Weight and BS control; carb amounts and the nutritionist,

Type 2
1

I will admit I am a stubborn person when it comes to what I think I need and want. For Over 20 years I weight over 250 lbs. Even before my diagnosis, I started eating low carb meals, 30,15,30, 15 and 30 carbs per meal or snack. It worked, where all kinds of other programs failed. I got into the swimming routine....and LOVED what I did. I loved how I felt. And then the diagnosis of diabetes t2. Well, the good news, I knew how to count carbs, knew how to track, and had a swimming habit already, But because someone was telling me what to do,,,,my donkey took over, and I didn't do what I was supposed to do, ballooning up to 258 lbs. AFter a year of being stubborn, I started in all over, counting carbs, exercising, eating correctly, take my readings, and taking my meds. In three years I lost over 80 lbs. Exercised 3 - 4 times a week, and neared my goal. After 16 years of treating my "D" very carefully, taking care of medical maladies that came along, I am doing good. ENTER : The diabetic Nutritionist --- tatada!..We will call her Laurie for short ---- She is a definite follow the rules, no deviations for any reason, not for poverty, not for family, not for any reason....you read "the book" and follow my directions: 40-15-40-15-40 carbs per meals and snacks. Life in Laurie's world doesn't have curves and corners, it is straight and no diviations! Needless to say we butt heads often. And I being me, having some success and controlled blood sugars, was NOT going to follow something I knew met eating more food, gaining more work (having proven that in June and July of 2014) I gained over 10 lbs. NOPE! not going to happen again. My joints and other maladies kept me from being in the pool....more land exercise and PT....I have lost about 7 of the 10 lbs, my A1C is 6.5 great for a 62 year old woman. I told the CNP who has been with me this entire 16 years, that I was going to be my usual non-compliant patient, going back to the 30-15-30-15-30 regime, Lantus, humalog and Janumet; Exercise 5 times a week. This is better for my mental and physical health.Normally I wouldn't say anything, but I am part of a group of over 55's who are being followed by our hospital to see how we are doing with our diabetes for the next 7 years. This is an important program, since we are the only clinic/hospital in the region who is studying diabetes in older persons in our area, It will help shape how we are treated and accepted health practices in our area. I refuse to give up losing this weight over adding carbs w hich I know helped me gain weight. I won't do it! Losing the weight will help me manage my diabetes, lower weight, better health. Nope not more carbs. Adjust my Lantus and watch carefully for lows, treat as directed.

Am I wrong for wanting to lose 15 more lbs to be healthier? Am I wrong to not follow her directions? I have tried, begged, explained, pleaded with her to understand, and there is no hope. My doc takes her report very highly, I've explained it to my doc. Give me your views and what I can do? I hate every appt being a confrontation, but this is my life, not hers.

2

Listen to your body, it knows how many carbs you can absorb before it's too many. Diabetes is a disease of carbohydrate intolerance. The challenge is to identify your carb tolerance threshold and stay below it. You're getting exercise, losing weight, great A1c; what's not to like??!

It's your body. You are the ultimate authority. They work for you! If her tenor creates stress for you, tell her that you don't like the effects that stress has on your BG levels.

You've got a winning formula. Ride it as long as you can!

3

I've been hanging around some workout people (P90X, etc.) and the thing they do is to find a "sweet spot" calorie-wise, where they don't gain weight, and then break down the macronutrients (pro/carb/fat) to try to go 50-40/20-30/30-20. A lot of them get great results with that approach. It's a bit different than carb counting but my carbs have worked out really well and I can do very well BG-wise when I do that. I don't think it's a bad idea if you think you can lose the weight. I used to weigh 275 and am now around 185-90 and it's much easier on my joints, back, etc. to be lighter. Another solution might be to find a remote person to work with, I think that Gary Scheiner's clinic has services that are online rather than in person and I think a better clinician farther away > a clinician in the hand? Good luck!!

I think you should talk to the doc, explain your data, which sounds really solid, and tell the doc you want a referral to a different nutritionist. I tried a nutritionist when I got my pump and got pretty much the same thing, eat way more carbs but had already been pretty successful losing weight on my own and I haven't been back.

4

My answer would depend on whether or not this specific recommended diet is part of the study design you are participating in. If you were randomized into a group that the study design had following this meal plan then I’d say your choice is to either follow the diet or withdraw from the study. That’s the luck of the draw in these types of studies and there should have been an informed consent that the study design included nutritional research.

Now if the recommendations of the nutritionist are not directly part of your study or they are not studying specific nutritional strategies but merely collecting data then I don’t see why you can’t follow a way of eating and exercising that works for you.

5

NO DianaS this is NOT part of the study....they are concerned about what means people use to control their diabetes, exercise, medications, insulin, food, or nothing.

6

One size does not fit all, no matter what the dietician or doc says. Only you know how the foods you eat and the carb counts and types of carbs consumed play with your BG at various times of the day. If you keep records of the portion, carbs, types and weight consumed vs BG numbers pre and post meal etc, you will have the hard data for your bodies response to your current condition.
Only you can experiment to see what works for you. If your current doc is clueless then another doc's knowledge may be can guide you on your journey.

7

The nutritionist is your adviser, not your boss. She is free to recommend whatever she thinks is right, but you are free to decide what advice to follow and what to disregard. The way to deal with any expert, whether your doctor, your CDE, an author, or your next door neighbor, is to take what you can use and leave the rest.

She does not live in your body and she can't ever know it as well as you do. She hasn't been there with you through the years to observe what works and what doesn't. She isn't there 24x7 managing it, you are. And -- bottom line -- she gets to go home at night. Meaning, she doesn't have to live with the consequences -- YOU do.

In case I haven't made my position absolutely obvious, you have not only the right but the responsibility to yourself to make the choices that work -- that produce the outcome you want. Nothing trumps that. Period. Full stop.

You might also get some reinforcement -- or at least a chuckle or two -- from this discussion. :)
8
but this is my life, not hers
'nuff said.
9

I agree here---Trust your knowledge of your body. It's not fun to argue with a caregiver, but we all need to be our own advocates. It's one of the downsides of this scourge we share. We are all different in how The D manifests in our bodies. By the book doesn't work for us. "If you want to treat diabetes by the book, you need to write a different book for every diabetic."......Hang in there. Trust yourself. And keep us posted.....Blessings

11

It isn't really the science that's catching up, it's the perception. The science has actually been there for a long, long time, and just keeps getting further bolstered by new research. What it has done is, pass through times when no one was paying attention to it.

For instance: ask people at random when low carb diets were first popularized for weight loss. Most people will say, very recently. A few of the more knowledgeable will say, Atkins. Guess what? They're off by about . . . . . . . a century. The evidence of the benefits of low carb diets has been around since the mid 1800s. Fact. Look up the name "William Banting". (No, that's not a typo. William, not Frederick.)

Like I say, it's the perception that's finally catching up. But -- LOL -- better late than never.

12

Ooooh, I don't argue, nor even tell them what I am doing. If you have to fill in a food diary and you don't want confrontation a little judicious cheating seems to be ok to me, whilst you carry on your successful diet. Hugs, Maureen

13

Absolutely do what works for you. Your diet, your exercise, your body.
Can you change dietician? Not a very good dietician if she is not able to personalize the approach IMHO.

If you can't change her and absolutely can't avoid her and she won't change, then tell her what she wants to hear and do personally for yourself what you need to do and what is working for you.

Keep up the great work!

14

Every time I come and write a question either in a comment format, or HELP! I'm being eaten by the system, you people are so supportive and wonderful in saying exactly what is in my head and heart! This dietician is the ONLY one, I do live in a small town, The places (clinics/hospitals) share a dietician --- go figure. Yet, the ideas aren't any different. THIS IS MY BOD, and I will do what I feel necessary to do to get and keep my as healthy as an old woman of *62* can be. Maureen, I've found it interesting that we feel "cheating" on our food diaries is the way to make it work, but gosh, how many have I written that I never put a single bite of what is down in my mouth, It works. And I am just stubborn enough to say to H*ll with it, and do it my way. I need to get the next poundage off, and I will do it for my health, that's how I got my Lantus, got away from Glucophage (sp) and taking care of my knees my way....you are all correct, we have to be our own advocates, no one lives in this body 24/7; and in the end we will have to show our dance cards on how we danced. A Very good friend once told me this and I try to live by it "YOU do and make the healthiest choices for YOU; in all situations and at all times. They may not be the healthiest choices tomorrow nor yesterday, but today they are the healthiest choices YOU can make for YOU. They may not be the healthiest choices for me, but YOU are making them for YOU; not for anyone else, and YOU will live with them." I can't think of anything wiser in any situation that works better. Thanks and ((hugs)) for the support.

15

OMG! if that isn't most of the dieticians/nutritionalists, wait 99% of them I've met.....I wish I could send it to them, and say here you are, that's YOU! Get over yourself. But not a battle I want to fight now. What a hoot! Thanks, david!

16

If it was me, I would keep doing what I knew worked for me, and just not pay any attention to her. These people with book smarts, not life smarts, are a pain in the butt sometimes. They read it somewhere so it must be how you should conduct your life! No allowance for an individual to do what they think works.

Do you really have to go see her? Can you go see someone else who might be less regimented? Seriously, I would not let this woman dictate what and how I eat, she is not me, I know me, and she only knows what she read in a book.

17

I've seen both spelling variations used in formal and informal contexts. Here is a one-page 2010 explanation from the International Confederation of Dietetic Associations.

Short answer to your question from the linked source; both are used but "dietitian" more frequently:

We have addressed concerns over the proper spelling of dietitian, over many years, with some limited success. Recent correspondence from Merriam Webster offers some comfort, “You may be happy to hear that research for your correspondence has alerted us to the fact that "dietician" may not be used as often, or as equally often, as "dietitian."
18

I'm a 67-year old T2 and have managed to keep my A1C under 5.6 (right now it's 5.1) by diet alone. It's not easy, I have to stay under 20g of carb a day, and also restrict calories. After 8 years I know exactly what to do and I do it. The dietitians who are available through my health care group are ALL under 30 years old and have never had an ounce of fat on their bodies for their entire lives. They give the same advice you were given and are just as inflexible. My good numbers prove nothing to them. At first I just went off in my own direction and ignored them. I don't do that anymore because I feel they are doing a horrible injustice to T2 diabetics who try so hard to follow this bogus diet and then end up in worse shape. Then they're told, "Well, your disease is one where you'll get progressively worse." That's BS and I call them on it. I've seen too many T2 friends and relatives go downhill, blaming themselves all the way.

19

That's so unfair to our intelligence. Congrats on knowing exactly what to do for you. That is an inspiration to me....at my very young age of 62!

20

I always thought "Dietitian" was one of the later Roman emperors . . . or maybe a Renaissance painter . . .