Welcome! This is written primarily for people with Type 2 Diabetes. Some information covers all types of diabetes. Always keep a positive attitude is my motto.
I am a person with diabetes type 2 and write about my experiences and research. Please discuss medical problems with your doctor. Please do not click on the advertisers that have attached to certain words in this section. They are not authorized and are robbing me by doing so.
Gary Fettke, who has promoted the high
fat low carb lifestyle for a long time is like many others, has been
ruthlessly attacked for doing this. Professor Tim Noakes was accusedof exactly the same thing, and the South African authorities dragged
him to court in order to silence him (not yet sure of the verdict).
Gary Fettke is an Australian orthopaedic surgeon who has suffered the same fate as Tim Noakes.
However, in Australia it seems you can be accused, tried and found
guilty without having any chance to defend yourself in person. This
is not a court of law, but the Australian Medical Board (AHPRA) who
can – as with the General Medical Council (GMC) – strike you off
being a doctor. Which for a doctor is a gigantic punishment.
Previously, Gary had been told that he
could not comment on any area of nutrition for advocating a reduction
in sugar intake (to what are now WHO guidelines). Of course, as with
all such cases the ‘authorities’ changed the goalposts from a
discussion on low carb high fat (LCHF) and turned the discussion into
Namely, that Gary Fettke, as an
orthopaedic surgeon should never give advice on dietary matters.
“The fundamental fact ‘is’ that you are not suitably
trained or educated as a medical practitioner to be providing advice
or recommendations on this topic as a medical practitioner.”
This of course allows the AHPRA to
silence him, without discussion any of the science, and no chance of
any appeal. So, his suspension about discussing any matters of diet
has now been turned into a lifelong ban. Please read Gary’s e-mail:
(This was sent to Dr. Malcolm Kendrick)
It is with frustration that I write
to inform you that I have been ‘silenced’, forever, by the
Australian Medical Board, known as AHPRA.
We have a draconian system here in
Australia where anonymous notifications can go in and they
are investigated for public safety. The accused can only submit
material but never have right of reply. It is a star chamber.
I recently got to present that
‘opinion’ of the process and the fabricated evidence at a Senate
Inquiry. My evidence on the failings of AHPRA was granted
parliamentary privilege which allowed a tell all opportunity. Within
a few hours, I received an email final determination of the 2 ½ year
investigation. Coincidence or just another kick in the guts?
My first notification in 2014 was
from an anonymous dietitian for me advocating cutting back sugar
intake to what is now the WHO recommendations. Behind closed doors,
with no right of reply or appeal, the goal posts shifted and I was
investigated for the whole LCHF concept, for being disrespectful to
health professionals (the Dietitians Association of Australia and the
Heart Foundation, but never an individual) on social media and for
failing to disclose a conflict of interest (COI) in our Nutrition for
Life Centre, whilst on social media.
The good news is that AHPRA have
decided NOT to argue the LCHF concept. I submitted enough material
for a thesis and they have accepted that LCHF may be that the
benefits of the LCHF lifestyle become the accepted best medical
The central issue for my silencing
has been that my primary medical degree and my further qualifications
as an Orthopaedic Surgeon are not satisfactory to give nutritional
advice. “The fundamental fact ‘is’ that you are not suitably
trained or educated as a medical practitioner to be providing advice
or recommendations on this topic as a medical practitioner.”
If it wasn’t so serious it would
be farcical. This decision is non-appealable under National Law. The
determination is life long and by its wording, does not allow me to
even do research in the area or gain further qualification because
that would involve me communicating in the area of nutrition. The
only thing I have not clarified is if it affects international
We have put up the post this
morning re the AHPRA decision and the launch of our community fund to
keep the LCHF message going
The other parts of the AHPRA
decision I can live with.
I will not force anyone to eat
LCHF, not that I ever did or ever could.
I will show respect to the medical
profession (doesn’t stop me from thinking otherwise).
The COI allegation is unproven as I
do declare my vested interest for all patients that I send to
Nutrition for Life. I admit guilt for not doing that in social media
but the doctor/patient relationship is not defined in that context. I
pointed out to AHPRA that they shouldn’t be applying jurisdiction
in an area that is undefined. That went down like a lead balloon.
I also pointed out that AHPRA don’t
govern nutritional advice in Australia. Another lead balloon.
I had a recent notification, again
from an anonymous dietitian, and have been investigated for
‘inappropriate’ reversal of someone’s Type 2 Diabetes and was
also reported for what I was ‘about to say’ at a hospital food
national conference. AHPRA actually asked me for a copy of my speech
BEFORE I gave the talk. I refused as it was an infringement of the
right of free speech.
AHPRA have just this week decided
to close that investigation but have warned me that they will be
observing me to see if a ‘pattern of behaviour’ continues,
presumably in relation to reversing more patients’ diabetes.
I hear rumours that I have
‘attacked’ health professionals at a personal level – that is
simply unfounded and I think started by some naysayers. Alas, I am
having some sh!t thrown at me at times. If you hear something, then
let me know please.
If this sounds like a horror story,
it is. I honestly thought that this would just fade away but strange
things do happen when you upset the ‘industry’. Just see what’s
happening with Tim Noakes. The only thing in Tim’s favour is that
it has gone to court. Mine is a closed process with no right of
appeal, unless I can continue to have politicians assist.
My next step is to challenge the
process via more closed groups and that will be years of tying me up.
I am going the public awareness path as the finding lacks the
common-sense conclusion. We are liaising with some media channels and
politicians. It’s all we can do.
Any support would be appreciated.
Happy to liaise. Feel free to forward this email as it is.
Gary Fettke Orthopaedic
Surgeon M.B.,B.S.(University NSW), F.R.A.C.S.(Orthopaedic
Science evolves by being challenged.
Not by being followed. @thegaryscience
If you think this is all completely
ridiculous, then please circulate widely, and make as much noise as
This comes after the council issued a
statement saying Noakes was guilty of unprofessional conduct. The
statement was issued after conclusion of the council’s hearing this
week on allegations Noakes gave “unconventional” and “dangerous”
medical advice about breastfeeding on Twitter.
Hours later, however, after releasing
the guilty verdict statement, the council issued a retraction and an
apology, but by then the “verdict” had gone viral. “The
previous statement is retracted and we apologize for incorrectly
stating that Prof Tim Noakes was found guilty by the professional
conduct committee,” read the statement from the council. The
Noakes inquiry is, in fact, set to conclude in April 2017.
Adam Pike, an attorney for Noakes,
reacted angrily to the initial statement. “This is deliberate. It’s
an intent to destroy the reputation of one of South Africa’s
greatest scientists. “It’s symptomatic of how the matter has
been run. This is so irregular and so incorrect on so many levels.
There’s a personal vendetta and I don’t know where it comes
Pike also attacked what he said was the
council’s lack of professionalism. “The council is a regulator of
the profession. They have failed in their duty.” The statutory
body regulates health workers. If it finds Noakes guilty, his
license could be revoked.
“Our feeling is that the hearing went
very well in our favor but obviously we can’t say yet what the
committee will decide.” Noakes referred all queries to Pike.
Council representative Daphney Chuma
said the PR department was to blame for the “guilty” verdict on
Friday. “The mistake is attributed to the PR department. It’s
not our legal team.” It appeared from Chuma’s comments the
council had prepared the guilty verdict statement and was prepared to
send it out when the hearing concludes. “There was no
communication breakdown. We sent a wrong statement. It was issued by
myself,” said Chuma.
The initial statement opened with the
line: “Professor Tim Noakes, a professor at the University of Cape
Town, was found guilty of unprofessional conduct. This is after he
provided unconventional advice on breastfeeding babies on social
media, which was not in accordance with the norms and standards of
“Professor Noakes testified and
called all of his witnesses in defense of his case. The witnesses
were cross-examined.” The council said further it “now closed
its case and there are no further witnesses to be called”. The
council said proceedings had been adjourned until April 4 and 5.
“The only outstanding issue is that
of argument of the matter. The matter will then be argued before the
(professional conduct) committee, which will then deliberate on the
issue and come to a decision between April 6 to 7. “A
judgment/verdict on the matter will be issued on Friday, April 21,
2017 by the committee.”
Noakes was accused of giving
“unconventional” and “dangerous” medical advice in February
2014 after a woman had asked him on social media whether he’d
recommend a low-carb, high-fat diet to breast-feeding mothers.
Noakes said his answer - that the
breast milk would be very healthy - had initially been deemed as
I have some serious doubts in my mind
about the accuracy of the data when it applies to people with
diabetes. I would have thought vitamin B12 would have been a larger
percentage because if the number I know that are B12 deficient it
seems that the average would be closer to 55 percent instead of 30
percent. I guess I will just have to accept the estimate of the
One nutrient in particular to note is
magnesium. Life Extension Foundation (LEF) points out in its most
recent issue (December 2016) that magnesium could be the next vitamin
D. It is a low-cost supplement that confers broad health benefits.
Magnesium is associated with reduced risks of sudden cardiac death,
stroke, type II diabetes, asthma, heart disease, hypertension, colon
and pancreatic cancer, and more.
Depending on the type taken, it also
helps the brain (magnesium-l-threonate is the most helpful) and bowel
regularity. Ironically, magnesium oxide, the type most commonly
sold, works best for regularity precisely because it is very poorly
absorbed by the body and thus does not confer most of the other
health benefits of this mineral! It is also important to have
functioning stomach acid to absorb and utilize any mineral. Those on
acid blockers are unlikely to be able to do so.
LEF also points out that food sources
for magnesium can be unreliable. This is because plants take
magnesium from the soil, and there can either be not enough magnesium
or too much of something else, like potassium, that crowds out a
plant’s absorption of magnesium. Studies show that the magnesium
content of food has declined precipitously from pre-1950s levels.
The bottom line: to get enough of this
vital nutrient, we probably need to supplement with it.
It’s ironic that the above chart data
comes from the US Department of Agriculture. Meanwhile, the FDA
continues its war against supplements, presumably intended to protect
the drug companies that fund the agency.
Continuous glucose monitoring (CGM) and
continuous subcutaneous insulin infusion (CSII) represent 2 of the
recent technological advances in diabetes care that aim to improve
glucose control and quality of life and minimize hypoglycemia.
Reliable data on such technology are scarce, however, due to the
rapid pace of advancement in such products and the less stringent US
Food and Drug Administration (FDA) regulation, and thus less demand
for clinical trials, of medical devices compared with
In September 2016, a task force appointed by the Clinical Guidelines Subcommittee of the Endocrine Society published a practice guideline pertaining to the use of CSII
and CGM technologies in adult patients with type 1 diabetes and
type 2 diabetes, based on a thorough review of relevant studies.
The guideline is co-sponsored by the American Association for
Clinical Chemistry, the American Association of Diabetes Educators,
and the European Society of Endocrinology. The fact that type 2 is
even mentioned should be an encouragement that there may be hope for
us to obtain this equipment.
“I think the guideline is making
more clinicians aware of the established role of technology in the
treatment of diabetes,” said Task Force Chair Anne L. Peters,
MD, director of the clinical diabetes program and professor at the
Keck School of Medicine at the University of Southern California in
“It is a good starting point for a
field that is rapidly advancing,” she told Endocrinology
The task force made recommendations
that they considered either strong or weak based on the quality of
the evidence available. For the former, they used the term
“recommend,” and for the latter, they used the term “suggest.”
They denoted the quality of evidence for each area reviewed, which
ranged from very low quality to high quality. “The Task Force has
confidence that persons who receive care according to the strong
recommendations will derive, on average, more good than harm,” they
stated in the document. “Weak recommendations require more careful
consideration of the person's circumstances, values, and preferences
to determine the best course of action.”
Throughout the 6 covered areas below,
the guideline authors emphasize the importance of patient and
caregiver training and education, as well as capability and
willingness to use the devices.
“Educating our patients on the use
of these technologies is vitally important,” Matthew Freeby,
MD, director of the Gonda Diabetes Center and associate director of
diabetes clinical programs in endocrinology at the David Geffen UCLA
School of Medicine, said in an interview. “Providing education
increases the chances of using them well and ensuring safety.”
#1. Insulin pump therapy without
sensor augmentation. The authors recommend CSII vs analog-based
basal-bolus multiple daily injections in patients with type 1
diabetes who have not achieved their HbA1c goal, as well as those
who, despite having achieved their HbA1c goal, continue to have
severe hypoglycemia or high glucose variability.
They also suggest CSII for patients
with type 1 diabetes in need of more insulin delivery flexibility or
improved satisfaction. “The flexibility provided by CSII with
rapid-acting analog insulin could be an advantage for those who
exercise and potentially those with gastroparesis because the basal
delivery dose and pattern can be modified,” they explained in the
paper. The guideline offers a detailed description of how to select
candidates for insulin pump therapy.
#2. Insulin pump therapy in type 2
diabetes. The task force suggests CSII for patients with type 2
diabetes who have poor glycemic control despite all reasonable
efforts with insulin or other injectable therapy, oral agents, and
#3. Insulin pump use in the
hospital. The guideline authors suggest continuation of CSII in
patients with type 1 diabetes or type 2 diabetes who are admitted to
the hospital, as long as the hospital has established protocols for
evaluating and monitoring the use of CSII in such patients. This
approach is supported by both the American Diabetes Association and
the American Association of Clinical Endocrinologists.
#4. Selection of candidates for
insulin pump therapy. Before prescribing CSII, the authors
recommend that clinicians conduct a comprehensive assessment of the
patient's mental and psychological status, history of adherence to
other self-care measures pertaining to the disease (such as
carbohydrate counting and sick-day rules), availability for necessary
follow-up visits, and willingness to use the device.
#5. Use of bolus calculators in
insulin pump therapy. The task force suggests that clinicians
encourage “patients to use appropriately adjusted embedded bolus
calculators in CSII and have appropriate education regarding their
use and limitations.” They do not recommend the use of non-CSII
insulin calculators, such as those available via smartphone apps,
which are not FDA-approved.
#6. Real-time continuous glucose
monitors in adult outpatients. The authors recommend real-time
CGM devices for patients with type 1 diabetes and above-target HbA1c
levels, as well as those with well-controlled type 1 diabetes, who
are capable of using such devices almost daily. They suggest
short-term, intermittent real-time CGM use in adults with type 2
diabetes who are not on prandial insulin and have HbA1c levels ≥7%.
They suggest that both patients with
type 1 diabetes and type 2 diabetes using CSII and CGM receive
appropriate education, training, and support to achieve and maintain
their glycemic goals. They note that data showing improved long-term
glycemic control using GCM underscores the importance of the
patient's skill in using the new technology.
“The authors of this guideline did
an excellent job reviewing the recommendations based on the current
available data,” said Dr Freeby. “As stated in the
guideline, there are plenty of data to support the benefits of pump
therapy and continuous glucose monitoring in type 1 diabetes, and
anecdotally, these therapies really work in day-to-day practice.”
Dr Peters hopes clinicians will be
excited about data analysis and how the new devices can help
patients. “I don't think they should be oversold—type 1
diabetes is still a challenge, but these are all steps on the way to
more fully automated systems,” she said.
Smart phone apps could offer patients
with type 2 diabetes a highly effective method of self-managing their
condition, concludes a study by Cardiff University.
Yes, this may help some people, but in
talking to members of our support group, of the 25 members, only two
members were using apps and even they were not happy with the apps
they had or were using. Both stated they could do better without
A systematic review of 14 previous
studies found that all had reported a reduction in average blood
glucose levels in patients that used an app, compared to those who
did not, with an approximate reduction in HbA1c (glycated hemoglobin)
of about 0.5%. The analysis also found that younger patients were
more likely to report a benefit. No evidence was found to support
the use of apps in type 1 diabetes, but further research is needed to
Dr Ben Carter from Cardiff University's
School of Medicine said: "With the number of patients globally
with diabetes expected to rise to over 500m by 2030, there is an
urgent need for better self-management tools. Both of the members
agreed that there is a great need for better tools, but until app
developers start listening to customers, apps will not improve much
to fulfill the needs of users.
As we enter an era where portable
technology is increasingly used to improve our lifestyles, as can
already be seen with physical activity technology, apps can offer a
large percentage of the world's population a low cost and dynamic
solution to type 2 diabetes management.
Diabetes management includes monitoring
and managing blood glucose levels. This is done by controlling diet
and knowing how foods affect blood sugar. For many people with
diabetes, it also involves taking medications that help manage blood
sugar levels. Current diabetes apps allow patients to enter data and
provide feedback on improved management. They can provide low cost,
interactive and dynamic health promotion by allowing patients to
track medications, set reminders, plan meals, find recipes and plan
for doctor's appointments and blood tests.
Dr Carter added, "By the end of
the decade it is predicted that global usage of mobile phones will
exceed 5 billion, so apps, used in combination with other
self-management strategies, could form the basis of diabetes
education and self-management."
The study comprised of a systematic
review of 14 diabetes type 2 randomized controlled trials, involving
1,360 patients. This type of research provides the strongest evidence
for drawing causal conclusions because it draws together all of the
"Do Mobile Phone Applications
Improve Glycemic Control (HbA1c) in the Self-management of Diabetes:
A Systematic Review, Meta-analysis, and GRADE of 14 Randomized
Trials," is published in Diabetes Care.
A new study finds clinicians less
likely to counsel less educated, and younger and older patients.
According to a study in Preventing Chronic Disease, low-income adults
who are overweight or obese are less likely to be counseled to lose
weight than adults with higher incomes.
High-risk patients, such as those who
are extremely obese or have comorbidities, are most likely to receive
weight-loss advice. However, demographic factors also appear to
determine who receives advice. Patients who have high levels of
education are more likely to receive advice than those who have low
levels of education and those who are middle-aged are more likely to
receive advice than younger or older patients. Study results are
unclear about whether health insurance plays a role in determining
who receives weight-loss advice; some studies found that insurance is
not associated with receiving weight-loss advice, whereas one study
found that patients who had private insurance were more likely than
uninsured patients to receive weight-loss advice. Income also
appears to play a role; those who have high incomes are more likely
to receive weight-loss advice than those who have low incomes.
This study is the first to explore the
determinants of receiving weight-loss advice in a sample of
overweight or obese individuals from communities with a high
proportion of low-income, racial/ethnic minority populations in a
multivariate analysis of race/ethnicity, age, sex, health status,
income, health insurance status, and education.
Over 1,100 overweight or obese adults
from New Jersey were surveyed about whether their healthcare provider
had advised them in the past year about weight loss. A substantial
proportion of participants had low incomes and were of a racial or
Only 35% said they had recently been
advised by a clinician to lose weight. After adjustment for health
insurance status and other variables, participants whose household
incomes were above 400% of the federal poverty level had a 64%
increased odds of receiving weight loss advice, compared with those
at or below the federal poverty level. Participants at 200–399% of
that level had 56% higher odds.
The US Preventive Services Task Force
recommends that all patients be screened for obesity and, if needed,
be provided weight-loss advice. This study aimed to describe the
determinants of receiving weight-loss advice among a sample with a
high proportion of low-income, racial/ethnic minority individuals.
The finding that individuals in the
lowest income group had significantly lower odds than individuals in
higher income groups of receiving weight-loss advice from their
health care provider is similar to the findings of previous studies.
Patients who have risk factors such as obesity, poor health status,
diabetes, and asthma would warrant special attention to weight. The
finding that these risk factors increased the odds of receiving
weight-loss advice aligns with the findings of other studies.
From the results of the study, it was
concluded that income is a significant predictor of whether or not
overweight or obese adults receive weight-loss advice after
adjustment for demographic variables, health status, and insurance
status. Further work is needed to examine why disparities exist in
who receives weight-loss advice. Physicians should provide
weight-loss advice to all patients, regardless of income.
On November 12, we met for our meeting.
This happened to be the same evening as our competing group. Brenda
brought the group to order and asked if there was discussion about
new members. Barry said there should be as he has had four people
talk to him about becoming members. One of the new members, B.J,
said he had three people approach him about joining our group.
Julie said she had two people ask her
about membership and Rose said she had been asked by three people.
Allen said we should have a discussion then. He said that the number
felt good with the present number of 25 and we had agreed on
accepting new members at the October meeting only. Sue commented
that maybe we should have them start a new group, as the group Glen
led had stopped membership, Dr. Tom's group was now about 30 members,
and the group that we separated from also had over 30 members.
Jason moved that we work with them to
form a new group. Sue seconded the motion and Brenda introduced Glen
to speak to the issue. Glen said the group he presently led had
capped their membership at 25 and had eight more wanting membership
so he could agree with the need for a new group. He continued that
the twelve wanting membership and the eight from his group would make
20 members for a new group.
Brenda asked if there would be more
discussion, and with no hand being raised, she asked for a vote. The
vote was unanimous and she asked Barry and Allen if they would work
with Glen or someone from his group to help form the group. Both
agreed and Brenda thanked them. Allen stopped and told everyone that
this is the first he has been thanked by a leader of the group and he
said he wanted everyone to know why he would support Brenda. This
brought a hearty round of applause.
Glen stated that he wanted to thank
Brenda for helping keep members of the separated group out of his
group, as three had tried to join his group. Brenda said we will need to work together in
the future to avoid other problems. We will also be having a few
meetings and inviting other groups. We hope you will find interest
in some of them. We had planned this to be one of them, but the
membership issue became important. In talking with you and finding
out the numbers of potential members, we felt this required our joint
attention, so thank you for your input.
Barry asked to speak and said a few
potential members may back away from a new group, but this should be
expected. Glen said this may happen, and these people should be told
that the membership in our groups is capped at present and we don't
anticipate any member changes in the near future. Allen said this is
correct and Glen has explained this very well.
Brenda then asked if any one disagreed.
No one disagreed and Brenda asked Julie, Rose, and B.J if they would
work with Glen, Barry, and Allen to support the formation of the new
group. All three said they would and B.J asked if he could be part
of the group with Glen, Barry, and Allen as he wanted to learn from
them, as he felt several could be in need of VA assistance like he
Allen said this was something Barry and
he had discussed and this needed to be accomplished. Brenda asked
Allen if he would work with the new members. Allen said Barry and he should have
done this in October and now this meeting was all but over, and it
had not been done.
Brenda asked B.J if he needed the
information now or later. He said there are three other new members
and three in those he knew that wanted to join. Julie said both of
her potential new members need this information. Rose said two of
her three were also veterans.
Barry said this means about 14 are
veterans and he asked Glen if he knew about those wanting VA
information. Glen said he was not sure, but he would ask. Allen
said there was a lot to be done to start the new group, but felt it
might help start the new group.
Brenda asked if there was any other
business. None was forthcoming and Brenda said cleanup is in order.
She concluded by saying she would suggest those working on the new
group stay in contact with her and each other. She said she would
forward any information that she receives. The meeting is over.