So, this is what they want to call it
when those of us with type 2 diabetes don’t allow ourselves to be
where certified diabetes educators (CDEs) want to pigeon hole us.
They think we are round pegs and they want to put us in square holes.
The author does admit that they don't take people's style or
personality into account when recommending treatments. Maybe it is
time to take the glaze off the eyes of CDEs and others, and let them
know who we are.
Yes, those of us with type 2 diabetes
do know this and this is one reason we avoid sessions with CDEs. We
are individuals and want to be treated and respected as such. We do
not like the one-size-fits-all category you try to put us in. You
say the treatment for diabetes is not very flexible. Is this because
of the professional organizations that wield unbending power and you
don't dare vary from the mantras they promote? Yes, for a great
majority of type 2 diabetes patients, it requires taking medications,
testing our blood glucose, and often eating on a schedule. The need
to have a consistent amount of carbohydrates at each meal is where we
come to a parting of ways.
I don't understand why it is that CDEs
and for that matter registered dietitians (RDs) need to be so set on
doing more harm than good when dealing with type 2 diabetes. Yes, I
said more harm than good. Some diabetes patients are able to consume
the awful number of carbohydrates with low fat you recommend, but
there are others of us that do better on much less carbohydrates and
more fat. That is because all of us are different and have different
needs where foods are concerned. Then when you happen to have
someone that is successful in controlling diabetes with exercise and
diet, you go ballistic and say they can't be in compliance because
they are not on medication. The truth is these people know how to
manage diabetes without medications and have the A1c's to prove it.
They are not the aberrations you want to tag them as.
We know that those with type 1 diabetes
are helped by you and you do good work for them. When it comes to
those of us with type 2 diabetes, you are an anathema for us,
promoting whole grains at times when they are not appropriate for
some, low fat when many of us need moderate to high fat foods. The
one-size-fits-all approach is not what works for many of us. This is
why you are disliked by many. You come at us with your mantras and
expect us to follow them. You do not teach us self-monitoring of
blood glucose (SMBG) because you feel we might actually learn what
your low fat, high carbohydrate mantra is doing to us. Because you
are also convinced that oral medications has to be our medication and
not insulin, you will not teach people with type 2 diabetes how to
count carbohydrates.
Those of us that have learned to eat by
what our meter tells us and how to use SMBG are a thorn in your side
because we understand that we may be able to consume more
carbohydrates in the morning and not in the evening while others have
the opposite problem. We do not believe the pronouncements of the
USDA that are trumpeted by the American Diabetes Association and
followed by the American Association of Diabetes Educators (AADE) and
the Academy of Nutrition and Dietetics (AND).
When you complain that breakfasts are
not carbohydrate equivalents, maybe you should stop and realize that
this is what this person needs and they just might have learned how
to adjust their medication to prevent having to eat the carbohydrates
you try to mandate that we must eat.
When you ask “how do we help the
round pegs?”, please know we are not asking you to change your
personalities, just leave us alone since you refuse to give us the
tools needed and shove mantras, mandates, and platitudes at us. I
have learned more from other patients in an informal peer-to-peer
setting than any CDE or RD has been able to teach me. We are also
fortunate to have some honest to goodness nutritionists still
available to help us that are more concerned about nutrition than the
number of carbohydrates we must eat for each meal. Yes, they do
suggest ideas, but in general try to balance our nutrition for what
we have found out via our meter works for us.
Thank goodness, we have some free
spirit type 2's that have learned how to count carbohydrates and
calories. They have learned to ignore some of your recommendations
from your blog here. They know that the fixed dose of insulin forces
us to eat a set number of carbohydrates so they know to ignore this.
Even the sliding scale is ignored by many as unworkable although some
of us use a type of sliding scale in our correction dose of insulin.
Most are quietly learning how to adjust their insulin dosage to
carbohydrates they will consume.
Another reason we can be free spirits
is that for many of us, our pancreas hasn't completely crapped out on
us and by avoiding the oral medications that force our pancreas to
work overtime, we often can have the hope of some functionality for
many years. More people are slowly waking up to the idea of using
insulin earlier on to preserve some pancreas functionality. Granted,
this may make our computations of carbohydrates to insulin ratio
vary, but we will learn to adjust.
I will continue to support other round
pegs and free spirits that have found the tools we need and are
advocating to others to learn what they need is available from other
sources. We have no organization looking over our shoulder or
licensure contentions to prevent us from saying what works for me, may
not work for you, your mileage may vary, and we are not locked into
mantras and unworkable mandates. We can honestly look people in the
eye and tell them about SMBG and how important this is to learn how
different foods affect our blood glucose levels.
We are not afraid to tell people that
the doctor is there for guidance, but we have to become our own lab
rat in our own science experiment to discover what works best for us.
Once we have this knowledge, no CDE or RD will again be in a
position to bully us into following them down the path to
destruction.
I am enthusiastic about working with
the round pegs and free spirits that reject the advice you hand out
to square holes and want people with type 2 diabetes to follow
blindly. Even some doctors and endocrinologists are discovering that
your advice does not work, especially for people that have found the
paleolithic lifestyle or the low carbohydrate lifestyle. There are
other types of living lifestyles that are working for other people
with type 2 diabetes and doctors are learning that good nutritional
information is more important than mandates and mantras.
Some of these same doctors and
endocrinologists are also beginning to understand the importance of
many of the tools CDEs and RDs continue to ignore and do not teach to
people with type 2 diabetes. Fortunately we are a very diverse group
and don't fit the square holes you insist we should fit into. Maybe
it is this diversity that puzzles you so much because we don't fit
nicely the patterns and established rules that you work with for
people with type 1 diabetes. We know that you don't like us becoming
our own science experiment because then you know we will not adhere
to what you preach. Viva La Difference!
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