This time I am going to ask for the services of the dietician, a service I have never used
Give it a go, but in my personal experience, most dieticians are relatively clueless when it comes to deciding what is a good diet for someone with diabetes.
For instance, I've had dieticians in the past tell me it's ok to eat as much fruit as I like. Unfortunately, doing so plays havoc with my blood sugar. It's a better option than eating cake, yes, but my feeling is telling someone with D that it's ok to eat plenty of bananas isn't a smart move.
There also seems to be a strange disconnect between the actual facts about insulin and fat storage. Most dieticians will tell you that high fat foods are bad for you because they clog your arteries. Yet in the same instance, they will tell you that you need to burn up more body fat. There's no metabolic difference between fat on your plate and fat on your belly - so why is it that metabolising dietary fat is apparently artery clogging etc, yet metabolising your own body fat is a completely benign process? The other thing to bear in mind is ask them to list what they would consider fatty foods. You'll get things like chips or burgers or pizza. Do make sure you ask them which is the largest macronutrient in all those things, and then ask why they're called 'fatty' foods when there's another component that's clearly larger.
Many dieticians will also affirm that you should eat plenty of carbs instead of fat 'to prevent hypos', and that by eating less fat, you'll lose weight. If they tell you this, firstly ask them, what will happen to your insulin intake if you eat more carbs. Then ask them, what hormone processes carbohydrate to be stored as fat - clue, it's insulin. Then see if they can keep a straight face when you ask them how taking more fat storage hormone, and more stuff that the hormone converts to fat, will make you lose weight.
For the record, I'm not a low-carber - I love my bread and my pasta and I'll always include those in my diet for as long as I'm able to adequately cover them with insulin and not gain weight. The point is that the diet advice offered by the NHS is frankly riddled with holes that fall apart the moment you look at the science and beyond the perceived wisdom. There are very few out there in the NHS prepared to consider diet options beyond the usual 50% of every meal must be starchy carbs and you must snack regularly - and then they wonder why so many people get complications!
There are people in there though who are prepared to consider that the best approach is find what works for your health goals, rather than stick to a 'this is the food pyramid and it's what you must do' routine. Hope your dietician is one of them.
