How important of dietitian in the diabetic care

I believe the diet is very important for managing T1D. Not only for T1D, eating healthy is for everybody. Since my son was admitted to hospital, I met this dietitian twice. This dietitian seems very nervous about the T1D is going to lose opportunity to have cakes, candies, and sweet. She keeps insisting on eating large amount of carbohydrates and giving the child what they want to eat, mostly pizza, fast foods, and sweets. Is that how your dietitian educate you? When I ask her about glycemic index, and vitamins and mineral for T1D, she has nothing to offer. I am thinking to request different dietitian, but don’t want to sound mean. Any suggestions and opinions are welcome. Thank you and have a good weekend!

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Chonbgo @Glucosebee , I agree with you that another dietitian is in order. Your thoughts about eating a healthy diet are exactly how everyone should behave, and “eating in moderation” is important for all.

It is true, that your son will be able to occasionally indulge eating cake, cookies, sweets as long as he is able to balance these foods with insulin and activity but over indulging on a regular basis can lead to other health issues. Keep in mind that insulin is a growth hormone, and although insulin must be used by people with T1D just to live, loading up on insulin to eat beyond heathy eating could lead to obesity and what is commonly called “Double D” - multiple types of diabetes which complicates management and treatment.

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Dennis, thank you for your reply! I will let my son read your post too since the information you just gave me is so important for his health. Big bow to you and to our T1D friends!

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@Glucosebee , you and your son are very welcome. There are many good T1D friends watching and posting here, I’m only one sharing suggestions from what I’ve learned living with diabetes for 65 years. I eat some of most foods, and was fortunate that right from the day I came home from hospital following diagnosis, that sat at the table with my family [9 of us sitting together at the supper table where we all ate the same of everything] and was able to dig into everything served - including a tiny bit of my birthday cake I missed eating when hospitalized. Usual meals consisted of meat, potato, and two other veggies.

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I’m with Dennis. Moderation is the key to life. There are dieticians who will tell you that you can’t deviate from the diet plan and there’s no room for diabetics to have sweets. You found one who says the complete opposite. It’s the middle ground you want. A healthy, balanced, varied diet with some wiggle room. Some carbs, some protein, some fruit, some veggies…

If she’s advocating for unhealthy eating and can’t answer your questions, it’s time to find someone better.

And getting into good healthy eating habits now, when your son is young and forming the habits he’ll carry into adulthood, is important. As Dennis said, a good diet is a good idea for everyone’s health, diabetic or not. We don’t need special vitamins and minerals that non-diabetics don’t, but, like everyone, we do need a healthy diet that includes a variety of foods (in particular for things like vitamins: a good amount of veggies).

Now that he’s out of the hospital, your son should be seeing a good endocrinologist on a regular basis. Often, that endocrinologist will have a dietician they like and work with regularly. So you can ask for a referral there. It’s good that you realized you needed a change. I hope you can find a good medical team now.

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I can’t add much to the advice above - moderation and eating healthful are key - and not just for us with Type1.
I am not a medical professional, but while you are on your own professionally as far as what to feed your child, I do have a recommendation for you to research: the Mediterranean diet - which I prefer to call an eating plan or lifestyle. The Mediterranean plan focuses on fresh fruits and vegetables, whole gains and healthy oils, with animal protein derived from fish more than red meat. That’s not to say you can’t have a steak or a burger if you want - it’s a lifestyle choice whereas “diets” tend to lock you into their food items - perhaps under protest.
Below is a link regarding Mediterranean. With regard to diabetes, as is often the case it focuses on Type2, which is much more prevalent; however the health benefits are pretty universal regardless of diabetes type or overall health in general.
I encourage you to research it for yourself.
By the way, there are some excellent tracking apps you can use to record meals, insulin, etc.: Sugarmate, MyFitnessPal and Glucose Buddy are popular and I think free; MyNetDiary is another good one but you need an annual subscription after trying it out for a certain number of days.
As far as requesting another provider - dietitian or otherwise - don’t worry about sounding mean. It is the right and need of both you and your child to get the expertise you will both need to learn to live with diabetes. If I recall correctly from your other post, the dietitian you saw was with your endo’s office. That is concerning to me, as your endo should want someone specifically knowledgeable in diabetes care. Perhaps they did not vet this person well, and maybe they are not even aware. Nonetheless, s/he is not providing the knowledge you need and is lacking in it him- or herself. I believe you also said the match was a bad fit (I’m paraphrasing) and a good fit is important as well. It may be uncomfortable for you to say you’ve decided to find someone else, but it will be good practice in advocating for your child in the years to come. The dietitian may even be relieved, who knows…
FWIW, I “fired” a doctor’s practice many years ago. It was out of character for me but the greatly mishandled something (thankfully everything worked out okay) so I found another.

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I would add don’t feel bad about getting a new dietician. You need to be able to work with them, and agree with what they are suggesting. If you can’t (or shouldn’t) it won’t do you or you son any good. T1 for 48 years and I was also fortunate to come home from a the hospital with a dr and was told I could still do just about anything I wanted, I would just have to be more award and have a few extra steps. Good luck!

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I don’t think you should deprive a young child of the foods he sees his friends eating, but moderate when you see that activity isn’t matching carbs. Many of the older type 1s here lack understanding of the mental impact of overly restricted diets on children. It’s okay to have a high bg after a birthday party.

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Hi - I’ve been a T1D for 65 years. I’m healthy and eat most things, in moderation and always with carb counting included. Your son WILL miss having some of the food items that others eat, but in the long run he will be healthier for it. Yes it can be hard, I was 12 y/o when diagnosed. I lived through my teens, young adulthood and into my 70’s now. Maintaining a relatively healthy A1C will be important in preventing an/or limiting other complications. It’s a long road - stay positive and help him to be positive too. Good luck.

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I have a bunch of kids, we try hard as a family to keep treats as treats. My child with diabetes is able to eat the same way we all eat, it’s just more complicated. The hard thing about diabetes in eating healthy is that white flour is much simpler to deal with than whole grains which take longer, but bring a rise later. She still eats them because it’s just something we have to figure out how to deal with and we are learning and getting better. I think a lot of people used to say kids with diabetes shouldn’t eat the pizza, ice cream and candy stuff so maybe they overdo trying to say it doesn’t have to be that way now. The main thing is what you are trying to do: eat healthy as a family and continuing that with diabetes. The hard part is at school, candy is used as a reward sometimes. My kids have always been instructed that they can have one piece a week, on Friday, so it won’t be just my child with diabetes eating differently than other kids, it’s all my kids. Hope everything goes well for your family as you figure it all out!

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@Glucosebee I heard Amanda give a talk on The Diabetes Psychologist Podcast, and I was curious and interested in her approach as to T1D nutrition, diet, and food. She is a T1D Dietitian, and she has academic credentials. She seems to take a more flexible approach, with a bend toward problem solving, working together, having choices, balance, and coming up with ways to successfully integrate the foods we enjoy into T1D management. This appeals to me because I was diagnosed in 1991 when the approach to diet and food was very inflexible, and this contributed to a “limiting” relationship with food. I experienced a lot of fear, uncertainty, and doubt related to food and diabetes. She may (or may not) be what you’re looking for. I’ve never worked with her personally, but I would like to. If you’re interested, here is her website: https://www.t1dnutritionist.com/.

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I am a dietitian with T1D myself- I often see two spectrums of care from dietitians in the field. Either they are incredibly restrictive OR they just want your child to eat whatever. I’m sorry that they have been dismissive of your concerns about your son’s overall health. I think there is definitely ways to find balance between these two extremes to assist with your son’s diabetes management AND eat in a way that is productive for his overall health as well. I would ask for a referral to another dietitian in the practice- if possible if you don’t feel they are meeting your expectations. Nothing wrong with that!

Thank you Amanda for sharing your knowledge as a dietitian who is living her own life with diabetes.
@t1dnutritonist Also Amanda, Welcome to the JDRF TypeOneNation Forum! We are pleased to hear from you and to hear your diabetes wisdom.

I would echo what’s said above. I was diagnosed at age 11 and was given the same advice. I ate the same diet as my friends and managed relatively decent control with A1Cs in the 7 but I really wish I would’ve been taught about a diet of moderation when I was diagnosed instead of waiting 17 years to really dive into the why behind food and blood sugar.

I have a long story but basically the gist of it is in 2021 I went through a weight loss journey. During this journey, I basically had to relearn how to be diabetic because my insulin doses changed so rapidly. It was during that period I realized in my 17 years of carb counting, no one had ever taken the time to really explain how certain foods would affect my blood sugar besides saying aim for 15-30 grams of carbs for two snacks per day and 60 g carb at every meal. My dietician also did not teach me how to balance foods like pasta or cake with more nutrient dense foods and honestly it set me up with a fear of any carbs for like 6 months because of how hard I worked to lower my A1C. My a1c is now 5.7 and I eat a much more balanced diet. I could never give up cake, pizza, French fries or burgers, but they’re not an everyday staple like I used to make them and instead they’re a conscious decision I make when I’m craving something which should be implemented for all people diabetic or not.

I did end up seeing a dietitian with T1 as well who was extremely beneficial and taught me how to dose better for stuff too. I would never say you can’t eat high GI carbs or anything, but there are better methods for that stuff to curb the spike like preboluses and pairing with higher fat/higher protein foods for less of an impact too!

Definitely smart to seek a new dietitian as it’s something I wish I would’ve done much earlier in my diabetes journey!

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Imo If you deny yourself something that you really want, sooner or later you’re going to cave. Unless what you crave is an addiction, you’re better off figuring out how to include small amounts of it regularly and frequently.
By doing so it ceases to be a tempting treat and becomes a regular part of your diet that is easily worked in without guilt. If you’re conscientious about how you do it the amounts that you incorporate will automatically be moderate, because you’ll have to trade something else for it.

There’s literally nothing that you can’t eat if you think about what you’re doing , observe and understand its effect on you.

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Dieticians are only as important as a patient believes they are. Your observation about leniency and restrictive match what I’ve seen from medical artists.

[RANT]
I’m skeptical about dieticians in general, because many of the guidelines dieticians are taught to follow have inadequate substantiation - like much of medicine.

One doctor has a theory, does something with a few patients, publishes, and if enough people accept that opinion, it becomes accepted as gospel. Followers want to do things “by the book”.

But too many medical authors didn’t understand what they were writing about. Like JH Kellogg who advocated a dried plant diet to address dyspepsia caused by debauchery, or multiple doctors who assumed coronary disease was caused by dietary cholesterol and ran self-fulfilling uncontrolled studies to “substantiate” that belief. These are the basis of the FDA food pyramid.

Like causes like is what dieticians are taught as fact. Eating sugar causes diabetes. Eating fat causes coronary artery disease. Eating salt causes high blood pressure Eating less of these protects against and reverses disease. There is some truth to the last, but common sense raised in stature without substantiation becomes religion and dogma, not science.

Religion doesn’t hold up to scrutiny and experience when you try to apply it to physics. A religion produces disciples and disagreement is heresy. Science produces practitioners with varying levels of levels of competence and skill. Disagreements lead to discoveries and refinements.

Your observation about leniency and restrictiveness matches what I’ve seen from all types of medical professionals who don’t have the disorder that their patient has. Patients know if they feel better or worse when they do something, even if they don’t understand why. Patients know better than doctors what a therapy costs, know what they can “afford” and what’s too expensive to do or sustain for the observed benefit. Their faith in doctors increases or decreases with results .

That is as it should be . Doctors aren’t scientists, they aren’t mechanics that fully understand the machines that they want to work on oh, they can’t fix everything . They are practitioners of an art. that’s true of every kind of medical professional . They do the best they can with what they believe they know with the tools and information they’ve been given. They can’t fix what’s wrong with you they can help you and your body heal itself to a limited extent .
[/RANT]

Older medical professionals who have seen lots of patients with a disorder and haven’t “burned out” - given up on making a difference - seem to have more empathy and are more pragmatic.

My former endo knew only one other person with T1D who was managing the disease in the same way I did - with “old” insulins. Both of us had exceptionally good results, but had other things in common-our jobs, age and level of commitment. \ My doctor’s reaction was he wouldn’t prescribe to anyone else doing what I did, it was “too hard” But as long as I continued to get good results I should keep doing it. Maybe consider a few small tweaks and experiments to see what results I got and let him know.

I miss that doctor. He was the only one who truly believed that medicine was an individual experimental participatory art, not a set of rules and policies created by “someone else”.

My favorite dietician was my mother. She introduced me to a variety of foods and the concept of moderation. She encouraged all my siblings to learn to cook and create… All four of us have different tastes and different chronic diseases that react to what we eat. From necessity, my second favorite dietician is myself.

I haven’t been to a dietician since they were still using the diabetes exchange diet. I just count carbs and eat what I want when I want pretty much.

My wife is a very good cook and cooks home made fresh stuff almost every day. So my diet is pretty good I think.

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