While I'm a huge fan of taking your medical condition by the horns and owning that sh#!, I'm less of a fan of listening to doctors, diabetes educators, nurses, and nutritionists who CAN ONLY SPOUT DOGMATIC GUIDELINES.
Here's what led to my break-up:
1. My endo (head of the clinic, BTW) found a teeny tiny module in my thyroid, put me through all these tests (ultrasound, biopsy--large needle straight into my neck, and testing thyroid hormones). First-of-ly, the nodule is so super teeny that it isn't big enough to be a concern! Second-of-ly, he told me the there was no way to take preventative measures to make sure my thyroid production stays normal. Pshaaaa!!! I started taking iodine, and like MAGIC, my levels got even better! Not that they were AT ALL worrisome in the first place.
Red flag #1: Doc takes the approach "wait until it's really bad and then treat it."
2. The pump specialist. Oh, the pump specialist. Bless her, she's a nice person, but wow. "Specialist" is a strrrrreeeeeetchhhhh. Point one: she's a type 2 diabetic on a pump. Nothing is wrong with that, but there are just different considerations for type 1s. And wouldn't you want a type 1 pump specialist? Or someone who is up on the latest research on type 1s/pumps? Considering most candidates for pumps are type 1s?
Next point: She has folks start on a flat rate and kind of wing it from there. I don't know about other type 1s, but I need more accuracy than that! So I looked up Medtronic's guidelines for adjusting rates to account for Dawn Phenom, higher day basal, etc, and started there. (OK, this is for preggers women, but is based on Medtronic's guidelines, and down the page lists out the calculations.) She was upset about this and told me she was "very concerned" that I had done this without consulting her. Wah?!?!?! Do you know type 1s? They are constantly making decisions about their doses. Seriously. She instead wanted me to go on a flat rate and just "wait and see" how Dawn Phenomenon affects me. Hon, I know how it affects me, I've been on a pump before, I'm on a CGM, and I've been a diabetic for 18 years! UGH.
Red flag #2: Pump specialist not so much a specialist, but someone who knows the basics of pumping.
3. I was shipped off to the clinic's nutritionist, who did little more than tell me the ADA Guidelines for nutrition. And the OUTDATED GUIDELINES at that! They have since updated their position, saying that there is no such thing as a one-size-fits-all nutrition guideline for carbohydrate, fat, and protein intake. They go on to cite several studies that show the benefits of low-carb diets on glycemic control:
Carbohydrates: Evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes. Therefore, collaborative goals should be developed with the individual with diabetes.They go on to say:
Some published studies comparing lower levels of carbohydrate intake (ranging from 21 g daily up to 40% of daily energy intake) to higher carbohydrate intake levels indicated improved markers of glycemic control and insulin sensitivity with lower carbohydrate intakes... Some studies comparing lower levels of carbohydrate intake to higher carbohydrate intake levels revealed improvements in serumlipid/lipoproteinmeasures,I wrote the nutritionist a note today, voicing my concern at her bad advice (trying to be diplomatic, but not too condescending).
including improved triglycerides, VLDL triglyceride, and VLDL cholesterol, total cholesterol, and HDL cholesterol levels...
Red flag #3: Not up-to-date on the latest research and prescribing a one-size-fits-all solution that doesn't actually work for most people.
4. When I did share with the endo (another endo on my "team" who I see more often than the head of the clinic) what I was doing, she balked. First, a little backstory: She congratulated me on my excellent HA1c (6.1 woot woot). Keep in mind that glycemic control is the NUMBER ONE indicator of overall health of a diabetic... poor control potentially leads to all of these complications you hear about. So she says: GREAT JOB! and furthermore, REALLY GREAT JOB on not getting plummeting lows anymore. Yet, when I shared what I was doing (less than 30g carbs daily) she said, "No, no, don't do that."
"Why?" I asked.
"It's not recommended."
"Why?" I repeated.
No answer.
Thanks for the advice, doc, but unless you can give me a why beyond the tired dogma of the traditional nutrition guidelines (which, by the way, I've read, and it's a REALLY SHAKY set of events that led to the current guidelines on carb consumption), then I am going to listen to my body and my numbers. Here's an interesting read by Gary Taubes on the history of the creation of low-fat, high-carb guidelines.
Red flag #4: Dogmatic approach to diabetes control. Can't answer "why." (Side note: I would have far more respect for "We don't know" as an answer.)
5. The cherry on top: The nurse that weighed me, took my HA1c, etc... told me the following:
She was going over my prescriptions: "Your prescriptions for test strips is for 10/day."
"That's right," I told her.
"Insurance won't cover that." She told me.
"Don't worry about insurance," I told her. (I get my 10 strips covered no problem.)
"But your A1c is good so you don't need to test so often," she offered up as unsolicited advice.
"Um, my A1c is 6.1 exactly because I test ten times a day," I let her know.
Red flag #5: Bad advice is coming out of the walls!
Here's my new plan:
I cancelled my appointments; my thyroid follow-up, my next two visits with the endos, a visit with another specialist. I'm going to a hollisitc doctor who I have seen before. Hopefully he will get it. His son has type 1 since childhood, so I'm very confident that his approach will be more about what's going to work for me, rather than what the guidelines state.
I also hope that he will be supportive of my low-carb approach and help me work through the kinks, rather than being dogmatically against it without any scientifically sound reason.
No comments:
Post a Comment