Your opinions on diabetic nurse advice please

[Loulabelle]

I am a bit confused following yesterday's visit to the diabetic nurse, I wonder if you would give me your opinions please?
I have been following a very low carb diet, feel good from that and have been testing a lot since being diagnosed. I am on metformin and have lost nearly a stone since July. I was following a low carb diet to loose weight before I was diagnosed in September.
I have been avoiding foods that take my levels higher than 7.8 2 hours after eating. From what i have read levels above this can damage me.
The diabetic nurse said that everyone's levels rise after eating and so long as they are back down to 6/7 before the next meal then I should not worry about them being as high as 9 2 hours after a meal. The nurse said that it is only when levels are continually above 7.8 that damage starts, if they are going up and down then there is no need to worry, damage won't be happening. It's only when they are always higher than 7.8 that damage happens? Is this right? Surely if they are high for short periods often that can't be good.
I know everyone's levels rise and dip and am now confused.
I wondered what opinions here were as to the advice I was given yesterday.
Much as I love the idea of being able to be a little more lax in what I eat I am not sure if this is right at all. The low carbing is helpIng my levels, my weight and my feel good factor.
(Oh and I got the don't bother to test anymore advice but I am going to ignore that!!!)
Thanks for reading, I hope it made sense!

 

[puzzymunkle]

so many conflicting views on diabetes treatment. I just tend to do what feels right.

 

[Squire Fulwood]

Technically your nurse is going against NICE guide lines which say that you are ok if your sugar levels are less than 8.5 two hours after a meal. Diabetics like to argue the points of whether that means the start of a meal or the end of a meal and whether the 8.5 is too high etc.

Personally, if I had to put a stop watch on to find out exactly what moment I started a meal then I am worrying too much. Also 8.5 is not a target, it's a max and you may not get anywhere near it on some days and anyway if you are sailing so close to the wind that you have to get your stopwatch out again then you have a problem.

Telling you not to test is daft. Ask her how you are to manage the life changing activities if you can't see whether or not you are progressing.

Finally there are more than a few people who think that the 8.5 limit is too high. I also think it may be a little high but that does not mean it should turn into a self punishing "got to get it even lower" treadmill. Sometimes if you are managing by diet you make a mistake. Try to be big about it and find out why.

I just remembered something else. After eating your sugar goes high then gets lower and the two hour point shows how it is progressing. If you start testing half an hour and an hour after eating you might frighten yourself. These spikes always happen to some degree but very large ones can't be good. Flour causes me to have high spikes and may well be causing damage so I feel I should avoid it.

 

[viviennem]

Hi Loulabelle

If low-carbing feels right for you, then stick with it. It's usually good for your BGs, you BP, your cholesterol and your weight!

The nurses have to promote the NHS' official guidelines, which is what your nurse is doing. Also, many HCPs seem to think that no-one can get proper control of their BGs so suggest a more lax target. Like one of my GPs once desperately reassuring me that an HbA1c of 6 is perfectly acceptable! Okay, yes it is, but my preference is the low 5s, and that's where I am at the moment.

I personally prefer to have my BGs close to, preferably within, the non-diabetic range. I do this by low-carbing. Okay, so I'm no angel and I do have slips, but on the whole I stick to what suits me. My practice nurse and my usual GP know exactly what I'm doing, and both quietly approve.

Do your research, and then stick to what suits you. :wink:

Viv 8)

 

[Daibell]

Hi. I think your DN should have some respect for the NICE diabetes guidelines which do appear to be well thought thru despite the madness of NHS diet advice. I wonder why your DN thinks she knows better than NICE? I wish we all knew how much damage is done when BS is raised for varying periods of time. It is almost impossible to have any read studies on this so I'm sure the best advice is keep the HBa1c as near to 'normal' as possible and avoid large spikes.

 

[Loulabelle]

Thank you for your replies. I think it is really stupid to suggest not testing, esp. as the diabetes nurse does not actually have diabetes herself and doesn't seem to realise how useful it has been for working out what food causes what reaction.

I fully intend on continuing my low carb diet because I know if I went back to eating what I used to my levels would be through the roof, I would feel awful and weight would pile on.

I suppose what I was really wondering was is having levels that peak at over 7.8 damaging if they go to under 7 before the next meal? I think I know I should really be avoiding the spikes.

Probably it's not worth running the risk. I just wanted a little banana now and then.... :crazy:

 

[Squire Fulwood]

My nurse says that I should eat little and often. The theory is that this could lower the spikes and flatten the graph of your sugar level during the day.

The interesting thing is that she is not happy about dips in the graph either. She says you risk a liver dump and some confusion as to where the sugar came from. In order to comply with her wishes I take the two hour test and then have a treat. I know it's hard but someone has to do it. As my sugar level is falling I provide the means for it to stop falling and so avoiding the liver's intervention.

I have not used a banana for this research yet and I think we need someone to try it and let us know how they get on. Two hours after your meal have half a banana and let us know what happened. It's all in the interest of science you know.

You don't have to do it again if it goes wrong.

 

[Loulabelle]

:wink:
I already know that banana raises me too high, I think that will be the case whether I eat it straight after my meal or after the two hour test.

Since no one seems to know if the highs do damage even though they are not constant I will err on the side of caution.

Thanks for taking the time to answer.

 

[Grazer]

suppose what I was really wondering was is having levels that peak at over 7.8 damaging if they go to under 7 before the next meal? I think I know I should really be avoiding the spikes.

Overall, your nurse sounds quite irresponsible really. There IS evidence that peaks effect us in themselves, but of course peaks also add to our overall average. Remember, if we got to 9, (which your nurse says is fine), we don't go there just for a few minutes. We would have elevated BGs for hours. Do that three times a day, and we're hardly likely to have good overall averages.
If you were just back to 6/7 before meals, again which your nurse says is fine, and then up to 9 again afterwards for a few hours,
we're probably going to have overall averages far higher than the level she says is ok (which most of us think are too high anyway)
So overall, my view is she's talking rubbish,. Carry on trying for those 7.8 max figures two hours after eating. We don't always get there, but it's a good target you've set to aim for.

 

[Loulabelle]

Thanks Grazer
I don't know why I hadn't thought about my averages, good point.
I am going to carry on as I have been trying to keep my levels lower and avoiding peaks and troughs. I gotta do what feels right for me.

 

[Cobra3164]

Heloooo. From what I am learning and this is only an opinion not a solid fact, think of your BG as a pressure vessel and max allowed is 7, would you want to take it over the limit and risk slow damage say within the same BG as your diabetic nurse advised you. Over time small amounts of weakening and damage will occur if you exceed maximum, the pancreas when it functions tries to keep a limit on blood sugar and when that rises the pancreas compensates by producing more insulin, like a safety valve in the vessel. Unlike the safety valve as diabetics we possess the limited or no ability to compensate, but at the same time in reality it is very difficult to get those levels right.

In conclusion without going on to much :lol: I do believe that we can do accumulative damage over a long period of time by exceeding limits, but one problem exists no real guidelines or proven limit can say what that excess limit is. The best to do is to set a realistic limit individually over time as we learn how our bodies react to different foodstuffs etc. Even healthcare people are not right all of the time.

Hope this input is of help


Simon aka Cobra3164

 

[Catsymoo]

Hello all. My diabetic nurse told me that as long as my blood sugar remains in single figures and doesn't stay high for long, then I am okay. But I am still relatively new diagnosed. I think they wanted to just get it stable for now and then I can work on tighter control later on. But considering I'm only a few months in, I am doing brilliantly. My consultant wants to switch me to basal bolus regime rather than a mix, but didn't have time to teach me to carb count before I went away to Holland.

I generally think single figures is an okay starter guideline, but I do like to keep it as close to a non-diabetic's levels as possible. I would rather eat smaller portions throughout the day, and risk hypos, than have it running high a lot. It is so much easier to fix a low than a high, for me anyway. I only have a mixed insulin and nothing to correct highs, so I have to be careful. I do find that if it's too high, if I inject a tiny bit (4-5 units), drink lots of water and go and run up and down stairs in my apartment complex, it drops to normal so fast I get dizzy! But as long as I get it down fast, I don't think it does any damage.

I gave up my favourite breakfast for now because porridge seemed to be so low GI, that although it did not give me any "spikes", per se, it was releasing the carbs slowly all day, and keeping it around 7. Which was an annoying figure to see 5 hours later when I was hungry again. So I tend to eat one piece of toast with peanut butter and cinnamon for breakfast. And 2 -4 squares of dark chocolate because I crave it when I get up, and it stops a hypo before lunch. :roll:

The downside of small portions all day is that sometimes I'm low, felt I've eaten loads and overdone it, test 2 hours later and it's still a bit too low. This makes me feel fat!

But overall, I think diabetic nurse is supposed to work as just a simple guideline for diabetes "in general". They can show you signposts on your journey, but it's still you that has to walk the path, and it's up to you and you alone which direction or shortcut you want to take.

 

[lindae]

Hi I am very confused I was told in june that I am type two the nurse said eat what I like in moderation as long as I have carbs at every meal do more exersise and that I do not need to test at all they will test at my birthday review which was in august but as off yet no review i rang about it and was told that august was too near june and it wasnt needed what should i be eating please linda :

 

[Squire Fulwood]

Hi I am very confused I was told in june that I am type two the nurse said eat what I like in moderation as long as I have carbs at every meal do more exersise and that I do not need to test at all they will test at my birthday review which was in august but as off yet no review i rang about it and was told that august was too near june and it wasnt needed what should i be eating please linda :

Since this is a difficult situation where you have been cast adrift until your next review I can only give limited help.

The four things that will aggravate your diabetes are sugar, flour, rice and potatoes but there is no need to get alarmed.

Sugar should be avoided particularly sugary drinks and unnecessary sugar anywhere else. For some of us flour based products are a problem and you should take avoiding action. BUT some flour, rice and potatoes in reduced portion sizes should tide you over to whenever you have a review.

 

[Squire Fulwood]

Sorry about the mis spellings and stuff. I think I have now edited them out.

 

[Daibell]

Hi Lindae. There is no medical/scientific evidence whatsoever that you need to have carbs with every meal. Do have some carbs during the day and as you will see in many places on the forum 'eat to your meter'. You probably know the HBa1c targets to go for if not have a look at the NICE Diabetes guidelines or ask a question on the forum. The best approach is to have a diet that enables you to meet your target. In the longer term if that doesn't work then some meds may be needed but hopefully that won't be a while yet.

 

[mattr]

I am a bit confused following yesterday's visit to the diabetic nurse, I wonder if you would give me your opinions please?
I have been following a very low carb diet, feel good from that and have been testing a lot since being diagnosed. I am on metformin and have lost nearly a stone since July. I was following a low carb diet to loose weight before I was diagnosed in September.
I have been avoiding foods that take my levels higher than 7.8 2 hours after eating. From what i have read levels above this can damage me.
The diabetic nurse said that everyone's levels rise after eating and so long as they are back down to 6/7 before the next meal then I should not worry about them being as high as 9 2 hours after a meal. The nurse said that it is only when levels are continually above 7.8 that damage starts, if they are going up and down then there is no need to worry, damage won't be happening. It's only when they are always higher than 7.8 that damage happens? Is this right? Surely if they are high for short periods often that can't be good.
I know everyone's levels rise and dip and am now confused.
I wondered what opinions here were as to the advice I was given yesterday.
Much as I love the idea of being able to be a little more lax in what I eat I am not sure if this is right at all. The low carbing is helpIng my levels, my weight and my feel good factor.
(Oh and I got the don't bother to test anymore advice but I am going to ignore that!!!)
Thanks for reading, I hope it made sense!

To me most of the advice seems fair, it's not just about the type of food it's also going to be about the portion size and insulin resistance/activity. For type ones the fast acting insulin with food can still be being absorbed for up to 4 hours making the 2 hour NICE guideline unachievable sometimes when eating the same as my friends/family. I place more priority on consistantly keeping my evening, overnight and morning BG stable and in target when I'm not eating carbs because as I understood it only mild damage starts to occur over 7.8

 

[Fraddycat]

Hi Linda, welcome to the forum!

Hi I am very confused I was told in june that I am type two the nurse said eat what I like in moderation as long as I have carbs at every meal do more exersise and that I do not need to test at all they will test at my birthday review which was in august but as off yet no review i rang about it and was told that august was too near june and it wasnt needed what should i be eating please linda :

Have a look at this link which gives more detail about the role of carbohydrates as the other posters talked about. Many of us have found that following the advice of the nurse will not necessarily keep us well.

viewtopic.php?f=39&t=26870

Ask lots of questions!