I havn't seen Pharmacist George in a while, but I feel he made some invaluable contributions! Check out this discussion from the past.
jigsaw a few seconds ago5 Report
My dietician seems to agree with much of what you have said here. For the most part, I do follow a food plan that incorporates much of what you have pointed out. I have been doing well with very good blood glucose mgmt, and I am now in my 18th year of diabetes!
I would like your input on what I am about to say. Everything I do with my food plan is tempered by the fact that I take insulin and Metformin. Without these meds, I would not be able to follow my dieticians food plan, or yours which is very similar in concept. Without insulin, I could not even eat one slice of Natures Own wheat bread, or a small baked potato without a substantial bg spike!
Yes, some people in the early stages of diabetes can eat properly and as you are recommending even if they do not need medication. Others, and because of the stage of diabetes that they are in, can only eat a healthy diet with the aid of medication.
Many specialty diets such as low carb/high fat diets may help for a short period of time, but they are generally not balanced food plans, at least not by ADA standards. I believe on a long term basis, they may be harmful as a result.
So, this is my point. There are people with diabetes that base much of what they eat mainly on their bg response. This may be ok for some, but I don't think it's the way to go for many. If you need medication,and don't take any, but are maintaining you bg #s in a normal range, then you are probably short changing your nutritional needs. Simply cutting carbs, as an example, and by itself without proper guidance can be very unhealthy long term, even if your bg appears to be well managed.
So at what point should a person with diabetes be taking meds? I think there is major confusion for some with this question. Most likely the one with the correct answer is a good doctor that specializes in diabetes. Also a registered dietician is very helpful for many when it comes to a good food plan.
The reason many people with diabetes cannot eat various foods is because of there diabetes. Some cannot even maintain a healthy food plan without excessive bg hikes. To simply compensate by lowering or eliminating carbs without professional guidance, especially if medication is needed , is a major and dangerous mistake.
George, your take and opinion on this, or anything you might add would be helpful for many, I'm sure. I hope to be helpful in clarifying this situation, that appears to be an issue of confusion, and conflict, for many.
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Pharmacist George Pharmacist George a few seconds ago4 Report
You’ve made a very valuable point that the vast majority of people with diabetes struggle with and I will help clarify this confusion. You are right many people take matters on their own and make inappropriate choices on their own before consulting with their doctor or pharmacist and that’s detrimental to diabetes control
Most people think, as you stated, that they can bring their sugar under control by skipping a meal, a category of nutrients such cut carbs and may beef up their intake of proteins, fats or skip medications or stop taking their medications altogether. Their actions are reactive and they can’t achieve blood glucose control as long as they behave in this manner and not address Pro actively ALL ASPECTS OF DIABETES CONTROL AT THE SAME TIME.
This is what I’ve been telling people in my posts over and over and focusing on the basics of diabetes control. I’ve help numerous patients for 26 years during my pharmacy practice regain control by sticking to the basics of the framework of the Five Action Steps that I’ve incorporated in the book that I authored for diabetes.
Here’s your answer Jigsaw. Here’s a valuable word for you and everyone else to remember about glucose control and it is REGULARITY. I am not talking only about bowl regularity but to your entire body. You’ve surely read my posts and you probably read me again and again recommending consuming balanced 3 main meals and 2 snacks, raising physical activity, raising fiber intake and how to go about doing so, cutting back on sugar (not because of diabetes but because it turns to belly fat), losing weight using the Two Step approach, cut back on saturated and stick with 30% total fat and making small sustained changes. Also, I’ve written a ton of posts and articles about medications and the importance to take them properly, quitting smoking and managing stress etc….
A Key factor is that all of those critical elements need to be IMPLEMENTED AT THE SAME TIME. After a short period of time of 2 to 3 weeks from implementing all these favorable lifestyle choices that are critical factors to diabetes control then those actions PROMOTE REGULARITY IN YOUR BRAIN. Only when you’re at this stage that you can achieve lasting blood glucose control and you become in charge of diabetes and not vice versa.
Again all these factors need to be implemented at the time. Fiber and physical activity are major insulin sensitizers when you incorporate them in your daily lifestyle they do wonders to your diabetes control. After a while of doing all these favorable lifestyle factors your blood glucose won’t spike from the smallest snack because you would have achieved regularity.
Due to daily physical activity your muscles take up the sugar from your blood, you may drop in weight but the most important issue is that with these actions you are keeping your blood sugar, blood pressure and cholesterol under control and that gets you to avoid diabetes complications.
This is when you become in the proactive phase of managing diabetes and only at that point that you can expect to avoid diabetes complications, enjoy the best quality of life and regain normalcy to your life. That’s the key to winning over diabetes.
I cover all these issues and the framework of Five Action Steps in detail in my book. I hope that answers your inquiry. Take care.
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