Why Do Diabetics Fail To Adhere To Dietary Regimes?

datkins65 said:

I would not comply either, because I would be in the hospital with diabetic ketoacidosis (DKA) in intensive care. Are you kidding? This is malpractice. I wouldn't trust her either. Obviously, you are not following that hogwash. Is what you are doing working for you?

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datkins65 said:

Sir, I am afraid I do not follow the sarcasm regarding my education. I am far older than you, and if you require a resume, please let me know.

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Shar67 said:

i had a reaction couldn't breathe, went to hospital, whilst there a doctor asked if I had eaten anything different, no, he then asked if I ate Brazil nuts, in any form, not shelled, shelled, covered in chocolate, I said I ate shelled ones. He then told me that there had had a huge increase in people who had eaten Brazil's coming into hospitals, so many that it wasn't a nut allergy that suddenly developed but something with the nuts itself.
Later the family GP told me that the chemicals used to keep Brazil's fresh had a paper written on it and anyone who had a reaction should never eat them again.
It is also interesting as a youngster I didn't know anyone with any nut allergy, I now know at least 10 children, so it makes you wonder is it the nuts or the chemicals, either used as pesticides and to keep them fresh for longer.

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datkins65 said:

A short definition of success and a goal in treatment in the diabetic mission is to meet the goals of the patient to achieve and maintain an HbA1c within a therapeutic range. (Some can reach normal levels and other may only reach, let's say, 7.) In addition, if weight or abdominal girth is an issue, than hopefully the regimen of diet and exercise chosen by the patient will be effective in reducing both. Many in this clinic cannot afford "the nice" food, as they call it, and we grow foods and provide to this patients. There is no charge.

The mission is funded by my husband's family. We have lost many to diabetes in this country, and when the urgency was identified here, they contributed land and minimal funding (rent & utilities) to open the mission. Secondly, grant funding has supported medication, foot clinic, exercise room, and diabetic supplies for blood sugar monitoring. Labs are funded by both grants and donations. This is why there is a difference.

I perform all the physical assessment and lab interpretation on each patient. On intake socioeconomic information is obtained (# in family, employment status, etc), and current foods eaten, favorite foods, and we try to identify problems this individual might have obtaining healthy foods. I intake 10 clients a day, working a total of 12 hours. I spend one hour with each, and intake is completed after 1.5 hours and they are discharged to come into the mission kitchen to observe a variation of a traditional dish being prepare. These 10 (and family) get a chance to taste the new recipe, get a copy of the recipe and take a parcel home to prepare. They are invited back the next week for a diabetic education class to learn about foot care, and the importance of control of blood sugar in maintaining eyesight and skin integrity. Each week, and as needed, this patients come to the mission for one or more reasons. Over half come to the dance we hold on Saturdays, some to exercise in our donated gym, some need medication adjustments or dietary adjustment. We see 60 a week in the foot clinic.

I believe it is an insult to spend 6 minutes with a patient. If I want someone to take care of my health, and they only take 6 minutes to assess me, than I do not feel anyone could determine what my medical needs are with such a short time spent.

We need more time to make a notable change in the treatment and prevention of diabetes (T2DM). With budget cuts across the board everything is being trimmed down, however, the cost on the economy at this point ranged in the 250 billion dollar are, it would seem a little more time could be spend at addressing the problems so that money can be saved in that manner. Sometimes, people cannot see past the end of there nose.

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datkins65 said:

Good Day LittleGreyCat,

My dissertation is focused on T2DM and nutrition. However, I must say that there is nothing narrow about the epidemic of obesity and T2DM. This is all interlinked.

Actually the majority of overweight/obese people can be classified as prediabetic as some do fully convert to diabetes, and others go back and forth from prediabetes state to a normal state and then back again to the prediabetes state. The important point is that being overweight is damaging to the metabolism and sets insulin intolerance free to attack every cell type in the body. Some of the latest research identifies fat as causing metabolic conversions in the liver creating insulin resistance which has the tendency to be permanent if not dealt with quickly and aggressively. I have seen many who have been able to reestablish normal labs including HbA1c's that actually convert back to a normal range. There are others that regardless of the weight loss and increase in activity never achieve a normal range again, however do reach an acceptable range where damage and risk factors are minimal.

According to the Harvard Gazette (7 mar 2012), 30% of all obese people already have T2DM. In addition, they state that 85% of all diabetics are overweight. Impossible to talk about diabetes without addressing obesity as well. ( See: http://news.harvard.edu/gazette/story/2012/03/the-big-setup/ ) I have reviewed many articles just based on being overweight, and the compliance failure for both remain well under 50%. One cannot discuss obesity without referring to diabetes these days.

Thank you for your comments.

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DaftThoughts said:

I want to start off by saying, I'm a 6'1" female weighing in at about 270lbs. I have been tall and heavyset my whole life. I'm also a type LADA, and my weight did not cause my diabetes, nor is it really relevant in my treatment at this time. It's all in the genes. I do have T1D and T2D in both sides of the family, which confirms to me that genetics play a bigger role in diabetes than diet and environment. There are many other types out there indicate obesity does not have to be involved in every diabetes discussion - MODY is a good example. As many pointed out before me, there is ample evidence that the reverse is true - diabetes causing obesity.

That's why so many people are upset that you're creating this link. I also feel like your focus is so heavy on T2D that you didn't consider the vast variety of conditions before creating this poll.

The reason I didn't follow my dietitian's plan and stopped seeing her is because she put me on a 1400 cal plan. (My BMR alone is over 2000 calories, never mind the exercise I do almost daily.) The options she gave me weren't bad, tailored to what I liked and disliked, but ultimately she was more focused on crash dieting me into quick weight loss than she was about sustainable eating habits that worked with my glucose levels. At the time I was assumed T2D, and she was of the opinion that if I lost weight, my diabetes would disappear, I never saw her again after I was diagnosed as LADA because it was clear she was focused on pushing an agenda, personal or professional, and had no interest in figuring out what would work for me and my condition. To my knowledge she doesn't even know LADA exists.

I am still working on my diet. I can't low carb because my own insulin production is too high (although I need basal insulin to maintain good fasting values) and I crash into hypos quickly if I don't eat around 40g carbs a meal minimum. I exercise about 4-5 hours a week through commuting on a bicycle, which requires a higher carb intake lest I pass out on my bike (I am hypo unaware during exercise, but not when idle). I am insulin sensitive to my knowledge partially thanks to metformin. My diet is also partially determined by my income. I'm on disability, a fixed income, with a massive load of debts. I have a budget of €40 a week for every expense I could have groceries wise, including cat supplies, toiletries and anything else that pops up, leaving the rest for food. Sometimes I haven't much of a choice in what I eat, though I can choose to eat smaller portions and fill up on water if my values run high.

To answer the question: I know my body better than most doctors. I know my weight is not related to the fact I am a diabetic (although it can affect treatment). I know more about my diabetes than most healthcare professionals. The last time I saw someone to figure out my diet, I was put on a dangerous crash course because the dietitian only saw a fat woman in the chair in front of her and assumed all her problems would go away by restricting her calories to 60% of what she needed in a day. I don't always have the luxury to buy the food I need, but I have become excellent at compromising. My values have never been better, and I got here without anyone's help.

I feel this is the case for a majority of diabetics. We are numbers, we are money making conditions, rarely are we people who deserve to be treated as individuals. It's no surprise we don't listen to people who don't bother to learn about us beyond the basic "What do you like to eat?" and "How much do you weigh?".

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