who takes no prisoners but I do attempt to have a rational conversation first. In the context of a 20 min appointment not the right strategy as I've learnt to my cost. I was so shocked by the initial onslaught and the lack of understanding of where I was coming from I spent far too much time trying to persuade her rather than just demanding to see someone who could help if she wouldn't.

I am relatively happy with where I am at the moment but will feel in a far more secure place in a few weeks time after I've had another HbA1c done that will hopefully show major improvement and lost a few more pounds. At that point it will become battle stations but I like to have all my bases covered before committing to action first.

Thanks for the advice and I'm pleased you've sorted things out.

Take care

 

[viviennem]

I would just ignore the nurse at the moment and carry on as you are. Have a look at some of the low-carb recipes on here - they are low-carb but many contain more carbs than you're presently allowing yourself, and might be worth trying. Consider adding the lowest GI veg and fruit, and see what they do to you. Apricots, plums and berries, if I remember rightly.

In your place I might see the summer through before I tried upping the carbs. You've only been diagnosed 3 months, after all - give your poor pancreas a bit more rest! You might find that, with a bit more weight off and that longer rest, you'll be able to eat a few more carbs without any problems.

I've been at this nearly 2 years now, and despite my slips I find that my BGs have become pretty stable, even if I do have a slip or many. What seems to happen (like the previous 2 weeks, with all that bread and wine) is that I don't spike any more, or not disastrously, my overall BGs just slide up to a higher level (in the 6s instead of the 5s).

You may just need to be a little more patient and give your body time

But next time you see the nurse - don't take any nonsense! You've obviously lost confidence in her :wink: so you can't possibly have a satisfactory nurse/patient relationship. (Try that one!)

Viv 8)

 

[Sid Bonkers]

Insulin will most likely make you gain weight, and increase your insulin resistance.

There is no reason to assume that Patch, if you eat sensibly and balance your insulin requirements then it is quite possible to control your bg levels to a very tight degree and loose weight just as I did whilst on insulin 3 years ago :thumbup: Insulin taken for a short period may even help T2's as it can give the pancreas a rest whilst any weight problem and insulin resistance is tackled.

Xyzzy I think you already know the answer you are looking for and perhaps a firmer - without being confrontational - approach might help, humour your nurse and ask leading questions like "what happens to carbohydrates in the stomach".

There are a whole range of meds available other than insulin although having been on insulin for a short while I am in a better position than some to state that its not the end of the road and it could help you to keep very tight control whilst allowing you to eat a few more carbs, although so would Sitagliptin for that matter as it only asks your pancreas to work harder when carbs are present unlike Glic which will be asking the pancreas to work harder at all times.

Another thought just occurred to me is the nurse you talk of a properly trained specialist diabetes nurse or a practice nurse as there is a big difference in they knowledge of diabetes and diabetes meds

 

[xyzzy]

is the nurse you talk of a properly trained specialist diabetes nurse or a practice nurse

Yes she was. I was reffered to her by the practice diabetic nurse. She had nothing to do with the gp practice I think she came from the specialist diabetic centre we have here at the local NHS trust hospital. I was told she was a specialist diabetics drugs nurse by the practice diabetic nurse.

We have supposedly a very enlightenned gp at the practice who speciality is diabetes according to the practice diabetic nurse. I have never seen him as he's not been around since I was diagnosed in early December. I keep being told he's away. He can't be that enlightenned as he doesn't follow many of the NICE guidelines as far as I can tell :x

 

[iainmay]

Find another nurse, seriously

This is your condition and how you want to manage it is really down to you. Find someone who will listen to you, challenge you when your wrong and that you are comfortable with. Don't take second best.

Iain

 

[Daibell]

If it was me I might consider lying to her that I've moved up to 200grams carbs (how about moving up a bit anyway as Grazer has suggested?). Your Hba1C will increase and perhaps she will then consider adding another tablet. Sitaplitpin is worth a try as it does reduce spikes, has few side effects and doesn't increase weight. I think you are being too tough on yourself trying to keep BS readings as low as you are now getting. Sitagliptin did reduce my spikes initially although it is having less effect for me now but that's probably due to a knackered pancreas (possibly another one with LADA?). If you have at least reasonable pancreatic function it could be a useful adder.