VOICE OF THE DIABETIC

The Diabetes Action Network of the National Federation of the Blind
A Support and Information Network
Volume 16, Number 3, Summer Edition 2001

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, Diabetes Action Network, National Federation of the Blind,1412 I-70 Drive SW, Suite C, Columbia, MO 65203; Phone: (573) 875-8911; Fax: (573) 875-8902.

Find us on the World Wide Web at: http://www.nfb.org and follow the links for "diabetes."

Copyright 2001 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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INSIDE THIS ISSUE

POSITIVE THINKER: ART LOCKHART'S STORY

ASK THE DOCTOR
by Wesley W. Wilson, MD

INSULIN RESISTANCE EXPLORED
by Peter J. Nebergall, Ph.D.

DEALING WITH OBESITY IN CHILDREN

PANCREAS AND ISLET TRANSPLANTATION
by Vanessa Sutherland

BOOK REVIEWS
by Marilyn Helton

HE OVERCOMES CHALLENGE, BY THOUSANDS OF FEET!
by J.Michael Kennedy

NEWSLINE FOR THE BLIND

WE ARE ROYANNE'S VASCULAR SYSTEM
by Royanne R. Hollins

COOKING WITH SUZI
by Suzi Castle

TALKING MEDICINE IDENTIFIERS
by Ed Bryant

TECHNIQUE KEEPS DIABETIC CHILDREN OUT OF EMERGENCY ROOM
by Lori Williams

INDEPENDENT DIALYSIS POSSIBLE FOR BLIND PERSONS
by Lois Schmidt, R.N., C.N.N.

RECIPE CORNER

ASK JANIS

NEW DEVICE EASES EYE EXAMINATIONS

FOOD FOR THOUGHT

WHAT YOU ALWAYS WANTED TO KNOW
BUT DIDN'T KNOW WHERE TO ASK
(Resource Column)

POSITIVE THINKER: ART LOCKHART'S STORY

Photo: portrait. Caption: Art Lockhart

Mr. Art Lockhart, author of MY FIRST 22,000 DAYS WITH DIABETES, is now 69 years old. He's had diabetes since 1940, and he is a survivor. He's done extremely well, he has a lot to tell us, and what is most impressive, perhaps even more than his long-term success in managing his diabetes, is the sense of humor he's brought to it. But then again, maybe that's a good part of his success? Let's listen:

I was eight years old, it was approximately January 1940. I celebrate it in January. So I am 61 years with insulin dependent diabetes. I love to read the stories of people who have done well with their diabetes. I think it's a lot positive thinking on their part. And you know you have to accept your diabetes and go on and live a full life. It's just a problem.

I have had some complications over the years, more in my later years. I stepped on something while swimming with my grandkids. I think it was a piece of metal from the pool. And I put my foot up and my daughter recognized the fact that something had caused the swelling and infection. She rushed me to the emergency room, and they gave me some antibiotic and all, and I stayed on antibiotics for close to six months.

But it just wouldn't heal. I guess it is typical of older diabetics to have slower healing, and the reason I didn't feel it was because I had neuropathy in the feet, I had largely lost feeling. I didn't even know I had stepped on whatever it was! Well I ended up having to have it amputated. It was my big toe, so the big toe on my right foot got amputated and I remember all the worries they told me about what might happen to my feet at the time this went on, and I said, oh no, I will think positive about it, I will be back to my bowling in three weeks -- and I did; I didn't bowl very well but I got back there. But that is about the worst that has happen to me.

About three or four years ago I had part of another toe amputated on that same foot, and for the same reason -- some kind of infection they couldn't cure it with antibiotics. It truly doesn't bother me, I tell me grandkids that 8 1/3 toes are plenty to walk on. I exercise and I walk a lot.

I am living now in Asheville, NC. It's a beautiful town by the way, up in the mountains. I have been here for 41 years now. I occasionally go back to New Jersey. and to the Philadelphia area, where I grew up. Once a year I go back to Philadelphia to see old friends and relatives.

When I was diagnosed, in 1940, it was really a relief to find out what was the matter with me. I hadn't realized it, but I was feeling quite lethargic, I had begun bed-wetting, I was thirsty all the time, and didn't feel very good. My parents discovered it because they were doing regular check ups, there were five of us kids, and my older sister had diabetes. They had been advised to check the other kids every half year. They checked me, and my urine was filled with sugar. They diagnosed and I remember my father turning to my mother and saying, "He's got it too." They took me to the doctor the next day or so, and confirmed the diagnosis.

My older sister Betty got it in 1932 or '33. Just after I was born, she was the same way, she was feeling lethargic, had no energy, frequent urination, all the typical things, we now realize, but the doctors didn't realize it back then. My parents lived in a small town, where I was born, Mount Holly, New Jersey, in the southern part of the state, about halfway between Philly and Atlantic City. They took Betty to the family doctor who treated our various illnesses, and he couldn't figure out what was the matter with her. So they took her back two or three times, and he still couldn't figure it. Well, finally she was just feeling terrible, and they went back, and he says: "I think I've figured it out, I believe she has," (oh, he sent her in the other room first), "diabetes, but unfortunately (to my parents only) I don't think she will live more than three weeks."

My mother passed out on that office floor, and when she recovered, my parents decided not to take his word for it. They went over to a near by Philadelphia hospital, where the doctors declared her diabetic, put her on insulin, and instead of just living three weeks, she lived 39 years more. So my mother loved to tell the story.

She was my oldest sister. She was 13 when she got it and 52 when she died. It was all over the family. My second sister was diagnosed as diabetic, I had four sisters total, and my second sister was diagnosed as a type 1 diabetic at about age 45. She is still living today, she's 77 or 78, and she lives with her diabetes successfully.

The oddballs in my family are the non-diabetics. And by the way, two of these non-diabetics, my middle sister and my own daughter, married diabetics. Can you believe that? It's so prevalent with us that they married into it when they didn't get it themselves. My father ended up with diabetes too, but not until about age 67 or 68. He was a very late type 1.

My father had a sister and a brother with diabetes. So three out of five of his family were diabetics, and three out of five of us.

My wife Joan died of lung cancer in 1993. She was a the world's most wonderful woman. I wrote a book about her too. It's called Immortal to Many, But Especially to Me. Anyway, she was wonderful with my diabetes, she had a instinct for it. She could hear it in my voice over the phone, she'd say "Art, get a snack, right away." I'd say "Why? I feel fine." She'd say, "Believe me, get a snack." She was always right.

I have two children, Vanessa is age 44, she has two girls, my lovely grandchildren. I have an adopted son living in South Carolina now, and he has two children.

You know, diabetes never stopped me from anything. We had it in the family, we accepted it, we lived with it, and it never interfered with education or work, travel or any of it. It was just a extra little problem with all those things. But I worked in the market research field for many, many years for a large fiber company, headquartered in Europe. I went to Europe six or seven times. When I went to Mexico, my wife usually traveled with me, the kids sometimes as well. Foreign travel was probably the roughest part of it.

The time difference made it a challenge, with my diabetes. There was 6 hours difference between here and Western Europe, largely where I went to, Holland, Germany, England as well. We tried everything to adjust, continuing to eat on American schedules and taking insulin accordingly. But they were all a little bit difficult, so we learned to snack, instead of eating three times a day. When I was in Europe, I'd eat six times a day -- very small meals, adjusting the insulin accordingly. It took us a while, but we figured it out.

Well, I don't want this to be taken out of proportion either, a typical type 1 diabetic, has at least one insulin reaction, one shock, a week. Some of them can turn serious, but most of them we defuse with a glass of orange juice or food of some type, and it doesn't become anything serious. But I've had maybe 14 or 15 really serious, and some had a touch of humor to them, and some had a real close call aspect to them. But still over 60 years with diabetes and only having, say 15 that really turned serious, that's less than 1 %. That's not so bad -- you take that many chances walking in traffic. Any of us, who say we didn't, are not telling the truth. It just is a normal part of it; it's not a deficiency on our part. It's a normal thing.

I guess the main thing that I feel about diabetes, other than the usual advice: be careful with your diet, follow a good diet, exercise as much as you can, test your glucose frequently, particularly with the type 1's, & take your insulin and all. Now these are normal bits of advice. Having done those things, think positively about your diabetes. I think about it as a problem, as something to face, but not something to fear. It's a background thing with me, I know it's there, and I test and take my insulin, the same way other people brush their teeth & comb their hair. It becomes second nature to me. I go ahead and live that life as full as I can. I was a bowler for 20 years, and a pretty good one at that. I traveled, I worked, I was successful at business, and I think the secret to it is positive thinking, it really is.

My mother used to quote Oliver Wendell Homes, who said: "If you want to live a long life, get a treatable chronic disease & take good care of it." It turned out to be good advice. She actually told me, and I can remember it distinctly, she said, "Art, if you take care of yourself, you will live a long life and probably outlive many of your peer group who won't be as careful as you are." I have followed that advice, and unfortunately I have watched many of my peers die off before me.

I have had some fun ones with the diabetic shock business. One I still laugh about. I went into shock early one morning when I was going to my business office, and I got on the elevator. I was on the third floor, and it had about six or seven floors. I got on the elevator, as I hear this story afterwards, people apparently spoke to me and I must have nodded my head or something but I didn't speak back. A fellow got on the elevator about 25 -- 30 minutes later, and I was still riding it, still going up and down in the elevator. He got off and went and found one of my business associates and said: "There is something a matter with Art, I saw him on the elevator 20 minutes ago and he's still riding up and down!" So they got me off the elevator and gave me some orange juice and I got kidded about it, I don't know how many times afterward, that Art couldn't find his floor, the ups and downs of diabetes and all the rest of it, but it's a lot of fun.

I had a good support network. My wife was wonderful, my mother, my sisters were great and my business friends were great and even strangers helped me out on many occasions. I tell a lot of those stories in my book. My publisher is RBI, International Carpet Consultants in Dalton, Georgia. We have a web site if people are interested in that, www.diabeticsurvivor.com . That will actually show them some pages from the book and my picture & tell them how to order.

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ASK THE DOCTOR

by Wesley W. Wilson, MD

Artwork: medical caduceus.

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 am a long term type 1 diabetic with a number of complications. I am having some odd stiffness in my hands, and am told it is "trigger finger." What is this, and what can I do about it?

A: I am sorry to hear about your problems with complications from diabetes. More knowledge is needed, to help persons with diabetes avoid complications or reverse them if they are present. Careful control of blood sugars reduces the likelihood of diabetic complications; but such "tight control" is difficult, and sometimes dangerous; for the tighter the control, the greater the risk of hypoglycemia (low blood sugars).

Let's talk about those "lows." They're not only frightening and uncomfortable; a "low" impairs one's judgement, and can lead to accidents and serious injuries. Most physicians who care for persons who take insulin for their diabetes can recite at least one serious auto accident in a person who became hypoglycemic while driving an automobile. It is vitally important to check blood sugars before driving a car. We diabetics tend to forget to do that; but it is important, and diabetics do need to safely operate motor vehicles. I remain concerned that regulatory agencies may wish to remove or restrict driving permits for insulin-using diabetics.

But, although tight control is difficult, it is possible. After all, 5% of the tight control participants in the DCCT (the Diabetes Control and Complications Trial) were able to maintain normal hemoglobin A1cs during the six years of that study

But back to your "trigger finger" problem. Tendons attach muscles to movable body parts. For example, a muscle in the arm contracts, pulling on a tendon attached to the finger, and the finger bends. The tendons move inside slippery tendon sheaths. If either the tendon or its sheath becomes sticky, like a rusty cable or a rough pulley, muscle pull on the affected tendon may result in jerky movement of the finger; or the finger may remain fixed until the force becomes very high - then it suddenly snaps or bends very quickly, as if pulling the trigger on a gun. The underlying problem seems to be increased "stickiness" in the tendon or tendon sheath.

Some people develop "trigger finger" from overuse of certain muscles or tendons, with inflammatory changes in the tendon or tendon sheath; but persons with diabetes have an additional problem. Glucose, if attached to the tendon or tendon sheath, causes stickiness, and this sticky glucose attachment to the tendons is called glycosylation. The same process of glucose attachment, this time to the hemoglobin protein in red blood cells, is what is measured in the A1c or glycosylated hemoglobin test that helps estimate average blood sugar level. The higher the average blood sugar level, the greater the degree of glycosylation of proteins, both in the red blood cells, and in places like tendons and tendon sheaths.

Persons with diabetes may and often do experience sticky tendons in a variety of spots: "Trigger fingers," "frozen shoulders," or the medical term "limited joint mobility of diabetes are terms used to describe manifestations of this problem. These problems may occur even in very carefully controlled diabetes; but keeping your sugars as near normal as possible is very important. It's nice to see the glycosylated hemoglobin test is readily available to see how effective attempts to control blood sugar have been.

You'd like a solution for your problem, and the good news is that often with blood sugar control, supervised stretching, and careful exercise, the problem will improve. Be careful not to overuse the affected tendons - attempt to increase joint mobility only under supervision. Some physical therapists have a good success rate - and can be found by contacting your diabetes educator or physician.

Anti-inflammatory drugs may help, but these drugs involve particular risks for persons with diabetes, since they may impair kidney function, especially if there is already any kidney problem. I'd be very careful about the use of these agents, either by prescription or over the counter.

Surgery can be helpful, but I feel it is a last resort, since many times the problem will improve with reduction of overuse, and with careful stretching and mobility exercise. I would again emphasize the importance of "supervised" use of the muscles and tendons.

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INSULIN RESISTANCE EXPLORED

by Peter J. Nebergall, Ph.D.

Photo: portrait. Caption: Peter J. Nebergall, Ph.D.

Diabetes Mellitus is not one, but two different conditions, that share the symptom of elevated blood sugars. Type 1 diabetes arises from insulin deficiency, from the absence of the hormone, and thus type 1 diabetics need to inject insulin, to preserve life. Type 2 diabetes arises from a body's inability to correctly and completely use the insulin it is producing, and we call that initial condition insulin resistance.

What is "insulin resistance?" What do we know about it? How can we change it? Insulin resistance is a serious condition, closely correlating with obesity, heart disease, and high blood pressure. We do not know the exact mechanism of insulin resistance, only that it is a measurable lessening in the body's ability to metabolize glucose, even though an otherwise adequate supply of insulin may be present. We don't know what the root cause is, but we suspect it is genetic (which would explain why type 2 diabetes so much seems to run in families).

Although there is close correlation between obesity and insulin resistance, it is not simple "cause and effect." Being overweight does not cause insulin resistance -- even though losing weight does indeed reduce insulin resistance. There are many overweight people who are not insulin-resistant, and these folks may never develop type 2 diabetes.

It appears that if a person carries the genetic trait for insulin resistance, but follows a healthy lifestyle (good diet, not too much of it, plenty of regular exercise), they may show little or no overt insulin resistance. If that same person slips into overeating and under-moving, one may expect the insulin resistance to become overt (obvious and apparent), and perhaps type 2 diabetes to appear. Taking it further, if such a person, overweight, under-active, takes control of their lifestyle, loses the weight, and commences a regular exercise program, the insulin resistance should drop, perhaps even into insignificance. This "diet and exercise" approach is the core of all good blood glucose self-management programs. There is no better argument for living a healthy lifestyle.

Insulin resistance as a syndrome cross-correlates with a number of potentially damaging conditions, most cardiovascular in nature. Although we cannot say which conditions cause insulin resistance, which are caused by it, and which are merely covalent, we know that aggressively reducing it, by lifestyle change and/or by medication, can both improve general health and lessen the severity and likelihood of diabetes complications.

Talk to your doctor. If you have it, your health care team can help you keep it under control. If you have progressed to full blown type 2 diabetes, your doctor can help you treat it, both with lifestyle change and medications, like Metformin, Actos, and Avandia, that reduce insulin resistance. There is much that can be done.

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DEALING WITH OBESITY IN CHILDREN

About 16 million Americans have diabetes, and approximately 90% of them have type 2, non insulin dependent diabetes (NIDDM). People with type 2 diabetes have insulin resistance, the inability to fully utilize their body's insulin to properly process blood glucose. Obesity and insulin resistance are closely linked -- the more excess weight, the greater the insulin resistance, and the harder it is to keep your blood sugars in the normal range. If you have type 2 diabetes, weight reduction is an urgent concern.

Current statistics tell us a majority of Americans (~55%, per the National Institutes of Health) are overweight or outright obese, and that more than 1/3 of America's children are overweight, some seriously. Many studies report a great increase in NIDDM among younger people, and link this to the observed 50% increase in childhood obesity in the last two decades.

Why are so many more children overweight? It is the usual diabetes answer: Diet and Exercise. One generation played outdoor games, another shuttles between television and the computer. One was never without a football, baseball, tennis racket, maybe a hockey stick... And the other, to echo a recent Canadian report, "has never been without a remote control in its hand." People don't move as much as they used to. One report states the average American child spends 24 hours a week watching television; "Time that could be spent in physical activity," according to the National Institute of Diabetes, Digestive and Kidney Diseases.

And there's Diet. As more Americans make "convenience foods" (what we used to correctly call "junk food") a significant part of their diet, we gain weight accordingly. We eat "til we're full," and is it any wonder our children do the same?

What to do? First, be a role model. If your children see you active and having fun, they'll want to emulate you. You can't be a couch potato, and expect, or honestly ask, your children to be physically active. Do your family activities include exercise, or do they mostly consist of evenings channel-surfing? Remember, you can probably use the exercise too.

Second, cut way down on the junk food, and work on healthy portion sizes. Your doctor can help you find a dietitian, who'll work with you on healthy diet and sensible amounts. More is not necessarily better, and your children are watching how you eat. Again, you'll help yourself too.

Third, never forget the power of praise. When your children find a positive example, a parent, an athlete, or perhaps a favorite actor, agree, and then make that the time to talk about "how they look so good." Children need to learn that fitness is not granted, it is achieved -- and that they can achieve it, if they put in the work.

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PANCREAS AND ISLET TRANSPLANTATION

by Vanesa Sutherland

Preface

The Diabetes Institute for Immunology and Transplantation (DIIT) at the University of Minnesota is devoted to the research and development of better treatments for diabetes and its eventual "cure." In doing so, the DIIT is constantly promoting education on pancreas and islet transplants as the only and most physiological treatment to make individuals with type I diabetes insulin-independent.

With more than 11,000 pancreas transplants performed worldwide since 1966, and the recognition by the American Diabetes Association (ADA), American Medical Association (AMA), and numerous insurance companies, pancreas transplantation has gained acceptance among physicians and the general public. In 1966, the University of Minnesota established the feasibility of the procedure, training surgeons and transplant physicians who have founded pancreas transplant programs nationwide as well as internationally. There are currently 96 pancreas transplant programs in United States. Even without Medicare coverage, more than 1000 transplants are being done annually.

More than 1000 pancreas transplants have been done at the University of Minnesota, nearly 10% of the world's total. The University of Minnesota's program is also a pioneer in living related donor segmental pancreas transplants, and the only program that applies this cutting edge procedure routinely before complications have appeared. More than 100 pancreas transplants were done at the University of Minnesota in 1998.

The pancreas, a small, elongated organ shaped like a little trout, is located in the left side of the body, underneath the stomach and extending transversely through the abdomen. It contains round clusters of cells called Islets of Langerhans (2% of the pancreas) that are interspersed in the glandular tissue. The latter tissue accounts for pancreas exocrine function, and helps the digestion process by releasing enzymes into the intestine. The endocrine function is performed by specialized cells in the Islets. Those that are responsible for the production and release of the hormone insulin into the blood are called beta cells. Insulin allows every cell in the body to use the different sources of energy, such as fat and glucose, to perform their function. The loss of, or the inability of, beta cells to adequately produce the insulin needed by the body is called diabetes.

A tremendous advance in treating diabetes was accomplished by Dr. Frederick Allen in 1917. He pointed out that diabetes was not just a problem with carbohydrate metabolism, but with protein and fat as well. The total calorie intake had to be reduced to the minimum that would allow subsistence while minimizing the acidosis that occurs from metabolism of the three offenders in the absence of insulin. The dilemma was that patients either died soon after diabetes onset or tolerated diabetes for a few years until they died of starvation. Dr. Allen's approach was severely criticized, but, as he noted, dying of diabetes is much more painful than dying of starvation, and "after all, do we have an alternative to prolong a diabetic life?" With this treatment Dr. Allen was able to prolong his patients' lives for a few more years.

Insulin was discovered in Toronto in 1922 by Dr. Frederick Banting. At that time, insulin was seen as a cure for diabetes; indeed, several patients who were alive, thanks to Dr. Allen's treatment, were able to use insulin and live longer than previously expected. With insulin's extensive employment as a treatment, diabetes was no longer a mortal disease.

Within that same year, the idea was conceived that maintaining normal glucose levels in the diabetic individual would lead to a quality of life equal to that of a non-diabetic. Therefore, a standard treatment based on several daily insulin shots, dietary restrictions, and exercise became the norm. However, despite insulin treatment, diabetic complications appeared over time. Diabetics treated with insulin no longer died from diabetic ketoacidosis, but eventually suffered devastating organ deterioration and, thus, a poor quality of life. Because of the idea or possibility of insulin-related organ damage, there was a liberalization in treatment during the 1960s.

In the 1980s several small studies on intensive insulin treatment and complications were conducted in Europe, with mixed results. In 1983 the United States, the Diabetes Control and Complications Trial (DCCT) was begun. This was the longest and first scientifically controlled study on diabetic complications, and confirmed the earlier notion that tight control is more effective than a liberal regime in allaying complications. Complications were not eliminated, however, and quality of life and patient survival for the diabetic individual remain well below that of the general population. New paraphernalia (disposable syringes, Humulin insulin, home blood glucose monitors, etc.) and procedures to treat diabetic complications (like retina photocoagulation), along with a vast and controlled health support system, have improved the effectiveness of intensive therapy. Tight control, achieved by three to four shots of insulin daily, adjusted according to four or five daily glucose determinations, frequent visits to physicians, exercise, and diet restrictions, can now at least reduce the risk of kidney failure and blindness. Even with strict control, however, complications are not avoided entirely.

The downsides of intensive treatment are frequent hypoglycemic episodes (very low blood sugar), weight gain, and the tremendous investment of time and energy. The DCCT has shown, on one hand, that a tight control is instrumental to retard or even avoid some of the most devastating diabetic complications. On the other hand, some individuals develop some complications despite intensive therapy. The amount of continuous social resources and effort employed to partially substitute the failed natural mechanism of insulin regulation is enormous.

There are one million insulin-dependent diabetics (type 1) in America, with 30,000 new cases diagnosed each year. Diabetes is currently the leading cause of kidney failure and blindness in adults, the leading disease-related cause of amputation and impotence, and ranks among the most common chronic diseases in children. One third of all type 1 diabetic individuals have one or more serious complications.
Pancreas and Islet Transplantation

Historically, pancreas transplants were first done only in conjunction with a kidney transplant, based on the notion that diabetic individuals would better stand the rigors of immunosuppression needed to keep the kidney graft if their diabetes was also corrected. At a time (1960s and 70s) when most physicians opposed kidney transplants for diabetic patients, a group of doctors from the University of Minnesota fought the battle. Today many centers perform double organ transplants to treat diabetic individuals with kidney disease, either a simultaneous pancreas and kidney (SPK) transplant or sequential transplants, usually the pancreas after the kidney (PAK). A few centers, including the University of Minnesota, do pancreas transplants alone (PTA) before kidney disease occurs. The first human islet transplant was done in 1974, eight years after the first pancreas transplant at the University of Minnesota. Islet transplantation has been under continuous development since that time, while pancreas transplants have become routine.

How Pancreas Transplants are Done

The recipient's own organs are left in place and the new organs are placed in the lower abdomen or pelvis. Preferably the pancreas goes to blood vessels on the right side and the kidney, when included, to the left. A whole pancreas is procured from a cadaver donor, or half pancreas from a living donor. In the case of a cadaver donor, the duodenum (the part of the small intestine joined to the stomach) is also transplanted, as the head of the pancreas is intimately attached to it. In the case of a living donor, the tail of the pancreas is surgically separated from the head during the procurement operation in the living donor, and the head remains in the donor, while the tail is transplanted to the recipient.

Bladder-Drained Cadaver Donor Pancreas Transplant

The surgeons first prepare the donated pancreas graft for implantation into the recipient. Both ends of the cadaver donor duodenum are closed and a new opening is made. The graft is then attached in three places to the recipient:

1. The portal vein coming from the graft is sewn to the recipient's iliac vein. (The iliac vein is the main vein that takes blood from the lower half of the body back to the heart.)

2. The pancreatic arteries of the donor pancreas are sewn to a graft of the donor's iliac artery, which is then sewn to the recipient's iliac artery. (The iliac artery is that artery which supplies the lower half of the body with blood from the heart.)

3. For pancreas-alone transplants, the duodenum's new opening is usually sewn into the recipient's bladder, as shown above. The bladder then receives the exocrine pancreas secretions (enzymes). Alternatively, the graft duodenum can be sewn to the recipient's intestine, as shown below (enteric drained). This is now usually done when the patient also receives a same donor kidney. There are different advantages and drawbacks to each technique. In the case of a living donor segmental transplant, there is no duodenum and the duct of the pancreas is sewn directly to the bladder or bowel, depending on the technique chosen.

The first two attachments establish blood flow to the pancreas, allowing insulin release. The third one allows the exocrine enzymes (and lipase) to be drained. When drained into the bladder, the urine is tested regularly for amylase levels. Low amylase excretion is a good marker of a pancreas graft rejection episode needing treatment, particularly for pancreas alone grafts. Serum amylase and lipase may also increase during rejection, but are less specific markers than urine amylase.

In the presence of a same-donor kidney graft an increase in blood creatinine is a good parameter of rejection that is probably affecting both organs. Thus bladder drainage is less important for SPK transplants and enteric drainage can be used from the beginning.
Enteric Drained Cadaver Donor Pancreas Transplant

Drainage into the bladder can lead to some urinary tract problems in about 10% of recipients due to irritation from sutures or pancreatic enzymes. The recipient may then need to undergo additional surgery in which pancreas graft drainage is switched to the intestine.

The surgical complication rate leading to graft loss after the transplant has been 9%. No fatalities during the actual surgery have occurred.
Living Donor Segmental Pancreas Transplant

How Islet Transplants are Done

Historically, the early complications with the exocrine portion of the graft (98% of the pancreas is exocrine tissue), led to the idea of isolating and transplanting the islets in an easier and non-surgical way. It continues to be deemed a promising approach.

The pancreas is procured from a cadaver donor (due to a current islet success rate of only 10% at one year, it is preferable to use cadaver donors). After the Islets of Langerhans, which contain the insulin-producing Beta-cells, are separated from the exocrine tissue (islet isolation) by a machine, they may be cultured for two to three days before transplantation. Under X-ray guidance, islets are injected into the recipient's portal vein. Once in the portal vein, the blood flow and pressure carries the islets to the liver where they encounter small-diameter capillaries which cannot be traversed through by the islets. Thus, the islets are physically lodged in place, and new capillaries grow to incorporate them in an anatomical form.

Islet Allograft Procedure

An islet transplant alone from another person (allograft) is still being perfected. Islets present a special and not-fully-understood susceptibility to rejection and to immunosuppressant side effects that may prevent the cells from functioning or surviving. Furthermore, there is not yet a marker to indicate rejection episodes and, thus, the opportunity to reverse the immunological attack is missed.

Currently, islet-kidney transplantation is performed for individuals that need a kidney but cannot have extensive surgery. Although the insulin independence percentage is lower than for pancreas transplants, one-third of the recipients have improved glucose control.

Islet transplantation alone, though, for people whose pancreas is removed to alleviate pain from pancreatitis, can be done with a 75% success. In these cases the recipient's own pancreas is the source of the islets (islet autograft, 1-aut) with no need for immunosuppression. This fact, and the development of new drugs (now under investigation), encourages patients, physicians, insurance companies and pharmaceuticals to keep trying.

What Can Pancreas or Islet Transplant Achieve?

A successful pancreas transplant recipient does not need to inject insulin or continuously monitor glucose. The new pancreas automatically adjusts the amount of insulin needed. Hyperglycemia or hypoglycemia (diabetic syndrome) is eliminated.

It is important to take into account the graft survival rates according to the kinds of organs transplanted and the sequence in which they are transplanted. For example:

1. A person who suffers from diabetes and has developed kidney failure may prefer to become insulin-independent and dialysis-free in one surgery by undergoing simultaneous pancreas and kidney (SPK) from a cadaver or living donor if health allows extensive surgery. If extensive surgery is contraindicated, simultaneous islet and kidney (SIK) transplant from a cadaver donor is a good option.

2. A diabetic individual with a previous kidney graft, or an individual with the opportunity to receive a kidney from a living donor, can proceed first with the kidney and then wait for a cadaver pancreas or islet [pancreas-after-kidney (PAK) or islet after kidney (IAK)]

3. Diabetic individuals who do not need a kidney but want to prevent complications from diabetes or individuals who suffer frequent hypoglycemia episodes or serious problems controlling diabetes may decide to have a pancreas transplant alone (PTA). In the case of SPK or SIK from the same donor and PAK or IAK from different donors, the decision implies that kidney transplant (and immunosuppressive drugs) is preferable to dialysis and the further surgery to add the pancreas is preferable to remaining diabetic. In the case of PTA, an individual must make an assessment, based on medical findings, of the future risk of diabetes and the burden of tight control versus the future risks of taking drugs. Below is a table with the recent insulin independent percentages a year after transplant according to categories :

In the past, half of the SPK transplant functioned for more than 14 years, while for PAK and PTA grafts half functioned for more than five to six years. With the new anti-rejection protocols we expect the proportion of grafts functioning long-term to increase. The effect of a pancreas transplant on diabetic secondary complications, when performed after the complications have already appeared or have been present for some time, varies. Early and mild neuropathy is completely reversed, while advanced neuropathy is improved in about half the cases and stabilized in the rest; early nephropathic (kidney) lesions are reversed after five to ten years, even in the presence of nephrotoxic immunosuppressants. Retinopathy stabilizes after three years post-transplant. Cardiac and gastric function appear to improve. Cholesterol and triglyceride levels improve.

Immune System and Immunosuppression

The immune system is in charge of protecting the integrity of our bodies. In doing so, it has developed several mechanisms to eliminate everything that is not recognized as part of the original genetic message encoded in our DNA. Anything not recognized as "self" is meant to be allowed no more than a temporary stay in our bodies. There are different ways and levels to protect us.

Externally, skin acidity, hair, and body fluids prevent some pathogens from entering the body. Internally, the immune system acts at cellular and molecular levels in a hierarchical and specialized fashion. First, the foreign substance (antigen) is recognized as non-self (after being degraded into peptides by macrophages). Second, an attack is organized to eliminate the offender. A set of inherited proteins called the Major Histocompatibility Complex (MHC) or Human Leukocyte Antigens (HLA) are expressed on the surface of all cells and contain genetically specific information about our tissue. Our macrophages, when presented with foreign material, use the MHC to help signal other cells called lymphocytes, (a type of white blood cell, T-lymphocytes and B-lymphocytes) to initiate the attack specifically against what is foreign. If what is foreign is an allograft with a different set of MHC proteins (transplant antigens), the donor macrophages can directly signal the recipient's T- and B-lymphocytes to begin an attack without going through the recipient's macrophages.

The immune system has two main characteristics: 1. Memory. A second exposure to the antigen reactivates the T- and B-lymphocytes with the rapid production of pre-formed antibodies to efficiently combat the invader; and 2. Specificity. The immune system directs an action toward a particular antigen. In some cases, the immune system does not work properly and attacks one's own cells in a specific organ because the genetic information is not recognized as self (autoimmunity). For example, type 1 diabetes is the result of an attack of the immune system against its own pancreatic insulin-producing Beta-cells. Other examples of autoimmunity are psoriasis and rheumatic fever.

To protect non-self organs (the transplanted grafts) from an immunological attack (rejection), the daily oral use of drugs that impair the body's immune system action is required. Presently, drug specificity (action directed just to block the attack to the organ transplanted) is not high, so the organ recipient is generally more susceptible to infections. Fortunately, people have been exposed to several pathogens before using immunosuppression, and once exposed to the same pathogens after the transplant, the immunological memory will require less energy for the immune system to act.

The percentage of grafts lost to infections for all recipient categories (SPK, PAK, PTA) is 4%. After the transplant, recipients usually take three different immunosuppressants, as well as antiviral and antifungal drugs, two or three times a day, and undergo weekly lab tests during the first three months post- transplant. After that, immunosuppressant doses are tapered down and, if there are no rejection episodes, Prednisone (one of the three immunosuppressants), is stopped. The antifungal and antiviral drugs are also stopped after about three months. Medication is reduced to twice a day and frequency of laboratory tests are eventually reduced to once a month. The probability of rejection episodes is highest during the first six months, but in most cases can be reversed with temporary increase in dosage, and intravenous administration of anti-rejection drugs.

The figure below shows the side effects of different drugs (circles), the side effects shared by two or more drugs (superimposed areas), and the general side effects of immunosuppression (rectangle encompassing circles). There are some important things to note:
1. Not everyone suffers the same side effects, and over time, doses can be adjusted or medications can be changed.
2. For reasons that are not clear, pancreas recipients experience fewer malignancies (like skin cancer and lymphoma) than other organ recipients. New protocols and tests allow stopping of Prednisone, thus avoiding its side effects.

Who is a Candidate?

1. Type 1 diabetics who need a kidney or other organ transplant and will be on immunosuppressants, or people who are already taking immunosuppressants for other reasons (autoimmune disease) should have a pancreas or islet transplant.

2. People with difficulty controlling diabetes, who experience frequent hypoglycemia or hyperglycemia or those with a predisposition to certain serious complications are also candidates. Also, those who want to prevent diabetic complications and assume the risks of immunosuppression rather than manage diabetes can be considered.

3. In people with heart disease, a complete evaluation is necessary before the transplant. Some cardiac anomalies can be fixed; if not, pancreas transplant surgery may not be recommended.

4. Blindness is not a contraindication for the transplant since quality of life will be improved by not having to manage diabetes after a successful transplant.

5. Most PTA recipients have been between 18 and 58 years old, but a small number of pancreas transplants have also been done in pediatric patients whose lives were threatened or disrupted by diabetes.

The Average Cost and Length of Hospital Stay

Most insurance companies cover the procedure and the drugs, particularly for those who also need or have had a kidney transplant. In the case the insurance company initially refuses coverage, the patient is encouraged to establish a dialogue with her/his insurance company. The transplant center physicians can provide supporting data for the insurance company. Medicare will cover SPK at selected centers soon, and drugs are covered for the first three years.

Making Contact

If you have seriously decided to explore pancreas or islet transplant as a better treatment for diabetes, you should make an appointment with a transplant surgeon to be evaluated.

First, you will be oriented in detail about the process by a transplant nurse in the transplant center. After that, a transplant physician will discuss with you which modality is most appropriate for you (SPK, PTA, PAK, IK, IAK) and the possibility of a living donor kidney and/or pancreas vs. being placed on a waiting list for a cadaver donor organ. Several tests must be performed as a part of a complete work-up to better assess your general health status as well as to determine your tissue or HLA type for matching. In the case of a potential living donor, the donor will also be carefully instructed of the risks and will undergo several tests to determine whether or not the candidate will retain enough organ function to sustain his or her own health as well as how suitable the organs considered are for the recipient..

Cadaver and/or Living Donor

The University of Minnesota started offering segmental pancreas transplants (half a pancreas) from living related donors in 1979 when the rejection rate for organs from cadaver donors was significantly higher. Since then, the results achieved with cadaver-donor pancreas grafts have dramatically improved and the success rates are close to that of living-donor pancreas transplant. More than 100 segmental pancreas transplants have now been done from living donors but the emphasis has been changed to those in need of both a kidney and pancreas in order to avoid dialysis or for those hard to match. Of 25 kidney and pancreas living-donor transplants done during 1994-98, all the recipients are alive, 24 have functioning kidneys (96%) and 21 (84%) have a functioning pancreas.

All of the living donors are alive, but some have been treated for complications, such as fluid collection (3) or abscesses (1). In overweight donors, some have developed abnormal glucose tolerance, so thin donors are preferred.

A recipient ideally is matched for two things with either a living or cadaver donor:

1. The donor and recipient should be ABO compatible. This means that the recipient and donor have either the same blood type or a compatible blood type. For instance, an 0 individual can always be a donor to the other blood types while he or she can usually only receive type 0 blood or organs.

2. They share one or more of the six HLA antigens that are taken into account (two each in regions A, B, and DR). Matching reduces the incidence of rejection episodes as well as the probability of graft failure from rejection, and in the long term is associated with lower doses of immunosuppressive drugs.

The table below shows the incidence of graft failure from rejection according to number of HLA mismatches (out of six) between a cadaver donor and recipient. As is evident, matching is more important for a pancreas done alone than for one done with a kidney. The results with living donors are better regardless of match.

How Does The Waiting List Work?

Your transplant center will enroll you in a nationwide central database which has access to the information on all the prospective recipients. The list is dynamic and the time you wait for a cadaver donor transplant depends on:

1. How long you have been on the list.

2. Your blood type: people with blood type 0 will wait the longest due to the fact that more than half of the population is blood type 0. A person with type 0 can only receive blood type 0, though they can be donors to other blood type.

3. Your HLA type: certain antigens are more common than others, so you will obtain a good match sooner if you have several common antigens.

4. Your level of antibodies formed to potential donors. Previous blood transfusions, transplants, or pregnancies can cause formation of antibodies to other individuals, increasing the probability you will be immunologically reactive to possible donors.

The tissue and blood type of every cadaver donor are matched with the prospective recipient list and the offer is made based on a combination of matching and waiting time. The donor organs are first offered locally, then regionally, and last, nationally. The people listed are ranked according to best match and longest time in the list. A perfect match has the highest priority and if there is more than one goes to the person waiting the longest. If there are no perfect matches, waiting time is given priority and the organ is offered to the ones waiting the longest with the best match. When a high antibody person has a negative crossmatch (nonreactive), she/he is given priority because of the low chance to get a suitable match in the future. The organ is offered for the patient through the transplant center where the prospective recipient is enrolled, and if the surgeon considers it a good offer the recipient is called. Once accepted, a final crossmatch is done to confirm that the recipient is not reactive to the donor.

The average waiting time for a SPK or SIK is 18 months for blood type 0 individuals, and 12 months for the rest; for PTA and PAK or islets after kidney it is eight months. Individual waiting time can be longer or shorter depending on the factors mentioned above. Recipients with living donors avoid waiting time.

Perhaps the most important and comprehensive indicator of the effectiveness of pancreas and islet transplant is how the recipients feel about it. There can be side effects from the immunosuppressants, and some patients have infections post-transplant, such as CIVIV, bladder irritation, or dehydration due to the pancreas' exocrine enzymes being excreted through the bladder. However, nearly all recipients express satisfaction with the transplant due to more flexibility in their daily life and experience a better emotional and psychological attitude. Sexual and overall satisfaction is well above that of kidney-alone recipients, and close to general population. Pregnancy may be undertaken with success but should be carefully monitored by the recipient and the physician. Results from a multi-center study reveal that the recipients gave birth to babies with the same rate of complications as the general female population, although some complications, like rejection episodes or loss of a graft were registered.

Names of donors and recipients will be provided upon request if you have questions about the experience.

Summary and Conclusions

1. Pancreas and islet transplantation has developed through the combined endeavors of physicians, health scientists, pharmacists, governmental institutions, private insurance companies, patients and their families, thus transforming the individual and social reality of diabetes. Technology, institutional development and societal maturation reach an historical peak in making possible a better treatment for diabetes.

2. Presently, pancreas transplantation has a success rate of over 80% in patients who also get a kidney transplant (SPK and PAK), and over 70% in those who only need a pancreas (PTA). It dramatically increases day-to-day quality of life, can prevent diabetic secondary complications, and may reverse some. The DCCT showed that tight glucose control makes a difference in respect to diabetic complications. Tight control is very hard to achieve short of a pancreas transplant, and transplantation has emerged as a safe, flexible and very effective treatment.

3. Immunosuppressive drugs are used: a) To force the recipient's system to accept the transplant (minimize the body's ability to reject); b) To prevent recurrence of diabetes (as diabetes is an autoimmune disease); In addition, c) Immunosuppressants have to be taken daily to prevent rejection. There are side effects associated with them, and it is their proper management over time that makes the difference in the delicate balance between side effects and rejection. d) New, more specific drugs are on the market or in investigational stage. e) Tactics of safe immunosuppression are: 1. Stop prednisone six months post-transplant, 2. Reduction of all drug doses over time, and switch drugs according to side effects, and 3. Use best HLA match combinations.

4. Although less successful than pancreas transplantation (but with a lower complication rate), islets are recommended for people who cannot have or want to avoid extensive surgery. Islet function may be inhibited by some immunosuppressants, and islet transplantation could profit by introduction of new drugs. The facts that islet autotransplantation has a 75% success rate in preventing diabetes after pancreatectomy for pancreatitis in non-diabetic recipients, and that there are a few diabetic individuals insulin independent for more than four years after islet allografts, encourage scientists and patients to continue trying.

5. Eventually, encapsulated islets (human or animal) or a vaccine or genetic engineering may cure diabetes without the need for immunosuppressants. Perhaps something else that we are not able to imagine today will do it. According to experts, a more safe and effective treatment than transplantation is not around the corner. Supporting the investigational alternative treatments to diabetes is the gift of today's man to the man of the future in the same way that we have received our gifts from the past. But certainly with a limited extent of life, the today's present for today's man is having transplantation as an option.
Future

There are not enough human organs to offer pancreas or islet transplantation to all diabetics. One way to overcome the organ shortage is xenotransplantation (transplanting islets from one species to another), and the Diabetes Institute is actively involved in research on this topic. The Diabetes Institute receives generous donations to support these and other studies from people who firmly believe that life is more than mere survival...

About The Author

Vanesa Sutherland holds a BA in Economics; a diploma in Finance; and a MS in Artificial Intelligence. She became diabetic at age four, and experienced several secondary complications from diabetes. In 1995, she received a kidney and half a pancreas from her mother. Vanesa volunteers part of her time to the Diabetes Institute for Immunology and Transplantation.

Contact the Institute (located at Fairview-University Medical Center) at: Box 193, 420 Delaware Street SE, Minneapolis, MN 55455; telephone: (612) 626-2101; website: http://www.DiabetesInstitute.org For more information about transplantation, contact Fairview-University Medical Center, Transplant Unit; telephone: 1-800-328-5465.

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BOOK REVIEWS

by Marilyn Helton

According to the National (USA) Diabetes Fact Sheet, released November 1998, the prevalence of diabetes by race/ethnicity in people 20 years or older was as follows: Non-Hispanic persons of African-American ethnicity have the highest percentage of diabetics in their population (10.8%). This is followed by Mexican-Americans (10.6%), American Indians and Alaskan Natives (9.0%), and non-Hispanic Whites (7.8%). Diet, with regard to cultural diversity, is a significant factor in diabetes, just as it is in cancer incidence.

THE NEW SOUL FOOD COOKBOOK FOR PEOPLE WITH DIABETES, by Fabiola Demps Gaines, RD, LD, and Roniece Weaver, MS, RD, LD, is the first African American cookbook for people with diabetes.

According to the authors, when the first slaves arrived in Virginia around 1619, common African-American foods included rice, beans, cornmeal, black-eyed peas, sweet potatoes, greens and onions. Foods were usually flavored with meat scraps (usually "fatback" from hogs), chiles from the Caribbean and molasses. Although diets were predominantly vegetarian, with some fish, possum or squirrel for flavor, foods were boiled, fried, roasted or baked. Stews and thick gumbos, liberal use of molasses, and fat-laden gravies provided calories. African-Americans used salt and sweeteners in abundance, but, due to long hours spent in hard manual labor, suffered few ill effects from the excess.

Authors Gaines and Weaver show the reader how much of the hypertension, heart disease, and diabetes plaguing the African-American population can be avoided by making easy changes to traditional soul food recipes without losing too much of the flavor. The basics of healthy food preparation and menu planning are incorporated with suggestions for cooking with traditional herbs and spices, along with advice for reducing fat, calories and sodium. Portion sizes are given to aid in blood sugar control and weight loss, as well as complete nutritional information and official ADA exchanges.

Now you can experience palate-pleasing soul food recipes such as Barbecue Pulled Pork, Hoppin' John, Hoe Cake, Soul Slaw, Collards with Smoked Turkey, Chicken and Dumplings, Key Lime Pie, Rice Pudding, Sweet Potato Pound Cake and more in The New Soul Food Cookbook. Published by the American Diabetes Association, ©1999, $14.95.

I had a great time spending my Christmas cash gifts last year, and one of my favorite treasures was DIABETIC DESSERTS, by Betty Wedman, PhD, RD. (Ms. Wedman, past president of the American Association of Diabetes Educators, also authored the best-selling Quick & Easy Diabetic Menus).

In Diabetic Desserts, Betty Wedman offers people with diabetes more than 80 delicious and easy-to-follow recipes for desserts that are good-tasting and health-conscious. I found myself in a full-faced grin as I read her dedication, "To all those individuals with diabetes who thought I was unscientific when I told them to use sugar instead of sugar substitutes in their recipes." She bases her statement position on the most recent ADA guideline which states that ". . . scientific evidence has shown that the use of sucrose as part of the meal plan does not impair blood glucose control in individuals with type 1 and type 2 diabetes."

You can enjoy a wide variety of rich-tasting, delicious recipes for cookies, cakes, muffins and quick breads, pies, tarts and tortes, puddings and custards, crumbles and cream puffs, snacks, sauces and sorbets, as well as holiday favorites and dessert beverages in this neat little cookbook. Wouldn't you just love a taste of Cappuccino Pudding Cake, or a bite of a Macadamia White Chocolate Cookie? How about Cookies and Cream Cheesecake, Chocolate Swirl Brioche, Mud Pie or some Lemony Bread Pudding?

Each recipe in Diabetic Desserts includes complete dietary information, and is based on the new American Diabetes Association recommendations and revised exchange lists. The recipes are low in sugar, fat, sodium and cholesterol—making these treats healthy as well as a sweet addition to your meals. If you have a sweet tooth as finely tuned as mine, don't miss this wonderful dessert book. I highly recommend it!

Diabetic Desserts, by Betty Wedman, PhD, RD., ©1996, published by Contemporary Books, $12.95.

Please join me again as we explore our choices for some good summer reading. Until then, stay healthy and enjoy every moment. Each one is a gift!

Marilyn Helton, type 2 diabetic since 1993, is the publisher of CINNAMON HEARTS --The Art of Living A Winning Diabetic Lifestyle, a positive-power online e-zine for diabetics and their families. You can find more of Marilyn's book reviews, articles and recipes online at: http://diabeticgourmet.com, www.fabulousfoods.com, www.practicalkitchen.com, or Cinnamon Hearts website: http://members.xoom.con/cinnhearts/

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HE OVERCOMES CHALLENGE, BY THOUSANDS OF FEET!

by J. Michael Kennedy

Photo: climbing a mountain. Caption: Erik Weihenmayer.

(This article appeared in the March 2001 edition of the BRAILLE MONITOR, published by the National Federation of the Blind. Reprinted with permission.)

From the MONITOR Editor: On Friday, January 5, 2001, the following story appeared in the Los Angeles TIMES. It sets the stage for the NFB 2001 Everest Expedition, which is scheduled to begin with the team's departure from the U.S. for Khatmandu on March 23. Here it is:

At the moment a 32 year-old adventurer named Erik Weihenmayer is in Antarctica, climbing the 16,066 foot Vinson Massif, the tallest mountain of the frozen continent.

If he succeeds, it will be another step toward his goal of climbing the tallest peak on each of the world's seven continents. He's already climbed those of Africa and North and South America. And in the spring, Weihenmayer will join a team of nine other experienced climbers to tackle the world's tallest peak, Mt. Everest.

What sets the Golden, Colorado, resident apart is that he's blind. Not just legally blind, but lights-out blind. Even so, he has developed himself into a world-class climber, by dint of superb conditioning.

"Believe me, it's not tokenism," said Everest climb leader Pasquale Scaturro of Lakewood, Colorado. "No one treats Erik like he's a blind climber. He gets really ticked off if we do."

Scaturro, veteran of two previous Everest expeditions, should know. He spent weeks last year with Weihenmayer as they attempted to climb Nepal's 22,486-foot Ama Dablam, only to be turned back by brutal weather 2,000 feet from the summit.

Scaturro speaks with awe as he describes Weihenmayer's athletic abilities, honed by years of punishing workouts that allowed him to push the limits of sightlessness.

Besides mountaineering, the former schoolteacher turned motivational speaker is also a skydiver and skier, long-distance biker and marathoner, wrestler and scuba diver, ice and rock climber.

Weihenmayer has received numerous awards, including induction into the National Wrestling Hall of Fame. Last summer, he delivered the pledge of allegiance at the Republican National Convention in Philadelphia. And next month, just weeks before the Everest attempt, Penguin Putnam/Dutton will publish his autobiography, titled Touch the Top of the World.

Born with a rare and incurable eye condition called juvenile retinaschesis, Weihenmayer's sight began to diminish gradually even as his mother Ellen sought to find some form of treatment. And just as he was going completely blind at age 13, his mother was killed in an auto accident.

Ed Weihenmayer, Erik's father, recalled those years after his wife's death as difficult for the family, but particularly for Erik, who was angered by the darkness that had engulfed him. But the elder Weihenmayer, a former Air Force attack pilot and Wall Street broker, did not let his son wallow in self-pity.

Instead he set him on a path of goals normally reserved for the very fit and sighted. The two of them, along with two older brothers, hiked the mountains of Peru and the rugged trails of northern Spain. It was, as Ed Weihenmayer put it, a way to bond the family, "to create the kind of glue" that his wife had provided.

But the son soon surpassed the father in athletic accomplishments, with minimal tools employed to compensate for blindness. Lead climbers wear a tiny bell so Weihenmayer can track their positions. Scaturro recalled that, on last year's climb of Ama Dablam, the Sherpa guides refused to believe that Weihenmayer was blind. "They'd jump out in front of him, waving their hands, trying to make him flinch," said Scaturro, a geophysicist specializing in oil and gas exploration.

And what makes Weihenmayer try these things? "It's because he's got the same sense of adventure that we all have," Scaturro said.

And what about Everest? Again, Scaturro is quick with a reply about the ascent, which will be along the same route described in Into Thin Air, the bestseller about an ill-fated expedition.

"He's ultra prepared," said Scaturro, who has reached the summit of Everest once. "Everest is no technical challenge for this guy. He's probably way more qualified than 80 percent of the people who climb Everest."

The Ama Dablam climb last year and the Everest expedition this spring are sponsored by the Baltimore-based National Federation of the Blind. Barbara Pierce, the organization's director of public education, said the idea is to show people that blindness and adventure can be combined, that the bottom line is that ten experienced climbers will make the assault on Everest. It's just that one will be blind.

"It's so important to get the world to recognize . . . this bold attitude about the human capacity to be victorious in the face of challenge," she said.

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NEWSLINE FOR THE BLIND

The National Federation of the Blind announces the availability of Newsline, an electronic publication of major daily newspapers, specifically tailored for blind and visually-impaired readers. With 69 regional "hubs" in 33 states, Newsline electronically "reads" all of each day's edition, which is immediately made available via modem to the local distribution centers. Users telephone the nearest local center (or place a long-distance call to the National Center for the Blind) and listen to the articles they choose, read to them in a synthesized voice. The reader is free to jump between articles, sections, and publications, and to pick the speed of reading to suit their needs. There is no subscription fee or other charge to access the system (although long-distance phone charges may apply, if the nearest local service center is not in your vicinity).

Newsline is not the Internet, and no computer is necessary to use it. The system is easy to learn, and easy to access. Service is available to any person at least legally blind, and again, there is no charge.

USA Today, The New York Times, The Washington Post, The Los Angeles Times, The Toronto Globe and Mail, The Wall Street Journal, and the Chicago Tribune already participate. More publications, including local papers, are expected to join shortly. As the system expands, even more blind individuals will have rapid and comprehensive access to daily print news media, a substantial improvement over "live reader" services. Our goal is to make the service available to every blind person in the country, and soon.

The NFB is looking for individuals and organizations willing to sponsor and maintain more new local distribution centers, in areas not yet served. For further information, about participating or sponsorship, contact Newsline Network, National Federation of the Blind, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314.

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WE ARE ROYANNE'S VASCULAR SYSTEM

by Royanne R. Hollins

Photo: portrait. Caption: Royanne R. Hollins.

From the Editor: The following is a unique, "from the inside," view of long-term diabetes. Royanne Hollins has experienced far more than her share of ramifications, yet never wavers in her determination to live life to the fullest. With minimal editing, here is her story.

Being greatly affected by a condition known as type I insulin-dependent diabetes, we have a story to tell about Royanne: We are arteries, veins and capillaries. We twist, wind and course throughout her body. We stretch 60,000 miles in length. That's 2 ½ times around the earth at the equator! Not only do we carry blood and oxygen to the major organs and systems, but we also carry away by-products for an efficient waste disposal. We are often called major vascular and microvascular systems.

For 31 years, Royanne lived with diabetes. She did a pretty good job of controlling the disease, not allowing it to get in the way of her everyday life and career goals. She lived with the disease for 22 years before any long-term complications set in. During those years, however, we knew very well what was happening to Royanne, but we're not allowed to tell her of these devastating events until obvious symptoms surfaced.

The first indication that something was really going wrong was proliferative diabetic retinopathy, also known as diabetic eye disease. This condition showed itself to Royanne and her health care team in December 1985. She was immediately placed on aggressive laser treatment therapy to save the vision. The aim was to keep enough sight to continue to drive, work and fulfill her life goals.

Prior to 1985, we all knew big trouble lay ahead. We depend on a balance of chemicals, enzymes, gases, pressure and glucose to allow us to function properly. If this crucial balance is upset, we feel it terribly. Although we try our best to pump blood through and continue to work, an overload of blood glucose is like pumping slow-moving molasses in the wintertime.

Unfortunately, there were times when her body began to fill us with ketones and acids—much like fingernail polish remover. We hated it. Can you imagine?

When Royanne's blood sugars fell too low, she would pass out and become unresponsive. We would try our best to get the other organs to give us a hand in this emergency situation. We called on the liver to release as much sugar as she could muster, but she seemed to be asleep most of the time. We would yell for the adrenal glands to get going, but even they got slower and slower as time passed. We lost count, but there were numerous times when we would see the floor rising to Royanne's face as she passed out again and we prepared ourselves for the trauma of the fall itself.

We could hear her discuss her problems with her health care team. We could hear the team's responses throughout the years. The level of frustration on Royanne's part grew greater daily. With each new emergent event, we became more and more concerned for her.

We know that we were directly responsible for Royanne's eye disease, but it was not intentional and she knows and forgives us for that. We were starving in her retinas. To prevent starvation, we were programmed to create new vessels, but we guess we did not do a good job. As the new vessels were created, they filled with blood but would soon burst under the pressure, as they really were not what God intended to be present in the eyes. We were just trying to help, but we were not the Creator, so we failed.

With the help of numerous laser treatments and surgery, Royanne has maintained some sight in one eye. Unfortunately, we were not able to prevent her from becoming legally blind nor her loss of driving ability. This was pretty devastating, since she was so independent, always wanting to be out there in the thick of things helping others.

Since the micro vascular system affecting the eyes was having such trouble, we knew that the same system affecting the kidneys was only a short time away. We tried to warn Royanne the best we could. Once again, we heard her vocalize her frustrating situation to her health care team over and over again. It seemed that the answers she was getting were all starting to sound like, "I'm sorry ... I don't know what to tell you ... Let's try this and see if this works ... Do you want to try such and such?" We give her much credit as she was willing to try just about anything to correct the situation.

Early signs of kidney disease began in 1991. Unfortunately, our ability to function properly worsened as Royanne's emergency events happened more frequently. It was taking us longer and longer to recover after each event and we truly felt we were letting her down miserably.

In our discussions with nerves and brain, we also learned of other problems that were happening. We felt terrible. Her stomach, heart and intestinal nerves were all being adversely affected. The nerves in her legs and feet were beginning to scream out in pain. Her fingers were going numb, making it impossible to read Braille. Royanne's brain confirmed our suspicions that with each emergent event, brain cells were being lost.

Thus, after 28 years with type I insulin-dependent diabetes, Royanne showed symptoms of autonomic neuropathy (heart, stomach, intestines, hypoglycemic unawareness), peripheral neuropathy (fingers, hands, legs and feet), early nephropathy (kidney disease), and retinopathy (eyes). She was only 37 years old at the time.

In November 1991, we traveled to the University of Minnesota to meet with Dr. Sutherland about a solitary pancreas transplant. The work-up for this evaluation was very thorough. Royanne got a bird's eye view of what to expect should she remain diabetic without a transplant and what might be expected should she receive a transplant. We were pretty amazed by the information.

In December 1991, Royanne met with Dr. Perez at UCDMC (University of California at Davis Medical Center) in Sacramento. He was the head of the kidney/pancreas and pancreas transplant program. Dr. Perez had been a transplant fellow with Dr. Sutherland in Minnesota and knew about Minnesota's extensive evaluation and testing of potential transplant patients. He accepted Royanne as a candidate immediately. She was then placed on the UNOS (United Network for Organ Sharing) list and began the long wait.

She waited almost 2-1/2 years for her new pancreas before its arrival on October 4, 1994. The transplant went well and she spent only eight days in the hospital.

We are all quite impressed with the results. We no longer battle over crazy blood sugar levels pulsing through us. Of course, Royanne is taking a good number of medications and will need to have her immune system suppressed for the rest of her life. The elements of her immune system say they don't have a problem with suppression because they know if they get out of whack the doctors at UCDMC will fine tune things quickly.

We all agree that it is much more pleasant to have the current medications coursing through us. We were really fighting a losing battle before. Now, we feel Royanne has a much better chance for a long, productive and fulfilling life than what she had before the transplant. We no longer have to yell and scream at her liver, kidneys, brain and adrenals to get back into action and get this girl out of trouble.

We love Royanne and were finding it harder and harder to watch, listen and suffer with her. She is now very energetic. We had been sleeping with her 12 to 16 hours a day. Since the transplant, we now get to experience full days, including the sunrise each morning. She has not passed out at all. If we see the carpet up close it now only means that she is cleaning again, not headed for another crash.

The nerves have told us that they are breathing easier these days, as if the air is new and fresher after years and years of being stagnant. The legs and feet no longer scream out in pain and the fingers have recovered their sensitivity. The stomach nerves have improved dramatically allowing Royanne to eat without nausea or vomiting. We can personally tell you this makes her glad.

Royanne is so happy with stable moods. She can now exercise, which makes her feel great. She had not been able to do so the two years before the solitary pancreas transplant because she had become so brittle that the exercise caused more problems than it solved.

The most incredible news yet is that the circulation to the eyes is returning. She and her eye doctor have seen an improvement in the acuity in one eye. What a terrific accomplishment. This was not a guarantee, as none of the improvements were, but it certainly has sparked a new zest for life that we always knew was there, but had become dormant over the years.

We are excited! With Royanne's new found zest for life, we are so proud to be here to experience it with her. We will continue to function to the best of our ability. She has certainly done the right thing where we are concerned and we will do our best to serve her well for many years to come. Royanne is now 40 and considers herself a diabetic "has-been" because she no longer has diabetes.

We are fearfully and wonderfully made. When God's creation is affected adversely from outside disease, sometimes the help of those called to be healers and physicians can make a tremendous difference. In Royanne's case, it truly has. She feels awesome and so do we.

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COOKING WITH SUZI

by Suzi Castle

Artwork: Bag filled with food.

It's time to treat your family and friends to a delicious, healthful dinner. There's no need to feel deprived, with so many delicious low?fat foods to choose from. By planning ahead, shopping carefully and preparing lower?fat versions of your favorite recipes, you can offer your loved ones the gift of health.

Roast Filet Mignon with Mushrooms served with fat?free Creamy Mashed Potatoes is guaranteed to satisfy the most discriminating tastes!

Roast Filet Mignon with Mushrooms

Ingredients

1-1/2 pounds lean, whole filet mignon, trimmed of fat
2 cloves garlic, cut into slivers
1 teaspoon Original Blend Mrs. Dash, divided
3 cups sliced mushrooms
½ cup sliced green onion
½ teaspoon Morton Lite Salt Mixture

Instructions
Make small cuts in filet and insert garlic slivers. Sprinkle ½ teaspoon Mrs. Dash over meat. Place filet in a large, heavy ovenproof skillet sprayed with nonstick spray. Roast in a preheated 450 oven. Cook 15 to 20 minutes for rare, 25 to 30 minutes for medium, or 35 to 40 minutes for well done. Remove roast from oven and let stand for 10 minutes on a warm serving platter. Meanwhile, add mushrooms and green onion to skillet. Sprinkle with Morton Lite Salt Mixture and ½ teaspoon Mrs. Dash. Roast vegetables in 450 oven for 10 minutes. Slice meat and serve with cooked mushrooms and green onion.

Serves 6. Per serving: 178 calories (43% from fat); 24gm protein; 8.4gm fat (3gm sat.); 1.8gm carbohydrate; 145mg sodium; 70mg cholesterol; 0.9gm fiber. Exchanges: 3-1/2 lean meat.

Creamy Mashed Potatoes

Ingredients

5 medium potatoes (2-1/2 lbs.), peeled and cut into quarters
1 teaspoon each: Morton Lite Salt Mixture, dried parsley flakes and dried onion flakes
1 package (3 tablespoons) Butter Buds
½ cup nonfat milk powder
1/4 teaspoon freshly ground pepper
½ teaspoon garlic powder

Instructions
Place peeled potatoes in a large pot and cover with water. Cover; simmer for 30 minutes, or until potatoes are tender. Drain, but reserve cooking liquid. Mash potatoes with a potato masher. Add ½ cup hot reserved cooking liquid and remaining ingredients. Mash until well blended.

Serves 8. Per serving: 87 calories (1% from fat); 4.1gm protein; 0.12gm fat (0.06gm sat.); 18.2gm carbo.; 251mg sodium; 1.5mg cholesterol; 0.31gm fiber. Exchanges: 1 bread.

Suzi Castle's Deliciously Healthy Favorite Foods Cookbook is available now in most bookstores or by sending $18.90 ($14.95 + $3.95 S&H) to: Health Cookbooks, Dept. M, 3520 McCourry Street Bakersfield, CA 93304.

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TALKING MEDICINE IDENTIFIERS

by Ed Bryant

Photo: portrait. Caption: Ed Bryant.

Blind people, and those losing vision, have always had difficulty identifying their medications and telling them apart. Serious consequences can follow, when prescriptions, oral or injectable, are mistaken, and the wrong dose given. One of those medications is insulin.

For years I have worked to make insulin manufacturers aware of this problem, of the need to make insulin vials distinguishable from each other by type/duration, without sight. The drug companies have not been particularly interested. We have been left with our homemade Braille labels, rubber bands, tape, and other temporary "recognition systems."

A partial solution has been the Roche VoiceMate blood glucose monitor, with its "talking insulin identifier" feature. This monitor reads the bar-codes on Lilly insulins - but not on any others, and, while quite functional, is very expensive. A more general solution is needed.

In September of 1999, Dr. Marc Maurer, President of the National Federation of the Blind, asked me to attend a meeting at the National Center for the Blind, in Baltimore, Maryland. Representatives from the ASKO Corporation discussed and demonstrated a prototype of their ALOUD Audio Labeling System.

First of a new class of "talking prescription containers," the ALOUD consists of three components: The recording unit (in the possession of your pharmacist, to whom ASKO will provide it without charge), the playback unit (cost: less than $100, and you need only one), and the Audio Label (which contains a digital storage chip). Each medication will need its own Audio Label.

When your pharmacist prepares your medication, and creates a written label, an "audio label" is created also. With the ASKO recording unit, the pharmacist reads pertinent dosage information onto the Audio Label, as if into a tape recorder. Like recorded tape, the Audio Label is reusable — when your prescriptions change, the pharmacist can replace old information with new. And note, there is no language barrier — whatever language your pharmacist speaks can be easily recorded. Standard reusable "audio labels" cost $10 each, and the smaller labels (for insulin vials) will cost $5 each.

The original ALOUD was very functional, but a bit large, not particularly convenient for use with an insulin vial. As those of us who most need a "talking label" on our insulin are likely users of an adaptive insulin drawing device such as the Jordan Count-A-Dose, any "talking label" needs to not interfere with insulin drawing. The original ALOUD made using the Count-A-Dose inconvenient, and I conveyed this fact to the management at ASKO.

Clearly ready and willing to work with the NFB, they promised to try to shrink the Audio Label, to make it more convenient for blind diabetics. The electronics, and the system's capacities, will remain unchanged. As of this writing, I have not seen the revised Audio Label, but I am told it is much smaller, about 3/4" x 1-1/2," and extremely thin. ASKO management is scheduled to bring samples of the smaller label to the NFB national convention in Philadelphia.

A completely different approach to the same problem, far more high-tech, has been taken by En-Vision America, maker of the ScripTalk system. Like the Aloud System, the ScripTalk consists of recorder, playback unit, and labels; but where the Aloud stores and plays back the pharmacist's voice, the ScripTalk utilizes Radio Frequency Identification (RFID) technology, and encodes a microchip with the same information typed onto the label - detected by the user's scanner and played back by through a voice synthesizer. As with the Aloud, the pharmacist determines the label content; the consumer can only play back the information.

At this early stage, the ScripTalk's recorder (sold only to pharmacists) and playback unit are fairly expensive, approximately $1500 and $250, respectively (each label costs $1), but these prices are expected to drop. Also, within a year, ScripTalk will have eight times the storage capacity of the present system, so each audio label will offer far more data to the blind user.

Because the ScripTalk's special microchip is in the label, no great bulk is added to the label or container, and an insulin vial with label attached should easily fit into adaptive measuring devices like the Count-a-Dose. They offer two label sizes (same chip) with the smaller label ½" x 3/4" specifically for small vials like insulin.

En-Vision, a regular exhibitor at NFB National Convention, has worked for years to develop products genuinely useful to blind people.

A simpler, more limited approach is offered by Millennium Compliance Corp., maker of the Talking RX audio label. Although the Talking RX looks like the Aloud, and stores spoken information on a digital chip, there is no separate "recorder" — each unit has the capacity to record. Where the Aloud requires a different "audio label" on each prescription, but only one playback unit, each Talking RX unit is self-contained, recorder and playback, and no separate "audio label" is required. You attach pillbox or insulin vial to the unit, and leave it there until you've finished that course of medication. They're inexpensive ($19.95 each, suggested retail); but if you take a lot of meds, you may need to buy a lot of Talking RX devices.

Your pharmacist programs the Aloud (your playback unit can't alter the message) but you load information into the Talking RX, and you, the consumer, can alter it. You will need a different Talking RX for each of your medications.

All the systems have their pluses, and their problems. Although both the ALOUD and the Talking RX are "lifetime" products, endlessly reprogrammable, and both are simple and relatively inexpensive, neither is particularly convenient for use with an insulin vial, as both are really too big to work well with adaptive measuring equipment, unlike the ScripTalk. (Note: I haven't seen the newest ALOUD label, but its smaller size should go a good way toward answering some of my misgivings.}

To conclude, my primary interest has always been the ability to distinguish one insulin vial from another. Designed for pill bottles, the ALOUD and Talking RX systems are only partial answers for insulin identification. Both require sighted intervention — and until there is some way a blind person can reliably and independently tell insulins apart, without such aid, the job is not completed. The ScripTalk, while a larger initial investment, appears to better fit for the needs of blind persons at this time.

Stay tuned for further improvement!

ASKO Corporation
c/o Audiosears Corp.
2 South St.
Stamford, NY 12167
1-800-533-7863

En-Vision America
1013 Porter Lane
Normal, IL 61761
1-800-890-1180
(309) 452-3008

Millennium Compliance Corp.
PO Box 649
Southington, CT 06489
860-681-9277

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Independent home dialysis possible for blind persons

by Lois M. Schmidt, R.N., C.N.N

Lois Schmidt, R.N., C.N.N., is a certified nephrology nurse formerly with the Peritoneal Dialysis Unit at Dialysis Clinics, Inc., Columbia, Missouri.

Kidney failure is a disease occuring in about half of those people who have diabetes. It presents new challenges to the person who may at the same time be experiencing visual changes or blindness.

Preparation for dealing with kidney failure should include a thorough education program to adequately assess all the choices for treatment. Some patients who are eligible will seek a kidney transplant to replace their failing kidney function. Others will decide to use a dialysis therapy. Those who choose transplant may also require a period of dialysis treatment while they await transplantation.

There are two basic types of dialysis therapies, with many variations depending on the provider dialysis unit. Hemodialysis is usually done at a dialysis clinic by specially trained nursing staff. However, it may be done at home if the patient has a partner who can be taught to perform the treatment. Peritoneal dialysis, commonly called CAPD (continuous ambulatory peritoneal dialysis), is a self-care, home therapy.

Peritoneal dialysis works inside the body. It utilizes the peritoneal membrane, which forms a "sac" inside the abdominal cavity, to remove waste products and extra fluid from the body. This process is accomplished by allowing dialysis solution to flow into the peritoneal cavity by way of a permanent tubing, called a catheter, which is surgically placed through the abdominal wall. The solution remains in the abdomen for four to eight hours while the person goes about his or her usual activities. At the end of this time, the dialysis solution is drained out and is exchanged for fresh dialysis solution. This "exchange" is usually performed four times daily.

Special training is provided to patients choosing CAPD to enable them to successfully use this therapy. All patients (including those without visual problems) are encouraged to have a family member or friend participate in their education sessions. Most people find it very reassuring to have a support person available if needed.

The exchange procedure of CAPD can be performed by a blind person using one of several assist devices available on the market today. This specialized equipment, as with all home dialysis supplies, can be obtained through dialysis units. For economic reasons, some dialysis clinics make use of supplies from only one company and thus offer only one type of device. However, there are at least four different types of systems available which may be used by a patient with visual impairment and/or neuropathy (nerve damage) of the hands. Some of the devices feature an ultraviolet light which provides extra protection against infection. Others make use of large or recessed connections to help prevent contamination. Each system has some special features which may make it preferable for an individual patient's needs.

Another form of peritoneal dialysis is CCPD (continuous cycling peritoneal dialysis). This type of dialysis makes use of an automated cycler which is designed to operate while a person is asleep. The cycler is programmed to exchange the dialysis fluid at periodic intervals during the night. While this dialysis is more complicated than CAPD, it does allow daytime freedom from exchanges. Also, it may be the appropriate choice for a patient who requires the assistance of another person.

As with all things in life, peritoneal dialysis is not without its disadvantages. The most serious potential complication of this form of dialysis is the risk of peritonitis, infection of the peritoneal cavity. This infection can usually be treated successfully with antibiotics. However, great care must be taken by the patient to pay attention to cleanliness, so as to avoid infections if at all possible.

There are also advantages to CAPD. One, particularly beneficial for the diabetic, is that insulin may be added to the dialysis solution rather than being given as an injection. Insulin administered in this way is absorbed and used by the body in a way that usually results in good blood sugar control. CAPD is a slow, continuous, gentle form of dialysis which provides a steady chemical and fluid balance in the body. This can aid in maintaining normal blood pressure as well as providing a sense of well-being. Also, since CAPD is performed at home, the necessity of travel to a dialysis center three times a week is eliminated.

CAPD has proven to be an effective form of dialysis for persons with diabetes, including those with visual impairment and neuropathies. Extensive education is required prior to the decision for choice of dialysis therapy. Each individual must make his or her own decision based on careful evaluation of needs, motivation and family support, as well as emotional and physical capabilities. Those persons most successful with CAPD are those who are highly motivated to participate in their own health care.

(From the Editor: I have received reports that sometimes, when blind diabetics begin dialysis treatments, they aren't told about CAPD. Because of the diabetic's blindness, his/her physician doesn't always explain the different types of dialysis treatments. Unfortunately, it is, in some cases, assumed that because the patient is blind, he/she won't be able to use CAPD therapy.

I visited Lois Schmidt, RN, CNN, at Dialysis Clinics, Inc. (DCI) Peritoneal Dialysis Training Room in Columbia, Missouri. She showed and explained to me step by step what CAPD patients, blind and sighted, must do to successfully use this form of treatment. The training room contained a dummy doll with a CAPD catheter connected to its lower abdomen. I actually went through the process of hooking and unhooking the dialysis bags with and without solution for the CAPD exchange.

All CAPD patients must be careful not to touch and contaminate the ends of the catheter tubing, which could cause infection to the peritoneal cavity. Blind patients are trained how to use the ultraviolet germicidal exchange device. This instrument delivers a dose of ultraviolet light, which kills almost all bacteria on key components of the catheter and exchange system connections. Some dialysis units require that all patients, blind and sighted, use some sort of exchange device when connecting and disconnecting solution bags. Lois Schmidt said that, "When blind or visually impaired people become familiar with the system, and can do it well and efficiently, they're no more at risk than anyone else." She also said that when diabetes has advanced to the point where the patient has lost his/her sight, they often, from neuropathy, lose the feeling in their fingertips as well. It is imperative that blind patients have fairly good sensory ability in their fingers because they must be able to feel slots and/or openings to correctly use the ultraviolet germicidal exchange device. DCI provides several days of step by step training for CAPD patients.

Lois Schmidt said that some blind diabetics may have difficulty adding medication, such as insulin, to the bag if there is a problem with dexterity. The insulin syringe needle is inserted into a small port, which must be prepped with an anti-bacterial solution. There is a needle guide available that enables blind persons to independently do this, but it is imperative that neither the port nor the guide be contaminated. It doesn't take much bacteria introduced into the port area to cause infection. The peritoneal cavity is a sterile area. This cavity contains no white blood cells to fight infection. As soon as bacteria is introduced, it colonizes, multiplies, and very quickly infects that cavity.

I am a blind diabetic who had no trouble with the CAPD exchange procedure. It is important to realize that some dialysis patients, whether they are blind or sighted, can use CAPD, and some cannot. It is well documented that there are alternative techniques which enable blind citizens to participate fully in mainstream society.)

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RECIPE CORNER

Artwork: vegetables.

This issue, all recipes are taken from The Diabetic's Healthy Exchanges Cookbook, by JoAnna M. Lund, published 1996 by Perigee.

HOMEMADE CREAM OF MUSHROOM SOUP

Ingredients:

2 cups chopped fresh mushroom

½ cup chopped onion

½ teaspoon dried minced garlic

2 cups (one 16-oz can) Healthy Request Chicken Broth

1 tablespoon reduced-sodium soy sauce

1/4 teaspoon black pepper

1-1/2 cups (one 12-oz can) Carnation Evaporated Skim Milk

6 tablespoons all-purpose flour.

Instructions:

In a large saucepan sprayed with butter-flavored cooking spray, saute mushrooms, onion, and minced garlic until mushrooms start to turn limp, about five minutes. Add chicken broth. Mix well to combine. Bring mixture to a boil. Lower heat. Stir in soy sauce and black pepper. In a covered jar, combine evaporated skim milk and flour. Shake well to combine. Stir milk mixture into mushroom mixture. Continue cooking, stirring constantly, until mixture thickens, about five minutes.

Makes four 1-cup servings: 157 calories, 1gm fat, 11gm protein, 26gm carbohydrate, 462mg sodium, 1gm fiber. Exchanges: 1-1/4 vegetable, 3/4 skim milk, ½ bread.

GREEN BEANS IN ONION SAUCE

Ingredients:

½ cup finely chopped onion

1-1/2 cups (one 12-oz can) Carnation Evaporated Skim Milk

3 tablespoons all-purpose flour

1/4 teaspoon lemon pepper

4 cups (two 16-oz cans) cut green beans, rinsed and drained

Instructions:

In a large skillet sprayed with butter-flavored cooking spray, saute onion until tender, about five minutes. In a covered jar, combine evaporated skim milk and flour. Shake well to combine. Pour milk mixture into skillet with onion. Add lemon pepper. Mix well to combine. Stir in green beans. Continue cooking, stirring often, until mixture thickens and beans are heated through, about five minutes.

Makes four 1-cup servings: 131 calories, less than 1gm fat, 9gm protein, 23gm carbohydrate, 449mg sodium, 2gm fiber. Exchanges: 2-1/4 vegetable, 3/4 skim milk, 1/4 bread

BUSY MAN'S SKILLET

Ingredients:

8 ounces ground 90% lean turkey or beef

½ cup chopped onion

1 cup (one 8-oz can) Hunt's Tomato Sauce

1 cup frozen whole-kernel corn

1 cup cooked spaghetti, rinsed and drained

1 teaspoon dried parsley flakes.

1/8 teaspoon black pepper

Instructions:

In a large skillet sprayed with butter-flavored cooking spray, brown meat and onion. Add tomato sauce, corn, spaghetti, parsley flakes, and black pepper. Mix well to combine. Lower heat and simmer for 5 to 10 minutes, stirring occasionally.

Makes four 1-cup servings. 197 calories, 5gm fat, 14gm protein, 24gm carbohydrate, 427mg sodium, 3gm fiber. Exchanges: 1-1/2 protein, 1-1/4 vegetable, 1 bread.

MAPLE CUSTARD

Ingredients:

1 (4-serving) package JELLO Sugar-Free Cook&Serve pudding mix

2/3 cup Carnation Nonfat Dry Milk Powder

1-1/2 cups water

½ cup Cary's Sugar Free Maple Syrup

1/4 cup Cool Whip Lite

Instructions:

In an 8-cup glass measuring bowl, combine dry pudding mix and dry milk powder. Add water and maple syrup. Mix well, using a wire whisk. Cover, and microwave on HIGH (100% power) four minutes, whisking after two minutes. Pour hot mixture into four dessert dishes. Refrigerate at least one hour. Just before serving, top each with one tablespoon Cool Whip Lite.

Makes four servings: 84 calories, less than 1gm fat, 4gm protein, 16gm carbohydrate, 242mg sodium, 0gm fiber. Exchanges: 1 starch.

Author JoAnna Lund also publishes the monthly HEALTHY EXCHANGES FOOD NEWSLETTER, addressing healthy weight loss, cholesterol, and diabetic concerns. For information, contact: HEALTHY EXCHANGES, PO Box 80, DeWitt, Iowa, 52742; telephone: 1-800-766-8961, website: www.healthyexchanges.com

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ASK JANIS

Photo: portrait. Caption: Janie Roszler.

Janis Roszler, RD, CDE, LD/N is a registered dietitian, certified diabetes educator, and certified insulin pump trainer. She has counseled individuals with diabetes for over 14 years, and is currently the diabetes educator for the website: www.diabetic.com

This column is for educational purposes only. For answers that meet your specific educational needs, consult your physician.

Dear Janis:
What should a complete diabetes examination consist of?

Dear Jim:
A quality diabetes physical includes:

1. A quality review of your home blood glucose results.

2. A discussion of your medication, diet, and exercise program.

3. A talk about your lifestyle. What changes have you made since your last visit?

4. An assessment of your weight, blood pressure, and pulse.

5. An exam of your eyes, heart and lungs.

6. A foot exam.

7. A check of your skin, with special focus on injection and test sites.

8. A check of your reflexes, sensitivity (with a pin, monofilament, or soft cotton), and review of any symptoms such as dizziness, pain, burning, numbness, constipation, diarrhea, difficulty with urination, and sexual performance problems, which can all be affected by diabetes.

9. A look at your gums, teeth, mouth, and throat.

10. A check of your thyroid gland.

11. A blood and urine test.

12. Vaccinations, as needed.

13. Other possible tests - mammogram/breast exam, pap smear, rectal exam for women, prostate and rectal exam for men. A stool sample should also be tested, to detect colon cancer.

Dear Janis:

Are airplane pilots allowed to fly if they have diabetes?

Dear Sandra:

In 1996, the FAA officially changed its policy regarding pilots with diabetes. Under the new policy, each pilot with diabetes is to be evaluated for a medical certificate. Candidates must meet rigorous medical guidelines, and comply with an FAA-approved monitoring protocol before, during, and after flight. For a copy of the medical guidelines, or for more information, please contact Joe LaMountain, Manager of Government Relations, American Diabetes Association, 1701 N. Beauregard Street, Alexandria, VA 22311. You can also contact him by fax at: (703) 549-8748. (Editor's Note: The FAA has posted its flying and diabetes policies on the following web page:
www.cami.jccbi.gov/AAM-300/insulin.html)

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NEW DEVICE EASES EYE EXAMINATIONS

We all know the importance of regular, thorough eye examinations. If you have diabetes, regular eye exams can pick up evidence of retinopathy, diabetic eye disease, early on, in time to intervene and possibly save your sight. Make it a habit!

But optometrists and ophthalmologists are not spread evenly around, nor equally trained or equipped. Hopefully, we're all familiar with the dilated retinal examination? The one that takes the better part of an hour, and hurts? Yes, it does a good job of revealing retinal disease, but it's NOT an automatic part of a regular eye exam.

Now there's an alternative. Optos North America, the US subsidiary of Optos PLC of Dunfermline, Scotland, has developed The Panoramic 200 system, a computerized scanning device that enables the operator to obtain a clear, wide-field image of the retina (the "Optimap") in about three minutes -- without the need for retinal dilation.

Does it work? A study conducted at the University of Pittsburgh compared results of the Optimap to those produced by traditional dilated examination (two teams saw each patient, and did not communicate with each other). Results were very similar (about 74% sensitivity for both). Then consider that the Optos device works very rapidly, allowing the eye doctor to see more patients in the same amount of time -- and you see how this new tool could become really important.

For more information, contact: Optos North America, 199 Forest Street, Marlborough, MA 01752; telephone: 1-800-854-3039; website: www.optos.com

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FOOD FOR THOUGHT

Artwork: dancing fruit and vegetables.

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.

Diabetes Newsletter

Are you always looking for more diabetes information? Insulin manufacturer Eli Lilly and Company offers the free quarterly Lilly Diabetes Today, in print and on the world wide web at: www.LillyDiabetes.com

The paper contains articles, advice, inspirational stories, recipes, and coupons. Subscription is free, but a short survey must be completed to receive it. Contact: Eli Lilly and Company, PO Box 4893, Trenton, NJ 08650-9058, or at the above website.

New Oral Medication

One of the most common ramifications of diabetes is nephropathy, diabetic kidney disease. Both type1 and type 2 diabetics are at risk (up to 40% of all type 2 diabetics develop end stage renal disease, ESRD), so both are in need of any treatment that could slow disease progression.

At this time doctors have a number of medications to turn to, to slow the rate of kidney destruction that so often follows diabetes. Many are blood pressure reducers: the ACE inhibitors, Calcium Channel Blockers, and, most recently, Angiotensin II receptor blockers (ARBs).

Novartis Pharmaceuticals Corporation is testing its antihypertensive (blood pressure reducing) medication Diovan, for use in treatment of patients with high blood pressure and proteinurea, a sign of ESRD. So far they, have found that Diovan is as effective as the frequently-prescribed ACE Inhibitor Captopril, without the chronic cough that so often follows therapy with ACE inhibitors.

The drug has been shown effective in lowering microalbuminuria (another diagnostic for the presence of kidney damage) and the current tests show it to be as effective in slowing the progressive rise of microalbuminuria as Captopril.

For more information, doctors should contact Novartis Pharmaceutical Corporation, 59 Route 10, East Hanover, NJ 07936-1080; telephone: (973) 781-5388; website: www.pharma.novartis.com

Bug Spray and Sunscreens

While you're out and about this summer, you'll probably be trying to avoid serious sunburn, by using a sunscreen cream. You may also be where the bugs are thick, and may reach for an insect repellent. The chemical DEET, active ingredient in many insect repellents, significantly reduces the effect of sunscreens, wherever it comes in contact with them. If you need to use both, take extra precautions, like long sleeves and perhaps a broad-brimmed hat.

The Secret Airbase

You've all heard of the Air Force's ultra-high-security, super-secret base in Nevada, known simply as "Area 51?"

Well, late one afternoon, the Air Force folks out at Area 51 were very surprised to see a Cessna landing at their "secret" base. They immediately impounded the aircraft and hauled the pilot into an interrogation room.

The pilot's story was that he took off from Vegas, got lost, and spotted the base just as he was about to run out of fuel. The Air Force started a full FBI background check on the pilot and held him overnight during the investigation.

By the next day, they were finally convinced that the pilot really was lost and wasn't a spy. They gassed up his airplane, gave him a terrifying "you-did-not-see-a-base" briefing, complete with threats of spending the rest of his life in prison, told him Vegas was that-a-way on such-and-such a heading, and sent him on his way.

The next day, to the total disbelief of the Air Force, the same Cessna showed up again. Once again, the MPs surrounded the plane ... only this time there were two people in the plane.

The same pilot jumped out and said, "Do anything you want to me, but my wife is in the plane and you have to tell her where I was last night!"

Phone Recording Equipment

Individuals who are blind or otherwise dependent on the tape recorder as a note-taking device know that sometimes it is necessary to record a telephone call. Traditional "phone mikes," for those of us who don't have a brother in the CIA, have been complex, unreliable, with more batteries and suction cups than a four-year old's Christmas toy, and their recordings have hardly been crystal clear. That has now changed.

Federationist Jerry Maccoux has developed the Phonote, a compact, no-batteries device that greatly simplifies the task of recording your phone conversations. It also gives a loud, clear, undistorted sound, as if the other party were in the room with you. You will need: The device, a tape recorder with an "aux-input" or remote microphone jack, and an extension phone line (which can be as simple as a Y-jack and six-foot phone line running from your modular plug). Plug the second line into the Phonote, the Phonote into your recorder, and you're ready. Please note a number of laws restrict the taping of phone conversations. To be safe, inform the other party a recording is being made.

The Phonote, priced at $12 (plus $3.50 shipping), is available from: Phonote, PO Box 6021, St. Joseph, MO 64506; telephone: (816) 279-4562; e-mail: [email protected]

Website for the Blind

It is not easy for blind people to find news, health and wellness information, assistive technology information, and current news about disability issues. Now there is a website, www.enablelink.com, that combines all the above with a fully accessible online shopping mall of assistive products for the blind: Talking watches, talking VCRs, talking thermometers, screen readers, software, Braille translators and embossers, and much more. Check it out: www.enablelink.com

Dialysis Information

Every year, thousands of people face kidney failure, End Stage Renal Disease, and must commence dialysis, or obtain a kidney transplant. Diabetes is both the #1 cause of kidney failure, and the leading cause of new blindness in the United States today. There is great need for informational material about kidney disease, both in print and alternative format.

The Life Options Rehabilitation Program publishes several informational items about dialysis, including the free audiotapes: Working Effectively with your Dialysis Team, and Voices of Experience: Personal Stories. They also offer the free video: Feeling Better With Exercise: A Video Guide for People on Dialysis. Other material is available free for downloading in PDF format. Contact: Life Options Rehabilitation Program; telephone: 1-800-468-7777; website: www.lifeoptions.org

Drug Tests

For any prescription drug to receive approval from the Food and Drug Administration (FDA), it has to go through a long and rigorous testing process -- and much of that testing is on human subjects. Generally these volunteers are adult, male, and white. Many drugs (not just diabetes medications) are not formally tested on children, the aged, women, or minorities. Only a very limited number of diabetes medications are licensed for use with children.

Doctors now routinely prescribe, for women and children, medications that have been approved by the FDA for adults. This makes determination of exact dose something of a trial-and-error process.

As type 2 diabetes is increasingly appearing among children and teens, the FDA and National Institutes of Health are pushing for more testing on women, children and minorities.

New Surgical Device

Camillo Ricordi, MD, Scientific Director and Chief Academic Officer at University of Miami School of Medicine's Diabetes Research Institute, has received a world prize for his invention of the Ricordi Chamber, a device that eases harvesting and transplantation of pancreatic islet cells. As islet cell transplantation is an important line of inquiry toward curing type 1 diabetes, the Ricordi Chamber is an extremely important invention.

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."

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.

Division Board

The current (2000/2001) National Board of the Diabetes Action Network of the National Federation of the Blind is:

President: Ed Bryant (Columbia, MO)

First Vice President: Eric Woods (Denver, CO)

Second Vice President: Sandie Addy (Prescott Valley, AZ)

Treasurer: Bruce Peters (Akron, OH)

Secretary: Sally York (Castro Valley, CA)

Board Member: Gisela Distel (Albany, NY)

Board Member: Paul Price (Valley Center, CA)

Board Member: Dawnelle Cruze (Portsmouth, VA)

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 291,436 VOICE readers could benefit from your story.

For information and article submission guidelines, contact: Voice of the Diabetic, 811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911.

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."

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.

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 291,436 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.

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.

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

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WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK

(Resource Column)

Artwork: Hand pulling book off shelf.

Inclusion of materials in this publication is for information only and does not imply endorsement by the Diabetes Action Network of the NFB.

New Diabetes Resource List

The Diabetes Action Network of the National Federation of the Blind will soon offer the 2001 edition of Diabetes Resources: Equipment, Services and Information, our comprehensive list of resources for diabetics. Diabetes Resources is a compilation of companies and individuals offering products and/or information to help diabetics, especially those who are blind or are losing vision, to self-manage their diabetes. The list will contain the following subject categories: General and Miscellaneous, Insulin Measurement Devices, Insulin Syringe Magnifiers, Insulin Injection Systems, Diabetic Foot Care, Blood Glucose Monitoring Systems, Insulin Pumps, Products for the Blind, Food and Diet, Literature and Information, Distributors of Diabetes Equipment and Supplies, and Medication Assistance.

Blind diabetics can and do accurately draw up insulin, monitor blood glucose, and perform the other tasks of independent self?management. By using alternative techniques and products, they can continue being independent, and control their diabetes as efficiently as do their sighted peers. Limitations are usually self-imposed—often all that is needed to overcome negative thinking is simply to know where to go for information.

Diabetes Resources: Equipment, Services, and Information will cost $5 per copy, and will be available in Braille, large print, and audiocassette (recorded at 15/16 IPS for the blind). Available July 30, 2001. Please order from: National Federation of the Blind, Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314. Note: the NFB Materials Center is open weekdays 8am to 5pm Eastern time.

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 with 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.

Save Your Skin

Lantiseptic is a line of skin care products of interest to diabetics. The line includes a cream and a skin protectant, both appropriate for the dry skin diabetics can face. The cream is especially appropriate for dry feet, and has been clinically tested as appropriate for diabetic foot care.

Both products come in tube or jar, and FREE SAMPLES ARE AVAILABLE. For information, or to obtain a free sample, contact: Summit Industries, Inc., PO Box 7329, Marietta, GA 30065; telephone: 1-800-241-6996. For a free sample, telephone: 1-800-347-2456.

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 , website: www.dsmedical.com

Insulin Pumps and Supplies

MiniMed is one of the worlds leading manufacturers of insulin pumps -- those precision microdevices that are the closest thing to an artificial pancreas we have. If you are an insulin-dependent diabetic, talk to your doctor about pump therapy -- you might find the MiniMed 508 pump right for you. If you need pump/infusion supplies, Minimed offers a complete line. Minimed also offers (for doctor's use) the Continuous Glucose Monitor -- which can precisely chart three-days' sugars, as an aid to establishing better control. And Minimed has the (still investigational) 2007 Implantable Insulin Pump. For information contact: MiniMed, Inc., 18000 Devonshire Street, Northridge, CA 91325-1219; telephone: 1-800-646-4633; website: www.minimed.com

Treat Male Impotence

For men who've had diabetes many years, one possible ramification is impotence, the inability to sustain an erection. This can be treated in a number of ways, but the least invasive is vacuum therapy.

The Vet-Co Vacuum Therapy System for male impotence is FDA-Approved, safe, non-invasive, and easy to use. For information, call: Coast To Coast Home Medical; telephone: 1-800-330-6316.

Diabetes Supplies

When you need it, you need it. When it's time to test, when it's time for medication, you need it already there. Diabetic Care Center will ship your diabetes supplies to your door, and they do the paperwork. No forms, no trips to the pharmacy. Medicare and most private insurance accepted. Call the Diabetic Care Center, telephone: 1-800-633-7167; website: http://www.diabeticare.com

Change Your Ways

Good diabetes management is a lifestyle. Although doctors can prescribe medication and recommend changes, sometimes "changing your ways," adapting/adopting a healthy lifestyle, can be a lot of work -- for there is so much to learn.

The NEWSTART Lifestyle Center offers 12- and 18-day in-house, physician-supervised intensive education programs, that emphasize permanent lifestyle changes designed to help the participant lose weight, maintain health, and adopt healthier habits in nutrition, cooking, exercise, and stress management.

Contact: Weimar Institute; telephone: 1-800-525-9192; e-mail: [email protected]

Reading Machine

There are many ways to cope with the problems loss of vision brings to reading. There are optical reading machines, where you scan a printed page into computer memory, from where it is then read by a synthesized voice. Now there is another alternative: the L&H MagniReader.

This device combines CCTV magnification with an optical reader. The MagniReader magnifies text or graphics up to 36x on screen, and reads it aloud, in a clear voice. You can use either or both modes.

To find out more about this reading machine, contact: Lernout and Hauspie Speech Products USA, Inc., Kurzweil Educational Systems Group, 52 Third Avenue, Burlington, MA 01803; telephone: 1-800-894-5374; website: http://www.lhsl.com/educationad/votd

Diabetes Supplies

Inverness Medical Corporation carries a full line of discount-priced diabetes supplies, including: Dex?4 glucose tablets, skin cream, and Excel test strips for the Glucometer Elite monitor. The company also markets the Monoject line of insulin syringes and lancets. Many Inverness (formerly Can?Am) products are also sold as "house brand" at major pharmacy chains. Their low price in no way compromises their high quality.

For information, contact: Inverness Medical Corporation, 200 Prospect Street, Waltham, MA 02453; telephone: 1-800-461-7448.

Adaptive Computing Equipment

Freedom Scientific is a powerhouse adaptive equipment maker for the blind and visually impaired computer user. A union of Arkenstone, Blazie Engineering, and Henter-Joyce, Freedom Scientific offers screen magnifiers, talking attachments (voice synthesizers) for your computer, Braille printers and much more. Whether you need software or hardware, check them out: Freedom Scientific; telephone: 1-800-444-4443; website: www.freedomscientific.com

Diabetic Products

Health Care Products makes many over-the-counter medications and supplements for diabetics, including DiabetiSweet sugar substitute and Diabetic Tussin sugar-free cough syrup. Find these products in the diabetic section of Wal-Mart, Rite Aid, Walgreens, K-Mart, and other retailers. For information, contact: Health Care Products, 369 Bayview Avenue, Amityville NY 11701; telephone: 1-800-899-3116; website: http://www.diabeticproducts.com

Nutrition Supplement

Your insulin or oral diabetes medications are only part of your diabetes self-management. Although food supplements do not replace your medications, and the U.S. Food and Drug Administration has not evaluated their efficacy to prevent or treat any disease, a healthy diet is important, and research is continuing on the role specific supplements may play in controlling diabetes. AlphaBetic Multi-Vitamin Supplement is a food supplement formulated for the special needs of diabetics. A blend of vitamins, antioxidants, and minerals, is available in sugar-free caplets. Contact: Abkit, Inc., New York, NY 10128; telephone: 1-800-226-6227; website http://www.alphabetic.com

Legal Advice

Rezulin was a diabetes medication recently removed from the market. A number of users suffered liver damage, and these individuals may be entitled to financial compensation. Nevada residents who believe they have been harmed by Rezulin use should promptly contact the law firm of Harrison, Kemp, and Jones, CHTD; telephone: (702) 385-6000, for a free case assessment.

Unique Glucometer

There are many fine, accurate glucose monitors out there, but the Bayer Glucometer Dex is unique. Other monitors require you to handle a new test strip each time, and many require a "hanging drop of blood." Some meters must even be held upright, and dead still. Not the Dex. Drop in a 10-test cartridge, and the compact, convenient Dex, a favorite of diabetic athletes, sets itself. Load it in the morning - test all day - without a pocketful of gear.

The Dex is widely available now, and probably on your pharmacy shelf. For information, telephone: 1-800-445-5901; or find it on the web at: www.glucometerdex.com

Talking Computer

The VoiceNote, from HumanWare, is a laptop note-taker/organizer for blind individuals and those losing vision. It combines the familiar MicroSoft WINDOWS CE operating system, and standard computer keyboard, with voice access. You can create MS Word documents, access your e-mail, transfer documents to and from a standard PC computer, use your VoiceNote as a speech synthesizer for another computer, and access a number of planning and scheduling tools. For more information, about the VoiceNote or other products, contact: HumanWare, 6246 King Road, Loomis, CA 95650; telephone: 1-800-722-3393; website: www.humanware.com

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TECHNIQUE KEEPS DIABETIC CHILDREN OUT OF EMERGENCY ROOM

by Lori Williams

Baylor College of Medicine

Teaching parents a fresh approach to an old medical problem is helping kids with diabetes stay out of the emergency room. Developed by doctors at Baylor College of Medicine, in Houston, Texas, the approach, called mini?dose glucagon rescue, puts control back into the hands of parents.
"Insulin and diet can keep the blood sugar levels of kids with insulin?dependent diabetes under control most of the time," said Dr. Morey Haymond, a Baylor professor of pediatrics and director of the diabetes clinic at Texas Children's Hospital.

"But, when a child can't eat, due to a common illness like the stomach flu, or won't eat as a form of rebellion, problems with hypoglycemia, or low blood sugar, can develop. Unfortunately, at that point, parents' options have been fairly limited and unattractive," said Haymond, also a researcher at the USDA/ARS Children's Nutrition Research Center at Baylor.

According to Haymond, when an insulin?dependent diabetic child refuses food or can't eat, parents naturally worry about hypoglycemia. As a result, they often believe they must force food on a sick or reluctant child, make a trip to the doctor or emergency room for assistance, or give their child a shot of a potent hormone called glucagon, which has the opposite effect of insulin.

"Parents often think of glucagon as a last resort or emergency measure to prevent convulsions when blood sugar levels get dangerously low,"he said. "The amount normally given must be administered with a 'real' shot into muscle tissue, rather than under the skin, as is the case for insulin. It can also cause nausea. Because of this, many parents prefer a trip to the ER."

The mini?dose glucagon rescue technique sidesteps these problems by using a dilute solution of glucagon that can be administered just like insulin. Parents can also monitor the effect of the glucagon using the same sampling technique used to test for blood sugar when insulin is given.

"This type of shot is much more comfortable for parents and the child," he said. "The dilute solution does not cause nausea, so parents might use it early in the course of a child's illness, saving them and their diabetic children undue conflict and trips to the ER."