X-PERT Course

[IanD]

Its here on line.

The Diabetes X-PERT Programme has been developed by Trudie Deakin. It is a six week professional led programme based on the theories of patient empowerment and patient activation. It has been thoroughly evaluated and has produced significant statistical evidence for improved diabetes control for those engaging with it.

I've just completed it in 4 session. I was invited as the dietitian I complained to about the DUK disinformation thought my experience would be helpful :!: Actually I was held up as an example of what good control can achieve :wink: The others were newly diagnosed, which is of course why they were on the course.

11- 1:30 with only a short tea/toilet break. I was the only one who took food. I commented on the dangers of the course delaying meals for diabetics. I've got orders for the low carb one minute muffin recipe. Everyone was horrified by the latest DUK advice to eat daily the equivalent of 42 tabsp of rice.

Only two of the 10 have test kits. They said Hounslow spend more on test strips than diab medication, so testing is discouraged. I pointed out that that could mean that testing aided control, & reduced the need for medication & the expensive treatment of complications. Statistics can be misleading.

They sympathised with me, when I said that on diagnosis I was told EVERYTHING that could go wrong, including the 15x more likelihood of amputation, & finally & helpfully computing the PROBABILITY of a heart attack at 25%. Delivering such a shock, without emotional support is very unprofessional.

They recommended getting to know the local pharmacist - they have far more time than the GP.

More as time goes by.

Can we become expert patients? I hope so, as we know ourselves, & how we react to medication & diet on a continuous basis.

[Edited to include the word "expert."]

 

[IanD]

2nd session .... Energy balance & the infamous 'healthy eating plate.' They stressed that those attending should limit carbs to 5 max portions per day, rather than 14.

Weight loss was discussed, & exercise. Again I was the only one with a packed lunch. I gave out copies of the 'minute muffin' recipe. My diet was commended as healthy - even though it includes lots of 'proper' cheese. Nuts were healthy, & vegetables.

The session finished with a DVD of 'George' eating unhealthily, going on a crash diet - & failing to lose more than 7 lbs of mainly water, then binging again. They then showed him exercising, but did not show what he was eating to accompany his exercise regime, nor how much weight he was losing. IMNSHO that DVD was a waste of time - worse than a 'time-filler.'

We were asked to fill in our own 'healthy eating plate' to see what we were eating. One lady's contribution was assessed at 1440 cals. The rest weren't analysed.

We were given coloured tape measures for waist measurement. Over clothes, mine was 92 cm so I'm OK.

Indian savoury foods - samosas, pakoras etc, were condemned, particularly as they re-use cooking oil & generate trans fats. Several times lately I've been offered vegetarian samosas & refused them - vegetarian means potato :evil: We need to get away from the fiction that 'vegetarian = healthy.'
My measurements are now OK, and I have learnt a lot of very useful stuff.

The DUK literature & plate clearly emphasise the spurious importance of carbs making a large contribution to the health of diabetics. While the dietitian showed that plate, she stressed that only sportsmen & manual workers who were using their enrgy needed up to the 14 portions of carb. None of us on the course needed more than 5 portions, amounting to 130 g carb.

Simple carb reduction transformed my life from threatened disablement - due to following the DUK advice - from peripheral neuropathy to a normal active life free from pain.

 

[IanD]

Eat freely: vegetables, meat, cheese, nuts, included fat, TEA
Avoid: bread, rice, potatoes, pasta, savoury snacks, sweets
Eat in moderation: fruit, added fat

That is very easy to follow. Obviously people with nut allergies, heart and/or kidney disease, etc need to make their own informed choices, & get professional advice.

I gave that to the leaders before sharing it at the final session.

My approach restored my health & activity, & is suitable as a basic approach for any diabetic without other health complications, who wants to achieve good control, thus avoiding complications, & maintain an active & healthy life. I'm 70 & I will challenge any club player to tennis (doubles) or table tennis. I may not win, but I need no concessions for age.

 

[IanD]

Third session - the dietician stressed that we should be on MINIMUM carbs & suggested 135 g per day as the figure, rather than the 300-400 you eat if you follow the DUK recommendations. (As I used to.)

We looked closely at labelling - what to look for, particularly total carbs rather than sugar. With advice on how & when to measure, with a Roche rep lending out meters for 6 measurements a day for 2 days.

One man's diet looked sensible, but still totalled about 260 g carb. He piled on the pasta at his evening meal - low GI but not low carb.

IMO - I did use the low-medium GI approach for several years the result was BG control at a higher level - instead of the BG spike of high GI I got a sustained BG above the level achieved by my present low carb diet. A diet of veg & proteins including fats gives sustained energy without raising the BG.

 

[IanD]

I had to point out to the demonstrator that the sides of fingers should be used - NOT the pads.

An extra session will take those who wish round the local Tescos.

 

[IanD]

Latest HbA1c= 5.9 Best ever.

2 years ago, on the DUK/NHS diet it was 6.7 & I was suffering neuropathy.

Kidney function (GFR) is 64, which is a bit low, but no change from 3 years ago, in spite of increased protein.

Forgive me shouting, but Dr says
KEEP UP WITH THE LOW CARB DIET.

He can't convince the Asians in his family to cut back on rice & rotis.

Results are just in time to report to the X-PERT course.

 

[IanD]

Final X-PERT session. Focus on complications, how to watch out for them, how to avoid them by care & control.

I took a leaflet I prepared, including my 'plate' & recipes, & samples for low carb fruit cake. I gave them to the leader, who was very happy to give them out & kept one for herself to copy ....

She asked if she could invite me back to contribute to future courses, as one who has taken on board the information provided, & adapted it to get good control & reverse complications.

If you get a chance, GO ON AN X-PERT COURSE.

Also
A SPECIAL 'THANK YOU' TO PEOPLE ON THIS FORUM WHO HAVE HELPED ME OVER THE PAST TWO YEARS.

With all the weird names people use, I wonder if I will recognise the others on the course when they join this forum.

 

[IanD]

A problem with most professionals - including those running this course - is that they are not diabetics - all their knowledge & experience is second hand.

I was able to contribute from the first hand experience of using the educational material - both sound & questionable - over 10 years, & suffering resultant predicted complications, as well as benefiting from the experience of others to tackle those complications & reverse them.

THE EXPERIENCE OF OTHERS IS VERY VALUABLE - THAT IS WHAT MAKES THIS FORUM SPECIAL.

 

[Katharine]

Well done Ian. It is great that they are allowing the low carb diet = much better control message through. I hope you can go on to help others on future courses.

 

[ditzeeblonde]

Great thread... Thank you.x

 

[Rievaulx7]

Thank you Ian. Very informative.

 

[CarbsRok]

y

 

[IanD]

I'm curious about your plate Ian.
Why have you used your plate again in this new thread?
I seem to remember you being told it was not very good at all by many members, which included a fully qualified dietitian.
Seems a bit daft to post it again and cause more confusion as to what is considered a suitable diet/learning tool.

The dietitian running the course approved it, & was happy to give it to other course participants.

I'll more reply by PM.

 

[IanD]

This is from two PMs I wrote in November 2008.

How many on the forum can report long term benefits? Fergus & who else? Lots have reported short term benefits.

The short term benefits for me are so great I am committed.

In one sense, I am not very interested in the long term down-side of carb restriction, as I have already suffered the long term down side of the NHS-DUK diet, & corrected it by reduced carb.
======== =
What that study [South-West study on restricted carbs - we are still awaiting publication - the comment was on preliminary results] shows is that carb reduction benefits T2s at least for the duration of the study. Most of us who have reduced carb would agree with that conclusion, & Ally has repeatedly advised carb control.

Presumably NONE of the subjects suffered adversely, or that would have been stated.

It is well known that higher BGs are the cause of all the health hazards for diabetics.

The report caveat is simply that they do have have data for long term carb reduction.

If short term data indicates benefits, surely they should pursue long term data.

Rather than therefore put the report in the back of the filing cabinet, "they" should set about gathering long term data to see if there are any long term negatives.

An alternative diabetic diet should be drawn up based around restricted carbs, taking into account the possible restriction of vitamins & minerals, & excess protein & fat, so that diabetics have a professionally guided option for BS control.

Such a diet should indicate side effects & counter indications that should be reported to the HPs.

If vitamin/mineral deficits are expected, there are enough diabetics for the manufacturers to justify a diabetic multi v/m supplement. I take the standard supplement anyway.

For me, the short term effect has been restoration of my active life. That has wonderfully corrected the long term effect of the NHS diabetes diet that was leading to neuropathy & disablement. i.e. the end of my active life.

For me, the benefits continue. Every blood test confirms my perception. My ONLY counter-indication is a mild kidney impairment - GFR=64 - & that predates low carbing & has not progressed.

The SABRE project tests - comprehensive heart/diabetes/cognitive function - were all satisfactory, so I have a tremendous incentive to continue doing it MY WAY* and recommending it to other T2s.

*MY WAY according to Paul Robeson, NOT Frank Sinatra.

My way leads to green, green pastures ....

 

[Katharine]

Ian, I agree your plate is not ideal. You've got a space for tea, but what about RED WINE?

 

[hanadr]

Well done Ian!
I wish my PCT would allow me on a course.( you know how I'd love to put the cats among the pigeons ) Apparently they don't run any. Plus they don't fund strips. Surprisingly :roll: they have a pretty poor record of diabetics with good control. Only around half hi HbA1cs of 7.5%
Hana

 

[IanD]

Well done Ian!
I wish my PCT would allow me on a course.( you know how I'd love to put the cats among the pigeons ) Apparently they don't run any. Plus they don't fund strips. Surprisingly :roll: they have a pretty poor record of diabetics with good control. Only around half hi HbA1cs of 7.5%
Hana

So, in PCTs like yours, what education is available for newly diagnosed diabetics :?:

When I was first diagnosed I was referred to a one day course run every week for new diabetics, where a team of nurse; dietitian; podiatrist & pharmacist gave us a grounding in the basics of our disease. I was also referred to the Hounslow diabetes support group.

That was very helpful & encouraging, even though the dietitian gave the standard DUK advice.

 

[sue32]

Ian - you've said it all. Well done lad, and congratulations on getting other people to realise it's the starchy carbs that are the problem. Since following the GL regime I have managed to lose in excess of 3 stone, simply by cutting out starchy carbs. The constant diarrhoea has gone, and I feel so much better. The only thing it hasn't helped is the osteoarthritis, which I'm surprised about. But for years diabetics have been told to eat a high carb diet and I was castigated when I told my diabetes nurse that I only ate complex carbs. She was astounded but when I told her my HbA1c had come down from 8.3 to 5.8 in 4 months she was a little more impressed. I think you do what works for you. AND I still have my 85% cocoa dark chocolate.

 

[Petal50]

2nd session .... Energy balance & the infamous 'healthy eating plate.'

We were given coloured tape measures for waist measurement. Over clothes, mine was 92 cm so I'm OK.[/b]

I've just done week 2 and we weren't give tape measure!
I agree that the "George" dvd was a time filler, and not diabetic relivant. As I am following a low carb eating plan they'll have fun sorting my plate out :lol: oh well back to the exercise..

 

[IanD]

Bumping this up as it's of general interest.

There are still NO counter-indications after over 3 years of reduced carb diet.