Diabetes Bloopers

Dr Jedha, Host

Welcome wonderful people to a very special episode, where we dive into the wild world of ‘Diabetes Bloopers.’ That’s right, today, we’re exploring some of the most astonishing, sometimes hilarious, and often concerning missteps in diabetes advice and management. From misguided dietary suggestions to bizarre medical recommendations, we know many of our members and subscribers have seen it all—and they’ve shared their stories with us.

Why focus on bloopers? Because learning doesn’t always have to be serious business. By discussing these real-life mishaps, we aim to educate and empower you to navigate the complex journey of diabetes management with more confidence and information. It’s about correcting misconceptions, advocating for better care, and maybe even having a laugh at the absurdity some of the people in our community have encountered.

So, stay tuned. We’ve got a lineup of stories that will astonish you, insights that will inform you, and trusted tips that will guide you through the maze of treating your diabetes more effectively. Okay, let’s dive in with the first blooper.

Dr Jedha, Host, 2:23

Ben said: I am a person with type 2 diabetes with perfectly normal A1c of 6% and I was told by the diabetes educator that I need to eat more carbs so I can go on insulin.

Let’s dive into this outrageous piece of advice Ben received. Holding an A1c of 6% is like hitting a bullseye in diabetes management—it means Ben is doing an outstanding job at keeping his blood sugar levels in check. Now, suggesting someone with such well-controlled diabetes should eat more carbs to justify starting insulin? That’s not just counterproductive—it’s reckless!

Here’s the deal: In managing type 2 diabetes, the goal is to stabilize blood sugar levels, often through a lower carb intake as we often talk about, not to spike them with unnecessary carbs to fit the bill for insulin use. Insulin therapy is generally considered when other methods aren’t enough to control blood glucose levels, and insulin therapy should really be a last resort. It is not a therapy that should be used as an excuse to eat poorly. 

Ben, and anyone else hearing similar advice, you should question it. Such recommendations defy the basic principles of diabetes management. You shouldn’t be getting this kind of advice because it’s just plain wrong and just emphasizes the issues in our system which is why it’s so important to seek out trusted professionals, such as us, who base advice on scientifically backed diabetes care strategies!

Dr Jedha, Host, 4:23

Ros said: When diagnosed a nurse said I shouldn’t try to lower my levels because I only needed to be a little bit higher and I could go straight on to insulin, my first HBA1c was 18.7 within 9 months I had it down to 4.9 and off Metformin.

Okay, listeners, this one’s a doozy. Ros was initially told by a nurse not to bother lowering her blood sugar levels because they were close to qualifying for insulin. Now, that’s a head-scratcher! Starting off with an HbA1c of 18.7 is extremely high, well into the danger zone, and suggesting that someone shouldn’t try to lower their levels from there is not just bad advice—it’s dangerous.

Ros, on the other hand, didn’t just take this sitting down. Within 9 months, she dramatically reduced her HbA1c to 4.9, and did this while coming off Metformin. This is a textbook example of why being proactive with your own health  is so important. 

The advice to avoid managing your condition effectively because it might make you eligible for insulin therapy completely misses the mark on diabetes care. The goal is always to manage and control blood sugar levels to prevent the myriad of complications associated with high glucose levels, and to minimize medication—not to manipulate them to fit a treatment protocol that isn’t even appropriate.

Ros’s experience is a powerful reminder: always challenge medical advice that doesn’t sound right to you. Effective communication with healthcare professionals, who should be up-to-date with current diabetes management practices, but often aren’t, is key. 

All I can say is Good for you on being proactive Ros.

Dr Jedha, Host, 6:41

Christina said: I was told I had type 2 was given a script for metformin and told I couldn’t reverse it. I decided to get a second opinion, because I didn’t agree with the diagnosis, turns out I was right , I don’t have type 2 . I am however pre diabetic, which I am working on getting rid of. It pays to get a second opinion if you feel your diagnosis wasn’t right. 

Let me start off by saying, glad you got a second opinion Christina!

Here’s another eye-opener from Christina. Initially diagnosed with type 2 diabetes and prescribed Metformin, she was told flat out that reversing her condition wasn’t an option. But something about that diagnosis didn’t sit right with her, prompting her to seek a second opinion. And guess what? She didn’t even have type 2 diabetes. Instead, she found out she was prediabetic.

Christina’s story highlights a critical aspect of healthcare—second opinions can be game-changing. Being labeled incorrectly with a chronic condition like type 2 diabetes is not just a minor error. It can lead to unnecessary medications, stress, and lifestyle changes that may not be needed. Christina’s proactive approach not only saved her from an incorrect medical treatment but also empowered her to focus correctly on managing her prediabetes.

This underscores a vital message: if you’re unsure about your diagnosis, or if something just doesn’t feel right, get that second opinion. It’s not about doubting professionals outright, but ensuring that your diagnosis is accurate. Good for you Christina for listening to your instincts and advocating for your health!

Dr Jedha, Host, 8:41

Terry said: My A1C is 5.8 and I have a normal BMI. I’ve been working with an RD (a dietitian) but she won’t give me a meal plan and it’s super hard for me to figure out which of the recipes I like that fit into the macros she says I need at each meal and for the day. It’s not working with her. I’m told I need:

Fat: 10 g bfast; 16.6g for lunch/dinner

Carbs: 35g bfast; 58g for lunch/dinner

Protein: 17g bfast; 29g for lunch/dinner.

I just want to eat better and lower my A1c. 

Terry’s experience really highlights a common issue many face—overcomplication of dietary guidelines; and even worse, receiving information that can potentially harm rather than do good. For example, recommending 58g of carbs for lunch and dinner is a bad recommendation – it’s going to keep your blood sugar and A1c levels high. Who knows where this advice has actually even come from!

Terry has a normal BMI and an A1c of 5.8, which is good, but he’s struggling to follow the very specific macronutrient targets set and it’s no wonder – I mean, how much more complicated can it get being bombarded with those numbers . 

No wonder constructing everyday meals feels more like a math problem than nourishment – and treatings diabetes effectively with diet and nutrition doesn’t have to be this rigid and certainly doesn’t have to be that complicated! 

The goal is to maintain a healthy and balanced diet that stabilizes blood sugar levels, but also one that is practical and sustainable – that’s the key and that’s what we help people do, find the right eating plan that feels natural and sustainable so you can maintain it long term. Or in Terry’s case, even get started in the first place!

So here’s something more simple Terry – Focus on one macro first: carbohydrates, and aim for a maximum of 25 grams for meals and up to around 15 for snacks – if you need snacks. Include quality protein at every meal and fat usually falls into place – it can be that simple. By using this simple method, you’ll soon start to find what works. Please listen to Episode 6 on what to eat to treat diabetes, and more on macros in episode 20.

And for anyone in the same boat as Terry, macronutrient recommendations should never be this complicated. 

Dr Jedha, Host, 11:42

Amanda said: I am someone who suffers from bad health anxiety and whenever l am coming up to blood work l get myself worked up. My last blood test recently had my fbg at 7 (126) but my Hba1c at 5.6. My GP still said l now have type 2 and lm not sure what to believe as l know stress can affect fbg levels but she just brushed me off. This is all very confusing. 

Amanda’s story brings to light the anxiety that often accompanies routine blood work, especially when you’re worried about something like diabetes. Her fasting blood glucose was recorded at 7 mmol/l or 126 mg/dl, which is a threshold for concern in diabetes screening, but her HbA1c was a healthy 5.6. Despite this good HbA1c, her GP declared her as having type 2 diabetes based on just one fasting blood glucose result. This is where the confusion—and the blooper—begins.

Firstly, let’s set the record straight about diabetes diagnosis. According to medical guidelines, a single fasting reading of 7 or 126 or above doesn’t automatically mean you have diabetes. For a reliable diagnosis, you generally need at least two fasting readings above the threshold. This is because many factors, like stress and illness, can temporarily elevate blood glucose levels. Amanda’s point about her HbA1c being more indicative of her overall blood sugar levels is spot on. An HbA1c of 5.6 is within the non-diabetic range and suggests that her average blood sugar has been quite normal. In any case, having at least two tests is what’s recommended by medical guidelines – so if in doubt, ask for another test.

I just wanted to note Amanda’s health anxiety is as important factor here. Anxiety can indeed impact fasting blood glucose levels or your daily readings as well, possibly causing them to spike. When she raised this point with the doctor, it shouldn’t have been dismissed. Health anxiety, and anxiety in general, can have real physiological effects, and it’s crucial for healthcare providers to consider this, not only in the manner they communicate with you but when interpreting test results as well.

So, for Amanda, if you feel your concerns are being brushed off, it’s completely reasonable to seek a second opinion. Remember, a diagnosis should be based on a complete picture of your health, not just a snapshot, and your input about how you feel is a critical part of that picture.

Dr Jedha, Host, 15:42

Mim said: We had a “dietitian” and I use the term loosely, tell us if hubby wanted to eat bad stuff to go ahead, just chew it and spit it out or throw it up.

Now here’s a blooper that’s not just misguided, it’s downright harmful. Mim shares that a ‘dietitian’- emphasized by Mim in quotes and notice the skepticism Mim exerts around that title—advised her husband to indulge in unhealthy foods by either chewing them and then spitting them out or even throwing up after eating. This advice isn’t just unprofessional; it’s potentially encouraging disordered eating behaviors, which can have serious physical and psychological consequences.

It’s not just about avoiding sugar spikes; it’s about promoting a healthy relationship with food that’s sustainable in the long term. And suggesting vomiting as a method to manage diet is even more alarming. This advice could lead to conditions like bulimia, which is an eating disorder that involves exactly this type of behavior.

So, Mim’s tale is a stark reminder: Not all advice from ‘professionals’ should be taken at face value, especially when it sounds as dangerous as this. Encouraging risky behaviors is never acceptable in healthcare. If you ever encounter advice like this, it’s definitely time to seek trusted support from professionals who use evidence-based practices.

Turns out Mim made a formal complaint against this supposed dietitian and she was never seen in that place again! I just want to say, that’s great, and if you do encounter these outrageous circumstances yourself, don’t hesitate to make a complaint because unfortunately we see far too much of this. 

Dr Jedha, Host, 17:51

Alanna said: My past 3 hbA1c’s have been 4.5, 4.7, and 4.6 and my dr wants to not only increase my Metformin, but also start me on insulin. hmm.. no thank you.

Alanna brings up a scenario that seems almost backwards in the world of diabetes management. With A1c levels like 4.5, 4.7, and 4.6, she’s not just in the clear—she’s excelling. These are the kind of numbers that typically have healthcare providers celebrating, not prescribing more medication. Yet, her doctor wants to increase her Metformin dosage and start her on insulin. That’s just ridiculous!

Research consistently shows that when A1c levels are stabilized at 7% or below, the benefits of continuing aggressive medication strategies often diminish. In fact, we want to be encouraging deprescribing medication with such good A1c levels. And research shows us that deprescribing when A1c levels are stabilized below 7%, medication often makes no difference in improving outcomes and can unnecessarily expose people to the risks of overtreatment and side effects. So in a case like this, what should be on the table, instead of more medication, is the conversation about deprescribing, and that’s certainly a conversation recommended with A1c levels ranging from 4.5 to 4.7.

Dr Jedha, Host, 19:32

Next up I’ve got a few instances of a similar situation to share:

Krystal got told by the diabetes team: “You can eat anything you want, just give yourself more insulin”.  And she said: I have so many people tell me this. 

Cliff also said he was told exactly the same thing by another person with diabetes. 

Kay said: I’m type 2, I was told to eat what you want just up the insulin.

Here’s a misconception that’s not just surprising—it’s dangerously misleading. Krystal, Cliff, and Kay all shared strikingly similar stories where they were advised, ‘You can eat anything you want, just give yourself more insulin.’ Let’s set the record straight: this is not sound advice for managing diabetes. Insulin isn’t a magic pill, or rather a magic injection. All insulin does is lower the blood sugar; it doesn’t stop the damage that high blood sugar or high insulin can do to your body.

And let’s just put it straight, managing diabetes isn’t just about controlling blood sugar levels after they spike; it’s about optimizing overall health through quality nutrition, which prevents those spikes in the first place. Over-relying on insulin to ‘fix’ poor eating choices is a risky strategy. Not only can this lead to weight gain, but it also increases the risk of severe hyPOglycemia, potential eating disorders and other health complications like heart disease.

Instead, focus on good nutrition and you can achieve and maintain healthy blood sugar and A1c, which minimizes the need for medication. 

Dr Jedha, Host, 21:29

Catherine was told by a diabetes educator that “Oh, you’re blood sugar is low? You better take some insulin.”

Let’s dissect this particularly alarming piece of advice shared by Catherine. She was told by a diabetes educator that if her blood sugar is low, she should take insulin. This is a fundamental misstep in understanding how insulin works and the basics of diabetes management.

Insulin is a hormone that helps to lower blood sugar levels, not raise them. Advising someone with low blood sugar to take insulin is not just incorrect; it’s hazardous. It could lead to severe hyPOglycemia, a condition where blood sugar drops to dangerously low levels and can cause symptoms like confusion, unconsciousness, and can even be life-threatening.

The correct approach when experiencing low blood sugar, or hyPOglycemia, is to consume a quick-acting carbohydrate. This could be glucose tablets, fruit juice, regular soda, or candy—essentially something that can quickly raise blood sugar levels to a safe range. Of course we don’t recommend these things in a general sense, but in the case of hypo’s it is important to raise levels to a safe range, hence, some quick-acting carbohydrate.

In any case, this advice that Catherine received is appalling and embarrassing and really should not be happening at all. 

Dr Jedha, Host, 23:10

Tim said he was told by his doctor that “I wouldn’t have diabetes if I wasn’t fat. Even my Dr told me if I would just lose weight and go down to 150 lbs it would cure the diabetes. She told me to get bariatric surgery to take 80% of my stomach out. I said no thanks. Next time I saw her she says I see you like being fat since you decided to not get the surgery.” 

Tim’s story touches on a crucial issue in healthcare: the stigmatization of weight and its impact on diabetes. He was told by his doctor that his diabetes was solely due to being overweight and that losing weight, specifically getting down to 150 lbs, would ‘cure’ his diabetes. His doctor even recommended bariatric surgery as a quick solution, and when he declined, she remarked that he ‘likes being fat.’ This is not just unprofessional; it’s potentially damaging.

First and foremost, while there is a relationship between excess weight and the development of prediabetes and type 2 diabetes, it’s important to understand that diabetes is a complex condition influenced by a variety of factors, including genetics, lifestyle, and environmental components. Suggesting that diabetes can be simply ‘cured’ by reaching a specific weight or by undergoing surgery overlooks this complexity and fails to provide a supportive approach to treating the diabetes effectively. 

The suggestion of bariatric surgery as the primary solution, without considering or discussing other methods of weight management and diabetes control, is not in line with best practices which advocate for a patient-centered approach tailored to individual needs and circumstances.

The response Tim received from his doctor is unfortunately a classic example of fat-shaming in the medical community. It’s vital for healthcare providers to offer respectful, empathetic care and to discuss all potential treatment options, including their benefits and risks, in a non-judgmental manner. If you find yourself in a similar situation as Tim, seeking a different healthcare provider who approaches diabetes management with a more understanding and respectful manner might be necessary. Because again, this stuff should just not be happening and you should never be spoken to or treated in such a way.

And.. that wraps up our journey through the wild and often wacky world of ‘Diabetes Bloopers.’ Thank you to all our members and listeners who shared their stories, and to you for tuning in today. Each blooper we discussed not only sheds light on the misunderstandings surrounding effective treatment for diabetes but also highlights the importance of informed, thoughtful care.

It is unfortunate, that these things are happening all too often and something to keep in mind is that just because a person has a professional label of ‘diabetes educator’ ‘dietitian’ or even a ‘medical doctor’ – doesn’t mean they are qualified to give guidance and recommendations about diabetes, which is why it’s so important to share Diabetes Bloopers like this, because hopefully, we’ve empowered you to question, to challenge, and to seek the best possible guidance from trusted professionals, like us – who have over a decade of research and experience in the field. 

Remember, you are your best advocate. If something doesn’t sound right, it probably isn’t. Always feel comfortable seeking a second opinion and reaching out for more information. And importantly, find trusted sources of information, like us with the information and resources we share at DMP and here on Type 2 Diabetes Talk. 

In the next episode, I’ll be joined by Emily, DMP Dietitian Nutritionist and we’re diving in to cover more questions from you. If you’ve got a question, head to our website to leave a voice message or email.

Have a great week, 

Dr Jedha, over and out.