Voice of the Diabetic, Fall '99
Voice of the Diabetic, Fall '99
VOICE OF THE DIABETIC
The Diabetes Action Network of the
National Federation of the Blind
A Support and Information Network
Volume 14, Number 4, Fall Edition 1999
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
VOICE OF THE DIABETIC, published quarterly, is the national magazine of the Diabetes
Action Network of the National Federation of the Blind. It is read by those interested in
all aspects of blindness and diabetes. We show diabetics that they have options regardless
of the ramifications they may have had. We have a positive philosophy and know that
positive attitudes are contagious.
News items, change of address notices, and other magazine correspondence should be sent
to: Ed Bryant, Editor, Voice of the Diabetic, 811 Cherry Street, Suite 309, Columbia,
Missouri 65201-4892; 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 1999 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.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
ADVERTISERS
Effective advertising doesn't scream at its audience. It persuades. It sells. The key
to cost-effective advertising is making your voice heard where an audience is already
listening. VOICE OF THE DIABETIC, circulation 261,818+, offers such an outlet. Make your
voice heard. For VOICE OF THE DIABETIC advertising information contact:
Eileen Rivera
National Advertising Sales Manager
726 E. Belvedere
Baltimore, MD, 21212
Phone: (410) 435-3648
Fax: (410) 435-6159
or find us on the Web at:
For SUBSCRIPTION information, see the end of this document.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
FREE! FREE!
VOICE OF THE DIABETIC is offered absolutely free to any interested person upon request.
Readers may receive the publication in standard print, on audio cassette for the blind, or
in both formats. To begin receiving the VOICE, please complete the subscription form (or a
facsimile), found at the end, and mail it to the editorial office.
Please Note: We have a special bulk-mailing permit that we use to ship the VOICE to you
at low cost--it does not allow for free re-mailing. The Post Office requires you place
first class postage on any VOICE you mail to others.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
INSIDE THIS ISSUE
DIABETIC PERIPHERAL NEUROPATHY
FLU SHOTS
AN INSPIRING EXAMPLE
DON'T FEEL GUILTY
by Ed Bryant
DOCTOR SUGGESTS NEW PRIORITIES COULD REDUCE DIABETIC BLINDNESS
TYPE 1 DIABETES PREVENTION TRIAL NEEDS VOLUNTEERS
THE "Y2K BUG" AND DIABETES
by Peter J. Nebergall, PhD
NEW DIALYSIS DRUG
GASTROPARESIS TEST UNDERWAY
NEW DRUG RESEARCH
BLIND DIABETICS CAN DRAW INSULIN WITHOUT DIFFICULTY
by Ed Bryant
DIABETES EDUCATION PROGRAMS ARE ESSENTIAL
by Roseanne Braiotta
COOKING WITH SUZI
by Suzi Castle
THE VALUE OF EXERCISE
by Arturo Rolla, MD
PARTIALLY SIGHTED--REALLY BLIND
by Catherine Horn Randall
RECIPE CORNER
LETTERS TO THE EDITOR
BOOK REVIEWS
by Marilyn Helton
ASK THE DOCTOR
by Wesley W Wilson, MD
WHAT YOU ALWAYS WANTED TO KNOW, BUT DIDN'T KNOW WHERE TO ASK
(Resource Column)
FOOD FOR THOUGHT
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
DIABETIC PERIPHERAL NEUROPATHY
Artwork: A foot
What is Neuropathy?
Neuropathy is a general term for physical damage to or impairment of the human nervous
system. It has many causes, and many symptoms. Because a long period of time with elevated
blood glucose can damage nerve fibers, diabetes is one cause of neuropathy. The Centers
for Disease Control suggests up to 70% of diabetics may have measurable neuropathy, though
a number of other diseases (and some medications) can also cause this condition.
"Diabetic neuropathy occurs in both type 1 and type 2 diabetes" (says Johns
Hopkins' "InteliHealth," an Internet magazine)," and it is most common in
those whose blood glucose levels have been poorly controlled. Although diabetic neuropathy
can occur in patients who have had diabetes for a short time, it is most likely to affect
those who have been diabetic for more than a decade, especially those over age 40.
Diabetics who smoke are especially at risk."
The human nervous system is enormously complex. The peripheral nerves carry information
to and from the brain, connecting it with the rest of the body. These nerves can be motor,
sensory, or autonomic. Motor nerves carry messages from the brain for the contraction of
different muscles. Sensory nerves relay to the brain sensations of touch, temperature,
position and pain, from the body's periphery. Autonomic nerves carry the brain's commands
to organs such as the heart, the stomach, lungs, and liver; and autonomic neuropathy, a
potentially severe condition though thankfully rare, will receive its own separate
coverage later.
The longer the nerve fibers, the more likely they are to show damage from long-term
high blood glucose. Such damage generally appears at the nerve terminus, at the end
furthest away from the central nervous system (brain and spine). For peripheral
neuropathy, the damage commonly manifests at the nerve terminals of feet, lower legs, and
hands. Doctors call this common form distal sensory polyneuropathy.
Symptoms can include diminished tactile sensation, numbness, loss of reflex reaction,
and various types and degrees of pain, from "pins and needles" to extreme
burning sensations. As neuropathy progresses, the symptoms frequently change. CAUTION:
Diabetics experiencing neuropathy sometimes have other ramifications as well, and these
have their own symptoms. Sometimes symptoms overlap, and diagnosis can be confusing.
Diabetic nephropathy--kidney failure--can exacerbate neuropathy, due to the uremic
toxicity of the condition. Other pain can be a symptom of undiagnosed orthopedic problems,
other medical conditions, drugs, or exposure to toxic chemicals. If you are experiencing
pain or abnormal sensations in hands, feet, or legs, check with your doctor.
The simplest way your doctor can check for the diminished sensation that can be an
early sign of neuropathy in your feet is with a monofilament, a thin, flexible filament of
nylon or broomcorn. The doctor will press it gently against areas of your foot and lower
leg, and ask you if you can feel the touch. Where you cannot, early neuropathy may be
present. The monofilament, the only tool this test requires, is extremely inexpensive, and
the test is highly advisable.
More sophisticated tests can be carried out with a tuning fork, and where the doctor
needs to inspect a nerve path more closely, by a test called an electromyelogram (EMG).
The EMG tracks the movement of electrical impulses along the nerve path, and can reveal
whether impairment is due to diabetes or follows a compression injury, such as back
problems or carpal tunnel syndrome.
Prevention and Treatment
As diabetic neuropathy follows extended periods of hyperglycemia, its best prevention
is good blood glucose management, "tight control," with numbers down in the
normal range. A healthy lifestyle, with plenty of exercise and careful attention to diet,
helps too. Incidentally, the same "tight control" regime can help those with
already established neuropathy. Although it is not clear exactly how it happens (there are
several theories), experience shows that getting your diabetes under control, and keeping
it there, can, over a several-month period, alleviate at least some of neuropathy's
symptoms.
Individual symptoms are as varied as individuals, but the most common complaint is
pain, and pain control becomes the single biggest challenge in dealing with established
neuropathy. Doctors have prescribed aspirin, acetaminophen, and various other nonsteroidal
anti-inflammatory drugs, the anticonvulsants Dilantin and carbamazepine (Tegretol), and
tricyclic antidepressants such as paroxetine (Paxil) and amytriptaline (Elavil), or a
combination of vitamins B1, B6, and Glutamine, with varying results. Along with the drugs,
some are prescribing capsaicin cream (Zostrix and its equivalents), a topical ointment
originally formulated for arthritis pain. Some use the epilepsy drug gabapentin
(Neurontin), while others relieve symptoms with local anesthetics or muscle relaxants.
Still others are investigating acupuncture, although not enough is known about it to say
for certain if it works in such cases. T.E.N.S., transcutaneous electrical stimulation (of
the affected nerves) with a short jolt of electricity, appears to interrupt the
transmission of pain signals, and works for some. Researchers are also experimenting with
aldose reductase inhibitors such as Sorbinil and Zenerstat, but these have not yet been
approved in the USA. And of course the search for new treatments goes on, with tests of
antioxidants, nerve growth factors (rhNGF), blood vessel expanders, and various
herbal/naturopathic substances.
There is a lot of disagreement over effective treatments for neuropathy pain. Folks
swear by their particular remedy. You need to find and use what works for you. Beware of
extravagant claims for pill or technique; there are no "miracle cures."
None of the pills and creams is as effective in bringing relief as is getting your
blood sugars into good control and keeping them there. The International Diabetes Center's
website advises:
"The best way to treat or prevent neuropathy in any area of the body is to control
your blood glucose levels. Good glucose control may not reverse numbness or tingling, but
it can slow or stop additional nerve damage. Good control also can bring on dramatic pain
relief. Medications can be used to control the symptoms of painful neuropathy and
gastroparesis (autonomic neuropathy of the digestive system) as well."
Consequences of Neuropathy
The main reason we, as human beings, have a pain reflex, is because pain lets us know
something is wrong in the affected area. If it hurts, we do something about it. With its
biggest symptoms being pain (when nothing is there) and diminished sensation/numbness
(when something is present), neuropathy can seriously interfere with a diabetic's
self-care, especially care of the feet. Circulatory problems stemming from diabetes can
lead to dry skin on the feet, with the risk of ulcers and lesions. Lacking normal pain
reflexes, the diabetic with neuropathy may not be aware his or her feet are in trouble.
Even stepping on a tack may be pain-free. This means otherwise treatable lesions are
allowed to progress into severe infection, sometimes into gangrene itself. Amputation is a
common result of this progression of events, and complications of diabetes account for the
majority of nontraumatic amputations in the U.S. today. All diabetics need to frequently
inspect their feet, but individuals with neuropathy need to be especially thorough, as
early detection of foot problems can be critical to saving the infected foot.
Other Coping Strategies
Although there are lots of variations, with the rule being "do what works for
you," there are a number of non-medicinal ways folks cope with neuropathy pain. One
individual, who reported "burning feet" at night, slept with her feet uncovered,
and a fan blowing cool air on them. Many others cushion aching feet with thick, seamless
hikers' socks, especially those made of cotton, or of man-made materials such as Thorlo.
Some folks report that exercise brings relief, however temporary. Others use
meditation-based relaxation techniques to help them manage. Another approach, followed by
many, is to wear high-quality, proper-fitting athletic shoes with good support, or support
sandals such as Birkenstocks, along with the socks mentioned above.
Many individuals whose feet are affected by diabetic neuropathy are also dealing with
circulatory/microvascular problems. Their ability to heal from otherwise minor cuts and
scrapes may be seriously impaired, leading to a history of ulceration, or even a partial
amputation. Special therapeutic shoes, with custom inserts, or "extra-depth
shoes," or several other shoe modifications, are covered by Medicare as durable
medical equipment. Discuss this with your doctor.
New Research
Although many medicines are used for treatment of neuropathy's symptoms, none are yet
officially FDA-licensed for such use. However, doctors have wide leeway in such
"off-label" prescribing, and these medications have passed safety inspection-and
are now being evaluated for their efficacy as neuropathy treatments.
There are also new medications under investigation; some to treat symptoms, and others
that might someday treat the underlying cause, the demyelinating nerve damage. At press
time, CenterWatch, a clinical trials listing service, lists 56 separate FDA-mandated
clinical trials of new neuropathy medications underway in the United States on human
subjects! One such study is of the drug memantine, which has been proved effective in
rat-based pain-reduction studies, and is now in FDA-mandated Phase II clinicals. There are
many more studies at the "test tube" stage, or currently in animal trials.
Conclusion
Unexplained pain or abnormal sensation is a serious matter. It may indicate neuropathy,
which may be from diabetes, or it may stem from some other condition--and your doctor
needs to promptly determine its source. Neuropathy is NOT an inevitable ramification of
diabetes, but you shouldn't just "grin and bear it," either. A lot of different
therapies and interventions bring relief to many diabetics. Keep the best blood glucose
control you can, keep your doctor informed, and don't lose hope.
For Further Reading
A great deal of research is being done on this subject. Although most findings are
published in professional research journals, World Wide Web searches on
"neuropathy" reveal hundreds of timely listings, many linked to other sources.
Here are a few websites you might find worthwhile:
http://www.niddk.nih.gov/health/diabetes/ndic.htm -- The National Institutes of
Diabetes, Digestive, and Kidney Diseases
http://www.centerwatch.com/studies/cat253.htm -- CenterWatch
http://www.intelihealth.com/IH/itlH -- Johns Hopkins IntelliHealth
http://www.cdc.gov/nccdphp/ddt/ddthome.htm -- U.S. Centers for Disease Control
http://www.diabetesmonitor.com/dr-00005.htm#neurop -- "Diabetes Monitor"'s
neuropathy page
http://www.hsmnet.com/IDC-Main.htm -- (International Diabetes Center's Home Page)
Published Sources:
"Diabetic Neuropathy: Current Practice and Promising New Therapies,"
"Interdisciplinary Medicine" (March 1999) Vol. 4 No. 1, Dept. GN173B, 405
Trimmer Road, PO Box 458, Califon, NJ 07830.
"Taming the Pain of Nerve Disease," "Diabetes Advisor" (May/June
1999) Vol. 7, No. 3.
"New Treatments for Diabetic Neuropathy" by Keith R. Edwards, MD. "Home
Health Care Consultant" (March 1999) Vol. 6, No. 3.
"Pathophysiology of Painful Neuropathy" by Mark Granberry, PharmD, Suresh
Baliga, MD, and Vivian Fonseca, MD. "Practical Diabetology" (June 1999) Vol. 18,
No. 2.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
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,
811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911, fax: (573)
875-8902. NOTE: Please provide a phone number so we can reach you.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
CORRECTION:
Last issue, in the article "Tips For the Newly-Blind Diabetic," the NFB
publication "If Blindness Comes" was listed incorrectly. Available in large
print or audiocassette, it is, in fact, available free of charge from: National Federation
of the Blind Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410)
659-9314. The Materials Center is open 12:30 to 5 pm Eastern Time, weekdays.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
FLU SHOTS
As regular as tax time, flu season is coming around. Just like tax time, there will be
lots of new nastiness we haven't seen before--and you'd better be ready. Influenza,
"the flu," is not just the aches, fevers, and fatigue--it can put you in the
hospital, or take your life. According to the Centers for Disease Control (CDC), each year
the flu kills about 20,000 people.
The CDC says most of the people seriously harmed by the flu will be members of its
"target populations": People over 65, people with chronic lung or heart disease,
with asthma, or with diabetes.
Why? A serious case of the flu can put anyone on their back for a week or two, but if
you have diabetes, it can cause real problems with your blood sugar control. The fevers
and infections can drive your blood sugars way up, and it is really hard to self-manage
your diabetes when you're that sick.
Prevention is the best cure! The CDC is already tracking the strains of flu expected to
be here this winter, and vaccinations have been available since September. Talk to your
doctor, and avoid this complication--get your flu shot.
To learn more about the flu, check out the following website: http://www.hcfa.gov/flu
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
If you or a friend would like to remember the Diabetes Action Network of the National
Federation of the Blind in your will, you can do so by employing the following language:
"I give, devise, and bequeath unto the Diabetics Action Network of the National
Federation of the Blind, 1800 Johnson Street, Baltimore, Maryland 21230, a District of
Columbia nonprofit corporation, the sum of $_______________" (or
"_______________ percent of my net estate" or "the following stocks and
bonds:____________________") to be used for its worthy purposes on behalf of blind
persons."
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
AN INSPIRING EXAMPLE
Photo: portrait. Caption: Evelyn Engelhardt
Artwork (at end of article): Blind man walking with a cane
Evelyn Engelhardt doesn't want young diabetics to be depressed. Too many, she thinks,
dwell on thoughts of going blind, losing kidneys, or facing amputation. "Why think
that way?" she asks. She knows the vast majority of diabetics who take care of
themselves will not face complications.
She ought to know. She's had diabetes 68 years.
When Evelyn was ten years old, in September 1931, she began to show the classic
symptoms of diabetes: the thirst, the weight loss... She dropped to 86 pounds, and her
parents thought she had a tapeworm.
Her old family doctor figured it out. He checked her urine, and said "she had
sugar." But he hadn't heard of insulin (it had been out ten years), so he put her on
"a real strict diet of gluten bread."
It didn't help. About a year later, in 1932, she went into a "diabetic coma,"
from the untreated high blood sugars. She could have died. Her mother told her they used
to call it "consumption."
But her aunt knew a doctor at Good Samaritan Hospital, there in Cincinnati, who
"knew something about diabetes." Into hospital Evelyn went.
They kept her there a month. "I got to know the nurses really well," she
says.
Evelyn didn't think what she had was all that bad, but her mother did--and kept her out
of school for the next year. During that year, her mother made sure that Evelyn took her
three shots of regular insulin (the only kind they had) on time, every day. Evelyn also
learned to weigh her food, and to test her urine for sugar, using a test tube and Bunsen
burner.
Not surprisingly (considering the big "reusable" syringe needles of the day),
she did not enjoy injecting her insulin. A local pharmacist found her an automatic
injection device: "This was a thing you put the syringe in, like a barrel, and it
pulls back--sort of like the lancet devices we have now. Then it would automatically go
into your arm, and you would get your insulin. It was really fantastic..."
Evelyn notes that once her diabetes was under control, her personality changed. She
became president of her high school freshman class. "I was outgoing; I was in all the
best groups, you know!"
But, inevitably, there were insulin reactions...
"I went to Our Lady of Mercy High School, and I belonged to one of the 'cliques'
as they called them. There were 13 of us then, and now only four are left--but we still
keep in touch. But anyway, this one girl friend of mine used to say: 'I remember when we
went down to Chester park, walked, and went swimming. You acted so funny...' My friend
remembered she had a Clark Bar, and once she gave it to me I was OK...
"And there were times when I was dating. I danced a lot, the jitterbug. I would
get home late, and there would be times they couldn't wake me up. And so my dad was the
only one who could take care of that. I would wake up and have Hershey chocolate smeared
all over my face--he was trying to get it into my mouth, you know--and I'd fight it like
crazy... Any time that happened, my mother wouldn't do it; my dad would always take care
of it."
Those were the early days; folks didn't know anything like what we do now about taking
care of diabetes. Still, Evelyn kept up her diet, her exercise (she loved dancing!) and
she prospered. As self-care improved, she adopted the new techniques, like regular blood
glucose monitoring.
Evelyn and husband Robby have been married for 54 years, and they have two daughters,
now 48 and 44 years old. They have four healthy grandchildren. "It's not the easiest
thing in the world to have children when you're diabetic, but it's certainly worth
everything I went through."
There are many veteran diabetics like Evelyn Engelhardt, and if you ask them how they
made it 50, 60, or more years without significant complications, they all seem to say the
same thing. Evelyn quotes her daughter, who owns a restaurant: "Mom, you really do
take care of yourself. I wish you'd see the people who come to this restaurant, who are
diabetic, and think nothing of ordering pie, cake, you know..."
But she never slipped up, and she's gone the distance: 68 years with type 1 diabetes.
Evelyn Engelhardt is living proof that with diligence, diabetes can be conquered. She is
an inspiring example to us all.
She would like to correspond with others interested in diabetes. Write to her: Evelyn
Engelhardt, 10602 Hamilton Avenue, Cincinnati, Ohio 45231.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
DON'T FEEL GUILTY
by Ed Bryant
Photo: portrait. Caption: Ed Bryant
Most of us know there are an estimated 16 million diabetics in the United States, and
that many have difficulty in coping with or controlling their diabetes. Many thousands of
diabetics have experienced blindness, kidney disease, amputation, neuropathy, etc., while
others have not experienced ramifications.
I communicate with many people concerning diabetes. I hear from far too many who have
been led to believe their diabetes, or its complications, result from bad behavior or
personal defect. This is not true. Too many diabetics "do their best," do
everything they are supposed to do, and still face serious complications. DIABETES CAN
CAUSE MANY PROBLEMS, BUT WE DIABETICS SHOULD NEVER FEEL "GUILTY" ABOUT HAVING
THE DISEASE, OR ABOUT HOW IT HAS AFFECTED OUR LIVES.
Good education is critical to proper diabetes self-management, and there are many good
health-care professionals who diligently strive to help patients understand and practice
good diabetes management. Unfortunately, there are other doctors who haven't kept abreast
of new developments, who don't spend much time educating their diabetic patients about the
condition. These diabetics are sometimes led to believe they should feel guilty about
whatever difficulties their diabetes may have caused. In other words, the negative is
accentuated instead of the positive.
I review many diabetes publications, and I find some of them seem to tell readers they
will have little or no problems if they take good care of their diabetes. I am fully
cognizant we need to do anything possible to keep our blood sugars in normal range
(euglycemia), and make every effort to keep the disease in check. But we also need to
recognize that we can do all this, do it correctly and diligently, and still have
problems.
We know that complications can be prevented or delayed if our blood sugars are kept
under control, if we eat correctly, if we exercise, if our medication regimens (insulin
and oral meds) are monitored, if we keep our blood pressure in a safe range, if we don't
smoke, if our cholesterol is under control and if we don't... Unfortunately, many people
follow all the "rules," to keep their diabetes in check and guess what, they
still have problems.
There are others, who for years didn't keep their diabetes under good control, because
they just didn't realize what complications could pop up. I have communicated with many of
these folks, and most of them say they didn't receive much diabetes education. Too often
they say their health providers diagnosed, prescribed, but didn't provide adequate
information about diabetes. This lack of education is not a past-times issue; it is very
prevalent even today.
Diabetes self-management is a discipline, and both lay people and health professionals
should constantly educate themselves about the disease and new approaches and findings on
the subject. Unfortunately, there are doctors today who do not ask patients to regularly
have a hemoglobin A1c lab test. Others tell patients it is okay for their blood sugars to
average around 200mg/dL. Some don't check the diabetic's feet each office visit, or don't
keep informed about new diabetes medications, or...
There are a lot of fine specialists providing the best possible diabetes care. But,
many of us only have access to a "General Practitioner," or "Primary Care
Provider," and to expect these folks, responsible for all types of medical
conditions, to be "up" on the latest research findings, is unrealistic--but we
do, and they do, too. There are some less than fully "clued up" doctors out
there, far too many, who don't do the best job when working with diabetics--because they
haven't kept abreast of the changes in diabetes care.
The health provider's job is to serve his/her patients in the best possible way. Any
decision, any treatment, any advice that falls short of "the latest and most
accurate" is substandard health care--and when people pay their bill for services
rendered, they have every right to expect good service. Otherwise, you should consider
seeing a different doctor.
How do you know if your doctor is doing a good job with your diabetes? As education is
a requirement for both doctor and patient, you learn as much as you can, taking full
advantage of all possible sources: VOICE OF THE DIABETIC, other diabetes magazines,
support groups, websites, e-mail discussion lists, and the many patient handbooks
published by doctors, dietitians, and diabetes educators. The more you, the diabetic,
learn, the more you'll be able to tell whether you're receiving the best possible care.
And you might consider passing on the latest material to your doctor...
To repeat, most health-care teams who deal with diabetes do good work, but if you are
not being kept apprised about diabetes issues, you should consider seeing a different
doctor. Diabetologists and endocrinologists would be the first choices, but this doesn't
mean an educated and informed family doctor is not capable of doing a good job in taking
care of you and your diabetes.
Our Diabetes Action Network knows that upbeat attitudes are contagious. Our positive
attitude is perhaps our best attribute. There is absolutely no reason for anyone to lose
self-esteem or dignity because of a hurdle in the road. I hope this article serves as a
catalyst, starting people moving in a positive direction. If we diabetics have a negative
attitude and feel guilty about our condition, then often our loved ones and friends are
affected. When I participated in the Juvenile Diabetes Foundation International's world
diabetes teleconference/press briefing, held March 19, 1997, as part of the JDFI Fourth
World Diabetes Conference, I heard Emily Spitzer, a JDF national board member, remind us
all that people are "not at fault" if they develop diabetes or its
complications.
IT IS NOT SHAMEFUL TO BE DIABETIC. AGAIN, DON'T FEEL GUILTY IF YOU HAVE DIABETES OR
HAVE EXPERIENCED ANY OF ITS COMPLICATIONS.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
DOCTOR SUGGESTS NEW PRIORITIES COULD REDUCE
DIABETIC BLINDNESS
James O'Rourke, MD, professor of pathology at University of Connecticut Health Center,
is calling for primary care deliverers to regularly obtain an image of their diabetic
patients' retinal blood vessels and then catalog those as part of a permanent medical
record. Today, one-half of all people with diabetes will eventually develop some degree of
retinal damage, and 10 percent of these will become legally blind after having diabetes
for 20 years. It doesn't have to be so, Dr. O'Rourke believes.
New technologies, particularly in the field of diagnostic imaging, are available to
health care providers. The problem has been to chart changes in an individual's eyes, and
to do that, physicians need a "baseline," a clear idea of the condition of the
patient's eyes at a given time. The tests, already available, which Dr. O'Rourke
advocates, will provide such a "baseline."
With this information in hand, doctors and nurses can easily discern changes in a
patient's retinal blood vessels in subsequent years, and quickly invoke proper treatment.
The expenses of making and maintaining the record are outweighed by the savings of very
expensive therapies and rehabilitation for those who go blind because of diabetes.
"We're not using our available resources, manpower, or skills to maximal advantage
to combat this problem," Dr. O'Rourke said. "Diabetes and diabetic blindness
numbers are growing, and we're not properly deployed. We're losing this fight," he
said.
Dr. O'Rourke suggested misunderstandings and misconceptions may have contributed to why
we are where we are now. His assessment of the situation includes:
* Diabetic blindness is not a disease of the retina, or an eye disease; it is a disease
of the blood vessels in the retina. Diabetes does not just cause retinal blood vessel
damage; the disease causes widespread blood vessel damage, particularly the fine blood
vessels of the kidneys, nerves, brain, and feet. Diabetes affects the walls of blood
vessels. There are more than 10 billion tiny blood vessels throughout the human body--or
more than 600 square meters of wall surface--about the size of three tennis courts.
* Viewing the retina is one of the most effective means of detecting early blood vessel
damage in diabetes. Unfortunately, viewing the retinal blood vessels through an undilated
pupil provides only a limited, transient image. Seeing retinal blood vessel damage early
on allows doctors to monitor and adjust medication levels. While maintaining a normal
blood sugar level is not easy, one of the keys to it is early detection.
* New ways are needed to rapidly screen for retinal diabetes at less cost. Proper
planning and improved technology can help, but screening has to be incorporated as part of
a regular health maintenance program.
* The medical system is divided into specialties that manage different aspects of
diabetic care. Early detection and prompt treatment of retinal diabetes requires more
efficient interactions among specialists, if we hope to reverse the diabetic blindness
problem.
To improve efficiency, Dr. O'Rourke suggests primary care physicians ought to obtain
full digital color prints of retinal blood vessels, with pupils dilated, from their
patients who have had diabetes more than five years. These images should be repeated
annually, and maintained in the patient's medical record, so that comparisons can be made
if the occasion warrants.
Dr. O'Rourke also suggests that community hospitals make retinal imaging available to
primary care physicians.
"Convenient screening by retinal imaging is the key to early detection," he
said. "The procedure takes 10 minutes, and it is painless. We do it here at the
Health Center in our Vascular Radiology Division, thanks to support from the Connecticut
Lions. This is something that will materially help reduce the growing problem of diabetic
blindness."
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
TYPE 1 DIABETES PREVENTION TRIAL NEEDS VOLUNTEERS
Can type 1, insulin-dependent diabetes be prevented? If blood tests suggest you are at
high risk of developing the condition, can anything be done to stop the process?
Type 1 diabetes, with its absolute insulin deficiency and the resulting need for daily
insulin injections, occurs when the body's own immune system mistakes the
insulin-producing Beta cells of the pancreas for "invaders," as if they were
germs, and attacks them. Researchers, who already know how the body's immune system picks
its targets and destroys them, wondered if the "ICA" (islet cell antibody)
attack on the Beta cells could be deterred or short-circuited, preventing or delaying the
onset of diabetes.
The National Institutes of Health has launched a research study to answer that
question. Researchers want to know:
A. Whether daily insulin injections, given to persons judged at high risk of developing
type 1 diabetes (but not yet "diabetic"), might slow or prevent the disease.
B. Whether oral insulin, insulin pills, might "teach" the immune system and
its ICAs to "accept" the Beta cells, halting the destructive process that causes
type 1 diabetes. This "oral tolerization" has already worked in animal trials.
Major tests of this type cannot be done in some laboratory. They cannot be done
quickly. They cannot be simply modelled on a computer. The Diabetes Prevention Trial--Type
1 needs volunteers, people at high risk of developing diabetes, to participate, to prove
whether either of these approaches has merit. If either technique results in a significant
reduction or delay in full-blown diabetes (as compared to similar folks not receiving the
insulin), we will have a potent new tool for diabetes prevention.
Researchers are still looking for close relatives of persons with type 1 diabetes, to
participate in the study. Eligible participants must: Be between the ages of three and 45
years, be willing to accept either "injecting," "oral," or
"control group" assignment, have blood test results that show the person is at
high risk of developing type 1 diabetes, and must have a close relative with type 1
diabetes. The researchers have very specific questions to answer, and need to interview
thousands of people to get the right test subjects. If you fit the criteria, and a free
preliminary test finds you have the ICAs, the islet cell antibodies, in your blood, you
might be one of them.
Nine different diabetes centers, located in California, Colorado, Minnesota, Washington
State, Florida, and Massachusetts, will gather data. More than 350 "screening
sites" across the country will help researchers find the right test subjects.
Participants living in other areas can have tests forwarded by their family physician. For
information and a list of screening sites, call the Diabetes Prevention Trial--Type 1
(DPT-1) National Coordinating Center, located in Miami, Florida; telephone:
1-800-425-8361.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
THE "Y2K BUG" AND DIABETES
by Peter J. Nebergall, PhD
Photo: portrait with cat. Caption: Peter J. Nebergall
As we approach January 1, 2000 AD, we hear a great many reports, and some dire
predictions, about "Y2K" and the possibility for real chaos upon the arrival of
the new millennium. What are they talking about? Does this have anything to do with
diabetes care? Should you be concerned?
What is "Y2K?"
All but the simplest computing devices contain electronic clocks and timers, some to
inform you, but most to enable proper storage and recording of data. In the 1950s, when
computers were huge, expensive, and small-brained, a two-digit standard was adopted to
mark the year: "59" meant 1959. This worked fine.
Computers got better, faster, cheaper, smaller, and vastly more popular. A great many
appliances formerly 100% mechanical, from cars to cameras, from stereos and VCRs to
microwave ovens, now incorporate computer electronics--but most folks never thought to
deal with those two-digit dates. Then "96" (1996) arrived, and folks started
noticing, started realizing that the two-digit system couldn't tell the difference between
"2000" and "1900." Come January 1 of 2000, some electronic devices
would give inaccurate dates. Data could be lost; scheduled tasks might not be
automatically performed.
Action and Reaction
Programmers, computer companies, and the Federal Government immediately got busy. It
was discovered that most home computers, business "mainframe" computers, and
many critical electronic devices could be cheaply and easily altered to avoid the
anticipated difficulties. "Y2K Compliance Engineering" became a booming
industry. Most hospitals, power plants, factories, and large corporations quickly made the
adjustment--and this includes major manufacturers and suppliers of diabetes equipment and
supplies. Many have posted statements of Y2K compliance on their websites.
PC computer users, like VOICE OF THE DIABETIC, had their equipment tested, and
installed the necessary "BIOS Upgrades." It cost about $20, and took about 15
minutes. No big deal. Most likely your corner pharmacy has done so too.
What About My Monitor?
Most home blood glucose monitors contain electronic date memory chips. Most of them are
"hardwired" (the memory is cast into the chip), and cannot be reprogrammed. Most
newer meters are "Y2K compliant," but manufacturers warn some of their older
glucose monitors "may experience difficulties after December 31, 1999."
If you are using a now-superseded machine, an older blood glucose monitor, I strongly
recommend you check with your supplier, or with the manufacturer. It might not be
"Y2K compliant," and now might be a good time to check out a new meter.
If you download data from your meter into a computer, using one of the many
"diabetes-tracking" computer programs available, make sure your computer has
been upgraded to Y2K compliance. LifeScan's website (www.lifescan.com) observes that some
older versions of these programs are not Y2K compliant, and should be replaced or
upgraded.
Where's the Trouble, Then?
With all the thorough preparation for Y2K (big pharmacy chains and drug companies state
they are ready), I see only two potential problems. First is the Internet. The Web is a
chain of computers, passing messages from one to another to another, and if some of those
computers experience difficulties on January 1, they could slow down the information
superhighway. The more Web-users who upgrade their computers to Y2K compliance, the less
the risk--but I would expect some delays on the Net for the first few weeks.
The second problem is civil chaos. There have been so many "end of the world"
horror stories about Y2K that there is some small risk of a self-fulfilling prophecy. A
lot of people are so primed for disruption that they may inadvertently cause it. I look
for some of the big cities to get a bit crazy for a week or two. I would recommend, if you
live in a big city, that you have two weeks' worth of insulin, strips, and other
life-sustaining medications on hand before New Year's Eve.
Conclusions
The world is not coming to an end. Your diabetes equipment manufacturers and
pharmaceutical suppliers are ready for the millennium, and will be there for you. Your
local corner pharmacy is probably ready too--go ask! Is your monitor ready? If in doubt,
ask your supplier, call the manufacturer's customer service number (on the box of test
strips) or look at their website. As for your computer, any supply store should have the
necessary programs to upgrade it.
Take care, and we'll all get through the big day with a minimum of disruption.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
NEW DIALYSIS DRUG
Individuals undergoing hemodialysis as a result of kidney failure, end stage renal
disease, often require a variety of supplements and medications to help counteract the
stresses imposed on the body by that procedure. Many dialysis patients (and a high
percentage of these are diabetic) have been prescribed calcitrol, an oral D-hormone.
Calcitrol works, but has potential side effects. It can cause excessive blood levels of
parathyroid hormone (PTH), producing a condition known as Secondary Hyperparathyroidism,
or SHPT. This condition has long been associated with increased risk of bone fractures,
cardiovascular morbidity, and death. There has been a search for a safer medication.
Bone Care International announced on June 10, 1999, that its investigational drug
Hectorol (doxercalciferol) had been cleared by the U.S. Food and Drug Administration for
use in the management of SHPT in patients undergoing renal dialysis. The company reports
that in a double-blind placebo-controlled study (the drug's action compared to that of an
inert substance, without patient or doctor knowing which) Hectorol dropped blood PTH
levels 70%, and the placebo did not drop them at all.
If you are undergoing hemodialysis, Hectorol may be of benefit. To learn more about
this new prescription medication, have your doctor contact: Bone Care International, One
Science Court, Madison, WI 53711; telephone: (608) 236-2500.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
GASTROPARESIS TEST UNDERWAY
New drugs have to be tested first, on human volunteers. That's right. Before you can
buy it at the drug store, before your doctor can prescribe it, people like you have to
volunteer to take it as an "experimental" medication--to see if it works. There
are lots of these tests, and they need volunteers! Here's another one:
Do you have gastroparesis (delayed gastric emptying)? If you have been diagnosed with
diabetic gastroparesis, and have any of the following symptoms: nausea, vomiting,
bloating, weight loss, early fullness while eating, or persistent fullness, please call
Southeastern Clinical Research; telephone: (423) 778-6947. Your location is not critical;
research centers all over the country are participating, and you will be told where to
find the nearest test site.
Physicians are studying an investigational medication for the treatment of
gastroparesis, and are seeking volunteers to take part. Volunteers will receive free
physical examinations and laboratory services, free doctor visits, and free study
medications. Contact: Southeastern Clinical Research, 979 East Third Street, Suite 1105,
Chattanooga, TN 37403; telephone (423) 778-6947.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
NEW DRUG RESEARCH
Data presented in Barcelona, Spain, at the 21st Congress of the European Society of
Cardiology, about new and investigational heart medications, could improve the treatment
of diabetic ramifications. We have not seen a full list of the papers presented last
August and September, but two studies already stand out.
In the first, the HOPE (Heart Outcomes Prevention Evaluation) study showed that the
anti-hypertensive blood-pressure medication ramipiril (Altace), an ACE Inhibitor like
those already recommended for management of diabetic End Stage Renal Disease (ESRD), has
significant cardiovascular benefits, for both hypertensive patients and those with normal
blood pressure. The study showed a 15 percent reduction in the need for revascularization
(coronary angioplasty, coronary artery bypass graft, peripheral angioplasty) with
ramipiril; a 22 percent risk reduction in stroke, heart attack and cardiovascular death;
and, among participants who had not developed overt diabetes by the study's start (1994),
a significantly smaller number of those taking ramipiril did so during the study than did
those receiving the placebo. Note: Altace has been available in the United States since
1991.
The other study of interest to diabetics was of the new Angiotensin II Receptor
Antagonist medication Teveten(R), eprosartan mesylate. Although most of its Barcelona
presentation concerned its effect on blood pressure, the presenters did state their
preliminary data suggested Teveten(R) had beneficial effects upon reducing urinary protein
excretion, and therefore may be of benefit in preserving renal function in patients with
progressive renal disease.
The presenters, Drs. Ritz, Sica, Weber, and Sever, noted that further research is
necessary before a recommendation can be made for use of Teveten(R) in patients with
severe renal impairment. The drug, which cleared the U.S. Food and Drug Administration in
December of 1998, is currently indicated for the treatment of hypertension. It should be
available to physicians now.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
BLIND DIABETICS CAN DRAW INSULIN WITHOUT DIFFICULTY
by Ed Bryant
A major aim of the Diabetes Action Network of the National Federation of the Blind is
to provide support and information for blind diabetics, so they might better maintain or
regain independence and productivity. Our national support and information network allows
communication across a wide area, something important for blind or visually impaired
diabetics and their families. With the trauma of sight loss, sometimes the newly blinded
do not realize that most blind men and women with diabetes CAN self-manage safely and
accurately, by use of alternative techniques.
I became blind from diabetic retinopathy about 22 years ago. When I first lost my
sight, I didn't use insulin gauges to help draw my insulin, as I had never heard of such
devices! Nineteen years ago, I designed my own insulin gauge, and I used it for
approximately three years, with no difficulties. I do not advocate the use of non-standard
or homemade insulin-measuring devices, unless they have been checked out by someone
knowledgeable in insulin-measuring techniques.
Members of the health care community sometimes forget that although a diabetic may be
newly blinded, he or she has often been successfully self-managing the disease for 15
years or more. Most long-term type 1 diabetics have had years of experience drawing their
own insulin. Veteran blind diabetics often have more experience with adaptive insulin
preparation devices than do many sighted health professionals. The following observations
are only a small sample.
Because of my experience with diabetes and blindness and my editorship of VOICE OF THE
DIABETIC, I am often asked to evaluate insulin-measuring gauges designed for the blind or
visually impaired. I have tested numerous measuring devices, and in my opinion the
Count-A-Dose, from Jordan Medical Enterprises, wins the blue ribbon. (Note: The
Count-A-Dose is available from Jordan: 1-800-541-1193, or from the NFB Materials Center:
(410) 659-9314). I hasten to add that no one instrument is ideal for everyone; however,
the Count-A-Dose provides a very easy method of insulin dispensing. Designed for the
Becton Dickinson LoDose syringe, the Count-A-Dose holds two insulin vials and directs the
syringe needle into the vials' rubber stoppers. Using the thumb-wheel, which clicks for
each unit measured (clicks can be both heard and felt), the blind diabetic can reliably
draw and mix his or her own insulin. (Note: The NFB Materials Center has a supply of the
older, now discontinued, 1cc, 100-unit Count-A-Dose, useful for anyone who needs to draw
up a larger amount of insulin. Operation is similar.)
How to Get Air Bubbles Out of an Insulin Syringe
There are techniques by which a blind diabetic may draw and mix insulin without drawing
air into the syringe. Like many others, I have used them successfully for years. I first
draw four or five units of regular insulin into the syringe and then inject all of it back
into the vial. I then repeat the operation two more times. The fourth time, I draw the
full amount of insulin needed from the first vial. Then, when I draw insulin from the
second vial, I draw the exact amount needed. I have put this to the test; 100 repetitions
without air bubbles. Diabetes Action Network First Vice President Janet Lee has twice
performed the same test. In both cases the complete absence of air in the syringe was
independently verified.
"Tapping the syringe to remove air bubbles," a common technique used by the
sighted, becomes unnecessary. The one to two units of air in the hub of the needle (where
needle meets syringe) are expelled during the procedure used with the first vial of
insulin. I demonstrate this technique to nurses, who are delighted to see that air bubbles
are not present and the insulin measurement is accurate. Of course, long-term insulin
users will be familiar with the need to inject as much air into the vial as the amount of
insulin they withdraw, to facilitate getting the insulin into the syringe. For further
information, consult your health care team.
How to Know When an Insulin Vial is Getting Low
Each vial of insulin contains 10cc, 1000 units. The maximum number of units used per
day, divided into the vial's 10cc (1000 units) capacity, gives the maximum number of days
the bottle can be used. When I open a new vial of Regular insulin, I divide its 1000 units
by 20 units, the maximum I use daily, so one supply should last me 50 days, but as a
safeguard, I assume that the new bottle contains only 940 units (9.4cc), which should last
a maximum 47 days instead of 50. I measure my NPH insulin in a similar manner. As long as
at least 60 units of insulin remain in the vial, the needle will remain submerged while
filling, and there is no danger of drawing air. In drawing out the insulin, I keep the
syringe vertical, needle straight up in the vial, so as not to inadvertently draw out air.
Many blind consumers (and diabetes educators) are unaware of this point's importance--that
the natural tendency is to tilt or slant while drawing, which can lead to inaccurate
filling and air in the syringe.
Many methods exist to determine how long a supply will last. One way to keep track of
the amount of insulin in the container is to set aside the number of syringes that will be
needed for 940 units of insulin. Another might be to employ Braille, large print, tape
recorders, or personal computers, to record how much insulin has been used each day. Many
blind consumers, like myself, realize the importance of keeping their blood glucose under
tight control, and follow regimes of insulin mixing and multiple injections, both of which
increase the need for precision. I have found the more precise the record of insulin
drawn, the easier to safely predict when it is time for a new supply. Note: Although not
as precise, before drawing insulin you can gently shake the vial and, with practice,
easily determine whether it is full, half-full or nearly empty.
The Possibility of Inserting a Needle into a Blood Vessel
Since injection sites are in fleshy areas, and insulin needles are short, chances of
inserting a needle into a blood vessel are minimal. The worst that can be done is to hit a
small capillary, which would result in a small area becoming infused with blood--a
hematoma. Again, it is unlikely the needle will be inserted into a small blood vessel. The
amount of insulin entering the bloodstream via a capillary would be insignificant, and
would cause no harm.
Something to Think About
I periodically have my insulin gauge checked for accuracy; it has always measured
precisely. If the diabetic is careful, difficulty in measuring insulin will not occur. I
have found that inaccuracy is often the result of haste or carelessness.
It is reported that insulin gauges are more accurate than sight. When the plunger is
pushed firmly to the gauge, the same amount of insulin will be obtained every time.
Sometimes my sighted friends make errors in drawing insulin. Perhaps they would be more
accurate if they used insulin gauges! Note: Syringes are mass-produced. Although there is
quality control, some errors are made in syringe markings. If a gauge is used, the
measurement will be accurate no matter what the syringe shows.
At first hearing, all this may sound like a lot to remember, but it is not difficult.
Marla Bernbaum, MD, CDE, Assistant Professor at St. Louis University Medical School
Department of Endocrinology, states: "In our experience here, most blind and visually
impaired diabetic patients have been capable of drawing their own insulin with complete
accuracy."
Janet Lee, Director of the Independent Management for Blind Diabetics Program at BLIND,
Inc., Minneapolis, Minnesota, states: "In my ten years of working with blind
diabetics, hundreds of them, there have maybe been two, who, because of a combination of
disabilities, could not measure their own insulin."
Ruth Ann Petzinger, RN, MS, CDE, Diabetes Care Manager/Educator at St. Peters Medical
Center, New Brunswick, New Jersey, states: "During the time I have been working with
persons with diabetes and visual impairment, I've never had a patient who truly wanted to
be independent with insulin administration or blood glucose monitoring who was not able to
achieve these goals."
Ann Reardon, RN, MSN, CDE, with the Georgia Dept. of Human Resources/Medical College of
Georgia, states: "In my experience, with proper training almost all diabetics are
able to prepare and administer their own insulin safely, regardless of visual
impairment."
Ann Williams, MSN, RN, CDE, Diabetes Program Coordinator, Cleveland Sight Center, and
her colleague Marylin Teasley, RN, CDE, state: "In the last eight years we have
taught about 800 visually impaired and blind people to measure and administer their own
insulin independently. Vision loss does not preclude safe and effective insulin
self-administration."
I have no problems managing and keeping my diabetes under control. I control it through
the use of alternative techniques, some of which are described here. Many members of our
organization, the National Federation of the Blind, use them daily to live active lives.
With alternative techniques, blind diabetics can be as productive as when they were
sighted.
Come to us and ask for assistance. We are ready, willing, and able to help. We want you
to know that no matter what your diabetes ramifications, you are not alone and do have
options. We in the National Federation of the Blind know that blindness is not synonymous
with inability.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
DIABETES EDUCATION PROGRAMS ARE ESSENTIAL
by Roseanne Braiotta
(Program Manager, Diabetes Education & Treatment Center, White
Plains Hospital Center, NY)
Diabetes has a major impact on the lives of 16 million Americans and their families.
Health care costs for diabetes continue to climb, and people with diabetes have average
medical costs almost four times higher than people without diabetes. Diabetes affects more
Americans, and costs more money, than AIDS and breast cancer combined (an estimated $100
billion each year). It is the seventh leading cause of death in the United States today.
Can anything be done?
Yes. The good news is that there is a simple and effective way for people to arm
themselves for the diabetes battle--Diabetes Education Programs. Such programs are
essential in helping individuals with diabetes to understand the importance of proper
blood sugar control. People with diabetes are at higher risk for heart disease, high blood
pressure, stroke, eye disease, kidney disease, nerve damage and amputations. Studies have
proven that people who manage their blood sugar can significantly reduce the onset and
severity of complications.
The Diabetes Education and Treatment Center (DETC) at White Plains Hospital Center,
White Plains, NY, is one example of how a patient education program helps set a solid
foundation for better diabetes care. The DETC, an outpatient education program recognized
by the American Diabetes Association, is designed to provide patients with the necessary
knowledge and skills for successful diabetes self-management. Patients are shown the
significant role they play in self-managing their diabetes, and in maintaining the
delicate balance between diet, exercise and medication. They receive individual and/or
group instruction on topics such as: understanding diabetes, how medications and insulin
work, blood glucose monitoring, diet and nutrition, complications, exercise, managing
stress and coping with psychosocial issues. Most sessions are taught by a Registered Nurse
and a Registered Dietitian, both of whom are Certified Diabetes Educators. Patients can
receive anywhere between 4-15 hours of education over a two to three month time period. As
time constraints make this type of extensive education virtually impossible to obtain at a
physician's office, doctors welcome the opportunity to refer their patients to centers
like the DETC to ensure their patients receive more complete diabetes education.
A team approach, and rapport, are developed between patient, diabetes educator and the
patient's physician. Physicians are kept informed of their patient's progress, and
patients are encouraged to pursue routine follow up care with their physician, especially
Hemoglobin A1c (also known as HbA1c) testing. The HbA1c test is an indicator of blood
sugar control over a two to three month period. It is recommended that this test be done
every three months, or at the very least, twice a year. After mastering the lessons of
diabetes self management, most patients see a decrease in their HbA1c.
If diabetes education has such wonderful benefits, why don't all diabetics receive it
as a matter of course? Some mistakenly believe such education is not important because
they "feel O.K. now" or that because they are taking a pill, or insulin, their
diabetes is under control. Many people underestimate, or simply lack the knowledge, of how
serious diabetes really is. Far too many people have waited until experiencing some sort
of complication before they start to take their diabetes seriously. Diabetes is easier to
ignore, if you don't have first-hand facts and information. Some people do not know that
programs like the DETC exist. Cost is sometimes an issue. Although many health care plans
(Medicare and some Managed Care) offer coverage for diabetes education, not all plans do.
Costs for diabetes education vary by program and state. Fees could range from $95-$125 per
one-hour session, with group instruction costing slightly less. It is important that
people check with their insurance company to inquire about their specific coverage. It is
also important to note that even if a person's insurance does not cover diabetes
education, they should strongly consider paying for services out of pocket. Money spent on
diabetes education is a worthwhile long-term investment in a person's overall health and
well being.
Increased diabetes awareness and education will undoubtedly help reduce the health
complications which have long been associated with this disease--therefore, also helping
to decrease diabetes-related health care costs. Whether an individual has had diabetes for
years or is newly diagnosed, diabetes education programs can enlighten and motivate that
person to live a happier, healthier lifestyle. For information on the diabetes program at
White Plains Hospital Center, call 914-681-1228. For information on programs in your local
area ask your physician or call your local hospital or local chapter of the American
Diabetes Association.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
COOKING WITH SUZI
by Suzi Castle
We're all concerned with healthful eating, but none of us want to give up occasional
treats. Although care and moderation are necessary in your diet, it is possible to create
sinfully rich-tasting, yet very low-in-fat and sugar-free quick-to-fix desserts that the
whole family will enjoy. Here is one!
Lite Pumpkin Pie
Serve with a dollop of fat-free whipped topping
Crust:
1 cup unbleached flour
Sugar substitute equal to 1 1/2 tablespoons sugar (i.e., 1 1/2 tablespoons Brown
SugarTwin)
1/4 teaspoon Morton Lite Salt Mixture
2 tablespoons Butter Buds
2 tablespoons chilled stick butter or margarine, cut into small pieces
1/4 cup ice water
1 egg white, lightly beaten
1 teaspoon cider vinegar
Filling:
2 cups canned pumpkin
2 cups water
1 cup low-fat (1/2% fat) milk powder (equal to 4 cups low-fat milk)
1/2 fat-free egg substitute
Sugar substitute equal to 3/4 cup brown sugar (i.e., 3/4 cup Brown SugarTwin)
1/2 teaspoon Morton Lite Salt Mixture
1 teaspoon ground cinnamon
1/2 teaspoon each: ground ginger, nutmeg and allspice
1/4 teaspoon ground cloves
CRUST: In a mixing bowl, combine flour, sugar substitute, Morton Lite Salt Mixture and
Butter Buds. Using a pastry blender or two knives, cut in butter until mixture resembles
coarse crumbs. Combine ice water, beaten egg white and vinegar. Using a fork, stir in ice
water mixture 1 tablespoon at a time.
Gather the dough into a ball and press into a flat circle. Place two overlapping pieces
of plastic wrap on a flat surface. Set the dough in the center. Cover with two more
overlapping pieces of plastic wrap. Using a rolling pin, roll the dough into a 12"
circle. Remove the top pieces of plastic wrap. Invert the dough over a 9" or 10"
pie pan sprayed with nonstick spray. Gently press the dough into the pan. Remove the
remaining plastic wrap. Fold in the overhanging edge of the crust to form a sturdy edge.
Patch any thin spots with scraps.
FILLING: Mix all ingredients. Pour into a crust-lined pie pan. Bake in a preheated 350
degree oven for 1 hour, or until knife inserted in center of pie comes out clean. Serves
8.
Per serving: 145 cal. (14% from fat); 8.2g protein; 2.33g fat (1.37g sat.); 23.6g
carbohyrdates; 258mg sodium; 7mg cholesterol; 1.4g fiber. Exchanges: 1 bread, 1/2
vegetable, 1/2 low-fat milk, 1/2 fat.
From the book, "Deliciously Healthy Favorite Foods Cookbook" by Suzi Castle.
Published by Health Cookbooks. To order call: (800) 444-2524 ($14.95 + S&H).
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
THE VALUE OF EXERCISE
by Arturo Rolla, MD
(FROM THE EDITOR: We recently encountered the following exchange, on one of the
Internet's many diabetes discussion lists. We thought it worth sharing. Arturo Rolla, MD,
the author, is an endocrinologist at Harvard Medical School.)
Q: I have heard many times that exercise helps to lower insulin resistance. My
question: Is it a fleeting or a cumulative effect? In other words: If I exercise today,
will it help me for some time after the exercise; or does only an active person who
exercises everyday benefit from exercise?
A: Exercise has many different effects. Just on carbohydrate metabolism there is an
acute decrease in insulin resistance with increased uptake of glucose in the muscles,
therefore the BGs decrease.
If the exercise is prolonged and you use up all the glycogen in your muscle (muscle
glycogen depletion) the muscles continue to take up glucose for hours after you stopped
exercising. That's why it is not unusual to get hypoglycemia from exercise at night!
If you exercise on a regular basis you decrease the fat mass and specially the
abdominal fat (the worst). The decrease in (abdominal) fat tends to improve insulin
resistance, most likely by decreasing the levels of circulating Free Fatty Acids. So,
prolonged exercising has a prolonged or more permanent effect on insulin resistance.
There is also a possibility that well trained muscle fibers (more and larger) by
themselves may be more sensitive to insulin, but that has not been shown clearly--as far
as I know.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
PARTIALLY SIGHTED, REALLY BLIND
by Catherine Horn Randall
Photo: portrait. Caption: Catherine Horn Randall
FROM THE EDITOR: Catherine Horn Randall is currently Second Vice-President of the
National Federation of the Blind of Illinois. An active Federationist, she has also been
an Alderman serving in the Jacksonville, Illinois, City Council. This article appeared in
the February 1989 issue of the BRAILLE MONITOR, published by the National Federation of
the Blind.
One rainy afternoon a young mother stood across the street from Main Hall on the
MacMurry College campus in Jacksonville, Illinois, watching the busy, laughing college
co-eds come and go. She cried for her four-year-old daughter who might not have the
opportunity to go to college or to lead a full life, because she only had partial sight in
her right eye. She was afraid and wondered about Cathy's future, and all she knew to do
was to have Cathy evaluated by the professional staff of the Illinois Braille and
Sight-Saving School in Jacksonville.
The professionals told her that Cathy had so much sight that she wouldn't need to
bother with Braille. The bewildered young parents were grateful to the experts for their
advice; who else could they turn to? The school didn't tell them that the National
Federation of the Blind even existed. Cathy's parents took her home, determined to enroll
her in the sight-saving program in Quincy, Illinois.
From this point on, I shall tell my own story. As I look back at the enormous
implications to my life and to my education from being denied the opportunity to learn
Braille as a child, I am as angry and frustrated now as my mother was afraid for my future
in 1951.
I happen to be an only child, and I like to think that I was constructively spoiled by
my parents. They could not have been more supportive of me. If they had received
commonsense guidance, I know I would have learned Braille. Whatever I needed to help with
my education, my parents enthusiastically provided. If we had only known it, what we
needed most were the National Federation of the Blind, Braille, and cane travel skills.
Unfortunately for me, we used the term "partially sighted" while I was growing
up. I wasn't really blind, because I had some sight. So I didn't think of myself as
"blind" until I began losing my remaining vision in my late twenties.
I was a blind child and a blind college student who was trying to get along without
either of the most important skills of blindness, namely Braille and cane travel.
I took typing lessons when I was ten, and again in both junior and senior high. Typing,
I believe, is another essential skill for blind and legally blind students.
A partially blind student who reads print, takes notes with pens or markers and uses
tape recordings is still greatly handicapped if he or she does not know Braille. I didn't
have much confidence in myself in high school or college, and I think not having the
skills of blindness was part of the reason, although I did not realize it at the time. Eye
strain was a constant problem for me in school. How wonderful and practical it would have
been to make an easy transition from print work to Braille when I used my eyes too much.
For years my father tutored me every night in math. My mother read to me so much that
by my senior year in high school she had damaged her vocal chords. I always loved school
despite the hard work. I was feature editor for both my junior and senior high newspapers.
I earned a bachelor of arts degree from that same MacMurry College, where my mother had
despaired for my future 19 years earlier. College took me four and a half years, and four
straight summers, to complete. I am now convinced that, if I'd had good Braille skills, I
would have been able to handle four courses a semester like everyone else, instead of
taking only three. I had a totally blind friend a year behind me in college who took full
course loads each semester and used Braille.
To blind and partially blind students I would say this--and I would say it with every
fiber of my being: Join and become active in the NFB. It is the greatest gift you can ever
give yourself. Take the initiative to learn Braille and cane travel. This may seem a tall
order, but believe me, it is an essential one. You will find the role models you always
needed in the NFB. You will learn that it is respectable to be blind.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
RECIPE CORNER
Artwork: Fruits and vegetables
Send your great food ideas to the editor. Your recipes will be evaluated by dietitians,
and if necessary, adjusted to make them more diabetically appropriate. Then he gets to
taste them...
This issue, all of our recipes were provided by Linda Coffee and Emily Cale, authors of
"The Diabetic Four Ingredient Cookbook," whose many recipes, fully analyzed for
carb-counting and diabetic exchanges, really do contain only four ingredients each.
Contact: Coffee & Cale, PO Box 2121, Kerrville, TX 78029; telephone: 1-800-757-0838.
Mushroom Salad
Ingredients:
1 medium head Romaine lettuce
1 cup sliced mushrooms
1 cup cucumber (peeled and sliced)
1/4 cup fat-free Italian salad dressing
Instructions:
Tear the lettuce into bite-size pieces and place them in a salad bowl. Add the sliced
mushrooms and cucumber. Toss with dressing.
Yield: 6 servings (Serving size--2 cups). Per serving: 48 calories; 1g fat; 0g
saturated fat; 159mg sodium; 4g protein; 8g carbohydrates; 0mg cholesterol; 4gm fiber.
Exchanges: 2 vegetables.
Shrimp Spread
Ingredients:
2 4-1/2 oz. cans of shrimp (drained)
2 cups fat-free mayonnaise
6 green onions (chopped fine)
whole-wheat low-sodium crackers
Instructions:
Crumble shrimp. Mix first three ingredients, then refridgerate for at least one hour.
Serve with crackers.
Serving size: 2 crackers and 1 teaspoon spread. Per serving: 79 calories; 0g fat; 243mg
sodium; 4g protein; 17g carbohydrates; 12mg cholesterol; 6g fiber. Exchanges: 1 bread.
Garlic Green Beans
Ingredients:
1 package (10 oz.) frozen "Italian-style" green beans
2 teaspoons olive oil
2 cloves of garlic (crushed)
2 tablespoons grated Parmesan cheese
Instructions:
In non-stick skillet over medium heat, combine beans, olive oil, and garlic. Bring to a
boil. Cover, reduce heat, and simmer for five minutes. Remove cover, stir, and cook three
minutes longer, or until liquid evaporates. Season to taste, and sprinkle with Parmesan
cheese.
Yield: 4 servings. Per (1/2 cup) serving: 55 calories; 3g total fat; 1g saturated fat;
68mg sodium; 2g protein; 5g carbohydrates; 2mg cholesterol; 2g fiber. Exchanges: 1
vegetable, 1/2 fat (mono-unsaturated).
Tex Mex Chops
Ingredients:
4 boneless pork chops
1 cup salsa
1 bell pepper (sliced)
1 cup white onion (sliced)
Instructions:
Season pork chops to taste. In nonstick skillet sprayed with cooking spray, brown both
sides of chops on medium high heat. Add salsa, bell pepper, and sliced onion; lower heat.
Simmer 30 minutes, or until chops are thoroughly cooked.
Yield: 4 servings. Serving size: 1 pork chop. Per serving: 200 calories; 7g fat; 2g
saturated fat; 516mg sodium; 26g protein; 7g carbohydrates; 62mg cholesterol; 2g fiber.
Exchanges: 3-1/2 ounces very lean meat, 1/2 vegetable.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
LETTERS TO THE EDITOR
Artwork: Quill writing pen in an ink well
June 15, 1999
I read my very first VOICE OF THE DIABETIC newspaper while waiting for a friend at the
eye doctors. What a wonderful paper!
My husband is diabetic, and I found your paper to be very informative. The recipes and
articles are just great. I work in a health care facility as a CNA and am hoping to
introduce your paper to them.
Excellent job to your news staff.
Barbara Henneman, CNA
Tonawanda, NY
* * * * * * * *
July 15, 1999
I read your paper for the first time yesterday at my work (I work at the local health
department) and I was very impressed with the amount of information you've made available
to people with diabetes. It was all very reader-friendly and interesting. Having just
gotten my son out of the hospitable after a hypoglycemic seizure, I especially found the
article on brittle diabetes, by Dr. Peter J. Nebergall interesting. The dawn phenomenon
was exactly what the doctors think was happening to Trey, and to find an article on this
after having experienced it was very reassuring to me. The article on the front page about
Irving Mushlin was especially uplifting to me as a parent because my son's mortality has
been on my mind since the initial diagnosis. To see someone like Mr. Mushlin, and to hear
of his happy and rewarding life, make it all a little brighter. The more informed I am the
better I feel I can cope with life's everyday happenings related to my child with
diabetes. Thank you very much for your wonderful publication and the opportunity for me to
write to you.
Amy Pettis
Mt. Dora, FL
* * * * * * * *
August 6, 1999
I was in a doctor's office, and waiting for my dad, who was getting his yearly
check-up. I happened to pick up your newsletter. I was totally engulfed with new
information on diabetes. I happen to be involved with a man who has diabetes for half of
his life. I love this man dearly, and whatever I can do or get new information, I surely
appreciate it. I know our doctor is the best person to ask questions and get information
from, but when we do see him it's for short periods of time and certain days, so any extra
information, concerns, and ideas of medicine, products, and etc., is helpful. I think
education is our best and only way to keep the diabetes under control. I am new to this,
and no one in my family has it, so everything I read, seek out, and hear is new
information, and I do want to get only the right information. After reading only one
issue, I feel this newsletter is the right one and interesting and the one to keep me
current with diabetic information. Thank you for putting this together; I think it's an
excellent source for people to read.
Sandra Hunsucker
Waco, TX
* * * * * * * *
August 6, 1999
Please send me fifty copies of the VOICE each quarter to be used as free literature for
our Diabetes Patient Self-Management Education Program. A majority of our target
population includes the elderly, the visually impaired, and homebound patients. This
literature will be a valuable resource for our patients with diabetes.
Barbara Gibson, RNC, CDE
Slidell, LA
* * * * * * * *
August 12, 1999
Thank you so much for supplying me with VOICE OF THE DIABETIC which I am passing out a
libraries and to our support group. It is new and growing steadily and rapidly, and the
magazine is very helpful to us. I also want to thank you for sending various articles
pertaining to my own particular needs. All had information which I had not seen anywhere
else in my research. They are just wonderful.
Again, many thanks for your continued assistance and contributions of helpful articles.
Ann Dellarocco
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
BOOK REVIEWS
by Marilyn Helton
Welcome to the holiday countdown! My desk and office show their impending
arrival--though the calendar tells me it's still only August! We have a very diverse
selection of books to share with you in this issue, beginning with the "Diabetes
Problem Solver," by Nancy Touchette, PhD., published by the American Diabetes
Association.
The "Diabetes Problem Solver" is the quintessential reference book for
detecting early signs of diabetic medical conditions, and a comprehensive reference guide
for all aspects of diabetes and its complications. I have referred to this terrific guide
on several occasions this summer, and found answers to every one of my questions, in
clear, concise, easy-to-read language. Flowcharts are included, to help you determine if
your symptoms require immediate medical attention.
Not only does the "Diabetes Problem Solver" contain excellent information for
the physical complications of diabetes, it is also a valuable resource for the
psychological conditions that can follow it. Adjusting to diabetes, dealing with stress,
depression, anxiety, alcohol abuse and eating disorders, discrimination in the workplace,
schools, day care and the military, managing your daily routine, traveling with diabetes,
coping factors for children, and sexual dysfunction are discussed. There's also an
excellent chapter on helping to solve kids' problems.
The "Diabetes Problem Solver" is hands-down one of the best reference books I
have seen in print. Highly recommended. The "Diabetes Problem Solver," $19.95,
ISBN 1-58040-009-4, available through the American Diabetes Association: 1-800-232-6733 or
through book stores nationwide.
Before my diagnosis of type 2 diabetes, my biggest passion was cooking. Most of the
diabetic cookbooks available at that time presented dull and tasteless recipes. You can
imagine my elation when the ADA revised the nutritional guidelines for diabetics in 1994,
following the 10-year DCCT (Diabetes Control and Complications Trial) results. These
guidelines for nutrition management now allow sugar as part of a healthful eating plan,
and this new change is explained in the Introduction of the next book.
The "New Family Cookbook for People With Diabetes," prepared jointly by the
American Diabetes Association and The American Dietetic Association, offers more than 375
recipes for easy-to-prepare delicious meals that the whole family can enjoy. The recipes
use lower-fat ingredients wherever possible, unsaturated fats whenever possible, and most
recipes use sugar instead of sugar substitutes. They provide a choice of fresh or dried
herbs, and each has a nutrient analysis including the portion size, dietary exchanges, and
sodium content in bold type whenever the serving size has more than 400mg of sodium per
serving.
Being passionate about cooking, I enjoy the description of each recipe, found just
under the title. For example, you can really get a "mouth-feel" for
"Chicken In Mole Sauce" with this description: "Mole is a deep, dark sauce
that's a Mexican specialty. Its unique flavor and reddish brown color results from
blending onions, garlic, and chilies with--surprise--a small amount of cocoa powder or
chocolate, which adds richness without sweetness."
In addition to the mouth-watering recipes, there are good hints and tips at the
beginning of each food section, and an extensive Exchange Lists for Meal Planning
Appendix. This is another winner; highly recommended. The "New Family Cookbook for
People With Diabetes," by the American Diabetes Association and the American Dietetic
Association, published by Simon & Schuster, 1999, ISBN: 0-684-82660-7, $30.
Last year, we at "Cinnamon Hearts" appealed to 150 food editors across the
nation to remember the diabetic in their holiday recipe sections. There are significant
numbers of diabetics among groups such as: Jewish Americans, Mexican Americans and
Latinos, African Americans, Native Americans, Alaskan Natives, Asian Americans and Pacific
Islanders.
I'm pleased to let you know that the Jewish diabetic with a Kosher palate can now feel
confident in consuming very healthy and delicious recipes from "MealLeaniYumm! (All
That's Missing Is The Fat)", a new book by cookbook author Norene Gilletz, one of
Canada's national treasures.
Norene Gilletz is the leading author of Kosher-style cookbooks in Canada and
"MealLeaniYumm!" shows you why. With over 800 recipes for all Jewish holidays as
well as the rest of the year, holiday table and menu suggestions, shopping hints and
pantry suggestions, culinary and dietary tips and facts, the book is very comprehensive.
Each recipe has a complete nutritional analysis, including carbohydrate counts, and
diabetics can feel confident in using them.
Norene is another cookbook author who knows the value of adding information regarding
the recipe's history and availability of ingredients, in personal anecdotes under the
recipe title. Her motto is "Food that's good for you should taste good!" She
also offers variations to the recipes, whenever possible.
"MealLeaniYumm! (All That's Missing Is The Fat)," by Norene Gilletz, $33.95,
1998, ISBN 0-9697972-2-2, is just beginning to be available in the U.S. It can be found
online at barnesandnoble.com and amazon.com. You can also order directly toll-free at
1-888-811-9866. Another highly recommended cookbook!
I wish you all the joy of the season, and we'll see you in January, with all the new
dieting and weight management reviews!
NOTE: Marilyn Helton is the editor of "Cinnamon Hearts~The Art of Living A Winning
Diabetic Lifestyle," a positive-power newsletter for diabetics and their families.
Subscriptions to "Cinnamon Hearts" newsletter are available for $18/year (USA);
$20 (Canada); from Cinnamon Hearts DLE, PO Box 578340, Modesto, CA 95357-8340.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
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: It seems that as I approach mealtimes, I'm almost always "low." Shouldn't
I eat first, then, and take my insulin after the meal?
A: The first part of my answer is that if you are often low at mealtime, you should
make some adjustment to your treatment, so as to avoid the lows. "Low blood
sugars" can have dangerous consequences, and the best course is to avoid them in the
first place. Frequent "lows" can cause hypoglycemic unawareness, in which you
lose the ability to sense that you are heading into an insulin reaction. Serious injuries
can occur during hypoglycemia.
The answer you wanted is easier to give now that we have the very fast-acting insulin
called Humalog. Regular insulin (previously the fastest we had) can take 30 minutes to
start having any effect. If you inject "R" insulin at mealtime, or after you
finish your meal, your blood sugar might rise too high before the injection could take
effect. Now, with quick-acting Humalog, it is appropriate to eat and then inject,
or as manufacturer Eli Lilly and Company suggests: "Inject while looking at your
food."
You can determine if it works by checking your blood sugar two hours after your meal.
It should be below 180mg/dL, unless you and your doctor have selected a different
postprandial sugar target. With human Regular insulins, such delay of injection very
frequently leads to high sugars two hours after a meal.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK
(Resource Column)
Artwork: Hand pulling a book from a shelf of books
Inclusion of materials in this publication is for information only and does not imply
endorsement by the Diabetes Action Network of the NFB.
DIABETES RESOURCE LIST
The Diabetes Action Network of the National Federation of the Blind now offers DIABETES
RESOURCES: EQUIPMENT, SERVICES AND INFORMATION, a 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 contains 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 costs $5 per copy and is
available in Braille, large print, and audiocassette (recorded at 15/16 IPS for the
blind). 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 12:30pm to 5:00pm Eastern time.
INSTA-GLUCOSE
If you have type 1 diabetes, you know low blood glucose can be a sneaky enemy. Diabetes
medications are powerful but imprecise, and, if you misdose, if you miss a meal, if you
are ill, or if you have unexpected, unscheduled exercise, you can find yourself going
down. You need sugar, fast! You need to be carrying it with you, before trouble hits.
Many people carry sugar candy, or diabetic glucose tablets, but one practical
alternative is Insta-Glucose, by ICN Pharmaceuticals. Insta-Glucose is stronger (one tube,
one treatment, equals 24 grams of glucose), and it works faster than glucose tablets. It
is easy to use, and very easy to carry. Be prepared! It is available at many pharmacies
and discount chains. For information, contact: ICN Pharmaceuticals, ICN Plaza, 3300 Hyland
Ave., Costa Mesa, CA 92626; telephone: 1-800-711-9486; website:
TALKING COMPUTERS
Henter-Joyce, Inc., maker of the "JAWS" series of computer screen readers,
offers screen-to-speech software such as JAWS For WINDOWS (JFW), the new MAGic 6.1 screen
magnifier, and tutorials on cassette for programs like Internet Explorer and Microsoft
Word 8. They also offer Windows 95, 98, and NT compatibility, and as of August 31, there
have been significant price cuts. Find out more at their website: http://www.hj.com, or
contact them for information: Henter-Joyce, Inc., 11800 31st Court North, St. Petersburg,
FL 33716; telephone: 1-800-336-5658; fax: (813) 803-8001; e-mail: [email protected]
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
NEEDLE-FREE INSULIN INJECTION
There is a way to inject insulin without a needle! The Vitajet 3 administers a fine jet
of insulin through the skin without need for a needle. It works, and users report less
discomfort. Try it yourself; 30-day money-back guarantee. Contact: Bioject, Inc., 7620 SW
Bridgeport Road, Portland, OR 97202; telephone: 1-800-848-2538; website:
DELIVERED TO YOUR DOOR
Homed Pharmacy Services will deliver your diabetic supplies to your door. If you have
Medicare, and/or private insurance, your supplies may come at no cost to you. Homed
handles all insurance claims, and delivery is free. For more information, call Homed
Pharmacy Services; telephone: 1-800-226-7212; fax: 1-800-381-9929; internet:
DIABETIC SPECIALTY PRODUCTS
If you have diabetes, you may need alternatives to some commonly used items, like cough
medicine (full of sugar!), table sugar for cooking and baking, or a good moisturizing skin
cream, for the dry skin so many of us have, especially on our feet. Health Care Products
offers all of the above.
DiabetiSweet is an alternative to table sugar, without the dietary impact. It handles
just like sugar, and you don't need complex math to figure out the proportions.
Diabetic Tussin is a line of cough syrups, formulated without sugar, sodium, alcohol,
fructose, sorbitol, codeine, or dye.
These items are available in most major drug and discount stores. For information,
contact: Health Care Products, telephone: 1-800-899-3116; or at their website:
http://www.diabeticproducts.com
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.
READING MACHINE
There are many ways to cope with the problems loss of vision brings to reading. One is
to use an optical reading machine like the Kurzweil 1000. With such a machine, you scan a
printed page into computer memory, from where it is then read by a synthesized voice.
Large print text is not necessary; you can read most any text.
There are several reading machines available today, but all are not "created
equal." They vary in accuracy, size of vocabulary, and quality of synthesized voice.
Kurzweil has been a leading name in sound synthesis for over 20 years, and the L& H
Kurzweil 1000, their newest product, is a superb instrument. 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; e-mail: [email protected]; website:
http://www.lhsl.com/kurzweil1000
NEW TALKING BLOOD GLUCOSE MONITOR
Roche Diagnostics has developed a new talking blood glucose monitor. Based on the
proven Accu-Chek Advantage meter, the 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 new, 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. Also
included is the Accu-Chek Softclix lancing device, and a packet of 10 lancets. The new
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
Preferred RX offers three ways to help you save on diabetes supplies and prescription
drugs:
1. INSURANCE BILLING: They file the claim, handle the paperwork, and pay for delivery.
No advance payment needed.
2. MEDICARE BILLING: Medicare pays for approved diabetic supplies (and now that list
covers type 2 diabetics!). Preferred RX will handle the details, and pay for delivery.
3. DISCOUNT PRESCRIPTION CLUB: No insurance? No prescription drug coverage? Preferred
RX offers discounts at over 36,000 pharmacies nationwide.
Contact: Preferred RX, 34208 Aurora Road, Suite 132, Solon, OH 44139; telephone:
1-800-843-7038; website: http://www.preferredrx.com
DIABETES SUPPLIES AT WAL-MART
Most people don't have to look too hard to find a Wal-Mart. You may even get some of
your diabetes supplies there. But it's time for another look! Wal-Mart now has a new line
of house-brand diabetes care products, what they are calling the ReliOn family. This new
ReliOn label is now on syringes, lancets, glucose tablets, skin cream, and alcohol swabs.
Check them out at your nearest Wal-Mart.
SUGAR FREE PRODUCTS
The Sugar Free Shoppe offers tasty holiday treats like candies, cookies, jams, sauces,
syrups and chocolates, all made with low-impact sugar substitutes, so you can enjoy more
of them. They have hundreds of items; so contact: The Sugar Free Shoppe, 4515 Vinewood
Lane, Minneapolis, MN 55442; telephone: 1-800-579-2572; e-mail: [email protected]
WINDOWS SCREEN READER
GW Micro now offers WINDOW-EYES for WINDOWS 98, a screen reader program that also
supports Microsoft WINDOWS 3.1, WINDOWS 95 and WINDOWS 98. Once equipped with a voice
synthesizer such as the Dectalk (your standard soundcard won't do), any computer that can
run WINDOWS can run WINDOW-EYES. A free demo disk is available, or you may download the
demo program from the Internet. The WINDOW-EYES program is available from: GW Micro, 310
Racquet Street, Fort Wayne, IN 46825; telephone: (219) 489-3671; fax: (219) 489-2608,
e-mail: [email protected]; website: http://www.gwmicro.com
DIABETES SUPPLIES
Heritage Diabetic Supply is a small, personalized source for your diabetes needs
(insulin included), offering reasonable prices and one-on-one service. If you need
something hard to find (like Diascan test strips), they will get it for you. Heritage
handles Medicare and private insurance paperwork (no HMOs), and offers a free Glucometer
Elite glucose monitor just for signing up! Contact: Heritage Diabetic Supply, PO Box 1270,
Marion, NC 28752; telephone: 1-800-267-6509.
FREE DIABETES LITERATURE
The National Federation of the Blind maintains an extensive literature collection, with
free materials on many subjects available in a variety of formats. The articles listed
below make up one part of the collection, the "diabetes" category:
"Insulin Measurement Devices," "Diabetic Peripheral Neuropathy,"
"Diabetics, Don't Give Up on Braille," "How I Went Blind...And Then
What," "Review of Oral Diabetes Medications," "Preventing, Minimizing,
or Delaying Kidney Failure," "Impotence, and How to Prevail," "Can I
Eat Sugar?," "Cardiovascular Health: Bypass May Be Better for Diabetics,"
"Arthritis and Diabetes: A Common Association," "Blind Diabetics Can Draw
Insulin Without Difficulty," "New Dietary Guidelines for Diabetes
Management," "Keeping Your Feet," "What Is Diabetes Mellitus?,"
"Talking Blood Glucose Monitoring Systems," "Diabetic Eye Disease,"
and "Kidney Failure, Dialysis, and Transplantation."
These articles are available in large print and four-track 15/16 IPS audiocassette for
the blind (all the diabetes articles are on one tape). All are free of charge. To order,
or to request a complete NFB literature catalog, contact: NFB Materials Center, 1800
Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314. The Materials Center is
open 12:30 pm to 5:00 pm, EST, weekdays.
DEX-4 GLUCOSE TABLETS
FROM THE EDITOR: Dex-4 glucose tablets, in lemon, raspberry, orange and grape flavors,
are tasty, effective, and the tubes of 10 are easy to carry in a pocket or purse. They are
also easy to open when you need them. I use Dex-4 myself. You can find them in pharmacies
and supermarkets nationwide.
Each fruit-flavored, easy to chew glucose tablet contains four grams of fast-acting
carbohydrate, with no fat, sodium, caffeine, or cholesterol, and only 17 calories. These
value-priced tablets are available in tubes of 10 tablets or economy size bottles of 50.
For further information about Dex-4 or their many other diabetes care products,
including Formulated for Fingers skin cream with tea tree oil, contact your pharmacist or
Can-Am Care Corporation, Cimetra Industrial Park, Box 98, Chazy, NY 12921-0098; telephone:
1-800-461-7448.
DIABETES SUPPLIES
American Diabetic Supply, Inc., will ship your diabetes supplies to your door. They
handle all insurance claims and provide free delivery. Folks with Medicare and/or private
insurance (no HMOs) may receive supplies at no further cost. For information, contact:
American Diabetic Supply, Inc., 400 S. Atlantic Ave., Suite 108, Ormond Beach, FL 32176;
telephone: 1-800-453-9033.
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, it is available in sugar-free caplets. Contact: Abkit, Inc.
New York, NY 10128; telephone: 1-800-226-6227; website http://www.alphabetic.com
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
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,
811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911, fax: (573)
875-8902. NOTE: Please provide a phone number so we can reach you.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
FOOD FOR THOUGHT
Artwork: Dancing fruits 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.
SUGAR FREE SYRUP
We have been asked to announce: One of the first things people who have to limit their
sugar intake give up is the taste of maple syrup on pancakes. There's just too many
calories there...
No longer. Now there is a low calorie syrup that tastes like maple, not like machine,
and is, for a normal two-tablespoon serving, "free food!" (34 calories for 1/4
cup). If there's room in your meal plan for pancakes, there's room for Cozy Cottage Sugar
Free Maple Flavored Syrup. Already available at supermarkets nationwide; sweetened with
Nutrasweet. Contact: Maple Grove Farms of Vermont, 167 Portland Street, St. Johnsbury, VT
05819; telephone: (802) 748-5141; website: http://www.maplegrove.com
BOARD MEMBERS
At this year's NFB national convention, in Atlanta, Georgia, we, the Diabetes Action
Network of the National Federation of the Blind, elected our new Board. All veteran
diabetics, they are:
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-At-Large: Gisela Distel (Albany, NY)
Board Member-At-Large: Paul Price (Valley Center, CA)
Paul Price, our newest board member, is an electrical engineer. Longtime Vice-President
Janet Lee, from Cedar, MN, chose not to run again. We thank Janet for her fine service.
ATTENTION BRAILLE READERS!
We have been asked to announce: The Braille Group of Buffalo's Diabetes Braille Project
is dedicated to improving the supply of quality diabetes information in Braille. The group
merely requests (they do not require) a donation of the print copy of the item/s selected
for Brailling. For more information please contact: Jill Pariso, Diabetes Braille Project,
Braille Group of Buffalo, 4660 Sheridan Drive, Buffalo, NY 14221; telephone: (716)
633-8877; e-mail: [email protected]
AND IT WAS SO...
God created the mule, and told him, "You will be mule, working constantly from
dusk to dawn, carrying heavy loads on your back. You will eat grass and lack intelligence.
You will live for 50 years."
The mule answered, "To live like this for 50 years is too much. Please, give me no
more than 20."
And it was so.
Then God created the dog, and told him, "You will hold vigilance over the
dwellings of Man, to whom you will be his greatest companion. You will eat his table
scraps and live for 25 years."
And the dog responded, "Lord, to live 25 years as a dog like that is too much.
Please, no more than 10 years."
And it was so.
God then created the monkey, and told him, "You are monkey. You shall swing from
tree to tree, acting like an idiot. You will be funny, and you shall live for 20
years."
And the monkey responded, "Lord, to live 20 years as the clown of the world is too
much. Please, Lord, give me no more than 10 years."
And it was so.
Finally, God created Man and told him, "You are Man, the only rational being that
walks the earth. You will use your intelligence to have mastery over the creatures of the
world. You will dominate the earth and live for 20 years."
And the man responded, "Lord, to be Man for only 20 years is too little. Please,
Lord, give me the 30 years the mule refused, the 15 years the dog refused, and the 10
years the monkey rejected."
And it was so.
And so God made Man to live 20 years as a man, then marry and live 30 years like a mule
working and carrying heavy loads on his back. Then, he is to have children and live 15
years as a dog, guarding his house and eating the leftovers after they empty the pantry;
then, in his old age, to live 10 years as a monkey, acting like an idiot to amuse his
grandchildren.
And it is so!
FDA HAS APPROVED AVANDIA
The U.S. Food and Drug Administration (FDA) has approved Avandia (rosiglitizone) for
use by type 2 diabetics who are not taking insulin. Avandia, a member of the
thiazolidinedione class of medications (the same class as Rezulin), reduces insulin
resistance, improving the body's response to endogenous insulin. Although there was no
evidence of liver toxicity during the tests, the FDA is recommending liver enzymes be
tested at the beginning of therapy and again every two months. For more information, talk
to your doctor.
DIABETIC FOOTWEAR
We have been asked to announce: If you have diabetes, you know one of its possible
complications is difficulties with your feet. Some diabetics will require special shoe
insoles; others will need custom protective shoes. Medicare Part B covers these items--and
will pay for one pair of protective shoes per year and/or up to three pairs of special
shock-absorbing inserts. Medicare also pays for custom inserts to replace amputated toes.
For Medicare eligibility, contact your Medicare carrier. For an information kit about
these foot products, send name and address to: Choice Healthcare, PO Box 99, Charleston,
AR 72933; telephone: 1-888-442-3390.
UNUSUAL MUSEUM
As part of its Museum, the American Printing House for the Blind has assembled a
collection of mechanical tactile writers and typewriters adapted for blind people. Several
machines from the 19th century are there, along with tactile books, early Braille
production machinery, recording equipment and players, and various illustrations. The
museum (which can be accessed on the Web at http://www.aph.org) is free and open to the
public from 8:30am to 4:30pm, Monday through Friday, at 1839 Frankfort Avenue, Louisville,
KY 40206.
BANQUET ADDRESS
This year, at our National Federation of the Blind annual convention in Atlanta,
Georgia, NFB president Dr. Marc Maurer gave the Banquet Address, titled "The Mental
Discipline of the Movement." This address is available, free of charge, in large
print, Braille, and audiocassette. This speech, and others by President Maurer and Dr.
Jernigan (and much more!), are available from the National Federation of the Blind
Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314,
open 12:30pm to 5:00pm EST, weekdays.
TALKING BLOOD PRESSURE MONITORS
Many people need to regularly check their blood pressure and pulse rate. Blind people,
and those losing vision, can carry out this task with one of the two talking blood
pressure monitors now available from the National Federation of the Blind. Both types cost
$169 with standard-size pressure cuff; one comes with cassette instructions, preset
volume,and runs on batteries only. The other has no instruction cassette, but runs on AC
current or batteries, and has an adjustable volume control. Both count pulse rate as well
as blood pressure.
For people with smaller arms, a small-size pressure cuff is available (specify which
machine) for $15; for those with large arms, a large-size pressure cuff costs $20. These
products and others (ask for your free catalog, in large print or Braille) are available
from: Materials Center, National Federation of the Blind, 1800 Johnson Street, Baltimore,
MD 21230; telephone: (410) 659-9314.
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 261,818 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.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
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
811 Cherry Street, Suite 309
Columbia, MO 65201
Telephone: (573) 875-8911
Fax: (573) 875-8902
Please make all checks payable to:
NATIONAL FEDERATION OF THE BLIND
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
END of VOICE OF THE DIABETIC, Volume 14, Number 4, Fall Edition 1999
Homepage
Share a Comment