June 25, 2012

Problems in Personalizing Diabetes Education for Type 2's

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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