Nutrionist Needed?

I went into DKA and then diagnosed with Type 1 in January. My A1C was 6.2 when I went into DKA. I'm now equiped with a Dexcom, lantus, and humanlog. The only time I need "starch" is about 1 1/2 cup of Cherios and milk for breakfast. The rest of the time I eat tofu and vegetables or fish and vegetables. Do you think I still need to see a nutrionist? I was introduced to one at my endo's office and they give me info on ratios if insulin to lower BG and ratios of insulin to grams of carb. I'm thinking I don't need to take classes or see a nutritionist. What do you think? My endo is happy with my lunch and dinner numbers. We are working on my breakfast (it peaks at 160). At first, she said I would need a nutritionist but did not really asked about it or pushed it since then. She just gave me a smile and said I will eventually need one? Would be it cheaper to buy some books on GI and GL?


Some of us use nutritionists, others of us learn a lot from books and other diabetics on sites like this. Nutritionists, like any profession come in all "stripes and sizes". Many, unfortunately, adhere to the ADA line which tells us to eat what many of us think are way too many carbs and to accept blood sugar levels that are too high.

You said the nutritionist you saw gave you ratios of insulin to carbs (I:C ratio) and insulin to lower BG (ISF). Do you use these? Ultimately nobody (especially someone you just met!) can "give you" these numbers. We are all different and you have to find out what works for you. Many of us have different I:C ratios for different times of the day. If your results are good (and YOU are happy with them - not always the same as what your endo thinks!) than you are doing something right. However, having said that, if you are dosing your insulin without having accurately determined your I:C ratio(s) and ISF(s), you will have problems. You might be eating pretty similar things for your meals so things are working, but if you vary your diet you need the ratios. You might also be in your honeymoon and that will change! Just FYI 1 1/2 cheerios and milk would be absolutely impossible for some of us to eat without ending up in the 200s, so you might want to look at less carbs for breakfast. You don't "need" starch - though many of us like it and eat a moderate amount. Actually carbs are often easier to process later in the day when it sounds like you eat very low carbs.

My own opinion? Books, and answering on here might be cheaper (don't know what your coverage is) but they also might be more helpful. I highly recommend Using Insulin by John Walsh.You might also find Richard Bernsteins The Diabetic Solution interesting (get the newest edition -2011). Also you mention the GI and GL. In my opinion, these things aren't terribly useful for a Type 1. What IS useful is learning to accurately count carbs (there are lots of sources of carb lists), and then to, through trial and error, compute your own I:C ratio so you can match insulin to food. In time you will also want to determine your ISF which is how much one unit of insulin lowers your blood sugar so that you can correct highs when they occur.

Ok, so how did you go into DKA and have an A1C of 6.2??? I guess maybe because the A1C covers about 3 months and your onset was very sudden??

I think it's a great idea to see a nutritionist - not that you are eating unhealthy, it sounds like you eat well but it really helps to get a new "angle" on food and how it impacts your body. If anything, Gary Scheiner has a pretty good book on accurate carb counting. I wish I could remember the title, but he goes in depth what you need to look for when dosing for meals and snacks.

You are right. She didn't give me my ratio rather give me charts of possible ratio guidelines to find my ratio. I still do not know my ratio. I eat pretty much the same thing consistently. My endo did say pretty much the same thing about carbs and that there are carbs in fruits and vegetables. I try to eat Cherios because it's the only thing that I could easily see vitamins and minerals listing. I have 3 options right now. 1) switch to lower GI cereal 2) switch out cereal for eggs 3) inject semplin along with insulin for the morning before I eat cereal. This is suppose to help my insulin cover for my morning meal since it seems in the morning my body wake up mechanism glugacon (?) is throwing it off.
I'm going to do option 1 first then try option 3 one time but most likely I'm leaning to 1 or 2. That's why I wonder if seeing a nutrionist would help or use books and research on my own.
And yes my DKA was very sudden. I was not aware of having diabetes. My annual blood test in feb of 2011 was 83. But by Thanksgiving, I was light headed when I sleep on my right side. I didn't think much of it. Day after new year, I had fungal infection and by end of that week I had shortness of breath. That's when I see a family doctor (internist). She said I was diabetic and gave me prescription for pills and had me see a cardiologist for the shortness of breath. She did not know I had Type 1. She might have asked me to research about eating changes but it wasn't really sinking in. The next day she said I had keytones and might have to be hospitalized. That night she changed her mind and said to come to her office on the 3rd day to try insulin and that I might have to admit to the hospital. On that 3rd day, she sent me from her office next door to the hospital. I dropped down in the parking lot unable to walk and someone found the hospital staff to wheel me in. I did the admittance paperwork. While in the room, someone took pitty and found a doctor to look at me right away. This hospital internist start yelling at the staff to bump whoever to get me to ICU room or he will take me to another hospital. I spent 3 days in ICU room to take the keytones out and balance my electrolytes. He said that if I would have died if I did not go to the hospital in time. I was also lucky my kidney is intact and that my a1c was 6.2.

I tend to remember and "sink" things in on paper than when someone tell me. That's why I wonder if I could read it up instead of seeing a nutritionist.

I went to a nutritionist every week for a whole year to learn how to eat. Insurance didn't cover it so I paid for it out of my own pocket. It was helpful to me because I had already struggled for 20 years not knowing what I was doing wrong. It sounds to me like you are already on the right track and doing what most of the people that frequent this site have come to learn---eat as little carb as you possibly can and try to keep your protein up. Prior to learning this, my A1c's were rarely under 8. Since I have made the lifestyle change about three years ago, I am consistently 6.2. I'd like to get it down under 6, but I just don't know how realistic that would be for me. Personally, I don't think you need a nutritionist, but a couple of sessions certainly wouldn't hurt and could only help.

It sounds like you know your own personal "learning style", Kelly. I'm the same way actually. Knowing that, you might want to read a variety of viewpoints on here as well as in books (you could ask for recommendations on the Diet and Nutrition thread). Then you can pick and choose what works for you. The most important thing, imho, is what works. What you enjoy eating (otherwise you won't stick with it) combined with what keeps your blood sugar in target more often then not, without taking an excessive amount of insulin.

Memories of near-death experience and seeing how much the hospital charged my insurance (40k) override any cravings I may occasionally have. My goal is simple, stay healthy to watch my kids grow up. Prioritize needs vs wants for their colleage funds. I'm trying to figure if a nutritionist is a need or a want. I consider the Dexcom a need (at least for 1 year until I establish a routine). Hopefuly I can wean myself off the Dexcom too. I'm told by Type 2 family members that I could try bean threads otherwise known as clear noodles should I start craving noodles/pasta/rice since this noodle is made from mung bean. Other than that I'm ok with going w/o starchy foods.

I beleive insurance is great but I don't want to lean on that too much. The $ I don't mis-use will be spent on better treatment for someone else in the system.