Diabetes classes - lockstep advice from start to finish

[rainne]

I signed up for a series of 4, 2 hour classes on diabetes, and had my first class today.

It was, as I expected, the Canadian Diabetes Association program.

"Carbs are good" one instructor said. "We need them to fuel the body" she added.

And the next thing out of her mouth was, "high protien diets lead to kidney damage", I had to say something.

It wasn't my intention to go there to argue with anyone. I had actually planned to stay fairly quiet. But these statements presented as an undisputed truth really bothered me.

I spoke up, politley asking that they acknowledge that there is a lot of controversy about some of their statements, and that it would be better for all of us if we could distinguish fact from theory and/or opinion.

At first, that went over like a lead balloon. I heard how no-one can sustain a low carb lifestyle after the initial weight loss period as it's an extremely difficult diet to follow. I heard how it's just a calorie reducing, portion control diet.

I said, 'look, I'm no expert. I've been at this only a month, but I can tell you this much -- I eat more calories now than i did before. I've lost some weight, but most importantly, my bg is down and far more level than ever. And that for every claim you make about the dangers involved in a low carb diet, I have read the opinion of another expert who claims the exact opposite. I suggest that we ALL be careful about what talk about as though it is fact."

The instructors were not all that happy, but as the class went on, I thought they tried to be less strident. And it turned out that one participant in the class had been put on the Atkins diet by her doctor two week previous, and was glad to know I'd heard good things about the prognosis for her kidney health.

I'm going to finish the classes. I'm not exactly sure why - so far I haven't really learned anything new. Maybe it's my role right now to temper their arrogant presentation.

[kjturner]

Go get 'em!!!

[rainne]

Thanks.

I've been remembering this morning some other things about the class.

After I presented a challenge (and the only challenge was to ask them to acknowledge that some of what they teach is currently under debate) the nurse started using lots of medical terminology. Way inappropiate for most of the audience.

Also, we learned that we are aiming for blood glucose readings of

4 - 7 pre-meal
< 11 post-meal

[c6h6o3]

In other words, you're aiming for no more than a 126 mg/dl differential (assuming 4 mmol/l preprandial and 11 mmol/l post) spike per meal! 11 mmol/l or 198 is higher than any reading I've ever gotten.

That's why when I was prescribed the "diabetes education" course at my local hospital, I just didn't go. Lacking your diplomatic skills, it's certain that I would have gotten myself thrown out and banned from the hospital.

And we wonder why our health care costs are so out of control!

[Lisa N]

4 - 7 pre-meal
< 11 post meal

My goals: 4-6 pre-meal
4-6 post-meal with no more than a 30-40 point rise at any point after eating.

Nearly 200 2 hours after eating would be totally unacceptable to me as that means that during the 2 hours between eating and when you checked, your blood sugar went quite a bit higher.
A good question to ask in response to those guidelines is at what point do blood sugars start doing damage (hint...the answer is anything over 150) and see what they say. If they get it right, you might want to follow up with the question of why they would recommend that anyone allow their blood sugars to get higher than that and present it as "acceptable".
It scares me to death that this is what they are teaching people "good control" means. Yikes!

[rainne]

Exactly! My goal is the same as yours, Lisa. 4-6 round the clock.
Eleven is just way too high!

But it seems to be the Canadian Diabetes Association standard.

[rainne]

An update. I went to class two Monday. Two more after this.

The good part. The Hemoglobin A1c test (HbA1c) was explained. I liked that. And we were given a good reference chart for comparing the results given in percentages with our mmol/L self test results.

A one percent decrease HbA1c reduces diabetes complications by 30%. That's a little factoid that I can use to keep things in perspective.




Then we spent an hour and a half talking about diet. YIKES. We saw how the fat in one fast food thingie compared to the fat in another. We passed around little bottles with representative amounts of fat. We learned how milk in coffee is sooooooooooooo much better than cream. We learned how 50% of our calories should come from carbs. And the rail thin woman who can't get her bg down any lower than she has (who eats very very little, and what she does eat is low fat and high carbs) was told she'd better get in to see her doctor as maybe she needs her meds adjusted.

Again, everything presented as god-given fact.

I was pretty quiet about everything. I simply asked after the first hour that the teachers acknowledge that what they teach is considered controversial by some scientists, researchers and doctors. They didn't say anythign to that. They just moved on.

Oh boy, I can't wait for next week now.

[nopie]

Rainne, you're just the skunk at the garden party, aren't you? I love it - stay after them.

[Lisa N]

And the rail thin woman who can't get her bg down any lower than she has (who eats very very little, and what she does eat is low fat and high carbs) was told she'd better get in to see her doctor as maybe she needs her meds adjusted.

You know....this sort of thing just makes me shake my head on wonder. She's eating exactly like they're telling her to and it's not working. Instead of saying...hmmm...maybe what you're eating isn't right, they suggest more meds! After all...it can't possibly be the diet, right?
Just makes me want to :bash: those folks!

[c6h6o3]

The prejudice is so strong as to defy belief:

From Chapter 9 of Dr. B's book:

"(The ADA has recently recognized officially that, for example, bread is as fast-acting a carbohydrate as table sugar. But instead of issuing a recommendation against eating bread, its response has been to say that table sugar is therefore okay, and can be 'exchanged' for other carbohydrates. To me, this is nonsense.)"

It's like Bizarro world from the Superman comics of old.

[rainne]

Skunk at the garden party. That was funny, Nopie.


The situation now is that a lot of evidence fits the accepted belief that
1) high carb/low fat is the best diet
2) diabetes progesses


When newly diagnosed diabetics start on Canada's food guide, they are probably eating a lot less than they once did. So they show some improvement, which only confirms that the diet works. Then, as the perscribed diet doesn't work, it must mean the disease is progressing. Hence the need for more meds.

Ergo, people like Dr. Bernstien, who offers a whole different paradigm, must be quacks.



I have the third class this afternoon.

[c6h6o3]

I definitely would've been expelled. Maybe burned at the stake for extreme heresy.

[rainne]

Jim, I think having you in the class would have been a lot of fun. Maybe not for the teachers, but at least for me.




Today's class was more of the same. We got tons of tips for how to reduce the fat in our diets, as well as some examples of people eating excessive amounts of fat -- with the proper amount of scorn shown. For instance, we heard about a friend of one teacher who goes through an entrie brick of cheese a week because she uses a lot of cheese in cooking.

Hello!? Only *one* brick?

Anyway, we were also told that a good way to lose weight, after watching portion size, was to reduce the amount of meat we eat. My first thought was, these poor people are going to be hungry all the time.

We were encouraged to indulge our human need for 'bad' foods a couple of times a week and eat the chocolate bar or the pie, and that will help us reduce the cravings and avoid the binging. I don't know about the rest of you, but it only causes both in my case. But whatever.

I liked the review of medications, and when I asked about pancreatic burnout from the sulfonylureas - the one instructor seemed to really know what she was talking about, and acknowledged it's a real possibility, although there hasn't been any clear research to prove it. But she suggested that metformin is the preferred medication for that very reason.



Three classes done. One to go.

[c6h6o3]

My daughters (ages 7 and 9) and I can easily demolish a pound of bacon on Saturday morning. I have to get at least two skillets going to meet their demands. Sometimes we add some Hilshire Farms Beef Polska Kielbasa (only 7 carbs in the whole thing!). I would take snapshots of our weekend breakfasts to the class.

[Lisa N]

Originally posted by c6h6o3
My daughters (ages 7 and 9) and I can easily demolish a pound of bacon on Saturday morning. I have to get at least two skillets going to meet their demands. Sometimes we add some Hilshire Farms Beef Polska Kielbasa (only 7 carbs in the whole thing!). I would take snapshots of our weekend breakfasts to the class.

Hee hee! That would be fun just to see the look of horror on the instructor's face! And then you can wave your lipid profile under her nose to show that it probably looks better than hers. :D <----evil grin.

Hey, Jim! Your daughters are about the same age as mine (7 and 8). On a weekend morning, the 4 of us can go through a pound of bacon and 7 or 8 eggs easily. :)

[wsgts]

Would you recommend these classes to a new diabetic?

My doctor signed me up for them several years ago when I was diagnosed. He said he was required to by the medical group he was working with, but it was a waste of time. He is the one that turned me on to low-carb lifestyle, and for me validated it more than anyone else.

Later,
wsgts

[rainne]

What a good question.

Well, no, I wouldn't. But that's too bad, because my background is in training and development, and I think there is a powerful potential benefit to classes for diabetics.

There's something reassuring for most folks to look around a room and know everyone there is in the same boat. I think it helps with acceptance of the disease. What's more, I don't know anyone whose doctor spends much time talking with them. Where else will people learn where to prick their fingers or how to pronounce the various medications and their types or what the various blood tests measure and how they do it?

But I deeply resent the lack of acknowledgement of other approaches, and think it's does a diservice to people. Folks need to be told that there are people doing things differently and where to learn more. Not once has this program done this. Not once have they even alluded to any success with any other approach. Instead, the content is sprinkled with hints about how dangerous low carb/high protien eating can be.

Also, never ever was there even a hint that some diabetics are striving for and achieving normal blood sugars. We were told what levels were normal and that was the only time those numbers were used. The rest of the time, over and over, we heard that 4-7 pre-meal and 7-11 post meal were our goals.


So, no, I would not recommend them. However, I could design something that I think would be well worth the time and energy. I don't mean that as a brag, but it's what I used to do and I believe it's possible.

[c6h6o3]

He'll have at least one patient before he even arrives

[rainne]

Originally posted by c6h6o3
My daughters (ages 7 and 9) and I can easily demolish a pound of bacon on Saturday morning.

I just cooked up a pound for my gang for dinner.

The Canada's Food Guide police are gonna be after all of us. We be bad.

[Jayne34]

I believe that we do need carbs. Afterall, the brain functions only on glucose and you don't get that from proteins.
There are good carbs, nice carbs and bad carbs. The Glycemic Index gives us a hint of which is which.
You can really damage the kidneys if you have disease present or if you have a propensity towards kidney disease.
The lastest studies show this to be a viable conclusion.
Sooo, one size doesn't fit all.
Jayne

[c6h6o3]

However, the liver can manufacture glucose from amino acids, in a process called gluconeogenesis. Amino acids are obtained when dietary protein is broken down.

So, the incredible fact of the matter is that the dietary carbohydrate intake necessary for the human organism to thrive, not merely survive, is zero. No problems with unit conversion here.

And while it is also true that high protein intake will further damage the kidneys if and only if substantial nephropathic damage is already present, excess protein does not cause kidney disease. Nephropathy is caused by chronically high blood sugar.

Please pass the steak sauce.

[c6h6o3]

Originally posted by Jayne34

There are good carbs, nice carbs and bad carbs.

Now if we could just teach the pancreas to tell the difference, we might be on to something. The sad fact is, though, that your endocrine system doesn't either know or care whether the glucose came from organic brown rice or a Hershey bar.

[wsgts]

Hi New Folks,

If you guys want to discuss the merits of eating sugar/carbohydrates, might want to make a few posts over on the War Zone. It is seen by more people than this very specialized group like the Diabetes Forum.

Just a brief response to "I believe we need carbs".

I can certainly promise there is plenty, and I do mean plenty of glucose circulating in my veins at all times. If there was not, I certainly wouldn't be taking Glucaphage XR once a day or monitoring levels to make sure that the amount of glucose out there isn't killing me.

Also, please link the studies on the kidney disease, I am interested (explanation below). When I decided a few months ago to go away from my low-carb/high-fat ways and go for the "healthy" alternative it wasn't two months (was going to have another hba1c and see the difference) before my BG was 405 and back on meds.

Low carbs HBA1c = 5.4 (no meds)
Healthy diet HBA1c (as of April 29th) = 8.6
Past Friday HBA1c = 6.2 (high for me, but ok overall as it's only been two months)

April 29th I had a protein of +2 in the urine, which is a very early indicator or kidney damage on a "healthy" diet. This past friday my urine had zero protein, not to mention a weight lose of 18 pounds.

It's good you keep an open mind and realize that not one size fits all. You are rare in the medical community for sure. However, when it doesn't fit, it just doesn't fit, and no amount of insulin sensitizers, insulin producers, or injected insulin will make it fit, but rather only prolong the inevitable.

wsgts

[alaskaman]

Was talking to a woman at work the other day - her father has bad diabetes, close to 400 lbs, and his kidneys failed. So her brother donated a kidney to dad. But he still has out-of-control sugars and a major weight problem. He went on Atkins - started to lose pounds. His doctors were horrified - "you can't eat that much protien with only one kidney and a history of blowing out your own." So now he's back on the ADA diet, high sugars, lots of insulin, gaining weight again. I think he's worse off now, but how does one know for sure? What would I do, if I had only one kidney, and no other donors left? I think I would continue to do Bernstein, but I'm not trying to persuade these people. Just too uncertain. Bill

[c6h6o3]

I think he's worse off now, but how does one know for sure?

One knows for sure through observation of the improvement in his condition upon going from an ADA diet to a low carbohydrate one.

[alaskaman]

Yeah, you're right - if his sugars were great, and the pounds were gone, why would the one kidney fail? But since he's doing the same stuff that he was doing, that led to both of his own kidneys giving up, why should it be any different this time? I feel sad about it.

[rainne]

I feel bad about it, too. But it takes a huge amount of confidence in all the things one can't see to go against the expert's advice when you are down to a single and last kidney. I sure do understand why this guy went back to his old way of eating.

Gee, I feel a bit like that guy. I have the earliest stages of kidney disease, and I wish there were fewer experts warning about high protien and kidney damange. And while I feel pretty confident that I'm doing the right thing for myself right now, I'm not 100% certain.

[nopie]

1) ADA diet causes high blood sugar which in turn causes kidney damage and failure, not to mention all the other ills that come with high blood sugar

2) Low carb, high protein diet causes kidney damage and failure but lowers blood sugar

We know number 1 is correct but 2 (the part about the kidneys) is not proven. And, number 2 lowers blood sugar so that you don't go blind, lose a leg, etc. You definitely feel better on low carb, high protein. No contest for me - it's low carb that will keep me alive, healthy and feeling good longer.

[Sherrielee]

So, I am wondering...why do we need any carbs? Dr Bernstein indicates in his book that he would ask his patients to do less than 30g per day...but they probably wouldn't like it!

Wouldn't we be better off with NO carbs when BG is unstable?

[alaskaman]

rainne - you say you have the beginnings of kidney disease. Scary. Just to encourage you a bit, remember Dr Bernstein also had beginnings of kidney disease, and now is free of it. So that's cause for optimism. Also, Somewhere in his book (I think) it is mentioned that kidney patients on dialysis who must minimize protien rely a lot on fat - olive oil, I think. So your WOE is not necessarily a high protien diet. Read the web pages for the "Cholesterol myths" and the "Cholesterol skeptics network" if you're worried about fat. Best wishes, Bill

[c6h6o3]

remember Dr Bernstein also had beginnings of kidney disease, and now is free of it.

Wrong. He had extensive kidney damage as evidenced by "advanced proteinuria" (his words, not mine) and is now free of it.

To quote him:

"Nondiabetics who eat a lot of protein don't get diabetic kidney disease. Diabetics with normalized blood sugars don't get diabetic kidney disease. High levels of dietary protein do not cause kidney disease in diabetics or anyone else."

[rainne]

I had my last class today, and am now a graduated diabetic in good standing. I have a certificate and everything.

I'm not sorry I took the classes, but I wouldn't recommend them to anyone. Not as long as they teach there is only one right way (and it's the wrong way).

The best part of the entire 8 hours was being able to compare how light plastic beads (simulated molecules) moved through a test tube with liquid of different viscosities (body fluids with normal or high blood sugars).

The thickness of the tube designed to represent a bg of 10 was horrific. Like corn syrup. It is so easy see how hard the body would have to work to keep itself working at all - and that there would have to be some damage.

I've already found that if I start thinking cookies or chips, I realize far quicker and with more certainty that carbs will kill me.

I really, REALLY don't get how so many intelligent people can work with this information and accumulated knowledge all the time and still teach that anything under 7 pre-meal and under 11 post meal is ok. Or that a chocolate bar is ok once or twice a week.

[c6h6o3]

I really, REALLY don't get how so many intelligent people can work with this information and accumulated knowledge all the time and still teach that anything under 7 pre-meal and under 11 post meal is ok. Or that a chocolate bar is ok once or twice a week.

Not just intelligent people. Medical school graduates.

[Doitnow]

My doc asked me if I wanted to go to classes. I asked her if the classes would offer the old fashioned diabetic diet approach. "Well, yes," she said, "I guess they would."

So I asked her why she was suggesting I go since she had just told me that I should follow atkins?

People are sheep. She wasn't even thinking, just operating on rote.

I have learned that I have to take ever increasing responsibility for getting information for myself.