VOICE OF THE DIABETIC, published quarterly, is the national news magazine of the Diabetes Action Network of the National Federation of the Blind. It is read by those interested in all aspects of blindness and diabetes. We show diabetics that they have options regardless of the ramifications they may have had. We have a positive philosophy and know that positive attitudes are contagious.
News items, change of address notices, and other magazine correspondence should be sent to: Ed Bryant, Editor, Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, Missouri 65203; Phone: (573) 875-8911; Fax: (573) 875-8902.
Find us on the World Wide Web at: (www.nfb.org). Our direct address is (www.NFB.org/voice.htm).
Copyright 2002 Diabetes Action Network, National Federation of the Blind. ISSN 1041-8490
Note: The information and advice contained in VOICE OF THE DIABETIC are for educational purposes, and are not intended to take the place of personal instruction provided by your physician, or by your health care team. Discuss any changes in your treatment with the appropriate health professionals.
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DENIAL
by Kim Arcari
MEDICATION ACCURACY--EVERYBODY'S PROBLEM
GLUCOWATCH UPDATE
ASK THE DOCTOR
by Wesley W. Wilson, M.D.
THE BURDEN OF DIABETES
INSULIN RESISTANCE: THE LATEST FINDINGS
by Peter J. Nebergall, Ph.D.
MY CAT HAS DIABETES
by Sharon Luka
MEET SHAUNTAY HINTON, MISS USA 2002
by Ed Bryant
STUDY RECOMMENDS DIABETES SCREENING AFTER HEART ATTACK
MOVE YOUR BODY! BEGINNING TO EXERCISE
by Ann S. Williams, MSN RN CDE
BOOK REVIEWS
by Marilyn Helton
WHAT'S IN YOUR TOOLBOX
by David Evans
UPDATE: WILL MEDTRONIC OFFER BLIND MINIMED PUMP USERS AUDIOCASSETTE
INSTRUCTIONS?
by Ed Bryant
RECIPE CORNER
ORAL DIABETES MEDICATIONS UPDATE
by Peter J. Nebergall, Ph.D.
NFB NEWSLINE NOW NATIONWIDE
by Peggy Chong
VOICE EDITOR RECEIVES AWARD
WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK
(Resource Column)
FOOD FOR THOUGHT
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DENIAL
by Kim Arcari
Includes photo: Caption: Kim Arcari
Although it's been 27 years since I was diagnosed with type 1 diabetes, I remember
it as if it were yesterday. Night after night I would awake with severe muscle
spasms in my calves, my mouth feeling as if it were glued shut from dehydration.
And, I was falling asleep in school almost daily.
I had just turned 13, and I was very active in sports -- especially
swimming and skateboarding. But it was getting harder for me to do all the things
I loved so much. My body was trying to alert me that something was out of sync,
but I was too young to realize it.
Finally, on Easter Sunday, 1975, I was diagnosed. My mother's side of our family arrived at our house as usual, and promptly noticed how thin I had become since we had last seen each other. That is when my mother recognized all the familiar symptoms of diabetes, as her own mother had the disease (and had died a few years previous to my being diagnosed).
Denial is our first reaction to anything that is hard for us to handle. Even though diabetes runs rampant on both sides of my family, no one even considered I could have the condition.
My mother and I headed straight to the emergency room that evening. I was admitted, and stayed there for eight days. While there, I met a dietitian who, coincidentally, is a type 1 diabetic also. To this day I am grateful she was my dietitian, because I had thought, up til meeting her, that I'd been given a death sentence.
Louise looked healthy; she was not blind, had both legs ... and was so upbeat she inspired me. In the past well-meaning people have said things to me like ..."my grandmother had both her legs cut off," or "my cousin lost his vision," or "my sister has these attacks," or "should you be eating that?" It is important for a newly diagnosed diabetic to have positive influences in their life -- for had I believed all the negativity I heard back then, and still hear today, I would not have believed I was capable of controlling my disease.
Unfortunately, I stayed in denial for 14 years, eating what I wanted. I did not feel any different when my glucose levels were up. I never exposed the fact I was a diabetic; it was easy to hide back then. I did, however, feel the effects of the low blood sugars, the sweating and shaking that always alerted me of an impending reaction. It was easy to deny my disease -- I could combat the lows with a quick snack and get right back to what I was doing. It was no big deal, no problem. I was just like all the other kids, I thought.
Until the day my husband couldn't wake me up. We had been to a party the previous night, and I'd had a couple of drinks. My liver was so busy processing the alcohol that it couldn't let out the reservoir of sugar to help combat my low blood sugar reaction. That was the beginning of a downward spiral.
There seemed no rhyme or reason as to why my BGs would fall. Many times since then I have awoken from severe insulin reactions with no inkling why it had dropped so low. Lately I have had only one severe reaction in 13 months, compared to having them every few months, like before, so I would say I'm doing quite well! The only thing I can attribute this to is I've had less stress in my life this past year. Utilization of insulin is different in all of us, I know from experience that stress definitely triggers my low blood sugars.
Diabetes is a full time job with no vacations. It is tedious
and jam-packed with road blocks, but I wouldn't trade it for another disease
I can't control.
As you see I am no longer in denial. I love to share my experiences with other diabetics in the hope I can inspire them in a positive way. My HbA1c is usually between 6-7, I'm very active now, and I live my life with a positive attitude.
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MEDICATION ACCURACY -- EVERYBODY'S PROBLEM
The following is abridged from ISMP MEDICATION SAFETY ALERT, published by the Institute for Safe Medication Practices; Web site: www.ismp.org. Reprinted with permission.
A 79-year old hospitalized woman accidentally received seven doses of the oral diabetes medication glyburide, which was intended for another patient. A nurse took a verbal order for glyburide, 10mg orally BID, for a diabetic patient, and correctly transcribed it onto an order form. But then this form was stamped (Addressograph) with the name and data of the wrong patient.
Pharmacy received a copy of the order, and dispensed the medication. Because the 79-year old woman was not diabetic, she eventually developed symptoms of hypoglycemia, and had to be transferred to ICU, where it was found her blood glucose level was 10 mg/dL. Fortunately, the patient recovered without permanent harm.
To prevent such errors, some pharmacies forbid dispensing dispensing insulin or oral hypoglycemic drugs unless the pharmacist confirms the patient is diabetic, is on TPN (IV feeding) and not tolerating the glucose load, or has some other therapeutic reason for the medication. If there is no reliable way to obtain this information in a timely manner through routine communication, the pharmacist must specifically seek out this information, and intervene, if the therapy does not appear to be indicated.
It is not a case of ignorance, of failure to access drug information. The problem is one of human confusion and inevitable error; and, as in so much of human endeavor, the answer is in vigilance -- in checking, cross-checking, and checking again ...
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GLUCOWATCH UPDATE
Readers of Voice of the Diabetic and other diabetes journals will know
that the Cygnus Glucowatch Biographer is now available. While the Glucowatch
is not truly non-invasive (the user must perform a conventional finger-stick
test every 12 hours), the device provides a number of services not seen before.
It is continuous, repetitive, and capable of recording patterns, results across
time (rather than the "snapshot" results of a traditional blood glucose
monitor). The Glucowatch can even be programmed to sound an alarm if your sugars
dip too low--a great tool for folks with hypoglycemia unawareness.
The Glucowatch was originally tested on, and approved for, adults. The juvenile market was, as they say, "off-label." Cygnus, the manufacturer, has just announced FDA approval of its G2 model for age 17 and under. The company reports that in one recently completed "clinical" of 40 children and adolescents (who were in poor glucose control before start of the test), use of the Glucowatch led to significant and sustained improvement in glycemic control. That means Glucowatch users did a better job of avoiding both highs (hyperglycemia) and lows (hypoglycemia.)
It's about information. The more you know, about what your body is doing, about how you, personally, react to diet, exercise, medication, and time of day, the better job you can do of dealing with your diabetes. I'm sure a lot of children and adolescents will indeed prove mature enough to use this new tool.
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ASK THE DOCTOR
by Wesley W. Wilson, M.D.
NOTE: If you have any questions for "Ask the Doctor," please send them to the Voice editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.
Wesley W. Wilson, MD has retired as an Internal Medicine practitioner
at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed
with type 1 diabetes in 1956, during his second year of medical school. He remains
interested and involved in diabetes education for patients and professionals.
Q: I heard recently of a toddler on an insulin pump. Young children are so active,
I don't understand how this could work. Could you explain? And how young is
"old enough to use an insulin pump"?
A: Insulin pumps sound like "Gee Whiz" solutions to the problems persons
with diabetes have with insulin delivery. Pumps are really just sophisticated
devices that deliver insulin according to previously programmed schedules and
increase or decrease insulin delivery at the wish of the wearer or the person
in charge. Insulin delivery with a pump is much more flexible than with mixed
"depot insulin" and therefore should be more appropriate for the variable
exercise patterns of children. Most importantly, the pumps use only rapid-acting
insulin (Humalog, Novolog, or Regular). Depot insulins are those insulin types
formulated to release insulin slowly after injection, and include products such
as Humlin NPH or Lente, and similar Novolin products. All these products have
the nasty tendency to release more insulin during exercise, especially if injected
over exercising muscle, just when less insulin is needed. Note: I cannot speak
to the effect of exercise on the new, very-slowly-released insulin called "Lantus."
Rate of release of insulin into the blood is hard to accurately predict with
depot insulins--fast-acting insulins are much more predictable.
Another handy aspect of pumps is the ability to increase or decrease insulin delivery on demand, so that if exercise is planned, insulin can be reduced. Pump users can avoid the problem with depot insulin called the "Snickers effect"--that is the need for a load of sugar before and during exercise to avoid or treat hypoglycemia.
With all the above it seems that pumps would be ideal for kids; but there are potential problems. Training in the use of the pump is required -- and kids do differ in their ability to use these complicated devices. Parents also differ in their motivation and skill in using pumps, and in supervision, or trusting their children to do it right. Children face problems attending school while using insulin, and I would expect even greater problems at school with a pump. The age at which pump use is appropriate is hard to define and depends on a number of factors. It is true that more children are using the pumps and enjoying the added flexibility that pumps provide. A dedicated parent is essential.
Insulin pumps do have other problems. I'm a firm believer that if something can go wrong, it will. A pump user must carry extra supplies, and these can be expensive. Since pumps use only rapid-acting insulin, if the needle falls out, if there is a kink in the tubing, or if something fails in the pump, the blood sugar will rise rapidly, and in persons with type 1 diabetes, acidosis (DKA) may develop in six to eight hours. A pumper must carry emergency supplies not only for the pump, but also insulin and syringes, to allow insulin injections in the old way if the pump quits. These supplies should be carried if the pump wearer is away from home base for more than half a day.
I've been accused of "being compulsive about my diabetes supplies," since I try hard to have everything needed with me, when I'm away from home. This includes my pump supplies, glucose tester, extra strips, insulin and syringes. Despite my compulsion, while on a three-day weekend in Las Vegas, I discovered that I had neglected to bring extra pump supplies. I ran out on Saturday morning, so I called the pump manufacturer, who said the earliest they could get supplies to me was Monday afternoon. I then called lots of pharmacies, none of which carried any pump supplies. BIG trouble!
A heading in the yellow pages for the Diabetes Treatment Center finally yielded results. Janet there didn't have the right supplies for my pump, but she took charge and put me in touch with Diane at Desert Valley Hospital on Flamingo Boulevard. Diane provided sufficient supplies to get me back home to Montana. My thanks to those two caring, concerned and professional women!
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CORRECTIONS
Last issue, Volume 17, No. 3, several errors were inadvertently published.
In one article, titled Metformin Warnings, the author confused the medications Glyset and Glucovance. It is Glucovance, not Glyset, that is part metformin.
In another article, titled Kidney Disease: Prevention, Dialysis, or Transplantation, the telephone number of UNOS, The United Network for Organ Sharing, was incorrectly listed. The correct number to reach UNOS should be: 1-800-292-9548.
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THE BURDEN OF DIABETES
(Selected Data from the U.S. Centers for Disease Control)
"Statistics" has a justifiable reputation as "the dismal science." Whether you're looking at the stock market, your checkbook, or the food values of your favorite hamburger, everything looks worse in a column of numbers. These data are real. However, we KNOW the better job you do of controlling your diabetes, the less your risk of becoming one of these statistics.
Today, an estimated 17.0 million Americans have diabetes. 11.1 million of them have been diagnosed; 5.9 million do not know they have the condition. Men: 7.8 million, 8.3% of all men, and Women: 9.1 million, 8.9% of all women, have the condition.
By race: An estimated 11.4 million non-Hispanic whites, 7.8 percent, have diabetes. About 2.8 million non-Hispanic blacks, 13.0 percent, making them "about twice as likely to have diabetes as are non-Hispanic whites of the same age."
Native Americans (the tribes and Alaskan natives) fare worse: 105,000, about 15.1 percent nationally. But, there is a regional skew, with diabetes least common among Alaskans (5.3 percent) and highest among the tribes of the American Southwest (25.7 percent). More than 50 percent of adults of the Pima tribe have (type 2) diabetes.
Diabetics "had contact with their physicians" 143 million times (17.9 times per diabetic per year) in 1996, and saw the doctor (office visit) 64 million times, about eight times per diabetic per year. About 14 percent of all diabetics had a diabetes-related emergency room visit as well.
Diabetes costs Americans an estimated $98 billion a year, with $44 billion of that (paid to doctor, hospital, and pharmacist) in direct medical costs, about $4,000 per diabetic.
About 73 percent of adult diabetics either have high blood pressure or achieve normal blood pressure through use of prescription antihypertensive medications. The risk of stroke is two to four times higher among diabetics, and heart disease is the leading cause of diabetes-related deaths.
Diabetes is the leading cause of new blindness among adults aged 20-74 years old. Diabetic retinopathy causes from 12,000 to 24,000 new cases of blindness each year.
About 60 to 70 percent of diabetics have detectable neuropathy, nervous system damage, from the condition. The results can include: impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other problems. Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations. More than 60 percent of "non-traumatic" (which means it wasn't war or accident that removed the limb) amputations occur among diabetics.
Diabetes is the leading cause of ESRD, end stage renal disease, accounting for 43 percent of new cases. In 1999, 38,160 diabetics began treatment for ESRD, and 114,478 underwent dialysis or received a kidney transplant.
What is the lesson you should take from these numbers? Is it "gonna getcha?" No. Diabetes is serious; it must be addressed -- but if you do a good job of controlling yours, these numbers should remain, like all "good" statistics, about somebody else.
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INSULIN RESISTANCE: THE LATEST FINDINGS
by Peter J. Nebergall, Ph.D.
Includes Photo: Caption: Peter J. Nebergall, Ph.D.
On Tuesday, June 11, 2002, the International Diabetes Center, at Park Nicollett, in Minneapolis, Minnesota, held an "open forum" on the subject of insulin resistance. I was privileged to participate, and would like to discuss some of the findings presented by Drs. Burton Sobel and David Kendall, co-chairs of the Partners Against Insulin Resistance (PAIR) Advisory Panel.
Insulin resistance, the inability of the body to fully and properly utilize endogenous insulin (the insulin your body naturally provides) is the principal "engine" driving type 2 diabetes. For years, the role of insulin resistance in driving up blood sugars, in "causing diabetes," has been understood, but the focus, in research and treatment, has been on the diabetes. What does insulin resistance do to your body before sugars climb up into the "diabetic" range - before the development/diagnosis of diabetes?
One of the major ramifications of type 2 diabetes is coronary artery disease.
Type 2 frequently co-occurs with obesity, with high cholesterol, with high blood
pressure--but is it the diabetes, and its hyperglycemia, that cause them, or
are their seeds sown before the diabetes develops? The presenters suggest the
latter is true.
Dr. Kendall reminded us that insulin resistance is antecedent to diabetes; that overt diabetes should be seen as an endpoint in the disease process. Dr. Sobel pointed out that data prove the risks of cardiac events increase before the development of overt type 2, and thus it cannot be clinical hyperglycemia that engenders those cardiac events--that insulin resistance itself, not the diabetes the insulin resistance causes in approximately 50 percent of cases (about half the folks with measurable insulin resistance or "IGT," impaired glucose tolerance, will go on to develop overt type 2) is the cause of these cardiac events.
The presenters distinguished between microvascular complications, damage to capillaries, to the glomeruli in the kidneys, and to the retina, all caused by diabetes, by hyperglycemia, and macrovascular complications, occlusions, blockages, changes to blood vessel walls, caused by insulin resistance--and well underway before diabetes appears. Insulin resistance has been traditionally seen as a metabolic issue--but, from its consequences, it is as much a cardiac one.
This last is a breakthrough. The thinking has been: "Here's diabetes; We'll treat it," without real consideration of those complications well underway before the blood sugars climb into the measurable range. If insulin resistance, rather than its product, diabetes, is doing the damage, what can we do about it? Recognizing surgery (PTCA, "balloon angioplasty," or CABG, "bypass surgery") does not end coronary disease, but merely repairs its consequences, how do we directly attack the cause, the insulin resistance?
Diabetologists have known for decades that lifestyle changes offer significant benefits in the treatment of type 2. Getting your diet under control, and increasing your regular exercise are always good ideas, and obese diabetics who lose weight generally find their insulin resistance decreasing and their condition easier to control. Drs. Sobel and Kendall say the patient should not wait until a diagnosis of overt diabetes to adopt these lifestyle changes.
Knowing that one class of oral diabetes medications, the thiazolidinediones, directly attacks the problem of insulin resistance, I asked the presenters if, in light of the seriousness of their findings, such medications should be considered for pre-diabetic individuals who exhibit significant insulin resistance?
"From a medical standpoint, yes," was their reply.
If insulin resistance, rather than overt diabetic hyperglycemia, is the source
of so many cardiac problems, then whatever clearly reduces insulin resistance
reduces the risk of these serious cardiac events. Where IR is present, and lifestyle
changes do not make a significant impact, use of IR-reducing medications should
be considered.
From an administrative standpoint, today's insulin-reducing medications, those
that have passed FDA-mandated clinicals and received "licenses," are
for the treatment of overt, diagnosed diabetes, not pre-diabetic IR. There's
a lot of paperwork to endure before we can use them for people who aren't yet
diabetic -- and may never become diabetic -- but who show demonstrable insulin
resistance. For some time we've been seeing insulin resistance solely as a precursor
to diabetes -- and this seminar suggests we need to see it as aggressor itself
-- and then take appropriate action.
Thomas Kuhn, in The Structure of Scientific Revolutions, would say we stand on the cusp of a "paradigm shift." It appears we are going to have to change our thinking; about type 2 diabetes, its cardiac complications, and the root causes of those complications. We'll be healthier, once we do.
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MY CAT HAS DIABETES
by Sharon Luka
I was shocked when I learned, on October 15, 2002, that my 14-year-old long-haired calico cat had been stricken with type 2, adult onset diabetes. Strange, you say? Actually, it is quite common among the feline population. I also have a friend whose dog has been blinded by diabetes.
Being totally blind, how was I going to care for my diabetic cat? As you can imagine, I wondered how I would help Callie manage her situation. I couldn't believe it. First of all, neither she nor I sustain obesity. Callie had been stricken with a respiratory illness, then, bang, she became a cat with diabetes.
Dr. Tom Cure, my veterinarian, many friends, and Jeff Denton, a Salina, Kansas pharmacist, worked with me to build Callie's health regimen. She was quickly placed on insulin injections, having first presented herself in the Veterinary hospital with a blood sugar of over 600.
I wondered how I would load syringes and administer injections, but I knew there were tools to enable a blind person to safely and accurately draw up and administer insulin. These I would use to take care of Callie.
After recovering from my own questions of "how I had erred as a pet owner
to cause this diabetes," reality struck. I needed to act. I bought a 1/2cc
Count-a-Dose, taught myself to load syringes, and I now give Callie her medication
(she is quite cooperative, and even purrs during shots). The local Regional
Health Center Diabetes Educator taught me to use an automatic injection device
to inject Callie's insulin, as I found I often bent needles, trying to smoothly
and quickly insert the needles between my cat's shoulder blades.
You may wonder how I discovered her diabetes. As many pet owners, and dog guide users know, one must be vigilant in observing animals' behavior. A few days after she bounced back from respiratory illness, I found loads of sticky urine in Callie's litter box. The dumpster was suddenly being loaded! Callie quickly lost four to five pounds of her 13-pound being, and she lay in the hall between the restroom and water bowl. (For feline diabetes observation, Scoop Away litter is best. Odor and stickiness abound when sugars are high.)
It took at least two weeks for me to feel confident drawing up Callie's shots. I'll never forget the first night I tried. With nervous tremor, I loaded to three clicks on the Count-a-Dose. Callie started her diabetes journey on three units of Humulin UltraLente twice daily.
It is now July, and Calllie is down to four units of insulin daily, and is strong and healthy. I want to thank my friends in the Salina community and the National Federation of the Blind for their notes of encouragement on my new adventure with Callie.
I also want to thank my veterinarian, Dr. Tom Cure, who gave many telephone consultations and words of advice. Dr. Cure told me of a gentleman who sought his council. Another vet had advised the man to euthanise his dog because of diabetes; Dr. Cure taught him proper care for his canine friend. It can be done!
It is all in our priorties. Dr. Cure observed that one can spend $100 on rock concert tickets, so certainly one can choose to spend $100 on pet care. He also stated, "caring for a helpless pet is a virtue."
It is with gratitude that I offer help to others who are struggling for independence, confidence, and accuracy in helping animals control their diabetes. I recall with interest that Dr. Cure admonished me: Now I can teach my blind clients to measure their insulin. Remember, we are constantly changing what it means to be blind.
I am interested in locating other blind persons who manage the diabetes of their canine or feline friends. My email address is [email protected].
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MEET SHAUNTAY HINTON, MISS USA 2002
by Ed Bryant
Includes Photo: Caption: Shauntay Hinton
Shauntay Hinton is a happy, gloriously beautiful, well-spoken young lady of
23. A senior in Broadcast Journalism at Howard University in Washington DC,
she is also this year's Miss USA. It's a long way from Starkville, Mississippi,
her childhood home.
Most young ladies who place in the big beauty pageants start early, and are seasoned veterans by the time their big day comes. Not Shauntay. She saw a televised competition, thought "I can do that," and entered online. A year later, the crown was hers. Unconventional? She's unconventional.
Shauntay, who calls Oprah Winfrey her role model, credits her two grandmothers, "extraordinary women," she calls them, with being her biggest positive examples. She told me how one of them even returned to college, in her late 60s, "to get her degree and live out one of her dreams."
Shauntay doesn't have diabetes, but both her grandmothers did, and both died from its complications. Now the "Miss Universe Organization," sponsor of the Miss USA competition, raises funds to fight breast cancer and ovarian cancer; but it also allows its winners to choose a charity goal of their own. Shauntay chose diabetes.
I asked her about the impact of diabetes on the African-American communities of the deep south, and she spoke of how, in rural areas, the poverty is reaching all-time highs -- causing real problems for folks who have trouble paying for their medications. But that's not the only problem.
"We don't pay enough attention to diabetes, compared to other conditions," she says. "With early detection, we can nip these things in the bud. There's a lot of new technology."
"The main message I want to get out," says Shauntay, "is to urge people to take better care of yourself."
She's not carrying her message alone. Insulin manufacturer Eli Lilly and Company helped out, by sponsoring Shauntay's trip to the ADA convention, so she could further her education about diabetes, and become a better spokesperson for the condition.
I found Shauntay Hinton well-prepared, well-spoken, engaging and intelligent. She's ambitious ("Oprah is almost as ambitious as I am," she says), and there's every reason to believe she'll succeed. During her reign, she'll go a lot of places, make a lot of appearances, and help spread the word about diabetes, and what we can do about it. Three cheers for Miss USA!
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STUDY RECOMMENDS DIABETES SCREENING AFTER HEART ATTACK
A study published in the medical journal Lancet (2002; 359:2140-44) recommends
all patients admitted to hospital with symptoms of myocardial infarction, who
have not been previously diagnosed with diabetes, should be screened for diabetes.
The study, carried out by Dr. Lard Rydes and colleagues at Karolinska Hospital,
in Stockholm, Sweden, found that more than 1/3 of patients admitted for myocardial
infarction, who did not have a previous diagnosis of diabetes, had the "pre-diabetic"
elevated blood sugars characteristic of IGT, Impaired Glucose Tolerance.
A significant percentage of these people either had undiagnosed overt diabetes or were well on the way to developing the condition. Diabetes, especially type 2 diabetes, can cause serious heart and vascular complications, and current research suggests much of this damage takes place before the individual's blood sugars rise into the "clinical diabetic" range.
Intervention (both cardiac and diabetic) is possible, but only once a person has been identified as "at risk." Cardiac events tend to be much more serious for diabetics than for non-diabetics, and diagnosis of diabetes can literally be a matter of life and death.
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MOVE YOUR BODY! Beginning to Exercise
by Ann S. Williams, MSN RN CDE
This column focuses on providing information to help people make their diabetes care fit their needs and their lives.
Almost everyone who has diabetes, and lives in an industrialized country, has been told it is a good idea to exercise regularly. Exercise is good for everyone, and particularly good for people who have diabetes. But many people know that, and think about exercise -- without actually doing it. Knowing you should exercise, and actually maintaining some kind of exercise as a normal part of your everyday life are two completely different things. If you think you ought to exercise, and you want to exercise, but you haven't yet begun, this column is for you!
When most people think of exercise, they think of "working out" in some way--whether it's a running program, weight-lifting, jazzercise, or using some sort of exercise equipment. So you might be surprised to learn that, for the purposes of improving your health, you might not need to do so much. If such programs help you, fine. But even if you are not going to a gym, or buying any equipment, or participating in any organized programs, you still get many benefits from exercising. Research shows that you can get almost all the benefits of a full exercise program by instead having several shorter bouts of exercise throughout the day. What is most important is to MOVE YOUR BODY! So for the purpose of this column, the definition of exercise is moving your body, being physically active. I'll use these terms interchangeably throughout this column.
Before you begin planning your exercise, it's important to be really convinced that moving your body would be good for you. So first, let's look at the many reasons it's good for people with diabetes to be physically active.
Most people with diabetes notice some immediate benefits from moving their bodies. Generally, right after a period of physical activity, your blood sugar is lower than it was before you were active. For many people who have type 2 diabetes, your insulin resistance can be lowered for up to two or three days after physical activity. If this happens, your blood sugar can be in better control for that entire period of time. So for you people who have insulin resistance, regular exercise can work as well as adding a new and very effective medication to decrease insulin resistance. And it happens without the potential for new drug interactions and side effects. In fact, almost all the "side effects" of moving your body are good!
Some good effects of moving your body you may notice quickly. If you have a lot of stress in your life, moving your body can be a very potent stress management technique. If you are prone to feelings of depression, physical activity can help lift you, and help prevent future bouts of depression. And if you have trouble falling asleep, or staying asleep, or waking up feeling rested, exercising can help promote deep, restful sleep.
It's important to note here that if your high stress, depression, or difficulty sleeping is severe, you may need other help with these problems. It would be a good idea to talk this over with your primary care doctor. But even if you do need other help, physical activity can be an important part of treating severe stress, depression, and sleep problems.
Moving your body has many important long-term benefits, too. One of the most important ones is that it can help you lose weight and keep it off. Many people who start exercising are surprised to find that their appetite actually diminishes after a few weeks. But whether this happens to you or not, simply burning more calories and becoming more fit is likely to help you lose weight. And all the research on maintaining weight loss shows that being active is a very important part of maintaining a desirable weight.
Another important long-term benefit of moving your body is that it reduces your
risk of cardiovascular problems--heart attack and stroke. Since everyone who
has diabetes is considered to be at risk for these problems, it's a good idea
for you to do everything you can to prevent them. We know that physical activity
can help reduce blood pressure, and reduce total cholesterol, "bad"
cholesterol, and triglycerides. It also raises the "good" cholesterol.
In addition, exercising the heart helps keep it strong. All of this adds up
to a much-reduced risk of heart and stroke problems.
Finally, people who are physically active generally feel better. You'll find after exercising for a few months that you have more energy and feel more alert. This is probably the result of all the above benefits added together. And "feeling better" is probably the most important reason of all to start moving your body.
Do you think you are ready now to plan how to increase your physical activity?
Many people have had the experience of beginning a physical activity, doing too much in the first few days, and then getting too tired or sore -- and stopping almost right away. To avoid this, it's a good idea for you to spend a little time thinking through a plan for increased physical activity.
First, before you begin, you should talk with your doctor about any physical limitations you might have. For example, if you have diabetic retinopathy, and you still have some useful eyesight, it's important to avoid activities that might start retinal bleeding. So you'd want to avoid any exercise with rapid, jerking movements of the head, such as basketball; or lowering your head below the level of your heart, like leaning over to touch your toes; or holding your breath and straining, as many people do with weight-lifting. If you have heart disease already, you will want to avoid straining your heart. It will be important for you to begin with gentle activities, and increase gradually over time. If you have foot injuries or ulcers, you will want to talk with your foot care specialist for advice about activities that will not add to your foot problems.
If you are using insulin, or any oral medication that works by increasing the amount of insulin your body makes, you need to watch out for low blood sugar. Most people can safely add a small amount of physical activity without having any blood sugar problems. But some people find that even a small amount of added physical activity is enough to give them hypoglycemia, low blood sugar. So as you begin moving your body more, it's a good idea to check your blood sugar before and after the exercise. And it's always a good idea to carry glucose tablets or some other portable source of carbohydrates to treat low blood sugar. Remember the rule of 15: If your blood sugar drops below 70, take 15 grams of carbohydrate (three or four glucose tablets, or one half cup of any juice or regular pop, or six or seven7 hard candies, or any other source of 15 grams of carbohydrate). Wait 15 minutes, and check your blood sugar again. If it's not coming up, take 15 more grams of carbohydrate.
Once you know whether you'll need to consider any precautions when you move your body, you're ready to make a specific plan. What physical activity do you want to do? And when do you want to do it?
It's important to choose a form of exercise that you can enjoy, so you'll keep
doing it. If you choose an activity that feels like a chore, you're probably
not going to keep it up. So think about what you might enjoy doing. Many activities
qualify as "moving your body," not all of them traditionally considered
"exercise." We all know, for example, that walking, swimming, and
bicycle riding are good forms of exercise. So are dancing, gardening, doing
housework vigorously, and playing active games with children. Let your imagination
go! The idea is to do something that gets you breathing a little harder, and
gets your blood moving around. In other words, the idea is to move your body.
If you are blind, you may feel that many forms of physical activity are no longer possible for you. It is true that many physical activities will take some adaptation. However, many blind people have found ways to safely do types of exercise others might think impossible. Of course, walking is still possible--with a white cane, a guide dog, by trailing a wall or a guide line with your hand, or with a sighted person as a guide. Swimming can work well in a pool with lane markers. Bicycling alone may not be safe, but riding an exercise bicycle or tandem bicycling with a sighted person can work. There are groups around the country organized for blind people to participate in all kinds of activities--beep-ball (an adaptive form of baseball), golfing, bowling, sailing, and many other sports. If you are interested in figuring out an adaptive form for a particular activity or sport, speaking with physically active blind people and blindness rehabilitation specialists may help you find other blind people who already participate in that sport. A lot of information is available. An internet search under "athlete" and "diabetes" or under "athlete" and "blind" brings up a lot. For more information, see the end of this article.
But suppose you just can't picture yourself doing any "sports," or setting aside much time at all for physical activity. You can still move your body. Research has shown that there are many effective ways to get the benefits of exercise. Several shorter bouts of moving around on most days can give you almost as much benefit as the traditional 30 minutes of exercise at least five days a week. Maybe you can't imagine yourself swimming for exercise, but you can imagine taking a few flights of stairs in your apartment building instead of riding the elevator. Maybe you'll never use exercise equipment, but you could turn on the radio and dance for ten minutes most afternoons. Maybe you'll never have a regular walking routine, but you can walk to a friend's house, or the grocery store, or a pharmacy, instead of riding the bus or taking a car. Maybe you can sweep and mop your floor a little more vigorously, or walk your dog an extra time every day, or add a little more gardening each week. If you take the time to think of all the ways you can add little bits of moving your body around all through the day, you'll probably be surprised to realize that it can amount to a substantial increase in physical activity.
After you have decided what kind of physical activity appeals to you, it's important
to set a specific time to begin, and to decide how long you'll move your body
the first time you begin your new level of activity. It really matters a lot
less that you start with a very small amount of activity than it does that you
actually start. For this reason, many people find it helpful to begin with a
very low level of exercise--say, five minutes a day, three days out of the first
week. Once you have begun, you can always increase from there. What is important
is that you succeed in beginning, and that you build a habit of more movement
in your life.
More Information:
America's Athletes With Disabilities, Inc., National Headquarters, 8630 Fenton Street, Suite 920, Silver Spring, MD 20910; telephone: 1-800-238-7632; Web site: www,americasathletes.org
Diabetes, Exercise, and Sports Association (DESA), P.O. Box 1935, Litchfield Park, AZ 85340; telephone: (623) 535-4593; Web site: www.diabetes-exercise.org.
United States Association of Blind Athletes (USABA), 33 N. Institute Street, Colorado Springs, CO 80903; telephone: (719) 630-0422; Web site: www.usa-ba.org.
Or you might find the following book useful: The Diabetic Athlete, by Sheri Colberg-Ochs, Ph.D., published 2001 by Human Kinetics, Inc.
[To be continued in the next issue--Moving Your Body: Increasing Activity]
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BOOK REVIEWS
by Marilyn Helton
Starting with Halloween in October, through Super Bowl Sunday in January, there's one eating event after another: Halloween, Thanksgiving, Christmas, Hannukah, Kwaanza, New Year's Eve/Day and finally, the ultimate tailgate event, the Super Bowl! The average weight gain over the holidays ranges from 7 to 10 pounds. If there were ever an Olympics for Eating, this would be it!
Who wins the Winter Food Olympics? Those who maintain their weight and good glucose control! Start training now so these eating events don't weigh you down. To help you prepare, and maintain your dedication to efficient diabetes management, I've selected several terrific cookbooks for this issue's Book Reviews. I think you're going to enjoy your training for this year's Food Olympics!
THE DIABETES HOLIDAY COOKBOOK (YEAR-ROUND COOKING FOR PEOPLE WITH DIABETES), published by John Wiley & Sons, Inc, (c) 2002, is the perfect starting point. It's about time someone wrote a holiday cookbook specifically for us!
The Diabetes Holiday Cookbook is bursting with flavorful recipes for every occasion
in a month-by-month guide to healthy holiday cuisine. Written by Carolyn Leontos,
MS, RD, CDE, Debra Mitchell, CEPC, and Kenneth Weicker, CEC, this book is a
must for your cookbook collection. (If you remember from past reviews, Carolyn
Leontos is the author of WHAT TO EAT WHEN YOU GET DIABETES.) Debra Mitchell,
an Executive Pastry Chef at Treasure Island, a Mirage/MGM Hotel and Casino in
Las Vegas, and Kenneth Weicker, Executive Chef of the Suncoast, a Coast Resorts
Hotel and Casino in Las Vegas, join Carolyn Leontos to bring their collective
talent and culinary expertise together to produce this worthy book.
The Diabetes Holiday Cookbook will provide you with more than 100 appetizing recipes for festive holiday dishes, complete and easy-to-put-together menus for 21 holiday celebrations, creative suggestions for enhancing flavor without adding calories, alternative ingredients suggestions for low-sodium and alcohol-free diets and helpful notes on holiday traditions and activities (which is a bonus for food editors).
I like the fact that this cookbook offers serving sizes and complete nutritional analysis, including dietary exchanges for those of you who have not yet advanced to counting carbohydrates for control. The ingredients are not exotic, and are easy to find in your local grocery store or supermarket -- an important consideration.
You definitely won't feel left out of the "holiday loop" with a copy of THE DIABETES HOLIDAY COOKBOOK, friends. Very highly recommended!
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If you "eat out" on a regular basis, you'll appreciate the GUIDE TO HEALTHY RESTAURANT EATING, 2ND EDITION, by Hope S. Warshaw, MMSc, RD, CDE. This is a very thick little book, packing a wealth of information on more than 3,500 menu items from more than 55 chain restaurants.
Hope Warshaw, one of my favorite cookbook/reference book authors, has put together the best restaurant guide available for people with diabetes. In her thorough and meticulous style, she's been able to present you with all the facts you need to choose your meals intelligently, whether you're enjoying "fast food" or making selections from a restaurant menu. You'll find complete nutritional information AND exchanges for every menu item listed in this book (it's rare to find a guide of this type which includes dietary exchanges). The author has included the basics about today's diabetes nutrition management and meal planning goals and strategies, common restaurant pitfalls, and strategies for defensive restaurant dining, in the section titled "Put Your Best Guess Forward." Further, if you can't find a particular restaurant chain in this book, or if there's a new menu item introduced for a restaurant that IS included, there's a handy list telling how and where to get the nutrition information you need.
This is the best guide to eating out I've seen to date. Published
by the American Diabetes Association, (c)2002 by Hope S. Warshaw, GUIDE TO HEALTHY
RESTAURANT EATING, 2ND EDITION makes an excellent stocking stuffer. Highly recommended!
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THE JOSLIN DABETES HEALTHY CARBOHYDRATE COOKBOOK, by Bonnie Sanders Polin, Ph.D., and Frances Towner Giedt with the Nutrition Services Staff at the Joslin Diabetes Center, is a cookbook I've coveted for some time. I recently switched from the traditional "dietary exchange system" to counting carbohydrates, and when I finally received a review copy of this book, I was one happy camper.
During the last decade, major changes in the approach to dietary "treatment" of diabetes have occurred. The standard "diet prescription" for diabetes control has disappeared. The Joslin Diabetes Healthy Carbohydrate Cookbook recognizes that meal planning today should match individual treatment goals and the lifestyle of each individual patient. Using the simple guideline of "eating healthy," people who have diabetes currently have many more options and opportunities to succeed!
Bonnie Polin and Frances Geidt show us how carbohydrate-containing foods are a significant part in diabetes meal planning, and how using carbohydrate counting makes improved glycemic control possible whether you're controlling diabetes by nutrition, insulin therapy or oral medications.
The Joslin Diabetes Healthy Carbohydrate Cookbook features a complete guide to stocking your healthy pantry; very informative sidebars including tips for cooking with artificial sweeteners, using ingredients which might be foreign to you (such as tofu), and a primer on lettuce and greens. Every recipe has a complete nutritional analysis and "Joslin Choices" (which will translate to your dietary exchanges). The 285-page book has 175 recipes from appetizers, soups and stews, salads, sandwiches, pizzas, pasta, grains and tofu to delicious desserts. There's also a helpful three-week menu plan.
Don't let some of the long ingredient lists discourage you; the results are definitely worth it. Besides, this is how you learn to substitute natural ingredients for enhancing flavor without fats, sugars and calories! Published by Fireside (a trademark of Simon & Schuster, Inc.), THE JOSLIN DIABETES HEALTHY CARBOHYDRATE COOKBOOK was definitely worth waiting for. Recommended with applause.
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Is there a senior citizen with diabetes in your family or circle of friends? You might want to consider giving them a copy of DIABETIC COOKING FOR SENIORS: DELICIOUS NEW WAYS TO EAT WELL, EAT RIGHT, by Kathleen Stanley, CDE, CN, RD, LD, MSED, published by the American Diabetes Association, (c)2001.
This is actually more than just a cookbook; it looks at some
of the challenges faced by seniors with diabetes: Handling meal plan changes,
reducing sodium, lowering fat and cholesterol, eating out, food and drug interactions,
digestive difficulties, loss of appetite, emotions, stress and boredom, making
food appealing (aging causes a loss of taste for many seniors, exclusive of
diabetes), and weight loss/gain.
I love the fact that Diabetic Cooking For Seniors has recipes purposely designed
to eliminate excess chopping, dicing and preparation, as many of us experience
painful arthritis as we age. Each recipe includes a nutritional analysis and
exchange information, and most are designed for cooking in small portions, ideal
for the reduced size senior family.
The recipes are divided into 10 chapters: Breakfast Ideas; Quick Fixes; Low-Sodium Stuff; Flavor Powerhouse; Low-Calorie Concoctions; Fiber-Rich Foods; Super Snacks; Low or No Cholesterol; High-Calcium Choices, and Simply Great Desserts.
I've already ear-marked several recipes such as Instant Picnic (this one will surprise you), Smothered Baked Portobello Mushroom (so Italian), Sticky Muffins (you get two per serving), Hot Skins (definitely not X-rated), Cows in the Orchard Salad (I'll let you try to guess what that one has in it), Apricot Candy (only three ingredients), and Cinnamon Rice, Chocolate Pancakes, and Strawberry Cloud Pie -- which will be offered to our Cinnamon Hearts readers!
This is a delightful book, and you're going to be happy with your purchase. Go ahead and make your mouth happy with a copy of DIABETIC COOKING FOR SENIORS. You'll enjoy these exciting new recipes!
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That's all, folks! Wherever you are when you read these reviews, I hope you're healthy, happy and living in the moment! Until we meet again in January, I wish you peace, hope and a joyous holiday season.
Marilyn Helton, diabetic since 1993, is the publisher of Cinnamon Hearts: The Art of Living a Winning Diabetic Lifestyle, a positive-power E-zine for diabetics and their families. Visit the Cinnamon Hearts Web site: www.cinnamonhearts.com.
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If you or a friend would like to remember the Diabetes Action Network of the National Federation of the Blind in your will, you can do so by employing the following language:
"I give, devise, and bequeath unto the Diabetics Action Network of the National Federation of the Blind, 1800 Johnson Street, Baltimore, Maryland 21230, a District of Columbia nonprofit corporation, the sum of $_______________" (or "_______________ percent of my net estate" or "the following stocks and bonds:____________________") to be used for its worthy purposes on behalf of blind persons."
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WHAT'S IN YOUR TOOLBOX
by David Evans
Includes Photo: Caption: David Evans
From the Editor: This article appeared in the July 2002 BRAILLE MONITOR, published by the National Federation of the Blind.
From the MONITOR Editor: The following article appeared in
the Spring 2002 issue of Florida Federation Focus, a publication of the NFB
of Florida. David Evans is a member of the NFB-F board of directors. Sometimes
it seems to me that people are just looking for excuses not to begin learning
Braille. I am certain that they do not enjoy the frustration of functional illiteracy.
Of course learning the code brings with it frustrations of its own. The difference
is that the pains associated with learning any new skill have about them an
aura of the constructive. In the same way, a person who is in poor physical
condition experiences pain climbing to the eighth floor when the elevator is
out of order and also when beginning a rigorous exercise program. Both activities
hurt, but one is healthy and positive while the other is simply unmitigated
misery.
David Evans offers some great reasons and a fine role model for those who wish things were different in their own lives. This is what he says:
Braille will be around as long as paper and ink are. As long as the sighted use paper and ink, there will be a place for Braille. I am not very good at it yet, but I am trying. I think the hardest thing for me to overcome was the mental image of me trying to read big books in Braille.
What helped me was this thought: the most important person I have to communicate with is myself. I needed some way of writing down small, short personal messages and the ability to read them back anywhere and at any time. Pocket tape recorders work well for some things, but what do most sighted people do in the same situation? They write it down on a piece of paper and put it in their pocket. Well, if writing things down on a piece of paper is the most common and practical technique for the sighted, then using Braille on paper should be a very good way for the blind.
I decided that I could picture myself reading information on a three-by-five-inch card written in Braille. So I decided to learn Braille, or at least enough to write those personal messages, and, if I went no further than that, at least I could copy down a person's name, address, phone number, an appointment time or date. I tried getting someone from DBS [the state agency for the blind in Florida] to teach me, but I will just say that this person did not work out.
Then, while I was attending an NFB national convention, a friend told me about
the Hadley School for the Blind. I called its toll-free number: (800) 323-4328,
and explained what I was interested in learning. They sent me a test to take
about the rules of the school and then sent me my course, called "Relevant
Braille"--all free of charge. This was an at-home course in Grade I Braille
using a slate and stylus. They sent me directions on tape that were easy to
follow and broken up into sections that explained everything. I followed the
instruction to do at least one card or 15 minutes a day. Being the impatient
type, I did all of the lessons at once and was writing and reading Grade I Braille
in about three weeks. By this I mean that I was using a slate and stylus to
write all of my personal communications down on three-by-five cards and using
them to keep my life organized. I did eventually get around to finishing and
sending in my course materials and getting my certification in Grade I Braille.
I think that learning to write and then read using a slate and stylus is the best way to learn. This teaches you to write Braille right-to-left and to concentrate on dot position. Most people I have met who learned on a Brailler seem to have a hard time making the switch to a slate, but those who learned on the slate do not have any problem going to a Brailler for greater speed.
I like the slate because I can carry it anywhere, and now I am rarely without one, even though I do most of my note-taking on a Type 'n Speak. I found that the trick to learning Braille is just learning the first ten letters. Once you learn them, you repeat the letters in order while adding dot three at the bottom. Then you do the same thing again, adding both dots three and six at the bottom until you have all 26 letters of the alphabet.
The only oddball is "W," because Braille was invented by a Frenchman named Louis Braille, and at that time the French did not use the letter "W" in their alphabet. The Hadley course also teaches the numbers and punctuation symbols. Learning the first ten letters also gives the student the ten digits when paired with the number sign. Last year I went back to the local Lighthouse and began learning Grade II Braille, all 200 contractions of it. This is where you get faster with Braille. Grade II turns Braille into a form of shorthand that speeds up both writing and reading. I am still very slow, mostly because I do not practice enough and because I have diabetes; but I am still using Grade I Braille because speed is not the most important thing; the ability to read it is.
I believe that, like all people, blind people need their own toolbox--special tools and skills that help get the work done. It is wise for all of us to include in our toolbox any and all tools we think may help us to do the job. And as with any collection of tools, they should be kept sharp, in their proper place, and available whenever they can do the best job. By the way, the friend who gave me that tip about Braille and the Hadley School was Doctor Jernigan. He could read over 400 words a minute in Braille. The average sighted reader reads between 225 and 250 words a minute.
Who says that reading Braille has to be slow?
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UPDATE: WILL MEDTRONIC OFFER BLIND MINIMED PUMP USERS
AUDIOCASSETTE INSTRUCTIONS?
By Ed Bryant
Includes Photo: Caption: Ed Bryant
In the last Voice issue, Volume 17, No. 3, I discussed how the insulin pump may be the best and most natural way at this time for an insulin-using diabetic to achieve good self-management. Thousands of Americans use insulin pumps. Diabetes is the leading producer of new blindness among working-age Americans, and a great many insulin-using diabetics are blind or losing vision - but still could make good use of the insulin pump to control the condition and reduce the risk of its complications.
Many blind diabetics already use insulin pumps, but far more could, if the manufacturers would make their products more tactile, and if they would provide audiocassette instructions for new blind users. I should point out there are experienced blind insulin pump users ready and willing to assist in the making of such instructions.
I first contacted Medtronic, maker of the Minimed line of insulin pumps, several years ago, about this project. I reached Mr. Ray Hoese, in their marketing department, and we discussed the idea of audiotape instructions. He delivered the information to his company's Education Department, and there, for a time, things sat.
Recently, Mr. Hoese contacted me again, by e-mail and phone. He asked for names and addresses of blind pump users who could help with audiocassette instructions. Although there is not yet any final commitment, he sounds interested in moving the project forward.
I hope this happens. There are a lot of blind diabetics ready to benefit from the insulin pump, and any manufacturer that takes their special needs into account will be helping both them, and its own market share.
Next issue, Voice Volume 18, No. 1, Winter Edition 2003, I will publish a review of all the insulin pumps now available in the United States. And I will keep on pushing the pump manufacturers to make their pumps, and their pump's instructions, more blind-friendly.
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RECIPE CORNER
Includes Artwork: Fruits and Vegetables
This issue, all recipes are taken from THE DIABETIC'S HEALTHY EXCHANGES COOKBOOK,
by JoAnna M. Lund, published by Perigee. Reprinted with permission. Contact
Healthy Exchanges at telephone: (319) 659-8234; Web site: www.healthyexchanges.com.
SEVENTH HEAVEN STRAWBERRY SALAD
Ingredients:
2 (4-serving) packages JELL-O sugar-free strawberry gelatin
1-½ cups boiling water
1-½ cups Diet 7UP
1 cup chopped celery
1 cup (one 8-ounce can) crushed pineapple, packed in fruit juice, drained
3 cups sliced fresh strawberries
1/4 cup (1 ounce) chopped pecans
3/4 cup Cool Whip Lite
Instructions:
In a medium bowl, combine dry gelatin and boiling water. Mix well to dissolve gelatin. Refrigerate 10 minutes. Add Diet 7UP, celery, pineapple, 2 ½ cups strawberries, and pecans. Mix gently to combine. Pour mixture into an 8-by-8-inch glass dish. Refrigerate until firm, about three hours. Spread Cool Whip Lite evenly over set gelatin and sprinkle reserved strawberries over top.
Cut into eight servings. 99 Calories, 3gm Fat, 5gm Protein, 12gm Carbohydrate, 57mg Sodium, 1gm Fiber. Exchange: 1 Fruit, ½ Fat.
BEAN AND CHEESE TACOS
Ingredients:
6 ounces (one 8-ounce can) red kidney beans, rinsed and drained
½ cup chunky salsa
1 teaspoon dried minced garlic
4 (6-inch) flour tortillas
1 (8-ounce) package Philadelphia Fat Free Cream Cheese
1/4 cup (3/4 ounce) grated Kraft fat-free Parmesan cheese
½ cup chopped onion
2 teaspoons dried parsley flakes
Instructions:
Preheat oven to 350 degrees. In a small bowl, combine kidney
beans, 1 tablespoon salsa, and minced garlic. Mash well, using a fork. Place
tortillas on ungreased cookie sheet. Spread about 2 tablespoons bean mixture
on half of each tortilla, to within ½ inch of edge. In a medium bowl,
stir cream cheese with a spoon until soft. Add Parmesan cheese, onion, and parsley
flakes. Mix well to combine. Spread cream cheese mixture evenly over other half
of tortilla and fold in half. Quickly spray tops with olive-flavored cooking
spray. Cook about 10 minutes or until tortilla beings to brown and filling is
hot. For each serving, place 1 tortilla on plate and spoon scant 2 tablespoons
salsa over top.
Makes 4 servings. 202 Calories, 2gm Fat, 16gm Protein, 30gm Carbohydrate, 647mg
Sodium, 5mg Fiber. Exchange: 2 Meat, 2 Starch.
CHUNKY SOUTHWESTERN SOUP
Ingredients:
8 ounces ground 90% lean turkey or beef
½ cup chopped onion
½ cup chopped green bell pepper
1-3/4 cups (one 15-ounce can) Swanson Beef Broth
3/4 cup (1 ½ ounces) uncooked elbow macaroni
2 cups reduced-sodium tomato juice
2 cups (one 16-ounce can) tomatoes, undrained and coarsely chopped
1 tablespoon chili seasoning mix
1 cup frozen whole kernel corn
1/4 cup (1 ounce) sliced ripe olives
Instructions:
In a large saucepan sprayed with olive-flavored cooking spray, brown meat, onion, and green pepper. Add beef broth, macaroni, tomato juice, undrained tomatoes, and chili seasoning mix. Mix well to combine. Bring mixture to a boil, stirring often. Stir in corn and olives. Lower heat. Cover and simmer 15 minutes or until macaroni is tender, stirring occasionally.
Makes four 1-½ cup servings. 247 Calories, 7gm Fat, 16gm Protein, 30gm Carbohydrate, 1,083mg Sodium, 3gm Fiber. Exchanges: 2 Vegetable, 1 ½ meat, 1 Starch, ½ Fat.
CARMEL APPLE DIP
Ingredients:
1 (4-serving) package JELL-O sugar-free vanilla cook and serve
pudding mix
1 (4-serving) package JELL-O sugar-free lemon gelatin
1/4 cup Brown Sugar Twin
1 teaspoon apple pie spice
1-1/4 cups water
1 teaspoon vanilla extract
1 (8-ounce) package Philadelphia Fat Free Cream Cheese
1/4 cup (1 ounce) finely chopped dry-roasted peanuts
Instructions:
In a medium saucepan, combine dry pudding mix, dry gelatin, Brown Sugar Twin,
apple pie spice, and water. Cook over medium heat, stirring constantly, until
mixture thickens and starts to boil. Remove from heat. Stir in vanilla extract.
Place pan on a wire rack and allow to cool five minutes. Meanwhile, in a medium
bowl, stir cream cheese with a spoon until soft. Add chopped peanuts. Mix well
to combine. Stir in slightly cooled pudding mixture. Refrigerate at least one
hour. Gently stir again just before serving.
Makes eight 1/4-cup servings. 62 Calories, 2gm Fat, 6gm Protein, 5gm Carbohydrate, 271mg Sodium, 0gm Fiber. Exchanges: 1 meat.
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ORAL DIABETES MEDICATIONS UPDATE
by Peter J. Nebergall, Ph.D.
Currently there are an estimated 17 million diabetics in the United States. Perhaps 5 to 10 percent are insulin-dependent; the rest are type 2 diabetics, controlling their condition with diet, exercise, insulin, and oral diabetes medications.
"Oral diabetes medications" are not insulin pills; rather five classes of drugs designed to improve the body's utilization of what insulin is still present. These are: The sulfonylureas, repaglinide and nateglinide, metformin, the "glitazones," and acarbose.
Most of today's "diabetes pills" are sulfonylureas, a class of chemicals that stimulate the pancreas to produce more insulin, effectively lowering blood glucose levels. Type 2 diabetics, those who need better management than diet and exercise can provide alone, often turn to these medications: tolbutamide, chlorpropamide, tolazamide, glyburide, glipizide, and glimepiride, for effective self-management. The sulfonylureas are effective "insulin secretagogues," but only for as long as the impaired pancreas maintains some part of its insulin-making capacity.
But the sulfonylureas grow ever less effective with the passage of time. They drive the failing pancreas to greater effort, but the patient may well require ever-increasing doses to maintain good diabetes control. All this time, the pancreas is continuing to fail, and at some point, no further increase in medication will be effective; the pancreas isn't doing its job. This patient needs to start injecting insulin. When the islet cells of the pancreas cease producing sufficient insulin, insulin must be injected.
Repaglinide (trade name Prandin), along with its sister nateglinide
(trade name Starlix), the second class of medications on our list, are a completely
new chemical formulation. Prandin and Starlix resemble the sulfonylureas in
mechanism of action, in that they stimulate the release of pancreatic insulin,
improving blood sugar control (and are of no use in type 1 diabetes, where pancreatic
insulin is not present). But they differ from the sulfonylureas in several ways:
* Prandin and Starlix are short-acting, with quick onset and fast excretion,
allowing more freedom in the timing of meals (dosages can be taken 0 to 30 minutes
before mealtime).
* Unlike the sulfonylureas, Prandin and Starlix are excreted via the liver. Individuals with renal insufficiency (kidney disease) should use caution ("dosage for each patient should be individualized, to achieve optimal clinical response" says Prandin's manufacturer), but even ESRD--end stage renal disease--is not a contraindication for Prandin or Starlix.
* Individuals with hepatic (liver) impairment should proceed with caution, and with longer intervals between dosages, as the drug will take longer to clear the body.
Metformin (trade name Glucophage), the third oral diabetes medication on our list, works to raise the body's sensitivity to its own insulin. Used for decades in Europe, it can be prescribed alone or with the sulfonylureas. Metformin helps the type 2 diabetic make better use of the insulin he or she has left. Like the sulfonylureas, it becomes useless when the pancreas ceases producing insulin.
Glucovance is a special case. A mix of metformin and the sulfonylurea glyburide, it represents convenient combination therapy. Being part metformin, it carries metformin's cautions: against heavy consumption of alcohol, against use when chronic kidney problems are present, and against use by pregnant women. Its clinical effects are the same as those of metformin taken with a sulfonylurea.
The "glitazones" (medically the thiazolidinediones): Actos, from Takeda Pharmaceuticals; Avandia, from Smith-Kline Beecham; and now-banned Rezulin, from Parke-Davis, are the fourth class of oral medication. These medications directly attack the problem of insulin resistance, the increasing inability to process insulin, that is the chief component of type 2 diabetes. In tests, they have enabled many diabetics to reduce volume and frequency of insulin injections. A few were able to discontinue insulin injections entirely.
Initially, the glitazones were tested and approved for use with insulin-using type 2 diabetics. As tests continued, it became clear they were also effective blood glucose reducers, either alone (in combination with diet and exercise), or in combination with a sulfonylurea, for type 2 diabetics who did not need insulin (although not a replacement for the sulfonylureas). Other applications and combinations may well follow.
Rezulin was the first of the class to be approved, and was very widely prescribed. It did its job very well, but collected a history of hepatic (liver) side effects. Doctors were asked to closely monitor their Rezulin-using patients. Much of the liver damage proved temporary, with normal function restored upon cessation of Rezulin therapy, but there were cases of serious, permanent damage, and more than 60 deaths. Early this year, the Food and Drug Administration asked Parke-Davis to remove Rezulin from the market.
At this time, there is no evidence that Actos (pioglitazone hydrochloride) or
Avandia (rosiglitazone maleate) cause the same permanent liver damage, but doctors
have been advised to follow the same liver-monitoring routines as for Rezulin,
in case a similar pattern of damage appears.
Acarbose (trade name Precose, from Bayer), the fifth of the "oral meds" on our list, is completely different. A carbohydrase inhibitor, it temporarily suppresses the digestive enzymes which turn carbohydrates into glucose, slowing digestion and glucose absorption, keeping glucose levels more even. More a management tool than an antidote to insulin shortage, Acarbose helps some diabetics keep a more constant blood glucose level. A "temperamental" medication, it has many side effects, and is less than universal in its utility. New Glyset (miglitol), from Pharmacia-UpJohn, appears to work in the same general manner.
Unfortunately, oral medications are often eventually insufficient. Many type 2 diabetics, diagnosed as young adults, at first successfully control their condition with diet and exercise, but find they need the pills as they grow older. A number of years (and dosage increases) later, these diabetics have reached the limit of what oral medications can do for them; they are "maxed out," and really need to start injecting insulin, to keep their blood glucose at a safe level. (Note: Regular, frequent blood glucose monitoring and HbA1c testing will show if you have reached the point where you should begin insulin therapy.)
Here we encounter what the drug companies call "psychological insulin resistance." Some of this is plain old fear of sticking yourself with needles-nurtured by memories from our childhood in the bad old days of dull-as-nails reusable syringes! Many men would rather face a bayonet. But some doctors contribute to the problem when they don't make it clear to the patient what the high glucose levels (consequent to remaining on now-useless oral medications) will bring in their wake, or worse, when they assume their patient would resist commencing regular insulin injections-so they don't even suggest it. Yes, insulin is a powerful medication, with risks if used incorrectly-but what in this world DOESN'T have risks if used incorrectly? A "completely safe" medication would have to be a powerless one, and the risks of remaining on oral diabetes medications once pancreatic insulin has diminished or ceased entirely are far greater than the risks of taking insulin.
Recent reports have mentioned insulin administration by mouth.
The nature of insulin, and of human digestion, make oral administration of insulin,
in "pill" form, ineffective for blood glucose management-the insulin
is digested before it can reach the bloodstream. However, several different
groups are pursuing variations of inhaled insulin, and at least two of these
are in late clinicals - and may prove sufficient to pass FDA regulatory oversight.
There are no "oral insulins" available for prescription - yet.
I note that in several diabetes prevention trials, individuals considered at
high risk for developing diabetes (but not yet "diabetic") were given
oral insulin in an effort to misdirect their body's autoimmune attack on the
Beta cells of the pancreas. So far, that strategy has not produced positive
findings.
Amylin Pharmaceuticals, Inc., has continued work on their Extendin-4 (AC2993), an analog of the hormone GLP-1, glucagon-like-peptide. This investigational diabetes drug has shown a number of potentially therapeutic effects in animal-based tests. Vitrase, from Advanced Corneal Systems, a drug that may help clear vitreous hemorrhage (following diabetic retinopathy), is currently in FDA clinicals. Trental (pentoxifyline, from Hoechst Marion Roussel) is now available to treat "intermittent claudication," a painful circulatory ailment and frequent companion of diabetic peripheral neuropathy. Some doctors are prescribing the antidepressant Paxil or the antiseizure medication Neurontin to treat painful neuropathy symptoms. ACE inhibitors, a class of blood pressure medications like Capoten (Captopril), have been proven to deter and retard diabetic kidney complications, and there is some evidence they aid against diabetic retinopathy as well.
Good work is being done with "combination therapy," where two known ingredients are combined into a new medication more effective than either component. We've mentioned Glucovance, but there is also work being done with blood pressure medications, combining an ACE inhibitor with a calcium channel blocker. Other oral medications are constantly being evaluated for possible diabetic applications, and some will make it to the pharmacy shelf.
Many of these are new, investigational or just-licensed prescription medications. Talk to your doctor about them. I list them here as an example of how unbelievably rapid is the pace of change. Where will we be two years from now? We'll be doing even better!
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NFB NEWSLINE® NOW NATIONWIDE
by Peggy Chong
Includes photo: Caption: Peggy Chong
Developed by the National Federation of the Blind, NEWSLINE® is a free service
used by blind subscribers to read newspapers through any touch-tone telephone.
Thanks to a one-year grant through the Institution of Museums and Libraries,
subscribers in all 50 states, the District of Columbia, and Puerto Rico, will
soon be able to access every newspaper that NEWSLINE® currently supports.
Although NEWSLINE® has covered large population areas in over 30 states
for the past few years, over half of our country has not been able to access
it without calling long distance. As soon as this service is online, any blind
person registered for NEWSLINE® can dial a new toll-free number, 1-888-882-1629,
to access all the newspapers carried on the service.
Readers already using NEWSLINE will find the new, expanded service easy to use. Pick up any touch-tone phone, dial the NEWSLINE number, listen to the menu, and choose options by tapping numbers on the phone keypad. Instead of the usual three national papers available each morning, subscribers can read over 50 newspapers, from across the country. Consider how interesting it will be to read the newspaper from a city in which a big story is breaking. In addition, NEWSLINE's non-newspaper features, which are currently available in each area, will now be available with all of the newspapers.
NEWSLINE is available, free of charge, to anyone at least legally blind. To register for this new nationwide service, or to check for updated information, contact the National Federation of the Blind, at the National Center for the Blind in Baltimore, see the NFB's monthly magazine, the Braille Monitor, call the local news option on your local NEWSLINE, or contact a local leader of the NFB in your community, or visit the NFB Web site: www.nfb.org
The NEWSLINE application is a one-page form. Get a copy of the form, fill it out completely, and return it to: NEWSLINE, National Center for the Blind, 1800 Johnson Street, Baltimore, Maryland 21230. Because NEWSLINE service requires a signature, prospective subscribers must acquire or copy a print NEWSLINE application form. A copy may be downloaded from www.nfb.org. Forms are often available from public libraries, or may be requested from local leaders of the NFB or from the National Center for the Blind in Baltimore.
NEWSLINE hereby requests all subscribers -- help us to spread the word about this wonderful opportunity. Please help us spread the word to special education departments, teachers, or schools serving blind students, and anywhere else Americans can be found who cannot read the newspapers because of their eyesight. National headlines or local stories, sports, Ann Landers, or letters to the editor and social commentary--there is much that our sighted neighbors and co-workers are enjoying, thinking about, and talking about. Now we can, too.
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VOICE EDITOR RECEIVES AWARD
Includes photo: Ed Bryant's Distinguished Service Award Plaque
From the Editor: I wasn't going to include the following, but several friends
asked that it be carried. I feel very honored that the National Federation of
the Blind chose to present me this award. On July 6, 2002, at the our annual
NFB convention, in Louisville, Kentucky, NFB National Board Member Gary Wunder
presented me with the NFB Distinguished Service Award. At the presentation,
Mr. Wunder made the following remarks:
Our recipient came into the world on February 10, 1945, a normal birth, and a real joy to his parents. They say, however, that he found the process so upsetting that it took more than a year before he would say a word. He's over that now, and it is through his words that he is known.
The person we honor is blind and a diabetic. His blindness in the middle of a successful and expanding career brought on his unwanted and unplanned retirement, but, in character with our Federation philosophy, he decided he must make lemonade from lemons. Our recipient simply found himself a new career, one that would give him a reason to live and give others an option to live.
With the help of the Federation and his own innate drive and creativity, this man transcended retirement and put his energy into a volunteer position which is every bit as demanding as any paid one.
When our recipient came to the Federation he knew what it was like to be independent and successful; but what he didn't know was how he could continue to be both and be blind. The organization which gave him that knowledge is one he credits with being the most important and impressive he has ever known.
When our colleague looked at blindness and diabetes, he found a lot of information about each but almost nothing about both. Where others said, "Gee, that's too bad," this man said "Listen, this is unacceptable." His colleagues in the National Federation of the Blind agreed with him and together we started a Division which since has become the Diabetes Action Network. Our new Division took up the cause of good, quality, people-oriented information about blindness and diabetes and so formed the Voice of the Diabetic. It's first and only Editor is the man we honor today. The Voice is the story of a small newsletter that soon became a magazine; its first printing starting at 600, and its circulation, now at 300,000.
We say we save lives, and indeed we do; but generally we mean we create opportunity so a life is worth living. The work we do with blind diabetics not only helps to make life worth living, but through the information we provide about self-medication and living independently, we often make the difference between life and death. It is with pleasure that I ask Mr. Ed Bryant to come forward to accept this token of our affection, admiration and love for the man he is and for the lives he touches.
Distinguished Service Award
To Ed Bryant
For your selfless devotion and unstinting effort to create a climate that brings greater independence to the blind, the National Federation of the Blind grants you the Distinguished Service Award. Your effort is unflagging; your spirit is unquenchable.
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WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK
(Resource Column)
Includes artwork: Books on a shelf
Inclusion of materials in this publication is for information only and does not imply endorsement by the Diabetes Action Network of the NFB.
Diabetes Education
Control Diabetes Services offers something we all need -- good diabetes education. Too many people are given their diagnosis, and a handful of syringes or pills, and left to sort it out by themselves. We all need to be shown the right way, so we don't "reinvent the wheel," making old mistakes over and over again.
Many health plans now cover the cost of diabetes education programs like this one. "A little education can go a long way," they say -- a long way toward helping you learn to manage this disease. Contact: Control Diabetes Services; telephone: 1-800-729-0114; Web site: www.control-diabetes.com
Full Service Diabetes Supplier
DS Medical Supply is a full-service supplier with a catalog of more than 55,000 items, dealing with diabetes, its complications, and many other medical supplies, delivered to your home. Diabetes products range from glucose monitors by Bayer and LifeScan, and the AccuChek VoiceMate talking glucose monitor, strips, lancets and other supplies, to diabetic orthotics/foot care items, and much more. They accept Medicare, private insurance, some HMOs, and, in most states, direct or crossover Medicaid. Contact: DS Medical, 2105 Newport Place, Suite 600, Lawrenceville, GA 30043-5561; telephone: 1-800-722-2604, Web site: www.dsmedical.com
Speech About Diabetic Feet
On July 6, 2002, at our annual Diabetes Action Network seminar, held in Louisville,
Kentucky, as part of the annual convention of the National Federation of the
Blind, podiatrist Kenneth B. Rehm, DPM, gave the keynote address, titled: "The
Importance of Treating Diabetic Feet." Dr. Rehm limits his practice to
the diabetic foot, and he had a great deal of useful information to impart.
We recorded his speech, and it is now available, on normal-speed audiocassette,
for $2 per copy, from: National Federation of the Blind, Materials Center, 1800
Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314; Web site: www.nfb.org
Talking Blood Glucose Monitor
Based on the proven Accu-Chek Advantage meter, the Roche Diagnostics Accu-Chek Voicemate provides the following: Clear, high-quality speech synthesis, talking the user through preparations, test procedures, and results, without the need for sighted assistance; an "insulin vial identifier" which reads Eli Lilly insulin vials and speaks their type, as a safety aid in tactile insulin mixing; a new, improved, "touchable" test strip -- the Accu-Chek Comfort Curve (no more "hanging drop of blood" needed!); no meter cleaning required; and a tactile "code-key" system for programming test strip codes. The Voicemate is the most "blind-friendly" talking glucose monitor available today, and the only one whose regular operations require no sighted assistance at all.
The Voicemate comes with an adjustable over-the-shoulder carrying case, with meter, voice box, battery, adapter cord, 10 Comfort Curve strips, earphone, insulin check-vial, manual and quick-reference guide (in print), and instructions on audiocassette. The meter (catalog #2030802) can now be ordered through any pharmacy (suggested retail price $495-525). To do so, have your pharmacist contact Roche Diagnostics, 9115 Hague Road, Indianapolis, IN 46250; telephone: 1-800-428-5074. For direct purchase, and a price below $500, contact any of the following retailers: BeyondSight, Inc., Littleton, CO: 303-795-6455 ($498); Independent Living Aids, Inc., Plainview, NY ($495): 1-800-537-2118; or the National Federation of the Blind Materials Center, Baltimore, MD ($475): 410 659-9314.
Diabetes Supplies
American Diabetic Supply, Inc., will ship your diabetes supplies to your door. They handle all insurance claims and provide free delivery. Folks with Medicare and/or private insurance (no HMOs) may receive supplies at no further cost. For information, contact: American Diabetic Supply, Inc., 400 S. Atlantic Ave., Suite 108, Ormond Beach, FL 32176; telephone: 1-800-453-9033.
Consider Lantus Insulin
LANTUS (Insulin Glargine Rdna), from Aventis Pharmaceuticals,
is very different from the "rapid acting" insulins types you hear
so much about today. How is this insulin different? LANTUS is a very slow insulin.
The company describes it as a "long-acting basal insulin ... providing
a relatively constant profile with no pronounced peak, and a glucose-lowering
effect for over 24 hours." Company literature states LANTUS is for once-a-day
administration, at bedtime, to treat adult patients with type 2 or type 1 diabetes,
who require "basal" insulin.
LANTUS is a recombinant dna insulin analog specifically formulated to provide
a long, flat response. Because of its special formulation, LANTUS cannot be
mixed in a syringe with any other insulin; so if you wished to take it with
Regular, Humalog, or Novolog, you'd have to take two injections.
LANTUS insulin is available now. To find out more, contact: Aventis Pharmaceuticals; telephone: 1-866-452-6887; Web site: http://www.lantus.com
Easy Diabetic Cookbook
If you want to prepare healthy diabetic meals, but find most cookbooks just too complicated, you need Linda Coffee and Emily Cale's The Diabetic 4 Ingredient Cookbook. There are over 200 recipes, in all food categories, with complete nutritional and exchange information, each one using four ingredients. The book costs $9.95 (+$2.95 shipping), from: Coffee and Cale, PO Box 2121, Kerrville, TX 78029; telephone: 1-800-757-0838.
Diabetic Supplies Online
Pharmacist Bryan Luna, Rph, offers diabetes supplies, including glucose monitors, online at www.diabeticsupplies.com. This convenient Web site is simply laid out, and can be accessed in large print, too. For those without the internet, telephone: 1-877-787-7543. They will file your Medicare, Medicaid, and private insurance forms. Free product catalog; 30-day, money-back guarantee.
WINDOWS Screen Reader
GW Micro now offers WINDOW-EYES Version 4.2 with Braille Support, a screen reader program that also supports Microsoft WINDOWS ME, WINDOWS 95, WINDOWS 98, WINDOWS 2000 and WINDOWS XP. Once equipped with a voice synthesizer such as the Dectalk (your standard soundcard won't do), any computer that can run WINDOWS can run WINDOW-EYES. WINDOW-EYES reads the internet too, and provides you both speech and Braille output! A free demo disk is available, or you may download the demo program from the Internet. The WINDOW-EYES program is available from: GW Micro, 725 Airport North Office Park, Fort Wayne, IN 46825; telephone: (260) 489-3671; fax: (260) 489-2608, e-mail: [email protected]; Web site: http://www.gwmicro.com
Free Diabetes Literature
The National Federation of the Blind maintains an extensive literature collection,
with free materials on many subjects, available in a variety of formats. The
articles listed below make up one part of the collection, the "diabetes"
category:
"Arthritis and Diabetes: A Common Association," "Blind Diabetics
Can Draw Insulin Without Difficulty," "Can I Eat Sugar?," "Cardiovascular
Health: Bypass May Be Better for Diabetics," "Check Your Hemoglobin
A1c I.Q." "Diabetic Eye Disease," "Diabetic Peripheral Neuropathy,"
"Diabetics, Don't Give Up on Braille," "The Emotional Side,"
"Finger-Sticking Techniques," "How I Went Blind...And Then What,"
"Hypoglycemia - Low Blood Sugar," "Insulin Measurement Devices,"
"Insulin Types: A Review "Keeping Your Feet," "Kidney Disease:
Prevention, Dialysis, and Transplantation," "Male Sexual Dysfunction,"
"Many Blind Diabetics Successfully Use Insulin Pumps," "New Dietary
Guidelines for Diabetes Management," "Oral Diabetes Medications Update,"
"Talking Blood Glucose Monitoring Systems," and "What Is Diabetes
Mellitus?".
A volume of these articles is available in large print, and four-track audiocassette for the blind (all the diabetes articles together), titled: "Diabetes Action Network Articles"). Both formats are free of charge. To order, or to request a complete NFB literature catalog, contact: NFB Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314. You may also order by e-mail: [email protected]. The Materials Center is open 8:30 am to 5 pm, EST, weekdays.
Full Service Diabetes Supplier
Access Diabetic Supply promises free delivery, no paperwork, and free in-home training in the use of blood glucose testing devices. Your private insurance is welcome, and they accept Medicare, too. They offer free blood glucose monitors to folks who sign up. Check them out online: www.diabeticsupply.com or call: 1-800-276-5712.
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New Diabetes Action Network Board
At this year's NFB national convention in Louisville, Kentucky, elections were held for the 2002-2003 Diabetes Action Network Board. Here are the results:
President: Ed Bryant, Columbia, MO
First Vice President: Eric Woods, Denver, CO
Second Vice President: Sandie Addy, Prescott Valley, AZ
Secretary: Lois Williams, Huntsville, AL
Treasurer: Bruce Peters, Akron, OH
Board Members: Paul Price, Valley Center, CA, Dawnelle Cruze, Portsmouth, VA,
and Sally York, Castro Valley, CA.
We congratulate out new board!
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FOOD FOR THOUGHT
Includes artwork: Fruits and vegetables with picnic supplies
We invite blurbs and tidbit articles for inclusion in this column. Materials received may be edited and used as space permits. Products and services included in this column are for information only and do not imply endorsement by the Diabetes Action Network of the NFB.
What Was The "DAWN Study?"
Not long ago, Novo Nordisk A/S, the Danish parent of U.S. insulin manufacturer Novo Nordisk Inc., sponsored a study of the relationship between attitudes toward diabetes and the quality of diabetes self-care. Christened the "Diabetes, Attitudes, Wishes, Needs" (DAWN) Study, the project attempted to move past the test tube and the glucose monitor, toward an understanding of the social context within which health care is delivered and consumed. The study interviewed more than 5000 diabetics, in 13 different countries, along with more than 2000 primary care physicians, more than 500 diabetes specialists, and more than 1100 nurses.
We know what diabetes is. We can define it, in a test-tube sort of way, and we can diagnose it. But, recognizing that living with diabetes is about coping, communication, and self management, the latest laboratory research findings may be a bit less relevant than the quality of the doctor-patient relationship.
If you develop a condition (such as diabetes) that imposes restrictions in diet and physical activity, and requires a significant time and energy investment in self-care, your attitudes toward yourself and your condition will affect the way you proceed. The DAWN Study was the first attempt to quantify those attitudes, on a truly grand scale. And it just happened to confirm what we at Voice of the Diabetic have been telling you all along, about the importance of positive attitude to good diabetes self-management.
Sadly, there are a lot of folks out there who believe that, no matter what they
do, diabetes complications are up to the Almighty, not to the quality and consistency
of their self-management. There are many others who, as we have written, believe
that complications happen "to others," that they, personally, are
immune. "It'll never happen to me!" they insist.
We know better. Living with diabetes, so much of your success is up to you. The DAWN study quantified what we already knew - that the best long-term treatment for diabetes is education, and that we as a people are in desperate need of more of it.
Banquet Address
This year, at our National Federation of the Blind annual convention in Louisville, Kentucky, NFB president Dr. Marc Maurer gave the Banquet Address, titled "Leadership and the Matrix of Power." This address is available, free of charge, in large print and audiocassette, or downloadable (in "RealAudio" format), from the NFB Website: www.nfb.org. This speech, and others by President Maurer (and much more!), are available from the National Federation of the Blind Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314, open 8:00 to 5 pm. EST, weekdays.
Islet-Cell Transplants
Enrico Benedetti, MD, and Cristiana Rastellini, MD, are pancreas transplant directors at the University of Illinois in Chicago. As of this time, their department is choosing 42 patients for free Edmonton-style islet transplants. For information, contact: University of Illinois, Department of Surgery, Attn: Enrico Benedetti, MD, 840 South Wood Street, Chicago, IL 60612; telephone: 312-413-3483.
Product Recall
LXN Corporation, makers of the InCharge glucose monitor and the Duet system, is closing its doors. Users of the InCharge meter should call 1-888-270-5365, to arrange for a free replacement meter (LifeScan has offered, as free replacements, the OneTouch Ultra or SureStep). All InCharge test strips are being discontinued.
The Duet system meter offered both a glucose test and a test for fructosamine - but research has shown that the fructosamine test strips may give inaccurately high results unless stored at or above 86°F - even though the package instructions say otherwise.
LXN Corp will offer a refund for every DUET system meter purchased in the last 12 months and returned to them. Contact The National Notification Center: 1-800-668-4391. They will send you the appropriate packaging and labels to return your meter. But do it promptly; the free recall offer expires November 15, 2002.
Rude Awakening
(from the Internet)
Sherlock Holmes and Dr. Watson went on a camping trip. After a good meal and a bottle of wine they were exhausted and went to sleep.
Some hours later, Holmes awoke and nudged his faithful friend. "Watson, look up and tell me what you see."
Watson replied, "I see millions and millions of stars."
"What does that tell you?"
Watson pondered for a minute. "Astronomically, it tells me that there are millions of galaxies and potentially billions of planets. Astrologically, I observe that Saturn is in Leo. Timewise, I deduce that the time is approximately a quarter past three. Theologically, I can see that the Lord is all powerful and that we are but insignificant specks of dust. Meteorologically, I suspect we'll have a beautiful day tomorrow. What does it tell you?"
Holmes was silent for a moment, then spoke? "Watson, you idiot, some rascal has stolen our tent!"
Survey Underway
We have been asked to announce: If you've had diabetes 20 years or more, and have experienced complications, you might wish to participate in an informal survey. The investigator, a veteran diabetic, is trying to gauge the impact on people's lives of diabetic complications. If you'd like to participate, contact: Debbie Fredericks; telephone: (618) 452-4849; e-mail: [email protected]
Need an E-Mail List?
There are electronic discussion groups, "listservs," for almost any topic you can imagine, including diabetes. If you have e-mail and web access, you can find dozens. Some are "professional;" many are for people with the condition, or specific ramifications. Many are in other languages, like Spanish, Swedish, or Dutch. Diabetes writer Rick Mendosa has prepared a 37-page catalog of many of these lists, and posted it on his Web site: www.mendosa.com
Voice Formats
Voice of the Diabetic is offered in two formats: standard print, and
15/16 IPS audiocassette ("talking book" speed). Anyone who is currently
receiving the Voice in print and having difficulty reading it, may receive
it on cassette at no charge. Voice tapes require the special tape player
available free to the legally blind from Regional Libraries for the Blind and
Physically Handicapped, which can be obtained by telephoning the National Library
Service at: 1-800-424-8567.
Periodically we receive requests for the Voice in Braille or large print. It is not available in either of those formats at this time. View the Voice on the World Wide Web at: www.nfb.org/voice.htm
Articles Needed
If you have diabetes, are a family member or friend of a diabetic, or a health professional with an interest in diabetes, we invite you to submit an article for publication in the Voice of the Diabetic.
Our philosophy regarding diabetes is positive. Do you have an inspiring, enlightening story? We, the Diabetes Action Network of the National Federation of the Blind, seek to show people they are not alone, and do have options, regardless of diabetic complications. If you have experienced ramifications, others, who may be facing the same side-effects, could benefit from what you have to say.
Perhaps you have not experienced complications--your unique insight, coping strategies, and lifestyle can still inspire others. Are you a relative, a friend, or a health professional? More than 315,000 Voice readers could benefit from your story.
For information and article submission guidelines, contact: Voice of the Diabetic, 1412 I-70 Drive, Suite C, Columbia, MO 65203; telephone: (573) 875-8911.
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SUBSCRIPTION/DONATION FORM
The VOICE OF THE DIABETIC is a quarterly magazine published by the Diabetes Action Network of the National Federation of the Blind (NFB) for anyone interested in diabetes, especially diabetics who are blind or are losing vision. An outreach publication, it emphasizes good diabetes control, diet, and independence.
Donations are gladly accepted and appreciated. Contributions are not only tax deductible but are needed to keep the VOICE and the Diabetes Action Network moving forward to help people with all aspects of diabetes.
Members of the NFB Diabetes Action Network enjoy priority services and unique
benefits such as a continuous free subscription to the VOICE, automatic access
to committees covering all aspects of diabetes, free counseling concerning all
facets of blindness and diabetes, as well as access to diabetics who have experienced
complications.
The VOICE is free to any interested person upon request. Each subscription costs the Diabetes Action Network approximately $20 per year. To help defray publication expenses, members are invited, and nonmembers are encouraged, to cover the subscription cost.
To begin receiving the VOICE, please check one:
[ ] I would like to become a member of the NFB Diabetes Action Network and receive the VOICE OF THE DIABETIC. (Members are entitled to special benefits.)
[ ] I would like to receive the VOICE OF THE DIABETIC as a nonmember. (Nonmembers are encouraged to pay the institutional rate of $20/one year; $35/two years; $50/three years.)
Send the VOICE in (check one):
[ ] print [ ] cassette tape for the blind [ ] both
and physically handicapped
(recorded at slower-than-standard speed of 15/16 IPS)
Optionally check this box:
[ ] I would like to make (or add) a tax-deductible contribution of $__________ to the Diabetes Action Network of the National Federation of the Blind.
PLEASE PRINT CLEARLY
Name:_____________________________________________________
Address:__________________________________________________
__________________________________________________
City:_______________________ State:______ Zip:__________
Telephone: ( )________________________
Send this form or a facsimile to:
Voice of the Diabetic
1412 I-70 Drive SW, Suite C
Columbia, MO 65203
Telephone: (573) 875-8911
Fax: (573) 875-8902
Please make all checks payable to:
NATIONAL FEDERATION OF THE BLIND
(V17#4)
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VOICE DISTRIBUTORS NEEDED
Since the VOICE is now offered free, our Diabetes Action Network will provide extra copies to anyone wanting to help spread the word. We will gladly send from five to five hundred-plus copies each quarter to be used as free literature. Medical facilities can order as needed for patients. Individuals can usually place copies of the VOICE in libraries, pharmacies, hospitals, doctors' offices, or other public locations.
Diabetes education is essential. Anyone who distributes the VOICE will be helping people with diabetes, and their families, to learn about the disease and its ramifications; to learn that they have options; and that their world is far greater than whatever "limits" may be imposed by the disease. If you would like to help spread the word by distributing the publication, please contact: Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911, fax: (573) 875-8902. NOTE: Please provide a phone number so we can reach you.
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END of VOICE OF THE DIABETIC, Volume 17, Issue 4, Fall 2002 Edition