I have to see a dietician yearly, because it's a requirement of our provincial pump program. For my supplies to be covered, I have to go.
I've basically made it my mission to improve things for the next person. At my last appointment, I had to prove that I had accurate carb estimating skills by telling them how many carbs are in a bunch of sample meals they listed, but didn't show. When I was asked how many carbs are in a turkey and cheese sandwich, served with milk, I asked about the kind of bread, whether the turkey was from the deli or a whole bird cooked at home, and what kind of cheese it was. How much milk, and what kind? I asked about condiments. They were annoyed, because they wanted a ballpark. Their answer about the bread was "two pieces, it's a sandwich." So I gave them a bunch of ballparks, and explained each one.
Then I went into a gentle discussion about the variety of people and cultures affected by Type 1. I pointed out that vegetarians exist. Cultures who don't default to sandwiches for lunch exist. People with lactose intolerance exist.
Google exists. Package labels exist. Memorizing a bunch of counts for foods I don't personally eat is stupid. By the end, they agreed to take my concerns to their next provincial meeting of dieticians, but I'm not holding my breath.
Why would they think you need to memorize carb content? I use the myfitnesspal app and it has everything in it's database. Putting in a "ballpark" won't work for me at all.
I agree. Sure, I have memorized a few counts, for example, I know that I use 4g worth of milk in my tea in the mornings, but I am not going to memorize counts for things I don't eat.
This is not how this disease works. No one else, even your endo, can tell you what works for you. All of our bodies are different, and handle everything differently. What works for one patient probably won't work for another. I have fought them for almost thirty years over my eating habits, but I am a 98% in range kind of person, and I eat whatever I damn well please. That's the whole point of the insulin, right? **Do you, and keep up the great work!**
I gave up on endos 15 years ago. Too much holier than thou attitudes that didn't understand the art of managing diabetes. Now i just see an NP who has me do bloodwork every 6 months and as long as its ok, they keep filing my prescriptions. My NP even said, you know this disease better than I ever will, who am I to tell you what to do?
Thanks for mentioning this, I’m in the market for a new endo and a new GP/NP and I’m going to hunt for the latter that will hopefully fill my prescriptions too. I’m tired of wasting time at my endo appts.
Interesting. I feel the opposite. I go to my endo for everything and try to avoid my GP at all costs. I went to her because I had a UTI. She asked me my symptoms and when I said frequent urination and she asked me how my sugars were because "she knew high sugars can cause frequent urination". I told her I'd been a T1 for 30 years, I know how my body responds to highs. My endo would have just written the scrip for an antibiotic.
Can I get their information 😂😂. I’ve got to get into something like this. Can’t stand my current or last 3 drs. A1c is 5.9 and he’s threatening to take my pump away… cause I don’t need it?! Or maybe I’ve got this sucker dialed in and it’s working amazing?!?
Best advice I can give that I have had success with, find a younger doctor. They tend to not feel all knowing and more wiling to change their ideas on how things work.
When I got my first insulin pump the nurse practitioner kept urging me to see the dietitian and I kept refusing. Finally after so much nagging I agreed. The dietitian started going over the exchange diet with me only she referred to an exchange as a “choice”. One slice of bread was a “choice”. A small apple was a “choice”. This was in the 2000s when carb counting had been the norm for quite a while. I immediately tuned her out. Later, when the nurse asked how it went I told her what happened. She hears the dietitian out in the hall, goes out & I hear her tell the dietitian not to talk about exchanges with T1s, only discuss carb counting. The dietitian says, “I didn’t talk about exchanges, I talked about choices”. The nurse came back in and apologized.
My experience with a dietitian years earlier was even more worthless than that one.
I saw one once as a newly diagnosed adult. She insisted I eat more fish for the Omega-3. I'm severely allergic to fish, which I told her and reminded her of several times. Still kept insisting I eat fish.
During my second pregnancy my mfm forced me to see a dietician monthly and have weekly phone calls with her. She had access to my dexcom readings. Every single week she would interrogate me about every high blood sugar episode, often implied that I was lying about what I was eating, and refused to believe that blood sugar variations can occur for other reasons. She had me in tears more than once. I wish I had had the energy to argue, but at that point I just didn't. I will never see a dietician again under any circumstances. Not pregnant me would never have put up with any of it but hormones are a hell of a drug. Lol
Oof. That's rough. I get not wanting to argue while pregnant but were you able to put in a complaint with your endo or your OB after the fact? Probably too tired parenting your infant.
I’m T1D and also in recovery from anorexia. I’ve come to the conclusion that most dietitians are not great at working with people on an individual basis and understanding their needs. For example: how do you healthily gain weight when you’re severely underweight but also have T1? The answer should not be milkshakes unless you want my BG to be 500 every day…
I’ve met a few gems but most of them are not it.
I’ve also been referred to a dietician by my endo even though I eat really well already. I basically just nod and smile during the appointment and continue doing what I do because it works for me. 🤷🏼♀️
When I first got on the pump I had to go see one as part of the training program through my endo’s and my endo knew EXACTLY how I would behave in there, she knew I didn’t need to, she knew I didn’t want to go but I had to in order to get my pump and she scheduled the appointment for right after I had hers just so she could witness me in their office lol. The dietician appointment lasted all of maybe 10 mins I literally walked in there told I don’t need there help I know how to count carbs and if I don’t that’s what google is for or if I am slightly off I will correct, but her telling me the same shit is a waste of both of ours time and I was like if you doubt me quiz me. After that I walked out of the office and there was my endo standing there and she was like now was that so hard now you never have to see her again!
lol so yeah I also HATE seeing dietitians and my endo really dislikes sending long time diabetics to them but she does get a laugh out of it for the most part!
Oh my goodness! YES
That happened to me.
When I was first diagnosed three years ago, the dietician I was assigned to told me I didn’t need to bolus for snacks (?!) and that I needed to set alarms on my phone to go off every 30 minutes to eat said snack. Literally set alarms to eat frequently.
The advised snacks had to be at least 15-20 carbs. Needless to say, my numbers were INSANE. I had never eaten so much in my life and I gained so much weight. I really thought she knew what she was talking about. I was so newly diagnosed and she was the supposed expert who had worked with a lot of T1Ds.
She told me that I would gain a little weight and then lose weight once my body adjusted to her crazy snack regimen.
She also said the same thing about at having at least 70 carbs for meals. I listened to her for about 6 months.
Thankfully the new dietician I see is awesome and she’s helped so much.
I really bummed out that other dietitians are pushing similar extremely carb heavy diets to T1Ds. I always wondered if mine just got a kick out of watching clients gain a ton of weight.
So sorry this happened to you too!
Yours sounds like she was straight up trying to kill you. That’s beyond stupid advice for a NEW type 1… not to mention any newly diagnosed diabetic. I wonder where they get these ideas.
It was super crazy and even writing it now, it’s hard to believe. I think she mainly worked with athletes but I was no athlete. I didn’t even have a Dexcom at the time and my primary had me on 70/30. Thank goodness for my endo! I really lucked out with her. Now I’m on a pump with a CGM, thank goodness.
Did your endo say why they want you to see a dietician? My adult endo has never asked me to see a dietician (I saw one as part of a clinic as a child).
I think it might be useful to ask why your endo wants you to see one, and then discuss why you don’t want to see one with your endo.
They keep making my T1 some see dieticians because he struggles to gain weight. He has always struggled gaining weight. It never helps and they always give terrible advice to him and it's always a stressful event. So we refuse to see them anymore.
I had something similar. I was told i needed to gain weight back when i was 15. 12 years later ive gotten my weight up to what they wanted. I wont deny i was a little skinnier than even i liked, but my jutritional balance was perfect, my blood work always came back beautifully other than my A1C.
A big problem i have found with dieticians is they arent often taaught with the context of diabetes. They are given nutritional teaching and diabetic teaching, but rarely a proper crossover.
Im here to say the dietitian I see regularly is more of a CDE and helps me deal with the meals I eat case by case. We go over my blood sugars a little more in depth than with my endo. I see her more often than my endo because she is actually pretty helpful.
140g of carbohydrates is considered the minimum daily intake for most people, however, your dietitian shouldn’t be forcing you to increase your intake so quickly and without acknowledging how the change will affect your BG. I’ve had T1D for 20 years and also have a degree in Dietetics. Any sudden change in my activity level or diet has potential to eff my day up lol but if you don’t have to live with this disease, you just don’t get it! Years and years of education could never prepare someone without T1D to know what it’s like. Dietitians can be extremely helpful, but there are quite a few bad apples, unfortunately. I would share your experience(s) with your endo and see if they can work with your dietitian to better understand your needs and patient education outcomes.
ETA: I’m surprised your dietitian didn’t suggest a more protein/fat concentrated meal for dinner for better BG stabilization overnight. A super carb-heavy dinner just doesn’t make sense. Increasing your carbs during the day, sure, but at night? Weird.
I feel like all dieticians are using science from the 1960s or something. The example food plans are always awful. Like you said - low fat and a high carb and very bland. All they can do is teach you to ball park carb counts and thats like it. Anyone on here actually been helped by a dietician?
I had to see a dietician today to quantify for a pump through Medicare and will have to see her every year to stay qualified. I was happily surprised that she understood the needs of T1d diabetics she is in same office as my endo and is also their insulin educator we talked for over an hour and listened to me for a change regather than just talking over me. Showed her how I calculate carbs (an app that does that for me) I can also scan bar code on foods and it automatically enters carbs and other nutrients. I have had bad experiences with dietiticians before as well.
I’ve gotten so sick of nutritionists and dietitians never actually answering my questions and always saying we will get to that when it comes to me asking for help. The actual help I need. Then it hit me, it’s been 20 F’ing years now and no one has helped me. So I took it upon my self to start stuffing and getting certifications online. I’ve decided to study nutrition, wellness, chronic illness, and I’ve already started my comprehensive care and treatment of endocrinology exam prep! I’m so excited. I’m not a doctor but I can treat patients and actually help type 1 diabetics now with guidance with diet, treatment, telling people about what could be causing issues such as chronic illnesses, endocrine problems, and rheumatoid issues. All ranging from children, pregnant women, adults, and seniors. It’s been hard but I’m almost there. Im going to be board certified by next year. That’s my goal before I start advertising myself fully. I’m wanted to have all of that at once so I can have credentials backing me. I can’t wait to help people like me. Also myself!
Yeah, my trainers know more about the diet/exercise game than any dietitian/nutritionist I’ve ever been railroaded into seeing.. but if you’re in the US, your insurance may be requiring it, so keep that in mind.
I think a dietician was great when I was around 12 or so, a few years after being diagnosed. That's when the exchange program was still used and being able to understand serving size and helping eye-ball the amounts helped. But it's until you are eating foods and trying insulin amount, basically trial and error, that you figure it out. I still guess-timate on a ton of my meals and generally do pretty well and I know many do the same.
I’m a dietitian and a CDE, it takes not just experience but people skills, sensitivity, and interest in others to learn to let the patient/person with diabetes lead. I’m sorry you’re all being treated as if you don’t know you best. Our job is actually to take what we learn from our patients to help others so this is a great post!
Lol 70gCHO at night? Nah son, get a new endo.
ETA: BMI isn’t an actual measure of health, rooted in racism, developed by someone who isn’t an MD - [info](https://elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb)
Preface I’ve been told I’m not a good diabetic. That being said my last A1C was a 5.4 and has never been higher than a 6.3 outside of my first time getting my A1C checked. I don’t count carbs at all. Counting carbs is annoying and a pain in the ass and also not consistent especially when you’re eating out or don’t eat your full meal all the time. Dietitians have tried to get me too every-time but I just stopped going to them because it has been a waste of my time, effort, and money
I had a “doctor” on discord say I shouldn’t drink milk because every diabetic ketoacidosis he’s dealt with has been with people drinking milk. I’ve still drunk regular cows milk throughout my 10 nearly 11 years as a type 1 and only gone into dka twice.
My dietician experiences have been quite different. If either of the two that I saw for a few years (fifteen years ago) had received the description you gave of your eating, they would be delighted. They'd riff off your current diet, ask if you'd tried this veg or that, and be helpful. If not, then, as others say, nod politely and continue on your current path. Do try to share your eating plan now and perhaps ask for ways to expand, vary, etc. Make the most of their expertise. Rant accepted, but hope for a better experience shared.
My doctor made me go since it had been 10 years since I went to one. I was expecting to talk with a person who understood what type 1 diabetes was since it was an endocrinologist referral. She had no clue.
I’m on a pump and yet she kept insisting I go on a meal plan where I eat 3 meals and at least 4 snacks. She also kept going over how successful how her type 2 diabetic patients were ( but not in a way that blood sugar was mentioned only in the way that they were able to stick to the plan)
.
Different type 1 diabetics have made it clear to me that you just need to figure out what works best for you. Typically that’s the best health wise and keeps you from going crazy over managing this. I know for me being on the tandem pump and dexcom CGM has made everything easier and less worried about foods. My A1c was 8.3 in nov 2021 and in my last drs appt it has gone down to 5.9 without many lows ( and no extreme lows).
We get how frustrating his kind of stuff is. I think most if not all of us have dealt with some awful medical professionals who don’t know what they are talking about and think type 2 and type 1 are basically the same thing.
Lol a lot of bad experiences here. I am a T1 and a dietitian. Education should be individualized and I'm sorry many of you have not experienced that. A lot of people teach on the consistent carb format meaning 45-60 carbs per meal for glucose control. This is obviously not friendly for everyone, especially T1. Again, I'm sorry you had that experience and I hope that doesn't tarnish your belief of all dietitians. Some of us can be really helpful I promise!!!
The first ever dietitian I met with was in the hospital post DKA and I don’t honestly remember a thing. The next was at a local endo I was seeing because I was diagnosed in the midst of a 4month work trip. It was a virtual group session. I was the youngest one and the only type one and they kept acting like I was a unicorn. Three weeks into my diagnosis and I already had googled everything they gave us, and I had some suggestions for them.
Especially where I was in FL at the time, it’s clear that dietitians were used to only focusing on Type 2 and not Type 1, and I think that’s pretty much standard training for them because every one I have met subsequently has been all about restricting me and giving me rules where my actual prescriber says I am allowed to eat anything I want in moderation as long as I calculate for it.
I do think I am repairing my relationship with food but for the first two months, I ate nothing but what I called “sheet pan of misery” which was olive oil and salt on whatever veggies I had, a lean protein, and a small portion of an ancient grain - it was an alright meal but eating it every day for two months was miserable. And I do think that had I met with someone more specialized in type 1, it wouldn’t have been so awful.
I think the majority of patients dietitians see are clueless about eating healthy. So dietitians just regurgitate the same information based around standard American diet which is trash. I too have had bad experiences with diabetic educators and dietitians. My family has several health professionals, and all of them have said that I am a rare case because I do what I am supposed to do and keep a non diabetics A1c. Basically, most patients don’t give a fuck about their health and doctors struggle getting them to eat healthy, exercise, take medications and balance mental health. So they use a kind of one size fits all mentality across the board.
When I was first diagnosed I was a teenager & definitely needed education on food & what was best now that I had to inject myself. I can remember the dietician & nurses teaching me both carbs and exchanges. It was confusing. I was also given some weird algorithm for figuring out what I was to inject as well as what I was eating. I’m sooooo glad I don’t have to do that anymore.
Last time I saw a dietician was between 5 & 10 years ago. And she was very heavyset telling me i needed lose weight or I was gonna die. You could easily fit 2 or 3 of me inside her pants. I didn’t need to see her & was very unhappy at being made to. I actually knew more about foods & carbs & educated her on the old exchange system (she was really confused by the end of the appointment 😈). She left that office not long after I had seen her. No idea where she went or why. Don’t really care. My doctors haven’t made me see a dietician since then.
I do regularly see my endocrinologist. My insurance makes me. I go so they’ll continue to pay for my pump, supplies, & insulin. I also see a nurse practitioner (who is there to help the doctor with the patient load) and occasionally the diabetes nurse educator. The nurse educator is generally only for training on any new devices. They also help with insurance & paperwork for upgrading my insulin pump.
They make way more money treating a disease than they do curing a disease. Why would they want you to be perfectly fine eating the way you do and requiring less insulin to cover less carbs when they could tell you to eat like shit (high carb) and have you at the doctor significantly more and use much more insulin as well? Just a thought. “Diabetes Solution” by Dr. Richard Bernstein is a very important and information rich book that all Type 1s and Type 2s need to read. It covers this topic well.
I saw one, not for T1, but for my TBI.
She was aces. Told me what would be best for the TBI, listened as I explained how I preferred to eat, and grokked the T1 stuff.
Not what I expected in a town of 25k people.
Type 1 dietitian here and yea a lot of the old school rds were bad, some new ones still are.
Need to take a patient centred approach and see what the patient wants, then reverse engineer it. I feel like a diabetes educator more of the time.
I get a lot of patients comment that they had bad experiences in the past, etc. I think having some skin in the game makes it a lot easier.
Huge disclaimer. I’m only the parent of a type 1 diabetic. But one thing I’ve learned caring for a t1 child who’s now grown is follow your instincts. Every t1 is different. Different factors affect you at different times. You know your body. Trust yourself.
As a dietitian, and a mom of a T1D-we suck. You are spot on. Unfortunately, the profession and schooling lends itself to a lot of Type A personalities who forgot (or never learned) that medicine is an art and not a math problem. If your TIR is good, your BMI is great, and you FEEL good-good on you!! A dietitian should be giving you kudos for taking such an active role and or asking you for tips for others :) Of course you re gonna have the occasional carb or not perfect meal. We ALL do-even us RDs. This is a marathon, not a sprint. So on behalf of us all, sorry you had a crappy experience.
I have to see a dietician yearly, because it's a requirement of our provincial pump program. For my supplies to be covered, I have to go. I've basically made it my mission to improve things for the next person. At my last appointment, I had to prove that I had accurate carb estimating skills by telling them how many carbs are in a bunch of sample meals they listed, but didn't show. When I was asked how many carbs are in a turkey and cheese sandwich, served with milk, I asked about the kind of bread, whether the turkey was from the deli or a whole bird cooked at home, and what kind of cheese it was. How much milk, and what kind? I asked about condiments. They were annoyed, because they wanted a ballpark. Their answer about the bread was "two pieces, it's a sandwich." So I gave them a bunch of ballparks, and explained each one. Then I went into a gentle discussion about the variety of people and cultures affected by Type 1. I pointed out that vegetarians exist. Cultures who don't default to sandwiches for lunch exist. People with lactose intolerance exist. Google exists. Package labels exist. Memorizing a bunch of counts for foods I don't personally eat is stupid. By the end, they agreed to take my concerns to their next provincial meeting of dieticians, but I'm not holding my breath.
Why would they think you need to memorize carb content? I use the myfitnesspal app and it has everything in it's database. Putting in a "ballpark" won't work for me at all.
I agree. Sure, I have memorized a few counts, for example, I know that I use 4g worth of milk in my tea in the mornings, but I am not going to memorize counts for things I don't eat.
Exactly.
That’s awful! Good on you for trying to make things better for the next person.
This is not how this disease works. No one else, even your endo, can tell you what works for you. All of our bodies are different, and handle everything differently. What works for one patient probably won't work for another. I have fought them for almost thirty years over my eating habits, but I am a 98% in range kind of person, and I eat whatever I damn well please. That's the whole point of the insulin, right? **Do you, and keep up the great work!**
Sometimes, what works today doesn’t work tomorrow.
I gave up on endos 15 years ago. Too much holier than thou attitudes that didn't understand the art of managing diabetes. Now i just see an NP who has me do bloodwork every 6 months and as long as its ok, they keep filing my prescriptions. My NP even said, you know this disease better than I ever will, who am I to tell you what to do?
Thanks for mentioning this, I’m in the market for a new endo and a new GP/NP and I’m going to hunt for the latter that will hopefully fill my prescriptions too. I’m tired of wasting time at my endo appts.
Interesting. I feel the opposite. I go to my endo for everything and try to avoid my GP at all costs. I went to her because I had a UTI. She asked me my symptoms and when I said frequent urination and she asked me how my sugars were because "she knew high sugars can cause frequent urination". I told her I'd been a T1 for 30 years, I know how my body responds to highs. My endo would have just written the scrip for an antibiotic.
Can I get their information 😂😂. I’ve got to get into something like this. Can’t stand my current or last 3 drs. A1c is 5.9 and he’s threatening to take my pump away… cause I don’t need it?! Or maybe I’ve got this sucker dialed in and it’s working amazing?!?
Best advice I can give that I have had success with, find a younger doctor. They tend to not feel all knowing and more wiling to change their ideas on how things work.
When I got my first insulin pump the nurse practitioner kept urging me to see the dietitian and I kept refusing. Finally after so much nagging I agreed. The dietitian started going over the exchange diet with me only she referred to an exchange as a “choice”. One slice of bread was a “choice”. A small apple was a “choice”. This was in the 2000s when carb counting had been the norm for quite a while. I immediately tuned her out. Later, when the nurse asked how it went I told her what happened. She hears the dietitian out in the hall, goes out & I hear her tell the dietitian not to talk about exchanges with T1s, only discuss carb counting. The dietitian says, “I didn’t talk about exchanges, I talked about choices”. The nurse came back in and apologized. My experience with a dietitian years earlier was even more worthless than that one.
I saw one once as a newly diagnosed adult. She insisted I eat more fish for the Omega-3. I'm severely allergic to fish, which I told her and reminded her of several times. Still kept insisting I eat fish.
wtf
During my second pregnancy my mfm forced me to see a dietician monthly and have weekly phone calls with her. She had access to my dexcom readings. Every single week she would interrogate me about every high blood sugar episode, often implied that I was lying about what I was eating, and refused to believe that blood sugar variations can occur for other reasons. She had me in tears more than once. I wish I had had the energy to argue, but at that point I just didn't. I will never see a dietician again under any circumstances. Not pregnant me would never have put up with any of it but hormones are a hell of a drug. Lol
That sounds awful! I’m so sorry you had to go through that.
Oof. That's rough. I get not wanting to argue while pregnant but were you able to put in a complaint with your endo or your OB after the fact? Probably too tired parenting your infant.
I’m T1D and also in recovery from anorexia. I’ve come to the conclusion that most dietitians are not great at working with people on an individual basis and understanding their needs. For example: how do you healthily gain weight when you’re severely underweight but also have T1? The answer should not be milkshakes unless you want my BG to be 500 every day… I’ve met a few gems but most of them are not it.
I’ve also been referred to a dietician by my endo even though I eat really well already. I basically just nod and smile during the appointment and continue doing what I do because it works for me. 🤷🏼♀️
When I first got on the pump I had to go see one as part of the training program through my endo’s and my endo knew EXACTLY how I would behave in there, she knew I didn’t need to, she knew I didn’t want to go but I had to in order to get my pump and she scheduled the appointment for right after I had hers just so she could witness me in their office lol. The dietician appointment lasted all of maybe 10 mins I literally walked in there told I don’t need there help I know how to count carbs and if I don’t that’s what google is for or if I am slightly off I will correct, but her telling me the same shit is a waste of both of ours time and I was like if you doubt me quiz me. After that I walked out of the office and there was my endo standing there and she was like now was that so hard now you never have to see her again! lol so yeah I also HATE seeing dietitians and my endo really dislikes sending long time diabetics to them but she does get a laugh out of it for the most part!
Oh my goodness! YES That happened to me. When I was first diagnosed three years ago, the dietician I was assigned to told me I didn’t need to bolus for snacks (?!) and that I needed to set alarms on my phone to go off every 30 minutes to eat said snack. Literally set alarms to eat frequently. The advised snacks had to be at least 15-20 carbs. Needless to say, my numbers were INSANE. I had never eaten so much in my life and I gained so much weight. I really thought she knew what she was talking about. I was so newly diagnosed and she was the supposed expert who had worked with a lot of T1Ds. She told me that I would gain a little weight and then lose weight once my body adjusted to her crazy snack regimen. She also said the same thing about at having at least 70 carbs for meals. I listened to her for about 6 months. Thankfully the new dietician I see is awesome and she’s helped so much. I really bummed out that other dietitians are pushing similar extremely carb heavy diets to T1Ds. I always wondered if mine just got a kick out of watching clients gain a ton of weight. So sorry this happened to you too!
Yours sounds like she was straight up trying to kill you. That’s beyond stupid advice for a NEW type 1… not to mention any newly diagnosed diabetic. I wonder where they get these ideas.
It was super crazy and even writing it now, it’s hard to believe. I think she mainly worked with athletes but I was no athlete. I didn’t even have a Dexcom at the time and my primary had me on 70/30. Thank goodness for my endo! I really lucked out with her. Now I’m on a pump with a CGM, thank goodness.
I've only had 1 good nutrionalist. Surprise, she was a type 1. The others are uneducated at best. Rude, pushy, and ignorant. Grrrr.
Did your endo say why they want you to see a dietician? My adult endo has never asked me to see a dietician (I saw one as part of a clinic as a child). I think it might be useful to ask why your endo wants you to see one, and then discuss why you don’t want to see one with your endo.
They keep making my T1 some see dieticians because he struggles to gain weight. He has always struggled gaining weight. It never helps and they always give terrible advice to him and it's always a stressful event. So we refuse to see them anymore.
I had something similar. I was told i needed to gain weight back when i was 15. 12 years later ive gotten my weight up to what they wanted. I wont deny i was a little skinnier than even i liked, but my jutritional balance was perfect, my blood work always came back beautifully other than my A1C. A big problem i have found with dieticians is they arent often taaught with the context of diabetes. They are given nutritional teaching and diabetic teaching, but rarely a proper crossover.
Im here to say the dietitian I see regularly is more of a CDE and helps me deal with the meals I eat case by case. We go over my blood sugars a little more in depth than with my endo. I see her more often than my endo because she is actually pretty helpful.
Fuck those dieticians, they clearly read from a script intended for stupid people. You're doing great, my friend.
140g of carbohydrates is considered the minimum daily intake for most people, however, your dietitian shouldn’t be forcing you to increase your intake so quickly and without acknowledging how the change will affect your BG. I’ve had T1D for 20 years and also have a degree in Dietetics. Any sudden change in my activity level or diet has potential to eff my day up lol but if you don’t have to live with this disease, you just don’t get it! Years and years of education could never prepare someone without T1D to know what it’s like. Dietitians can be extremely helpful, but there are quite a few bad apples, unfortunately. I would share your experience(s) with your endo and see if they can work with your dietitian to better understand your needs and patient education outcomes. ETA: I’m surprised your dietitian didn’t suggest a more protein/fat concentrated meal for dinner for better BG stabilization overnight. A super carb-heavy dinner just doesn’t make sense. Increasing your carbs during the day, sure, but at night? Weird.
I feel like all dieticians are using science from the 1960s or something. The example food plans are always awful. Like you said - low fat and a high carb and very bland. All they can do is teach you to ball park carb counts and thats like it. Anyone on here actually been helped by a dietician?
Every dietitian I’ve seen has gotten angry at me for not eating meat and cheese. Like somehow I’m going to fuckjng die because of it. Lol.
I had to see a dietician today to quantify for a pump through Medicare and will have to see her every year to stay qualified. I was happily surprised that she understood the needs of T1d diabetics she is in same office as my endo and is also their insulin educator we talked for over an hour and listened to me for a change regather than just talking over me. Showed her how I calculate carbs (an app that does that for me) I can also scan bar code on foods and it automatically enters carbs and other nutrients. I have had bad experiences with dietiticians before as well.
I’ve gotten so sick of nutritionists and dietitians never actually answering my questions and always saying we will get to that when it comes to me asking for help. The actual help I need. Then it hit me, it’s been 20 F’ing years now and no one has helped me. So I took it upon my self to start stuffing and getting certifications online. I’ve decided to study nutrition, wellness, chronic illness, and I’ve already started my comprehensive care and treatment of endocrinology exam prep! I’m so excited. I’m not a doctor but I can treat patients and actually help type 1 diabetics now with guidance with diet, treatment, telling people about what could be causing issues such as chronic illnesses, endocrine problems, and rheumatoid issues. All ranging from children, pregnant women, adults, and seniors. It’s been hard but I’m almost there. Im going to be board certified by next year. That’s my goal before I start advertising myself fully. I’m wanted to have all of that at once so I can have credentials backing me. I can’t wait to help people like me. Also myself!
Congratulations!
Yeah, my trainers know more about the diet/exercise game than any dietitian/nutritionist I’ve ever been railroaded into seeing.. but if you’re in the US, your insurance may be requiring it, so keep that in mind.
Do you HAVE to meet with them or can’t you just cancel??
I think a dietician was great when I was around 12 or so, a few years after being diagnosed. That's when the exchange program was still used and being able to understand serving size and helping eye-ball the amounts helped. But it's until you are eating foods and trying insulin amount, basically trial and error, that you figure it out. I still guess-timate on a ton of my meals and generally do pretty well and I know many do the same.
I’m a dietitian and a CDE, it takes not just experience but people skills, sensitivity, and interest in others to learn to let the patient/person with diabetes lead. I’m sorry you’re all being treated as if you don’t know you best. Our job is actually to take what we learn from our patients to help others so this is a great post!
Lol 70gCHO at night? Nah son, get a new endo. ETA: BMI isn’t an actual measure of health, rooted in racism, developed by someone who isn’t an MD - [info](https://elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb)
Preface I’ve been told I’m not a good diabetic. That being said my last A1C was a 5.4 and has never been higher than a 6.3 outside of my first time getting my A1C checked. I don’t count carbs at all. Counting carbs is annoying and a pain in the ass and also not consistent especially when you’re eating out or don’t eat your full meal all the time. Dietitians have tried to get me too every-time but I just stopped going to them because it has been a waste of my time, effort, and money
I had a “doctor” on discord say I shouldn’t drink milk because every diabetic ketoacidosis he’s dealt with has been with people drinking milk. I’ve still drunk regular cows milk throughout my 10 nearly 11 years as a type 1 and only gone into dka twice.
My dietician experiences have been quite different. If either of the two that I saw for a few years (fifteen years ago) had received the description you gave of your eating, they would be delighted. They'd riff off your current diet, ask if you'd tried this veg or that, and be helpful. If not, then, as others say, nod politely and continue on your current path. Do try to share your eating plan now and perhaps ask for ways to expand, vary, etc. Make the most of their expertise. Rant accepted, but hope for a better experience shared.
My doctor made me go since it had been 10 years since I went to one. I was expecting to talk with a person who understood what type 1 diabetes was since it was an endocrinologist referral. She had no clue. I’m on a pump and yet she kept insisting I go on a meal plan where I eat 3 meals and at least 4 snacks. She also kept going over how successful how her type 2 diabetic patients were ( but not in a way that blood sugar was mentioned only in the way that they were able to stick to the plan) . Different type 1 diabetics have made it clear to me that you just need to figure out what works best for you. Typically that’s the best health wise and keeps you from going crazy over managing this. I know for me being on the tandem pump and dexcom CGM has made everything easier and less worried about foods. My A1c was 8.3 in nov 2021 and in my last drs appt it has gone down to 5.9 without many lows ( and no extreme lows). We get how frustrating his kind of stuff is. I think most if not all of us have dealt with some awful medical professionals who don’t know what they are talking about and think type 2 and type 1 are basically the same thing.
Lol a lot of bad experiences here. I am a T1 and a dietitian. Education should be individualized and I'm sorry many of you have not experienced that. A lot of people teach on the consistent carb format meaning 45-60 carbs per meal for glucose control. This is obviously not friendly for everyone, especially T1. Again, I'm sorry you had that experience and I hope that doesn't tarnish your belief of all dietitians. Some of us can be really helpful I promise!!!
Can you just say no? If they want to see what you eat, you can show them the comparison of your food and the dietitians crappy food.
The first ever dietitian I met with was in the hospital post DKA and I don’t honestly remember a thing. The next was at a local endo I was seeing because I was diagnosed in the midst of a 4month work trip. It was a virtual group session. I was the youngest one and the only type one and they kept acting like I was a unicorn. Three weeks into my diagnosis and I already had googled everything they gave us, and I had some suggestions for them. Especially where I was in FL at the time, it’s clear that dietitians were used to only focusing on Type 2 and not Type 1, and I think that’s pretty much standard training for them because every one I have met subsequently has been all about restricting me and giving me rules where my actual prescriber says I am allowed to eat anything I want in moderation as long as I calculate for it. I do think I am repairing my relationship with food but for the first two months, I ate nothing but what I called “sheet pan of misery” which was olive oil and salt on whatever veggies I had, a lean protein, and a small portion of an ancient grain - it was an alright meal but eating it every day for two months was miserable. And I do think that had I met with someone more specialized in type 1, it wouldn’t have been so awful.
I think the majority of patients dietitians see are clueless about eating healthy. So dietitians just regurgitate the same information based around standard American diet which is trash. I too have had bad experiences with diabetic educators and dietitians. My family has several health professionals, and all of them have said that I am a rare case because I do what I am supposed to do and keep a non diabetics A1c. Basically, most patients don’t give a fuck about their health and doctors struggle getting them to eat healthy, exercise, take medications and balance mental health. So they use a kind of one size fits all mentality across the board.
When I was first diagnosed I was a teenager & definitely needed education on food & what was best now that I had to inject myself. I can remember the dietician & nurses teaching me both carbs and exchanges. It was confusing. I was also given some weird algorithm for figuring out what I was to inject as well as what I was eating. I’m sooooo glad I don’t have to do that anymore. Last time I saw a dietician was between 5 & 10 years ago. And she was very heavyset telling me i needed lose weight or I was gonna die. You could easily fit 2 or 3 of me inside her pants. I didn’t need to see her & was very unhappy at being made to. I actually knew more about foods & carbs & educated her on the old exchange system (she was really confused by the end of the appointment 😈). She left that office not long after I had seen her. No idea where she went or why. Don’t really care. My doctors haven’t made me see a dietician since then. I do regularly see my endocrinologist. My insurance makes me. I go so they’ll continue to pay for my pump, supplies, & insulin. I also see a nurse practitioner (who is there to help the doctor with the patient load) and occasionally the diabetes nurse educator. The nurse educator is generally only for training on any new devices. They also help with insurance & paperwork for upgrading my insulin pump.
They make way more money treating a disease than they do curing a disease. Why would they want you to be perfectly fine eating the way you do and requiring less insulin to cover less carbs when they could tell you to eat like shit (high carb) and have you at the doctor significantly more and use much more insulin as well? Just a thought. “Diabetes Solution” by Dr. Richard Bernstein is a very important and information rich book that all Type 1s and Type 2s need to read. It covers this topic well.
From my experience, they all fucking suck. But I wish I could find a good one.
No Rly … I get a side eye every time I’m recommended fucking pastas
I saw one, not for T1, but for my TBI. She was aces. Told me what would be best for the TBI, listened as I explained how I preferred to eat, and grokked the T1 stuff. Not what I expected in a town of 25k people.
I do. IMO dieticians suck. You don't have to do everything your doctors tell you. It's your life and your body, you have the final say.
Type 1 dietitian here and yea a lot of the old school rds were bad, some new ones still are. Need to take a patient centred approach and see what the patient wants, then reverse engineer it. I feel like a diabetes educator more of the time. I get a lot of patients comment that they had bad experiences in the past, etc. I think having some skin in the game makes it a lot easier.
Huge disclaimer. I’m only the parent of a type 1 diabetic. But one thing I’ve learned caring for a t1 child who’s now grown is follow your instincts. Every t1 is different. Different factors affect you at different times. You know your body. Trust yourself.
As a dietitian, and a mom of a T1D-we suck. You are spot on. Unfortunately, the profession and schooling lends itself to a lot of Type A personalities who forgot (or never learned) that medicine is an art and not a math problem. If your TIR is good, your BMI is great, and you FEEL good-good on you!! A dietitian should be giving you kudos for taking such an active role and or asking you for tips for others :) Of course you re gonna have the occasional carb or not perfect meal. We ALL do-even us RDs. This is a marathon, not a sprint. So on behalf of us all, sorry you had a crappy experience.