Why Do Diabetics Fail To Adhere To Dietary Regimes?

azure said:

I'm not sure that the majority do fail to follow it. In the UK dieticians will suggest foods to fit in with family meals and favourites. This is free.

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Exactly! The foods I was advised to eat - the 'healthy plate' with carbs with every meal would have been a disaster for me. As it was I had read about eating your way out of T2, I bought a blood sugar meter, Reverse your T2 Diabetes by Dr David Cavan, discovered this site and LCHF and in the process discovered that it was exactly the 'healthy' stuff on the 'healthy plate' pyramid that was causing the spikes in my blood sugar.

I recorded everything I ate and eliminated the foods that spiked my blood mostly the foods that I was advised to eat most of, once I did that I lost weight - an unexpected but added bonus believe me - and my HbA1c is now below pre diabetes level.

In my case I really don't feel I was at all well advised. For a start I wasn't given a blood sugar meter, I was told 'my diet sounded alright ( so alright I was classed as - but not told I was! - pre diabetic. I was toldto stick to not more than one banana a day and to avoid pineapples and grapes and come back in three months' time. When I asked what would happen if diet and exercise didn't work I was told I'd be put on the diabetic register.

OK blood sugar meters cost money - but surely if they can get people to keep be really aware of what is going on and keep their blood sugar as low as they can it will cost the NHS less in the long run.

I really don't think a lot of people - especially the ones who don't use this site - can be aware of the progressive consequences of T2, metformin and then insulin.

LittleGreyCat said:

Given that 80% of overweight/obese people are not diabetic, isn't your focus a little narrow?

Perhaps the inability to stick to a sensible eating regime has nothing to do with being diabetic; it is just that unfortunately 20% of the overweight/obese go on to develop T2 Diabetes.

I know that it isn't that simple, and that insulin imbalances can make it very hard to lose weight whatever the diet and exercise regime, but I would be interested to know if dietary compliance is better, worse, or average between diabetics and non-diabetics.

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I am confused, you stop taking Metformin, because of wanting to continue weight loss, and then re-started it again, when desired weight loss was attained. My doctor said...Metformin has nothing to do with weight loss/gain.

MissMac said:

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.

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Oh dear, here we go again, I personally know of 6 people who have diabetes 2.....and they are not overweight but bordering more on being too thin. I was within an acceptable weight when I became diabetic, and now have ballooned. I am convinced that in some older people especially, fibromyalgia, arthritis, general inflammation throughout the body, insomnia, and other, can be interlinked with diabetes 2.....and can be contributory to higher glucose readings. I have much difficulty in controlling my blood sugars even though I try very hard in restricting carb intake, and try to exercise.

Mental health becomes a huge part for me. That and, even after getting an insulin pump in and getting my thyroid out, my medications work against me every step of the way still. Thyroxine drives them up, antipsychotics tend to drive them down. I tend to need to be a bit more reactive with those circumstances. That and sometimes when some of my schizophrenic symptoms get annoying I use exercise, especially swimming, to manage them which throws more spanners in the work.

The problem is simple - it doesn't kill u quickly like cancer - so people start with the best intentions then phase out after a month or two.

Hell I was diagnosed in Feb this year - HbA1c inital was 11.3 - first blood test was fasting 17.3.

Fast Forward 7 months - HbA1c now 5.7 - how was this achieved - diet and exercise. I'm 47 weighted 115kg height 185cm - was never sick didn't even know I has this disease - now 98kg - so 17kg lost, BG in good control.

People decide to do lots of unhealthy things - make excuses because it's hard. Like to complain about their lot in life.

It's not been easy for me - hell no I bloody well dislike riding my bike at 6am in the cold to work - I could easily take the car - it's a mindset - u must decide to do something, but it's easier to make excuses and do nothing.

Galja said:

I love your expression prairie cakes

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I'm glad and I have plenty more. I attribute it to being a cynical, warped and twisted old b...
I can't take credit for the age - but the rest is all my hard work.

Impressive results and well done. Its easy to stand on the sideline and cheer for someone who does well and is not a victim in his mind. I am waaaay head of you mate. I'm 69 and still putting the left foot in front of the right on a fairly regular basis. Been a Type 2 since 2010, unfortunately I am not the sharpest tool in the shed and took me a while to wake up. Once I got on way the results kept coming.
Just a word of caution - make sure you have a good sustainable eating plan when you have reached your objective. Although if I were a betting man I would put a bundle on you.
Keep at it and the best of luck champ.

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 have had weight gain, but I attribute this in part to being LADA and having a very irregular output of insulin as it is. Gliclazide helps to lower glucose but sometimes it causes too much insulin production and I have to eat quite a bit to stay above 6.0. Naturally that leads to weight gain.

I'll be asking to take off the gliclazide and switch to bolus instead for better results because of this.

Here where I live (and I think it is the same in UK/USA..etc) they recommend avoiding fat for people with T2. Ok I know now its total ****, but I just want to know why the hell are they recommending that? Whats the story behind "fat makes T2 worse" ???

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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but don't you find most (not all) DSN's and Dr's do talk to you like that !!!! mine do .. but I still used to blindly follow their advice .. thankfully the wife just sees them as people.. and ignores any advice or orders they give.

Galja said:

Dear David,

Could you tell us all about the C-peptide test and what it shows by the numbers? Maybe we all should be paying for this one?

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Sorry for slow reply. It's been several years since I paid for this test and it was about £90 at the time. I had been having an ongoing ding dong with my doctor at the time and I wanted to know what state my pancreas was in, hence the c-peptide test. I can only tell you what's in Google.

C-peptide is released from the pancreatic beta-cells during cleavage of insulin from proinsulin. It is mainly excreted by the kidney, and its half-life is 3-4 times longer than that of insulin. The reference range of C-peptide is 0.8-3.1 ng/mL (conventional units), or 0.26-1.03 nmol/L (SI).

So, although it's not measuring insulin, the two are so closely related that it's a reliable measure of insulin production. BTW diabetes.co.uk say the normal range is 0.51 to 2.72 nanograms per millilitre as opposed to the 0.8 to 3.1 mentioned above.

In answer to the original thread title, Not all do.

But when I do deviate, slightly, from my own self-set plan, it's because of tiredness or fatigue, and exasperation and impatience.

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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My input is this (and I am a T2 aged 71) - I understand that T2 is not advisable, but I have only altered my desirability of diet choices after suffering myself a potentially very damaging nerve palsy which if it had continued, would have caused me to have to stop driving. In other words my poor adherence to a T2 diet has been that my personal choice says I still like "ordinary" foods in preference to T2 diet foods. My conclusion for me is that the industry (for who else is there) needs to find a way of causing me to alter my priorities e.g. less pleasurable eating, less risk of bodily damage. In fact I am continuing to eat some pleasurable foods, but trying to lose weight using the 5/2 fasting approach diet, which I plan to shortly extend to 4/3 !

I have had type 1 for 55 years in Feb 2017 (no complications). My motivation for sticking to that same diet for all those years is because it makes me feel good. If blood sugar is anything over 7 I feel absolutely awful--I need lots of energy to be able to do everything I want and need to do & would hate to be the way I was when diagnosed at aged 8 years--I will do anything to ensure that I keep bms within normal range....!!!

Avocado Sevenfold said:

I can't think of anything worse than this patronising tinkering. My prescribed photocopied diet sheet suggested I "fill up on starchy carbs at every meal" and "eat less pies". I wouldn't trust my dietitian to feed my cat.

Does not comply

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Oh lovely--when I saw a dietician she didn;t even know how much bread contained 10g cho!!!!!!!

prancer53 said:

Oh lovely--when I saw a dietician she didn;t even know how much bread contained 10g cho!!!!!!!

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...I had to tell her!!

prancer53 said:

I have had type 1 for 55 years in Feb 2017 (no complications). My motivation for sticking to that same diet for all those years is because it makes me feel good. If blood sugar is anything over 7 I feel absolutely awful--I need lots of energy to be able to do everything I want and need to do & would hate to be the way I was when diagnosed at aged 8 years--I will do anything to ensure that I keep bms within normal range....!!!

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--do 30/ 30/ 30 g cho + 10-15g cho before bed (to stop nocturnal hypo). Aim for bm 4-7.

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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It really helps to know how much cho foods contain, to have a set amount for each meal and to stick to that amount of cho at mealtimes but vary the types of food eaten (easy if you know cho content of foods). I was diagnosed at 8 years and whilst in hospital was taught cho content of different foods. It was also thought that if a child thinks they cannot eat sweets and chocolate they are more likely to want it, eat it secretly and even binge therefore I was encouraged to exchange, for example, to exchange an apple for 2 squares of Cadburys choc which contained the same cho. This was so sensible and made me realise that I could work treats into my diet providing they contained the correct cho. I can remember my mother preparing me to go to a childrens party: she buzz tested me daily for a couple of weeks on cho contents of foods that might be at the party. I was allowed 50g cho at teatime so could eat a sandwich (round of thin bread was 30g cho) and then have a chocolate marshmallow (15g cho-probably different now) and I still had 5g left for 1/2 a biscuit or 1/2 a desert spoon of vanilla ice cream (cho contents again probably vary now)! You have no idea how confident I felt after having met the challange and my wee test was 0% sugar before bed too--no blood tests then but a test tube in which I put 5 drops of wee, 10 of water (if I remember correctly & then a tablet--like the fehlings test for sugar content of potato in secondary science). I now realise how good my mother was--not to mention brave!! I have now had diabetes for 55 years in Feb 2017. I eat less cho now (30/ 30/ 30 + 15g before bed to stop nocturnal hypos) and have no complications. My motivation is to have plenty of energy--a bm of over 7 depletes my energy severely!!!!! As well as the correct cho amount I have salad or veg and protein at each meal. I always prepare my own lunchtime food to take with me to work. I exercise a lot (I trained and worked as a professional dancer when younger). I work as a teacher and during the school holidays I organise & deliver youth activities on board cruise ships. Key to a balanced diet (imperative for anyone with diabetes) is to know cho contents of foods--I balance my food with the amount of insulin I take.

donnellysdogs said:

Or the average human!!

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equipoise said:

Sorry to sound sceptical, but could you explain what you mean when you say you are an 'an advanced diabetic educator'? What actual qualifications and experience do you have? What 'dissertation' are you doing and where are you doing it? What are the 'many articles' that you have read? How many of these are in proper medical journals (as opposed to 'the Harvard Gazette')?
So much of what you write begs so many questions -- 'normal range', 'acceptable range', 'hba1c goals' -- and you don't make any allusion to the role that certain foodstuffs have in generating food cravings ('diet compliance' is not just down to 'attitudes').

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....yes not specific enough.....

dbr10 said:

We are carbohydrate intolerant (specifically type 2)

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...and type 1 even worse--totally unable to metabolise cho without the correct amount of insulin