I agree Jen, it makes no sense to me at all. They should be promoting a diet that is good for our condition and the majority of pwd cannot tolerate a high carb diet. For people with severe celiac total gluten avoidance is necessary.- even cross contamination will effect them as for a lot of people with severe food allergies. The high carb diet is being promoted to everyone also... I just found a plan outlined on a flyer that was given to a friend of mine at a meeting where he lived- it said to eat 55-65% carbs.
I think maybe it is because as Zoe said if someone with Celiac eats gluten and they have the more severe form they will end up in the hospital. But many people with celiac also get slow, long term damage and are not even aware they have it apparently. I think I have gluten sensitivity and eliminating grains seems to have helped me. I also have reactions to other grains like corn.
Unfortunately I don't think most of the docs care as long as the complications don't land on their doorstep as you said. Look at the knowledge that most docs have about D, very, very little.
When I was dx, my doc knew nothing and I stormed out of her office in a rage. The D is a legacy from my Dad, who I adored. And a legacy I very much worry about bequeathing my daughter who has experienced gestational D and is trying to have another baby with her wife...
But I did my research and got things under control, at least temporarily....
My first doc, an internist, was useless. As my A1c went from 6.9 to 5.4 over 6 months, I had to instruct her in giving me a pat on the back as opposed to a remote checkmark on my test results....
Anyway, when I searched for a new Doc and couldn't find an internist, I found an absolutely amazing Family Practice Doc who I adore. I have given her a care package of Dr Bernstein's books, as well as Jenny Ruhl's Blood Sugar 101 book. And Joseph's 4-carb flax pitas (which she and her kids love as a pizza base)....
The level of knowledge---the level of compassion---in the medical community can vary widely. And so the DOC becomes increasingly important....
We are our own best advocates (while being our own guinea pigs, too). I would just say stay open to it all. Do your research. Test a lot. Eat to your meter. Do the best you can. Wallow in achieving another full moon...
This time of year in Oregon the Harvest Moon is sometimes the last full moon we can enjoy for a few months and it has been magnificent....Blessings on us all......Elizabeth
To comment on Annabella's obeservation about A1Cs masking BG variability, I believe that if your A1C is in the low 5s and you are aiming for 85-90 BG you greatly reduces your ability to mask swings, simply b/c your BG is moving towards the middle most of the time. This is the main reason I think that it has been easier for me to have a 5.2 A1C than when I blew up into the 7s while I was getting into TKD on MDI in 2007-8. If my BG isn't where I want it to be, I fix it.
RE the comments on "compliance" vs. "non-compliance", it's sort of weird how it seems to have drifted into a usage pattern that means "good" or "bad" instead of "following doctor's orders" which is what I think it's supposed to mean. I haven't ever gotten much in the way of orders from my doc, I sort of rattle off my schtick ("a line of BS..." as my old boss used to say...) and they go "well, I guess you've got it figured out..." and write my RXs.
I think Dr Bernstein is right in regards to their motivations. Doctors would rather see us all die slowly of diabetic symptoms than risk having a patient die from a hypo. The medical community feels that it allows them to spend less time on patients, but given complications, I think they're wrong on this front as well. With the ADA, maybe they're just clinging to poor decisions of the past, but I gotta think that all the money they receive from the pharmaceutical industry is influencing their approach. Imagine the amount of money the pharmaceuticals would lose if T2s were going low carb en mass.
very interesting topic. Now, since I m really not very good with analysing statistics and percentages, would someone be able to explain to me what a for instance "50 percent reduced risk" in the case of kidney disease really means? Does it mean that half as many tight controlled people got kidney disease compared to the conventionally treated people? And if there was a "100 percent reduced risk", would that equal no elevated risk at all compared to a non-diabetic? Thanks for clarifying! Julez
I’ve always thought of it as a smaller percentage, like a couple of pouts although lowering the risk to say 2% from 4% would sort of be 50% less risk. I not worried about that as much as doing the best I can. Pilseung!
I'm just not buying your argument. Patients should have the right to be well informed, and then they should be allowed to fail. Instead the medical community assumes they are lazy and never gives them a chance to change their lifestyle. 9 out of 10 patients don't because their doctor never gives them that option. Why isn't it the medical community's fault when they are telling diabetics to eat a high carb diet, and getting upset with any patient eating less than say 100 carbs a day? Why isn't it their fault when they get upset with anyone whose A1C is close to 5 and when they (PCPs at least) refuse to work aggressively with patients to improve their A1C anytime it is under 7? Why is it their fault when they are patients are handed a system that doesn't work, and give up as a result?
Furthermore, one of the big reasons that many diabetics are non compliant is because they've been handed a system that doesn't work. It's like teaching people to drive their car around town in reverse. When a T2 is given a high carb diet (200g/day), they're generally going to gain weight and become more insulin resistant. Additionally, they're going to need more medication, and likely 2-3 different meds. It isn't the T2 taking a pill due to laziness, but rather because that's the diet and system, they've been handed (eat carbs and take pills). So Joe Patient is doing everything they are supposed to, but it isn't working and they give up. Their BG is bouncing back and forth between highs and lows, and they have no control. Oh, and they're sick from the meds and diabetic complications.
With type 1 diabetics, one really needs to be skilled to control their BG while eating a fairly high carb (ADA) diet. So again, their BG is shooting between lows and highs, and they say 'to hell with it, if I can't control my BG while doing so much work, why bother.
Then both groups see their doctor who tells them that they need to work harder, but taking a lower carb approach (100g or less/day) is generally a lot easier. With T2s it helps them lose some of that weight, and it often allows them to stay on just metformin. It also greatly decreases their highs and lows. With T1s, they don't risk death from hypos or going into the 300s every time they eat a meal.
As an added plus, when doctors get a patient who is busting their rears, and having problems, they generally assume that the patient isn't doing their job.
Kristina I too am the only PWD in my family. But I have never heard the chance of passing it on is strictly from the fathers' genes. There is an on-going research study http://www.diabetestrialnet.org/ From their website:TrialNet is a network of 18 Clinical Centers working in cooperation with screening sites throughout the United States, Canada, Finland, United Kingdom, Italy, Germany, Australia, and New Zealand. This network is dedicated to the study, prevention, and early treatment of type 1 diabetes. I am not overly concerned with having passed it on to my son who is turning 23 this year. But I will give him the website address should he have an interest.
I think the people motivating this might be lawyers, and the potential for malpractice claims, as much as a desire on the part of doctors one way or the other. When DCCT started, meters were just coming into use but there’s been very little adjustment to targets, despite the potential to hit them.
Regarding A1c variability, agreed. If you are hanging in the low 6s even, you just don't have the same range open to you as you would with higher A1cs. While you can have highs into the 300s, staying there for long periods of time, to drive you into the upper range of A1cs, you can only go so low before you are experiencing uncomfortable, or even dangerous, lows that force you back into higher BGs.
I think if you're staying in the 5s, even 6s, most likely, you're doing a pretty good job with your variability as well. The bottom line is, if you want to stay in the 5s and 6s, you have to keep your spikes under reasonable control. I don't know if it's even possible to effectively drive down A1cs by staying in the 50s and 60s for enough time to offset highs into the upper 100s even.
The thing about the DCCT is that it is the single largest database of its kind on diabetes control. Researchers are still crunching the numbers and still publishing new papers base on the data.
I would also love to see something as robust telling us about really tight control in the 5s and low 6s, but I seriously doubt if you could gather enough data on diabetics with that kind of control even today.
The problem with studying individuals with tight control is that, without the statistical power of large sample sizes, you're looking at results that are largely anectdotal.
My feeling is that it's the denial that anything can ever really happen, even as it happens, that drives our ability to deny ourselves what we need, anything we might need, to keep good control.
For the first 5 to 10 years after diagnosis at the age of 20, you wouldn't even know I was diabetic from my labs. I had an A1c in the 4s and low 5s all the way through college, and well into my post-college competition days. I was eating 3000 to 5000 calories a day and 75% of that was carbs. I was feeling pretty indestructible.
20 years later and the only things that changed were my activity level and the fact that, at some point, I came out of my honeymoon. A1cs in the stratosphere did nothing to change my poor habits until I had confirmation of diabetic complications. That's when it became real, that's when I started looking into what I needed, starting with insulin, then a CGM, then a pump, to get the best possible management.
I imagine that it takes a lot more than early diagnosis of complications, where you can't actually feel the effects, for many people to finally decide they should take things seriously.
I do think the latest information, or technology, isn't always readily available to people. That probably includes information on what constitutes the best care possible. As you can see even from those of us on this board who are hyperaware, hyperinformed and hyper-OCD about our management, agreeing on what actually does constitute the best care possible may not even be possible for most diabetics out there.
I agree that a good chunk is legal. Doctors don't want to do anything that might get them sued, but also having patients die on their watch from hypos could threaten their license. It's just safer to be conservative. The legal end might motivate the ADA as well. I mean if you are recommending a very high carb diet without scientific evidence to back it up, and it is proven wrong, you open yourself up to lawsuits. It's not like they can say "hey everyone, we were completely wrong, and our recommendations have been killing people."
Well, as a T2 with I:C 1:5, I'm low carb without intending to be. I generally eat between 60-100g a day.
The main driver of this low value has nothing to do with consciously trying to be low-carb... Rather, I just can't "mentally stomach" the tanker-truck of insulin I have to pump if I were to eat a "normal" 200g a day (according to my CDE).
Crap, that's 40U of insulin, on top of the 40-50 I'm basaling already. Pod holds 200U, and one way or another, with DP corrections and so forth, I wind up under the 50U alarm by the 48 hour mark anyway.
I'd like to go 3 days on a pod, but that ain't happening for the moment.
I'm just working the exercise leg of the stool back in my life, so expect that to give me some more breathing room in that 200U, hoping it will eventually stretch to 3 days.
It's been noted elsewhere in another discussion that I:C is inversely modulated to some degree by BG level -- higher BG, lower insulin sensitivity.
I've really seen this consistently in action. If I eat X carbs with a FBG of 85, my 1:5 ratio seems to work accurately, and if I pre-bolus properly I'll never exceed 140 postprandial (more and more I'm not even going over 130, as I continue to heal after that long stretch of destructive non-control).
OTOH, if I start with an FBG in the 120-130 range, eat exactly the same food -- EXACTLY -- the insulin seems to work just a little less effectively.
It sure would be nice, you know, as adults to be able to decide for ourselves what risks we want to take, and then be solely responsible for the consequences, wouldn't it?
Of course, if a professional tells you something wrong and you rely on it, they should be culpable. However, what really gets my boxers in a wad is being disallowed from doing something I want to do, feel I am sufficiently informed, etc.
Regardless of whether I am as wise as Solomon or a foolish ignoramus, I should be free...
I'm 70 & well over menopause so I don't think that applies. Though I have heard that women still go through hormone cycles for the rest of our lives! And I thought it was all over!
