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Discussion Starter · #1 ·
Me -- T2 F 67. Diax Autumn 2020.

I am grateful that after diax the PCP didn't just send me off with pills, but did refer me to a diabetes dietitian and and endo specialist (PA). I have been grappling with the advice that they have given me as I attempt to manage the diabetes, as the advice is sometimes contrary and usually incomplete.

The more I learn, the more I understand that there is no one-size-fits-all for diabetes management. And that's okay. Poke how many times a day and when? And for what purpose? The PA told me today that it's mostly all about the big picture. Well, then, why has she put off my next A1c when it's past 3 months since my last?

The dietitian told me one number (based on ADA, I assume) of < 180 for after-meal poke test. The PA told me a different number (based on AACE, I assume) of < 150. No one told me that it is important to poke before the meal, too, if I am trying to ascertain the effect of any particular carb meal (like tacos or pizza). After my questioning, the PA told me today that she would expect a rise of 50 from before to after for people with diabetes, and that's the first I heard of that.

It also concerns me that ADA and AACE are not on the same page. WTH?

I'd like to hear your experience of poor (or no) diabetes education.

Best to you all.

~Onga
 

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There is a lot of information out there. Some of it, as you noted, is incompatible. As diabetics, we have to figure out what the best information is, and then temper it with our own experience. As you also noted, diabetes is a very individual condition.

When I finally decided to take my diabetes seriously, I did my own research. I have a background in science and statistics and there are doctors and nurses among my family and friends. When I see a scientific study, I want to know how they arrived at their conclusion, what assumptions they made, and whether factors that could influence the conclusion were accounted for.

The ADA recommendation for blood glucose levels below 180 mg/dL was determined many years ago. More recent research indicates the level at which organ damage occurs may be as low as 140 mg/dL (even lower than the 150 you've seen). I trust these recent studies, though the differing numbers make me think there still are factors which haven't been accounted for yet.

Whenever we're dealing with a matter of public health, however, unpredictable humans come into play. There's what is and there's what (most) people can do. In a culture like the U.S.'s, where food is a part of every activity (snacks, coffee breaks, movies, ball games, funerals,...) and so much of it is full of carbs (lots of reasons for that), making a universal recommendation that BG remain below 140 mg/dL even after meals may not be possible. For many Type 1 diabetics I know of, it's quite difficult. Do you make that recommendation anyway? Will people listen and remember if you tell them to keep-BG-under-140-if-you're-Type-2-but-if-you're-Type-1-then-it's-different? How many people are willing to poke themselves several times a day to see how particular foods affect their BG? Does it foster compliance to tell people to test just once each morning and use that as a (very rough) guide?

I also can understand an organization with the influence of the ADA not wanting to keep changing their recommendations. After all, look at how the changing advice from the CDC about COVID-19 precautions has affected peoples' perception of that organization.

I don't want to make it sound like I'm defending the status quo. I'm here because I think it should change. But I realize that poking myself ten times a day, like I was at the beginning, was hard. Saying no to favorite foods and being the one drinking pop at the microbrewery was not easy. Some people just can't do that. So do you go for the achievable and hope people meet that (for their own benefit)? Or do you go for the absolute best information possible even if that means making difficult changes, sometimes more than once?

When I took my diabetes "education" class, the dietitian downplayed my commitment to eating low-carb, saying I could never keep it up. I've seen even prolific posters here run into situations in life in which they kind of fell off the wagon; eating low-carb is not trivial. It would have been nice to have some encouragement, however. I was not advised to poke myself multiple times a day -- but at that point I'd never poked myself once (I had to buy a meter for the class). Be told I had to do this 8-10-12 time a day? Fuggeddaboudit. I was interested enough in my own health at that point to do it. The other guy in class still had the deer in the headlights look from his recent diagnosis. I don't know that he was ready to give up donuts and coffee with his coworkers or stop drinking beer or to test his BG several times a day. The dietitian went with what has (mostly) worked for (most) people. Not the best choice for me, but I hope the guy in class with me hasn't given up completely.
 

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In my case, I never really turned to my PCP (or her supporting cast at Kaiser) for an education. Obviously she mentioned some of the basics, like avoid sweets, and we talked a little, mostly recall me lamenting the loss of my low sodium potato chips since they served a tasty purpose in my diet at the time (decent source of MUFA’s, potassium).

Having been on diets since adolescence, I already had a fair grasp of what I’d need to do, though further study from sources beyond the “conventional” stuff has been enlightening.
 

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Discussion Starter · #4 ·
Thank you for your lengthy and informed, insightful response, itissteve.

It is concerning that your diabetes "educator" downplayed low-carb eating. Did she offer what the alternative might be, such as just letting pharma control the glucose?

I have been eating low-carb for many years now, way before my diabetes diax. I started that WOE in order to lose my menopause weight and was successful in losing the 25 pounds that I wanted gone, and I have kept the weight off for more than 17 years. It was easy for me because me I have never been a big sweets, bread or pasta eater. However, in the past 2-3 years I have gotten lax, indulging the occasional Morning Bun, ice cream, or French baguette with herb olive oil. Maybe that's what pushed me over the edge from non-diabetic to diabetic. Or maybe it is just genetics and my age. We don't really know, do we? (I am underweight as far as the BMI scale.)

I immediately got turned off by ADA after I bought their meal-planning cookbook and they recommended Stouffer's Macaroni-and-Cheese, and a McDonald's Quarter Pounder! I was been turned off by AACE many years ago because their standards for treating hypothyroidism (which I have) are so wrong.

Finally, the other day, and I had to ask, the diabetes PA told me that she commonly expects a 50-point rise in glucose level after a meal. That was news to me as she had never told me that and I don't remember running into that info online.

There was one web page I found -- "What to eat to manage your blood sugars" -- which advised eating apples instead of strawberries, and eating oatmeal! There is so much misinformation out there, too. How to be discerning?

I was only diax with Type 2 in 11/2020. I appreciate your "deer in the headlights" comment about your classmate, because the diabetes diagnosis plunged me into depression. When I asked if depression is part-and-parcel with diabetes, no one gave me an answer, and there wasn't much to be found online except that one is at greater for risk of depression when one has diabetes, whatever that means. Thankfully I have an integrative medicine PCP who looks at the whole person rather than just symptoms.

And thank you, itissteve, for the 140 number. Can you point to any particular study that you've found that is credible?

Yeah, when I first got my meter (prescribed by my diabetes PA) I was told to poke 4 or more times a day. While I understand the FBG number's importance, no one ever told me why 4 or more times a day, or what I might be looking for. Now I know that in order to get a decent representation of what any particular food does to me, it's important to measure before eating it, and after.

I don't expect medical professionals to be perfect or to know everything. All I hope for is that they will stay informed to make their judgments, but also point me in the direction toward more information.

Thank you for your involvement and advocacy in this, itissteve.

~Onga

There is a lot of information out there. Some of it, as you noted, is incompatible. As diabetics, we have to figure out what the best information is, and then temper it with our own experience. As you also noted, diabetes is a very individual condition.

When I finally decided to take my diabetes seriously, I did my own research. I have a background in science and statistics and there are doctors and nurses among my family and friends. When I see a scientific study, I want to know how they arrived at their conclusion, what assumptions they made, and whether factors that could influence the conclusion were accounted for.

The ADA recommendation for blood glucose levels below 180 mg/dL was determined many years ago. More recent research indicates the level at which organ damage occurs may be as low as 140 mg/dL (even lower than the 150 you've seen). I trust these recent studies, though the differing numbers make me think there still are factors which haven't been accounted for yet.

Whenever we're dealing with a matter of public health, however, unpredictable humans come into play. There's what is and there's what (most) people can do. In a culture like the U.S.'s, where food is a part of every activity (snacks, coffee breaks, movies, ball games, funerals,...) and so much of it is full of carbs (lots of reasons for that), making a universal recommendation that BG remain below 140 mg/dL even after meals may not be possible. For many Type 1 diabetics I know of, it's quite difficult. Do you make that recommendation anyway? Will people listen and remember if you tell them to keep-BG-under-140-if-you're-Type-2-but-if-you're-Type-1-then-it's-different? How many people are willing to poke themselves several times a day to see how particular foods affect their BG? Does it foster compliance to tell people to test just once each morning and use that as a (very rough) guide?

I also can understand an organization with the influence of the ADA not wanting to keep changing their recommendations. After all, look at how the changing advice from the CDC about COVID-19 precautions has affected peoples' perception of that organization.

I don't want to make it sound like I'm defending the status quo. I'm here because I think it should change. But I realize that poking myself ten times a day, like I was at the beginning, was hard. Saying no to favorite foods and being the one drinking pop at the microbrewery was not easy. Some people just can't do that. So do you go for the achievable and hope people meet that (for their own benefit)? Or do you go for the absolute best information possible even if that means making difficult changes, sometimes more than once?

When I took my diabetes "education" class, the dietitian downplayed my commitment to eating low-carb, saying I could never keep it up. I've seen even prolific posters here run into situations in life in which they kind of fell off the wagon; eating low-carb is not trivial. It would have been nice to have some encouragement, however. I was not advised to poke myself multiple times a day -- but at that point I'd never poked myself once (I had to buy a meter for the class). Be told I had to do this 8-10-12 time a day? Fuggeddaboudit. I was interested enough in my own health at that point to do it. The other guy in class still had the deer in the headlights look from his recent diagnosis. I don't know that he was ready to give up donuts and coffee with his coworkers or stop drinking beer or to test his BG several times a day. The dietitian went with what has (mostly) worked for (most) people. Not the best choice for me, but I hope the guy in class with me hasn't given up completely.
 

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Several studies linked to on Jenny Ruhl's Blood Sugar 101 site. She has done lots of research and links to the sites and studies that back up her research iin the articles she posts.

Diabetes nutritional information from the current medical community is slowly beginning to recognize that low carb WOE is beneficial to diabetics, but they aren't pushing yet, amazing since we don't really need carbs at all. Maybe one day they might, but I'm not holding my breath.
 

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Discussion Starter · #6 ·
Thanks mbuster. I think Blood Sugar 101 is where I first saw < 140 mentioned.

Several studies linked to on Jenny Ruhl's Blood Sugar 101 site. She has done lots of research and links to the sites and studies that back up her research iin the articles she posts.

Diabetes nutritional information from the current medical community is slowly beginning to recognize that low carb WOE is beneficial to diabetics, but they aren't pushing yet, amazing since we don't really need carbs at all. Maybe one day they might, but I'm not holding my breath.
 

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It is concerning that your diabetes "educator" downplayed low-carb eating. Did she offer what the alternative might be, such as just letting pharma control the glucose?
Not really. But "carb up and shoot up" has never made sense to me. And I've seen too many family members and friends who followed the U.S. standard of care and ended up hobbled by neuropathy and cardiac issues and vision problems.

When I asked if depression is part-and-parcel with diabetes, no one gave me an answer, and there wasn't much to be found online except that one is at greater for risk of depression when one has diabetes, whatever that means.
I don't know (I don't think anyone knows) if there is a physiological link between diabetes and depression. However, being diagnosed with any chronic disease is depressing. Awareness of the long-term effects of managing high blood glucose that we've seen in other diabetics is depressing. Even the lifestyle changes can be depressing -- as a diabetic you become aware of the massive influx of carbs that a pizza party or ice cream social or beer bash provides and that you will either have to counter by restricting intake or increasing medication. Even knowing you'll have to poke yourself at least once a day with a lancet or insulin needle isn't exactly uplifting. So, yeah, I can see a link, though it may not be causal.

It is tough to know what's true. We're learning all the time. There have been almost no rigorous long-term studies of people who've followed a low-carb/keto way of eating for years/decades. Maybe, long run, there are issues. But, based on what I've seen in studies of low-carb eating and knowing what I know of drug side effects, I consider poorly-managed BG more of a threat to my health than low-carbing. So I eat low-carb.

I understand that the current understanding of nutrition holds that higher fiber is good for human nutrition, so that's why an apple is endorsed over berries and oatmeal is encouraged rather than toast. But, in my mind, carbs are carbs and my body has problems managing them no matter how quickly they enter my digestive system. It's like asking if you want the bandage ripped off your wound quickly or slowly -- either way, it's going to hurt and my preferred alternative would have been to not need the bandage at all.

There's a good group of people here who are interested in the science and who are willing to find out what works for them. Your contribution and my contribution to that body of knowledge -- all of it helps!
 

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Avocados are a good source of K too, as well as fats and fiber.
 
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Discussion Starter · #10 ·
Reminds me of the time I was first diagnosed as having hypothyroidism. I found a great forum of others who have hypoT and it was far more helpful than what the medical establishment was saying/doing that was outdated. So I am glad to have found this group.

There's a good group of people here who are interested in the science and who are willing to find out what works for them. Your contribution and my contribution to that body of knowledge -- all of it helps!
 
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