What do you guys think?

I was invited, some months ago, to attend a Cognitive Behavioural Therapy course designed to help diabetics cope with the depression caused by having trouble controlling their diabetes. Since the NHS paid, I went out of curiosity. I DO control my condition[ A1c in the 5% s] and I am NOT depressed.
After the course we were asked for an evalutaion.
My comment was that if the NHS is spending this money on psychological training, It would be better spent teachig people to manage the diabetes and thus avoid depression in the first place.
Several of my classmates were definitely depressed. One woman has veery high numbers. I asked her about her eating and she told us she does exactly what the dietician has told her. that included a generous portion of cereal followed by toast for breakfast!!
I said thawt if she had an egg instead, her numbers would be better, but that idea was ridiculed.
I am not a medically qualified person, so my comments were dismissed. This sort of thing makes me MAD
Hana

I still don’t get where this thinking comes from, where’s the science in continuing this approach? How can they continue giving advice that clearly doesn’t work for many T2’s and leads to depression in some? Start with a high carb diet, if you must, but in that percentage of patients where it doesn’t work, start cutting the foods that spike the patient. This is simple logic, and what is science but applied logic.

That sucks that they ridiculed the suggestion of just eating an egg. I agree that the money would be much better spent on diabetes education than on psych classes about epression. Something that came up in the dietician thread was that doctors, at least in the US, generally defer any food questions to a CDE who, in turn, will “calculate” (sic) a diet of something like 3x 30-60G of carbohydrate meals and 3x 15-30G of carbohydrate snacks. In my experience, I have figured out that I don’t need to eat that much, although I eat quite a few more carbs than many of the people here.

To me, it seems like 50% of my “medicine” is food since diabetes is not just about “taking insulin” or “taking Metformin” or “exercising after every meal” but about balancing food and whatever else one does. If the doctor you are paying money to to “manage” or at least help manage diabetes won’t talk about food, they are leaving out a critical component of successful management that seems to me to be very likely to be where the “breakdown” in general diabetes care lies. This seems like it would be a relatively easy “fix”, change the 99213 visits to a 99214 and have the doc talk about food and discuss your plan with you but, whenever this comes up for me, I am sort of introverted and sort of glib which, inevitably, seems to lead doctors to the conclusion that “you know what you are doing…”.

The fascinating and, at least to me, very amusing Christopher Gardner video BSC shared the link to in the other thread (LINK) explores some of the hazards of dealing with food research for scientists but, watching it (it is a bit long but I was totally engaged…) it also sort of suggests some of the pitfalls of living a food research project which is what diabetes amounts to. The conclusion of the study seems to be that eating less carbs (Atkinsing, a bitter pill for vegetarian Gardner to sell…) is the best and healthiest way to lose weight but that’s pretty easy to translate into it’s also the best way to manage diabetes successfully and feel the sense of accomplishment lacking when I eat toast and cereal at the same time for breakfast!!

Thanks for sharing this Hana. It makes me feel so angry too.

I wondered if the woman you mentioned had ever feedbacked those high numbers to the dietitian? I know most people automatically defer to the judgments of medical professionals but as the patient, surely you’d suspect something was wrong if you did ‘what the doctor/nurse/dietitian’ told you to do, and the numbers were still bad?

I agree with you that much of the mainstream advice is criminally wrong, but surely as patients, we also have a responsibility of self-management?

We can’t assume the patient in question is on insulin. People on insulin have a better idea about how food affects them because they test more. A T2 following the usual advice to test once a day or at best a couple of times a day can’t really be expected to determine the cause and effect between a given food and it’s results. They must rely on the advice they are given, which in this case, is clearly the wrong advice.

As a T2 on metformin only I have zero chance of going low, all the danger for me is on the high side.

It might be cheaper to simply provide these folks with sufficient test strips to determine what foods are causing the problem rather than pay for these classes.

What about some sort of “carb tax” to make carbohydrates as expensive as their consequences? I can recall the Civil War/ Weimar stories about taking a wheelbarrow full of hyperinflated currency to buy a loaf of bread. Obviously we don’t need that but if there is, as seems clear, a health risk associated with carbs, analogous to that posed by smoking and drinking, perhaps a tax would cut consumption across the board?

Acid, you haven’t been listening carefully to Hope Warshaw! Didn’t you know that wholegrain, unprocessed carbs are good for you?

Milking the fattest cow, that’s what it boils down too…

-Yogi

From personal experience, I went blind with cataracts, as a result of “professional advice”. If there’s any advice im gonna accept, it will be the advice of ANOTHER DIABETIC, WHO HAS THE LIFE EXPERIENCE!!! Not saying that all doctors are bad. It’s just that there is a huge difference between what’s taught in school, and living the life of a diabetic 24/7

-Yogi

I absolutely agree with what everyone has said about education about carbs and managing diabetes.

But I disagree about the value of this course. As someone who is well acquainted with CBT I very much do think it can be useful for depression secondary to diabetes. I was excited to hear about it when I read the title. Not everyone’s depression is either caused entirely by their diabetes, nor alleviated by good management. CBT is about changing the way we think to get rid of faulty assumptions that are affecting our well-being. For example I got up this morning, tested my blood sugar, thought about the result and looked forward today to evaluating a new dosing for insulin and Symlin I’m working on. A person with Major Depressive Disorder might get up, not test due to feeling it’s “going to be bad no matter what I do”, eat the cereal and toast because “I never do anything right on my own so may as well do what the doctor said” or even “I’m doomed to lose my legs and my vision so what difference does it make what I eat?” etc. Those negative thoughts are getting in the way of this person managing their diabetes and having the motivation to learn how to do so better, let alone enjoy their lives. CBT can help with this.

And yes, I do agree, the person who responded to your egg suggestion was rude and ignorant.

I agree with you that we have a responsibility for self management, but what happens when we have a problem that we don’t know how to fix? When I started having problems with gastroparesis and my blood sugar was bouncing all over the place, I knew I had a problem but did not know how to fix it. I was testing my BS about 10 times a day back then and had data, but I did not know what to do with that data. The one time when a doctor was criticizing me because my BS was all over the places, I even said “tell me what to do and I will do it.” I was met with blank stares and the jerk didn’t even say one word. I quit asking anyone for help because I didn’t get any. If I hadn’t found the DOC, I would probably be dead today and it wasn’t that I didn’t want help or didn’t want to do the right thing.

It’s my experience that if sometrhing doesn’t work,the medics accuse the patient of "cheating"and not telling the truth.I’ve met many people who have been told that
Hana

I hadn’t even finished reading your post and I was immediately responding. Turns out I am in agreement with what everyone here seems to be saying.

There is a huge cognitive dissonance when the very people supposedly “on our side” recommend diets that will kill us. Taking the regular old food pyramid, and writing ADA Food Pyramid on it, recommending something like 6 grains a day, diabetic cook books with lunch time meals containing 200 grams of carbs, you all know what I mean.

It all leads to anger and depression.

Jackie
my own doctor is with me on most of what I do. i don’t tell him everything, but our working relationship goes back 35 years.
In my last discussion with him, he said that “low” not caused by medication is harmless. It can’t cause death unless there’s something there continuing to depress the blood glucose. Otherwise a “liver dump” will correct it.
I’ve tried to find figures for deaths from hypo. No country seems to keep them; and in any case it’s very rare. Deaths from complications of High sugars are VERY common.
Hana

If “unprocessed” means “Raw” then wholegrains are indigestible and toxic [we lack the enzymes to process them]. I’d hardly call that "good for you"
Hana
PS unless you were being sarcastic.

My wife is a psychologist who uses CBT so that I am probably biased but from her experience CBT has been helpful with patients with depression. CBT which emphasizes identifying unhelpful beliefs and helping patients free themselves from being dominated by them might be very useful for those who cannot control blood sugar on a high (or even moderate) carb diet but who is instructed to keep working on an approach that doesn’t work. Just don’t find a therapist who is tied into the 45-65% Mafia.



Maurie

I 100% agree with this, and think it’s sort of sad that an opportunity to talk about the use of CBT to address the (very real) psychological burdens that go along with fighting diabetes has been railroaded to have yet another high carb v. low carb discussion. Regardless of your feelings about diet, psychology is an important aspect of diabetes management, and we’d have a much better discussion if most of this site’s posters could walk around without a giant chip on their shoulder.

Diabetic Radio: Sorry to hear about your experience. What happened?

I agree with Maurie as I too have effectively used CBT both at work and for myself. While I had training, I used the techniques with weekly input from a fully qualified psychologist. My concern would be that the therapists would not have the training required for the task. If psychologists become involved, perhaps there would be fresh eyes to problem solve. For example, many PWDs catastrophize over the complications and a psychologist might recognize that the current scare tactics are causing this problem.

Long story short. When I was young, diabetes was a silent epidemic. Only old people were viewed as getting diabetes. I had all the symptoms as a child, and no doctor caught them (despite doctors being aware that it runs in my family). By the time I was officially diagnosed, I already started developing cataracts, and I went almost legally blind within a year. However, I had both surgeries, and my sight is doing better then ever. So I still have a heavy bias towards doctors in general.



-Yogi



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