Strange behaviour of a US doctor

[Phil Aypee]

Hi,

Yesterday, at the diabetes clinic (at my GPs surgery), I learnt a lot more. Particularly the dietician told me of a British diabetic who had to be checked in a US hospital for something like [i:500c0cef4c]deep vein thrombosis[/i:500c0cef4c]. He had, obviously, to tell the attending doctor that he was diabetic.

He was immediately asked what his “carbs” were (I don’t even know what carbs are - except they’re probably to do with carbohydrates) despite not being in for any diabetic-related reason. He was roundly castigated for not knowing.

He was put in a waiting room for diabetics with about a dozen patients, all Type 2, all overweight, some badly overweight. He’s Type 1, fairly thin and his diabetes is well under control.

But he was the [b:500c0cef4c]wrong[/b:500c0cef4c] one for not knowing what his “carbs” were!

Does this show the difference between the US approach and the UK one (and I assume most countries are closer to the UK model)?

[Phil Aypee]

Hi,

I’m not thin - but I’m not fat. At worst (many years ago) I was about 8-9 pounds overweight, now I’m only a couple of pounds over according to the medics. I’ve been within a couple of pounds of the same weight for about 20 years but I’ve had comparatively little exercise since my stroke five years back.

I imagine that comparative inactivity triggered the diabetes.

But in the US-based NGs there seems to be a vociferous element that are absolutely sure that diabetes (T2 anyway) is only caused by obesity and that the way to stop it is to abuse diabetics (us) for being obese.

I don’t understand this.

If I were obese, how would abusing me cure my diabetes?

Or is it me that’s stupid?

[Gemstone]

Hi Phil,

To my knowledge diabetes is not due only to obesity or every obese would have it while it's not the case as there is also many thin people who have it. Genes would be the answer. I am overweight and have diabetes type 2 like both grandmothers. My sisters and brother are overweight too and don't have it. On the other hand, my husband is thin as is his father and they both have diabetes type 2 too. Both my kids are glucose intolerant and one is thin one is overweight. We all are similarly active.

The US-based newsgroups are not representative of the overall diabetic world. I've been reading them for almost 5 years now; tried to participate at the beginning but let's say they do not correspond to my idea of a peaceful and sharing place. A few were nice and open but for most, your opinion better be the same as theirs or you are guilty before proven innocent.

Gemstone

[Phil Aypee]

Hi Gemstone,

I’m not sure I agree that that the answer is genetic (though it might be). I rather think that T2 is (inactive) in everyone, but that the triggers vary. As it’s a condition rather than a disease this is certainly possible.

But the only way to prove/disprove it is to deliberately try to make new diabetics!

I totally agree that the US NewsGroups are far from representative. But their loonies do seem to try to infest as many diabetes NGs as possible. Being a rational man, I do indeed dismiss the stupid postings by (usually illiterate) stupid diabetics and stupid anti-diabetics.

And I can quite see why Anita started this forum.

I honestly hope it is a success - but it’ll probably take a while to catch on.

[sistersandy]

I am not too sure what the doctor would have meant by What are your carbs?
Carbs are food, not numbers, and he would have asked if the person know what his blood sugar was at present. I have been seen in Emergency rooms in the US, and when they are told I am diabetic, they did a stick, and told me I needed to eat as soon as I got home, as I was at 85.

But they were never rude, or expected me to know what carbs I was>?

[Phil Aypee]

Hi,

Karen, if anyone thinks you’re a troll then they don’t belong here! :shock:

I, like Sandy, cannot see the relevance of carbohydrate intake to T2 diabetics (and probably T1 too) unless, perhaps, they have a weight problem.

But that isn’t just a diabetes-specific concern, it’s general.

As I understand it, diabetes is about the breakdown of natural blood sugar control (partial or complete loss of insulin production {T1} or partial or complete loss of insulin function {T2}). So the important thing is to control blood sugar artificially which means measuring it.

Now, I know it’s true that a significant proportion of T2 diabetics [b:ed91dd916f]do[/b:ed91dd916f] have a weight problem. But, as with Sandy’s family (and me), a significant proportion [b:ed91dd916f]don’t[/b:ed91dd916f] and for them carbohydrate intake is, surely, irrelevant.

Certainly the dietician advising me didn’t think it was relevant to my diabetic condition, and I have to respect that.

[Gemstone]

Phil, the ingestion of carbohydrates is relevant. It's what makes your blood sugar go higher after each meal. Since, for whatever reason your body doesn't deal well with the sugars, the more *carbs* you eat, the higher your level of blood sugar and that's what you want to control. Each time your blood sugar is higher than a certain range ( 4 to 7 mmol is generally the target ) damages are caused to your body.

Not all carbohydrates are created equals either. The more refined sugars like in candy, soft drinks or pastries are much faster in your blood stream while the complex sugars like in brown rice and whole bread are more slowly absorbed. Fibers are slowing down the process too.

To understand the whole process, nutrition classes or books are a must.
If you want to control your diabetes, you have to know how your body react to various carbohydrates ( starches included) . That's why I test before and 2 hours after each meal as well as before going to bed and when I wake up in the morning.

Gemstone

[Phil Aypee]

[b:425af74645]Hi,[/b:425af74645]

Gemstone, I really didn’t mean that the ingestion of carbohydrates is totally irrelevant.

But my diabetes dietitian, my diabetes nurse and my diabetes doctor (specialists all) do not think it important for someone of a stable and healthy weight whose diabetic problem is not severe - me, in fact. I assume that if my weight begins to fluctuate or I have any other problems that could be diabetes-related then the situation may alter.

I was also told that taking my blood sugar level (BS level perhaps :lol: ) more than once a day was quite unnecessary [b:425af74645]for me[/b:425af74645]. I do take it at 6 different times to get a good idea of how it varies (before breakfast, 2 hours after breakfast, before lunch, etc.), also my blood pressure as the hospital diabetes doctor recommended.

My next-door-neighbour, Matthew, has been a T1 diabetic for some years whose pancreas now produces no insulin at all but he only tests twice a day (as advised by his doctor).

I think this is primarily a difference between the approaches of professionals in different parts of the world. The U.K. approach is probably more relaxed so that diabetics are also more relaxed which I think [b:425af74645]must[/b:425af74645] ease their problems. I’m quite sure the standard of care is fully equal to elsewhere.

[Gemstone]

Hello again Phil,

In Quebec, the guidelines for diabetes treatment are to eat 45 grams for a woman and 60 grams of carbohydrates for a man, for each meal, as well as 15 grams for a snack twice a day. The doctor send us to see a dietician and she is the one giving us the diet, everybody have the same guidelines. If the diet lead to too high blood glucose results, at the next visit, the doctor increase the medication. The recommendation for testing was twice a day, before breakfast and before supper and then the next day before lunch and before bed. Those are the basics. Once every 3 months we are supposed to have a hba1c test by the lab which should read under 7. Then, blood pressure and cholesterol are also tested and the results are expected to be lower or better than the average population as we are more at risk.

I would say that the approach of Doctors here is too relax as diabetes worsen(?) with time and if there is a way to slow down that progression, we have to do it.

From when I was diagnosed 5 years ago there is already an improvement in their way to handle everything. I guess the fact that it seem to be epidemic is quite scary and everybody realise there is something to be done.

As a side note, about the jargon, I don't know all the abbreviations used by our american counterparts as French is my first language and since they use a different system for blood tests results and all, I am not following everything. I do know that Endo is the endocrinologist and I never saw one, our GP are handling most diabetes cases.

Gemstone

[Phil Aypee]

Hi Gemstone,

I guessed French was your first language. Your use of English is very French. :wink:

My French is very rusty though one of my neighbours is actually French. She’s also a jazz freak, like me.

The guidelines you quote for carbohydrates are actually about the same as the content of Sainsbury’s ready meals and I’d guess that my diet is probably already getting pretty close to the ideal too.

I don’t know how often I should have an HBa1C test as I was only diagnosed a few weeks ago. I do know they are considered [i:8dd42ffb5e]de rigeur[/i:8dd42ffb5e] by my doctor.

I know a guy who has been T2 for many years and he has been able to cut back on his medication (with his doctor’s approval). He had to maintain it for a while when he had a stroke but he’s been able to reduce it since. It’s not been a dramatic reduction but it is real.

It just shows that improvement [b:8dd42ffb5e]is[/b:8dd42ffb5e] possible.

I guessed that [b:8dd42ffb5e]endo[/b:8dd42ffb5e] was endocrinologist, but I didn’t know.