# Opinions on low carb diets



## luisa (Nov 3, 2011)

Hi all,

My name is Luisa, I am a dietitian and I have been doing a course in Diabetes. 

I have consistently seen patients on low carb diets have good results and I am looking at journal articles with varying degrees of evidence at the moment but, I feel any essay on the pros and cons of a low carb diet would be incomplete without the comments of those who have done them, or are doing them.

I am looking for comments good and bad with as much detail as possible - energy levels, weight, bowels etc

Please PM me or reply on here.

Thank you,

Luisa


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## Steff (Nov 3, 2011)

Hi Luisa have you mailed admin before you put this on the forum, usually not too keen on you given out your email address for all to see,so maybe use the PM(private mail) facility... 

Sorry if im doing a mods/admins job here dnt wanna step on anyones toes.


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## Jennywren (Nov 3, 2011)

I really wan to do a low carb diet , to loose some weight


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## luisa (Nov 3, 2011)

Thanks Steff,

Hi Jenny sorry I wouldn't be keen to give any advice on low carb diets as the position statement from Diabetes UK remains that there is still inadequate evidence but I do have an interest and so would like to hear from those who have tried them.

Thanks,

Luisa


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## Northerner (Nov 3, 2011)

Hi Luisa, as long as you are just looking for anecdotal evidence, I don't see any problem with you asking for responses here about people's experiences with low, or shall we say 'controlled', carb diets. Personally, I don't consciously restrict the carbs in my diet although I do tend to avoid snacking on carbs so that I don't have to have extra injections of insulin. I probably have somewhere in the region of 140-180g carbs per day. 

Really, it is a trade off for people I think. People need to discover how much carbohydrate they can consume in a meal or snack without raising their blood sugar levels too much. If they find that this amount is too low and represents too great a restriction then medication can allow for a more flexible diet. Some people are happy to restrict carbs to a very low level. We're all different! For me personally, lower carb content of meals means smaller amounts to inject, which also tends to mean better blood sugar control.


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## Pumper_Sue (Nov 3, 2011)

Hi Luisa,
           firstly you need to tell everyone what you consider a low carb diet 
There does seem to a rather wide veriation on what people consider low carb.


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## Robster65 (Nov 3, 2011)

I would personally find it difficult to eat enough calories on a low carb diet. I've tried lowering my carbs lately and am often falling short of my calorie targets.

The only solution would be more cheesecake.

As a T1, it isn't such a necessity to cut carbs unless research shows health benefits. I'm pleased it's being looked at, as long as it's done scientifically.

Rob


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## Natalie123 (Nov 3, 2011)

Hi Luisa,

Low carb diet is something that I have read about mainly from this forum and I get the opinion from type 2's that it can be really helpful for blood sugar control but dieticians I have spoken too don't recommend it and instead say we should stick to a balanced diet including plenty of carbs for energy. 

Personally I eat a reasonable amount of carbs but find that if I eat to much long lasting carbs like pasta or pizza this can make my sugar levels very hard to control even by using carb counting and insulin injections to compensate. I stick to medium amounts of carbs (under 90g carbs at a time which is high for some people).

The only time I have found low carb diet helpful is in the morning. I have dawn phenomenon where the liver outputs sugar in the morning. As a result I have high insulin resistance and need a high insulin to carb ratio in the morning. By cutting down my carbs to only 12 g and incresing the no carb foods (I have poached egg, tomatoes, mushrooms) in my breakfast I have been able to drop my insulin dose significantly and no longer suffer from spikes after breakfast, I feel better in terms of energy levels and there is the added bonus that I don't get hungry so quickly so I snack less.

Basically, low carb, and low GI diets can really help a lot of people and work like yours looking in to the pros and cons is really needed so that people can make a better informed choice of which diet to follow. People also need to know of any risks of a low carb diet before deciding.


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## Copepod (Nov 3, 2011)

Speaking purely personally, I generally match my insulin dose to carbohydrate content of food, which is connected with things like physical activity, infection, weather etc. However, it is a pleasure to have a carb free snack or meal once in a while - a meal with no associated injection. 

There was also an incident a few years ago when my partner and I were stuck on the wrong side of a Andean meltwater stream for 2 days (alternative was a 2 day walk over a 2000m pass, then bus back to city, then boat trip to reach the same border post), so we had to limit ourselves to 1 bowl of porridge a day, keeping other rations, dried apricots and muesli bars, for the 20km walk once we crossed the stream, left Argentina via a border post and walk towards Chile. We had a bonus of mugs of hot chocolate sold by Argentinean border post officers and apples and blackberries collected from roadside. Then we had to hope that our dried apricots wouldn't be confiscated as illegal imports into Chile. Obviously, in that situation, the ability to adapt MDI regime to just one bolus dose per day was pretty vital!


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## cherrypie (Nov 3, 2011)

Pumper_Sue said:


> Hi Luisa,
> firstly you need to tell everyone what you consider a low carb diet
> There does seem to a rather wide veriation on what people consider low carb.



I echo these sentiments.  Some people think that because they have lowered their carbs slightly from the recommendations that they are low carbing.  I would like to know what you consider the ratio of carbs and fats necessary to be a low carber..  Some extreme low carbers, 30-50gms per day, insist that you have to up your fat intake considerably.


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## luisa (Nov 3, 2011)

Thanks for the responses so far, they are all very useful. 

I see many Type 1s have been in touch and I think compared to Type 2s your knowledge on carbs tends to be better because it is repeated so often and if you are testing you BG levels regularly you can't help but be aware that what you eat will have an effect on your results.

Indeed Sue - what is a low carb diet? Well I may be as baffled as you! Many of the studies which look at a low carb diet state it as being 30-40% of the total intake which isn't really a big reduction on the recommended 55-60%.

I would be interested in those who have followed an Atkins or Paleo or DUKAN diet as these are particularly low carbohydrate. Interestingly they also advise that you reduce your alcohol intake. So, with so many variables are they really that easy to follow? But if you do, are the results worth it?

I should hasten to add that all the studies I have looked at have been with overweight or obese individuals and have resulted in weight loss therefore a very low carb diet  (e.g Atkins etc) is unlikely to be useful in a normal weight person with Type 2 Diabetes.

Any more queries, please feel free to ask. 

This is not a study just looking for opinions. Anything I use will give the 'jist' of what was said and no names. 

Luisa


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## Northerner (Nov 3, 2011)

luisa said:


> ...I should hasten to add that all the studies I have looked at have been with overweight or obese individuals and have resulted in weight loss therefore a very low carb diet  (e.g Atkins etc) is unlikely to be useful in a normal weight person with Type 2 Diabetes.
> ...Luisa



I think you will find that there are a lot of 'normal weight' people who do follow a very low carb diet, so that they can reduce their dependency on medications to control their blood sugar levels


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## trophywench (Nov 3, 2011)

There's a snag with everything though isn't there Luisa? - for instance, if you are gonna do Atkins properly, you need to take quite a lot of supplements.

I eat approx 130g of Carb a day.  I did before I was diagnosed - they asked what I ate typically, I told them, they said it was fine and balanced and enough calories, then told me what injection would cover all that (one jab a day then!!!)  I ate 130g a day, because that was 'normal' for me pre diabetes, within my 1500-ish cals, it kept my weight at 8st 6lbs, it kept me satisfied and why would I want any more?

I wish dietitians would stop telling people we NEED carbs.  We don't.

(We may WANT them though .....)


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## Pumper_Sue (Nov 3, 2011)

Personal view from me, as a type 1 for 47 years using an insulin pump.

Carbs are counted and restricted to no more than 50 carbs per meal.
If I eat more then my control goes wonky. If I lower carbs to far or just have fat and protein then I need almost twice as much insulin as I would for a carb meal. Pasta, rice, pizza, are never on the menu. ( I don't like them).

So you could say I am very carb aware and as I have aged my consumption of carbs has reduced greatly


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## cherrypie (Nov 3, 2011)

I also think that in the case of Type2's there is not enough education being handed out as to why we need to control, the amount of carbs we eat.  That is why forums like these are the best for Type2's as we are talking to other diabetics who understand.  We don't necessarily have to be extreme but if all Type2's were given a meter and test strips then we could educate ourselves as to the amount that is suitable for us on an individual basis.

I am an underweight Type2 and can manage 130 gms per day but any more than that and my levels are raised.  I do not take medication, although there may come a day when I have to. I am never hungry because I eat plenty of fresh veggies and balance my meals throughout the day.  It is very rare for me to have a snack.


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## luisa (Nov 3, 2011)

Hahaha! Tophywench you do make me smile. I feel that as a dietitian I need to use the evidence available to me to the best of my ability whilst supporting what my atient wants because ultimately it is your body and your Diabetes. Patients will do what they want and I want to facilitate that in a safe environment that takes what they want to do into account.

Also, yes Atkins and Paleo diets all suggest supplements which is an issue all of its own as some suggest mega-dosing which if you look at the studies can have links to cancer.

This is a very contentious issue, which I think is probably why I wanted to study it. I don't think there can be a conclusion with the current evidence just a need for more studies.

Northerner, yes definately I agree many 'normal' weight people do follow a much lower carb diet. I suspect when they see me in clinic they may tell me what they think I want to hear!


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## Pumper_Sue (Nov 3, 2011)

luisa said:


> Northerner, yes definately I agree many 'normal' weight people do follow a much lower carb diet. I suspect when they see me in clinic they may tell me what they think I want to hear!



Lol there's plenty of evidence about people doing this on all forums.
With the attitude of some dietitions it's hardly surprising though.


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## everydayupsanddowns (Nov 3, 2011)

I have never felt I was lacking in carbs - often I seem to be having more spuds than everyone else.

It therefore surprised me to read in various places that the typical 120 - 160g I have is considered 'moderate' by some and 'low' by others.

Although I can happily eat upwards of 100g in a single meal if it's something I am used to and have worked out a suitable split-dose system for I am a believer in small numbers:small mistakes / big numbers:big mistakes

The higher the carb load the greater significance of the inaccuracy in my usual guesswork (say 10-15%)... Additionally large boluses just do not behave as reliably (well in my experience anyway) as small ones. Much over 7 or 8u for me and the results just don't play out as I would expect - something to to with surface area:volume of the insulin according to a poster on another forum.


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## luisa (Nov 3, 2011)

Cherryie brilliant I am delighted for you and pleased that you have such good control.

We do try to have people within a normal weight range however if you have always been slightly underweight then I wouldn't have a problem with it, because as you describe you seem to have a healthy and varied diet. 

I get the feeling that perhaps Dietitians can be a bit hard on people with Diabetes sometimes, or certainly come across as being that way but I honestly believe that is for us as profession to change. 

My next wee project is patient satisfaction questionnaires but I daresay that is for a different forum!!!

Back to low carb experiences please


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## luisa (Nov 3, 2011)

Also thought this may be of interest:

http://www.diabetes.org.uk/About_us...ydrate-diets-for-people-with-Type-2-diabetes/


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## Pumper_Sue (Nov 3, 2011)

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.


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## Robster65 (Nov 3, 2011)

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


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## luisa (Nov 3, 2011)

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


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## everydayupsanddowns (Nov 3, 2011)

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


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## luisa (Nov 3, 2011)

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?


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## Pumper_Sue (Nov 3, 2011)

luisa said:


> 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.
> ...



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.


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## Pumper_Sue (Nov 3, 2011)

luisa said:


> 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.


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## slipper (Nov 3, 2011)

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.


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## everydayupsanddowns (Nov 3, 2011)

luisa said:


> 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).


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## cherrypie (Nov 3, 2011)

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.


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## Tubolard (Nov 3, 2011)

cherrypie said:


> 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.


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## Northerner (Nov 3, 2011)

Tubolard said:


> ...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! )


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## Tubolard (Nov 3, 2011)

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


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## luisa (Nov 4, 2011)

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


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## Northerner (Nov 4, 2011)

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!


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## luisa (Nov 4, 2011)

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


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## Mark T (Nov 4, 2011)

> 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.


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## Northerner (Nov 4, 2011)

luisa said:


> ...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!


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## Northerner (Nov 4, 2011)

luisa said:


> ...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


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## FM001 (Nov 4, 2011)

Northerner said:


> 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?


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## cherrypie (Nov 4, 2011)

This link is taken from a Dafne Forum and it seems that some Type2's on insulin are given access to Dafne.  Quite a grey area though.
http://www.dafneonline.co.uk/forums/4/topics/24


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## rhall92380 (Nov 4, 2011)

luisa said:


> 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 have been fortunate to have been referred to excellent dietician advice. Their advice helped me to lose 4 stones of weight and get my HbA1c down to less than 5% (my last one was 4.4) by diet and exercise alone. I got a free meter from a rep and was prescribed strips until a GP decided I didn't need them anymore!

I am not low carb - horses for courses I guess - but I run 3 times a week.

Richard


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## Northerner (Nov 4, 2011)

cherrypie said:


> This link is taken from a Dafne Forum and it seems that some Type2's on insulin are given access to Dafne.  Quite a grey area though.
> http://www.dafneonline.co.uk/forums/4/topics/24



Interesting, but it still begs the question of why there is no appropriate course available for Type2s on MDI? I can see that a mix of T1 and T2 might not work very well, but surely T2s on MDI and with weight issues are in even greater need of education? I know of several members in this situation that have been unable to benefit from a structured education course relevant to their treatment. Perhaps they are just too rare for courses to be viable - I have no idea what the figures are (or even whether such figures have ever been compiled).


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## cherrypie (Nov 4, 2011)

Northerner said:


> Interesting, but it still begs the question of why there is no appropriate course available for Type2s on MDI? I can see that a mix of T1 and T2 might not work very well, but surely T2s on MDI and with weight issues are in even greater need of education? I know of several members in this situation that have been unable to benefit from a structured education course relevant to their treatment. Perhaps they are just too rare for courses to be viable - I have no idea what the figures are (or even whether such figures have ever been compiled).


It seems that the National Service Framework for Diabetes is to blame as to why Type2's on insulin are treated in the primary care setting.  "There is now expectation that nurses in primary care will become more involved in the initiation of insulin therapy in Type2 diabetics".

This is a guide from the RCN to their members to help to educate them with insulin therapy for Type2's.  Don't know how good it is as I am not an insulin user.  Perhaps others could comment on it?

http://www.rcn.org.uk/__data/assets/pdf_file/0009/78606/002254.pdf


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## luisa (Nov 4, 2011)

There is now a DESMOND programme (and possibly X-pert also) for those with Type 2 Diabetes commencing insulin.

Unfortunately I think it comes down to governmental budget. When I worked in East Yorkshire the provision for services for those with Diabetes was excellent. And the Diabetes Specialist Dietitian was fantastic. I really couldn't say enough good things about her as she was quite inspirational to me at that time. She was down to earth and I like that.


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## Pumper_Sue (Nov 4, 2011)

luisa said:


> There is now a DESMOND programme (and possibly X-pert also) for those with Type 2 Diabetes commencing insulin.
> 
> Unfortunately I think it comes down to governmental budget. When I worked in East Yorkshire the provision for services for those with Diabetes was excellent. And the Diabetes Specialist Dietitian was fantastic. I really couldn't say enough good things about her as she was quite inspirational to me at that time. She was down to earth and I like that.



Only one? 





> And the Diabetes Specialist Dietitian was fantastic. I really couldn't say enough good things about her as she was quite inspirational to me at that time.


 there lies the the problem 

How many people with diabetes was she expected to see?


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## Robster65 (Nov 4, 2011)

It is a numbers game. As the number of diabetics grows at astronomical rates, so the personnel to support them diminishes at a similar rate.

There's no way they're going to employ more dieticians or other specialists with the cuts as they are. Hence things being left to GPs to try and cover the services. Sadly, the GPs have their own profit margin to consider along with the postcode lottery of informed and proactive practices.

Rob


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## Northerner (Nov 4, 2011)

Robster65 said:


> It is a numbers game. As the number of diabetics grows at astronomical rates, so the personnel to support them diminishes at a similar rate.
> 
> There's no way they're going to employ more dieticians or other specialists with the cuts as they are. Hence things being left to GPs to try and cover the services. Sadly, the GPs have their own profit margin to consider along with the postcode lottery of informed and proactive practices.
> 
> Rob



I remember reading a (US) article a while ago. The increase in diagnoses over there is already outstripping the capability of the Diabetes Educators to keep up, plus the number of people choosing it as a specialty is declining, so both things are heading in the wrong direction and will soon (if they are not already) be stretched to breaking point


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## Robster65 (Nov 4, 2011)

I don't know why we don't have diabetes educators over here. I'm sure they could set up some sort of advocate system. Even a semi-formal email system for when DSNs are busy. No clinical advice but coping strategies and what's normal/abnormal, etc.

Even dietary advice would not be out of the question. The forum is good for that but there must be people who don't feel confident to post but could do with a helping hand. A bit of basic training in tuition and some pointers on what's acceptable and away you go.

Rob


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