Diabetes Dietician meeting failure

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Ralph-YK

Ralph-YK

Much missed Member
Relationship to Diabetes
Type 2
Just had appointment with the Diabetes Dietician (that's her post). I handled it very badly. I've not been that great with any of the appointments I've had with people. However I made complete hash of this one with the dietician.
I may have come accross a tad obsesive about self testing. I kept explaning & excusing myself. At one point she was saying to reduce carbs in one of the meals on my food diary (really, she did) and I actually got her to back down. Arg. ;( The rest of the time she was for not controlling carbs and was adament I wasn't to cut carbs from my diet altogher (based on one cooked breakfast!). She also wasn't happy with how often I was testing in a day. It is necessary to establish what is going on. Ok, nine times a day is edging toward numerious 😉 And there was too much concert about cararies and leaning towards weight control.
 
Ralph-YK said:
Just had appointment with the Diabetes Dietician (that's her post). I handled it very badly. I've not been that great with any of the appointments I've had with people. However I made complete hash of this one with the dietician.
I may have come accross a tad obsesive about self testing. I kept explaning & excusing myself. At one point she was saying to reduce carbs in one of the meals on my food diary (really, she did) and I actually got her to back down. Arg. ;( The rest of the time she was for not controlling carbs and was adament I wasn't to cut carbs from my diet altogher (based on one cooked breakfast!). She also wasn't happy with how often I was testing in a day. It is necessary to establish what is going on. Ok, nine times a day is edging toward numerious 😉 And there was too much concert about cararies and leaning towards weight control.
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It's really just advice Ralph. If you think you've got it worked out for yourself in terms of what keeps your levels stable, why worry? Nine times a day is a lot for a type 2 who has been diagnosed over 18 months but perhaps you've only just started self testing and are trying to work out what suits you.
My advice would be never apologise to these people and don't be defensive. It's your body and your choices and she can only advise what they see as the ideal balanced diet. I simply said thanks very much, never mentioned self testing and declined a further appointment. She recommended far too much fruit to suit me. They get funny about carbs because they refuse to accept current dietary thinking especially if they trained years ago. Most still demonise all fats and are hung up on continuing to eat spuds and/or buns with very meal.

Is the 'concert about cararies' meant to be 'concern about calories' or a reference to birdsong! Lol
 
Amigo said:
Is the 'concert about cararies' meant to be 'concern about calories' or a reference to birdsong! Lol
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Ah, yes. Spelling correction error.

Amigo said:
It's really just advice Ralph. If you think you've got it worked out for yourself in terms of what keeps your levels stable, why worry? Nine times a day is a lot for a type 2 who has been diagnosed over 18 months but perhaps you've only just started self testing and are trying to work out what suits you.
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Sorry Amigo. Yes, I have only just started testing, last week. Thread here: https://forum.diabetes.org.uk/boards/threads/first-set-of-readings-self-testing.59847/
I've had the "you don't need to" and "you'd only worry if you knew you're figures!"
I've been making the point that I'm not sorted and need to figure things out. If I'd been testing less I'd have missed the peak at 1 hour post eating. (Which is higher than at 2 hours). Once I've established what's going on I can reduce the tests I do. Then after seeing the effects of any changes I make I should be able to drop it right down.
The dietician was bothered about me hurting my pore fingers. Apart from an instruction last time I saw here to eat more vegitables, and her problem with the cooked breakfast, she's very much "carry on as you are."
The only reason I brought up the testing was because I'd put readings on the food diary to get some feedback. Without them it's pointless showing them to her.
I've had low carb off here, controlling carbs from the recent info sessions I've done, otherwise all I've had is them just about giving the healthy eating advice. Which actually is nothing more than a reminder.
 
I wonder if all the conflicting advice is making you over-think things Ralph and isnt helping you. My advice would be to test before you eat on a morning, 2 hrs after breakfast and then the same lunch and teatime until you know what suits you. Keep a record of what you're eating and how the figures change. You'll soon work out what your unique tolerances are and which foods to limit or even eliminate, I'm not sure why you're testing 1 hr after eating too. That will have your fingers sore if you continue with it and your hba1c doesn't seem so extreme to warrant it. Just my view.

Start trusting your own testing and records and if it's a good balanced diet, your diabetic levels will be good and your weight should start to reduce. Concentrate on reduced carb and I think you'll get into a way of controlling that suits you. I don't always find it necessary to have carbs for every meal.
 
Your post summarises my plan. And my understanding was to test 2 hours after eating. However, it's mentioned on here that some things would peak a lot sooner. So I tested a couple of times and found a higher peak at one hour. Looks like everything I eat is higher at one hour. I guess that's when I'm going to have to test, instead of at 2.
 
The one-hour peak can be a little misleading.

In a non-D, eating food triggers a blood sugar rise that leads to the insulin response. By definition then, all non-Ds must go 'high' after eating, although the insulin response will kick in to prevent that high from being too substantial.

Therefore, you will inherently have higher blood sugar readings one hour after eating than you would after two. This shouldn't be a cause for concern providing the spikes at the one hour mark are not massively high and your two-hour reading is broadly in line with your pre-meal reading.

By way of example, if your premeal reading is 4.5, your 1 hour reading is 8.5, and your 2 hour reading is 5.5, I would consider that whatever you ate was 'safe'. If that one hour reading was in the 9s or higher, I would be more concerned, and if your 1 hour reading was 'good' (ie. under 7) but your two-hour one was higher, I would also be concerned.
 
Premeal: 5.9 1 hour post: 11.7 2 hour post: 8.7
 
A bit too high that one, probably Ralph.

Why don't you, now that you are on all fours with it and know you can't decide to have a carb fest at the drop of a hat - instead of doing all meals every day - just 'intensively' test one of them, for a while and experiment with what you eat for that meal till you find a choices or choices, that you and your BG meter are happy with? Then ignore that one for a bit - knowing you should be OK - and move on to intensively testing the next for a while?
 
Ralph-YK said:
Premeal: 5.9 1 hour post: 11.7 2 hour post: 8.7
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As a matter of interest Ralph, what did that meal comprise of? Presumably you've logged the content of that meal so you'll know to either reduce the carb content in it or reduce portion size.
I never test after 1 hr for the reasons Deus gives. However my 2 hr reading would normally be higher than my pre-meal reading and I'd expect it to be but I aim for no more than 2 points, i.e. If it was 6.5 pre then no more than 8.5 two hours after.
 
I have recently been doing 1hr testing and have worried that it was higher than my 2hr reading. But it looks like I don't need to worry too much if that 1hr rise is below the 9's.
 
If I'm trying out some new food I test after an hour then about every half hour till my levels start to drop.
 
That particular one was shredded wheat.
I've also had the following:
Large jacket potatoe, cheese & salad. Mug of coffee
5.7, 7.8, 7.0

Jacket potatoe 9 oz. Macrel, peas, sweetcorn, runner beans
5.6, 11.1, 7.0

Egg salad sandwich on small brown breadcake
5.3, 10.3, 5.7

Cooked breakfast, bacon, egg, sausage, baked beans, chopped tomatoes
6.3, 8.7, 7.8.
 
trophywench said:
...instead of doing all meals every day - just 'intensively' test one of them, for a while and experiment with what you eat for that meal till you find a choices or choices, that you and your BG meter are happy with? Then ignore that one for a bit - knowing you should be OK - and move on to intensively testing the next for a while?
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That's an idea TW
 
I think it might help you better to see the wood from the trees, rather than trying to cover all day altogether.

How does one eat a whole elephant? (shheesh - nobody can do that - it's not possible!)

Oh yes they can! Divide the elephant up into bite-sized pieces!
 
How do you get down off an elephant? You don't. You get down off a mouse, it's easier.
I think I may very well do that.
 
you don't have to cut out all carbs, just reduce the ones that spike you. I eat most above ground veg and salad carbs as I want to, moderate protein and a bit more fats. It's only the sugars and starches I avoid or measure. That 9oz potato and corn would push me too high, too

I don't know if you have seen this but I found it good info for testing
http://www.phlaunt.com/diabetes/14045524.php

SD codefree meter have the cheapest strips if you self fund.
http://www.homehealth-uk.com/medical/blood_glucose_monitor_testing.htm
if you buy extra boxes of strips there is a discount code ..5 packs 264086
 
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Thanks Bilbie. The dietician was all bothered about the idea of me cutting out all carbs. Interestingly, that idea hasn't come from me.
I have the SD code free.
 
Ralph-YK said:
Thanks Bilbie. The dietician was all bothered about the idea of me cutting out all carbs. Interestingly, that idea hasn't come from me.
I have the SD code free.
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There are plenty of other carbs to get some minerals, vitamins and fiber from. I don't think sugar/starch is a food group

Just my thoughts on your meals, if they were for me and I was testing a specific meal.
Large jacket potatoe, cheese & salad. Mug of coffee
5.7, 7.8, 7.0
*I think the cheese fats slowed down the higher starch digestion and gave a lower spike @1hr but higher over time, @2hr (I would have tested @2.5 and @3hr to see when my BG went back to normal. As you would know, this is known as the 'pizza effect')

Jacket potatoe 9 oz. Macrel, peas, sweetcorn, runner beans
5.6, 11.1, 7.0
* bad spike @1hr, still high @2hr (too much carb)

Egg salad sandwich on small brown breadcake
5.3, 10.3, 5.7
*bad spike @1hr..normal @2hr (too much carbs)

Cooked breakfast, bacon, egg, sausage (?? depending on meat/fat content higher is better), baked beans,(and sugar carby sauce) chopped tomatoes
6.3, 8.7, 7.8.
* pizza effect slowing the baked beans/sauce and maybe carby sausage spike and longer over time.

From my poor example.. 115kg to 105kg/230lb, in a few months, and same weight +/- 2kg for 3 years now. With A1c that is ok, but nothing special now, If you want to lose weight, you may need to do more that just have good bloods. ( I've had starch creeping up, I was at A1c of 5.2% )

This gives a simple overview to how it works for me. The more carbs I eat the more carbs I want. They don’t give up easy and it’s biochemical


an introduction to low carb (no need to pay to see more, there is plenty on the net)
http://www.dietdoctor.com/low-carb

what to expect the first week, besides being starving hungry for the first 36 hours, then it stops
http://lowcarbdiets.about.com/od/lowcarb101/a/firstweek.htm
 
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I've now told the Diabetic Dietician's office to cancel any future appointments with her, saying "I have got as much as I can from these appointments". It's been completely useless seeing her, and I don't see her as being any help to anybody.
It's really disheartening that she's providing no useful information, guidance or support.
 
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