Certified Diabetes Education makes me stabby

concordancia

Evidently, as long as you label something as a protein, you don't have to worry about the carbs in it for meal planning. Specific examples include Greek yogurt and peanut butter.

Someone even tried to point out the importance of being aware of portion size for proteins, and she said they were making it too complicated.

I knew I wasn't going to like this class going in, since I have chosen a low carb approach, rather than the ADA recommendations, but this woman is going to kill someone. Or at least make them insulin dependent before their time!

Yes, I did write some of these comments on the evaluation form. But I still needed to vent. At least the teacher for my previous classes was a sweet bumbling fool, this one came in bragging about her credentials and recent research experience.

Christine_72

I don't know the ins and outs as I am not a diabetic, but i have heard many diabetics say they are mind boggled by some of the ADA's recommendations...

I assume they are similar to dietitians in that they cant stray away from what they were taught in school, nor are they permitted to think outside of the box??

concordancia

@Christine_72 , the classes I attend present a PowerPoint, but tend to go off script quite a bit, usually to add a pseudo scientific explanation for things, ie fiber is good because it pushes everything else through.

My mother had a different program, which included being part of the same group for a longer series of classes, which she found helpful.

I keep attending so that I get compliance check marks so that my caregivers are more likely to interact with me, rather than just tell me what to do. My dietician is much better about actual science and is trying to convince me to request a continuous glucose monitor so that we can play with all the data.

Christine_72

How confusing... So these educators are completely bull headed and refuse to stray off course, or they go the complete other direction.

I think each individual should experiment and do what works for them, rather than follow a cookie cutter regimen. A glucose monitor would be very enlightening to see if they were on the right track.

concordancia

Christine_72 wrote: »

How confusing... So these educators are completely bull headed and refuse to stray off course, or they go the complete other direction.

I think each individual should experiment and do what works for them, rather than follow a cookie cutter regimen. A glucose monitor would be very enlightening to see if they were on the right track.

That's the other bizarre thing. Glucose monitors were discussed in the intro class, but no mention was made of them in the healthy eating class that was entirely focused on carbs (protein and fats get their own class, evidently).

I have a nice app enabled monitor, the continuous monitor would give more info about exercising and other times I don't currently check. Healthy eating does not seem to cause spikes for me. I suppose I could go eat a piece of cake in the name of science?

anubis609

There's nothing pseudo-scientific about fiber pushing things through; it's true. It also slows gastric emptying and plays a part in delaying post-prandial digestion rates so glucose doesn't rise as high as it would with a high-glycemic index of food.

http://jandonline.org/article/S2212-2672(15)01386-6/fulltext#sec2.2

http://onlinelibrary.wiley.com/doi/10.1111/jdi.12376/full

Whether it's "good" or otherwise is a subjective statement, but you certainly don't need to incorporate it if you chose to follow a low carb diet. By extension, you've already resigned yourself to not liking it prior to attending, so it's not very surprising that their information would conflict with your own thoughts. Follow a low carb diet as you see fit, but you can't force their hand in changing from the status quo of health care bureaucracy.

150poundsofme

Years ago I did 2 different 5 day diabetic classes, both at different hospitals. The first hospital each class was given by a different person. They gave conflicting food advice. One said do not eat dessert at all, the other said you can eat dessert. No one every mentions what are you supposed to do when you see a higher blood glucose number - eat less, eat more, eat less carbs? Then they all talked about the exchange program - they made it complicated. I said to myself I will ask the endocrinologist (my first meeting with him). He said I don't believe in the exchange program. And then gave no other advice. In my experience, the people who were supposed to educate me and the class did not do a good job.

anubis609

The reason why there's so much conflicting advice for diabetic patients is that each person responds differently to food substrates. Potatoes might not spike someone's glucose as high as another, or whole grain/wheat bread might make someone's glucose shoot through the roof.. it's unfortunately not very easy to give blanket statements to a group of people suffering the same disease.

That said, a nutrient dense diet with a low glycemic/low insulin load is probably the closest to meet a wide range of T2D patients.

As diabetics, you have to be your own practitioner most of the time. You have your glucose monitor at your disposal. Use it often and use it to let you know what food you handle well, while trying to aim for the goal of losing excess body fat if you carry larger amounts of it. Eating in a caloric deficit alleviates the amount of insulin necessary to keep fat cells in energy balance, therefore reducing insulin resistance.

Physical activity helps reduce the postprandial load of food and improves insulin sensitivity. Do what you can as often as you can to tolerance.

The overarching rule for most diabetic classes is that there are restrictions to limit the amount of carbs per meal that you can allow, therefore, you have full control over exactly how many you're willing to ingest. It can range from the maximum recommended to none at all.

It's up to you, but don't wait for someone or a class to tell you what to do. If you care about your health, seek knowledge from the resources online, and weed out what you feel are trustworthy sources, and seek it aggressively. Your blood sugar monitor will let you know if you're heading in the right direction.

swebb1103

I am T2D and have not taken a class. I use my glucometer to get to know my body - what can I eat? What should I avoid? What time of day am I likely to spike despite my best efforts?
I also work out religiously, 5 days a week, a minimum of 40 minutes a day. Cardio and strength training. I track what my blood sugars are doing before and after to avoid lows. I have only lost 10 pounds in the past year, but my A1C went from 8% down to 5.4%, and I am off 2 out of 3 medications. My advise is get to know your body and find what works for you. This is a manageable disease.

singingflutelady

anubis609 wrote: »

There's nothing pseudo-scientific about fiber pushing things through; it's true. It also slows gastric emptying and plays a part in delaying post-prandial digestion rates so glucose doesn't rise as high as it would with a high-glycemic index of food.

http://jandonline.org/article/S2212-2672(15)01386-6/fulltext#sec2.2

http://onlinelibrary.wiley.com/doi/10.1111/jdi.12376/full

Whether it's "good" or otherwise is a subjective statement, but you certainly don't need to incorporate it if you chose to follow a low carb diet. By extension, you've already resigned yourself to not liking it prior to attending, so it's not very surprising that their information would conflict with your own thoughts. Follow a low carb diet as you see fit, but you can't force their hand in changing from the status quo of health care bureaucracy.

The only issue with fibre for diabetics is if they develop gastroparesis, which can be a complication of diabetes, fibre makes things way worse.

RodaRose

I believe that those "educators" try to make things easy to follow.
They mean well even if they do stink most of the time.

1houndgal

150poundsofme wrote: »

Years ago I did 2 different 5 day diabetic classes, both at different hospitals. The first hospital each class was given by a different person. They gave conflicting food advice. One said do not eat dessert at all, the other said you can eat dessert. No one every mentions what are you supposed to do when you see a higher blood glucose number - eat less, eat more, eat less carbs? Then they all talked about the exchange program - they made it complicated. I said to myself I will ask the endocrinologist (my first meeting with him). He said I don't believe in the exchange program. And then gave no other advice. In my experience, the people who were supposed to educate me and the class did not do a good job.

One of the healthiest diets I have been on was the ADA exchange. I lost a lot of weight then and kept it off over 5 years. It taught me so much about nutrition and eating a well balanced diet. It reversed my diabetes also. I don't know if they teach the exchange diet in diabetes programs nowadays.

I will say I follow the same principals and insights while I choose my food and follow the mfp plan. It works for me. I have plenty of energy to swim fast and swim for endurance.

But I also recognize that what works for me may not work for others.

Everyone is an individual and has a choice in what they eat or don't eat (as long as they have access to foods).

Personally, a Keto type diet literally ends in me getting physically sick.

And I get very fatigued shortly into my workout with my legs feeling like lead, if I don't fuel my body with enough of the right kinds of carbs and the other macros.

I "bonk" if my carb intake is too low, to the point of hypoglycemia symptoms.

So for me, I am one that needs to steer clear of Keto. For myself, it is dangerous to eat to be in ketosis.

concordancia

anubis609 wrote: »

There's nothing pseudo-scientific about fiber pushing things through; it's true. It also slows gastric emptying and plays a part in delaying post-prandial digestion rates so glucose doesn't rise as high as it would with a high-glycemic index of food.

http://jandonline.org/article/S2212-2672(15)01386-6/fulltext#sec2.2

http://onlinelibrary.wiley.com/doi/10.1111/jdi.12376/full

Whether it's "good" or otherwise is a subjective statement, but you certainly don't need to incorporate it if you chose to follow a low carb diet. By extension, you've already resigned yourself to not liking it prior to attending, so it's not very surprising that their information would conflict with your own thoughts. Follow a low carb diet as you see fit, but you can't force their hand in changing from the status quo of health care bureaucracy.

Yes, for her discussion, slowing was more important than pushing through, as you have demonstrated. But she literally said the pushing through was why net carbs was an OK way to count.

She also wrote on the board that the categories of macros are fats, carbs, protein and vegetables.

T1DCarnivoreRunner

As a type 1 diabetic who does not eat carbs, I bolus for protein at an amount and time for it to be used for protein synthesis rather than waiting for gluconeogenesis. If I don't do that, I will have a later BG spike and it will take twice as much insulin to correct the high.

I'm on the 670G and the auto mode doesn't seem to have any programming to understand that insulin does more than just remove glucose from blood.

Lots of things about a lack of understanding about diabetes bothers me, both from the medical community and from the general population.

concordancia

1houndgal wrote: »

150poundsofme wrote: »

Years ago I did 2 different 5 day diabetic classes, both at different hospitals. The first hospital each class was given by a different person. They gave conflicting food advice. One said do not eat dessert at all, the other said you can eat dessert. No one every mentions what are you supposed to do when you see a higher blood glucose number - eat less, eat more, eat less carbs? Then they all talked about the exchange program - they made it complicated. I said to myself I will ask the endocrinologist (my first meeting with him). He said I don't believe in the exchange program. And then gave no other advice. In my experience, the people who were supposed to educate me and the class did not do a good job.

One of the healthiest diets I have been on was the ADA exchange. I lost a lot of weight then and kept it off over 5 years. It taught me so much about nutrition and eating a well balanced diet. It reversed my diabetes also. I don't know if they teach the exchange diet in diabetes programs nowadays.

I will say I follow the same principals and insights while I choose my food and follow the mfp plan. It works for me. I have plenty of energy to swim fast and swim for endurance.

But I also recognize that what works for me may not work for others.

Everyone is an individual and has a choice in what they eat or don't eat (as long as they have access to foods).

Personally, a Keto type diet literally ends in me getting physically sick.

And I get very fatigued shortly into my workout with my legs feeling like lead, if I don't fuel my body with enough of the right kinds of carbs and the other macros.

I "bonk" if my carb intake is too low, to the point of hypoglycemia symptoms.

So for me, I am one that needs to steer clear of Keto. For myself, it is dangerous to eat to be in ketosis.

I think the ADA exchange made balance fairly easy. They seem to have morohed more into My Plate and counting carbs. The claim is that the exchange system was too complicated, but I remember working it out for my grandmother back in the 80s. What could be easier, from an intellectual perspective?

There is a lot of room between keto (~<50 carbs/ day) and the same amount per meal. I understand that these classes can't cover all the variables, as they are aimed at folks who are not educating themselves and therefore have been standardized, but there was a lot of bizarre information packed into the 50 minutes of what was supposed to be a two hour class.