This patient is a total loser who doesn't know....

[chocoholic]

.....what a healthy diet is! That is how I felt I was labelled today when I received a copy of a letter sent by my new dietcian at the hospital to my G.P.(Why it has taken 2 months to be sent, who knows?!)

I quote " We spent some time discussing carbohydrate counting as she was about to be changed to multiple injections during the same clinic appointment. We also discussed the importance of following a healthy diet, consisting of regular meals, low in fat and low in sugar."

For a start it forgets to mention that we actually discussed me wanting to follow a lower carb diet and her telling me, that was the wrong thing to do and she could not agree to that. I have been eating healthily for years so I'm not exactly chuffed at the inference that she had to "newly" tell me the importance of eating healthily.
Perhaps I'm being touchy but she's made me sound like a right numpty who pigs out on deep-fried food and sugar and knows nothing about healthy eating.

Interesting that the booklet I was given by her on learning about carb-counting had the most ridiculous list of foods for a diabetic. Let me elaborate......
First page: Breads
Next Page: Breakfast Cereals
Next Page: Biscuits, Buns & Cakes
Next Page: More Buns & Cakes
Next Page: Confectionery
Next Page: More Confectionery
Next Page: Dairy/Desserts
Next Page: Fruit
Next Page: Meat products.....this is the best page :roll: .......I'll type the short page contents in full...
Steak & Kidney Pie
Yorkshire Pudding
Sausage Roll
Pizza
Pork Pie
Cornish Pastie

Next Page: Rice, Pasta etc & a short Home Baking list....flour,oats,sugar,dried fruit, syrup, honey
Next Page: Snacks (Crisps and nuts though it only mentions peanuts and cashews in the nuts bit)
Sugars & Preserves
Next 2 Pages: Takeaway Foods
Next Page: Vegetables (which as far as I can see are all the vegetables high in carbs)
Final Page: Alchohol

I must make clear that it says on Page 1 that this is not a diet sheet but goes on to say the lists are of "usual" foods and that you can use the list to adjust your insulin accordingly.
There is NO mention anywhere in the booklet about reducing carbs. being beneficial at all, it is just basically saying "eat what you want as long as you adjust the insulin."

I'm so glad my doctor now knows that I have had a discussion with my dietician about the importance of healthy eating. I feel so enlightened. :roll:

 

[IanD]

WOW :!: :twisted: Words fail me :!:

Did you discuss the letter with your Dr :?:

 

[ally5555]

I am not defending her but depends what she wrote in her notes .

She would have passed the letter to a secretary for typing if she is lucky to have access - hence the length of time - not ideal.

Has she suggested a carb countng course - just remember that those foods are in the book - all foods are doesnt mean you have to eat them.

If uwant to discuss it mail me

 

[Ozzie]

next visit, stamp ya feet very rapidly, stick ya thumbs in ya ears and wiggle ya fingers while shouting you're a nincompoop lol, won't achieve anything but be fun

 

[ally5555]

lol - she would press the panic button!!!

in some depts there is no freedom to prescribe!

I had a big discussion with the senior partner a few weeks ago about testing - he thinks its a waste of time so i asked him to look on here - think he was suprised that people find it useful - duh!

 

[wiflib]

It's not 'useful' Ally it's downright necessary!

I'm now down to very infrequent testing, much to my GP's budget delight, but I still need to know whats happeneing with my body.

wiflib

 

[ally5555]

i know it is and i asked him well if you were a diabetic what would u do ! just grinned at me!

 

[chocoholic]

Sorry to have had that rant last night. I was just feeling cross that the letter made out I needed a "talking to" about healthy eating when I felt handing out the said booklet did nothing to encourage healthy eating. Had the booklet been entitled..."Foods to try and cut out or down on", I'd have understood.The assumption that "usual" food for most folk consists of pork pies, takeaways, cakes etc. is frankly a bit insulting.I'm diabetic not a one of Jamie Oliver's lost souls.
Perhaps I just got out of bed on the wrong side yesterday! :lol:

 

[chocoholic]

next visit, stamp ya feet very rapidly, stick ya thumbs in ya ears and wiggle ya fingers while shouting you're a nincompoop lol, won't achieve anything but be fun

Forgot to say....love it!

 

[hanadr]

Trouble is that there is no large body of experimental research on what constitutes a healthy diet.
What's usually designated healthy is low fat/high carb. That came in in the 70s I think and it coincides with the explosion in obesity and T2.
What little work has been done suggeststhat low carb is healthy for everyone, not just diabetics and that animal fats are better for us than vegetable fats. I used to think that someone had proven that the "Mediterranean diet" actually is healthy, but the figures don't confirm it. However, Mediterranean with not too many carbs may well be.
I like the "Eat like a caveman" approach.that they were hunters more than gatherers has now been shown and accidents apart, they lived longer than used to be thought. They had no effective medicines, but in isolated family groups of anout 30 individuals, infections would either have wiped out a whole tribe or missed them completely.

 

[chocoholic]

"Eat like a caveman"

Ah, that explains why hubby is partial to dragging me to the kitchen by the hair! And I thought he was just kinky. I guess it's just the caveman mentality kicking in.

 

[phoenix]

I'm not defending the letter, which to be honest sounds like a standard one, though I can understand why it anoyed you .I think that the book is a different matter.


It would be a bit pointless to have a carb counting book and then include meats with a carb count of 0. On the other hand there may be times when it is useful to know the carb count of a sausage roll or a slice of steak and kidney pie. The book needs to be fairly comprehensive in order to be useful to everyone.
Recently I went to a friends for diner, steak and kidney pie acompanied by mash and a few veg was the main course . I wouldn't normally choose this meal myself but I was able to dose for it. There are a few things that I would say no to, your line would probaly be different to mine but being able to be flexible is what dose adjustment is about. Done carefully you can have very good glucose control.
How you use the information given , both from the carb book and the dietitician ( remember she has her entrenched belief system, just as you do) is up to you.

 

[hanadr]

I have a 3 or 4 books on nutrient values. I use the little Collins one all the time, but I also have an insatiable curiosity. So if I'm ever in a supermarket queue, I'm checking out the contents of the other trolleys. At one time, my fellow Lidll Habitues ( us oldies and many ethnic minorities like our local Polish population) were all just buying basics and most of them fresh. Now the crunch has brought a new kind of clientelle. the ready food buyers. the store has put on more lines of this kind in the freezers, and now I'm seeing the trolleyfuls of frozen boxes I used to see in Sainsbury's and ASDA. An amazing amount of food that's bought and sold in this country is "prepared".
I remember being stunned by the sight of ready chopped cabbage in the freezer. I don't bat an eyelid at it now. The most wholesome thing many children ever see, I suspect, is a cheese sandwich.
It's not surprising the dietitians are reeling.
Jamie oliver's struggling souls are not a small minority.
In some families no-one knows how to cook anything more complex than a microwave meal and primary schools are getting people in to teach children how to use a knife and fork.
I personally have the shudders when I see shelves of jars of "Cook-in Sauces". You put this, whatever is in it onto pieces of chicken and you've "cooked" a meal.
I'd need a booklet to investigate what rubbish goes into one of those jars.

 

[IanD]

How you use the information given , both from the carb book and the dietitician ( remember she has her entrenched belief system, just as you do) is up to you.

A dietitian is not trained nor paid to defend "her entrenched belief system" (we preachers do that (in my case without pay)) but to advise patients on healthy eating. If meats have a zero carb count, then tell us to eat them (or quorn or veggy stuff.)

I'm becoming an evangelist for reduced carb as well as the Gospel of Jesus Christ.

 

[ally5555]

Ian - they do tell people to eat meat .

i think that could have been a standard letter and thinking about it how long did u get with her - you cannot do carb counting in 10 minutes!

 

[chocoholic]

I had about 15 minutes with her ally and don't get me wrong I liked the girl. (Unlike the first dietician I saw five years ago, who I took an instant dislike to because she spoke to me like a naughty two-year-old and I refused to see again). The second dietician hubby paid for me to see privately,shortly after diagnosis and she had a totally different attitude and spoke to me as an intelligent human being.(She also said she knew the first dietician and had a low opinion of her handling of patients herself....think Joyce Grenfell!) It was a short meeting because she recognised the fact I was eating healthily and not existing on meat pies and takeaways.
I do have a Collins Gem guide that is useful but what I'm saying is that the leaflet I was given was almost egging me on to eat unhealthily and to just adjust the insulin to cover it. Even if I was not diabetic, I would not pig out all the time on pork pies and takeaways.

 

[graham64]

Hi Karen,
I just wish I could clone my Dietitian then you could have copy. She's so clued up about carbs and the effects on BG and on top of that shes a lovely caring lady.

Regards Graham

 

[ally5555]

of course dietitians are different and they develop their skills as they get experience.

My feeling is that is takes several visits to build up a rappore with a pt . BUT the bottom line is that there arent enough for the no of pts . In Wales there are 300 for a population of 3 million - and only 6000 in the whole of the uk.
diabetics are not our only clients - renal/liver disease creates very complicated diets, special care babies, pts on itu on very complictaed feeds., cystic fibrosis, post surgery - the list goes on and on.

I did a diabetes talk on thurs and there were 5 new pts and none had access to a dietitian not good enough. Our knowledge evolves all the time but you also have ro take a rational approach as so much reseach contradicts itself

Dietitians are not reeling from anything

 

[martinbuchan]

Remember that many health professionals believe type 2 is a lifestyle disease. It sort of is in a way, but it doesn't help anyone to be treated as a naughty child. Proof your regime works is essentially the a1c . If A1c is high, then we all reevaluate. There is an underlying blame ethos that pervades diabetic care other than the specialist diabetes care teams. Having said that, my own diabetologist giving a lecture with me in the audience still promoted the lifestyle disease idea.

Not all dieticians are specialised in diabetes, and there is never enough of them to provide the service that dieticians themselves want to give.

The majority of diabetics are elderly, diet/drug controlled and 'mild'. The diabetologist's forum on a doctors website is frequently spied on by myself. They do seem to have great debates on what contitutes appropriate care and discuss the evidence. Really, there is not a lot of evidence for extremely tight control in the elderly. In fact, is even linked to a deterioration in mortality. Frequent BS testing is probably not useful for the elderly type 2 and does cause more anxiety. However, the type of person on this forum is motivated and keen to improve their outcome and sadly we see the deficiencies and variations across the system.

Does make you a wee bit paranoid.

 

[hanadr]

I'm sure you're right Marty, but why can't doctors see that younger, well motivated T2s need to feel in control. I'm 61 and would like to see my grandchildren grow and go to university. If I become a typical statistic, I won't. Now why can't the medics see that? Surely those Diabetics who are happy with twice weekly bg testing, should be on it and there's room in the statistics for someone like me who doesn't find twice a week with 1 HbA1c a year enough. My GP grudgingly gave me a scrip for a pack if strips, whilst telling me about the others who come in ot him with HbA1cs in the 10s and who don't care. I suggested he send them to me and I'll show them how to get it down to an acceptable number. However the other member of my water exercise class who is diabetic. doesn't worry either. she's got Bgs in the 4s and isn't bothered about complications, because she's nearly 80. I think that there ought to be much more individual planning for patients aand that it should have the patient's full consent. that way surely the level of compliance would increase.