Replies to This Discussion

Permalink Reply by MossDog on April 26, 2012 at 5:53pm

I still think the actual number of people that those who already eat a low carb diet assume would choose low carb were they given the options is WAY smaller than the usual assumption. I give the Low Carb option (clearly stating what the alternative is and what the problem with the old eat more and take more approach is)to every patient I see and I would venture to guess maybe 1 in 100 choose low carb. Not very good batting numbers. What you all need to remember is people on this website are highly motivated individuals and are willing to "work" however they must to get the right numbers. The general PWD population- not so much. Giving someone a "diet" to follow is only effective if they actually follow it....:{

• ▶ Reply

Permalink Reply by BadMoonT2 on April 26, 2012 at 7:03pm

I believe you when you say you have very few takers, and give you a lot of credit for continuing to present different options and giving the pro's and cons of various approaches.

My whole problem with the standard dietary advice is that the scale is stacked in favor of the higher carb approach with statements like you need 130g of carbs to survive etc.. In the vast majority of cases low carb is not even presented as an option. In many cases low carb is dismissed as dangerous. While I personally don't believe it is dangerous, I am quite sure high blood sugars will kill you, and must be dealt with.

Perhaps one reason for the low interest is that another facet of the standard advice is to just test once a day. I started out on the exchange diet given to me by a dietician. But because I was testing before each meal and one and two hours post meal, I saw immediately it was not working. I next tried a diet based on the glycemic index but again found it to be ineffective. When I cut out the sweets, starches, legumes and fruit I began to see numbers I could live with. Without the testing I would never have known the damage I was continuing to do to myself.

• ▶ Reply

Permalink Reply by MossDog on May 4, 2012 at 1:09pm

I really think that is where the problem is. I quite honestly do not think the effects of high blood glucose is immediate enough that people perceive it as a problem. Even when their family members are dealing with significant problems from long term uncontrolled diabetes they still sit there and shrug their shoulders when you point out what they are doing to their bodies.

I know it sounds bad but even getting people to eat what is considered around here as high carb intake (~180 grams/day)is like asking someone to "starve" themselves in the general DM population (at least in the area of the world I live in).

I will agree that GENERALLY RD's are behind the times when looking at this issue (carbs). However, depressingly enough I don't think that even if every last one of them was recommending a low carb approach we would see any real change in overall control in the Western world. I see over and over how "if only those evil RD's would tell people differently everything would be so much better". I am sorry folks but the issue is WAY bigger than that.

• ▶ Reply

Permalink Reply by acidrock23 on April 27, 2012 at 4:20am

I think some of the "marketing" problem might be that it could be easier to sell "lower carb" than "low carb"? I have steadily cut carbs out here and there for sheesh, 6 years? I run down, I run up, I don't stick to a particular level of carbs but, in general, when I've looked at my regular (M-F...) food, I've identified "extra" carbs I felt I could try to do without and cut them out (1/2 sandwich instead of whole sandwich, 86 potato chips, 86 yogurt sub broccoli, etc.) and lost weight. That was my main motive, when I was up > 200 lbs but, while I was doing that, I also noticed that it was clearly easier to "nail" BG "targets" consistently with less carbs. I occasionally will have some times when I'll run lower carbs, down around 80 but I don't do it all the time and rarely on weekends.

I have had pretty much zero medical advice on the subject?

• ▶ Reply

Permalink Reply by MyBustedPancreas on April 25, 2012 at 5:17am

Regardless of the financial situation, punishing people for bad A1Cs is just nuts. First of all, there are frequently issues with lab results (be it A1Cs or anything else you have measured) due to equipment calibration issues, preservation of samples, etc. Labs are meant to be a guidepost, not an absolute. I have had doctors run labs multiple times in the past because something came back abnormal (and was then normal in subsequent samples).

With regard to the A1C - it's just ONE thing that can be looked at when assessing diabetes care. HOWEVER, A1C values can vary for any number of reasons. For example, if I get sick (cold, flu, infection), my BGs are going to go up and my A1C will too, no matter what I do. That's just part of being diabetic. If my A1C is drawn during the week when I notoriously run high because I'm PMSing...yep, gonna be a bit higher then too and not reflective of all the work I've done throughout the month. If I get a bad batch of insulin or multiple failed infusion sets or my pump dies, well, all these things that are somewhat out of my control are also going to throw off my A1C.

What scares me about this approach is that it is likely going to result in people finding ways to just game the system OR running dangerously low to avoid punishment. Also, what is a "good" A1C seems to change all the time. There was a period of time where every endo I met said, "You need to have an A1C in the 6s." Now, that tide has turned a bit; my endo says that I should focus less on the A1C and more on the standard deviation and my overall trends. She felt that aiming for an A1C in the low or mid 6 range was, for me, unrealistic and putting me in danger because of severe hypos.

• ▶ Reply

Permalink Reply by Chris Miller on April 25, 2012 at 7:33am

My doctor told me that she wanted me under 7%. I was 7.2%. She didn't lecture me, but indicated that I could do better. I go for my next one in mid-May. I fully expect a similar number. If I lived in Hungary, I guess I'd be hooped!

• ▶ Reply

Permalink Reply by MyBustedPancreas on April 26, 2012 at 5:24am

And the important thing to remember here is that what is good for one person is not necessarily good for another. For one person, aiming for an A1C below 7 is fine. For someone else, it might not be. Medicine is NOT always a science. Sometimes it is art. Sometimes it is therapy (i.e., LISTENING to what the patient is telling you). At the end of the day, we the patients have to make our own decisions and live with them.

• ▶ Reply

Permalink Reply by Benjamin McLaughlin on April 25, 2012 at 8:46am

This situation reminds me of the new thing Louisiana education is going through. They are implementing a system that will pay teachers based on how well their kids score. To a suit in an office, this seems very logical. If a teacher sucks, his students will likewise. On the surface it seems great, if a diabetic isn't taking good care of themselves, why should tax payers money go more to them. Kind of like insurances that used to deny CGM's because they were in "too good of control." Yeah on the surface it seems like a great way to do it, but there are so many intangibles that you can't see. Like someone said earlier, what if you are fighting an illness for over a month. What if you are in a very stressful time in your life. It's hard to look at a number and determine how well someone is controlling their diabetes. So many variables work together to get those numbers, some we can't fix. Just like a school teacher. I can't affect if a student of mine didn't get any sleep at all the night before the BIG test. He may be my best student, but problems at home, having a bad day, not eating breakfast, you fill in the blank for reasons why a kid might show up and do worse than he normally would on a test.

Bottom line is, it's so hard having people that aren't diabetics make decisions based on statistics. I wish that there was a way for the government to find out who was taking good care of themselves verses who wasn't. The people who are blatantly crapping their lives away SHOULD have to pay more, but there is no way in the world that anyone can use one, or even multiple tests to do that. You will always have "good" diabetics for whatever reason fall on the "bad" side, and therefore be punished. I am a teacher, I feel I am a good one. I wish there could be a nice easy way to evaluate teachers to weed out the bad ones. But do not look at a single, or even a few test scores and judge me on that. True I can affect their scores based on what I do, but there are just so many variables that go into that that I cannot control. There's no easy answer to any of these types of problems. The governments head is in the right place, but there is no plausible way of actually implementing strategies like that.

• ▶ Reply

Permalink Reply by Benjamin McLaughlin on April 25, 2012 at 8:51am

And please don't misunderstand my "blatantly crapping away" comment. I am talking about those who know they have diabetes bu do not care, not those who are struggling with control. I have learned, even in this "easy" honeymoon period, that control can be a beast. I am just talking about those with diabetes who don't try to control it at all, not the ones who are trying, even if they are struggling.

• ▶ Reply

Permalink Reply by Bug74 on April 25, 2012 at 10:58am

There have been many recent reforms to health care and more to come. Soon, medicare will begin paying providers by outcomes as opposed to service provided. I think providers will start scrambling for external partnerships to help patients do better.

"punishment" can come in many forms. When I asked to be a new patient of my current endo, she asked for labs and her staff did a short phone interview. It took several days to learn I was accepted. Not sure her exact reasoning...but wondered at the time if she could see what was coming.

• ▶ Reply

Permalink Reply by acidrock23 on April 25, 2012 at 3:54pm

I have to agree w/ BadMoon that the handwriting is on the wall. The US is competing with China/ Europe/ India but has hamstrung the ability of the government to do, well, just about anything because politicians are not allowed to raise funds the government needs to operate. Health care costs are going to continue to rise without any "supervision" and there's not really a significant "will" to do so in Washington. Plans are "bad" and "tools of big government" and the suggestion that private healthcare insurance will solve things favorably, particularly with our longstanding tradition of cutting seriously ill people loose and tossing them on the scrapheap of Medicare/ SSDI. I suspect that we may end up there someday, with R/N and 4x strips/ day.

• ▶ Reply

Permalink Reply by Stemwinder on April 25, 2012 at 4:41pm

Unfortunately this is what happens when the government gets involved just about anything. When they get their claws into the health care industry you better just watch out. You hear so many people asking for universal health care. All I can say is be careful what you wish.

I am all for everyone's health needs being cared for. There are members here that sure can use the help and deserve it but government run health care is not the answer. I think that a better idea for caring for the masses is not universal government run health care but rather universal government supplied insurance coverage. In my utopian world the government would supply each person regardless of wealth or lack of with a voucher for the cost of a basic insurance policy. A voucher that could be redeemed with the insurance carrier of their choice. The gov would set the coverage and price on a basic policy thru negotiations with the insurance industry and then get out of the way and let the free market take over and only get involved to settle disputes.

That's my suggestion for health care, now if I can only get a bunch of politicians to agree.

Gary S

• ▶ Reply

• ‹ Previous
• 1
• 2
• 3
• 4
• Next ›
• Page