Arguing with my endo's PA

[gary.keith]

I keep trying to tell my endo's PA that the salads I eat every day for lunch do have a significant amount of carbs in them. And she keeps telling me there's no way any kind of salad has any carbs in it, significant or otherwise.

I eat a salad made with three ounces of mixed baby greens (2g net carbs), a dozen grape tomatoes (6g net carbs), a cup of sliced red onions (13g net carbs), a cup of broccoli florets (4g net carbs) and some Walden Farms dressing (no carbs).

That's a total of 25 grams of net carbs. More than half the net carbs (13g) come from the red onion. Do red onions really have that many carbs? I want to be sure of my facts before I tell the PA to mind her own business! ;)

[Joeprep4820]

That does sound like a lot, but that also sounds like you are eating a lot of onion as well. Wouldn't want to be the person working next to you after 1!

[poodlebone]

I just looked up onions in the Calorie King database and it says that 1 cup of sliced onions has 12g carb, 2g fiber. It does not have a separate listing for red onions, just a general "onion" choice. Red onions could be slightly higher in carbs but I don't know for sure.

I like red onions but I'm not sure I could handle an entire cup of them in my salad!

[Granny Shanny]

Per CalorieKing, they're darn close - this sez 11.6g.

CalorieKing - Calorie Counter - Calories in Vegetables, Fresh: Onions, all types, raw, edible portion (http://www.calorieking.com/foods/calories-in-vegetables-fresh-onions-all-types-raw-edible-portion_f-Y2lkPTE0Nzc1JmJpZD0xJmZpZD03MDk1MCZlaWQ9NDg0MDIyOT I2JnBvcz0xJnBhcj0ma2V5PW9uaW9u.html) (be sure to set the serving size to 1 cup, sliced)

And don't be surprised at what happens if you reheat cooked onions! Aarrgghh!

[fgummett]

Absolutely your salad has carbs... you've already done the math. Ask her how a glass of OJ compares to a cola in terms of BG effect.

But fruit and veg are supposed to be good for us... so more must mean even gooder ;)

Why do you think it is called "caramelizing" when you cook down onions till they brown?

You stick to yer guns Gary :D

And of course I'm not saying to cut out salads... just to recognise the carb content and manage accordingly.

[musique913]

I can't imagine eating a cup of onions on a salad! Your breath! :mad:

[gary.keith]

That does sound like a lot, but that also sounds like you are eating a lot of onion as well. Wouldn't want to be the person working next to you after 1!

:laugh: I'm one of those weirdos you occasionally see in the bathroom brushing his teeth after a meal!

I just looked up onions in the Calorie King database and it says that 1 cup of sliced onions has 12g carb, 2g fiber.

I like red onions but I'm not sure I could handle an entire cup of them in my salad!

Per CalorieKing, they're darn close - this sez 11.6g.

And don't be surprised at what happens if you reheat cooked onions! Aarrgghh!

I do love onions! I found a site that lists red onions. They have slightly more carbs and fiber than a white or yellow onion.

Shanny, what's going to happen if I reheat cooked onions?

ADDED: Thanks, Frank. I always appreciate your support!

[Joeprep4820]

Absolutely your salad has carbs... you've already done the math. Ask her how a glass of OJ compares to a cola in terms of BG effect.

But fruit and veg are supposed to be good for us... so more must mean even gooder ;)

Why do you think it is called "caramelizing" when you cook down onions till they brown?

You stick to yer guns Gary :D

And of course I'm not saying to cut out salads... just to recognise the carb content and manage accordingly.

I drink OJ when I have a hypo, and my constant hypos through college and high school ended with me drinking lots of it, which I attribute to me hardly getting sick through those years (lots of Vitamin C).

[Josselyn]

Gary, the onions carmelize and turn to sugar. :eek:
I believe the 12 grams only covers them while raw.

[Granny Shanny]

Shanny, what's going to happen if I reheat cooked onions?


They'll just zap your glucose worse than ever . . . Frank's reference to caramelized onions is right on target - the more they're cooked, the more sugar available.

[Joeprep4820]

They'll just zap your glucose worse than ever . . . Frank's reference to caramelized onions is right on target - the more they're cooked, the more sugar available.

Sadly, they are more delicious when fried.

[Granny Shanny]

Sadly, they are more delicious when fried.

And especially when fried with peppers, beef strips, etc., and wrapped in a hot tortilla - à la fajitas . . .!!!

[fgummett]

I drink OJ when I have a hypo...Exactly my point, but somehow (even in your idea about Vitamin C) the massive sugar content concentrated (by removing all the fibre etc...) in a glass of OJ gets forgotten in the quest for a healthy drink... volume for volume, OJ and cola are just about equal in terms of rapid-acting sugar.

This I believe, is one of the fundamental changes needed to address our growing health problems... in much the same way as the Endo's PA fails to recognise the carbs because (I'm assuming here) salad is automatically considered "healthy".

Our society's idea of "healthy" needs a shake-up... consider a "healthy" breakfast, as seen on TV: OJ, cereal with fat-reduced milk, toast/bagel/muffin with margarine and jam, coffee with creamer... or for the really health conscious, a low-fat yogurt (HFCS instead of fat) with a banana. All those refined/concentrated carbs at a time of day which many of us find is exactly when we have the least tolerance for any carbs.

[gary.keith]

And especially when fried with peppers, beef strips, etc., and wrapped in a hot tortilla - à la fajitas . . .!!!

Thanks for crippling my willpower! :D And this after I did so well today. Kept my BG in the 100-110 range with absolutely no PP bolusing. You have single handedly forced me to eat another package of Reese's Peanut Butter cups after dinner tonight! :laugh:

[Joeprep4820]

Exactly my point, but somehow (even in your idea about Vitamin C) the massive sugar content concentrated (by removing all the fibre etc...) in a glass of OJ gets forgotten in the quest for a healthy drink... volume for volume, OJ and cola are just about equal in terms of rapid-acting sugar.

This I believe, is one of the fundamental changes needed to address our growing health problems... in much the same way as the Endo's PA fails to recognise the carbs because (I'm assuming here) salad is automatically considered "healthy".

Our society's idea of "healthy" needs a shake-up... consider a "healthy" breakfast, as seen on TV: OJ, cereal with fat-reduced milk, toast/bagel/muffin with margarine and jam, coffee with creamer... or for the really health conscious, a low-fat yogurt (HFCS instead of fat) with a banana. All those refined/concentrated carbs at a time of day which many of us find is exactly when we have the least tolerance for any carbs.

OJ is good for you, and it does contain sugar. The two are not mutually exclusive. The problem is that people drink way more than a serving size. OJ is much healthier than soda, and any doctor would agree with me, as would any nutritionist.

[Granny Shanny]

Thanks for crippling my willpower! :D And this after I did so well today. Kept my BG in the 100-110 range with absolutely no PP bolusing. You have single handedly forced me to eat another package of Reese's Peanut Butter cups after dinner tonight! :laugh:

They darn better be Atkins Endulge PB cups! Not Reese's! :D :D :D

[gary.keith]

They darn better be Atkins Endulge PB cups! Not Reese's! :D :D :D

I haven't been able to find any place locally that sells them. I even asked the manager of my supermarket today and they're not on his list of things he can special order. Where do you get them from?

[Granny Shanny]

It's that dad-burned Walmart that's 40 miles from you . . . or however far it is! ;)

[fgummett]

OJ is good for you, and it does contain sugar. The two are not mutually exclusive. The problem is that people drink way more than a serving size. OJ is much healthier than soda, and any doctor would agree with me, as would any nutritionist.We're maybe taking this too far off topic but I'm not suggesting that OJ is the same as soda in all regards.

But that may be my whole issue with OJ: because it is perceived as healthy (which it is, in some regards), the assumption seems to be that more is better (as you say "serving size")... whereas vitamin C and all the other micro-nutrients are required in such "micro" quantities that more is not necessarily better at all AND you are getting a massive hit of concentrated sugar as a by product.

Why not just eat an orange? Wow.. this OJ out of a carton is just so darned convenient -- no messy peeling or seeds -- and tasty too (AKA sweet) maybe I'll have another please...

I watched a Mother and her toddler in the Mall a while back... they where both sucking back adult-sized fruit-smoothies from a local stand. I'll bet you any money that Mother thought she was doing the absolute best by her child and who could blame her for trying. Just imagine what kind of a sugar-hit that child was getting, and maybe once in while that may be OK... but I have to wonder how often it was repeated and the effect that would have in the long term..?

It's about perception.

[gary.keith]

It's that dad-burned Walmart that's 40 miles from you . . . or however far it is! ;)

I went to see exactly how many miles I was from that Walmart and guess what I found? A new Walmart that seems to have just opened and it's only about 15 minutes from where I live. Around here we tend to measure distances in how long it takes to drive there instead of the miles. Because if you look at a map and find where I live and where this new Walmart is you'd think it's a two minute drive. Traffic here is horrendous! I'll go there tomorrow. It'll be my very first time ever inside a Walmart. Please pray for me! :laugh:

[Joeprep4820]

We're maybe taking this too far off topic but I'm not suggesting that OJ is the same as soda in all regards.

But that may be my whole issue with OJ: because it is perceived as healthy (which it is, in some regards), the assumption seems to be that more is better (as you say "serving size")... whereas vitamin C and all the other micro-nutrients are required in such "micro" quantities that more is not necessarily better at all AND you are getting a massive hit of concentrated sugar as a by product.

Why not just eat an orange? Wow.. this OJ out of a carton is just so darned convenient -- no messy peeling or seeds -- and tasty too (AKA sweet) maybe I'll have another please...

I watched a Mother and her toddler in the Mall a while back... they where both sucking back adult-sized fruit-smoothies from a local stand. I'll bet you any money that Mother thought she was doing the absolute best by her child and who could blame her for trying. Just imagine what kind of a sugar-hit that child was getting, and maybe once in while that may be OK... but I have to wonder how often it was repeated and the effect that would have in the long term..?

It's about perception.

It appears you and I agree on this issue then. I drink grapefruit juice every morning anyway - more vitamins, less sugar, and still only drink an 8-10 ounce serving of it.

[JayDee1950]

Well, I would tell the PA to stuff it.
When they have MD after their name then can lecture me.
I'm allergic to onions but cooking them would surely raise the sugars.
Found that my Trop OJ (from concentrate) always blew my BG thru the roof and started diluting it with water 25-50% some time ago.
Too lazy to squeeze my own/eat them, also they are quite sour here - like grapefruit.

[jenb]

Why not just eat an orange?

You beat me (again!) to this question. I'm sure any nutritionist would agree - it's an even healthier alternative than the juice.

Jen

[Joeprep4820]

You beat me (again!) to this question. I'm sure any nutritionist would agree - it's an even healthier alternative than the juice.

Jen

I agree, but when I'm having a hypo I'd rather get it up as quickly as possible rather than peel or handle a knife. I drink a serving size, 8 ounces or so, which is much less than what most people drink.

[musique913]

I can't drink juice at all, even in small amounts, my darned sugar spikes like crazy. I eat very little fruit really. It's something I hope is possible someday anyway..lol

[fgummett]

When they have MD after their name then can lecture me.They can try..! :D

[dbaratta]

That's a total of 25 grams of net carbs. More than half the net carbs (13g) come from the red onion. Do red onions really have that many carbs? I want to be sure of my facts before I tell the PA to mind her own business! ;)

That is weird about the red onion, I would question that but you are correct there are plenty of carbs in there. Do what your body tells you too. Those are even the good carbs, complex carbs! I find that a good salad keeps my BG in perfect sync. You just keep doing what you are doing. :eating:

[jillybean]

All those refined/concentrated carbs at a time of day which many of us find is exactly when we have the least tolerance for any carbs.
Yupyupyup! And at least one study I've read showed that even those who are perfectly healthy (no diabetes or insulin resistance) are more sensitive to carbs first thing in the morning, so it's not just an issue for diabetics.

They can try..! :D
heh, that's what I was thinking - having "MD" after their name STILL doesn't mean they're always right!

[gary.keith]

That is weird about the red onion, I would question that but you are correct there are plenty of carbs in there. Do what your body tells you too. Those are even the good carbs, complex carbs! I find that a good salad keeps my BG in perfect sync. You just keep doing what you are doing. :eating:

I'm glad to hear that about your salads and BG. The same holds true for me, but only if I'm feeling brave enough to deviate from bolusing the prescribed amount. With a salad like that if I take 25 units of Novolog I go hypo, sometimes dangerously so. 15 units seems to be the right dose for me.

[COLOR="Indigo"]heh, that's what I was thinking - having "MD" after their name STILL doesn't mean they're always right!

Going against what my Endo has told me to do is one of my biggest challenges. As I've stated elsewhere, I'm at a point where I know just enough to be potentially dangerous to myself. However, when I've done the research, asked questions; as I'm doing here, and experimented a little bit to confirm my suspicions about how things affect my BG, then I'm finding growing confidence in my ability to make my own decisions, even if they contradict my Endo or her PA. And yet I still feel the need to get the PA to agree with me. Why the heck did my mother have to instill in me that I should always do what my doctors tell me to do?

[foxl]

And especially when fried with peppers, beef strips, etc., and wrapped in a hot tortilla - à la fajitas . . .!!!

Granny ... STOP that!!!

[fgummett]

Going against what my Endo has told me to do is one of my biggest challenges. As I've stated elsewhere, I'm at a point where I know just enough to be potentially dangerous to myself. However, when I've done the research, asked questions; as I'm doing here, and experimented a little bit to confirm my suspicions about how things affect my BG, then I'm finding growing confidence in my ability to make my own decisions, even if they contradict my Endo or her PA. And yet I still feel the need to get the PA to agree with me. Why the heck did my mother have to instill in me that I should always do what my doctors tell me to do?DISCLAIMER: my sarcastic comment above was not meant to suggest that Doctors are idiots who are not to be trusted (my words, not anyone else's).

While of course, all Doctors are only human, the ones I see are intelligent and educated professionals who I trust and whose opinions I value. While legally they may have the final say in such matters as specialist referrals or prescriptions, I like to think that we have a collaborative/team approach where I bring at least as much to the discussion and decision making process as they do.

As an example, I was warned by my local MM rep that my Endo was against insulin pumps -- just another money-making scheme -- and would not even meet with her. At my next appointment, I presented him with printed studies, forms etc.. I explained what I wanted to do and why... he agreed and at each follow up appointment he has proudly told me how many more folks he now has on the pump.

Knowledge is indeed power, but I have so far found it useful to engender cooperation between myself and my health care team rather than becoming adversarial with them.

And I'm largely speaking about the management of my D or any other chronic condition... when I had my appendix removed, as emergency surgery a couple of years back, I was NOT sitting up on the table discussing with the surgeon how it should be done ;)

[ShottleBop]

That is weird about the red onion, I would question that but you are correct there are plenty of carbs in there. Do what your body tells you too. Those are even the good carbs, complex carbs! I find that a good salad keeps my BG in perfect sync. You just keep doing what you are doing. :eating:

Not necessarily "complex" carbs; onions are high in sugar, compared to other veggies. If you're following Dr. Bernstein's diet, they're on his "have a limited amount on a salad or something, but don't go crazy" list. (Of course, that doesn't stop me from eating that big 'ol slice of onion that comes on my burger, but it does stop me from having them grilled.)

[gary.keith]

And I'm largely speaking about the management of my D or any other chronic condition... when I had my appendix removed, as emergency surgery a couple of years back, I was NOT sitting up on the table discussing with the surgeon how it should be done ;)

Once you get to the operating table, I would agree with you about your surgeon.

When it comes to my D, and the topic of this thread, I wish she would recognize when I've done my homework and, barring any reasonable medical concerns, agree that I'm informed and rational enough to make some decisions on my own now.

[fgummett]

Not necessarily "complex" carbs; onions are high in sugar, compared to other veggies. If you're following Dr. Bernstein's diet, they're on his "have a limited amount on a salad or something, but don't go crazy" list. (Of course, that doesn't stop me from eating that big 'ol slice of onion that comes on my burger, but it does stop me from having them grilled.)It's another of those "perceptions" I alluded to above... all fruits and vegetables are good because they contain complex carbs

As is widely known here on DF, even so-called complex carbs can cause rapid BG spikes for at least some individuals... hence our need to test around new foods.

While I am a proponent of real whole food, and it is often suggested that Paleolithic humans ate fruit and vegetables... consider what that fruit and veg looked like compared to what is on offer in our stores today, and remember that it was seasonal back then as well. Many of the varieties we have today have been bred for size and sweetness, not necessarily for improved nutritional value.

---
When it comes to my D, and the topic of this thread, I wish she would recognize when I've done my homework and, barring any reasonable medical concerns, agree that I'm informed and rational enough to make some decisions on my own now.I agree Gary, but bearing in mind that some Doctors still come from a background where they are the "experts" and we are supposed to passively comply with instructions... perhaps we need to take the initiative and show them that we do in fact know what we are talking about... at least so far as the management of our own D.

[mortis505]

As an example, I was warned by my local MM rep that my Endo was against insulin pumps -- just another money-making scheme -- and would not even meet with her. At my next appointment, I presented him with printed studies, forms etc.. I explained what I wanted to do and why... he agreed and at each follow up appointment he has proudly told me how many more folks he now has on the pump.

Perhaps Gary could do something similar with the PA. Print out the nutrition info on each item as per serving size and show it to them. Hard to deny proof when its in your hounds. Also it may be useful to bring info from multiple sources.

Calorieking (http://www.calorieking.com/) is excellent, but for a quick peek i also use the chart at Mikes (http://www.caloriecountercharts.com/chart1a.htm).

[foxl]

Well, I would tell the PA to stuff it.
When they have MD after their name then can lecture me.


JayDee, MDs rarely have much in the way of nutrition education. SOME CDEs do ... but not all of them, either. I no longer let anyone lecture me ... let alone some clown hired by my insurance co ... ;)

[Subby]

Perhaps Gary could do something similar with the PA. Print out the nutrition info on each item as per serving size and show it to them. Hard to deny proof when its in your hounds. Also it may be useful to bring info from multiple sources.

That's the ticket. And you can practise your interpersonal skills to see if you can present it in such a way that allows them to keep face. If such a thing is impossible (they will not accept they are wrong, or move on gracefully, given a polite effort to "educate" them) then you know this person is of no use to you, you simply cannot trust them.

[gary.keith]

I agree Gary, but bearing in mind that some Doctors still come from a background where they are the "experts" and we are supposed to passively comply with instructions... perhaps we need to take the initiative and show them that we do in fact know what we are talking about... at least so far as the management of our own D.

This is what I've been doing. Hence the need for this thread. I've been telling her what my research has found and trying to convince her my salad lunch has far more carbs in it that she's willing to acknowledge.

Perhaps Gary could do something similar with the PA. Print out the nutrition info on each item as per serving size and show it to them. Hard to deny proof when its in your hounds. Also it may be useful to bring info from multiple sources.

I'm thinking your suggestion is what I need to do next so she has no wiggle-room to deny what I've been telling her. Thanks also for those links. I already had the Calorie King link, but adding Mike's to my list of paper-proof just might be helpful in persuading the PA that I am not stupid :smarty:!

That's the ticket. And you can practise your interpersonal skills to see if you can present it in such a way that allows them to keep face. If such a thing is impossible (they will not accept they are wrong, or move on gracefully, given a polite effort to "educate" them) then you know this person is of no use to you, you simply cannot trust them.

You mean I shouldn't just scream at her while flailing my arms about and tell her what an idiot she is? Gosh, you're no fun at all! :D

[jillybean]

You mean I shouldn't just scream at her while flailing my arms about and tell her what an idiot she is?
I see no reason why you can't do both :T

[JayDee1950]

foxl, agree with you there.
To me, a PA is just a glorified secretary/nurse -
or a MD wannabe.
I never talked to them.
If I pay for a doctors visit - I WANT A DOCTOR!
And insurance companies that review/deny claims that are processed by bean counters just irks me.

[JayDee1950]

Ten years ago - before I moved here - I had 4 physicians who were wonderful.
GP was in the insurance 'health wellness network/program'.
Cardiologist, Pulminologist, Gastro-enterologist.

The Cardio ordered all of my labwork, forwarded results to the others and was responsible for discovering the Diabetes.
The others ordered specific procedures based upon their specialty and everyone shared results/reports as well.

Cardio started treatment for Diabetes and recommended a local Endocrinologist - oops out of network - was denied by insurance company.

The Endo (in network) was almost an hours drive away and it took me 2 months to get an appointment. I brought my labwork results (CBC from previous week), but Endo stated they were no good and they would need to run all new labwork, adding to the costs - of course.

Endo then wanted to change all my meds (as they knew better than the others) and wanted to have the leading role regarding all treatments / be primary for my case. As they were the only in-network Endo within a 2 hours drive, their office was jammed with patients. Found them arrogant, obnoxious/control freaks with a 'my way or the highway' attitude.

They made Dr. House look like Ben Casey or Dr. Kildare (if you remember them).

Needless to say after 2 visits I never went back, used the local Endo from my Cardio and paid out-of-pocket.

[Granny Shanny]

We've run into the same thing, JayDee . . . arrogant, obnoxious/control freaks, and also the business of retesting, etc. Even on referrals yet! For gosh sake we wouldn't even BE in the guy's office if another doc hadn't referred us, and yet he dismisses the first doc's tests. We said "no thanks" after only one visit . . . :mad: :mad: :mad: (can't believe it still makes me made just thinking about it! :eek:)

[SteveFromIowa]

I'll go there tomorrow. It'll be my very first time ever inside a Walmart. Please pray for me! :laugh:

So how did it go at Wal-Mart today Gary? :)

[Granny Shanny]

So how did it go at Wal-Mart today Gary? :)

(or would we be happier not knowing? hee hee)

[gary.keith]

Y'all crack me up! I ran out of time yesterday so I never made it to Walmart. The opthamalogist took two hours instead of one and the optician took two hours instead of 30 minutes. By that time it was too late and traffic too heavy to try venturing any further west than my home. The only errand I need to run Monday is the supermarket so I'll have plenty of time to venture out to Walmart.

[plattb1]

Oh, Gary, you were saved from venturing into Wal-Mart once. It's probably a sign .... maybe you should reconsider visiting the Evil Store ...