Lack of Education

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Stickin' to It
New Member


Date Joined Dec 2007
Total Posts : 5
   Posted 12/25/2007 2:00 PM (GMT -7)   
Hello everyone!

I was diagnosed 10 years ago now, and I have to say that I was fortunate to have a great dietitian in the hospital really break things down for me. We went over carb counts, how to read labels, meal planning, mixing foods for even sugar distribution throughout the day. Flat out, she was wonderful.

Unfortunately, I am hearing from more and more diabetics that they are receiving very little, if any, education upon being diagnosed and/or hospitalized. I've heard many say the doctor told them to "eat better and exercise" and that was it. How can this be?

My best friend (he's 38 years old) is extremely obese and was diagnosed 3 weeks ago. He too, was given almost no education from the professionals. I taught him everything I've learned over the years, but still, why is this happening?

Just curious, how confused were all of you when you left the hospital? Did you have a great experience like I did, or was the education almost non-existent?

SGB

Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 12/26/2007 9:45 AM (GMT -7)   
Welcome to HealingWell, Stick. It's THE place to be if you are into sharing tips and what works to keep your sugars in line. For myself, I had my two classes ten years apart, they were covered by insurance and they were pretty much along the ADA guidelines. They taught me about portions, measuring my sugars, taking meds and following my prescribed "diet". Looking back, I feel that they were meager and inadequate.

I tried to do as I was told and my sugars just kept going up, my medication amounts kept increasing and my weight steadily climbed... eventually I was on three meds, Lantus insulin, Avandia and maxed out on metformin. I was 13 lbs away from 300 and miserable as could be. Even though I was a forum moderator here I was pretty discouraged.

Then, last spring our finances hit the skids and I (now without insurance) could no longer afford my Avandia. In desperation I did something that my friends here on the forum had been proposing for years. (I had thought that they were fanatics about the 'low carb' food plan.) I stopped eating anything white except cauliflower. No milk, grain based products or potatoes... period. Even without my Avandia, with this new plan my blood sugars dropped dramatically.

Eating was weird for a time. A turkey sandwich was really turkey rolled up in lots of romaine lettuce with some mustard and mayo. Nuts became a good friend, especially with cheese. I upped my fruit consumption and doubled up on the veggies at each meal, increasing my salads and trying new canned and frozen veggies and sprinkled everything with lots of olive oil. I wasn't hungry, and I wasn't trying to be virtuous... I was just trying to get those darned sugar numbers down so I wouldn't have to increase my Lantus, which, by the way, was costing me a fortune without insurance, as well.

Then something amazing happened... My neuropathy started to diminish. My stamina and energy levels increased... and then my clothes started to get baggy... REALLY BAGGY! I was losing weight without even trying!!! I had been fighting my weight my whole adult life and tried multiple 'diets' including everything from liquid protein to visiting a weight loss clinic four days a week. I had never in my life lost weight without a major emotional battle, tons of commitment and lots of feelings of deprivation and martyrdom.

Here I was, losing weight slowly but surely... not five pounds a week or anything... just a bit at a time the way you should.. and not even trying! The kicker came when I lost my slip walking out of church Easter Sunday! It was a nice 'fat lady' 1/2 slip that I'd had for years and as I walked to the car it just fell down around my ankles. I was so overjoyed that I wasn't even embarrassed! I"m off the avandia, no longer on Lantus insulin and have decreased my metformin by 500 mg a day. My doctor is overjoyed and told me to KOKO! (Keep on keepin' on!)

So, to return to your question about education... No, I don't think any of the teaching out there is adequate. I'm a bit angry that I had to stumble upon this forum and be fortunate enough to meet up with peeps like fergusc who actually understand the physiology of the glucose/insulin response in our bodies. I don't think that there is a conspiracy to keep us on meds, as some people do, but I think that the doctors in this country are woefully undereducated about nutrition and energy consumption in the body and I believe that we need a revolution in thinking that will re-write the ADA guidelines. I feel cheated of all of the years that I was fighting to keep my sugars down and eating grain based foods because that's what the 'diet czars' were proposing. I feel angry for the loss of sight and all the foot problems I have experience from moderately elevated sugars over the years. I just wish someone with some guts would have told me to stop eating all starches and to substitute vegetables and nuts and healthy oils! ... But now I know... so I'll just have to smile and carry on from here.... Sorry for the rant.
~ Jeannie, Forum Moderator/Diabetes & Fibromyalgia
~Please remember that 50% of all doctors graduated in the bottom half of their class! Yours may be one of them...
"People are like stained glass windows: They sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."- Elizabeth Kubler-Ross


ceebee
Regular Member


Date Joined Dec 2006
Total Posts : 401
   Posted 12/26/2007 10:00 AM (GMT -7)   
I was given very little information about what to eat. Maybe 5 minutes and told to look up ADA diet on line. I wasn't even taught to give the lantus shot. I was really left to find out everything myself. Tried eating the ADA way. Didn't work for me. I was in ketoasidosis when admitted to the hospital and kept three days and sent home with BS of 500 and just Metformin. I was also given lasix to start at home and I was already dehydrated. Was taken by ambulance two days later and on IV insulin, IV liquid and antibiotic for a week. I almost died and still not given much information. That was the last week in October and I am just getting into a program and an endo this week. Doctors here treat diabetes as a common disease and say just eat and cover it with insulin. I learned the low carb eating here and it is working great for me. Haven't had to use the novolog I have for emergency at all and hope to get the lantus down from 28 or stopped all together after I see the endo dr. I am starting to feel good for the first time in 18 monthes.I was diagnosed in October and has Ac1 of 15.2 and will be tested in January after three months. I can't wait to see how far it has come down. Also have lost 55 pounds on the low carb eating plan. I even cheated and ate some carbs yesterday and the BS only hit 112. Back to low carb today:) Question... I have low BS most mornings and take 1000 Metformin and 28 units lantus before bed. Have to eat carbs before bed to stay at 80 in morning. Too much meds? I do not feel good lower than 80. Thanks:)

fergusc
Regular Member


Date Joined Dec 2005
Total Posts : 230
   Posted 12/26/2007 10:48 AM (GMT -7)   

Always look on the bright side of life, I say.

If you haven't been 'educated' by the doctors or dieticians traditionally assigned to care for diabetic patients and advise on appropriate diets, you're already much better off than those who have!

There's no shortage of great posts on this website that discuss in depth the issues surrounding what we eat, so I'll not get started on that again. Suffice to say, those who restrict or eliminate carbohydrates from their diet will enjoy enormous health benefits including weight loss, normal blood sugars and improved blood lipids. NONE of these things are possible on the sort of carbohydrate based diet a 'specialist' would be likely to recommend.

And thanks, Jeannie!

All the best,

fergusc


Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 12/26/2007 11:37 AM (GMT -7)   
Ceebee,
As you have lost weight you should probably talk to your doctor's office over the phone about decreasing your Lantus. I'll admit, I just started experimenting with mine and dropped from 15 units to 13, then 12 etc. until I quit it. I watched my morning sugars and the lowered weight seemed to be the thing that decreased the need for insulin. I can't prescribe here, but that was my experience. Sounds to me (in all my ignorance) that your Lantus amount is too high and that's leading to the morning lows. Call the nurse at the doctor's office and see if it's ok for you to cut down on your dosage, ok? That way you can get an answer without having to pay for an office visit.
~ Jeannie, Forum Moderator/Diabetes & Fibromyalgia
~Please remember that 50% of all doctors graduated in the bottom half of their class! Yours may be one of them...
"People are like stained glass windows: They sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."- Elizabeth Kubler-Ross


Stickin' to It
New Member


Date Joined Dec 2007
Total Posts : 5
   Posted 12/26/2007 4:04 PM (GMT -7)   
Perhaps you all are right. Maybe those who didn't get much of an education from the doctors are better off! Anyway, I've been reading alot of posts from you all describing your success with the low-carb diet. I have noticed though that I get kind of shaky and irritable when I go without carbs (blood sugar not low however). Is this normal? Some experts believe that the body MUST have carbs for energy. If it is working for you all so well, I may have to try it and monitor my progress. I suppose everyone reacts different to different methods.

LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5408
   Posted 12/26/2007 4:36 PM (GMT -7)   
Stickin', what are your blood sugar readings before and after eating?  If someone's blood sugar has been running very high for awhile, then that person might even feel shaky in the 90's or low 100's even though those are normal (more or less) blood sugar readings.  It might take some time to get used to having normal or lower blood sugar.  Of course, I'm not talking about too low, which is not good either.  Our body gets carbs from vegetables, legumes, nuts and other food.  We don't have to eat obvious carbs to get them.  I think many people panic when they think of giving up carbs.  Maybe they think they'll faint or have no energy because as everyone learns in school:  carbohydrates provide us with energy and brain food.  If you follow a low carb diet, your body can (and will) convert protein to blood sugar but very slowly.  If you are an athlete or take meds to control diabetes, you may need to adjust the diet as well as the meds to keep your blood sugar from going too low, which is why you need to test fairly often when you change your diet or meds/dosage.  If you are overweight, as many type 2's are, a low-carbohydrate diet will let you lose weight.  Yes, most people here feel that a low or no carb lifestyle is more beneficial than other plans for controlling blood sugar.   

Lanie
forum moderator - diabetes
"pre-diabetic" controlled so far by diet and exercise
following low/no carb diet, no meds


tutorgirl
Regular Member


Date Joined Aug 2007
Total Posts : 235
   Posted 12/26/2007 5:40 PM (GMT -7)   
I think I am probably in the same boat as everyone else. The only education I had was a session with a nutritionist where she gave me a book on the diabetic exchange diet. That worked for awhile, but I think that was only because I was walking my brains out. (I really need to do that now.) But my lifesaver has been this forum and Dr. Bernstein's book. The low carb way of eating is the only thing that has worked for me. I have lost close to 50 lbs. by not dieting...just eliminating most carbs. And my numbers have been so much better. They still aren't where I would like them, but I'll keep doing what I'm doing. I have my first appointment with an endo on Jan. 7 and it will be very interesting to see what her take on the low carb way of eating is. I have been hearing more and more of actual diabetic specialists embracing the very low carb idea. Maybe if we keep screaming it from the rooftops it will finally get through...ya think?
===================
>Karen<
~Forum Moderator/Diabetes~


Stickin' to It
New Member


Date Joined Dec 2007
Total Posts : 5
   Posted 12/26/2007 7:18 PM (GMT -7)   
Lanie,

You are right, my sugars have been very high for quite sometime. I'm sure that must be why my body seems to not like it very much when I don't get carbs. I am a little overweight (about 20 lbs), but nowhere near the massive 267 lbs when I was diagnosed. Don't give me too much credit though, I think most of the weight came off the wrong way.

TutorGirl,

Keep us posted on what the endo says.

LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5408
   Posted 12/26/2007 8:06 PM (GMT -7)   
I went to one class for newly diagnosed diabetics and didn't go back.  They were faithful to the ADA's diet plan.  The "heart healthy" diet pamphlet I was given by my doctor and the class is low fat with lots of whole grain food.  This was nearly a year ago.  I think there are two camps in the diabetes war: the standard food pyramid group and the low-carb,  and I decided to belong to the low carb group after doing a lot of reading.  If the low-fat, heart healthy diet worked, I'd follow it, but it doesn't help you control blood sugar or lose weight.
 
Stick, if you set goals for your blood sugar to bring it down more slowly, you'd probably adjust to the lower blood sugar better.
Lanie
forum moderator - diabetes
"pre-diabetic" controlled so far by diet and exercise
following low/no carb diet, no meds


gelchick
Regular Member


Date Joined Aug 2006
Total Posts : 477
   Posted 12/27/2007 3:41 PM (GMT -7)   

I would like to point out from a biochemical point of view that that there is no such thing as an essential carbohydrate- there are essential amino acids (which are obtained from proteins) and essential fatty acids ( which are obtained from fats). This means that you must eat proteins and fats to obtain necessary components for maintainance and repair. If you never in your life ate even one leaf of lettuce or any other form of carb- you would not suffer from any nutritional deficiency as long as you ate adequate calories to meet your metabolic needs. The human body has several biochemical pathways that allow it to manufacture all necessary glucose from the carbon, oyxgen, and hydrogen it breaks out of the proteins and fats you eat.

I was diagnosed with sugars in the mid- 400's- I thought I would die when I dropped down into the high 200's. Today, my average blood sugar runs in the mid- to- high 80's most of the time and I feel great.  Your body is designed to function best when the blood sugar is maintained in this range with an A1c between 4.0 and 6.0. This is called homeostasis. Anything higher on a regular basis is asking for trouble.

When I was diagnosed, several meetings with a diabetes dietitian and CDE were covered by my insurance and appointments were booked for me by my doctor. I received numerous booklets written by the ADA, and an eating plan that included 200 carbs per day. I followed this plan religiously. As a scientist, I own several precision digital balances. I weighed and measured every molecule that crossed my lips. On the ADA plan and the drug Actos- I gained 27 pounds in 2 months ( 14 pounds in 14 days-  I called my doctor and told her I would not swallow one more of those pills). I called the dietitian for more help - and she told me to decrease my fats and proteins and increase my carbs to drop my calorie count- my sugar climbed higher, my doctor blamed that on my refusal to take the Actos ( I was taking glipizide so my sugar should have been dropping).

I started to search out ways to control blood sugar and happened upon The Diabetes Solution- by Dr. Richard Bernstein- I didn't believe most of what he said- after all, my Ph.D. is in protein biochemistry and I knew that Atkins type diets were very dangerous. I also was well acquainted with the dangers of eating saturated fat, and the virtues of eating organic carbs. I knew that 7th day adventists (who are vegetarians) live longer and have far less diabetes and heart disease than the general population. Again, because I am a scientist, I went to the actual literature ( not interpretations by the media, or reviews by scientific writers) and started to read, and look at, and interpret the data for myself.

I slowly came to realize that although the human body prefers to burn carbs (they are cheap fuel), it doesn't require that the carbs be actually ingested, and I started to reduce my carbs. The further I reduced my carb intake, the better I felt- until I hit about 60 net carbs per day (less than half of the minimum 130 recommmended by the ADA and most dietitians). That's about the minimum that I can eat and still meet my protein requirement (vegetable protein sources such as beans and nuts have more carbs than animal protein sources which have none).

You owe it to yourself to get your blood glucose numbers down into a non-diabetic  (normal homeostatic) range. More medicine is not the answer- lower carbs and increased exercise is the best way to do this. Read the Diabetes Solution, Carb Wars, and Good Calories Bad Calories and decide for yourself. It's your body and your health.

sandy

 


I just want to live happily ever after-every now and then. Jimmy Buffett


fergusc
Regular Member


Date Joined Dec 2005
Total Posts : 230
   Posted 12/27/2007 5:02 PM (GMT -7)   
Yours is a really interesting story, Sandy.
It's interesting that so many people are coming to similar conclusions about the dangers of carbohydrates and the efficacy of diets much lower in carbs and higher in priotein and fats. Some have gone straight for the kill, having read Bernstein's book and found it worked for them straight away. Others, like us, have, made some of these discoveries for ourselves and then found the supporting information to consolidate things afterwards.
I think if people are reaching similar conclusions via different methodologies, it strengthens the low-carb position even more.
I was slightly puzzled by your comments about the dangers of Atkins type diets and saturated fats though. Were these dangers which you perceived based on prior assumptions which you then dismissed? Or did you dismiss the dangers on the basis of your own experinces?

All the best,

fergusc

LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5408
   Posted 12/27/2007 7:20 PM (GMT -7)   
Good post, Sandy.  When I was trying to figure things out (before Bernstein), I bought a paperback book by David Medosa, something with a title like "What Makes Blood Sugar Rise, What makes it Fall" - can't remember the exact title.  In it, he states that carbs make blood sugar rise.  When I read that, I figured that's the key, that's all I needed to know and that was just the beginning.  No thanks to the medical profession, I've been able to control it pretty well.  I think most people still think that grains are a necessity and butter/animal fats will give us heart attacks.  We still read this and hear this everywhere. 

Lanie
forum moderator - diabetes
"pre-diabetic" controlled so far by diet and exercise
following low/no carb diet, no meds


ceebee
Regular Member


Date Joined Dec 2006
Total Posts : 401
   Posted 12/27/2007 10:36 PM (GMT -7)   
At my appointment today I asked how many carbs a person had to have as EVERYONE kept telling me I needed them except for here...I was told NONE.

gelchick
Regular Member


Date Joined Aug 2006
Total Posts : 477
   Posted 12/28/2007 12:33 PM (GMT -7)   
fergusc,
 
I probably should have placed that entire paragraph in italics. I did my Ph.D. through a medical school and 90% of my classes were the same classes that the med students took- the difference was that I was required to carry a 90% average to Pass and the med students were required to carry a 75%- so I needed to be better educated to kill rodents in the lab than the young doctors needed to be to kill people (irony intended!)
 
My nutrition and organic biochemistry (study of the human body and its biochemical pathways) classes stressed the dangers of high protein diets, high fat eating, saturated fats and their relationship to heart disease, etc. AHA, ADA, USDA partyline to the core. I was so good in these classes that I was hired (at an obscenely high hourly rate) to tutor the med students who couldn't make it through the semester class and were given a make-up class in the summer (ph.d. students didn't have this option- either they passed or were dismissed from their programs). 
 
So when I first encountered Bernstein- I was sure that he was some sort of nutcase. I was so well-versed in the low-fat, high carb dogma I couldn't even imagine that a person could thrive under a low-carb regimen, much less a person with a damaged metabolism, and prone to liver and kidney problems ( reportedly exacerbated by a high protein diet). I also 'knew' that the human brain required glucose as its only source of energy- and starvation in the human body is largely driven by a glucose-starved brain. My thinking was further solidified by the experiences of one of my high-school students who went on a zero-carb diet to make weight for his wrestling class and wound up in the hospital with mental and physical deficiences that were attributed to his new-diet.
 
It took a lot of reading to convince me otherwise. It's hard to give-up long held beliefs that you learned at the feet of world-class experts. I became my own lab rat- and so far the experiment is proving the hypothesis.
 
sandy
I just want to live happily ever after-every now and then. Jimmy Buffett


fergusc
Regular Member


Date Joined Dec 2005
Total Posts : 230
   Posted 12/28/2007 1:34 PM (GMT -7)   
This is fascinating stuff, Sandy.
If nothing else, it highlights the dangers inherent in any scientific dogma - it matters little how eminent or worthy the expert, without an open mind capable of rational thought and analysis, we may as well be back in the Spanish Inquisition!
My diabetes specialist physician is an eminent Professor and author of many research papers on the subject. Yet he thinks I'm insane running an HbA1C in the 4% range, thinks low carbohydrate diets are dangerous and a short term fad, and has never heard of Richard Bernstein. D'oh!
I feel every bit as dogmatic myself at times, but then I lived the alternative way for many years and know from direct experience that the benefits of low-carb are enormous. Not only that but the overwhelming archaelogical evidence supports the contention that humans have never subsisted on a high carbohydrate, low fat diet. And this one aint startin now.

All the best,

fergusc

Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 12/29/2007 8:46 AM (GMT -7)   
I can't tell you how gratifying it is to find not one, but TWO eminently capable food experts here on the forum. In case nobody has said it often enough, Sandy and Ferg, we appreciate your knowledge. The rest of us are just bumbling around in the dark sort of following your lead.. Thank heavens you know what you are talking about.

Maybe we could make some headway with the ADA if we had them look at the LDL's and blood sugar rates of Laplanders and the Inuit Peoples... I'm not sure, but I believe that if you live in the land of the midnight sun where it's cold almost all of the time, there isn't much growing season for grains. How do they (ADA) explain those people's continued existence? Magic?

And I have to say that the Haggis stories gave me a great belly laugh!
~ Jeannie, Forum Moderator/Diabetes & Fibromyalgia
~Please remember that 50% of all doctors graduated in the bottom half of their class! Yours may be one of them...
"People are like stained glass windows: They sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."- Elizabeth Kubler-Ross

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