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Comment by giantg2 | Hacker News Reader

True, the field is vast. But I expect that a doctor should know the basics of a common condition. If they aren't counseling diabetics about carbs... wtf is going on? It would be different if it were a rare or complex topic, but even then the Epic system that most places use have standard printouts with information for patients.

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It might be much like a dentist lecturing you on brushing your teeth. You’re in there because you don’t. The dentist might resent this, stuck with disgusting idiot after disgusting idiot in their mind. Alan watts says the dentist should make peace with it. Maybe you know you’re meant to brush your teeth but you don’t remember to, or a tooth fell out after brushing once and you thought it caused it etc. Some people avoid the dentist completely because of being ashamed of that lecture/disappointment. Then there’s the seeming popular “victim blaming is a hate crime” angle of doing anything more than prescribing something. Anecdotally, the super rare, in tales: old man doctor, who calls you a dumbass and tells you how it is straight is a treasured item. Various comedians have bits as such. Much like a professor who sees right through your self deceptions and justifications. They want their delusions shattered. To other people though the insolence and condescension that they perceive from that same person is seen as trash, doctors and professors should of course empathise with me instead of putting me down kind of thing. They don’t want their delusions handled too roughly. Trash or treasure. It’s not an even field though because if you did the “wrong” thing, the former doesn’t get the most useful help to them but the latter may try and bring down professional consequences upon thee. Which is probably why the mystical “no heck’s given” doctor is always old/bitter in the stories.

I don't have a source since I read it in a magazine at a doctors office 10 years ago, but I recall an article about how recommending diet and exercise had no meaningful increase in patients actually doing those things in a study. Combined with some patients being offended by the suggestion, the article made the case to no longer make the recommendation because it didn't work anyway!

Of course they start with diet/exercise - but ask yourself how many patients you think take that advice… high blood sugar is a really serious problem and the unfortunate reality is that people are very resistant to lifestyle changes — so the least harm is often to medicate.

Literally, the root(?) commenter said diet was not discussed. They had to find out about a low carb diet on their own, and it worked.

Sure, but that's almost certainly an exaggeration where OP gets to cosplay as the 'hero' in their story -- every single treatment protocol in every single medical setting for diabetes starts with a low-carb diet and exercise.

Literally the top of the 'treatment' section on WebMD:

> Managing type 2 diabetes includes a mix of lifestyle changes and medication. Lifestyle changes: You may be able to reach your target blood sugar levels with diet and exercise alone.

And the section on preventing type 2:

> Adopting a healthy lifestyle can help you lower your risk of diabetes.

> Lose weight. Dropping just 7% to 10% of your weight can cut your risk of type 2 diabetes in half.

> Get active. Thirty minutes of brisk walking a day will cut your risk by almost a third.

> Eat right. Avoid highly processed carbs, sugary drinks, and trans and saturated fats. Limit red and processed meats.

https://www.webmd.com/diabetes/type-2-diabetes

It was not an exaggeration. I was morbidly obese at the time, and the doctor almost completely ignored that condition for the roughly five years that I saw him. He did once recommend that I always eat a salad at the start of dinner. That was it.

When he saw that I was losing weight and that my A1C was heading downward, he asked what I was doing. I told him about the carb restriction. He looked down, smiled, shook his head, and said nothing. That was the end of it.

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