X-PERT course

Haven't got any personal experience, the course website is here, http://www.xpert-diabetes.org.uk/.

The course structure is here: http://www.xpert-diabetes.org.uk/artman ... dex_27.php

Regards, Tubs.

%5.7% sounds pretty good to me. Why do they want to raise it? Ask them to do their own HbA1c and see what a non-diabetic is. You have a right to be at non-diabetic level. They shouldn't be trying to make you into a sick person. That makes me furious. Are they just control freaks? Fight for the right to be healthy nad free of complications.

i had a look at the link that Tubs gave, no wonder your BS isnt considered high enough it still preaches the hi carb doctrine. Personally speaking thats enough for me not to touch it with a barge pole but its your choice of course .

Ask away

Dave P

Perhaps it's me, but I fail to see how the course preaches a high carb doctrine, on this page the site says:

An important concept for the participants to understand is that for optimum diabetes control it is not the amount of sugar in food or drink, but the quantity and quality of carbohydrate.

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And on this page, the site says

The group explores the process of carbohydrate food digestion and the resulting rise in blood glucose levels

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Personally, I find the idea of a supermarket visit slightly patronising, but if it helps, it helps. I don't buy into the idea that the NHS recommendations for people with diabetes are as simplistic as eat loads of starches and consume less fat. I do agree that in certain cases the delivery of the recommendations has been, for want of a better word, flawed.

George.

George its a free country and your opinions and views are yours to do with as you will. But take the standard plate of 25% carbs then test your BS and come back with the results.

Dave P

can I just say that I sometimes refer pts to an xpert course and they have found it really useful . The info on the website is just for a guide - the course is pt led and so works around individuals.

it tends to be low gi focused - no doubt that works .

tbh the supermarket visit is actually very useful - it generates a lot of chat and is informal. I live where I work and often find my own pts struggling with food labels - it is' nt patronising at all honestly. I take athletes on similar

I would rec it because you more time with people . Sometimes the infois flawed maybe because it is coming from the wrong HP!

Dave,

And there you have it, yes the course makes reference to the eatwell plate, what does the FSA say about the plate? Well here it says the eatwell plate does

not include references to frequency of serving and ‘recommended’ portion sizes, other than in relation to fruit and vegetables – at least five portions of a variety a day – or fish – eat two portions a week, one of which should be oily

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and goes on to say

The eatwell plate is intended as a tool suitable for use with most adults, and therefore it would be misleading to include specific frequency or proportion advice when people have individual requirements. However, registered dietitians, who work with individuals, should still tailor their advice in consultations based upon the individual's current diet and food preferences.

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The BDA says, in its factsheet for people with diabetes:

What you eat or don't eat and your physical activity level are vital in controlling all these factors

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and goes on to say

Include some carbohydrate foods with a lower glycaemic index at each meal

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The way I read the information from both sources is that the eatwell plate is a good starting point, however because of our diabetes, we need to pay careful attention to the quantity and quality of carbohydrates we stuff into mouths. Which is what I meant when I said that I don't consider the NHS recommendations are as simplistic as eat loads of starches and consume less fat.

There have been too many posts on this forum where people have just been shown the eatwell plate and told to eat according to that with no discussion about changing the quality or quantity of carbohydrates, and that is what I mean by the recommendations have been badly delivered.

Far too often we see people reporting good HbA1cs who have been told that they are far too low and that the person should aim for a higher A1c. Which is arrant nonsense, it seems to me that whoever is passing that advice on isn't bothering to find out any information about the individual concerned. There appears to be an underlying assumption that a person with diabetes who has a normal or near-normal A1c must be experiencing some hypoglycaemic episodes. The fact that type 2s on diet alone or diet and glucophage may experience low blood glucose levels - but can recover from them by switching off insulin production - seems not to occur to some of our HCPs. The simple question, "Have you experienced any disabling hypos?", should be asked. To get someone to decrease their meds which by inference will raise the A1c is, I have to say, absolute madness.

I have to say here that I think that the NHS is at fault, the move of services to primary care means that some of us are dealing with GPs who have not had any specialist training in diabetes. Our GPs are following the NICE playbook which, it has to be said, leads them to treat patients in a general way rather than the truly unique individuals we are.

George

george that was a good post.

I use the plate as you said - as a tool . Soetimes its no use talking about carbs or protein it is easiet to talk food groups.

and yes many pc staff have no training in diabetes at all - someone just gets lumped with it. I have to say it isnt the case with the HP I work with they are excellent and we work as a team

I have been snowed under with new type 2 in recent months - we had 26 new pts in oct and similar numbers in nov and dec !

Can I just add, that in my haste to post a link to the x-pert course that I neglected to congratulate sleepylu on the fantastic achievement of reducing her HbA1c?

Regards, Tubs.

Looks like an updated Desmonds to me but retaining the same dietary information. Having read through it and seen the eatwell plate, its the same **** advice re carbs, see extract below.

try to eat:
– plenty of fruit and vegetables
– plenty of bread, rice, potatoes, pasta and other starchy foods – choose wholegrain varieties whenever you can– some milk and dairy foods
– some meat, fish, eggs, beans and other non-dairy sources of protein
– just a small amount of foods and drinks high in fat and/or sugar

Regards Graham

I read the words on the FSA website, not just the picture. It says to eat "plenty of bread, potatoes, rice and pasta." It does say that wholegrain are preferable. So it's still the same old nonsense. However if a supermarket trip is included in the EX-PERT course, that's excellent. Not everyone is as clued up as this group and reading nutrition panels is a vital skill.( just think how many people don't know what acarbohydrate is) Members of this forum can possibly slip in a few sharply pointed questions. It might get some people thinking. Patients and educators.
No-one in my area gets courses, because the 2 full time diabetes educators have too little time or funds to run them. I'm still trying to work out what they do do. Perhaps visit GP surgeries and drink tea!
My GP agrees that I am right to go for a non-diabetic HbA1c.
I'm hoping!!!!!
Blood was taken yesterday and I haven't seen a BG above 6 for months.
Ps Graham was writing at the smae time as me and we obviously agree

Graham and Hana

The food plate is a guide and just that - its not set in stone.

What does plenty of carbs mean any way - its not specific advice.

These type of courses help alot of people , maybe those who don't have access to the internet.

I think it is a great shame its a postcode lottery again.

Well,Ally ,what does 'plenty' mean?? To a lay person it means lots.The same as 'some' to a lay person would mean not so much.It's high time these people got their act together and re-read their own information and made it much clearer.

I do agree with you its is very wooly advice and I dont know what it means and I am a Dietitian - tbh I have no idea who writes this stuff anyway - it certainly isnt dietitians as the FSA does not have any!

They cannot put specific advice on the expert site but the wording is wrong!

Bungle said:

I don't buy into the idea that the NHS recommendations for people with diabetes are as simplistic as eat loads of starches and consume less fat.

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But that's exactly what it said on the leaflet I was handed!

This happens to a lot of people. Others are fortunate to meet either more aware doctors and dieticians, or ones with less restrictive guidlelines they are told to follow

(AFAICR my leaflet was copyright 1978 or something)

where did you get that leaflet - I dont recognise it!

Just found this while looking for guidelines.

http://pubs.acs.org/doi/full/10.1021/pr ... ookieSet=1

I've started a new thread about guidelines so that this thread can go back to topic.