Good morning everyone,

I remember thinking that I could not longer eat anything good or
satisfying... Then, I thought, I guess I shall simply waste away and
starve, but then, if I eat anything, I shall die of diabetes, anyway.

Chuck is right.... The first thing is to impress upon new T2's, as
well as T1's, is  that there is no need for panic. In fact the
diagnosis can be thought of as good news, because a person with
diabetes who is undiagnosed is at infinitely greater risk of severe
complications and untimely death. We just have to adjust our
lifestyles.

Then, the ADA needs to impress upon newbies  the importance of
education and learning about this disease as the first line of defense
in combatting it.... First and foremost, they should make sure their
information and dietary recommendations are up to date, and not based
upon outmoded thinking that has been proven wrong by recent research.
For instance, some of the books and literature I bought right after my
diagnosis that bore the ADA stamp and publication data said many of
the wrong things about diet. It was only later, that I realised that
current research was contra much of the older info in the ADA
literature. Now, it seems they are making an effort to bring
themselves up to date.

One thing the ADA is doing that I very much appreciate is sending
weekly, and sometimes daily, announcements of the results of current
research in an email newsletter. Anyone can sign up for this
newsletter online. Also, the 'Diabetes Forecast' seems to be a really
nice magazine. I get it every month.

Have a great weekend, everybody.... :-)

Will, T2

Err, gee Jim.

But what do you really think of the ADA?
(ducking:-)

Cheers, Alan, T2, Australia.
d&e, metformin 2x500mg

Good job, Jim!

Wow, Jim - I think that's one of your longer posts : )  So what do you
really think about ADA, then? : )

Nicky.

Then you've met my lawyer...

In this case I have already posted my feelings, ad nauseum, about the
ADA.  I think they do a good job as a large organization and their
website offers good basic information.  I started a thread months ago
regarding the myths about the ADA and the actual facts because many
were misrepresenting what they actually say.  In this thread I
sincerely want to read what others think in here because too often the
disparaging comments about the ADA are flippant and brief without
offering suggestions of how they could do better.  So far I like the
quality of the responses, whether it's the cathartic kind or the simple
suggestion that Grandpa Chuck offered (which I think is right on as so
many people do panic).  If the thread continues on its current path,
pro or con, I will forward a link to it to the ADA.  Probably won't get
much attention but I have pretty good luck and a tenacity of at least
getting to the right people when I want to.

They have been so far.  In my experience it is so much easier to
criticize than to create and creating some proactive suggestions,
rather than blind hate, really puts things in perspective.

Best,
Kurt

Hi ADA

Remaining an optimist - maybe someone at the right level may
actually read this. Maybe.

Further thoughts - actually, old thoughts re-presented.

Back in June '04, I wrote an epistle to my version of the
ADA, Diabetes Australia, as a letter to the editor of their
magazine, Conquest.

You'll find the follow-up post here http://tinyurl.com/z4jsj

They never gave the courtesy of a reply, and of course it
never appeared in the magazine.

I'll repeat it in full below, because my views haven't
changed much in the succeeding couple of years and it's a
clear statement of what I believe needs to be changed in the
dietary approach of the ADA. To be accurate when reading the
personal details towards the end, I've crept back over 6%
and started on 2x500mg metformin, but that doesn't change
the logic of my argument. Also, the link to the ADA site has
changed slightly with more emphasis on grains as against
starches.

So this is now my plea to the ADA, because, like it or not,
the rest of the world listens to them. They affect the
health of millions of people around the world.  I think it's
time they meditated on that thought and the responsibility
it implies. And which way the scales may tip if the number
helped was weighed against the number hurt.

http://tinyurl.com/o3tvy

"To The Editor, (and now to the ADA)

   I am eternally grateful for the work the pioneers at
Diabetes Australia did in helping us get the NDSS and the
support system that we now have.  The organisation continues
to do a great job.  But I have a basic difficulty with the
logic of the dietary advice recommended by your dieticians.

   I see their advice like this:
1. Dieticians advise high complex carbohydrate consumption,
apparently for heart, kidney and vascular health;
2. High complex carbohydrate consumption causes high blood
glucose levels;
3. High blood glucose levels cause diabetic complications
such as retinopathy, neuropathy, nephropathy and heart
disease;
4. DA dieticians therefore recommend balancing the high
complex carbohydrate consumption with medication or insulin
to control blood glucose levels. This advice appears to be
in line with the recommendations of overseas organisations
such as the American Diabetes Association (ADA).

   Specific examples can be found on the DA web-site at
http://www.diabetesaustralia.com.au/multilingualdiabetes/healthpros/f...
or the ADA web-site at
http://www.diabetes.org/nutrition-and-recipes/nutrition/starches.jsp
   My difficulty in understanding this is because no-one
seems to be investigating the alternative approaches.  I
don't mean herbs and supplements, just a better diet for
diabetics, together with exercise, to enable minimal
medication.

   To me, the most obvious alternative is to search for a
diet for the diabetic which provides adequate nutrition for
good health but does not cause high blood glucose levels. If
such a diet is possible it would minimise the need for
medication, particularly for type 2, with side benefits for
overall health and health costs.  I can attest that it is
possible; I've done it, as have many others. However, when
diabetics write to give examples, such as K ...... in the
Autumn issue, they are dismissed and told that their
improvement must be because of exercise, or weight loss, or
some other factor.

   The method I followed, as a type 2, was simple. I
started with a standard, sensible diet to lose weight. Then,
as I followed that diet, I tested everything I ate one hour
and two hours after I ate it. If I consistently found that
something led to high blood glucose, I changed it. Sometimes
I changed the food, sometimes the quantity, sometimes the
timing, but always the aim was to minimise "spikes".
Gradually I found I was eating significantly less
carbohydrates, a little more protein and a little more
"good" oils. And I did a little "lazy man's" exercise along
the way. I also gradually reduced the high level of initial
testing as results became predictable.

   After attaining a degree of control over my blood
glucose, I now progressively review my diet to ensure there
are no missing nutritional requirements and to further
improve lipids etc.  At diagnosis in 2002 my HbA1c was 8.2,
now it's 5.9 and I take no diabetes medications. It's a
long time since I've seen a "spike" over 8, rarely over 7.5.
The improvements continued long after I reached my target
weight.  And my heart, blood pressure, lipids, kidneys and
so on are also in good shape.
   
Why do your dieticians continue to promote high carbohydrate
consumption?  What is it I'm missing, apart from
complications? "

Cheers Alan, T2, Australia.
d&e, metformin 2x500mg

Very interesting post, Amy.

Will, T2

<snip>

Hi Amy

Have you been posting or reading on asd.uk? Because that
certainly hasn't been the impression I've gained of the NHS.
Not from asd.uk, and not from limited personal experience.

It sounds to me like you may have had a winning ticket in
the post-code lottery. I won't say more, but I'm sure that
Nicky or Beav or one of the other Brits may clarify what I
mean.

You might find this post I made recently in asd.uk clarifies
my position: http://tinyurl.com/rc65m

Kurt, I'd appreciate it if you read that too, and the link
within it. It gives you some of the background of why I feel
the way I do.

There are reasons why I don't wish to re-post it in full
here.

<snip>

Fully agreed. If you analyse it - only one side of the
debate is suggesting anything radically different.

Cheers, Alan, T2, Australia.
d&e, metformin 2x500mg

You got it Evelyn.

On that first page I wouldn't put much more than the "DON'T PANIC" in
large bold type. If I added anything it would be something like, "Take
a deep breath. Try to relax. Then move on to the following pages."

It is on those pages that I would put Jennifer's advise to the newly
diagnosed along with many of the other things that have been
mentioned. I would emphasize that a diagnosis of diabetes of either
type can actually be a blessing because that information can be used
to changing one's life and building a new, healthy life style.

Kurt,

The choice of Don't Panic in big bold letters gets my vote too (Perfect
hit Grandpa!). The disgust felt collectively by this group towards ADA
for not making genuine efforts to help their true audience and
eloquently captured by Jim and followed by Alan should be eye opener
for them if they are to be seriously interested in accomplishing what
they have set out to do.

I also agree in keeping almost every page of first ten or twenty pages
a first time visitor is likely to see very simple and stay with no more
than two or three messages per page kind of layout. Alan has suggested
nice tree structure of the information here.

Amy's following observations were also quite right on and should be
captured in first few pages:

As some one who came to ASD through Goggling, I too have my own
thoughts on what appealed to me and what I still see as big void in
either ASD or ADA sites.
Broadly speaking following distinct areas need to be highlighted in
these self help groups.

1. Role of exercise (Of course this applies to this who can and
   I am sure that a good 70% to 80% of this first diagnosed as T2 are
quite
   capable of doing it). It should be emphasize that as a diabetic you
want to
   start thinking of devoting a good 1 hr a day for this activity.
Anything less is
   sub optimal especially when you have the capability. Brisk walking
is costs nothing!

   The cost aspect is important to highlight. I insisted on coming up
with activities that cost me nothing and was able to do anywhere I was.
Due to by busy travel schedule I wanted the nature of exercise both
intense but not needing any equipment.

2. Any life style change is to be considered as forever. This is some
what hard message to swallow but beating around the bush does not quite
cut it. Like some one said, its not about dieting but its about
changing the diet and sticking with it!

3. As much as don't panic is important message to give, not to get
angry at the system or for that matter yourself is also important to
internalize. I am still struggling to deal with my own anger with the
system that did not wake me up early enough. And that brings me to the
following point.

4. Not every one who comes to ADA is diabetic. They should be also
educated in understanding how to find for themselves what the symptoms
are in a simple way. For example if you can afford an iPod you sure can
afford a BG testing meter for the whole family. A pointer to show where
they can get free meters would be helpful too. In my way of thinking
every one whose weight 10% higher than their weight at age 23-24 or any
one whose waist size is > 36 should be testing their FPG and PPBG at
least once a month. I know I would have woken up at least 5 years
earlier!

5 Importance getting HbA1c done should be highlighted. Its relationship
with avg BG numbers should not be hidden too deeply either.

6. Right after asking for T2 or T1 when advising about dieting, a
person with vegetarian life style should be guided correctly instead of
making him more nervous by advising this person to start thinking of
lean meat or even fish!  As I found out by my own study vegetarian diet
is wonderful way to meet all the numbers and stay very healthy. Advice
along the lines of Bernstein diet is sure way to make a vegetarian give
panic attacks. There is no justification for it.  When you have chosen
vegetarian lifestyle based on ethical reasons (and I am not debating
right and wrongs here) at the very least such a person is entitled to
know that there are plenty of perfectly healthy and wonderful choices
for him/her to enjoy without having to question appropriateness of
wholeness of the diet. Even the non-vegetarian community can benefit in
adding some of the most sumptuous dishes that are diabetes friendly to
their own diet.

Good luck with getting ADA to overcome its financial
obligations/interests :-)

Part of the problem is the new emphasis on evidence-based
medicine. Sounds great. In practice what it means is they look
carefully at what it's worth doing in terms of cost of doing it
related to likelihood of it working. If it's going to cost half an
hour per patient to explain to them how to change their diet for the
better, and only 1% are going to stick to it for more than a few
months, whereas it takes only 1 minute to prescribe a pill which 50%
will take for as long as they're told they ought to, evidence-based
medicine suggests that they should stop wasting their time and money
trying to talk people into changing their eating habits.

I don't think it's an accident that the current criteria for
diagnosing diabetes happen to be set at the level where it's reasonably
likely that prescribing drugs will be useful.

Take the problem of obesity. Everyone knows that more exercise and
less fast food helps to prevent obesity. Where is all the research
money going? Into finding a safe weight-reducing pill. Why? Because
research shows that people are much likely to take a pill than
exercise or eat less.

Hi Kurt,

I did a quick review of the ADA page to refresh my memory of what is
on the page.  For General information, it's not too bad.  Note the
word General.  

Somewhere on that page I saw the phrase Diabetes Experts.  That kind
of implies that the answers they give are definitive.  And the answers
are not really definitive.  Because, and this is what I would like to
see, diabetes is NOT a one size fits all disease.  It is a progressive
disease.  There are folks reading that page who range from IGT on up
to folks who at diagnosis are swinging around in glucose toxicity
because they were diagnosed with a fasting of 600.  Then there are the
T1 varieties and GD.

I can appreciate that the ADA is reaching out to a wide and varied
audience and as such must keep the replies as general as possible.
But they should state as much.  To have Diabetes Experts boldly
printed on the opening page and then not state that the information
provided is base-line for a disease that ranges all over the map,
well, that's a little disingenuious.

If I missed that kind of disclaimer, I hope someone will point it out
to me.  It shouldn't be hidden.  

Ladies and gents, we have a winner.  ;-/

Susan