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Twitter threads on why most GP's won't suggest low carb

Boo1979 said:
I think this is the kind of stuff that scares them, not hypos per se
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5669378/
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Thanks for the link Boo, yes, I know hypo's can be life threatening but so can hyper's. I'm definitely not being dismissive about hypo's but I do think that there is another solution rather than Drs deliberately keeping us high. Give us the equipment to manage our levels.
 
GPs aren't PA's for our health.
Why does doctors get the blame for diabetes?
They are there to help prevent death. So..... that tells me that if meds are needed, then they are needed. If hba1c is none diabetic level then a GP won't risk hypo death.
Its as simply as that.
 
Myself I don't blame doctors for diabetes. Everyone else could be different.
In fact I know some families do seek legal advice in times of diabetic deaths. Some. Some don't.

If I died due to a bad hypo my family would do what they want to do.
I wouldn't expect a GP or consultant who I haven't seen for a year to know my struggles unless informed or having regular consultations and I've made changes without their approval.
Dieticians use 800cals and low carb diets these days if obesity clinic is attended.
 
I get temperatures due to other medical conditions and paracetamol or ibuprofen isn't paid for by gp as cheaper if sourced myself.
So are meters and test strips.
Have those who struggle to pay for meter and strips tried for dwp PIP payments? They help workers pay for medical supplies.

The GP doesn't do everything nor know whether you'll be granted help. GP isn't Google.

I find this forum great for loads of things but it doesn't prescribe meds or order blood tests. I'd expect my diabetes team to do that.
 
The fear of hypoglycemia is often coupled with the understandable but misguided fear of ketones. This results in a high insulin condition for T2D where the natural ketones production is no longer possible.

It is not low glucose that is dangerous. It is low glucose in the absence of ketones that makes it dangerous and deadly.
 
I speak for myself I wouldn't expect a GP or nurse to advise lchf.
A 1-2-1 dietician... yes, if I don't have other health conditions which may need a more customised diet.
This is for me. Everyone has there own needs and may not be as severe IR as me. They may be more or less active or on more hyper or hypo prone meds than me.
We are all different.
Lchf works for many diabetics, even some type1s.
I hear some none diabetes eat that way too. Very beneficial for various people.
 
A friend of the family (T2) died recently on too much insulin. He was producing his own insulin but too much insulin injected.
 

I agree. I have argued with another t2 at work several times now. He eats crisps fruit bread. Hell anything he likes. Tests his blood from time to time but according to him. Anything upto around 12 is fine, you need a bit of sugar to function. He has his met and that's him happy.
Unfortunately he suffers very little from any high sugar problems at the moment and his 1c is down 15points . Stii high 50s.

These are the people that make it hard for us.
 
I agree but with the caveat that the equipment needs to be very accurate
I’m on Gliclazide but rarely have any hypos nowadays. I combine the Gliclazide with low carbing and have done for years
My last diabetes review saw a non diabetic hba1c returned - I was chuffed, but my consultant was concerned - he argued that to have achieved it, I must be experiencing hypos and so he cut the meds in half.
Im happy to go with that (although my sugars are running somewhat higher ) but I was concerned that the main thing he used to back up his aguement was that my (self funded ) Libra sensors were showing multiple nocturnal hypos, even tho (when administered), comparative blood BG readings showed the Libre to be consistently reading at least 2mmol below the BG reading, even allowing for the time lag etc
 
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The other issue for health careers which I omitted to address is risk management. We - as a society - tend to follow the trends of our American “cousins” who at the drop of anything larger than a pin, sue. We have also become increasingly litigious and health professionals are very wary of giving anyone an opportunity to make serious money from a “mistake”. There are some very greedy unprincipled people out there who would just love an excuse to line their pockets. I met only a couple in my career but it was unpleasant and potentially very scary. They were unsuccessful I might add.
 
He may never have problems. He may not need to eventually increase his meds. He may out live us all.
After all he sounds far less stressed than me. Ha ha
Stress doubles and triples my hormone production. Fact. My prolactin is high due to stress which may muddy the metabolic waters. Many hormones influence the digestive system.
Food of course does too.
 
Was he prediabetic or type2? Was he same weight or same at producing insulin or good quality insulin. Less active or more active?
So many varients can influence damage. Genes too.
 
Drs aren’t being blamed for diabetes as individuals. The profession and those that set guidelines that are making us as diabetics worse by advocating we eat precisely what makes us sick are.
Doctors are there to facilitate health. That includes at the top of the scale prevent death that is preventable but is no means the only goal.

Sure if meds are required then they are required. The point of so many in here is that in far too many cases there are alternatives that can work even better than drugs that aren’t being encouraged, offered or even discussed as the first line of attack.

I’m not sure what you mean by non diabetic level not risking death. Who has talked about people at that level being given insulin or glucose lowering meds? Or do you mean avoid low carb if drugs have lowered bgl to non diabetic? How about swapping that around? Far fewer side effects and cheaper and safer.
 
zand said:
I thought I read somewhere on this forum that there were NICE guidelines going back to Dec 2015 saying that low carb should be offered as an option for T2s? Can't find the thread now. Perhaps I was dreaming it.
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this is exracted from the 2015 NICE guidelines for Adults
"
10. Provide dietary advice in a form sensitive to the person’s needs, culture and beliefs, being sensitive to their willingness to change and the effects on their quality of life. [2009]
11. Emphasise advice on healthy balanced eating that is applicable to the general population when providing advice to adults with type 2 diabetes. Encourage high-fibre, low-glycaemic-index sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include low-fat dairy products and oily fish; and control the intake of foods containing saturated and trans fatty acids. [2009]
12. Integrate dietary advice with a personalised diabetes management plan, including other aspects of lifestyle modification, such as increasing physical activity and losing weight."
 
You really aren’t answering my points.

Public health policy is what we are talki g about here. Death liability depends on many factors. Very much is case by case it if someone has been give BAD advice particularly recently that directly caused death then yes questions should be asked.
 
ickihun said:
Was he prediabetic or type2? Was he same weight or same at producing insulin or good quality insulin. Less active or more active?
So many varients can influence damage. Genes too.
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He is T2. First 1c was in the 70's. Not the decade.
Takes met and gliclazide I believe.
That's is it as far as he is concerned. Meds will fix it.
He is not a low stress person either.
 
If you agree it works for so many why shouldn’t gps use lchf as a routine thing for their patients without complicating factors and save the specialist dietitians for those more complex cases.
 
Spl@ said:
He is T2. First 1c was in the 70's. Not the decade.
Takes met and gliclazide I believe.
That's is it as far as he is concerned. Meds will fix it.
He is not a low stress person either.
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I used to be like that. TOFI, feeling fine no troubles with high bgl >32 mmol/l with meter screaming KETONES at me - I happily ignored it. But then I had my strokes and my heart attack, and an HbA1c > 100 and my GP was referring me for insulin treatment. Then I woke up, and stumbled on this site. I have not left since. I am still here pontificating away and finding success with a lower carb lifestyle. My HbA1c was classed by the GP as Normal (3 successive results <58) so I am in his good books. However @Boo1979 and I seem to be on similar paths, and my GP has asked me to raise my averge bgl up to 7 mmol/l so my next HbA1c coming soon will be higher. I did have occasional hypo's on Gliclazide, but have managed to significantly reduce my doses. The hypo's were minor, never needed assistance and I have been keto adapted, so were not a major concern to me.

LC is a winner for me and I am starting my 4th year which for a diet is almost unnatural.
 

I think patients can play a part in educating doctors on this, for the simple reason that, though they are doctors and might even have worn libre for a fortnight, long term users have way more practical experience of its quirks.

I've told mine that libre is notorious for under-reading at low levels, and I've even taken a few pictures of it alongside a meter reading to prove it.

Blinging it with a transmitter and running it to xDrip+ improves the accuracy hugely, often to levels like 0.3 or 0.5, whereas libre read with the Reader can easily be 1 to 1.5 out.

XDrip+ has some useful statistics - time in range, high and low, averages, SD and RSD, and an AGP graph, so those give a much clearer picture of how the a1c is arrived at.

The doc just has the a1c number, and a preconception that a low a1c must mean lots of hypos, whereas we've got lots of more meaningful numbers to show that a low a1c is achievable through just avoiding going above 8 or 9 much.

I also tell them that with libre, we can spot dropping levels so easily that we can have a few dextrotabs to level things off, so most hypos tend to be "soft landings", technical nudges below 4, and most of that comes from libre exaggerating drops.

I've also told them that pre-libre, I'd quite often have situations, for a variety of reasons, where I was likely knocking around above 10 overnight. Whereas now, with having a hyper alarm at 7.6, I'll get woken and make a judgment call on whether a correction is needed, and/or a basal adjustment. I'm convinced that ironing out overnight highs which can last for hours plays a big part in notching down a1c.

To be fair, the docs I've seen have been fairly receptive to this new stuff.

I've got a vague recollection that even in T0s, levels will regularly fall below 4 when sleeping - why shouldn't they when the person is just sleeping and doesn't need much energy. I'm not certain about this, though, it's just a hazy memory, might google it.
 
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HSSS said:
If you agree it works for so many why shouldn’t gps use lchf as a routine thing for their patients without complicating factors and save the specialist dietitians for those more complex cases.
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Because they have their preference not too, currently.
Some GPS do advocate low carb eating.
 
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