Why Do Diabetics Fail To Adhere To Dietary Regimes?

datkins65 said:

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.

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Oh dear! It's not so much that I'm disagreeing, it's just that previously I was taking Gliclazide (I gained weight after I started taking it), Januvia and Atorvastatin. Plus my present GP was talking about putting me on insulin. I had been told by my previous doctor not to reduce carbs and although my present doctor wasn't convinced, she didn't object, I wanted to lose weight, so I cut out bread, potatoes, pasta and rice and by my "Weight by Date" software I had reduced my carbohydrate intake to about 80 gms.

I lost weight, my cholesterol dropped to 3 and my BG was so low I started to have hypos regularly. In other words, I was over medicated if that's the expression. I therefore avoided "progressing" on to insulin, I no longer take Gliclazide or Januvia and I finally plucked up the courage to ditch Atorvastatin. I still take Metformin.

It might just be me, but I don't have as many colds or infections that I used to, I feel much better than I have done for years and the regular bouts of depression I had experienced since my twenties can now be counted as "off" days. That of course might be that at 64 I don't give a . . . . . . . for most things.

It was the highlighted part of your message that caught my attention and I started to google "minimum carbohydrate". I'm the first to say the net is probably not the best place because there's so much ****, but you can easily sort out the wheat from the chaff and get some proper empirical evidence and even that left me with several different answers.

So, for me, it's a no brainer. I could follow the guidelines suggested by my previous doctor (I've never been on any of the courses) and my diabetes would progress in the way medics like to tell you. OR, I could keep my carbs down while still eating healthily, have a much better chance of controlling my weight, and hopefully, not allow my condition to worsen.

It's worth mentioning that I'm fortunate that my pancreas seems to working OK, I paid for my own c-peptide test. Also, because of a doctor in the US who my wife described as being "as mad as a box of frogs" I have had every heart test going and some I didn't know existed at the expense of my travel insurance. The result of those tests was that I'm as fit as a fiddle, heart wise.

datkins65 said:

I am an advanced diabetic educator dedicated in finding solutions as to why diabetic patients fail to follow their diets and exercise regimens. I do recognize socioeconomic status, level of obtained education and depression as reasons that compliance has not been achieve, but measures are being taken to address each of these obstacles.

I am of the opinion that taking the time to assist the patient in building an individualized dietary plan creates "ownership" in the task of managing T2DM. Another component in building the dietary plan is to identify the patient's favorite foods and traditional family recipes, and discuss making minor changes to effect the glycemic load of the dish. The patient is made aware that this diet can be changed as required, and that they are not stuck with eating the same food over and over for the rest of their life. Discussions about appropriate portions of each food group, and acceptable snacks is also discussed. Before the appointment is concluded, the question as to why these dietary restrictions are so important is answered, and the patient is able to repeat this information. Written information including substitute options, easy recipes, and contact information accompany the full dietary plan created by the patient with the assistance of the diabetic educator or nutritionist. Follow-up in 6 weeks intervals.

In tracking 100 patients over the period of a year in the clinic, these dietary changes have produced a gain of dietary compliance of 12%. Weight loss ranging from (13 to 26 pounds), and HbA1c have been decreased in these patients by 9% with HbA1c goals reached in 88%.

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I see several forum members have said something similar. I personally have never been given a diet regimen, possibly because I have followed a disciplined diet since 1989, when my wife and I started living together and she informed me that I was going to eat properly from then on LOL. I gained 3 stone in 3 months, seems my **** diet was better. LOL

The closest thing to dietary advice was my then doctor telling me quite emphatically "not to reduce carbs", never understood why. So, if other patients can't follow a regimen, I have no idea why. Probably one or all of those suggested, but I don't know.

bulkbiker said:

watch and listen and learn from this
http://www.thefatemperor.com/blog/2016/8/18/dr-jason-fung-and-fat-emperor-the-fad-of-fasting-part-1
there is no need for a pill..in my humble opinion.

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Thanks for posting. BTW no need to be humble about your opinions.

datkins65 said:

The majority of research is bickering about the failure of the low-carb diet

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The "failure" of my low carb diet has seen my Hba1c figures reduced from 52 at diagnosis to 33 now. I would not have seen this improvement if I had followed NHS dietary advice.

Brunneria said:

I am absolutely the same.

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Me too, only have A2 milk now if anything.

It seems some times the educators need educating. And this is one place to get it. If they are willing to listen.

Galja said:

When you get prescribed stuff like glipizide/glicide/rhymes with suicide and you go off it because of massive weight gain and a feeling you are going to die so you go out and buy a heart monitor and you are told that the higher blood pressures you are having and the weight gain must be related to something else you are doing wrong and then you finally get fed up and get rid of the doc who isn't getting a clue, then your efforts to get rid of some professional idea that this stuff that causes weight gain and makes you sicker is not over. I regularly review the electronic version of my "meds" where this evil garbage still turns up on my list of medications. It took me three years to get rid of glipizide off my medications list even though I only took it two months with massive side effects. Finally, I said to the last person who said "Your numbers still aren't down where we'd like to see them. I'm going to add glipizide to your regimine"

"NO you aren't. The stuff causes massive weight gain and edema. The more weight gained, the harder it is to oontrol my numbers as you call them. "

That blessed doc marked me down as allergic to sulfonureas and haven't been bugged since. When I looked up sulfonureas on wiki, I found that these are weed killers. Why is this garbage still being pushed by the drug pushers, er medical establishment?

https://en.wikipedia.org/wiki/Sulfonylurea

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The word "sulfonylurea" is used to describe a substance which has a particular chemical group in its structure. The rest of the molecule differs between the different sulfonylureas, giving them different properties. The sulfonlyureas used in weed control are not the same as those used in medicine.

It's a bit like alcohols - they all share a particular chemical group but you can drink ethanol quite happily in wine, for example, whereas drinking methanol or ethylene glycol (antifreeze) may blind or kill you. Even if the sulfonylureas were the same, it's not unusual for a particular molecule to have different effects in different species. Antibiotics work by killing bacterial cells while leaving human cells undamaged. Theobromine in chocolate is harmless to humans but kills dogs.

I didn't follow the dietician's or my diabetes nurse's recommended dietary regime for two main reasons: 1) I bought a blood glucose meter and I could see what the recommended starchy food did to my blood glucose levels and 2) I wanted to lower my blood glucose levels, not raise them.

The fasting c-peptide test tells how much insulin you are producing. If it is very high like in my case but you are still having very high BS like I was, it means you are very insulin resistant. The last thing I would want to do with my high insulin level is take more insulin or go on a drug that makes the pancreas secrete more. If the c-peptide is very low it means you are not making much insulin and those drugs may be appropriate or it may be time to consider insulin. Some doctors tend to just throw drugs at people without this test and I think that is wrong.

Galja said:

Dear Dark,

Do you know anyone who has been on this drug a significant amount of time without side effects?

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Dear Galja

I don't think that who I know is relevant to the discussion. Perhaps you think I implied that sulfonylureas do not have side effects? I didn't. All drugs have side effects with some people. What I was saying was that if substances have a chemical group in common it does not necessarily mean that their effects are identical. Even if some sulfonyureas are used as weedkillers, we cannot assume all sulfonylureas kill weeds or indeed, are harmful to humans.

If you had a bad reaction to sulfonylureas, you shouldn't take them. It doesn't mean that they can't be useful for other people.

Even if all the people I know on sulfonylureas had side-effects we could not infer anything other than "some people on sulfonylureas have side effects". The only way to judge how prevalent side-effects are is to have some kind of double-blind study where neither participants nor clinical staff know whether the patient is taking the sulfonylurea and the side-effects are recorded.

chalup said:

The fasting c-peptide test tells how much insulin you are producing. If it is very high like in my case but you are still having very high BS like I was, it means you are very insulin resistant. The last thing I would want to do with my high insulin level is take more insulin or go on a drug that makes the pancreas secrete more. If the c-peptide is very low it means you are not making much insulin and those drugs may be appropriate or it may be time to consider insulin. Some doctors tend to just throw drugs at people without this test and I think that is wrong.

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My c-peptide result was low so my endo said oral meds will not work... have to be on insulin.

Mep said:

My c-peptide result was low so my endo said oral meds will not work... have to be on insulin.

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Yes that is how it should work. Probably saved you a lot of grief and money and time with non effective drugs that cause side effects. I wish all doctors would run this test instead of guessing.

chalup said:

Yes that is how it should work. Probably saved you a lot of grief and money and time with non effective drugs that cause side effects. I wish all doctors would run this test instead of guessing.

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That was my 3rd c-peptide test since diagnosis. I insisted they do the GAD and c-peptide again because I was on oral meds at the time that hadn't really been doing much for me for at least a couple of years. I had already wasted money in my opinion. But docs insist they try all the oral med combinations first. Of course when the result came in I was taken off oral meds immediately. The oral meds only work when you produce sufficient insulin. I agree every T2 should ask for these tests to be done if things clearly are not working. We get beta cell damage from years of insulin resistance and the pancreas stops doing what it is supposed to do.

urbanracer said:

Given that this is primarily a UK based forum (we do have some members from the US) you need to be aware of the fact that we get some forum members reporting that they've received little or no dietary advice.

I also think that more often than not, any failure to adhere to a diet will be the result of more than just one of your possible responses.

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I was diagnosed with T2 a few years ago and have had ZERO advice on how to manage it from ANY medical professional - other than being told to take my tablets and go away and get on with my life. This clearly hasn't worked as I've recently had to increase my meds.
As someone who has had pretty major weight/ eating disorder issues since the age of 8 (and I'm now 43) and has underlying medical conditions other than the T2 that make weight loss more difficult, you'd think they'd be a bit more focussed on trying to help - I've not even been offered an appointment to see a dietician or a diabetic nurse. I have no plan, no advice, no nothing. I've asked for more help but this doesn't seem to actually result in more actual help! I know the NHS is over-stretched but diabetes is a very confusing thing and I think most people struggle to get their head around it without focussed, personal help.

Compliance... An interesting word. As is the phase 'failure to adhere'. I'm afraid these words sound didactic and undermining of free choice. I immediately feel rebellious in response to these terms. I am type 1 and consider that I look after myself pretty well. For years, I've worked on my relationship with food and lead a pretty active lifestyle. As soon as the words failure/ compliance come into the vocabulary of my diabetes, it would be like a red flag to a bull. I could not work with anyone using these terms. I am not a robot or a child and do not aspire to comply, nor do I see life as success or failure. I could say I am intrinsically driven- know my relationship with myself well enough to make kind decisions about my body.

Galja said:

Dear Dark,

Do you know anyone who has been on this drug a significant amount of time without side effects?

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I was on full dose Gliclazide for many years with no side effects or weight gain but eventually found it did nothing for me probably due to increasing death of my islet cells (honeymoon effect?). I was having fairly low carbs which probably avoided weight gain.

chalup said:

The fasting c-peptide test tells how much insulin you are producing. If it is very high like in my case but you are still having very high BS like I was, it means you are very insulin resistant. The last thing I would want to do with my high insulin level is take more insulin or go on a drug that makes the pancreas secrete more. If the c-peptide is very low it means you are not making much insulin and those drugs may be appropriate or it may be time to consider insulin. Some doctors tend to just throw drugs at people without this test and I think that is wrong.

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I agree. I had my c-peptide done privately and it showed my insulin to be at the lower end of the range which confirmed that I did need to take insulin. My result was 1.19 in the 1.1 to 4.4 range. The test numbers are not an accurate measure but help guide whether you are insulin resistant or insulin defficient

Lifeissweetenough said:

Compliance... An interesting word. As is the phase 'failure to adhere'. I'm afraid these words sound didactic and undermining of free choice. I immediately feel rebellious in response to these terms. I am type 1 and consider that I look after myself pretty well. For years, I've worked on my relationship with food and lead a pretty active lifestyle. As soon as the words failure/ compliance come into the vocabulary of my diabetes, it would be like a red flag to a bull. I could not work with anyone using these terms. I am not a robot or a child and do not aspire to comply, nor do I see life as success or failure. I could say I am intrinsically driven- know my relationship with myself well enough to make kind decisions about my body.

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I cannot disagree with your attitude. You really have to pick your own way through the prairie cakes. Crickey, its good to see someone talk about "my relationship with my food' and make 'kind decisions about my body'. If I could give gold stars for your comments I would.
Regards

I gave the reason that the diet prescribed to me was impeding my success ... My prescribed diet at diagnosis was an overload of bread, meat and very high carb things I never ate in over 30 years. Vegan for 38 years and after a month of whacky readings I just went back to what I had always done before and it's been a success. Now my daily average is about 4.9 and I am happy and feel so much better.