Why Do Diabetics Fail To Adhere To Dietary Regimes?

[Lamont D]

Oh dear, you have a lot to learn about brain metabolism, energy and immunity. Fats do a better job than carbs in these respects. You say you are a researcher, so I humbly suggest you do some research on ketogenic diets.

Indeed, how much glucose do we actually need?
I have recently discovered through a lot of scientific papers that the liver will always respond if the brain needs energy.
In ketosis the brain feeds itself from muscle fat.
In a carb laden diet, and in some T2s, and with my condition, what happens is the glucose is swamped by the insulin and cannot get enough glucose to feed the brain!
Therefore nypos occur because of hyperinsulinaemia.
It is not as the op has posted.

Edited by a mod

 

[datkins65]

This minor tinkering will be completely inadequate.

This minor tinkering as you say, has had a more effective response in my practice than in any other reported over the past ten years worldwide. We have maintained a 65% compliance rate for 536 patients out of the 825 this mission follows.

We never abandon our patients to failure, we stick with them until they tell us to "hit the road" or until they are happy with their dietary changes and have achieved success. They are welcomed to return any number of times to work out at our exercise facility, attend the weekly dances, or join some of the cooking classes, moving classes or sign up for a diabetic educator/dietitian or the nurse practitioner for foot care, sight check or labs.

 

[Totto]

It is very unhealthy to cut carbs lower than 130 grams a day. Without knowing that carbs are essential in brain metabolism, energy and immunity, many have cut carbs down so much that they becomes depressed or physically ill. Dietary requirements are individual and should be fulfilled when creating a plan with the patient.

If your advice to diabetic patients is to eat at least 130 grams of carbs per day I can understand why they choose not to follow your advice. Very few of us who are not on insulin could tolerate that amount.

Personally I've been low carbing for years and on LCHF for around 2-3 of them and am doing well. My HbA1c is 32 and cholesterol perfect. And I aim for around 80 E % fat in my diet. No sign of depression or illness so far, quite the opposite as at 53 I'm happily bouncing around.

 

[datkins65]

Well Dona the diet that works for me has virtually no carbohydrate in it so it sounds as if you think I am depressed or physically ill of which I am neither. I think you need to educate yourself a bit more before you give people incorrect dietary advice. Until I read your response above I was prepared to give you the benefit of the doubt but after that I'm afraid you are wrong (in my opinion).

If your diet works, that is great. As I have repeatedly stated, we all are different and we respond differently to any thing placed before us. We are individual down to the cellular level and cannot be put into some standard diet. The human body is not STANDARD but has a diversity far beyond our meager understanding. If you are not depressed or physically ill, and your labs are great, than your diet is working for you. Isn't that all that matters? I am not giving dietary advice to any group other than for an individual to find YOUR OWN diet that works, because we are not all the same. Agree?

 

[datkins65]

If your advice to diabetic patients is to eat at least 130 grams of carbs per day I can understand why they choose not to follow your advice. Very few of us who are not on insulin could tolerate that amount.

Personally I've been low carbing for years and on LCHF for around 2-3 of them and am doing well. My HbA1c is 32 and cholesterol perfect. And I aim for around 80 E % fat in my diet. No sign of depression or illness so far, quite the opposite as at 53 I'm happily bouncing around.

GREAT! You hit a homerun with your diet then.

 

[Lamont D]

Of course fats are essential. I was not talking about fats, but diets that strip carbs from the diet. I am totally aware of ketogenic diets, and unfortunately for patients with renal impairment, this cannot be an option. This is also one of the diets that works great for some folks, but not so for others. How long have you been on this diet? I know weight loss can really be fast, and my question is has the weight loss been maintained?

I have been in ketosis for nearly three years come October.
I use to have an awfully of mental health problems. Anxiety, mild depression and forgetfulness, memory loss and time loss.
All these symptoms have gone, as have my endocrine problems except my pancreas.
I am as fit and healthy, no mental problems, and really clear headed, I have my life back. I don't eat any carbs except for the ones in salad and protein, which isn't any at all, I have great energy, I work and look after my wife, my home, I cook everything from scratch. My only relaxation is sport and this forum to help those who have been fed the usual BS from so called medical practitioners.
My endocrinologist is a man doing a lot of studies which includes RH. He is a doctor who thinks outside the box and treats you individually, he saved my life!
I was heading for my coffin, now, I'm going to be around for a long while yet!

My last point, is, I really do believe, that a lot of conditions that modern day humans have can be treated by a low carb diet, not only diabetes!

It would save the country an awful lot of taxpayers money.

 

[Brunneria]

It is very unhealthy to cut carbs lower than 130 grams a day. Without knowing that carbs are essential in brain metabolism, energy and immunity, many have cut carbs down so much that they becomes depressed or physically ill.

Wow. Your information is decades out of date.

I have been happily eating fewer than 50 g carbs a day for years, and feeling better on it than I did in the previous decades of up to and over 100g of carbs.
As a result I now have optimum cholesterol ratios, slow weight loss, better energy levels, reduced inflammation, better sleep, better metal clarity.
The depression cleared up with sufficient Vitamin D. Nothing whatsoever to do with carb intake - except of course that I am now exceeding happy not to feel dreadful all the time due to excessive carb intake.

If you are trying to push your T2 clients into eating so many carbs, then you are preventing many of them from feeling their best, and giving them the best control of their T2 diabetes. In my case, since I also have reactive hypoglycaemia, you would also be pushing me into daily hypos - since if I eat more than about 50g carbs a day, I risk hypos after eating.

If you would like to understand very low carbing properly and ditch the nonsensical myths (such as the 130g/day needed for brain function), whilst providing a better service to your clients, I suggest reading the Voleck and Phinney book mentioned in my signature. They explain, excellently, how and why low carbing works, and works so well.

Incidentally, I have no problems sticking to my very low carb regime. I love food, and eating low carb is both delicious and satisfying. I am never hungry, cook from scratch, eat masses of veg, some fruit, and have far better nutrition than people who fill themselves up with stodgy, starchy carbs.

 

[busydiabeticmum]

Ms. Donnelly...Love your photo!

I have over 20 years experience in diabetes education, 42 years in advanced nutrition and critical care nursing. I am very happy to learn from any and every person or patient, and I realize that none of us have the key to success in treatment, however, we still can learn from one another.

You are correct that many of these diets are unhealthy. As an example, It is very unhealthy to cut carbs lower than 130 grams a day. Without knowing that carbs are essential in brain metabolism, energy and immunity, many have cut carbs down so much that they becomes depressed or physically ill. Dietary requirements are individual and should be fulfilled when creating a plan with the patient.

I disagree...

Ms. Donnelly...Love your photo!

I have over 20 years experience in diabetes education, 42 years in advanced nutrition and critical care nursing. I am very happy to learn from any and every person or patient, and I realize that none of us have the key to success in treatment, however, we still can learn from one another.

You are correct that many of these diets are unhealthy. As an example, It is very unhealthy to cut carbs lower than 130 grams a day. Without knowing that carbs are essential in brain metabolism, energy and immunity, many have cut carbs down so much that they becomes depressed or physically ill. Dietary requirements are individual and should be fulfilled when creating a plan with the patient.

I disagree... i cut to almost no carbs a day (lower than 50 max) i have never felt better with more energy, less mood swings less depression and healthier than i have ever been... but not every one is the same... i also eat to my monitor as there are things on the low carb diet that i cant tollerate either.

 

[datkins65]

I can't vote because I would have to tick most of those boxes.


I would like to know what you mean by compliance. Which type of diet is not complied with? Which foods do the non-compliers eat?

Sadly, in the UK at least, the dietary advice given to type 2 diabetics is nothing short of criminal. I would happily have complied with the advice given to me - basically cut out sugar, have carbs at every meal, a jacket potato with a tin of baked beans is an excellent lunch because of the glycaemic load and so on and so forth. Compliance with this advice is of no help to any T2 and those "in the know" will not comply with it.

Why Do Diabetics Fail To Adhere To Dietary Regimes?

Have you any particular dietary regime in mind. I don't follow most of them especially the diet sheets I got from the surgery.

Going to see the dietitian didn't help since she wanted to push her own opinion with which I didn't agree.

I feel that pushing opinions NEVER works. That is my why handing those impersonal sheets with dietary suggestions is a waste of paper. It is the patient that is to make the change, so why shouldn't the patient have the opportunity to make out his own plan along with his family? If the diabetic educator offers suggestions, and monitors labs for success, doesn't that sound more palatable?

 

[Totto]

GREAT! You hit a homerun with your diet then.

Mind you, I do approximately the complete opposite to the dietary advice I was given on diagnosis. But as I can read and understand a bit about diabetes and nutrition I would never, ever even attempt to follow that advice.

 

[Brunneria]

I am totally aware of ketogenic diets, and unfortunately for patients with renal impairment, this cannot be an option.

Why?
If you think that ketogenic diets cannot be followed by patients with renal impairment, you are probably assuming that ketogenic diets are high protein.

This is not the case.
A well formulated ketogenic diet contains enough protein for health, without so much protein that it raises blood glucose via gluconeogenesis and reduce the body's capacity to stay in ketosis. Again, I refer you to Voleck and Phinney. They explain this clearly, with excellent references.

 

[datkins65]

Wow. Your information is decades out of date.

I have been happily eating fewer than 50 g carbs a day for years, and feeling better on it than I did in the previous decades of 100+g of carbs.
As a result I now have optimum cholesterol ratios, slow weight loss, better energy levels, reduced inflammation, better sleep, better metal clarity.
The depression cleared up with sufficient Vitamin D. Nothing whatsoever to do with carb intake - except of course that I am now exceeding happy not to feel dreadful all the time due to excessive carb intake.

If you are trying to push your T2 clients into eating so many carbs, then you are preventing many of them from feeling their best, and giving them the best control of their T2 diabetes. In my case, since I also have reactive hypoglycaemia, you would also be pushing me into daily hypos - since if I eat more than about 50g carbs a day, I risk hypos after eating.

If you would like to understand very low carbing properly and ditch the nonsensical myths (such as the 130g/day needed for brain function), whilst providing a better service to your clients, I suggest reading the Voleck and Phinney book mentioned in my signature. They explain, excellently, how and why low carbing works, and works so well.

Incidentally, I have no problems sticking to my very low carb regime. I love food, and eating low carb is both delicious and satisfying. I am never hungry, cook from scratch, eat masses of veg, some fruit, and have far better nutrition than people who fill themselves up with stodgy, starchy carbs.

I am not suggesting changes based on my information. Your diet is perfect for you obviously, but it may not be for others. I have seen those trying many variations of diets from fad to prescribed and have come into this program very ill and out of control. Some may have problems with carbs, some with fat, and other with various other imbalances. With proper physical analysis, and by trial and error, most are able to find the perfect diet and gain success. The suggestion I have is NEVER give up on yourself and never stop learning about your body and its requirements. By the way, Vitamin D3 is my best friend. Voleck and Phinney is wonderful, and I have several patients along with myself who follow without discretion! I would image you are feeling so great, you do not want to "rock the boat."

 

[dbr10]

This minor tinkering as you say, has had a more effective response in my practice than in any other reported over the past ten years worldwide. We have maintained a 65% compliance rate for 536 patients out of the 825 this mission follows.

We never abandon our patients to failure, we stick with them until they tell us to "hit the road" or until they are happy with their dietary changes and have achieved success. They are welcomed to return any number of times to work out at our exercise facility, attend the weekly dances, or join some of the cooking classes, moving classes or sign up for a diabetic educator/dietitian or the nurse practitioner for foot care, sight check or labs.

Replacing foods with lower GI foods merely causes blood glucose to spike later in many people; and sometimes to stay elevated for longer. More fibre does appear to slow things up a little.

At a recent meeting with a diabetes dietician I got the usual nonsense "You can eat porridge". I can't. Whereas eating low carb usually means that my BG returns to normal after about 2 hours, today it took 3 hours after a small bowl of porridge. Some people seem to be okay with it - I am not. Perhaps you should get a meter and test your own reaction to different foods if you want to be in a position to advise people.

 

[Brunneria]

@datkins65 You are giving out completely mixed messages, changing opinion and contradicting yourself from post to post.

I think this thread may be a wind up so I will bow out of the discussion. No point in continuing when all the OP does is agree with everyone and contradict themselves.

 

[datkins65]

Whilst we know that weight can be a factor...yet again another person who believes that the weight came first and not as a symptom of the increasing insulin resistance. I am particularly tetchy today but the original poster has also hit one of my large nerves and that is a grave shame as this forum has been a life saver for me and has always felt like a "safe" and supportive place. The poll is total tosh...how can you vote when we have NO idea on what the "diet" is consisting of? As others have said, the NHS in England continues with their "eat well" plate which we know to be damaging. Maybe you need to elaborate as others have suggested and maybe not consistently attribute Type 2 to those who are overweight...you do very much run the risk of upsetting a lot of people further than they need to be upset.

I apologize for disrupting your support mechanism. Ever person who is a diabetic should have been given some sort of diet to follow, right? Whatever that diet is, why do they fail at being able to follow the prescribed diet. I have said this multiple times. We are all different, and must find the diet that works with our own body. By the way, this NHS "eat well" plate sounds terrifying! Please do not think I am passing judgement on anyone, MissMac. You are a beautiful young woman, and there is absolutely no shame placed on you or any other in this forum. I am here to learn, and offer what I can.

 

[donnellysdogs]

Because they assume you are following THEIR diet, thus the people who arent and are getting bad bg results are accused of being non compliant!!!

Not a T2 but only got told how to work out exchanges for food 30+ years ago. Never saw a dietitian until this year and that was regarding my stomach and diabetes. She was staggered at my detail and knowledge. She asked why I was there! Explained that I couldn't keep weight on and could only eat certain foods due to stomach trouble. She said as I could obviously work out insulin/carbs etc to add in ice-cream and condensed milk.... Went back to my gastroenterologist and he said, no way for condensed milk-it would make my stomach worse, and as I found out with ice cream-perfect blousing but it raises my levels 12-18 hours later.

The dietitian admitted I knew my body best and the only thing I could do was to add dried milk to my milk intake from all her advice. In the end, the thing that has added extra weight on and kept my weight reasonable now is the tablet Letrozole. Gained almost a stone since taking that.

Every consultant (I've had a lot) in 30 years and the nurses have known I have never seen a dietitian. Even for my pump training I did not have to attend courses as I could prove I knew my carbs/ratios etc. still, nobody has ever asked how Ikept lean and low hba1c's and reasonable cholesterol.

 

[zand]

Of course fats are essential. I was not talking about fats, but diets that strip carbs from the diet. I am totally aware of ketogenic diets, and unfortunately for patients with renal impairment, this cannot be an option. This is also one of the diets that works great for some folks, but not so for others. How long have you been on this diet? I know weight loss can really be fast, and my question is has the weight loss been maintained?

Many of us have found that a low carb diet increases kidney function. There was a lady on here who had quite severe kidney impairment. A few of us tentatively suggested she try LCHF and her kidney function improved dramatically. We suggested low carb, moderate protein and high fat. It worked.

 

[zand]

I apologize for disrupting your support mechanism. Ever person who is a diabetic should have been given some sort of diet to follow, right? Whatever that diet is, why do they fail at being able to follow the prescribed diet. I have said this multiple times. We are all different, and must find the diet that works with our own body. By the way, this NHS "eat well" plate sounds terrifying! Please do not think I am passing judgement on anyone, MissMac. You are a beautiful young woman, and there is absolutely no shame placed on you or any other in this forum. I am here to learn, and offer what I can.

My prescribed diet made me gain 8 pounds in 2 weeks! That's why I didn't stick to it after 2 weeks.

 

[ickihun]

All of the 'reasons' in the poll are quite offensive. This is a poll for people with prejudices, not for people with diabetes.

I totally agree.

We need a poll.
Why does diabetic educators not listen to their patients?
A) cannot be bothered
B) mentally exhaused dealing with every indiviual case
C) don't know anything other than 'book'
D) doing job too long so arrogance sets in and educator knows best
E) I'm not overweight so they arent doing what I'm doing, right?
F) I cannot believe they are having less than 1600 cals a day, they're liars!
......should I go on?

 

[datkins65]

@datkins65

From the foods that you list for eating was there a reason for no dairy? Or only olive oil?

As you stated at one point "all diabetics" I have jumped in here because I am included in the "all diabetics" range not T2.

I also think nutritionalists / dietitians have to look at the wider picture too of so many people nowadays having stomach issues. Some people (myself) have very limited foods that can be processed by their stomachs/colons and a lot of foods can impact upon things like IBS/constipation etc...

One size does not fit all in this world.

Even my gastro enterologist and dietitian says that I am the only one to try a food and see if it ok as one size does not fit me....

I think I have a problem with dairy, and I did not realize it until one of my patients said she had to leave it out because she was not feeling well on the days she ingested cheese or consumed milk products. I dropped it from my diet and many of my stomach issues resolved and I was able to tolerate more raw vegetables that I love without the gas and stomach pain. Many of the patient's in my program noticed the same thing. Who would figure?

I have observed that by using olive oil primarily, the ratio between the LDL and HDL improves greatly in my labs and many of the patients I continue to see.

I apologize, for the "all diabetics" which also includes myself! You are 100% right, my doctor just ignored many of my own issues with GERD (reflux) , and constipation and allergies. I believe that doctors are not prepared to spend the time with the patient to truly know a patient. In the states, they average less than 6 minutes per patient which is a travesty. A person would think a physician would especially know that we all are not the same and one size does not fit all.