Type 2 Diabetes
Replies
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Thanks! Great advice. I will try some of your ideas. Do they make a low sugar carb tomato sauce? I have one more class and I will definitely be asking more questions.I athink I may have heard some of the same advice, especially about the number of carbs per meal or snack; however, I think they are meant to be maximums. In my opinion, starch is entirely optional, though I frequently include it. Balanced meals also do not require dairy, though it can be an excellent source for some essential nutrients. Get a variety of foods. Log it all and look beyond the macros. Chicken and fish aren't you're only options, but that greasy burger may not be something you awant to eat daily - or even every week. LEan ground beef in a tomato sauce over spaghetti squash or a sweet potato with a salad can be quite nutricious. Maybe a roasted pork loin with roasted root veggies.
The red meat (beef and pork) restriction may have more to do with your kidney problems, so it's worth asking.
Try to have an individual appointment with the nutitionist. Discuss what you like to eat and your goals.
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Thanks! Great advice. I will try some of your ideas. Do they make a low sugar carb tomato sauce? I have one more class and I will definitely be asking more questions.I athink I may have heard some of the same advice, especially about the number of carbs per meal or snack; however, I think they are meant to be maximums. In my opinion, starch is entirely optional, though I frequently include it. Balanced meals also do not require dairy, though it can be an excellent source for some essential nutrients. Get a variety of foods. Log it all and look beyond the macros. Chicken and fish aren't you're only options, but that greasy burger may not be something you awant to eat daily - or even every week. LEan ground beef in a tomato sauce over spaghetti squash or a sweet potato with a salad can be quite nutricious. Maybe a roasted pork loin with roasted root veggies.
The red meat (beef and pork) restriction may have more to do with your kidney problems, so it's worth asking.
Try to have an individual appointment with the nutitionist. Discuss what you like to eat and your goals.
You can find no added sugar tomato sauce in the grocery store. You have to comb through a lot of added suger ones first to do so. Alos, keep in mind that tomatoes are naturally sugar-y0 -
My son is type 1 diabetic so I don't know if this would
Be the same for type 2 diabetics but his carb recommendation is 45-60 per meal and 15-30 for snacks. He's been diabetic since he was 2 so now after eating lower carbs his whole life he's not a fan of carbs. He in actuality eats about 30-45 carbs per meal often times less and 15 for snacks.
I'd assume the lower carbs the better for type 2 diabetics as well as its all about carbs breaking down in to sugar and that's why you limit it.
Veggies (although corn and peas as pretty "carby"
Lean meats (my son fills up on lean meats and veggies)
His snacks are normally
Eggs
Small amounts of fruits
String cheese
Popcorn
Rice cakes
He does probably drink too much diet soda but since I had to be so strict about other foods i was pretty lenient about diet soda as long as he also drank tons of water.
For a different low carb drink the diet V8 drinks are surprisingly good and only 6-8 carbs per 8oz cup
Good luck you can do this and will be so happy once you get it all under control
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I eat burgers on occasion, but with only the skinny part of the bun, so they are open-faced
But if that recommendation has to do with kidney health, I wouldn't know anything about that. I'm just talking glucose.
The carb amount does sound high, unless we're talking beans, tomatoes, or peas, etc. I'd do them as maximums, yeah.
Do you have a glucose monitor? Check your blood after eating different meals and see how they affect your sugars. See if you go down to 140 or below 2 hours after eating whatever it is (without eating anything else in between, which is usually my problem with coffee, etc).
For the cholesterol, eat more fiber and use olive oil, etc, instead of saturated fats like butter. If it's your triglycerides that are the main problem, fixing your blood sugar will really help with that on its own. Good luck!0 -
Yes, it is a legit question. It's not that I'm purposely not eating the amount of calories and number of carbs the nutritionist is telling me to eat. It's actually not my doctor who's telling me anything. I'm getting this info from a nutritionist class that consist of about 20 other people who range from all races, age, weight, and other health issues. I just can't force myself to eat that much calories a day and I don't want to eat that much carbs a day. Is that wrong? I was eating carbs like crazy before and that's how I got here. So I just feel like if I'm going to beat this I need to make a big change. I've done some research and many people have said low carb and high protein is a great start. I've been doing it for a month now and it's getting better. But after being told I need to eat a complete balanced meal that consist of the starch, veggies, protein, dairy, and fat it's been hard to do. I feel like that is just a lot of food. I'm just so tired of eating chicken and fish. I miss that greasy burger or carne asada burrito.
Is that legit?Your doctor is giving you around 200 carbs per day. How many are you aiming for and if it's lower than 200, why are you aiming lower than your doctor suggested?
Legit question.
I just noticed that you said you are trying high protein. You need to ask what numbers are safe/recommended there for kidney issues. High protein is usually not recommended for that.
You might want to use a blood monitor and check out the Glycemic Index/Glycemic Load, then. It can help you find more foods that don't spike blood sugar (with some individual variation, so check your levels). Then you could avoid meat a bit more by eating carbs that aren't a problem. They actually help regulate blood sugar better, so they are often recommended for diabetes.
You might get into a lot of (homemade) chili-like meals like I love! Tuscan bean stews, Lentil stews, Quick Cassoulets, etc, as recipes are really yummy and use mostly beans with meat as a smaller highlight. The beans are cooked in the meat, so it's still very tasty for meat-lovers! Regular chili works, too That's still protein as well, but it probably won't add up as quickly as a lot of meat will. 0 -
Yes, it is a legit question. It's not that I'm purposely not eating the amount of calories and number of carbs the nutritionist is telling me to eat. It's actually not my doctor who's telling me anything. I'm getting this info from a nutritionist class that consist of about 20 other people who range from all races, age, weight, and other health issues. I just can't force myself to eat that much calories a day and I don't want to eat that much carbs a day. Is that wrong? I was eating carbs like crazy before and that's how I got here. So I just feel like if I'm going to beat this I need to make a big change. I've done some research and many people have said low carb and high protein is a great start. I've been doing it for a month now and it's getting better. But after being told I need to eat a complete balanced meal that consist of the starch, veggies, protein, dairy, and fat it's been hard to do. I feel like that is just a lot of food. I'm just so tired of eating chicken and fish. I miss that greasy burger or carne asada burrito.
Is that legit?Your doctor is giving you around 200 carbs per day. How many are you aiming for and if it's lower than 200, why are you aiming lower than your doctor suggested?
Legit question.
I'm not a doctor. I'm not qualified to give you medical advice. I'm in no way against low carb. I actually encourage most people to try it, since it can work great for many of them.
When you say you might have kidney disease... you're now in territory outside my particular studies. But one thing with low carb is you need to eat more salt and such, and the extra electrolytes and excess protein are both things that can make your kidneys work harder. Now, if your renal issues are more from excess sugar, getting the diabetes under control might reverse it. I'M NOT A KIDNEY EXPERT, I'm just brainstorming off the anatomy and physiology I do know. I'd hate for you to solve one issue (T2 Diabetes) and worsen another one (kidney function).
Certainly the carb advice from the nutritionist might be more of a maximum thing. But I also would be highly wary of going too high of protein for you. I really think a more balanced approach is best until you get a little healthier. I stick with my recommendation for a moderate carb Mediterranean diet. Losing weight just on its own should help quite a bit with the cholesterol and diabetes. There's lots of studies that show complex carbs in things like oatmeal help lower cholesterol.
It's great you're taking charge of your health. Good luck.0 -
Anyone have some easy meal plans or recipes they can share for someone with Type 2 diabetes and high cholesterol???
I was diagnosed T2Dm almost 2 years ago and am already off all meds and my A1C has been maintaining just below 5.5. My meal plan has really been fairly simple: I have a maximum daily carb allowance of 180 (total, not net) and I log everything to make sure I don't go over (most days. I have an occasional high carb day, but keep them to a minimum).
Some things I do:- Sandwiches do not need 2 pieces of bread. One works just fine (Sandwich thins which give you 2 pieces for the calorie/carb equivalent of one slice of bread work even better for sandwiches and hamburger buns
- I limit my fruit and do not drink juices at all
- When I make a stew or something that I will eat with rice, I make sure there is enough liquid in it and I cook the rice right in the stew (1/4 c. DRY per serving). That way I am not tempted to add that "just one more spoonful" onto my plate
- When I make a soup or stew that has potatoes, I substitute turnips instead. Just as hearty and tasty, but about 1/3 the carbs of potatoes
- I eat carbs at every meal and make sure I also get protein and fat along with them
- One glass of red wine before dinner (OK, this is my thing, not a recommendation but I have noticed that my BG reading drops quickly after having a glass of wine)
- I limit the carb heavy treats, but plan them into my day when I know I will be having them. If I will be going to a party where there will be cake, I eat fewer carbs at my meals.
- When I go out to eat, as much as possible, I check out the restaurant menu online and plan what I will be having. I always ask about substitutions. Many will sub something like a side salad instead of fries.
- I keep lower carb snack things like nuts, hard cooked eggs, cheese, light microwave popcorn (not totally low carb but definitely a good choice when you need to eat a big bag of something), etc. around
- I no longer eat cereal for breakfast. 2 minutes in the microwave and I have a big bowl of scrambled eggs (I use Egg Beaters), which makes for a satisfying breakfast, especially if I include a veggie sausage patty with it.
- Load up on the non-starchy veggies. Eat a double serving, make a huge salad. Add a large onion instead of a small one or throw an extra tomato or two into stews.
It was amazingly easy to reduce my carbs to a moderate level by just being aware of what is carb heavy. Unless it is recommended by your doctor or you personally find it more satisfying, there is no reason to go keto or low carb.
If you haven't already, find a health care professional who has advanced diabetic care knowledge, especially if you can find a Certified Diabetic Educator (most are RN's but some will be MD's, PA's, or Nurse Practitioners who have gone through the certification process). Take any classes you can, especially if free or your insurance will pay for them. There are a lot of resources available at the ADA website ( http://www.diabetes.org/ ) and the Bloodsugar 101 website ( http://www.phlaunt.com/diabetes/ )
It takes knowledge and awareness, but it can be done! Good luck to you.
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I was eating carbs like crazy before and that's how I got here. So I just feel like if I'm going to beat this I need to make a big change. I've done some research and many people have said low carb and high protein is a great start.
First of all, you did not get this way by "eating carbs like crazy" except for what the excess food did to make you gain weight. The main risk factors in T2 diabetes are genetics, excess weight, and age. There are lesser risk factors like long term use of certain medications (especially anti-depressants and statins), if your mother had gestational diabetes while carrying you, some cancer treatments (especially in childhood), etc. Eating carbs is not one of them and most people who develop T2Dm have 2 or more of the risk factors.
Moderating carb intake is the first, and for most, the most effective way to manage the disease. Exactly how you define "moderating" is personal. Low carb is not necessarily the best thing for you (but it might be, like I said, it is personal).
You were asking about actual meals.
A typical day for me (1360 calories plus I eat back most exercise calories so I average about 1700-1800 calories a day):- Breakfast: coffee with cream, scrambled egg beaters with a veggie sausage patty
- Lunch: sandwich with lean meat and one slice of bread, 1/2 c of Greek yogurt with 1 scoop protein powder, a serving of fruit
- Mid- afternoon snack: some nuts, cheese, maybe a protein bar
- Dinner: big salad and a piece of meat with steamed veggies or, most of the time, a stew or casserole with meat, veggies, maybe rice, maybe a tortilla.
- Bedtime snack: a couple of hard cooked eggs, cheese, maybe a slice of bread or a couple of crispbreads with the cheese.
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Thanks! Great advice. I will try some of your ideas. Do they make a low sugar carb tomato sauce? I have one more class and I will definitely be asking more questions.
Tomato sauce should not have sugar added. Spaghetti sauce will. Buy plain tomato sauce or diced tomatoes and season it yourself.
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For the diabetes, are you on insulin (if yes, what kind(s)?), pills, or none of the above? Are you regularly testing blood glucose (BG)?
I can't help with kidney issues, and (as others have said), I would hate to give advice that helps one issue and is harmful for the other issue. But I know a great deal about diabetes (I have "double diabetes" - i.e. I have both type 1 and type 2; my training is primarily on type 1, as it is more difficult to treat and contains higher short-term risks such that I manage it daily myself and can't usually wait until an endocrinologist appt. to figure something out).
First, approx. 165g of carbs (45g per meal X 3 = 135g + 15g X 2 snacks = 165g... assuming 2 snacks) on a 1,600 calorie diet is not low carb.
It is typical for type 2 diabetics to eat low carb, especially if they are not on any type of bolus insulin. So I understand the idea behind low carb, but that doesn't sound like what your plan entails.
Second, I'm not sure what to do about your kidney issue or if this would be harmful, so definitely speak with a qualified medical professional who has a deep understanding of all of your health issues. For type 2 diabetes, low carb is a good way to go. If you do plan to eat carbs, I suggest spreading them out over time (i.e. don't eat a whole bowl of oatmeal at once because your BG will rise to at least 180-200 and take some time to come back down) and eating some protein and/or fat with it to slow absorption. Non-starcy vegetables are good options as well because they are low carb and contain micronutrients. Stay away from starchy vegetables like corn, potatoes, peas, etc. because of the carbs.0 -
midwesterner85 wrote: »But I know a great deal about diabetes (I have "double diabetes" - i.e. I have both type 1 and type 2
How can you have both T1 and T2 diabetes? Either you body does not produce insulin (Type 1 diabetes) or your body does not deal properly with carbs (T2) either by not producing enough insulin or by being resistant to the insulin it does produce.
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Thank you so much!!blkandwhite77 wrote: »My son is type 1 diabetic so I don't know if this would
Be the same for type 2 diabetics but his carb recommendation is 45-60 per meal and 15-30 for snacks. He's been diabetic since he was 2 so now after eating lower carbs his whole life he's not a fan of carbs. He in actuality eats about 30-45 carbs per meal often times less and 15 for snacks.
I'd assume the lower carbs the better for type 2 diabetics as well as its all about carbs breaking down in to sugar and that's why you limit it.
Veggies (although corn and peas as pretty "carby"
Lean meats (my son fills up on lean meats and veggies)
His snacks are normally
Eggs
Small amounts of fruits
String cheese
Popcorn
Rice cakes
He does probably drink too much diet soda but since I had to be so strict about other foods i was pretty lenient about diet soda as long as he also drank tons of water.
For a different low carb drink the diet V8 drinks are surprisingly good and only 6-8 carbs per 8oz cup
Good luck you can do this and will be so happy once you get it all under control
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Awesome!! Thanks for the info.cafeaulait7 wrote: »Yes, it is a legit question. It's not that I'm purposely not eating the amount of calories and number of carbs the nutritionist is telling me to eat. It's actually not my doctor who's telling me anything. I'm getting this info from a nutritionist class that consist of about 20 other people who range from all races, age, weight, and other health issues. I just can't force myself to eat that much calories a day and I don't want to eat that much carbs a day. Is that wrong? I was eating carbs like crazy before and that's how I got here. So I just feel like if I'm going to beat this I need to make a big change. I've done some research and many people have said low carb and high protein is a great start. I've been doing it for a month now and it's getting better. But after being told I need to eat a complete balanced meal that consist of the starch, veggies, protein, dairy, and fat it's been hard to do. I feel like that is just a lot of food. I'm just so tired of eating chicken and fish. I miss that greasy burger or carne asada burrito.
Is that legit?Your doctor is giving you around 200 carbs per day. How many are you aiming for and if it's lower than 200, why are you aiming lower than your doctor suggested?
Legit question.
I just noticed that you said you are trying high protein. You need to ask what numbers are safe/recommended there for kidney issues. High protein is usually not recommended for that.
You might want to use a blood monitor and check out the Glycemic Index/Glycemic Load, then. It can help you find more foods that don't spike blood sugar (with some individual variation, so check your levels). Then you could avoid meat a bit more by eating carbs that aren't a problem. They actually help regulate blood sugar better, so they are often recommended for diabetes.
You might get into a lot of (homemade) chili-like meals like I love! Tuscan bean stews, Lentil stews, Quick Cassoulets, etc, as recipes are really yummy and use mostly beans with meat as a smaller highlight. The beans are cooked in the meat, so it's still very tasty for meat-lovers! Regular chili works, too That's still protein as well, but it probably won't add up as quickly as a lot of meat will.
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Wow! Thank you so much for taking the time to share all this great info. I really appreciate it. I will definitely look into those links.Anyone have some easy meal plans or recipes they can share for someone with Type 2 diabetes and high cholesterol???
I was diagnosed T2Dm almost 2 years ago and am already off all meds and my A1C has been maintaining just below 5.5. My meal plan has really been fairly simple: I have a maximum daily carb allowance of 180 (total, not net) and I log everything to make sure I don't go over (most days. I have an occasional high carb day, but keep them to a minimum).
Some things I do:- Sandwiches do not need 2 pieces of bread. One works just fine (Sandwich thins which give you 2 pieces for the calorie/carb equivalent of one slice of bread work even better for sandwiches and hamburger buns
- I limit my fruit and do not drink juices at all
- When I make a stew or something that I will eat with rice, I make sure there is enough liquid in it and I cook the rice right in the stew (1/4 c. DRY per serving). That way I am not tempted to add that "just one more spoonful" onto my plate
- When I make a soup or stew that has potatoes, I substitute turnips instead. Just as hearty and tasty, but about 1/3 the carbs of potatoes
- I eat carbs at every meal and make sure I also get protein and fat along with them
- One glass of red wine before dinner (OK, this is my thing, not a recommendation but I have noticed that my BG reading drops quickly after having a glass of wine)
- I limit the carb heavy treats, but plan them into my day when I know I will be having them. If I will be going to a party where there will be cake, I eat fewer carbs at my meals.
- When I go out to eat, as much as possible, I check out the restaurant menu online and plan what I will be having. I always ask about substitutions. Many will sub something like a side salad instead of fries.
- I keep lower carb snack things like nuts, hard cooked eggs, cheese, light microwave popcorn (not totally low carb but definitely a good choice when you need to eat a big bag of something), etc. around
- I no longer eat cereal for breakfast. 2 minutes in the microwave and I have a big bowl of scrambled eggs (I use Egg Beaters), which makes for a satisfying breakfast, especially if I include a veggie sausage patty with it.
- Load up on the non-starchy veggies. Eat a double serving, make a huge salad. Add a large onion instead of a small one or throw an extra tomato or two into stews.
It was amazingly easy to reduce my carbs to a moderate level by just being aware of what is carb heavy. Unless it is recommended by your doctor or you personally find it more satisfying, there is no reason to go keto or low carb.
If you haven't already, find a health care professional who has advanced diabetic care knowledge, especially if you can find a Certified Diabetic Educator (most are RN's but some will be MD's, PA's, or Nurse Practitioners who have gone through the certification process). Take any classes you can, especially if free or your insurance will pay for them. There are a lot of resources available at the ADA website ( http://www.diabetes.org/ ) and the Bloodsugar 101 website ( http://www.phlaunt.com/diabetes/ )
It takes knowledge and awareness, but it can be done! Good luck to you.
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If I might pipe in on @midwesterner85 's behalf, he produces no insulin AND his body does not deal properly with carbs. He's got it coming and going. Diet-wise, it means he walks a very narrow tightrope. And takes insulin. And monitors his carb intake.0
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If I might pipe in on @midwesterner85 's behalf, he produces no insulin AND his body does not deal properly with carbs. He's got it coming and going. Diet-wise, it means he walks a very narrow tightrope. And takes insulin. And monitors his carb intake.
If the "not dealing properly with carbs" is the result of producing no insulin, that is T1. Not dealing with carbs for any other reason is not diabetes.0 -
midwesterner85 wrote: »But I know a great deal about diabetes (I have "double diabetes" - i.e. I have both type 1 and type 2
How can you have both T1 and T2 diabetes? Either you body does not produce insulin (Type 1 diabetes) or your body does not deal properly with carbs (T2) either by not producing enough insulin or by being resistant to the insulin it does produce.
It happens. Prolonged use of high doses of insulin in T1D can lead to insulin resistance aka Type 2 diabetes. http://www.diabetes.co.uk/double-diabetes.html0 -
If I might pipe in on @midwesterner85 's behalf, he produces no insulin AND his body does not deal properly with carbs. He's got it coming and going. Diet-wise, it means he walks a very narrow tightrope. And takes insulin. And monitors his carb intake.
If the "not dealing properly with carbs" is the result of producing no insulin, that is T1. Not dealing with carbs for any other reason is not diabetes.
Just came back and am seeing this... here is some clarification:
Type 1 - Type 1's make no insulin, and is usually caused by an auto-immune condition that attacks pancreatic beta cells (aka islets of langerhans). In other words, I have no capability to make any insulin of my own and must take insulin to survive. It may be helpful for some lurkers who are curious to note that a patient is still type 1 during the "honeymoon stage" after the auto-immune response has been triggered and before all beta cells are dead. During that time, a person could still be a type 1 and make some insulin (but will cease to do so once all beta cells are dead). A patient has both a genetic predisposition (HLA genes on chromosome 6) AND an environmental "trigger" for the autoimmune response (often an illness such as flu, chicken pox, other illness fought by the immune system becomes a trigger). Most with the genetic predisposition never have a trigger.
Type 2 - Inefficient / resistant to insulin. I'll acknowledge that type 2 often includes a spectrum of circumstances, so there is a small group (around 5%) of type 2's that don't make enough insulin. That group has a different issue that gets diagnosed as type 2, but is physically different than most type 2's. It is also the only circumstance of type 2 diabetes that has been definitively linked to genetics - a lot of type 2's claim it is genetic with anecdotal evidence such as "my mom/grandma/etc. had type 2," and some genetics have been identified as making one prone to things like obesity that often cause type 2, but no gene is identified to cause insulin resistance. - Most type 2's (who are not also type 1's) make enough insulin, but don't use it efficiently.
As a "double diabetic" (the earliest I've found that term used was in a study published in 1991, but I didn't hear it widely used by endocrinologists until the early 2000's), I have no way to make any of my own insulin AND I don't use insulin efficiently. So I inject large amounts of insulin (compared to if I only had type 1 and used insulin properly) to compensate for being resistant and take oral medication as well.
ETA: "Not dealing with carbs" is a bad explanation for type 1 - it is misleading and doesn't describe what is really happening. Even if I eat zero carbs, I still need to take insulin. Carbs raise BG for everybody, diabetic or not. Type 1's will have increasing BG even when we eat nothing at all. It is a poor description of a symptom and it fails to describe the pathway of the disease entirely.0 -
Yes, it is a legit question. It's not that I'm purposely not eating the amount of calories and number of carbs the nutritionist is telling me to eat. It's actually not my doctor who's telling me anything. I'm getting this info from a nutritionist class that consist of about 20 other people who range from all races, age, weight, and other health issues. I just can't force myself to eat that much calories a day and I don't want to eat that much carbs a day. Is that wrong? I was eating carbs like crazy before and that's how I got here. So I just feel like if I'm going to beat this I need to make a big change. I've done some research and many people have said low carb and high protein is a great start. I've been doing it for a month now and it's getting better. But after being told I need to eat a complete balanced meal that consist of the starch, veggies, protein, dairy, and fat it's been hard to do. I feel like that is just a lot of food. I'm just so tired of eating chicken and fish. I miss that greasy burger or carne asada burrito.
Is that legit?Your doctor is giving you around 200 carbs per day. How many are you aiming for and if it's lower than 200, why are you aiming lower than your doctor suggested?
Legit question.
Are your chicken and fish plain? Kick up the spices! I have a cold, so am all about spicy Asian soup right now, and am currently enjoying Tom Ka Gai. To reduce calories, I use less coconut milk and more stock. I use the recipe from the Joy of Cooking, which I cannot find online, but could scan if you are interested. This is similar, but I'd leave out the turmeric. I eat this with a small amount of rice or rice noodles and green peas or broccoli.
Also, chicken thighs have a lot more flavor than chicken breast. I mostly use chicken breast in a stir fry or baked skin-on and bone-in.
Here's another flavorful chicken recipe: http://www.chowhound.com/recipes/slow-cooker-burmese-style-noodles-31184 I reduce the coconut milk to 8 ounces and only have an ounce or so of cooked noodles with it.
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I athink I may have heard some of the same advice, especially about the number of carbs per meal or snack; however, I think they are meant to be maximums. In my opinion, starch is entirely optional, though I frequently include it. Balanced meals also do not require dairy, though it can be an excellent source for some essential nutrients. Get a variety of foods. Log it all and look beyond the macros. Chicken and fish aren't you're only options, but that greasy burger may not be something you awant to eat daily - or even every week. LEan ground beef in a tomato sauce over spaghetti squash or a sweet potato with a salad can be quite nutricious. Maybe a roasted pork loin with roasted root veggies.
The red meat (beef and pork) restriction may have more to do with your kidney problems, so it's worth asking.
Try to have an individual appointment with the nutitionist. Discuss what you like to eat and your goals.
@cilladade - I agree that an individual appointment with the nutritionist would be a good idea. Sound like the class isn't focused enough for you or that you are not getting enough individual attention.0
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