Diet (carb) compliance and the diabetics you know IRL (in real life; a.k.a. not just online)

Many people have excellent control who eat 140 grams of carbs a day, Jan. And many doctors advise a lot more than that. (I'm not justifying the latter).

Agreed (as usual)! By the way if TuD ever comes up with a reward for "connecting Type 1's and Type 2's" I'm voting for you, Jean. (Despite the fact that I hate the stupid popularity contests!

Is it okay to post this? http://waroninsulin.com/ Peter Attia's blog today pretty much addresses the same subject, and I found it helpful.

Zoe, the people I'm talking about are all T2s who are not on insulin. Yet. Do you think that would make a difference?

Interesting article although Iā€™d be inclined to suggest that the increase in %age w/ diabetes is more due to the increase in diagnostic technology more than a plague of carbs? Still, the food pyramid seems like a likely suspect for a large degree of contribution to the problem too?

Ah! That is a different issue. I think many Type 2's put off the need for either oral meds or insulin by going low carb and exercise And that is a choice, though I know many people feel strongly about taking oral meds. I don't have any data, but I think for Type 2's who do use oral meds, their blood sugar is easier to manage than Type 1's and yes, I think many eat 140 carbs a day or more, take oral meds and have good results. I think we need to remember how really atypical both the Type 1's and Type 2's who frequent the DOC are. In "the real world" 140 carbs would be considered a fairly strict "diet".

I think your last sentence here - about "deaf and uninterested ears" is probably the reason most doctors would cite for why they don't inform/treat more aggressively. Low success/compliance rate. Many (most?) patients prefer denial, can't or just won't work that hard at managing this costly serpent of a disease. They just want to live their lives without the hassle.

In my real life experience, I only know a couple of other diabetics, type 2's (I'm T1), and this describes their attitude. Constant complaining, but they glaze over if I offer suggestions for better control/health - so I don't anymore. Makes me sad, but I understand it. I was in denial myself for decades!

Maybe we at Tudiabetes are the exception. Or maybe even on Tudiabetes only the ones really trying, caring post, while a larger percent just lurk?

I find that people do come to me to discuss their conditions--i imagine for 3 reasons: 1. I am an excellent listener (thanks to my mom the therapist for that skill! 2. I have maintained pretty solid control from the onset (at age 39, 4 years ago) of my type 1.5. 3. because I tend to be vocal and am happy to share my experiences and experiments.

It is almost exclusively type 2's that I encounter, and most keep engaged with me on their efforts even if they are in poor shape. Some though avoid me when they are not following their own strategies. Like you I won't go to them during that period. I am there to help, but not to simply be another thing in their life that makes them feel guilty.

Posters vs. bloggers is an interesting observation.
I'm going to do some more peeking around. :)

Thanks Jan, this blog makes for interesting reading, I'm going to go back and read his previous posts. He says 30 to 40 % of the population is born with insulin resistance.

Thanks, Zoe, but my "we're all diabetics together" song can only be heard by those who are willing to listen. ;0)

Too true and I think if I were a Type 2, I might be a bit intimidated by the decidedly Type 1 culture.

Something my endocrinologist said to me a couple of weeks ago has haunted me ever since that visit. My BG has come down dramatically, from 13.1% in October to 5.9% early this month. I've lost about 45 pounds. I'm eating very low-carb, 20-30 grams a day. I've worked very hard to have the success I've achieved. It hasn't been easy, but there's no question that it's worth it to me. I'm 53 years old and want to have another 35 years of high-quality, productive life.

My endo was over the moon, so happy with my test results. He said that I make him feel like he's a good doctor. That floored me. I realized that I may never have seen a doctor be so happy. I do think he's a good one, and said so. He shrugged, saying that all he's done is answer a few questions, write a couple of prescriptions and stay out of my way. He said that he doesn't deserve to feel like he's done a good job, but he does anyway, even though I've done all the real work. On our way to the supply room to get me a different kind of pen needle, he stopped two nurses to tell them about my success. They were impressed, which was nice for me, to be sure, but I also realized that telling them about my results was also part of him feeling like he'd really helped me.

It must be very hard to be a doctor working with people who have chronic diseases. One of the nurses said that less than 10% of patients in the hospital diabetes clinic make beneficial changes in their diets and less than 5% have the kind of success I've had so far. Wow. That's absolutely staggering! I believe that most doctors want to help people be healthy. But if 90% of diabetic patients don't do much to help themselves, it's no wonder that so many physicians become a bit cynical or seem disengaged from their patients. A lot of them probably feel a need to protect themselves mentally and emotionally from patients who won't try to get better.

This thread is about whether we know people in the real world who have diabetes and work hard at controlling it. The only person I know who has diabetes is my partner. He's been a Type 2 for about 10-12 years. He's mostly uncontrolled. He says that he doesn't know how to bring his BG under control. He followed the ADA/CDA diet but only gained weight on it. He was told he only needed to test it when he got up in the morning, but he doesn't do it sometimes for weeks at a stretch. Two weeks ago, he tested his BG after taking me to see the endo. It was in the upper stratosphere and that number truly frightened me. I've talked to him about complications. I've encouraged him to read the Blood Sugar 101 website, to lower his carb intake and to test his BG 6-8 times a day. At first, he welcomed my help. But he isn't following my advice. I can see what happens as his BG rises high and crashes low. He becomes increasingly irritable. He can't concentrate on anything for more than a few moments. He's depressed and when he's not depressed, he's angry. His emotional reactions seem extreme in comparison to the things that provoke him; this may be a product of his body pumping adrenaline, hard, so that his pancreas will feel forced to produce insulin to bring his BG down. At other times, when he swings down into the low 5's, his liver dumps glucose to bring him back up. He's on a glucose teeter-totter that's exhausting and sometimes scary to watch. It must feel even worse. He's tired all the time. I don't know whether he will choose to take care of himself. He has many excuses for not doing it, including working shifts, not liking low-carb, not having time to prepare food to take with him to work, etc. I'm worried about what will happen to him and not sure that I can stay in this relationship.

To pick out one part of what you said.....you think people who eat pizza or ice cream or whatever aren't in control, or aren't trying hard to control their diabetes?

Hmmm. That's sort of jumping to conclusions about people, IMO.

SOME people CAN eat those things and be fine.

I have had an A1c under 6% for over a year, and I eat pizza, ice cream, and pasta.

My blood sugar is my main focus, not what I eat or don't eat. I give myself the insulin I need at the ratio I need, either all at once or extended over time, to keep myself in range for the food I'm eating. I know it doesn't work for everyone - that some people DO need to cut out certain foods or certain types of carbs, but I hate when people assume that if someone's eating pizza, ice cream, etc they aren't in control. I mean, unless you know all of someone's BGs and their A1c, you really don't know how ANYONE is doing. I'm sure that conversely there are people who are eating great 'diabetic friendly' meals all the time and are totally out of control.

Wow, Ann, I'm very touched by your honesty in talking about your partner and saddened by how painful it must be for you to watch him neglecting his health. I wrote earlier about a long-time friend and her husband who doesn't care for his Type 2 and your post made me understand a bit more about how she must feel. It's really hard to be in a relationship with someone who is slowly destroying themselves, whether it's with alcohol and drugs or not caring for their own health. Even though you are a Type 2 yourself, I wonder if it would help to talk to other partners of Type 2's who will understand what you go through. Partner's of alcoholics have Alanon because the struggle they go through is as painful as the one their alcoholic partners go through.

Other than that, there is little I can say, besides "it's very hard to change someone else who doesn't want to change themselves." Maybe just: Do you think he would be shocked if he "heard" you say your last sentence? I don't know how long you've been together, but, especially if your lives are fairly entwined, maybe he needs to hear it.

I have only met one T1 in 'real life' (this is real life too?).. and she was an avid follower of a very low carb diet, and gave me a very hard time for eating an apple with my lunch.. that has unfortunately really stuck in my head. She also proceeded to tell me about what I should and should not eat..

I've tried to find a T1 support group here, but there are not any that I can easily find.

My father is a T2. He keeps his numbers fairly regulated- BUT he takes a crapload of insulin and eats whatever he wants, and is overweight. Instead of trying to eat moderate carb and seeing how that works out for him- he tries to go Atkins style or eats a TON of carbs in a day. Both extremes obviously do not appear to work for him because when he's on very low carb, he will suddenly give in to the carb cravings..

It has always hurt that he treats himself this way. I hoped back when I was diagnosed with T1 that he would start taking better care of himself.

But of course, he hasn't.

Ann, I am so sorry that you are going through this!

My mom tried to help my dad when he was diagnosed with T2.. but it was the same exact thing.. she would buy foods that he said he could eat, and then he would go out and buy things like a burger and fries for dinner. She finally gave up when he continued to do this.. I asked her why, and she told me, "I'm not his mother. I cannot make him take care of himself. If he wants me to help him, I will, but I can't help him if he will not help himself." I know it hurts her, but they've been married over 30 years..

When I was diagnosed with T1, she started helping me try to figure out things that would be OK for me to eat, that had less carbs than their normal counterparts and were healthier. He said to her, "You never did any of that for me!" And then she had to remind him of everything she did that he ignored... but none of this ever phases him. It never changes the fact he won't take care of himself. He is convinced that insulin by itself makes you fat and that's why he can't control his weight. But he eats huge quantities of food in general and never exercises. It's not just the insulin, I've tried to tell him that, but he will not listen.

I'm sorry for the ramble, but I know how heartbreaking it is to watch. I just wish he'd give at least a little effort; sometimes it makes me feel as though he must not care about my mother or me because he does not try to care for himself.

Zoe and palominovet, thank you for your empathy. I do appreciate it, very much! I've decided to talk about L and what goes on because it IS hard to watch. At times I think I'm unfaithful in considering ending this relationship because of his poor management, but I recognize how his poor management affects his moods and how that, in turn, drags me into some very deep, dark places that are hard to get out of. That's not good for me. It's not good for my son, who lives with me. I'm working hard to be well and stable so that my son doesn't have to worry about me and so that my friends won't need to be concerned that I may need help soon. L seems not to notice the impact that his moods and behaviour have. That's a sad thing. We've been together for a little over a year and I can see how he's gotten worse this year. It's upsetting to think that, at any point, I may get a call because he's had a heart attack or a stroke. Right now, I think that's going to happen sometime soon. He has heart disease. His BG is in the 400s or more about half of the time.

I think that, in order to care for the people I love, I have to do my best to be the best I can be. One day, that won't be possible, I know. I will get old. I will wind down, probably. I accept, more or less, that I will die one day. But I think I have a responsibility to avoid dragging my loved ones through a slow decline if at all possible. For the most part, I don't think it's good to say to someone, "You would do this if you loved me." But the thing is, it's true. L loves me. I know that. But he doesn't love me enough to make the choices he needs to make to live a good and healthy life with me. I'm sorry about that. I hate diabetes! I hate that it's more compelling in some ways than I am, for him. That's not what I want in a relationship. I'm trying to tell him but as long as his BG is really high, he can't pay attention to much of what I say. What a terrible irony that is! I'm taking all of this in; it's a warning to me to stay well.

Palominovet,I'm sorry about your father. It's very hard to see your parents in this struggle, I'm sure. You sound like a strong woman who has her heart in all the right places. I'm sure your parents are very proud of you--rightly so! I hope that things may ease for you so that your heart can be settled and you can find some peace. I hope your mother can continue to be strong and brave. I hope that your father can wake up and recognize that he has two women who love him and will help him take care of himself, that he doesn't need to be afraid.

Human beings don't do well when we're frightened. Fear is a demon that can take over too much of our best selves, diminishing our lives, strangling hope and filling us with despair. We don't make consistently good choices when we're frightened. We can't see clearly. We latch onto things that we believe will help us even if all they do is make us feel better while silently harming us--emotional eating can be that way, sometimes, I think. In my experience, the only antidote to fear is love. The way to love and to be loved is to reach out, share what we're going through and accept help. When we can't believe that things will be better sometimes we can believe in other people and let their belief buoy us up for awhile. That's one of the great things about a community like this one. We can believe in each other even when, individually, we have trouble believing in ourselves.

Kari,

My quoting people and their food needs was not an indictment of the food or of people who can successfully manage their blood sugar while eating those foods. The people I was quoting are all out of control to varying degrees and slipping further. I am not guessing at their data, they provide me with their fingerstick #s and A1cs.

There is a great spectrum of insulin resistance and for some people all that is needed is a moderate decrease in carb intake. Others can maintain their normal diet with just the aid of oral meds, insulin or exercise. I personally think that it is tricker to pull that off for most, but kudos to those that can!

My apologies if I came off as snooty or presumtive. It was not my intent.

Ann,

I understand how difficult this is. I was married for 22 years to an alcoholic. Sort of the same thing, something else is more important than their family. His behavior seriously affected our kids. Ultimately, I chose to leave the situation because it was hurting the three of us and doing nothing to help him.

Perhaps you can pick a day where he is doing pretty good and explain this to him. It most likely will get a poor reception but it may sink in and be the trigger he needs to improve his health.

My current husband doesn't take very good care of himself. We both quit smoking together but with him it didn't stick. He has gained an enormous amount of weight from eating junk but he wouldn't watch what he would eat. I just went about my business and took care of me. I know from experience I can't do anything to change anyone else. He is talking about quitting smoking again. He has actually taken off about 15 lbs and is eating in a way that is sustainable and realistic. Before he'd starve for 2 days, declare that he couldn't diet, and start gorging again. Sometimes all you can do is set an example.

I'm very sorry you are going through this. It is very difficult to watch someone slowly kill themselves and be unable to do anything to help.