Opinions on low carb diets

[Pumper_Sue]

Well ok then according to that article, I have been a low to moderate carber from the age of 4 1/2 I have no complications so it must be safe then.

 

[Robster65]

Just thought I'd pitch a bit more about carb amounts.

When I was diagnosed in 1978, as a 13 year old, I was given a diet sheet totalling about 300g of carbs per day. As I've aged and changed regime to MDI it was never suggested that I modify that amount by any of the dieticians I've seen over the years.

Only when I came on this forum last year did I realise I'm probably eating a lot more than many other T1s or T2s. I would also add that, for me, that amount isn't a huge problem, so it's still a horses for courses thing.

The othe rpoint is that many newly diagnosed T2s come on saying they've been advised to avoid sugary foods and eat starch. When we point out that all carbs raise blood glucose, they are often surprised.

Surely patients need to be taught what carbs are before debating the high or low carb diets.🙄

Rob

 

[luisa]

Yes you would be surprised how many Type 2s are not aware that starchy CHOs also break down to produce glucose.

Which obviously begs the question why? If they attend a dietitian or structured education programme e.g. DESMOND or X-pert this should not be the case.

Another thing I would like to mention is that after diagnosis with Type 2 Diabetes sometimes the patient isn't ready to listen to the changes they need to make until the second or third consulatation and for some it may be a year after diagnosis before they are ready to take on information and make dietary changes.

Luisa

 

[everydayupsanddowns]

As soon as I satrted visiting forums I began to come across T2s who had initially followed the dietary advice they were given (variations of: eat starchy carbs at every meal / base every meal on starchy carbs / eat lots of starchy carbs at every meal) and found their weight ballooned and their A1cs stayed dangerously high no matter even on maximum doses of oral meds.

Many seemed to find that acquiring a meter and 'Jennifers Advice' (or another variant) revolutionised their BG levels, weight dropped, insulin resistance fell away and several were/are able to reduce of come off meds entirely.

It is very heartening to hear a dietician who is advocating a moderated carb approach. Many in your profession seem to recommend newly diagnosed T2s on D&E increase their carb intake after diagnosis 😱

 

[luisa]

Thank you everyday, I appreciate your comment.

Everone is an individual therefore we must make our advice tailored to each individual. Further to a more moderate carb approach Diabetes UK have emphasised that for overweight/obese Type 2s we should be aiming to reduce total kcals wherever possible conducive to weight loss as weight loss is the one thing that all papers agree improves HbA1c and cardiovascular risk.

Surely it should be that simple?

 

[Pumper_Sue]

Yes you would be surprised how many Type 2s are not aware that starchy CHOs also break down to produce glucose.

Which obviously begs the question why? If they attend a dietitian or structured education programme e.g. DESMOND or X-pert this should not be the case.
If about sums it up. How many see a dietition? Most are given unqualified advice from the practice nurse.
Another thing I would like to mention is that after diagnosis with Type 2 Diabetes sometimes the patient isn't ready to listen to the changes they need to make until the second or third consulatation and for some it may be a year after diagnosis before they are ready to take on information and make dietary changes.

Luisa

Again Luisa how many people with diabetes do you know who get to see a dietition 2 or 3 times?
Even though I am type 1 I have seen 2 in 47 years.

 

[Pumper_Sue]

Thank you everyday, I appreciate your comment.

Everone is an individual therefore we must make our advice tailored to each individual. Further to a more moderate carb approach Diabetes UK have emphasised that for overweight/obese Type 2s we should be aiming to reduce total kcals wherever possible conducive to weight loss as weight loss is the one thing that all papers agree improves HbA1c and cardiovascular risk.

Surely it should be that simple?

Then perhaps you should think about binning the recipe section on diabetes UK. It's not well thought of by the enlightened diabetic. 🙄

 

[slipper]

Agree with Mike above. I was told, by my Nurse, not to test more than twice a week and get plenty of starchy carbs.

However on buying my own strips and testing various foods, an idea picked up from forums like this one, I was horrified at some of my readings.

I cut out a lot of carbs, perhaps too much,(down to about 50g per day,) and both lost a lot of weight and tamed my BG levels. I have found though that I seem overly sensitive to carbs, something I would not have known without self testing, and the next stage of my diabetes knowledge is to find out what to do about it.

BTW, bowels are better for it.🙂

 

[everydayupsanddowns]

Surely it should be that simple?

Indeed it should. Yet up and down the country people have had *that* appointment today and they have been sent away with a half-page diet sheet and to come back in 6 months. Meanwhile their eyeballs are frying.

The alternative? Test strips and proper dietary education for all T2s in the first 6-9 months so that they can observe and evaluate exactly what type and level of carb intake and at what time of day their body can satisfactorily process. GI notwithstanding, as the saying goes: YDMV (your diabetes may vary) and the only way you can really tell what is going on, as Slipper points out, is to test test test.

Once the initial splurge of testing/education has taken place strips could be reduced to a more 'maintenance' level to save short term cost (though I suspect the avoidance of treatment of complications would make the approach cost effective in the longer term).

 

[cherrypie]

I have never been offered the services of a dietitian and I was diagnosed 8+ years ago. If I hadn't had a great G.P. who gave me a meter and test strips and recommended following a low G.I. diet, with book titles to help me, I dread to think where I would be now. Access to the internet and plenty of research also helped.
Not a day goes by without Type2's joining forums and they have had very little education or advice. They find that fellow diabetics do more for them to help manage their condition than their HCP's.

 

[Tubolard]

I have never been offered the services of a dietitian and I was diagnosed 8+ years ago. If I hadn't had a great G.P. who gave me a meter and test strips and recommended following a low G.I. diet, with book titles to help me, I dread to think where I would be now. Access to the internet and plenty of research also helped.

Not a day goes by without Type2's joining forums and they have had very little education or advice. They find that fellow diabetics do more for them to help manage their condition than their HCP's.

It's a shame that dietetics is an under resourced over stretched function in many PCTs. I was lucky, I was extremely overweight when I was diagnosed and was referred to a dietitian almost immediately. It was three months or so before I managed to get an appointment tho'.

So, all I had was the leaflet from the PCT and another forum to help me. Either the leaflet from my PCT is better written than everybody else's or I misunderstood it. The advice I received was to mind the quality of carbs rather than quantity, and I maintain that that's still solid advice.

I've managed to lose ten stone since diagnosis three years ago, and I've still got more to lose; there's no denying that I've reduced the quantity of carbs I'm eating but nowhere near the extremes recommended by some 'nutritionists'.

Regards, Tubs.

 

[Northerner]

...I've managed to lose ten stone since diagnosis three years ago, and I've still got more to lose; there's no denying that I've reduced the quantity of carbs I'm eating but nowhere near the extremes recommended by some 'nutritionists'.

Regards, Tubs.

Terrific weight reduction Tubs 🙂 (You took your time making your first post - it's been nearly 3 years! 😉)

 

[Tubolard]

Oooh! it is my first post - and there was me thinking I'd posted on before I'll just go and shuffle back into my shell then

 

[luisa]

Tubs fantastic!!! I am delighted for you 🙂

I am very fortunate that in the primary care area in which I work I see all newly diagnosed Type 2s and anyone with either a raised HbA1c, raised Chol or lower HDL and I see them annually after diagnosis EXCEPT, when I feel they would benefit from further intervention. Then the practices give me the freedom to bring them back for a review as often as I feel appropriate.

I also work closely with DSNs for less well controlled patients or those going on to insulin, byetta etc.

We also have a weight management service which patients can be referred to in order to aid weight loss.

I do agree entirely for a motivated patient (I am sure all those on here are but some are not) regular 'finger prick tests' to assess blood glucose levels are incredibly valuable to gain good glycaemic control or then again if control starts to deteriorate.

I feel the provision of good health care professionals should be available as often (or infrequently) as the patient feels they are required.

Hope all that is ok?

Luisa

 

[Northerner]

Luisa, if only all people could access such a good service. I have been very fortunate in that my experiences were only good ones post-diagnosis and it horrifies me to read some of the experiences from people here - if it can be achieved in one place, why not another? And you are right that motivated people should be given access to self-monitoring, but many people hit a complete brick wall when they request strips on prescription, often despite being able to demonstrate the usefulness of it and potential future savings (not to say, additional quality of life for the patient) by avoiding costly and distressing complications.

For patients who are not motivated to test, I do wonder how often this is because the advantages are not explained to them and either their doctor subscribes to the notion that they will become depressed and anxious at high levels, or simply wants to save the money that would be required to provide strips AND instruction on how to use the information they provide to improve glycaemic control.

It needs to be borne in mind that a lot of people are diagnosed in late middle-age, and may have spent a lifetime respecting and obeying the doctor and it may never enter their minds to question the advice they are being given. Unfortunately, some of that advice is completely wrong - I've even heard of doctors saying a person can't be Type 1 if they are over 40, or that testing more than twice a day for someone on insulin would be excessive! I kid you not! 😱

 

[luisa]

Absolutely ridiculous! Cost saving is often the primary concern and I am lucky that I don't look after budgets 🙂 I do know that after the recent set of cuts I am very lucky to still be working!

There are many good medics as well though who do see the benefits for a Type 2 to test regularly but frequently its only for a short period or those Type 2s commencing insulin.

I personally find the food diary BG diary combination essential to improving glycaemic control in a motivated patient. Those who aren't motivated simply don't test or keep an inaccurate food diary. The ones who do tend to lose weight and have improved control (the DSN is my partner in crime!)

Personally, it is very rewarding when a patient does well - I was walking on air on wed when I saw a patient who had completely turned round his lifestyle because he realised he needed to if he wanted to avoid insulin. BG levels are improving, weight is dropping and his diet is perfect. I am very very proud of him as I can only give advice and he has to put in the hard work! (Yes he was using a blood glucose meter to achieve this!)

Luisa

 

[Mark T]

Which obviously begs the question why? If they attend a dietitian or structured education programme e.g. DESMOND or X-pert this should not be the case.

I think the answer to this is already well known - structured education programs as not available to all. Since DUK included this in the survey question sent earlier this year- I wonder how many did reply that they had been offered or had access.

I did ask the question if there was one in my area but I got a blank look. Similarly there are 2 dieticians within the team at my local hospital, but it's never been suggested that I could see one.

I didn't actually push the dietician issue all that much because I assumed they would just reel out the standard advice - which I felt would be as much use as a chocolate teapot.

I was on about 70g Carb per day when I was trying to loose weight. I'm probably now on 130g - 140g Carb per day (I'm at BMI ~23) but I don't tightly monitor my carb consumption - but I do avoid snacking and eating know High GI foods.

 

[Northerner]

...Personally, it is very rewarding when a patient does well - I was walking on air on wed when I saw a patient who had completely turned round his lifestyle because he realised he needed to if he wanted to avoid insulin. BG levels are improving, weight is dropping and his diet is perfect. I am very very proud of him as I can only give advice and he has to put in the hard work! (Yes he was using a blood glucose meter to achieve this!)

Luisa

This is one of the most rewarding things about forums like this. Week by week we see people joining, learning and acting to get to grips with their diabetes and there has been a stream of successes. Which brings me to another point - peer support can be just as essential to achieving good blood sugar control as many medications. In fact, many people are able to reduce their medications after participating here and learning how to stabilise and lower their overall levels (and I'm sure we have a lot of 'lurkers' who similarly benefit!).

I would like to see more patients informed about well-managed forums and their benefits, and if necessary given introductory lessons in how to use them. Many HCPs already recommend sites, but I think there is still a large proportion who are suspicious of the internet and patients finding out things for themselves, in the mistaken belief that they will get dangerous advice that will jeopardise their treatment. Here we make it clear that we are not healthcare professionals (for the most part!), and we share experiences rather than giving advice. Learning from the experiences of others and adapting those to suit your own particular needs is one of the primary benefits. Plus, of course, we have a lot of fun too. Hope and humour! 🙂

 

[Northerner]

...Which obviously begs the question why? If they attend a dietitian or structured education programme e.g. DESMOND or X-pert this should not be the case.
Luisa

One very serious omission in the diabetes education field is a course for Type 2s on insulin. There are somewhere in the region of 900k Type2s on insulin in the UK, but they are denied access to courses such as DAFNE or BERTIE as they are designed for Type 1s. Granted, many of those Type 2s are on basal insulin only, but many Type 2s are on MDI and should receive instruction equivalent to what a Type 1 can expect.

As has already been noted, some HCPs are oblivious of the existence of any T2 education courses, which is shameful given that it affects 2.5m people

 

[FM001]

One very serious omission in the diabetes education field is a course for Type 2s on insulin. There are somewhere in the region of 900k Type2s on insulin in the UK, but they are denied access to courses such as DAFNE or BERTIE as they are designed for Type 1s. Granted, many of those Type 2s are on basal insulin only, but many Type 2s are on MDI and should receive instruction equivalent to what a Type 1 can expect.

As has already been noted, some HCPs are oblivious of the existence of any T2 education courses, which is shameful given that it affects 2.5m people

Why are type 2's on MDI denied access to dafne? Doesn't make sense to me Is it because dafne was introduced in Germany in the 90's and they didn't recommend MDI for type 2's then?