martinbuchan
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Exactly right. You would think your GP would be relieved to get a well motivated patient for a change. Mibd you, its a fine line between well motivated and self-obsessed.
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This patient is a total loser who doesn't know....
- Thread starter chocoholic
- Start Date
martin - if you work with people then you will know that there are alot who will take no notice of anything you tell them - food, smoking , alcohol and exercise!
Hana for you that may be hard to understand -its not just that pts fail to turn up for appointments , education sessions etc . is that the only time your husband has ever see a dietitian?
HP are just swamped because you are not the only group of pts who need their time!
I hate to say this but for some this is a lifestyle disease - I keep saying this on here but if you could actually see what soe of my pts actually ate you would be shocked - - I see pts every week who are consuming upward of 4000 calories of complete rubbish. i don't know what the percentage would be but I think it would be more than half of the new diabetics I see are clinically obese. I certainly do not think the people I see are different to any part of the UK.
Hana for you that may be hard to understand -its not just that pts fail to turn up for appointments , education sessions etc . is that the only time your husband has ever see a dietitian?
HP are just swamped because you are not the only group of pts who need their time!
I hate to say this but for some this is a lifestyle disease - I keep saying this on here but if you could actually see what soe of my pts actually ate you would be shocked - - I see pts every week who are consuming upward of 4000 calories of complete rubbish. i don't know what the percentage would be but I think it would be more than half of the new diabetics I see are clinically obese. I certainly do not think the people I see are different to any part of the UK.
lilibet
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Ally
I think you are right to a degree and find it sad because this mindset in professionals makes it harder for people who do take notice and who are educated, motivated and serious about maintaining their well being.
I am told by my clinic on the one hand that my sugars are good, I have settled well, clearly working hard to manage it etc etc but on the other hand am told I am too clinical (er, hello, testing and injecting at their behest thank you !!), need to relax a bit and eat what I want as insulin will cover it. I am lucky in that i saw the dietician in my first week out of hospital and had kept a food diary for her to see - she could not comment on my choices. Ironically whilst in hospital I refused the white bread, fresh orange juice, puddings (amongst other things) by staff who told me that I should just 'eat what I want'. This with a bs 27 the previous day. :evil:
I have always watched what I've eaten, I dont smoke, always had good cholesterol, BP and BMI and am generally quite healthy (or was :cry: ) so am majorly p***d off that I have a condition that leaves me at risk of things I had previously control over and therefore knew I had very little chance of getting (cardiovascular stuff). Its even worse when you are made to feel like a zealot or a stressed out pscyho who cant see the wood for the trees when all you are doing is trying your best. I was actually referred back to the dietician in about week 5 and clearly (to my mind) on the basis that my sugars were coming down too quickly and this was in relation to having made ref to low GI and managing carbs and was not following their advice. Again, showed food diary - no comments to be made except maybe eat bigger portions of carbs.
I am on a premixed insulin that gives me practically no flexibility with time or portion and any slight deviation in time of eating, injecting or quantities of carbs eaten will guarantee I am an hyper or hypo.
What would medics have us do, if we find something that works for us should we give it up for 'accepted wisdom'? Christ, it was only about a month ago taking aspirin was accepted wisdom for diabetics. . Im not getting at you personally as I know you have stated you have seen good results on low carb but swimming against the tide when so much depends on getting it right just exhausts my brain.............
L
I understand what you are saying - hp are struggling i think there is just too much to do.
I saw 20 pts on wed in the surgery - some were follow ups that just come for a weigh in but by the end i was brain dead - it is incedibly hard to keep seeing pts one after another. It is very draining .
Are you a type 1 ?
I saw 20 pts on wed in the surgery - some were follow ups that just come for a weigh in but by the end i was brain dead - it is incedibly hard to keep seeing pts one after another. It is very draining .
Are you a type 1 ?
lilibet
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Yes. Straight to insulin, do not pass Go, do not collect £200 :mrgreen:
I appreciate that as a dietician (and esp in light of the Nutrient Quest project) you would be concerned about the potential for a lack of balanced diet if someone was cutting carbs.
However, any quasi-lectures I've had have been on the basis of presumption of absolute expertise that means that my attempts to deviate from the advice are pathologised .Its just too easy to see me as someone whose tightly controlled diet is symptomatic of someone struggling with diagnosis than to think, hey her sugars are really good for a newbie on a **** insulin regime, she must be doing something right!
BTW, my diet is pretty similar now to than pre dx, choc and occasional blow outs (pizza etc) aside. Only real difference is slightly less fruit , though now more veg, and much less portions of pasta for dinner. Main meal would just be huge amount pasta with basic sauce, now its small pasta, millions veg, and protein. No processed food however, and likely less calories by default.
At no point has anyone said they would be concerned about my reduction in carbs due to weight loss/malnutrition/nutritional deficiencies etc etc, which I would be more respectful of and take on board if there were legitimate concerns (to the point of taking supplements at least LOL), its more a blind obedience response in pushing the diet that is generally recommended that gets my goat.
It does puzzle me somewhat, given that DAFNE et al is based on the principle that you need to bolus insuin for carbs, ie carbs = glucose = raised blood sugar.
I appreciate that as a dietician (and esp in light of the Nutrient Quest project) you would be concerned about the potential for a lack of balanced diet if someone was cutting carbs.
However, any quasi-lectures I've had have been on the basis of presumption of absolute expertise that means that my attempts to deviate from the advice are pathologised .Its just too easy to see me as someone whose tightly controlled diet is symptomatic of someone struggling with diagnosis than to think, hey her sugars are really good for a newbie on a **** insulin regime, she must be doing something right!
BTW, my diet is pretty similar now to than pre dx, choc and occasional blow outs (pizza etc) aside. Only real difference is slightly less fruit , though now more veg, and much less portions of pasta for dinner. Main meal would just be huge amount pasta with basic sauce, now its small pasta, millions veg, and protein. No processed food however, and likely less calories by default.
At no point has anyone said they would be concerned about my reduction in carbs due to weight loss/malnutrition/nutritional deficiencies etc etc, which I would be more respectful of and take on board if there were legitimate concerns (to the point of taking supplements at least LOL), its more a blind obedience response in pushing the diet that is generally recommended that gets my goat.
It does puzzle me somewhat, given that DAFNE et al is based on the principle that you need to bolus insuin for carbs, ie carbs = glucose = raised blood sugar.
chocoholic
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I'm a Type 1 Martin though didn't know that at the time but Type 1 or Type 2, none of us should be treated in a Joyce Grenfell tone. (Unless caught picking our noses of course!! :wink: )
martinbuchan
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Aye, many pateints have no interest in following advice. There is only so much you can do. If only 10% of new diagnosis type 2s are fully compliant then there must be thousands of cured type 2s out there, but this not the case. We all know type2 s that loose lots of weight, exercise and normalise the a1c. Later become ill, have a heart attack etc and the BS raise. The underlying genetic metabolic defect does not resolve.
Again, for diabetics like my late grandmother, would fastidiuos BS control have improved her quality if life? No, I am not convinced. For me with neuropathy and mild retinopathy at 41 yrs old? Yes it does. I need to keep an income and see my kids grow up. The anxiety of not always getting my control right is outweighed by striving to delay the progression of my inevitable complications.
Our hospitals are filled with the results of lifestyle choices. Runners with bad knees, nurses with bad backs, footballers with broken ankles, drunks with assaults, thin women with osteoporotic hip fractures, participants dangerous sports, English hill walkers in the highlands in winter etc. The list is endless just from my own speciality. People have many reasons for not looking after themselves. In general it is a failure of health promotion/education to engage society. You would think it was only poorly controlled diabetics that had bad diets. They just reflect the broad spectrum of diet found in society. One must rant and rave at poor choice diets of diabetics. However, everyone knows what they should eat. No-one is immune to healthy eating information out there. However, the failure of a diabetic to change poor eating habits has to be , in part, a failure of the NHS/government as well. Not every fat person is diabetic, but most types 2s are. Why? Because of hyperinsulinaemia. Why? Its the metabolic syndrome, stupid!
Rant over.
Again, for diabetics like my late grandmother, would fastidiuos BS control have improved her quality if life? No, I am not convinced. For me with neuropathy and mild retinopathy at 41 yrs old? Yes it does. I need to keep an income and see my kids grow up. The anxiety of not always getting my control right is outweighed by striving to delay the progression of my inevitable complications.
Our hospitals are filled with the results of lifestyle choices. Runners with bad knees, nurses with bad backs, footballers with broken ankles, drunks with assaults, thin women with osteoporotic hip fractures, participants dangerous sports, English hill walkers in the highlands in winter etc. The list is endless just from my own speciality. People have many reasons for not looking after themselves. In general it is a failure of health promotion/education to engage society. You would think it was only poorly controlled diabetics that had bad diets. They just reflect the broad spectrum of diet found in society. One must rant and rave at poor choice diets of diabetics. However, everyone knows what they should eat. No-one is immune to healthy eating information out there. However, the failure of a diabetic to change poor eating habits has to be , in part, a failure of the NHS/government as well. Not every fat person is diabetic, but most types 2s are. Why? Because of hyperinsulinaemia. Why? Its the metabolic syndrome, stupid!
Rant over.
Trinkwasser
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Sounds like you met my old dietician.
When my lipids got WORSE on a Healthy High Carb Low Fat diet she wrote that I was "failing to comply"
Actually I WAS complying, but with the WRONG diet.
She simply refused to believe that I was actually eating what I said I was.
Of course the next problem with such an attitude is, even if you tell them what you actually did to improve they STILL wouldn't believe you. Dogma outweighs evidence.
Fortunately we are seeing increasing numbers of medical professionals including dieticians who ARE learning not only from experience but from modern dietary research, but they are still grossly outnumbered.
When my lipids got WORSE on a Healthy High Carb Low Fat diet she wrote that I was "failing to comply"
Actually I WAS complying, but with the WRONG diet.
She simply refused to believe that I was actually eating what I said I was.
Of course the next problem with such an attitude is, even if you tell them what you actually did to improve they STILL wouldn't believe you. Dogma outweighs evidence.
Fortunately we are seeing increasing numbers of medical professionals including dieticians who ARE learning not only from experience but from modern dietary research, but they are still grossly outnumbered.
lionrampant
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She wrote down what she was expected to talk to you about. If she didn't, someone would question her competence (especially if you encounter problems in the future). It justified her sitting down with you, and her getting paid for it. Rightly or wrongly, that's the basic reason.
