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This just proves it all

Discussion in 'Type 2 Diabetes' started by sdgray22, Feb 14, 2012.

  1. catherinecherub

    catherinecherub · Guest

    You don't have to remind me what Atkins is Viv, I know what it is. I am speaking generally and not including myself. I know a lot more about diabetes than a lot of HCPs do as do lot of peeps here. We have to live with it 24/7 and it is in our best interests to learn about it.

    It seems that everyone is in agreement about this topic and surely the question is what are peeps prepared to do about it? This topic comes up time and time again on this and other forums and there has never been a resolution. I wrote to A. Lansley last year about the care being patchy, after doing a a poll on here and quoted poster's comments.
    The reply I got back was that the NHS is committed to improving care but it takes time. :roll: There are always bog standard answers regardless of which politicians are in Government.

    I seem to recall you did something similar Viv about the issue of test strips?
     
  2. viviennem

    viviennem Type 2 · Well-Known Member

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    Quite right, Catherine, I picked up a list from people on this forum about which PCTs were issuing instructions not to give test strips to Type 2s (and in one case trying to limit Type 1s) and sent it to Andrew Lansley, to my own MP, and to Diabetes UK.

    I got the usual waffle from the politicians (even mine, who is generally excellent!) and Diabetes UK said they agreed with me and were lobbying.

    Anyone who wants to email their MP, or even a Lord, go to http://www.parliament.uk - all the contact details are on there.

    It may be worth having another shot following the article that pointed out how much cheaper for health care costs was providing test strips and education rather than dealing with complications. Did anyone pick up the URL for that?

    Viv 8)
     
  3. sdgray22

    sdgray22 · Well-Known Member

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    I think I opened a can of worms!
    I think that as you say we should if it is our job to give advice to people in any field, keep ourselves up to date with the latest information, that cannot be refuted. You cannot do your job well unless you know what you are doing, in any walk of life. I now feel the Practice Nurse and if she is like this I am assuming the Diabetic Clinic GP at my surgery is going to follow the same lines as she works under their guidance,both do not know what they are talking about when it comes to diet. I am not at any time presuming that I know more about medications or problems caused by those medications, and indeed what those medications do to my body than they do.

    Can I also ask about the comment that GP Surgeries are dealing with chronic diseases of many kinds and have only a very basic knowledge of each of those, but that is what they are there for - what else would they deal with there are hospitals for acute illnesses. Preventative medicine is OK but constant tests on their patient lists to see if you have something does seem to be the norm, have a test tick a box. I do not I repeat do not think my Doctor does not have a vast knowledge of illnesses gleaned from many years of practice, but he also gets paid very well for that knowledge and for the work he does, and I would expect him to read medical journals and know all the up to date advice as I would his practice nurses as part of their jobs. Gp Surgeries appear to be following the party line because to do anything else would presumably endanger their funding. How do you convince the NHS to change their dietary advice to Diabetics. What does it take, I would like to know?
    Sharon
     
  4. noblehead

    noblehead Type 1 · Guru
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    I had this problem when I started my DAFNE course, at the time I was eating around 90-100g of carbs a day and told the staff that I was on a low-carb diet, the look of horror on their faces thinking I was on a Atkins style (ketogenic) diet was priceless! :lol: After reassuring them I wasn't reducing the carbs that low they were a lot happier but did suggest that 130g a day would be a better figure for optimum health.

    ''Not really the point though - you don't need definitions (although it's easy to talk about a "reduced" carb diet if you want), you just need the nurses or whoever to know that a reduction is necessary. That can't be hard surely. And rather than medics "thinking" you're on an Atkins diet, they could of course ask''

    I agree Malc that you shouldn't need definitions on how best to describe a diet, if your bg levels are steady and below your own personal levels then this in itself speaks volumes, we are not school kids where we need to be told what we can and cannot eat, provided a diet is not effecting your health then we should be free to eat what we like! :thumbup:
     
  5. Helenababe

    Helenababe · Well-Known Member

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    I wonder how long the DNs at surgeries are trained for? My GP openly admits he doesn't know enough about diabetes.

    Look at it this way. If you go to your GP and he doesn't know what is wrong with you, he will send you to see a specialist, but T2s don't get to see a specialist, unless there are complications. So, we, with our serious, life long diabetes need well trained DNs and GPs to look after us, in the way we should be. We need to feel we have trust in them, and in their decisions. We shouldn't expect anything less.

    Unfortunately, for alot of diabetics, this isn't happening. Sometimes my DN doesn't know what I'm talking about if I bring certain things up that are happening to me. I'm trying my best like all of you are to control my diabetes and learn as much as I can, and it was hard work during the first year, but when I walk out of the surgery, feeling frustrated, angry, and let down, through lack of 'their' proper care and lack of knowledge, I feel as if I'm on my own with this.

    Helena
     
  6. xyzzy

    xyzzy Other · Well-Known Member

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    Exactly and the Swedish Health Service document "Kost vid diabetes" is precisely that. It recommends a low to moderate carbohydrate diet, positively discourages the NHS starchy carb one, and in Viv's and other ULC diet followers cases does not say they should be discouraged just that someone on ULC should be monitored by their HCP's.

    The document which is the official Swedish Healthcare approach to diabetes uses research done this century and doesn't just rely on research done in the 1970's and 1980's which is what we get pushed down our throats (excuse the pun) here.

    I found it all in my own time and I'm not a HCP.

    Apparently it is by our HCP community in this country.

    Well said, why should "amateurs" like have to pick up the pieces and sort so many people out. It's time for the HCP community to raise its game.

    btw noblehead you still owe me what you would have done to those HCP's in the my earlier examples. I have noted that even though you have been quoting some of my comments and misrepresenting what I actually said and have labelled me a " complainer" you haven't had the courtesy to answer any of the points I put directly to you. Fine but to me it shows a very complacent and defensive attitude.

    I do note that Catherinecherub did agree there were bad HCP's out there still didn't condemn the ones in my examples and nor has any other HCP who has read this thread. It's this "closing of ranks" attitude that really sums everything up imo.
     
  7. catherinecherub

    catherinecherub · Guest

    Hi zyxxy,
    Without going through all my posts I will not be able to find the quote you made about the Type 2 being told not to eat donuts. I do recall being involved in that topic and no way would I have condoned it. You do not know me, how I feel about things and you have not read a great deal of my posts so to assassinate my character does you no favours in my book.
    Viv was very patronising to me this morning in her post and chose not to reply to my comment about her remark, does that make her a bad person too. This thread is getting very personal IMHO and it seems to be because people will not say what others want them to say.
    I tried to get poor care noticed by doing a poll and writing to A. Lansley, I try and help newbies to the best of my ability, answer all posts that I am able to and bump up posts that I cannot answer in the hope that someone else will. I do my best and leave the rest and if that is not good enough then so be it. Instead of in house disagreements in this thread perhaps you could think of a solution that would meet with your approval? Complaining about HCP's on a thread here is hardly going to resolve the problem.
    This is the final post I will make in this thread so as not to upset you, regardless of how much you upset me.
     
  8. Dillinger

    Dillinger Type 1 · Well-Known Member

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    I think there's an endemic problem with diabetes in the NHS.

    I think we would all agree that some form of carbohydrate control is the essential starting point in looking after our diabetes, but the NHS does not see carbohydrate as a problem; it sees fat as the problem. This leads to all the many examples of 'cognitive dissonance' that we see with diabetes; i.e. HCP's saying low-carbing may work for you but we cannot advise it.

    This also leads to the terrible outlook for most people with diabetes (whether Type 1 like myself or Type 2).

    It happens all the way through the NHS from a lowly part time dietician to consultants. My Diabetes Consultant (by definition an expert in the field) said to me 'I don't have a problem with you reducing carbohydrate in your diet as long as you don't eat more protein or fat.' Honestly; that's what he said. What else is there to eat but protein and fat??? Am I meant to be eating rocks?

    That is an example of the cognitive dissonance I talk about above; the NHS believes strongly that people should have a low fat diet; that means you have to eat more carbohydrate and protein. Diabetics in particular have a greater propensity to heart disease and elevated blood pressure to they should in particular eat less fat (to help their hearts) and less protein (to protect their kidneys from high blood pressure) so that means eating carbohydrate. Which should make everything fine.

    The problem being that it isn't fine; it doesn't work. What works is the exact opposite, but that means heart and blood pressure risk under the 'orthodox' view so you have to either abandon the orthodox view or ignore the positive responses of those of us who ignore it. Otherwise you are stuck in the uncomfortable world of cognitive dissonance; something has to give and it is rarely the orthodoxy that gives; it is the pesky contradictory 'facts' that are presented by patients that must be wrong, irrelevant or as we get a lot 'statistically insignificant'. So, the patients keep eating the carbohydrate and their diabetes keeps progressing.

    I suppose one reason why blood testing is frowned upon is that it will constantly expose the NHS approach as nonsense, and it's expensive (in the short term), so you can poor oil on the water and save money by just getting everyone to stop doing it, shut up and eat your high fibre granary bread with low fat spread and the problem will go away. That is until the diabetic you are treating dies, or goes blind, suffers kidney failure or loses a limb or two, but at least no one was rocking the boat...

    Take solace from places like this - 10 years ago there was no way to hear the voices crying in the wilderness.

    Dillinger
     
  9. Grazer

    Grazer · Well-Known Member

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    Great post Dillinger. My thought is that fat/protein may be bad for kidneys/heart, but no worse than for anyone else (non-diabetic) IF our BGs were very well controlled and thus not putting our organs at risk in the first place. So control the risks (less carbs) rather than worry about the things that are bad for us if we DON'T control the risk
     
  10. smidge

    smidge LADA · Well-Known Member

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    Hey Guys!

    I'm not really sure what you're disagreeing about - you all seem to be saying very similar things:

    1. Diabetics need to reduce their carb intake
    2. They are not told this consistently by the medical profession
    3. GPs/nurses in GP surgeries are not experts in diabetes
    4. Much of the advice given is either wrong or misunderstood by the patient
    5. Without self-testing (at least initially), Type2s cannot be expected to know what their BG is and cannot learn how to adjust their food intake to manage their condition effectively
    6. Without education, Type2s cannot be expected to make the lifestyle changes many need to make to control their condition effectively

    I strongly believe that everyone with diabetes should be educated properly about their condition and given the means and knowledge to manage it. You can't force someone to manage their condition properly any more than you can force someone to stop smoking, but you should give them every opportunity to choose to do so. In my opinion, that means making sure everyone who has diabetes has access to experts rather than to well-meaning, but often ill-informed, generalists and making sure they have access to a means of monitoring.

    Smidge
     
  11. Pneu

    Pneu · Well-Known Member

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    I think we can all agree that what the NHS currently promotes doesn't work for everyone, after all if it did this forum wouldn't be full of people seeking help!.. I also think many myself included have had bad experiences of HCP's...

    I realise this is an emotive subject for many of us however can we please ensure that we don't make this personal. Just remember what you post can sometimes be ambiguous to another user who does not necessarily understand the sentiment behind it..
     
  12. Daibell

    Daibell LADA · Master

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    Hi Catherinecherub

    The reason there isn't enough 'evidence' for reduced-carbing being the way to go is that in my experience the local GP surgery staff do not listen to feedback from their patients. I tried to discuss my need for a low carb diet at my last session and my GP just didn't want to listen hence the evidence many of us have is lost. My GP also said my reduction in Hba1C results in previous years had been due to my tablets whereas I know they have little effect compared with the controlled carbing and food intake reduction I had been undertaking.
     
  13. noblehead

    noblehead Type 1 · Guru
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  14. xyzzy

    xyzzy Other · Well-Known Member

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    Catherinecherub I apologise if I have upset you.

    Yes that's easy just have HCP's recommend a low to moderate carb diet. That would meet with everyone's approval. What else can we do but complain if that simple message is put across so many times without it being listened to AND acted upon.

    I also believe I have a right to complain about HCP's

    I was diagnosed pre diabetic in Dec 2010 and as Grazer mentioned yesterday advised to swap to the NHS dietary guidelines which I did. By March 2011 I had an HbA1c of 8.3 which was never reported to me and never chased by my surgery until in early December 2011 I went back as I felt very ill. At that point an apology was made I was told I was diabetic. I went to see my son and discovered I had BG readings in the 20's, he pointed me at this site and I immediately started a low < 50g / day carb regime. In late December some 3 weeks after my initial gp appointment and 3 weeks into my low carb diet I had a second HbA1c test which came back at 9.9%. In my mind IF I had been given the low carb advice by my HCP all the way back when I was pre diabetic I MAY have avoided progressing to full Type 2 diabetes. Oh and it took to the second week of January before I got to see a DSN. When I phoned my GP and reported BG's in the high teens I got told not to worry about it.

    Here's another one. My father went into hospital for key hole surgery. 3 days later he died from septicaemia because the hospital failed to give him the correct antibiotics. I and my siblings were taken into a room secretly by a doctor and told point blank that it was their fault. This statement was immediately followed by "But of course don't ask me to stand up in court and say that because I won't"

    Another, my mother died last year. My wife and I cared for her here at my home for the last years of her life. She died with me beside her at home where she wanted to be. When she was first diagnosed with the brain tumour that killed her she was in hospital. As it became clear there was nothing to do for her I went to a meeting which was supposed to organise all the home care stuff she would need in my house. At that meeting I got told "this make take a few days to organise so there is an outside chance you mother will need to be discharged into a care home for a few days if it goes on for very long". I agreed, by the time I got home the phone was ringing and my mother was on her way to some slum where she was physically abused by the staff over a period of a week to the extent that my family had to organise as close to 24hr care for her ourselves. My niece who is a director of social services and absolutely outraged by the treatment her grandmother received is still trying to bring the staff who abused her to account.

    More, my mother-in-law an ex nurse and midwife was diagnosed with MS in her late 40's by the time she was in her 70's she was totally bedridden. It wasn't the MS that killed her. She died of cancer, two tumours were identified early on and radiography was supposed to be given for both but a mix up occurred and one tumour was never treated.

    I'll keep going. My eldest son a Type 1 diabetic who is highly respected member of this forum who all you HCP's talk too on a regular basis has spent years battling the ignorance of his gp, his DSN and even his consultant. I can't relate any of his anecdotes (but he has posted many) as I don't want to identify or embarrass him.

    One more, my daughter had a miscarriage last year. She has a medical condition that was known to her gp and there is as we later discovered a very effective and cheap treatment that could well have saved her baby. She is now racked with guilt as "the cure" was easy for anyone to find if only she'd looked it up on the internet. She has now split with her long term partner. Even before getting pregnant her attitude to all the gp's she went to was they never believed I was ill and all they ever wanted to do was give me a Chlamydia tests even though I was in a long term relationship.

    I'll end with this one. My aunt a woman of great faith was diagnosed Type 2 late on in life. When she could no longer cope she was placed in a care home. At the age of 94 they put her on a strict diet and forced her to exercise. Within two months she was dead. She contacted my mother and asked her to visit. At the visit she told my mother she couldn't take the way she was being treated any more and would rather be with her husband. Three days later she died she simply lost the will to live.

    ..and after all that I still believe there are good HCP's out there but they are being drowned out by the status quo seekers and the arrogant ones who think they know best. Please don't give me the "complain to your practice manager or take them to court or whatever" Like most people I am not the vindictive type but I do what change to happen.
     
  15. Sid Bonkers

    Sid Bonkers Type 2 · Well-Known Member

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    The problem is that there is no one size fits all as we know all too well when it comes to how to control diabetes, as someone has already mentioned doctors and diabetes nurses give advice which is evidence based, and unfortunately there is no long term evidence that says a low carb diet is good for anyone and no evidence that a diet with increased fat is good for anyone. And as you well know there are members here who do low carb high fat and others who dont, some that low carb are well controlled and others aren't just as some of those who dont ultra low carb have excellent bg levels and have lost weight like myself. Therefore if doctors gave out the advice that you would want them too who is to say that more or less targets would be hit, to assume low carb is the be all and end all is just as bad advice as telling someone to eat lots of starchy carbs, there are plenty of overweight out of control low carbers here on this forum.

    Until there is research undertaken in the long term to either prove one way or the other that lchf is good then the advice is going to be what is known as of now.

    I actually think that rather than give any particular diet advice it would be better to educate about carbs and testing so people can find their own way. Of course you probably wouldn't agree with that as you seem to be from the 'theres only one way' cult :D
     
  16. borofergie

    borofergie Type 2 · Well-Known Member

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    I don't agree. It's not a question of it not working for everyone, the standard NHS advice will not work for anyone (without a lot of external information and interpretation). [T2 on diet and/or metformin only].

    Brilliant posts by Dillinger and Smidge by the way.

    I agree with Dillinger that the problem underlying all of the bad advice, is the NHS's reliance on the outdated "low-fat" dogma.
     
  17. xyzzy

    xyzzy Other · Well-Known Member

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    No and that's your problem not mine noblehead.
     
  18. noblehead

    noblehead Type 1 · Guru
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    :lol: It's certainly not a problem as far as I can see, everyone has a view on what's right and what's wrong in the NHS and no-ones is more valid than the next persons :)
     
  19. Pneu

    Pneu · Well-Known Member

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    The current NHS advise and one - size fits all approach is incorrect on that we can agree.. however taking a different one size fits all approach would also be incorrect. What the NHS needs to do is provide better information so that people can make informed decisions.

    People may then choose to low-carb or not.. to take additional medication or not.. but to lay out a low-carbs approach fits everyone is also incorrect.
     
  20. borofergie

    borofergie Type 2 · Well-Known Member

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    No-one is suggesting a "one size fits all" policy. I thought we'd all agreed that the NHS message should be more focused on educating new diabetics about carbohydrate control. There are plenty of ways of doing this, no-one in this thread has suggested anyone way is better than the others:
    I think that it would be helpful for us as a (T2) community if we agreed that "the key is carbohydrate management" and stopped disrailing the discussion by splitting ourselves into "low-carb/ultra-low-carb/low-GI" factions (which in my opinion exist only in the memory of certain forum members).

    While I don't know what the consequences of eating too much fat or too much protein are, I do know for sure what will happen if I carry on eating too much carbohydrate. I'll choose exposing myself to potential "unknown risks" over exposing myself to a devastating "known risk" anyday.
     
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