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Old 19.05.2011, 00:30
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Re: Diabetes - English speaking dietician / advisor ?

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This is not true, Type I yes it is insulin dependent but Type II is insulin "insensitive". Most Type II start needind only pills depending on how early the disease is diagnosed, they produce enough or more insulin than normal people but their insulin does not work, hence they need medication, excersice and a diet change. Some type II diabetes that are poorly controlled nned insulin.
Hmmm, still not sure about that. It was explained to me that type II is caused by low quality insulin produced at regular amounts, or low production of insulin (quality insuilin at low amounts) OR an insensitivity to insulin.

So I still stand by my previous post and disagree with your "not true" claim.
For clarification, which part is not true ?
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  #22  
Old 19.05.2011, 09:36
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Re: Diabetes - English speaking dietician / advisor ?

Dear upthehatters, I can understand that you disagree and that you have your opinions, which I see you have just about everything. In Medicine though, I stand by my knowledge as an MD PhD. What it is not true is that type II diabetes patients have low insulin levels, that is a fallacy, at least when the disease is just diagnosed, maybe years later the pancreas is so battered that insulin production is reduced.
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Old 19.05.2011, 09:42
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Re: Diabetes - English speaking dietician / advisor ?

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Dear upthehatters, I can understand that you disagree and that you have your opinions, which I see you have just about everything. In Medicine though, I stand by my knowledge as an MD PhD. What it is not true is that type II diabetes patients have low insulin levels, that is a fallacy, at least when the disease is just diagnosed, maybe years later the pancreas is so battered that insulin production is reduced.
Oh so, it is true then, Type II diabetes can infer low insulin levels ?
For a minute before there, I thought you were saying it wasn't true

I am still a bit confused as to what you say was untrue in my post though
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Old 19.05.2011, 10:07
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Re: Diabetes - English speaking dietician / advisor ?

This thread has gone very off-topic, but highlights the biggest problem in the 'diabetes world'.

It used to be that one diabetes was called 'childhood' or 'insulin dependent' diabetes, and the other was called 'adult onset' diabetes.

This is now a misnomer....

Instead, they are called type 1 and type 2.

Type 1 diabetes usually occurs before age 30 (although it can occur later), it's auto-immune, and appears when the immune system has attacked and destroyed all the islet cells (insulin-producing) in the pancreas. Usually by the time it is diagnosed, almost all those cells are destroyed, and they have not yet found anything that can prevent the cells from being destroyed, or reverse this process, so the person is then dependent on insulin injections for the rest of their life...

Type 2 diabetes usually occurs later in life, and this is the one that is more associated with diet and lifestyle. At the pre-diabetes stage it appears as 'insulin resistance' - the body is producing plenty of insulin, but the cells can't use this insulin properly. I can't explain the actual mechanism, but it's a combination of genetics and environment. There are several 'feedback loops' that trigger the production of insulin and the ability of the cells to use sugar, and all those loops needs to be working properly for your blood sugar levels to stay stable.

For both types of diabetes, eating very healthily, watching your carbohydrate intake, and measuring your blood glucose are important.

For type 1, a lifetime of insulin injections...there is no cure...

For type 2 it might be possible to lose weight (which is doubly hard for a person with pre-diabetes because of the way their body uses and stores sugar/fat), eat a very healthy diet, and exercise properly (the body uses insulin much more efficiently when you are physically active)....

A type 2 diabetic might need insulin because their pancreas cannot produce enough insulin to keep their blood sugars down. Their pancreas may be producing a heap of insulin, but because of this situation of 'insulin resistance' the body just doesn't use the insulin efficiently, so it needs more and more...

Giving insulin by injection can also give the pancreas a 'rest' - if we introduce injections, then the pancreas responds and produces less.

The whole carbohydrate thing has changed dramatically in the last 10 years with the discovery of 'glycaemic index' but talk to any diabetic and they will tell you how they have discovered for themselves different things that send their sugars high - my aunt discovered more than 20 years ago that basmati rice was ok, but jasmine rice gives her a sugar 'spike' - now we know that basmati rice has a lower GI than jasmine rice...

Either way, back to the original thread. My experience is that diabetics of both varieties have access to specialist diabetes dieticians who understand the mechanisms, are up to date with the research, and can advise on the best way to modify the diet to stay as healthy as possible.

Actually, my son, who has type 1 is probably the healthiest of all of us. With a family history of type 2, obesity, high blood pressure...his dietary restraint and awareness of his blood sugar levels will probably mean that he lives longer than the rest of us!

We see the dieticians at the kinderspital. They had no trouble nominating to us the staff member who had the 'best' english. She was a bit nervous about her language skills, but it was absolutely fine....

I'm sure your endocrinologist would be able to refer you to a clinic. Personally, I would not be happy with a GP managing Type 2 /Insulin resistance. I think the expertise of an endocrinologist is really awesome...
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  #25  
Old 19.05.2011, 14:02
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Re: Diabetes - English speaking dietician / advisor ?

Hi
I was diagnosed with type 2 a couple of years ago. I then had a roller coaster ride of medication. Finally I was put on a medication that was not so bad. But i really did not like the idea of taking medication. In addition I was still not eating properly. A year ago, I decided that I no longer wanted to take medications and wanted to live longer so I went on a diet. I lost 19 kilos. I am no longer diabetic but I know that if I go back to my previous diet that will be and will become sick or die.

I also got assistance from Hirslanden.

I stopped eating the refined carbs, cut out all sugar including that lively black chocolate bar with nuts. No more oils. Lots of fruit and veggies and no red meat.

I am 58 and can not remember feeling this good. Oh yes, one problem, had to by new clothes.

I think that one of the challenges is going out for lunch and almost everything has refined carbs. I eat at Manor and COOP for the salad bars.

If anyone is interested I would be happy to start up a support group
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  #26  
Old 19.05.2011, 14:52
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Re: Diabetes - English speaking dietician / advisor ?

One thing that interests me, which is at a level I cannot really discuss in detail with my GP for language reasons is actually what risks diabetes poses, why they are risks and what the distinction between causality and symptoms are.

For example, since being on medication I am able to maintain a pretty good HbA1c result (generally between 6.5 and 7.5) every 3 months. I stopped taking daily strip tests due to costs and my perception of the usefulness of these results (they are so sensitive to short term swings).

Now, if my HbA1c results stay in that range, am I pretty much immune to the bad effects of Diabetes ? Or are the HbA1c results and the red cell sugar levels that drive them just one indicator of a more complex problem, which could still present long term effects even if that indicator is under control ?

How sure is the medicine world that sugar levels are the cause, and not just a symptom ? Will we discover in some years that actually the real driver is e.g. sleep, environmental toxins, or state of mind etc. and that the correlation between sugar and ill effects of diabetes are common symptoms rather than cause/effect.

Would be interested in opinions from others.
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  #27  
Old 19.05.2011, 15:01
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Re: Diabetes - English speaking dietician / advisor ?

Jaudi your questions are very interesting! Research has shown that glucose needs insulin to go inside cells, except neurons, so when there is an overload of glucose and not enough/not working insulin the first cells to get the overload will be neurons, hence a symptom of diabetes is tingling, numbness of fingers/toes/extremities. Glucose overload will also correlate to atherosclerosis and that is why hyperglycemia leads to nerve and vascular damage, that is why people with diabetes get blind among other complications. Also, when your glucose levels is too high it damages the renal tubule (not going into detail because I am having trouble organizing ideas in English-sorry!) hence people with diabetes get renal impairment. What is more, if you transplant a diabetic kidney to a healthy (non diabetic) person, the kidney will work normally.
I do not want to make this post tedious, so if you really want to discuss this please feel free to PM me, I can get you some papers for you to read, after all research is what I do for a living
Best!
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  #28  
Old 19.05.2011, 15:02
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Re: Diabetes - English speaking dietician / advisor ?

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Hi


If anyone is interested I would be happy to start up a support group
I tried to start one but did not have much success
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  #29  
Old 19.05.2011, 15:06
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Re: Diabetes - English speaking dietician / advisor ?

Well, lets see what kind of a response we get now. If you want to meet and I tal I would be willing
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  #30  
Old 19.05.2011, 15:16
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Re: Diabetes - English speaking dietician / advisor ?

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why they are risks and what the distinction between causality and symptoms are.


How sure is the medicine world that sugar levels are the cause, and not just a symptom ? Will we discover in some years that actually the real driver is e.g. sleep, environmental toxins, or state of mind etc. and that the correlation between sugar and ill effects of diabetes are common symptoms rather than cause/effect.

Would be interested in opinions from others.
Recently there have some news reports about the negative effects of sugar. At the moment I do not have them at hand and am busy. Maybe later.

Angela mentioned some of the symptoms. One of the symptoms was blackness in my toes nails. This was a clear message to me. Other symptoms is light headedness etc. This is not normal. I had to face reality instead of waiting for some pill to let me continue the way I was living.

I wanted to stop the pills because in my mind they were delaying the inevitable. Now I would not advise stopping the pills until you have taken off the weight.

I had a choice and had to stop depending on other people to tell me what I should and should not do. I had to stop depending on a little machine to tell me what my sugar levels are. I was overweight. I needed to change my diet and take off the weight. I was taking pills and I was still overweight and eating unhealthy foods.

If I can do it anyone can do it.
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Old 19.05.2011, 15:27
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Re: Diabetes - English speaking dietician / advisor ?

This is a pretty good summary of the effects of an elevated HbA1C.
http://www.nlm.nih.gov/medlineplus/e...cle/003640.htm

With type 2 diabetes, or pre-diabetes, you might not see dramatic short-term illness, but over time, your risk of complications are higher...with untreated Type 1 it's much more dramatic (diabetic coma and death within a couple of months).

'Normal' HbA1c is under 6. The target for diabetics is to keep it below 7.

You are at higher risk of eye damage, foot and skin problems, damage to the heart and blood vessels, nerve problems, kidney disease.

The reason for using test strips is so that you can be aware of your mistakes, and keep an eye on your blood sugar levels, and to balance your medication and diet to your needs....

All of the diet and exercise recommendations for diabetics are healthy for non-diabetics too - and whilst you might perceive yourself as 'healthy', I followed my son's diet for about 6 months, lost about 12kg and am now for the first time within the 'recommended' weight range for my height, and I am much fitter, and my back and knees that would cause me pain from time to time, are much stronger and I rarely have problems...

What is your blood sugar when you test ? In a normal healthy person it would be always between 4-8...

I can totally relate to 'burning out' with testing - and taking medication - non-compliance with medication and treatment is the biggest hurdle for most people who have a chronic health problem...
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  #32  
Old 19.05.2011, 15:35
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Re: Diabetes - English speaking dietician / advisor ?

Angela

Thanks for your reply.

As someone with a semi-scientific and quite analytical background, but lacking detailed human biochemistry knowledge I find the information level of your description interesting, accessible and a little unusual.

Normally in material I have found online, the information content seems to be vague assertions and dependencies without much justification of stated 'facts', or on the flip side incredibly detailed organic chemistry processes that I have no chance in understanding. I also have found that my interpretation of what I have read leads to contradictory conclusions.

I have found online forums (which I have browsed rather than participated in) seem to be populated by quite neurotic people who have spun a lot of their own theories based on day to day observations and anecdotal evidence - I was also a little guilty of this when doing daily sugar tests, one aspect which I considered very unhealthy (mentally) and which contributed to be stopping such tests.

With diabetes there are various short and long term effects and consequences. Hypoglycemia has a very clear and undesirable short term effect. Hyperglycemia has a less clearly justified (to me) , but well accepted long term effect. However, the flip sides of these are even less clear. I have read some evidence that indicates low induced/controlled HbA1c levels (less than 6.5 or so) in people who are diabetic could actually be a bad thing over the long term. I have also seen vague reference to short term acute negative effects of Hyperglycemia, but these are not clear to me either.

There is a part of me which has a huge distrust of the vested interests of drugs companies - after all, a worldwide diabetic explosion is just what they need to generate the generation of profits.....which makes me wonder how much is known compared with how much is known and made public in a clear way. No, I'm not in general a conspiracy nut, but...

If you can point me and fellow EF'rs to online references at an informational level which you have described, but maybe with a bit more expansiveness that I'm sure would be much appreciated.
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  #33  
Old 19.05.2011, 16:02
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Re: Diabetes - English speaking dietician / advisor ?

I am unusual
You are right about people belonging to some support groups being a bit neurotic and conspiracy theories, that is why I do not belong to one.
You are also right about Hypoglycemia being the worst as it can kill you, it is though easily treatable and you can do as I do and carry some fast releasing glucose pastilles, you can get them at any pharmacy and they are yummy
I read avidly and I can tell you that what I said before I learnt in Med school and in all my readings, I read from high impact journals and usually try to read more about thesame subject.
About normalizing HbAc1, what has been "proven" is that if you need to aggressively medicate a person to do so, then you are more likely to induce hypoglycemia and some severe adverse events. If you, as a patient on the other hand, stick to your medication and most importantly try to lose weight and change your eating habits and then you regulate your HbAc1 in that way then it is another story, so the key point here is how you do it and know just to do it.
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Old 19.05.2011, 16:24
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Re: Diabetes - English speaking dietician / advisor ?

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You are also right about Hypoglycemia being the worst as it can kill you, it is though easily treatable and you can do as I do and carry some fast releasing glucose pastilles, you can get them at any pharmacy and they are yummy
This is one of the many inconsistencies I found. I used to get an earful of abuse from the clinic if I admitted I was not carrying any glucose. But, my problem has never been low sugar, but high sugar. Even when on insulin I was on a combination of slow release and 'old' type and never saw sugar levels below 5.5. Now I am on medication which claims to have 'no chance' of inducing Hypos.

But your summary, and the comments from swisspea are quite right. All the knowledge in the world is secondary to achieving the correct weight, exercise, balanced diet and finally sugar levels. My doctor has been telling me this for years, and will probably still be telling me this in years to come....
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Old 19.05.2011, 17:15
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Re: Diabetes - English speaking dietician / advisor ?

Well there are medications that really are VERY UNLIKELY to cause hypoglycemia (like metformin when used alone for example) BUT blood sugar is affected by so many factors such as stress and excersice for instance that it would be smart to carry sugar around, not a kilo though
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Old 19.05.2011, 17:16
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Re: Diabetes - English speaking dietician / advisor ?

My Mother is a Renal Dietician in the UK, she specialises in renal and N stage kidney failure, I'm not sure about the type II diabetes, but I'm sure she would be happy for the external work; I know she did a similar freelance thing for a person in South Africa.

b.t.w Dietician is a registered term nutritionist isn't, they are not the same thing.
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Old 19.05.2011, 17:39
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Re: Diabetes - English speaking dietician / advisor ?

I think you mean END stage renal failure?
IT is quite different since renal patients are restricted from proteins, still a Dietician is a Dietician, shame she is not in CH.
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Old 19.05.2011, 18:46
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Re: Diabetes - English speaking dietician / advisor ?

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Dear upthehatters, I can understand that you disagree and that you have your opinions, which I see you have just about everything. In Medicine though, I stand by my knowledge as an MD PhD. What it is not true is that type II diabetes patients have low insulin levels, that is a fallacy, at least when the disease is just diagnosed, maybe years later the pancreas is so battered that insulin production is reduced.
If you are an 'MD PhD', does that mean we call you 'Doctor, Doctor'?
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Old 19.05.2011, 19:07
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Re: Diabetes - English speaking dietician / advisor ?

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If you are an 'MD PhD', does that mean we call you 'Doctor, Doctor'?
Nah just call me genius
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Old 05.09.2011, 15:12
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Re: Diabetes - English speaking dietician / advisor ?

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Hi

It appears that I have just been diagnosed with type 2 diabetes and my doctor wants to send me to a clinic so they can advise me on next steps etc. The clinic she sent me to do not have anyone that speaks English so they and I are looking for alternative clinics.

Does anyone have any experience of a clinic here in Zurich that have an english speaking consultant ?

Many thanks

Julie
Dear Julie

I am an Sri Lankan Ayurvedic and TCM Therapist. I would like to give you traditional medicine point of view on Daibetics.

In Ayurveda there are 20 different forms of diabetic. When you are diagnosed early, (1- 5 years) and specially when its type 2, it can be completely cured faster than you think, through natural herbs and some Ayurvedic dietary regulation. I have treated people with diabetic with Ayurveda, yoga and Accupuncture. If you like to speak about this we can email or chat on skype.

kind regards,
Indika
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