To refuse to see a dietician during pregnancy

[Battleshiphips]

I have type 2 diabetes but I am in very good control of it. My diabetic nurse was amazed at how low my HBAC1 was and every doctor that I have seen has said how well I am doing (I have also lost a load of weight) and that my diet (I follow a paleo one) is really healthy and to carry on as I am. I am now pregnant and intend to carry on with my way of eating. The midwife was really pleased and said there is absolutely no harm in losing weight during pregnancy and that she was very happy for me to carry on as I am as I eat very healthily. However when I saw the dietician and told her what my diet was she instantly said I wasn't having enough carbs and that I needed to eat more bread, pasta, rice and potatoes. I told her that if I have more of these carbs then my blood sugars would rise. She said "oh well we'll just have to give mother nature a boost and put you on insulin"! I was shocked, surely it's better for me to eat healthy and control my sugars that way. WIBU to refuse to see her again. I am definitely not going to add more carbs to my diet as I do not want to end up on insulin. I have been monitoring my sugar for the past few days and my readings are perfect.

[CrabbyTheCrabster]

YANBU. She needs to bring her training up to date.

I would refuse to see her again and write a letter to her managers detailing exactly why, somthat they can look at her practice and whether she needs further training.

[Alconleigh]

I find these threads frightening as it sounds like so many healthcare employees know basically nothing at all. Like the health visitors or midwives who have no clue about how breast feeding actually works so just advise giving it up.....why isn't this more of a scandal?

[Kym134]

I was told that I would be seeing a dietician in pregnancy as my BMI meant I was "definitely" going to get GD. I refused point blank. The consultant said "but I will have to put it in the notes" I said go ahead. I have since tested negative for GD..... Still refusing the dietician.

[contractor6]

Confused as to why you should eat more carbs? I have gone off them with early pregnancy and now bread and rice give me heartburn. Potato's taste yuck. Midwife is fine with my diet and 33 weeks baby is perfectly well. I'd ask dietician what they think carb loading will achieve??

[eatyouwithaspoon]

Its funny my friend who had type 2 was not advised to reduce her carbs just me with gd.

[RubyReins]

Congratulations on your pregnancy. I saw a dietician when I was pregnant last time and newly diagnosed with gestational diabetes. She advised me to eat bread, pasta and baked potatoes and she was rather shocked that I generally avoided those foods. I had PCOS and controlled it with a low GI diet and I told her that I thought her advice was out of date. I never saw her again after she told me that there is nothing wrong with sugary breakfast cereals as they are full of vitamins and iron... She also didn't see anything odd in controlling sugars with insulin rather than avoiding foods that cause a sugar spike. So I echo a lot of the sentiment on this thread! It sounds as though you are doing brilliantly on a paelo diet. I am pregnant again and desperately hoping to avoid GD this time!!!

[maddening]

I would ask to see the person specialising in diabetes rather than a dietician - I don't think dieticians trump more highly educated medical professionals.

[toffeeboffin]

She's talking bollocks.

In five year's time the general consensus will be for people with/prone to diabetes to reduce their carb intake.

Takes a while for them to catch up, that's all. (confused)

[FundamentalistQuaker]

MY BIL has diabetes and was advised to go low-carb, and he found it helped.

[Battleshiphips]

I'm so glad I'm not the only one who thinks the advice is bad. She basically told me to eat the equivalent of 2 slices of bread with every meal and then to make sure all my snacks were carb based. Congratulations sweetcharlotte I'm very early pregnancy only 7 weeks 4 days. I felt a bit lost during my last pg especially when I developed GD. This time I'm more clued up and determined not to let myself be talked into doing something I know isn't good for me.

[EustaciaBenson]

I was told by an nhs dietician that I would lose weight if I ate more bread, specifically up to 7 slices a day, she suggested I cut vegetables out of my diet to do so, what a load of tosh!

[SweetCharlotteRose]

I'm type 1 and nearly 12 weeks pregnant. My hbA1c is always between 5.5 and 5.9. At my first antenatal appointment I saw a nurse I haven't encountered before who demanded to know why I don't use the bolus wizard on my pump. Mainly because my sugars vary too much in accordance to time of day / month / exercise / stress and it's too much hassle. She basically threatened me by saying that 'in having the pump I agree to use it how they want me to' and now I've been referred for sodding carb counting. I've been on carb counting before. I've been diabetic for 26 years. And now I have 24 hour a day morning sickness so I'm not going to mess around with things at the moment.
Anyway I'm not going. They won't be pleased but frankly I don't know how much time they think I have. I have midwife appointments plus I have to go every fortnight to the diabetic antenatal appointment which takes about three hours as you have to see several different people.
It pained me.

[Battleshiphips]

amanda that was kind of my point when I asked why I needed to increase carbs she just said because diabetics need to. Wouldn't tell me why then went on to say if your sugars get too high we'll give Mother Nature a hand with insulin. I am just really at it all. My blood sugars after lunch was 4.5. I'm struggling to see how that is bad. I think the general consensus seems to be that a lot of dieticians need to up date their views. I shall carry on regardless.

[PosterEh]

After delivering dc2 my blood sugars were 26! Ds was hypoglycaemic too. They'd turned off my insulin drip during labour because my sugars were too low but had left my glucose drip in.

I think a dietician would be useful if they could provide accurate, up to date, individual advice. But as that doesn't seem likely I can see why you wouldn't be bothered about seeing one.

[Moominmammacat]

I was diabetic with DS 3 ... blood sugar of 2.5 after delivery, flat on my back with spinal tap and trainee midwife coming at me with insulin syringe "to bring my sugars up" ... which of course, as all diabetics know ... just the opposite would happen. Low carb is the way forward. I didn't put on any weight in my diabetic pregnancy.

[AmandaJane82a]

I have been type 1 for 21 years. The advice given by some health professionals with regards to carbs is ludicrous, I now have very good control but eat fairly low carb most of the time and have meals with out carbs occasionally, adjusting my insulin accordingly. However since following this regime I have been told by six health care 'experts' to increase carbs and therefore insulin. Why??? Nobody can answer that, they just say do it anyway!

Within regard to dieticians, I too refuse to see one as I have seen two in the past who just didn't know what they was talking about. Just do what you feel is best for you OP. Used to have a GP before we moved, who Told I knew my better body better than anyone and follow my instincts.

[Tuskerfull]

YANBU. I'm a type 1 diabetic and, in 15 years, I've only seen one dietitian with good advice. The rest push the 'healthy plate' which is anything but healthy for us... low-carb is truly the only way to properly control diabetes in the long term. It doesn't have to be paleo, any low carb will do, but the NHS insists on pushing carbs and demonising fats.

[Battleshiphips]

I would imagine high protein would be bad during pregnancy. Fortunately I don't eat a high protein diet. I eat a portion of protein with either vegetables or salad and all my snacks are fruit and nuts. I have reintroduce dairy into my diet too. Too much protein is not good regardless of being pregnant or not. That's why I try to eat a balanced diet, I try to make sure that I eat a operate amount of each food type. I'll carry on as I am for now and see how I go. I will not be seeing dietician again though. Maybe the fact that I have PCOS makes a difference to me personally too.

[PosterEh]

A quick Google has some stuff on high protein being bad in pregnancy but not from particularly reliable sources. It might be worth asking about that too.

[Battleshiphips]

poster and sorcha I do understand what you are saying but I eat plenty of carbs. Fruit and vegetables give you plenty of carbs and I don't restrict them. I eat all fruit and veg apart from potatoes. I will look into how carbs effect an embryo though. Thanks for your input.

[PosterEh]

I agree with both you and Sorcha, op. NHS pushes (low gi) carbs for diabetics even though most people do better on very low carb diets.
But I do wonder if restricting carbs in pregnancy might have other effects than just lowering blood sugar and I would want expert advice on that.
I would skip the dietician though and ask your consultant at your next appointment.

[SorchaN]

Congratulations on your pregnancy, and for maintaining an excellent HbA1c!

Re the dietician, YANBU. She doesn't seem to know what she's talking about. You can certainly refuse to see her again.

On the other hand, there might be legitimate reasons why a small increase in carb consumption is necessary in pregnancy, and that good control is just one part of the equation.

I'm not an expert on this kind of thing, but I was told by a doctor once that a fetus needs carb for brain development - however, it was many years ago and may no longer be the current thinking.

Nevertheless, a low carb diet is not the norm in pregnancy (since most pregnant women aren't diabetic). So in your shoes I'd want to know if there might be any adverse effects of a low carb diet, despite the positive effect of good control.

If I were you I'd ask the GP about getting access to research / information about nutrition and fetal development - maybe a referral to a consultant who specialises in diabetes and pregnancy?

Really sorry if this isn't helpful, and feel free to ignore me completely if this isn't the sort of thing you want to hear about.

[AllTheUserNamesAreTaken]

It seems most dieticians are still following the NHS 'healthy plate' advice which is far too high in carbs for most diabetics. I declined to see one when I was diagnosed with type 2 in April and have reduced my HBA1c from 53 down to 38 (which for those who don't know is into non-diabetic figures) through eating low carb.

If I had followed the NHS dietician advice, as I did when I had gestational diabetes 2 years ago I would be on medication. I had to take insulin during pregnancy as I couldn't control blood glucose. Hardly surprising when none of the diabetic specialists or the dietician told me to significantly cut down carbs!

[Battleshiphips]

ottilia I have no intention of just missing the appointments. I will be telling the diabetic midwife that I no longer wish to see the dietician because I don't feel her advice is beneficial to me personally. Hopefully my monitoring should show her that I am in good control.

[OttiliaVonBCup]

I think they tend to be keen on portion control and keeping all food groups in the diet.

I would ignore her advice but I think it might be better for OP to just go along to app and keep doing what she's doing. OR tell someone she's not happy with dieticians advice. If she just misses appointments it will get the alarm bells going and she's get extra app with consultants and what not.