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.
10,000 Steps
There has been a lot of publicity about "10,000 Steps" programs to reduce the risk of complications from diabetes. Exercise is a good idea--but how long is 10,000 steps? The old Roman "mile" was 1000 military paces, i.e. 2000 steps. To walk 10,000 steps, you'll need to go, on the ground, on a treadmill, or in a combination of exercises, about five miles.
It's worth it.
Amputation Statistics
We know having diabetes increases the risk of leg amputation. We know certain ethnicities, those at the bottom of the economic ladder, with limited options for healthy food and good medical care, have a lot more diabetes. Put the two together, and how bad is it?
The following data are provided by In Motion Magazine, published by the Amputee Coalition of America. Contact them at telephone: 1-888-267-5669; website: www.amputee-coalition.org
Of all the major racial groups, African Americans who have diabetes are twice as likely to face amputation as are diabetics of other races. Among Native American diabetics, amputation rates are three to four times higher than those of the general diabetic population. An Indian Health Service study found Native Americans with diabetes, ages 15 to 44, had a risk of leg amputation that was over 150 times the risk for Native Americans without diabetes.
What's the answer? Education, and more education. People need to be taught what to look for, and then how to avoid it. Its the only way.
LANTUS in a Pen
Aventis, maker of LANTUS insulin, has been developing an insulin pen administration device for it, for some time. In late February 2004, Aventis revealed it had submitted marketing applications, in Europe, The USA, and Japan. The new pen, the Aventis OptiClik, will also be used for Apidra (insulin glulisine), Aventis' new rapid-acting insulin analogue.
Please note this is submission to the approving authorities, not approval; LANTUS is not yet available in a pen. Stay tuned; we'll keep you posted.
Diabetics Needed
We have been asked to announce: Attention all individuals with insulin-dependent diabetes over age 18. You are invited to participate in a web survey on adaptation to diabetes and time orientation being conducted by Dr. Erin Martz at the University of Missouri, Columbia.
This is a voluntary, confidential survey. We will not ask for your name and address in the demographics form of the survey. If you want to enter a contest to win $100, which will be awarded to one person who completes the on-line survey, you will be asked to submit your name and address. This information will be stored in a file separate from your survey responses and deleted once a winner's name is drawn. You will not be contacted after completing the survey unless you win the prize.
Please go to the following web address to complete the survey, which should take an average of 15 or 20 minutes: http://www.coe.missouri.edu/~martze
Your participation will be greatly appreciated. If you do not have access to a computer at home, most public libraries have free access to computers. Thank you!
New Medicare Pilot Project
Medicare's reimbursement policies, like traditional American medicine, set far more value upon cure than upon prevention or disease management. As Representative Newt Gingrich put it some years ago: "Why will we pay to cut your leg off, but not to teach you how to avoid needing to have it cut off?"
But things are changing. An experiment in underway. Chronically ill Medicare patients with diabetes in the state of Texas are taking part in the nation's largest demonstration project aimed at improving care through disease management. So far, more than 400 physicians and 1200 patients have volunteered to be part of the demonstration. More are being recruited to take part in the three-year pilot program, which supplements regular doctor's care with day-to-day monitoring and support services, particularly between office visits. To be considered for this pilot program, a patient must be a Texas resident, a Medicare recipient, have a diagnosis of diabetes with lower extremity complications and cardiovascular disease or congestive heart failure.
The designers of the pilot program believe that by providing better and more thorough disease management, they can reduce amputations and repeat cardiac events by 50 percent, and delay the progression of renal failure by up to 25 percent--improving both health and Medicare's balance sheet.
If you fit the above criteria, and would like to learn more about participating in this pilot study, telephone: 1-888-284-0001.
The Ultimate Carb Counting Test
"The Ultimate Carb Counting Test," designed by Gary Scheiner and Regina Taddeo, RD, contains 32 questions about diet. Some are true-false, some are multiple choice, and some are "Applied." All use photographs of basic food items as a basis for the questions. The test explores your knowledge of fiber, artificial sweeteners, and the Glycemic Index as well.
The test is free, and is available by return mail, telephone Integrated Diabetes Services: (610) 642-6055, or on the Web, at: www.integrateddiabetes.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. Note: Attempting to play Voice tapes (or any other tapes in NLS format) on a conventional music-speed tape player will yield incomprehensible "chipmunk sounds."
The Voice is also available by email, distributed quarterly. Go to: www.nfbcal.org/listserv-signup.html to sign up.
Periodically we receive requests for the Voice in Braille or large print. It is not available in either of those formats at this time.
All a subscriber needs to do, to switch from standard print to tape, or to receive both formats, free of charge, is contact us at the Voice of the Diabetic Editorial Office.
How Easy It Can Be
(Adapted from ISMP Medication Safety Alert, January 29, 2004, published by the Institute for Safe Medication Practices. Used with permission.)
Sometimes it is terrifyingly easy to screw up. A nurse found a list of patient names with accompanying room numbers. She mistakenly thought the room numbers were blood glucose values--and so she gave each patient insulin, according to a standard insulin sliding scale protocol.
A hospital doctor wrote a patient order for 10 units of LANTUS insulin, then changed his mind, crossed it out, and changed it to 8 units. However, the form was thick, and the cross-out didn't print all the way to the pharmacy copy of the order. To the pharmacist, it looked like "108 units," and, as the signature on the order was that of a respected diabetologist, the high dose was accepted and given.
The writer does not say what happened to the patient.
A hospital physician wrote "d/c SSRI" on his patient's orders. What the doctor meant was to "discontinue sliding scale regular insulin." However, the patient was also taking a selective serotonin re-uptake inhibitor, and the pharmacist duly discontinued the wrong medication.
What's the answer? Question, question, and question again. Too often, we fear questioning the words (or notes) of our superiors, and we forget they are just as human as we are, and just as subject to error. They need our help. And, just as we have been taught to "drive defensively," we must teach ourselves to handle medications "defensively," to question changes, to know why alterations in procedure are taking place.
That's how we can all stay safe.
Diabetes and Hearing Loss
A study conducted at the US Department of Veterans Affairs suggests diabetes may significantly increase the risk of hearing loss. The long-term study included 694 veterans, 342 with diabetes; 352 without. Diabetic veterans under the age of 60 exhibited greater hearing loss symptoms than those without--and the loss was of a nature consistent not with mechanical damage to the ear, but with neuropathic changes in the brainstem. There is far more to do with these data, but I hear an argument for good, tight control.
Pre-diabetes
Seventeen million Americans have overt diabetes, either type 1 or type 2. Millions more have elevated blood glucose, sometimes called "impaired glucose tolerance (IGT)." It is estimated that about half these individuals will progress to overt diabetes. Because so many individuals with this "pre-diabetic" condition will progress to type 2 diabetes, many researchers now call the condition formerly termed "IGT," or (incorrectly) "borderline diabetes," as "pre-diabetes."
The principal test for the detection of diabetes (and "pre-diabetes") is the fasting plasma glucose (FPG) test, a finger-stick blood test given first thing in the morning, after a night without food. A reading above 126 suggests diabetes, and, until last October, a reading above 110 suggested "pre-diabetes," IGT.
An international expert committee has recommended moving the minimum figure downward, from 110mg/dl, to 100mg/dl. By doing so, millions more will be told they are at risk of developing overt type 2 diabetes, and can seek appropriate treatment with diet and exercise, weight loss, and, if necessary, medications.
Talk to your doctor about pre-diabetes, and about the fasting plasma glucose test.
Follow Your Dream
(includes photo of Nora House-Petz)
In Voice of the Diabetic, Vol. 18, No. 3, July 2003, Nora House-Petz, a legally blind, diabetic, insulin-pump using amateur competitive bodybuilder, wrote "Living My Dream," about her life, her diabetes, and her successes. Since then, she has had more successes. Nora, whose website is www.diabeticexercise.com, has placed second at competitions at West Penn and Indiana State, and has a win at Indiana State as well. She didn't let her diabetes, or her blindness, interfere with her dream.
What's your dream? Follow Nora's example--don't let anything interfere with your pursuit of it.
Ascensia Dream Fund
Two issues ago, Voice, Vol. 18, No. 4, Fall 2003, we brought you the story of John Dennis, sailing around the world alone, with type 2 diabetes. Captain Dennis was sponsored by blood glucose monitor manufacturer Bayer HealthCare--who found the trip, and and the publicity, so inspiring, that they set up a grant, the Ascensia Dream Fund.
The fund recognizes people with diabetes who "dream big," and achieve extraordinary personal goals. In December 2003, Bayer HealthCare announced the fund's first winner.
She is Coleen McCarthy LaPierre, from Rhode Island. Her winning proposal was for "Dream Big," an adventure camp for teens with diabetes. Her camp will offer up to ten 16- and 17-year olds fitness, meal-planning, and diabetes education, along with a trip to the US Virgin Islands and SCUBA instruction. Eligible teens will be nominated by their doctors and diabetes educators.
"I want 'Dream Big' to demonstrate to children and teenagers everywhere that they are not limited by their diabetes," says LaPierre.
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 332,025 Voice readers could benefit from your story.
For information and article submission guidelines, contact: Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911.