Good teachers & healthcare professionals equally help all their students & patients. Not sure what your point is. It shouldn’t be a matter of who deserves time when & if all patients are given the same info & helped to reach acceptable goals.
Finally someone breaks through the ranks and becomes a dissenting voice, from the rhetoric that is some of the ADA guidelines, I applaud you and hopefully you will not lose your job for this. I have always looked at CDE’s as the enemy because their continue to teach these guidelines that they know are just plain wrong…
Kudos
I must be lucky because I have received a great deal of help from CDEs over the past 4+ years including when I disagree with their advice.
A nurse/CDE sent me to the ER after my PCP diagnosed me (incorrectly) as T2 and her feedback - “you aren’t going to only need Lantus , you’ll also be taking humalog before meals” makes clear that she assumed I was misdiagnosed.
My first CDE at the Joslin helped me get my blood sugar under control - having me email her my numbers every 3 days for 6 weeks - when I was too shell shocked and out of it to help myself.
A CDE helped me with my pump start and argued that I use somewhat looser ratios than I thought appropriate. She was right and I was wrong.
I’m currently working with a nutritionist/CDE on tweaking my insulin regime to cut down on lows. She thinks I’m too restrictive. I think her targets are a little loose. But we both are agreeable and have made some progress.
With enemies like these you don’t need friends 
Maurie
LCD,
You’ve answered the question that was lurking in my mind. I’d been wondering if you were diabetic yourself. I wondered too if that made a difference in your approach.
I respect the right of every diabetic to find a diet that works for them and I know some can tolerate more carbs than others. But I didn’t even need to be discharged from the hospital at diagnosis to quickly suss that the standard ‘healthy’ high-carb low fat diet did not agree with my meter.
Anybody who’s had diabetes for more than five minutes knows (or should know!) how carbs affect their blood sugar. I have often wished that medical professionals who push high carb would get diabetes themselves! Bet they’d change their advice pretty quickly. It’s so blindingly obvious that every diabetic can eat as many carbs as their meter says they can - for some people it might be quite a lot, for others, rather less, but there should not be a prescribed amount and if there is a disagreement, the meter wins each time!
When I was dx’d last October my a1c was 12.3, I already had PN and retinopathy. My eyesight was so bad by the time I started insulin (about Thanksgiving) I was no longer legal to drive. Needless to say, I was motivated to find a way to reverse anything I could. I quickly realized that the canned info I was getting would NOT deliver the control or results I was seeking. I came here and began my own research to understand more about this crazy disease.
I opted for low carb because I need a lot less insulin and have much more consistent bg’s. I eat to my meter and usually consume 100g of carbs or less per day. Maybe I am lucky but my a1c in Feb was 5.5 and this last time (July) was 5.4. There is no way I would have achieved these results following the ADA guidelines. In fact, after these levels, three rounds of injections and two laser surgeries, I still am reminded every waking moment of the dangers in following these unbelievable guidelines.
Keep up the great work. Keep offering options and accurate information. You are a rare bird.
This is tough news to hear, but I am glad you are standing up for what you believe in! I have a few thoughts that directly come to my mind after reading this. Is your office going to lose some patients? If your office does it would likely be “the best and brightest” patients that believe glycemic control matters. I wonder if there are ways that you can casually put your opinion into the mix? Like hanging the poster that is in multiple locations in my endo’s office. It shows an A1C of 6% has this % reduction in complications while an A1C of 7% has some but less % of comlication reductions. Could you hang a big posters like that where you meet with the diabetics or would this be too upsetting for some PWD?
I feel that your office could be shortening a newly diagnosed diabetic’s life by a considerable amount if this advice is handed out. Its quite upsetting!
I discovered, a LONG time ago, that when I start craving carbs, it means that I’m low on protein. And replenishing my protein makes the cravings go away completely. My off-the-wall theory is that it has something to do with the Krebs cycle, which has to do with how glucose and protein work together to convert ATP to ADP and release energy. But what do I know? All I know is that it works for me, if I have my act sufficiently together to eat the protein, and endure the carb cravings until they go away.
Actually, WE’RE not going to be the victims of the ACCORD study. We are smart enough and proactive enough to let the CDEs talk their heads off, and ignore them and do what we want, anyway. (And why do you have to see a CDE, anyway? Just to get prescriptions. Otherwise, in one ear and out the other!)
The people who are going to suffer are the ones without the educational background or ability to do their own research, and who will blindly follow whatever advice they’re given. I feel so bad for them!
I’m that way too. Put it in front of me, and I’ll eat it, and sometimes to the point of making myself sick. When I’m depressed, and unable to control impulses at all, I go to the store and stock up on all kinds of horrible stuff and eat it until it’s gone. As you know, I almost killed myself that way.
Fortunately, when I was headed into another depression about a month ago, I went to my psychiatrist immediately, and got put back on a med I had discontinued, and it worked, and although I binged a couple of times, I’m back in control. For me, the depression has to be in control before I can even think of diabetes control.
So, yes, we all have to do what works for us, regardless of what anyone else says, and to quote Danny, even if we backslide, “tomorrow’s a spanking new day!”
I am a T-2 and follow Dr Bernstein. I read his book a couple of times, subscribe to his radio show, yes I am a follower and true believer.
I dont follow my CDE very much or my dietician as they are basically in your supervisors camp. I know what works and doesn’t for my diet and am very careful on quantity. I actually feel better than I have in years now. I think that many problems people have can be attributed to too many carbs even though they are not diabetic. My sinuses cleared up, some infectious rashes I had are gone were the two big ones for me.
Going lower carb for me means less dose on everything. I only use what I need to cover me.
Keep fighting the good fight. Thanks for making us aware of this. Take care. Pauly
I totally empathize with you. The relaxed standards in diabetes control assure that many PWD will be destined to suffer the tragic health problems inherent to this disease.
When I was first diagnosed, I knew nothing about the disease or what it meant to control it. It was my doctor who recommended Dr. Berntsteins book “Diabetes Solution.” I am forever grateful to her for that.
I also attended diabetes education classes at our local hospital. As I followed the low-carb way of eating, my glucose control improved remarkably. Instead of being commended by my diabetes educator, I was chastised for a post-prandial of 126!!! Her remark was that “that is a non-diabetic number and that just isn’t right.” She would have a real problem with me now as my post-prandials are much less than that.
I also spoke to an endocrinologist about the low-carb way of eating and he was very familiar with Dr. Bernstein. He commended my doctor and said he wished more health care providers were as committed to helping PWD achieve control.
My heart goes out to anyone working in this field. My doctor told me that many PWD are very depressed and feel terribly isolated - perhaps the thinking at your facility is based on this. Many in the field of D-care don’t want to over-burden people who have just learned they have this disease.
Don’t lose heart. You’ll be able to tell in your 1:1 consultations who wants to take control and those for whom this disease is overwhelming. You will still be helping them. There are ways to present low-carb without actually recommending it per se. People simply need to eat according to their meter.
I’m sure you will continue to be of great service to PWD regardless of the relaxed standards.
Thanks for trying. I hope you’ll consider starting an independent practice (perhaps with like-minded RD’s) that really HELPS diabetics. I’d love to work with an RD who would be OK with me doing 35-50 gm of carbs per day. It would be like heaven for me to have a trained healthcare professional actually HELPING me for a change. Heaven on earth.
Write books. Publish articles. Do research. Picket at RD conventions. Raise heck. We need lots more people like you on our side.
Here’s a huge (((((HUG))))), too.
Oh goodness, I wouldn’t want the job of following you around and trying to second-guess your minute-to-minute calculations, AR23.
You’d wear me out – I’d be in the convalescent hospital by the end of one week.
For their sake I hope that they figure out that the best approach is to keep your prescriptions topped off and keep the heck out of your way. ;0)
I am sure there are a lot of us that are like that Natalie. If I ever lived with anyone and they wanted to keep certain foods in the house, they would have to keep them locked up so I couldn’t get them!
I think the depression has to be in control before worrying about BS. I think food is a comfort thing for lots of us and hard to control BS if we turn to food for comfort. I went thru a hard time after a bad break up (and I am even the one that told him to take a hike but it was still hard) and I was eating cake and lots of other carbs everyday for about 2 months.I don’t think I was too worried about my BS!
No, I’m not trying to discredit her, I’m just saying that getting an A1C of 7% is in fact the result of a lot of hard work (either the provider or the patient or most likely both).
I agree that we should all have worthy goals and tools to keep us healthy. I just think that sometimes here we concentrate too much on getting from 7.0% to 6.5%, or 6.5% to 6.0% in A1C, when really for every one of us like that on tudiabetes, there are 1000 diabetics out there who are not so electronically connected and just trying to get an A1C below 12% or 10%. We can’t lose sight of them and their needs.
Telling people their results are not representative of good control, when really they are doing better than 90% of diagnosed diabetics, is a bit misleading. (e.g. 90% of T1’s do have A1C’s above the 6.0% number mentioned in the original post. It’s only the super-elite who make it into the 5% club.)
I’m all for healthy goals and continuous improvement. I just don’t want anyone reading the OP’s goals and thinking they’re doing a job that is not acceptable. They may have further to go, we all have further to go, but they should be able to feel good about the progress they’ve already made to get healthier, and the enormous amount of work already done to stay healthy.
Tim, I don’t think anyone is losing sight of anyone’s needs. This isn’t an either/or situation. Everyone should have the knowledge, info & tools to do the best they can. I believe that’s LCD’s point. Lowering standards isn’t the way. Like everything in life, it’s a journey with ups & downs along the way.
Tim,
I don’t believe it should be a sliding scale to make people feel good or bad. The goal is for people to be given correct info to use as they see fit. Facts.
I think I understand where you’re coming from, Tim.
A metaphor might be found in policing. If I were on the highway patrol, and just about everyone on the freeway one work-day morning was going 62-mph to 67-mph in a 60-mph zone, and some dude went flying by alone in the HOV lane going 95, it would be a waste of my time and the taxpayer’s money to ticket some poor schlump going 63 while ignoring the menace going 95.
I was the equivalent of that wild rider about eighteen months ago, with two back-to-back H1C’s of 10.7 and 10.6. I’m very proud that I got my H1C down to 7.4 (as of two weeks ago) and am deeply grateful for everyone who encouraged and educated me along the way.
It wouldn’t have helped much if they’d berated me and fussed at me in a negative way. Neither would it have been helpful if they’d deceived me about what my A1C should be in order to protect my health long-term.
I think it’s truly helpful and supportive for people to be 100% honest with me along the way as I learn to manage my BG’s.
I needed to hear that my A1C was harmful, that ideally I should achieve as normal an A1C as possible, and that others are getting their A1C’s below 6 – that being a 5% club member is both a positive and an achievable goal.
Someone famous once said, “If you don’t know where you’re going, you’ll probably end up somewhere else.” Give me a bulls-eye to aim for and help me learn how to hit the bulls-eye. That shouldn’t be too much to ask, even if I’m currently shooting wide of the entire target. Don’t just assume that I’ll never be capable of doing better than wildly hitting the edges.
Teach me as if you believe in me.
Agree 100% Jean. Professionals owe their patients the straight dope on what their A1C means for their future health. But a positive approach toward helping them find ways to improve is the best way to help. News flash… eating tons of carbs isn’t going to help.