Voice Of The Diabetic, Summer 1998
Voice Of The Diabetic, Summer 1998
VOICE OF THE DIABETIC
A Support and Information Network
The Diabetes Action Network of the National Federation of the Blind
June 13, Number 3, Summer Edition 1998
VOICE OF THE DIABETIC, published quarterly, is the national
newsmagazine 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.=20
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 1998 Diabetes Action Network
National Federation of the Blind
ISSN 1041-8490
Note: The information and advice contained in VOICE OF THE
DIABETIC are for educational purposes, and are not intended to
take the place of personal instruction provided by your
physician, or by your health care team. Discuss any changes in
your treatment with the appropriate health professionals.
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INSIDE THIS ISSUE
A LIFETIME OF GOOD DIABETES CONTROL
by Ed Bryant
ASK THE DOCTOR
by Wesley W. Wilson, MD
DIABETES, STUDENTS, AND LOW BLOOD SUGARS
NEW OBESITY STUDY
STATE DIABETES PROGRAMS
"ALTERNATIVE" MEDICINE
by Peter J. Nebergall, PhD
A FISH STORY
by Beth Finke
LETTERS TO THE EDITOR
INSULIN TYPES: A REVIEW
UPDATE: NONINVASIVE GLUCOSE MONITORING
NEW IMPOTENCE MEDICATION
THE PITFALLS OF POLITICAL CORRECTNESS:
EUPHEMISMS EXCORIATED
by Kenneth Jernigan
NEW MEDICARE PREVENTIVE BENEFITS
ALTERNATIVE TREATMENTS FOR DIABETES
by Simeon Margolis, MD Phd, and Christopher Saudek, MD
NEW HIGH BLOOD PRESSURE STUDY
REVISED BLOOD CHEMISTRY VALUES
by Priscilla Laliberty
EUGENE PAYNE, JR. SETS AN EXAMPLE
BOOK REVIEWS
by Marilyn Helton
TRANSPLANT PATIENTS SPEAK
FOOT CARE GUIDELINES
RECIPE CORNER
COOKING WITH SUZI
by Suzi Castle
A DONOR'S STORY
by Debbie Dupree
FOOD FOR THOUGHT
MY KIDNEY TRANSPLANT UPDATE
by Ed Bryant
WHAT YOU ALWAYS WANTED TO KNOW
BUT DIDN'T KNOW WHERE TO ASK
(Resource Column)
A LIFETIME OF GOOD
DIABETES CONTROL
by Ed Bryant
Photo: portrait. Caption: Jerry and Kathryn Seidel
Last issue, we brought you the story of an infant with
insulin-dependent diabetes. Today, we go to the other extreme.
Jerry Seidel is 80 years old. He has had type 1, insulin-
dependent diabetes, for almost 56 years, since 1942! And
although some folks still believe diabetes inevitably means a
traumatized and shortened life, he is living proof to the
contrary.
"I was diagnosed around 1942," he says. "I was in the
service, in basic training, going on the usual hikes and whatnot.=20
I would have to stop by every tree, and drink from everyone's
canteens."
"Finally, my eyes started to get blurry, and I was getting
run down, so I went on sick call," he told me. "They had two
young doctors there, and they said: 'you look pretty run down
and pretty beat up,' so I told them I was a little tired. They
told me to go over to the PX and drink some malts!"
Jerry's unit was shipped to another camp. On the train, he
tried to eat a Hershey bar, and could not. The next morning, he
couldn't get up: DKA, diabetic ketoacidosis, from the sustained
high blood sugar. He was 25 years old.
He was immediately placed on insulin, and sent home.
"I was going with my wife then; we weren't married yet," he
told me. "I called her up, and told her I was coming home,
because I had diabetes. She thought that was the greatest thing
that had ever happened!"
Back home in Columbia, Missouri, Jerry found a good doctor,
who taught him the importance of a healthy diet. Then he and
Kathryn learned diabetic meal planning together. He is still
very conscientious about food, as he has observed a clear link
between poor dietary habits and complications, such as diabetic
foot disease. "I've seen more guys lose feet, and die before
they should," he says, "just because they won't watch what they
eat. One guy wouldn't stop eating fast food hamburgers..."
I asked him how he was doing now.
"I've got all my feet, and my eyes are working well. No
kidney problems. The only medicine I take is my insulin, and
though I've had a couple of heart attacks, I've recovered, taking
only aspirin." (He also works out in a cardiac rehab program
three times a week.)
I found that what sets Jerry apart is his motivation. There
are plenty of people who do not take care of themselves--but he
does. As he says:=20
If you want to keep your feet, live a few years
longer, and be in good shape, you have to do a few things.
They are not easy: Diet, watch what you eat, and never miss
an insulin shot. These are the main things, and a lot of
people can help you with this.
I made up my mind, that by watching what I eat I could
keep my feet. I know a lot of people, friends and such, who
don't watch their diet. Someone will tell me "Joe passed
away; he was a diabetic, and never watched what he ate..."
As Jerry puts it: "You've got a choice--good hamburgers,
and other things you shouldn't be eating, or you've got your
feet. It's not easy, but with a little effort..."
Of course Jerry has mastered the skills of good self-
management. He tests often, and takes at least 3 insulin shots a
day, adjusting his dosages on a "sliding scale."
For those who lack motivation to follow good self-
management, Jerry has a suggestion: Visit a wound clinic.
There, as he says, you will find a lot of folks with unhealed
wounds and lesions from diabetes. Some will be facing
amputation. "Go see what happens when they don't watch their
diet and medication," he suggests.
Jerry has not let diabetes run his life. He took control
early, learned what he needed to do (he is still learning, he
told me), and then kept with it. As he says, it's not easy, but
he has done the right things. His reward has been a long and
full life, and the opportunity to raise his family (his daughter
is 47, and his son will soon be 50). He is a positive example
for all of us.
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 Wilson, MD is 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.
Q: My husband sometimes has sudden and severe "lows," and
I've had to call 911 several times. The doctors suggest we keep
Glucagon on hand. What is Glucagon, and how does it help?
A: Glucagon is a hormone, naturally produced by the Alpha
cells of the pancreas, and also available (by prescription) in
"kit" form, for emergency use to correct hypoglycemia. If a
person is experiencing a "low," an injection of Glucagon quickly
raises blood sugar by causing release of glucose stored in the
liver. The Glucagon kit contains powder, diluent solution, and a
syringe. The diluent is added to the powder, which dissolves
immediately, and the resulting solution is injected just like a
shot of insulin. Blood sugar should rise rapidly, with changes
evident in about 15 minutes. Although an individual undergoing a
severe "low" cannot self-administer Glucagon, anyone who is at
risk of hypoglycemia, and who can depend on another person for
help, should have a Glucagon kit--and the "rescuer" should be
trained in its use.
Glucagon is only one of the measures available to counter
the risk of hypoglycemia. The first thing a person can do is
test more frequently, especially if anything occurs that might
increase the risk of hypoglycemia. Even a modest increase in
exercise or physical activity, a lighter-than-usual meal, or a
history of repeated "lows" at a given time of day, can increase
the risk of hypoglycemia. Caution and early detection can
prevent most severe lows.
Since the Diabetes Control and Complications Trial (DCCT)
was published in 1993, there has been much emphasis on "tight
control" of blood sugars, keeping the numbers as close to non-
diabetic "normal" as possible, to reduce risks of complications.
Although tight control brings an approximately 60% reduction in
risk of eye, kidney, and nerve complications, it increases the
risk of serious hypoglycemic episodes.
Although many people can detect, from how they feel, whether
or not their sugars are below normal, that is not always a
reliable test. Insulin-using diabetics can sometimes lose this
ability, particularly if they have experienced repeated "lows."
They are then said to have "hypoglycemia unawareness." This
complicates blood glucose management, as the "safety margin" is
gone, and now the first sign of a low may be confusion or (in
children espcially) seziure. Is your husband always aware of his
blood sugars, or is he sometimes surprised to find them down
around 50 to 60mg/dL with no symptoms?
The measures needed to reduce the risk of hypoglycemia are
the same ones used for careful management of diabetes. All
persons with diabetes should watch diet and "do carb counting."
They should have a daily regular program of exercise. They need
to check blood sugars often. If there is any hint of something
wrong, check the sugar. Early detection means prompt action can
be taken. In extreme circumstances, that action might be a
Glucagon injection.
DIABETES, STUDENTS, AND
LOW BLOOD SUGARS
Several issues ago we told VOICE readers of an incident in
which a young diabetic student, ready to take a glucose tablet,
was asked "for a taste," by another student. A tablet was
shared, a school official observed, and the kid was charged with
drug-dealing, and suspended from school. A nasty letter was
placed in his permanent file. As of May 14, 1998, the boy's
parents, his doctor, their attorney, the American Diabetes
Association, the U.S. Food and Drug Administration, and the maker
of the tablets, Can-Am Care Corporation, had not yet been able to
change the school's misguided policies, or have the document
removed.
You know better. You know insulin is not heroin, and
glucose tabs are not rock cocaine--but too often the school
doesn't! Terrified of the creeping invasion of truly dangerous
drugs into the classroom, teachers and school administrators,
many tragically ill-informed, will pounce on whatever looks to
them like "substance abuse." Mistakes will be made. What should
you do, so you, or your child, will not get into such a mess?
First, make sure someone at the top knows. If you have a
diabetic child, the principal, the school nurse, and the teachers
should be informed. Tell them what your child needs to do, to
avoid the risks of hypoglycemia. Tell them about glucose
tablets; how they are a food supplement, no more sinister than a
cookie or a milkshake (they're SUGAR!) and vital to an active
diabetic, child or adult. Show them this article, and a bottle
or package of glucose tablets. Invite them to read the label!
These adults are part of your child's environment; they need
diabetes education too! There may have been a time when such
revelation ("My child is a diabetic") risked discrimination, but
under the Americans with Disabilities act, that is now illegal.
If the authorities already know what your child must consume or
inject, any notice by concerned others should be shrugged off.
Also, your child should have medical ID, clearly showing that he
or she is diabetic, and subject to low blood sugar reactions.
"Glucose is food," says Julie Arel, Marketing Manager
at Can-Am Care. "That is what it is classified as, a food
[supplement]--not a drug. We make and sell our Dex-4
glucose tablets, fast-acting carbohydrates, so people with
diabetes can use them for low blood sugar episodes, but
athletes use them for energy... like a lot of sweets, or
even Gatorade. We put the carbohydrate into a convenient
tablet for people with diabetes..."
You might also caution your child that glucose tabs, like
medicine-taking, are "private business." There's no stigma; you
just don't do some things in plain sight. A child for whom tabs,
pills, and needles are everyday events may not understand that
others may see these tools differently. Recognize that most
children want to "fit in," to feel "normal," and counsel your
child that his/her glucose tabs are for his/her own needs, not
for sharing, regardless how harmless they may be.
Talk to your school. Be prepared to explain and educate.
Do it before confusion happens. You, and the school, might find
the American Diabetes Association's information pamphlet
"Children With Diabetes: Information for Teachers and Child Care
Providers" helpful (obtain this publication by calling 1-800-342-
2383). With a modicum of preparation, you should be able to keep
this diabetes complication at bay.
NEW OBESITY STUDY
At its annual convention in June, 1998, the American Heart
Association (AHA) heard a number of papers and presentations
about the links between obesity and heart disease. Some of the
material they covered directly pertains to diabetes. Data from
the "National Health and Nutrition Examination Survey" (NHANES)
showed that over 70 percent of obese people have at least one
additional risk factor for heart disease, such as hypertension,
dyslipidemia, and type 2 diabetes. Data derived from the
"Framingham Heart Study" (which we reviewed in the last issue of
the VOICE), showed that over 50 percent of obese people have at
least two additional risk factors for heart disease, such as a
combination of hypertension, type 2 diabetes and/or dyslipidemia.
Further Framingham data indicate that 25 percent of obese people
have at least three additional risk factors for heart disease.
Cardiologist James M. Rippe, MD, who spoke at the AHA
convention, stated: "More than one in three Americans are
classified as overweight or obese, and the rate of obesity has
been growing at an alarming rate over the last few years."
Obesity is of special interest where diabetes is present.
Perhaps 95 percent of diabetes is of the type 2 variety, where
the principal component is insulin resistance, the body's
inability to correctly utilize its own (endogenous) insulin.
Obesity increases insulin resistance. Weight loss, regular
exercise, and physical fitness decrease insulin resistance. The
diabetic who, under medical supervision, starts and maintains a
regular fitness program, and keeps an ideal weight, will lessen
the need for medications and cut the risk of complications, like
eye disease, kidney disease, and heart disease.
STATE DIABETES PROGRAMS
The Centers for Disease Control (CDC), part of the U.S.
Department of Health and Human Services, is one unit of the
Federal Government's public health program. The CDC is active
against many diseases, and its Division of Diabetes Translation
is particularly active against diabetes. Of course some of this
is high-level laboratory research, but a lot takes place "on the
front lines," in state and territorial Health Departments. What
does the CDC do for the states?
One way they help is by developing educational programs
that target those populations statistically at highest risk for
diabetes and its complications. Another is their financial
support of state- and territory-based diabetes control programs
targeted at reducing diabetes complications. Although these
"core programs" do not themselves cover entire states, they are
meant to provide a framework for the states to build more
comprehensive programs. In several states, CDC funds
"comprehensive" programs of their own.
Specifically, CDC, as part of its long-established mandate
to statistically track disease activity, creates workgroups to
define the burden of diabetes in a given state. These groups
examine vital statistics, hospital discharge records, behavioral
surveys, renal disease records, and other sources. Resulting
data are used to develop guidelines and strategies for prevention
and intervention, at the local level, including "community
empowerment programs." CDC also sponsors training initiatives,
some specifically targeted to the needs of high-risk populations.
CDC makes its national publications available to the states,
to primary health practitioners, and to consumers, and is taking
a leadership role in translating diabetes materials into Spanish.
For information about their diabetes publications, contact:
Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion, Mail Stop K-10,
4770 Buford Highway NE, Atlanta, GA 30341-3717; telephone: (770)
488-5015; website: http://www.cdc.gov/diabetes
As the Federal Budget permits, the Centers for Disease
Control intends to expand support for its core diabetes programs
into all states and territories, and to use its national
perspective to monitor outcomes, provide new data for
policymakers, translate current research findings into effective
clinical and public health strategies, and in other ways reduce
the burden of diabetes.
"ALTERNATIVE" MEDICINE
by Peter J. Nebergall, PhD
Photo: portrait with cat. Caption: Peter J. Nebergall
There are a great many "alternative medical products"
available to the consumer today. Some claim efficacy regarding
diabetes. A few of these have yet to be tested by the medical
establishment and the Food and Drug Administration. These may
have merit--we just don't know it yet. Others have been tested,
and found to be without merit, too variable in their success rate
("you pays your money and you takes your chances"), or too
potentially harmful to the user--but still we clamor to buy them,
and, as consumers, we're not particularly selective.
We could stand to be. America has a long tradition of
"medicine shows," "carny barkers," "cure-alls," and "snake oil
salesmen." We are fascinated with the possibility of cheap,
quick, simple, miraculous cures--with relief from arthritis,
incontinence, psoriasis, and male pattern baldness thrown in at
no extra charge. Can you make it rain, too?
Skilled hucksters see us coming. They know what we want,
and they give it to us, in a bright, attractive package and a
shower of dubious testimonials. To cover their tracks, many of
them cite mythical, ancient, or deeply flawed research studies.
Others take a more paranoid line: "What the doctors don't
want you to know!" or simply "No More Doctors!" That strategic
hint of scandal, of coverup, juices up sales. The idea that
there is a "Medical Conspiracy," that the doctors are holding out
on us, brings on a buying frenzy.
Why do we fall for this? Why are we so willing to be taken?
Why have so many lost faith in their doctors? It is partly the
fault of the doctors, who in their haste to "become more
scientific," have become increasingly detached from the doctor-
patient relationship. Some of it is the fault of the medical
establishment, which, for whatever its reasons, steadily
increases prices, year after year, far past the rate of
inflation, pricing medical care out of reach for many, with
tragic consequences. But a large part of the problem is ours, as
consumers.
We, the consumers of health care, need to educate ourselves.
Any "con man" will tell you he looks for "suckers," for folks
willing to fall for jazzy presentation at the expense of content,
and the medical field has its share. We need to become far more
critical; if it sounds like a slick sales presentation, it
probably is.
Even more so, we need to accept responsibility for our own
well-being. I have spoken to too many who rationalize their
unhealthy lifestyles with an unreasoning, almost religious faith
in their doctors' ability to cure them of whatever. Doctors are
not magicians. The medical profession sometimes fails. We need
to accept the humanity, the imperfection of current medicine, and
do the best we can, rather than turning to alternative sources
who promise us the unachievable in return for our wallets and the
contents thereof.
The snake-oil salesman exists because we want him; we want
the easy answers he offers. As long as we are impatient with the
slow pace of reality, and as long as our service providers insist
on stretching the definition of "reasonable charges," there will
be snake-oil salesmen, selling us the answers we want to hear.
For the sake of our health, it is up to us to turn our back on
them.
A FISH STORY
by Beth Finke
Photo: portrait. Caption: Beth Finke
Artwork: Catfish grabbing a fishing bobber (located at the end
of the article).
Four hundred to five hundred blind people flinging fishing
hooks and bait around? Sounded dangerous to me. But scary and
crazy as the Visually Impaired Persons' (V.I.P.) Fishing
Tournament sounded, I signed up anyway.
My husband Mike and I had just moved here to the Outer Banks
in August along with our son Gus and my Seeing Eye Dog Dora.
Little did we know that Nags Head was the site of North
Carolina's annual fishing tournament for the blind.
The yearly event is sponsored both by businesses here on the
Outer Banks and by the North Carolina Lions Clubs. Blind and
visually impaired people from all over the state are invited to
attend, free of cost. The tournament began in 1983, and ever
since then it has grown both in size and popularity. In other
words, a whole bunch of blind folks accept the invitation to come
to the Outer Banks and fish. In 1997, I was one of them.
I hadn't been fishing since I'd lost my sight 12 years earlier in
the summer of 1985. Heck, I had never even fished when I could
see! Never had any interest in fishing or learning to fish at
all. But with this tournament taking place right in my backyard,
I felt compelled to give it a try. Maybe I'd borrow Mike's
motorcycle helmet to prevent any injuries from flying fish
hooks...
When fishing day came, in early October, the weather was
unseasonably warm. Could I wear sandals on a fishing boat, I
wondered? Would it be cold on the open seas? Should I wear
pants? I finally decided on sandals, shorts and a t-shirt. I
packed sweat pants and a sweatshirt to take along in case it got
cold on the boat. I decided against bringing the motorcycle
helmet, it was just too hot out for that.
Smart move, for the helmet turned out to be unnecessary.
The tournament was well organized, and any hooks that were flung
were flung towards the sea and not towards each other. The whole
event was downright civilized, really. The 400-plus of us met in
the morning for meetings at the Outer Banks Worship Center on
Nags Head's main highway. The worship center is built in the
shape of a boat, and everyone around here just calls it "The Ark
Church." Everyone knows where it is, too, so even though we were
new to town, Mike found the place with no trouble.
There were special seminars and exhibits suited especially
to the blind taking place at the church the morning of the
tournament. I didn't pay much attention to the seminars or
exhibits--I just wanted to fish!
At least, I thought I wanted to fish. But as the time to
leave the safety of the ark and go to the boat drew nearer, I
started getting nervous. The anxiety must have shown on my face,
for when Mike leaned over to kiss me goodbye he seemed concerned.
"Are you going to be okay?" he asked, pulling back suddenly right
before the kiss.
"Yes!" I answered, trying to sound like that was the
silliest question I'd ever heard. Honestly, I didn't know HOW I
was going to be. How was I going to get from the Ark church to
the fishing boat, for example? How would I get onto the boat?
Would the boat ride be rough? What if I get sick? What if Dora,
my Seeing Eye dog, gets sick? What if the waters get rough?
What if the boat capsizes? Will we all be wearing lifejackets
while we fish? =20
Why had I opted for the boat, anyway? I could have been
safe, on terra semi-firma, on a pier. When signing up for the
fish tournament, each blind participant is given the choice of
fishing off a pier or off a boat. Originally I'd chosen the
pier, thinking that if I decided I didn't like fishing, or if I
got bored, I could just leave. On a boat you're trapped. But
then a friend recommended I go on the boat. "I'll take you
fishing off the pier if you ever want to do that," she said, "but
how often do you have an opportunity to fish off a boat in the
ocean? Go for it!"
I called the VIP officials and had them change my
preference. So here I was, "going for it", and Mike was going
away, leaving me there at the Ark. I tried to smile so he
wouldn't worry about me. He saw right through that smile, I
know, but kissed me anyway and said goodbye. I heard him walk
away and hoped he wasn't looking back. I could only hold that
fake smile of confidence for so long, I'm afraid it left my face
seconds after Mike gave me that kiss.
It wasn't long, though, before an authentic smile crossed my
face. This smile came to me when someone touched my shoulder and
asked, "Are you Beth?" I said yes, and she invited me to join
her at another table. "The folks from Dare County are all over
here," she explained, "take my elbow, I'll lead you there."
Blind people can be pretty resourceful and independent, but
there are a few things sighted people can do that we're just no
good at. One of them is finding people in a crowd.
A volunteer named Alice drove me and a 12-year-old blind
girl from Kill Devil Hills to the boat we'd be fishing from.
"From there you're on your own," Alice told me.
"You mean you're not going on the boat with us?" I asked,
panicking a bit. =20
"Oh, no," she said, "I'm going on the boat. But I don't
know a thing about fishing."
"I've been fishing before," the 12-year-old chimed in, "I'll
help you."
The 12-year-old wasn't the only blind person there who'd
been fishing before. I was eavesdropping at the dock, and it
sounded to me like everyone there had fished before. All of them
had been to previous VIP Tournaments, and some of them had come
to every tournament since the thing started in 1983.
It occurred to me then that any other blind person at the
fishing tournament for the first time would have done the sane
thing and fished off the pier. The boat, it seemed, was for
weathered Fish Tournament veterans.
I would have sat there and worried about the boat again, if
my neighbors hadn't, thank goodness, interrupted my thoughts by
engaging in conversation with me. It was odd how I couldn't tell
who was blind and who was sighted, who were the participants in
the tournament and who were the volunteers. People would just
come up, ask me where I was from, and start talking about how
many fish they hoped I'd catch that day. One person noticed my
anxiety and reminded me that the boats never go out to the ocean,
they stay on the sound for the safety of the participants.
Knowing we wouldn't be thrashing around in ocean waves made me
feel better. Really, just sitting around talking with all these
people made me feel better. Blind or sighted, they all were
friendly, and everyone seemed happy to be there and excited to
get on the boat and start fishing.
The exuberance was contagious. When we finally were told we
could get on the boat, my Seeing Eye dog and I practically flew
to the steps, we were so eager to get started. "Hold on!"
someone yelled to me, "Watch your step!" It was probably the
owner of the boat who was doing the yelling, as he seemed very
skeptical about what Dora would do in guiding me up and down the
steps to the boat. Everyone else there had spent time with Blind
people; they all knew how skillfully a guide dog can maneuver
even the most unusual paths, like the one that leads you onto a
boat. Dora had never been on a boat before, but she guided me
beautifully and sat quietly under my bench the entire time I
fished.
And that time was l-o-n-g. By the time we were done that
afternoon, we'd been on the boat almost 5 hours. We didn't go
hungry, though. The tournament provided us with a sack lunch and
soda, which were handed to us almost immediately after we'd all
found a seat on the boat. "Good thing you brought these," I told
the woman distributing the food, "We would starve out here if we
had to rely on what I catch today for nourishment."
"Now, how do y'all know that?" the woman questioned me. She
was teasing me with her southern twang. "Y'all haven't even
stuck y'alls pole in the water and y'all think y'alls not going
to catch anything already. Y'all are no fisherman!"
"I know it," I admitted, feeling for my sandwich in the bag
she'd given me, "that's why I'm glad you gave us these
sandwiches. Do you know much about fishing?"
"No ma'am," she said, "I'm just here to give out these bags
of food." "That's good, 'cause that's important," I said, taking
a big bite out of the sandwich I'd finally uncovered. I chewed a
bit and then continued: "Mmmm, this sandwich is good, and like I
said, food is important. But do you know anyone on the boat who
likes to fish?" I asked. "I mean, besides the blind people
fishing for the tournament?"
"Well, sure," she answered.
"Is there anyone on the boat who likes to fish and likes to
talk about it so much that he bores everyone to death with fish
stories?" I asked, "'cause that's the person I want to meet,
that's the person I need to have come and help me."
"Well, I'll see who I can find for y'all," my sandwich
friend told me, "but first I have to give all these other folks
their food."
I finished my sandwich as she left to feed the others and
find a fishing partner for me. I was thirsty, too, but went easy
on the soda, not sure if there was a toilet on the boat.
It wasn't long before my sandwich pal returned and
introduced me to Alan. I moved over and told Alan to sit down
next to me. Alan stayed with me the rest of the trip. He wasn't
actually there on the boat to help with we blind fishers; he had
been "recruited" for the event to run the ham radio. We chatted
for a while before I found out he was only 16 years old. He had
received an excused absence from school that day to fill his
important ham radio position on the boat.
Alan loved to fish, and loved to talk about it. He was born
and raised on the Outer Banks; outside of a 3 year stint he spent
in Raleigh, he'd always lived on the ocean. He could answer
every question I had about high tides, low tides, inlets, surf
fishing, pier fishing, you name it. More importantly, he wasn't
shy about showing me what he knew. Before I knew it, Alan had
set his ham radio aside and was helping me fish. He was
amazingly patient with me, teaching me how to bait my own hooks
and then letting me do it on my own. "Now here's the rod," he
said, putting the bottom of the pole into my right hand, "and
here's the holder for it." He took my left hand and let me feel
the holder. Then he had me put the pole into it.
"Okay, good job!" he said, "now we're set." He put my right
hand on a crank and had me turn it a few times. Then he took
that same hand, had me extend my pointer finger and showed me
where a little release mechanism was. "That's what you release
when you want to let your line out," he explained. Taking that
same extended finger and putting it near the crank I'd used
earlier, he showed me how to feel the line going out, and how to
know when it had extended as long as it needed to.
Alan never once grabbed the pole from me and said, "Here,
let me do it." I told him I appreciated his letting me do all
this on my own, he answered, "Well, I figured if you're here to
learn to fish, you oughtta do it yourself." Ah, out of the
mouths of teenagers...
Once I cast my line, I had a hard time feeling whether
anything had bitten or not. Over and over again I pulled my line
up and over and over again all I could feel on the end was the
very bait I had put there myself. Alan watched me struggle with
this and finally decided I should forget about feeling for the
line to tug near the cranking mechanism. Just lean over to the
end of the pole," Alan instructed, "and feel the line there."
"How?" I asked, leaning over the end of the boat. Amazing to
think that a few hours earlier I had been worried about getting
seasick. Now I was leaning out of a boat over the open seas,
without a care in the world. Well, that's not exactly true, I
DID have a care. I cared about catching a fish!
"Just let the line drape over your finger," Alan said,
placing the line over my extended pointer finger, "this way
you'll really feel it when something bites."
It wasn't long before I did feel a tug. And, of course,
Alan was as excited as I was when I pulled that big ol' four
ounce pigfish from the water.
"It's a Croaker!" Alan said, "touch it!"
I touched it and heard a distinct "oink!" We both laughed
and began a spirited debate about whether my catch was a Pigfish
or a Croaker. Whatever the case, I'd never known a fish could
make that kind of noise. I'd never known I could catch a fish,
either.
That fish was the only thing I caught that day. After
catching my 4 ounce Pigfish, I didn't pay as much attention to
the rod and reel anymore. I talked to Alan instead, learning
about all the places he'd fished since he was a little kid, where
he was going to high school now, all the different addresses he'd
had on the Outer Banks.
"Geez!" I said, "why is it that you've lived so many
places?"
"My mother has been married and divorced 3 times," he
answered, "so we've moved around a lot." I wondered if maybe
that's where Alan got that maturity of his, maybe it came from
all the changes he'd lived through, all the adjustments he'd made
already at age 16.
Alan was curious about some of the adjustments I'd made in
my life. He asked me how I'd become blind--a result of juvenile
diabetes--and how long I'd been blind--12 years. "What's it like
not to see anything?" he asked me, "did getting a Seeing Eye dog
really help a lot?" We talked and talked.
Before we knew it, it came time to say goodbye and get off
the boat. Alan and I gave each other a big hug. "Thank you so
much," I told Alan. "No," he said, "thank you."
Once we were off the boat, Alice, my original volunteer,
drove me and the 12-year-old girl home. The 12-year-old was very
excited, she had caught three fish that day. There were dinners
and fish fries to attend that night as part of the Visually
Impaired Person's Fish Tournament. They'd be giving out trophies
and awards at the banquets, and this 12-year-old girl was sure to
win at least one of them.
I was as exhausted as that 12-year-old was excited. I
decided to skip the banquets and stay home, especially seeing as
I already had my awards: I'd made a new friend in Alan, and I'd
overcome my fears and learned to fish. It is one thing for me to
relearn to do things I used to do when I could see; it's an
entirely different thing to learn a new skill, learn to do
something I couldn't do even when I had sight.
And the trophy? My 4 ounce Pigfish (or was it a Croaker?),
of course.
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."
LETTERS TO THE EDITOR
Artwork: Quill writing pen in ink well
December 1, 1997
I want to thank you for making the VOICE available via the
Internet. I really enjoy reading your columns and think that you
do a terrific job. Also, my congratulations on the tactile
marking issue.
Betty Cook
Baltimore, Maryland
* * * * * *
March 9, 1998
We have a generous supply of the 1997 Fall edition which we
acquired quite by chance. Please send us 100 copies of each
future edition so we can display them in our office for the
people we service. We find your paper very interesting and would
be glad to help you circulate it in the diabetic community.
Diabetic Association of Texas, Inc.
Fort Worth, Texas
* * * * * *
May 7, 1998
I have Diabetes Mellitus. A friend gave me a copy of your
VOICE OF THE DIABETIC which is packed full of information. I
would like to receive this paper.
Thanking you,
Daniel Borden
Huntsville, Alambama
* * * * * *
May 26, 1998
It is needless to say that I enjoy reading the VOICE OF THE
DIABETIC. Your dedicated efforts, as correctly mentioned by you,
are more than filling the need of the diabetic community
nationwide. You are doing a wonderful job indeed.
Writing Kindest Regards.
Sincerely,
M.S. Sheriff
Irvine, California
INSULIN TYPES: A REVIEW
Earlier articles have discussed insulin's role in our
bodies, what happens when we don't have it, and why some of us
have to take it by injection. But all insulins are not the same.
How are they different? WHY are they different? And, how can we
use their differences to better self-manage?
Insulins are described and subdivided by concentration
strength, source, and time of onset/peak. This last category is
most critical, but an understanding of all three criteria is
needed.
Concentration Strength
All insulins sold in the United States today are of U-100
strength, 100 units of insulin per cc of fluid. But there are
other dilutions in other countries, and if you were to encounter
one of these (all perfectly usable), and inject your usual volume
of insulin, you'd get a different amount of insulin. You'd get
the wrong dosage.
Source
At one time, all insulin was produced by laboratory animals,
most often cows and pigs. In the last decade, however, American
insulin manufacturers have almost completely shifted to use of
"recombinant DNA" technology, enabling laboratory production of a
close analog to real human insulin. This "human" insulin is said
to more closely match our endogenous (pancreatic) insulin.
Although labelled much like "animal source" insulins,
recombinant DNA insulins are not quite the same, either in time-
of-onset or in amount of insulin required. Experience shows that
any switch between the one and the other must be done with care,
and under your doctor's supervision--the types might be different
enough to cause you trouble otherwise.
Time of Onset/Peak
The different insulin types: Humalog, Regular, NPH,
Lente, Ultralente, and the pre-mixes: 70/30 and 50/50, divided
and distinguished by their time of onset and duration. As shown
in the chart below, critical questions are:
1. When does this insulin begin to act in my body?
2. When does it reach its peak?
3. When does it fade to insignificance?
NOTE: We're all different! Charts reflect averages--you
may well find a given insulin is different for you. Test
frequently, keep good notes, and make your own chart!
Below is a general approximation, derived from data
furnished by both U.S. insulin manufacturers, Eli Lilly and
Company and Novo Nordisk Pharmaceuticals Inc.
INSULIN START PEAK END
------- ------ ----- -----
Humalog 10 min 1 hr 4 hr
Regular 30 min 2-5 hr 8 hr
NPH 1.5 hr 4-12 hr 22 hr
Lente 2.5 hr 6-16 hr 24 hr
Ultralente 4 hr 8-18 hr 30 hr
70/30 30 min 2-12 hr 24 hr
50/50 30 min 2-6 hr 24 hr
Where Humalog, Regular, and 50/50 premix have sharp and
definable "peaks," the long-acting Lente insulins come on slowly,
and have long, flat "peaks," and a slow rate of decline. They
are hard to describe in specific terms.
There are several insulins not charted above, "buffered
insulins" from Lilly and Novo Nordisk, and a special U-400
insulin from Hoechst of Germany. These are strictly for use in
insulin pumps, and should not be used for any other purpose!
Avoid Rigid Thinking
The most accurate chart will still be imprecise. Short-
term, things will vary because diabetes, like life itself, is
like riding a surfboard--no one can control all factors! Novo
Nordisk says it best: "The time course of action of any insulin
may vary in different individuals, or at different times in the
same individual. Because of this variation, time periods
indicated here should be considered as general guidelines only."
Long-term, things will vary because your body is not the
same from one decade, or one year, to the next. Your chart will
need regular updating. Use it as guide, not gospel.
Mixes and Mixing
Although users of the insulin pump generally take only fast-
acting insulin, most insulin-using diabetics employ a mix of
faster and slower insulins, to provide best control. The idea is
to let the fast insulins (Regular or Humalog) cover meals, and
let the longer-acting types (NPH, Lente, Ultralente) cover the
period between meals. There is quite an art to insulin mixing,
as you must consider diet, exercise, injection frequency, total
insulin volume, ratio of slow-to-fast insulins, general health
(including other medications you might be taking!), and your own
unique intangibles. NOBODY is exactly "average."
Some folks employ commercially-prepared "pre-mixes," like
"70/30" (70% NPH to 30% R), or "50/50." While these pre-mixed
insulins provide a convenience (precise and consistent mixing)
they also come with a liability: What if, to achieve optimal
control, your best mix, right now, is 68/32, or 75/25? And what
if tomorrow, due to variations in your diet, activity level, and
general health, it's 60/40 or 81/19? You can't make fine
adjustments with a pre-mixed insulin--you're stuck with the mix
the doctor gave you--and for some, that means less than optimal
control. Yes, you can vary your total dosage, total volume, and
injection frequency, but, as the different insulins are really
there for different purposes, adjusting insulin with a premix can
be like scratching an itch--with a sledgehammer. There can be
consequences.
A Caution
Both U.S. insulin manufacturers report that one insulin mix
could have dangerous consequences, and should be avoided. The
Lente insulins, the longest-acting insulins available, should
NEVER be combined with intermediate-speed NPH insulin. Chemicals
in the NPH would alter the Lente or Ultralente, turning it into
an approximation of fast-acting Regular insulin! Mix those two,
and you'll have a very different result than you might expect!
Be sure to talk to your doctor about appropriate and
inappropriate insulin combinations.
Adjusting Insulin
People's bodies, and insulin needs, change. Not only by the
year, the month, or the decade, but, to achieve the best possible
control, you may choose to vary your dosages by day, linking them
to results of your blood glucose monitoring. To preserve optimal
control, you will need to adjust your insulins, to compute, draw
up, and inject different amounts and mixture percentages. Some
folks, working with the full potential of "tight control," use a
sliding scale, adjusting their insulins every day, in close step
with their diet, exercise, and blood glucose test results. The
rewards of their discipline can be greatly reduced chance of
complications.
Once you realize the role played by the different types of
insulin, and how you can optimize your control by utilizing the
most appropriate blend, you're well on the road to staying
healthy. Knowledge is power!
Blind diabetics, and those losing vision, need to adjust
insulin as well, and the technology to do so is available:
Tactile insulin measuring devices like the Jordan Count-A-Dose
enable reliable non-visual insulin measurement and mixing. Lack
of sight is no bar to good control!
The Count-A-Dose (Low-Dose model, B-D 50-Unit syringe) is
available for $49.95 from Jordan Medical Enterprises, 202 Oaklawn
Ave., South Pasadena, CA 91030; telephone: 1-800-541-1193. An
instructional audiocassette is available. Both the Low-Dose
model and the now-discontinued 1cc, 100-Unit Count-A-Dose are
also available ($40, either model, but no cassette for the 1cc
model) from the 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 EST,
weekdays.
UPDATE: NONINVASIVE GLUCOSE
MONITORING
Arriving in the 1960s, the home blood glucose monitor was a
tremendous advance over urinalysis. Reasonably instantaneous
glucose measurement was now possible, and "tight control" could
now take place. But improvements since then have been
incremental; you still need to draw a drop of blood. However
minor, blood glucose testing still requires the need to prick
yourself with a sharp object.
For thirty years, people have dreamed of a noninvasive
glucose monitor, some device that would read blood sugar levels
without self-inflicted pain. It hasn't happened yet.
Recognizing there are millions of dollars spent every year
on blood glucose monitoring, a number of companies have tried to
develop a monitor that would produce a reliable reading without
the need to bleed. A number of different techniques have been
tried, and there have been many failures. Some have produced
litigation. Meanwhile, we bleed, drop by drop.
The demand for a "stick-free" glucose monitoring device will
continue until it is fulfilled. Different companies will
continue trying, and eventually one will succeed. When the U.S.
Food and Drug Administration (FDA) is satisfied that a new
monitor works as promised, and that its results are within
accepted standards for reliability, it will be approved, and we
will see it on the market. Until then, there will be updates
like this one. So what's on the immediate horizon?
The most promising new development appears to be the
Glucowatch, produced by Cygnus, Inc., of Redwood City,
California. The Glucowatch system uses a sensor on the wrist
(the Glucowatch), and a replaceable sensing "patch" (the
Autosensor). Cygnus anticipates filing for FDA approval later
this year.
Bioject Medical, of Portland, Oregon (not to be confused
with Biocontrol, whose early machine was rejected by the FDA), in
partnership with Elan Corporation, has developed a similar
"watch" type machine, but one that uses different chemical and
mechanical principles. They have not yet filed for FDA approval.
While the above machines would be worn on the body, and
would provide more-or-less continuous readings, another set of
monitors utilize infrared, or near-infrared, spectroscopy, to
read and measure blood glucose. Biocontrol and Futrex (the Dream
Beam), two early competitors, employed this technology, as does a
prototype from CME Telemetrix, of Waterloo, Ontario, Canada.
There are many more. While these companies and their
competitors sort out issues of accuracy, reliability, and cost,
several others are pursuing new uses for pre-existing technology.
These are the "semi-invasive" glucose monitors, worn like an
insulin pump, providing continuous readings. Insulin pump
manufacturer MiniMed, of Sylmar, California, filed for FDA
approval of such a semi-invasive device in December of 1997.
Several other companies are working on similar machines at this
time.
The future will bring things we have not imagined: self-
adjusting insulin pumps, noninvasive meters with continuous
readout and hypoglycemia alarms... It won't be long now.
NEW IMPOTENCE MEDICATION
Viagra, Pfizer, Inc.'s new oral medication for the treatment
of male erectile dysfunction (impotence) was approved by the U.S.
Food and Drug administration on March 27, 1998. There are many
treatments for impotence, diabetogenic or otherwise. Some of
them are very effective, but, until now, most have required
machinery, surgery, or direct penile injection. Viagra is a
simple pill.
Tests and evaluations of this product suggest that along
with its noninvasive administration, Viagra's very efficacy is
more subtle and "natural" than any previous impotence treatment.
Where other methods promptly cause an erection, Viagra appears to
"encourage" one.
It is not a "magic bullet," however. There are many
different causes for impotence, and it is more effective against
some than others. Diabetogenic impotence generally has a
vascular cause, and against it, current statistics suggest a 59%
effectiveness rate.
As with any powerful new medication, there are side effects.
A few users reported transient color-vision disturbances, or
increased sensitivity to light, but only one discontinued for
this reason. Patients with severe renal insufficiency
(Creatinine clearance <30 ml/min) will experience inhibited
clearance of the drug from the body, and an altering of its
response. Patients taking organic nitrate medications need to
avoid Viagra, as it is antagonistic to those medications. Be
sure your doctor knows all the medications you are taking! Most
will find Viagra as safe as it is convenient.
If you are experiencing erectile dysfunction, talk to your
doctor, or seek out a urologist who specializes in this
condition. Nothing is gained by suffering in silence; many
therapies are effective against impotence. Viagra may prove to
be the most convenient. For information, talk to your doctor and
your pharmacist. Have them contact Pfizer, Inc., 235 East 42nd
Street, New York, NY 10017. Read more about Viagra at
http://www.pfizer.com/pfizerinc/about/viagrarelease.html
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. Please provide a phone number so we can reach you.
THE PITFALLS OF POLITICAL CORRECTNESS:
EUPHEMISMS EXCORIATED
by Kenneth Jernigan
Photo: portrait. Caption: Kenneth Jernigan
FROM THE VOICE EDITOR: This article appeared in the BRAILLE
MONITOR, August 1993, published by the National Federation of the
Blind. Five years is a long time, but I've had some experience
with "PC" myself. A few years ago, a large diabetes organization
attempted to chastize me for my use of the word "diabetic." I
find their stance odd, as the vast majority of diabetics I have
encountered don't mind the term, or prefer it to some trendy
euphemism. Even more surprising, this same group, while
attempting to re-engineer its members' speech, accepts
advertisements (worth thousands of dollars each) from
corporations that use "diabetic" in their text. Of course I
responded to this group's silly accusations--but they did not
bother to reply.
As civilizations decline, they become increasingly concerned
with form over substance, particularly with respect to language.
At the time of the First World War we called it shell shock--a
simple term, two one-syllable words, clear and descriptive. A
generation later, after the Second World War had come and gone,
we called it combat fatigue. It meant the same thing, and there
were still just two words--but the two syllables had grown to
four. Today the two words have doubled, and the original pair of
syllables have mushroomed to eight. It even has an acronym,
PTSD--post traumatic stress disorder. It still means the same
thing, and it still hurts as much or as little, but it is more in
tune with current effete sensibilities.
It is also a perfect example of the pretentious euphemisms
that characterize almost everything we do and say. Euphemisms
and the politically correct language which they exemplify are
sometimes only prissy, sometimes ridiculous, and sometimes
tiresome. Often, however, they are more than that. At their
worst they obscure clear thinking and damage the very people and
causes they claim to benefit.
The blind have had trouble with euphemisms for as long as
anybody can remember, and late twentieth-century America is no
exception. The form has changed (in fact, everything is very
"politically correct"), but the old notions of inferiority and
second-class status still remain. The euphemisms and the
political correctness don't help. If anything, they make matters
worse since they claim modern thought and new enlightenment.
Here is a recent example from the Federal government:
United States Department of Education
Washington, D.C.
May 4, 1993
Memorandum
TO: Office for Civil Rights Senior Staff
FROM: Jeanette J. Lim, Acting Assistant Secretary
for Civil Rights
SUBJECT: Language Reference to Persons with a Disability
As you know, the October 29, 1992, Rehabilitation Act
Amendments of 1992 replaced the term "handicap" with the
term "disability." This term should be used in all
communications.
OCR recognizes the preference of individuals with
disabilities to use phraseology that stresses the
individuality of all children, youth, and adults, and then
the incidence of a disability. In all our written and oral
communications, care should be given to avoid expressions
that many persons find offensive. Examples of phraseology
to avoid and alternative suggestions are noted below:
"Persons with a disability" or "individuals with
disabilities" instead of "disabled person."
"Persons who are deaf" or "young people with hearing
impairments" instead of "deaf people."
"People who are blind" or "persons with a visual
impairment" instead of "blind people."
"A student with dyslexia" instead of "a dyslexic
student."
In addition, please avoid using phrases such as "the
deaf," "the mentally retarded," or "the blind." The only
exception to this policy involves instances where the
outdated phraseology is contained in a quote or a title, or
in legislation or regulations; it is then necessary to use
the citation verbatim.
I hope this information has been helpful to you. If you
have any questions about any of these favored and disfavored
expressions, feel free to contact Jean Peelen, Director,
Elementary and Secondary Education Policy Division, at (202)
205-8637.
That is what the memorandum says, and if it were an isolated
instance, we could shrug it off and forget it. But it isn't. It
is more and more the standard thinking, and anybody who objects
is subject to sanction.
Well, we of the National Federation of the Blind do object,
and we are doing something about it. At our recent national
convention in Dallas we passed a resolution on the subject, and
we plan to distribute it throughout the country and press for
action on it. Here it is:
Resolution 93-01
WHEREAS, the word blind accurately and clearly describes the
condition of being unable to see, as well as the condition of
having such limited eyesight that alternative techniques are
required to do efficiently the ordinary tasks of daily living
that are performed visually by those having good eyesight; and
WHEREAS, there is increasing pressure in certain circles to
use a variety of euphemisms in referring to blindness or blind
persons--euphemisms such as hard of seeing, visually challenged,
sightless, visually impaired, people with blindness, people who
are blind, and the like; and
WHEREAS, a differentiation must be made among these
euphemisms: some (such as hard of seeing, visually challenged,
and people with blindness) being totally unacceptable and
deserving only ridicule because of their strained and ludicrous
attempt to avoid such straightforward, respectable words as
blindness, blind, the blind, blind person, or blind persons;
others (such as visually impaired, and visually limited) being
undesirable when used to avoid the word blind, and acceptable
only to the extent that they are reasonably employed to
distinguish between those having a certain amount of eyesight and
those having none; still others (such as sightless) being awkward
and serving no useful purpose; and still others (such as people
who are blind or persons who are blind) being harmless and not
objectionable when used in occasional and ordinary speech but
being totally unacceptable and pernicious when used as a form of
political correctness to imply that the word person must
invariably precede the word blind to emphasize the fact that a
blind person is first and foremost a person; and
WHEREAS, this euphemism concerning people or persons who are
blind--when used in its recent trendy, politically correct form--
does the exact opposite of what it purports to do since it is
overly defensive, implies shame instead of true equality, and
portrays the blind as touchy and belligerent; and
WHEREAS, just as an intelligent person is willing to be so
designated and does not insist upon being called a person who is
intelligent and a group of bankers are happy to be called bankers
and have no concern that they be referred to as persons who are
in the banking business, so it is with the blind--the only
difference being that some people (blind and sighted alike)
continue to cling to the outmoded notion that blindness (along
with everything associated with it) connotes inferiority and lack
of status; now, therefore,
BE IT RESOLVED by the National Federation of the Blind in
convention assembled in the city of Dallas, Texas, this 9th day
of July, 1993, that the following statement of policy be adopted:
"We believe that it is respectable to be blind, and although
we have no particular pride in the fact of our blindness, neither
do we have any shame in it. To the extent that euphemisms are
used to convey any other concept or image, we deplore such use.
We can make our own way in the world on equal terms with others,
and we intend to do it."
NEW MEDICARE PREVENTIVE BENEFITS
On July 1, Medicare coverage regarding diabetes was
substantially expanded, especially for type 2 (non insulin-
dependent) diabetics. The rules have changed, and you should
call 1-800-772-1213 with any specific coverage questions. The
U.S. Department of Health and Human Services has an "Official
Press Release" regarding the expansion of Medicare benefits
regarding diabetes. In their own words:
"As of July 1, 1998, all Medicare beneficiaries with
diabetes, whether or not they use insulin, will have coverage for
their blood glucose monitors and testing strips, so they can
monitor their own blood glucose levels. Diabetics who keep their
blood glucose levels within the normal range reduce the risk of
complications, such as blindness and amputations that are
associated with uncontrolled diabetes. (In the past, Medicare
covered blood glucose monitors and test strips only for insulin-
using diabetics.)
As of July 1, 1998, Medicare will cover a wider range of
education and training programs to help teach diabetics to
control their blood glucose levels. These training programs do
not have to be based in hospitals. A physician must certify that
a patient needs the service under a comprehensive plan of care.
(in the past, Medicare covered only education and training
furnished by hospital-based programs.)"
ALTERNATIVE TREATMENTS FOR DIABETES
by Simeon Margolis, MD PhD, and Christopher Saudek, MD
In recent years, a growing interest and market has emerged
for the use of "alternative" therapies to manage diabetes.=20
Several natural remedies and nutritional supplements reportedly
reduce blood glucose levels. Other techniques are purported to
treat or prevent the major complications of diabetes, including
peripheral vascular disease and CHD. Following are some of the
more common alternative treatments for diabetes. While several
of them show enough promise to warrant further study, there is
little or no hard medical evidence that any is as effective as
insulin or oral diabetes drugs in controlling blood glucose
levels or preventing complications. If you wish to consider
trying one of these options, do so in addition to, not instead
of, your prescribed treatment regimen.
ALPHA-LIPOIC ACID is an antioxidant nutrient that
neutralizes free radicals, which damage cells. (Several diabetes
complications, including neuropathy and cataracts, may be
mediated by such free radicals.) A review article by Lester
Packer, PhD, of the University of California at Berkeley,
theorizes that alpha-lipoic acid has potential applications for
both prevention and treatment of diabetes and its complications.
He cites two placebo-controlled, short-term studies in which
daily injections of alpha-lipoic acid reduced pain and numbness
in people with diabetic neuropathy (though objective measurements
showed no improvement in nerve function.) However, little other
evidence supports the benefits of alpha-lipoic acid for treating
diabetes, and long-term studies are needed to prove its
effectiveness.
CHELATION THERAPY--which administers the chelating agent
EDTA (ethylene diamine tetra-acetic acid) intravenously in 20 to
30 treatments--is purported to remove plaque from artery walls.
Considered the standard treatment for lead poisoning, chelating
agents bind to heavy metals and remove them in the urine.
Advocates claim that chelation can also treat diabetes
complications such as peripheral vascular disease, CHD, and
stroke--and is at least as effective as more costly conventional
therapies. However, the American Heart Association's Task Force
on New and Unestablished Therapies found no scientific evidence
to demonstrate any benefit from chelation therapy in treating
arteriosclerotic heart disease. And two placebo-controlled
studies showed that infusions of EDTA were no more effective than
salt water in alleviating symptoms of peripheral vascular
disease.
CHROMIUM is an essential mineral found in trace quantities
in drinking water and many foods. Necessary in tiny amounts for
many bodily processes, chromium increases insulin's effectiveness
in making blood glucose available to cells. Growing evidence
indicates that deficiencies in chromium can lead to impaired
glucose tolerance, and a few studies have suggested that some
people with diabetes may benefit from chromium supplements (which
usually also contain picolinate, a substance that may increase
chromium absorption into the bloodstream.) However, other
studies have shown no beneficial effect. One possible reason for
the conflicting results: Supplements may only benefit those who
are chromium-deficient, a condition rare in the U.S. Currently,
no method can reliably measure chromium levels in the body, so it
is impossible to determine who may benefit from supplements.
EVENING PRIMROSE OIL, which comes from the seeds of the
evening primrose wildflower, contains large amounts of the
essential fatty acid gamma-linoleic acid (GLA). One placebo-
controlled study published 11 years ago reported that GLA
reversed neurological damage in patients with diabetic
neuropathy. However, no subsequent research has supported this
finding, nor have objective studies substantiated the many other
claimed benefits of GLA.
GINKGO BILOBA is the world's oldest living tree species.
Extracts of ginkgo leaves are widely used in Europe to treat a
variety of conditions, including memory loss, circulatory
problems, and diabetes. Believed to work by stimulating blood
flow in the body, German studies have found that ginkgo may
reduce coldness, numbness, and cramping in the limbs due to
peripheral vascular disease.
GYMNEA SYLVESTRE is a common plant in Africa and India. In
a branch of alternative medicine known as Ayurvedic medicine,
leaves from this plant have been used to manage diabetes for
centuries. Although gymnea sylvestre is said to lower blood
glucose in rats, there have been no placebo-controlled studies of
the plant in people. Other than suppressing the taste of sweet
foods, there is no evidence that it helps people with diabetes.
VANADIUM (vanadyl sulfate) is a trace element that appears
to exhibit a variety of insulin-like effects. Small studies
lasting only a few weeks showed modest reductions in blood
glucose levels in people taking vanadium, but further research is
needed to demonstrate its long term safety and effectiveness.
VITAMIN E is an antioxidant vitamin that can only be
obtained in small amounts in the diet. Population studies have
shown a reduction in heart attacks in those taking Vitamin E
supplements. Large-scale, placebo-controlled trials are now
underway, but none has yet proven that vitamin E supplements
reduce CHD or prevent heart attacks.
NOTE: Excerpted with permission from "The Johns Hopkins
White Paper on Diabetes," (C) Medletter Associates 1998. Single
copies are $19.95 plus shipping and handling, and may be ordered
by calling 1-800-829-9170.
NEW HIGH BLOOD PRESSURE STUDY
One of the ramifications of diabetes is nephropathy,
diabetic kidney disease. It has been known for some time that
ACE (angiotensin-converting enzyme) Inhibitors, a class of blood
pressure medications, have been effective in reducing kidney
disease in patients with type 1 diabetes. It was assumed these
medications would be equally effective in cases of type 2
diabetes. A Los Angeles, California study of the efficacy of
different blood pressure reduction therapies has suggested
otherwise.
Harry J. Ward, MD, Professor of Medicine at UCLA, and his
colleagues recently presented a paper to the American Society of
Hypertension, which showed that, for his study subjects (1100
inner-city African-Americans, Hispanics, and poor Whites, 241
with type 2 diabetes, 40% of them showing microalbuminuria or
proteinuria) the fact of blood pressure reduction is more
important than the means. If you get the blood pressure down,
the study suggests, the rate of kidney disease will drop. =20
One hundred fifty five of the study's diabetic patients had
their hypertension treated with ACE inhibitors. Eighty-six were
treated with other medications, such as calcium channel blockers,
alpha-blockers, or diuretics.
Reasoning that patient compliance may be as important as
class of medication, Dr. Ward's study also compared the efficacy
of four different behavioral approaches:
* Traditional care, where patients merely visited the
doctor and received their prescription;
* Exit interviews, where patients received individualized
counseling sessions to reinforce their understanding of treatment
instructions;
* Computerized tracking, by which patients received
timely reminders to visit the clinic; and
* Home visits/focus groups, involving visits by community
workers to patients' homes to assess problems with patient
compliance, and to work with patients' families, spouses etc., to
improve compliance.
What did they find? After four years of follow-up, the
investigators observed no significant difference in the rate of
diabetic kidney disease progression (how fast it got worse)
between those study participants treated with ACE inhibitors and
those treated with other therapies. They also found that the
"biobehavioral" interventions offered by the study significantly
improved patient compliance, and were a major component in the
success of any one of the therapies.
Dr. Ward noted that although in type 1 diabetes ACE
inhibitors have been demonstrated to be the best choice for
kidney protection, in type 2 the ACE inhibitors were not
necessarily better than the other anti-hypertensives tested. It
appears that for type 2 diabetics who suffer from hypertension
and nephropathy, the need to get the blood pressure down is more
important than the class of medications used to do so.
Dr. Ward also noted there are still unanswered questions,
and that several more studies of type 2 diabetes and hypertension
are currently underway to answer them. Two studies he mentioned
involve the new angiotensin receptor antagonists (Losartan and
Irbesartan). When they are reported (in two or three years), we
should have a much better idea which are the best therapies for
high blood pressure and type 2 diabetes.
REVISED BLOOD CHEMISTRY VALUES
by Priscilla A. Laliberty, RD, LDN
FROM THE EDITOR: On April 20, 1998, I received the
following response to the article "Blood Chemistry Values for
Dialysis Patients", which was published in the April Edition
(Vol. 13, No. 2) of VOICE OF THE DIABETIC. Ms. Laliberty
informed us that some of those guidelines have been revised.
Here she sets the record straight. Be sure to talk to your
doctor and your dialysis team about your specific blood chemistry
values.=20
I would like to have you consider some updated thoughts on
specific dialysis blood chemistry values.
For Calcium, the "Accepted Normal for Dialysis Patients" is
now a little different from "normal values," because it has been
shown that, when your calcium is a little higher than for normal
people, the action of the parathyroid gland is suppressed, thus
the demineralization of your bones common in long-term dialysis
patients is decreased. The goal range for this group is now 10-
11mg/dL. To get your calcium level higher, talk to your doctor
or dietitian. Calcium Acetate is best taken with meals to lower
phosphorous, but calcium carbonate is better, if taken between
meals (without food), to raise the calcium level. (Abbott Lab
has wonderful teaching tools to explain this. Another option
your doctor has is IV or oral Vitamin D, already processed into
the form your body can use. (As your kidneys aren't working,
you'd need this form.)
Hematocrit (HCT) is the percentage of red blood cells in
your blood. Due to your kidneys not working, your body cannot
make red blood cells as it should. Amgen has a product called
EPOGEN that is used (by IV) during dialysis treatments. This
erythropoietin works to make red blood cells, but it needs
available iron in order to work. If your HCT is less than 30%,
ask your dialysis team to look at your case. Average HCT is now
about 32% nationally, with average range about 30-36%.
BUN--For dialysis patients, your =FEBlood Urea Nitrogen=FE
should be below 80mg/dL. I would say our patients (at Rhode
Island Renal Institute) are in the range of 60-70mg/dL. And the
Blood Albumin should be close to 4.0g/dL. In my 19 years of
working with dialysis patients, I rarely find them eating enough
protein. (Editor's Note: Protein requirements for dialysis
patients may be different from those of End Stage Renal Disease
[ESRD] patients not undergoing dialysis!) My patients average
3.9g/dL for Albumin and have BUN in the 60-70mg/dL range. If you
have urine output, your BUN may be lower. If your urine output
changes, your BUN may go up, and then you may need to compensate,
with increased dialysis (ie. blood flow, dialysate flow, kidney
size or clearance ability, or time on dialysis.) If your number
is high, another area to check is your access. Are you using a
catheter for dialysis, or do you have a problem with
recirculation? Your team at your unit can look at this.
"Know your Numbers" refers to KT/V and/or URR. These
numbers are available at your unit, and in one number estimate
how well you are dialysed, the adequacy of your dialysis. =20
Creatinine is considered to be one marker of toxins in the
blood. For dialysis patients, it will generally be in the 8 to
15mg/dL range. Most of our patients will be in the 8 to 12mg/dL
range, but some will be lower. For people with diabetes, the
creatinine range may be 5 to 8mg/dL. If your urine output level
drops (volume), you will see a rise in your creatinine. You may
need to increase your dialysis to compensate for this change.
EUGENE PAYNE, JR., SETS AN EXAMPLE
Photo: portrait. Caption: Eugene Payne, Jr.
In a time when "volunteering" and "community service" are
much talked about, we can learn a lot from the fine example of
Mr. Eugene Payne, Jr. Not only is he an active Federationist and
member of the Diabetes Action Network, distributing VOICE OF THE
DIABETIC in inner-city and suburban Detroit, he also finds time
for a great deal of community service. To top that, he's running
for Precinct Delegate, District V, Precinct 29! He has been a
precinct delegate for 16 years! Why?
"I want to set an example for other blind people, to show
them they can get out and do things," he says.
Mr. Payne is president of Christian Outreach Association,
president of the New Cop Block Club (a neighborhood watch
organization), president of the Displaced Persons Association, a
member of the Detroit Urban League, the Michigan Consumers'
Lobby, the Michigan Senior Citizens' Group, the City Council
Community Action Group, the University New Gratiot Lions' Club,
the Michigan State Police Association, the Detroit Police 9th
Precinct Buoy, and the Michigan Landlord Association. He was a
Democratic National Convention delegate in 1992, and is a
licensed Notary Public. In the course of his service, Mr. Payne
has collected quite a few testimonials and certificates of
appreciation, from the City of Detroit, Wayne County, and the
State of Michigan.
We can all learn from a good example. Eugene Payne provides
one of the best. Thanks, Eugene!
BOOK REVIEWS
by Marilyn Helton
Greetings and welcome to the debut of the VOICE Book
Reviews, bringing you news of the latest publications on diabetic
care, cooking, and coping strategies. In this issue we're
reviewing two new releases from Chronimed Publishing: "When
Diabetes Complicates Your Life (Revised Edition)," and "Daily
Bread: A Daybook of Recipes and Reflections for Healthy Eating."
"When Diabetes Complicates Your Life (Revised Edition)," by
Joseph Juliano, MD, is a book which has been brought back, due to
increasing demand, since it went out of print less than two years
ago. The Revised Edition is now available, with new chapters on
vitamins, herbs, supplements and the latest research, including
the new findings from the 1993 Diabetes Control and Complications
Trial.
Dr. Juliano, a type 1 diabetic, blind since 1984 due to the
complications of diabetes, speaks to the reader, with compassion
and sincerity, of his own experiences with the disease. Through
his personal story, Dr. Juliano sensitively expresses the
diabetic's feelings of fear at the initial diagnosis, through the
accelerating symptoms of complications, to (in his case) the loss
of sight.
Although the major focus of this book is on chapters such as
"Nerves and Circulation," "Kidneys," "Eyes," "Measuring Glucose,"
"Insulin," "Meal Planning," and "Exercise", this writer feels
that Dr. Juliano's shining moment is best expressed in his final
chapter, "Brain Power and Positive Thinking." It is beautifully
written, an example of the courage and dedication this
compassionate endocrinologist and research scientist has brought
to his lifetime of working to understand the disease. Soft-
cover, ISBN: 1-56561-127-6, 114 pages, Chronimed Publishing
1998, $12.95.
If you're looking for a quintessential, all-around diabetic
cookbook and daily common sense health & nutrition advisor,
"Daily Bread: A Daybook of Recipes and Reflections for Healthy
Eating," by M.J. Smith, RD, is the book for you! Ms. Smith's
"Daybook" is filled with practical food ideas, menu ideas and
quick recipes. There is a page for every day of the year, and
each day is packed with check lists and health tips to keep you
on a sound nutritional track. Her spiritual thoughts will give
you inspiration to help you cope with the daily challenges of
diabetes.
"The Daybook" is divided into six bimonthly themes:
"Comfort & Renewal" (Jan/Feb); "Nurturing Our Commitment to
Healthy Changes" (Mar/Apr); Celebrating our Connections"
(May/June); "Taking a Full Breath of God's World" (July/Aug);
"Gathering A Harvest" (Sept/Oct); and "Thankful Celebrations"
(Nov/Dec). I highly recommend this book as much more than "just
a cookbook." Use it as a treat for yourself or a perfect gift
for anyone you love. Hardcover, ISBN: 1-56561-113-6; 384 pages,
365 recipes, Chronimed Publishing 1997, $19.95.
To purchase either of these books, ask at your bookstore, or
call Chronimed; telephone: 1-800-444-5951.
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); and sample issues are available for $4 Each (USA); $5
(Canada), by writing to Cinnamon Hearts DLE, PO Box 578340,
Modesto, CA 95357-8340.
TRANSPLANT PATIENTS SPEAK
The following individuals are the "real" experts. They live
with their kidney transplants, and collectively, they have almost
140 years experience doing so! All of them would choose a
transplant again. Although kidney transplantation is not for
everyone, and sometimes it doesn't work, it should be given
strong consideration.
Eivind Frost, from Montana, received a cadaver kidney on
April 24, 1973, at University of Minnesota Hospital in
Minneapolis (now Fairview-University Medical Center), and is
doing fine. He tells us, "I've been feeling great for 25 years
now."
Ken Carstens, from Minnesota, who also received his kidney
transplant at University of Minnesota Hospital, on September 10,
1975, states, "It's been 23 years now, and I'd make the same
choice again."
Karen Mayry, from South Dakota, received her kidney
transplant at University of Minnesota Hospital, on January 12,
1977. She declares, "I feel great!"
Betty Walker, from Missouri, received her transplant on July
13, 1978, at Yale-New Haven Hospital in Connecticut. In her
words: "I was just existing on dialysis; and my transplant gave
life back to me."
Lenny Ruygt, from California, received her kidney at
Presbyterian Hospital (now Pacific Medical Center), in San
Francisco, on St. Patrick's Day, March 17, 1980. She says: "On
dialysis, I had no energy at all--I would sleep all but two hours
of a day. After my transplant, I felt energized!"
Linda Bingham, from Ohio, who received a dual transplant
(kidney and pancreas) at University Hospital in Cincinnati, Ohio,
on December 10, 1981, says, "I feel great. I have been given a
whole new life."
Ed Bryant, from Missouri, received his transplant on August
9, 1983, at University of Minnesota Hospital. He says: "There
is no comparison between life on dialysis, and how I've felt
since my transplant."
FOOT CARE GUIDELINES
Curative Health Services, Inc., a wound care specialty
company, has produced an informative pamphlet about caring for
your feet. If you are facing diabetogenic circulatory damage
("progressive venous insufficiency"), or dealing with wounds or
infections on your feet, the following is good advice! As
diabetes is the leading cause of nontraumatic foot and leg
amputations, this is especially valid for us. Prevention of
complications is always a good start.
=20
Guidelines for Patients With Venous Insufficiency or Wounds
(c 1997 Curative Health Services, Inc.)
Give Your Legs a Rest
Elevate your feet above your heart while sleeping and at
regular times during the day (elevate foot of bed or mattress).
Avoid work that requires you to stand or sit with your feet on
the ground for long periods. Change positions frequently. Take
walks to help leg muscles "pump" fluid out of your legs.
Give Your Legs Support
Wear professionally made support stockings that apply
pressure from ankle to knee or other compression devices (your
doctor can help you choose the kind that is right for you and
send you to a professional who will properly measure your legs
for stocking size). Have at least two pairs of support stockings
available so you can change them daily. After laundering, hang
them up to dry. Do not put them in a dryer. Always put on
support stockings early in the morning before fluid pools in
lower legs. Wear support stockings all day and then remove in
the evening when going to sleep. Buy new stockings every 6
months so their strength doesn't wear out.
Avoid ACE bandages. It is extremely difficult to wrap them
properly to provide the pressure you need.
If your doctor has prescribed the use of a compression pump,
follow the instructions completely. It may take a little time to
adjust to the pumping procedure.
Take Care of Your Skin
Make sure to wash your lower legs and feet regularly with
mild soap and water. This will help to avoid a build-up of
lotion. Do not soak your feet. Use moisturizing creams and
emollients after washing. It is important not to use petroleum
or lanolin based creams when wearing stockings which contain
latex. Your doctor or pharmacist may suggest appropriate brands.
Be particularly careful to avoid activities that are likely
to cause injury to legs or feet. Prevention is very important.
Watch for Skin Changes
Pay particular attention to signs of progressive venous
insufficiency:
* SWELLING that does not go away quickly when you lie down.
* DISCOLORATION, especially brownish skin discoloration around
ankles and lower legs.
* DRYNESS AND/OR ITCHING in the same areas.
* ANY WOUND OR BRUISE that doesn't go away within a week.
If Your Wound Doesn't Heal in 1 Week...
Don't put off seeing your doctor. Any wound that doesn't
heal in a week should be seen by your physician. Remember you
are a vital part of your treatment program and it is essential
that you faithfully follow all medical directions. Always
consult your physician before making any change to your
healthcare routine, if you have questions or if your symptoms are
becoming worse.
Guidelines:
If you have a wound...
* KEEP IT CLEAN. Keep minor wounds clean and protected with a
bandage.
* AVOID strong antiseptics. Many antiseptics such as hydrogen
peroxide, povidone-iodine (Betadine) and sodium hypochlorite
(Dakin's solution) can damage skin and interfere with healing.
* DON'T stop wearing support stockings during your daily
activities. If it is difficult to wear them over the bandage,
put on a knee length nylon stocking first and wear the support
stocking over it.
* WATCH the wound carefully. You will need to describe any
changes to your doctor. Remember that any wound may turn into a
chronic wound and early treatment has been shown to be
beneficial.
(Pamphlet reprinted with permission. For more information,
contact Curative Health Services, Inc., 14 Research Way, Box
9052, East Setauket, NY 11733-9052; telephone: 1-800-991-4325;
website: http://www.curative.com)
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...
Espanola Rice
from Ms. Belver Ladson
of New York, NY
Ingredients:
2 tablespoons fat-free chicken broth
1 cup fat-free rice (raw)
1/4 cup chopped onion
1/2 cup sliced green pepper
2 teaspoons chili powder
1 cup crushed tomatoes
2 cups water
Instructions:
Lightly spray a large nonstick skillet with nonfat cooking
spray. Add the chicken broth. Heat over medium-high heat. Stir
in the rice and cook until the rice is lightly browned. Add the
remaining ingredients. Cover and simmer over low heat for
approximately twenty (20) to twenty-five (25) minutes until all
the liquid has been absorbed.
Makes 4 Servings (approximately 3/4 to 1 cup each). Per
Serving: 154 calories; 33 grams carbohydrates; 0 mg cholesterol;
4 grams protein; less than 1 gram of fat. Exchanges: 2
carbohydrates.
Cuban Black Beans
from Hazel Trujillo
of Miami, FL
Ingredients:
1 can black beans (15-1/2 oz.) rinsed and drained
1 small onion, chopped
1 small green pepper, chopped
1/2 cup green olives with pimentos, chopped
1/2 cup sherry or red wine
1/2 teaspoon cumin powder
1/2 teaspoon dried oregano
1 tablespoon olive oil
Instructions:
Place all ingredients in a pot. Bring to a boil. Bring
heat down to a simmer, for 10 to 15 minutes, or until onions and
peppers are soft. =20
Pour over white or brown rice. Makes six servings.
Serving Size: 1/2 cup.
Per Serving: 125 calories, 15gm carbohydrate, 4gm fat, 2gm
protein. Exchanges: 1 carbohydrate, 1 fat. (Please count 1/3
cup rice as an additional carbohydrate exchange.)
Chicken Florentine
from Boone Hospital Center
of Columbia, MO
Ingredients:
8 4-oz. boneless, chicken breast halves, skinned
1 10-oz. package frozen chopped spinach
vegetable cooking spray (like Pam)
1/2 cup diced celery
1/4 cup diced onion
1 tsp. peeled, grated gingerroot
2 cloves minced garlic=20
1 1/2 oz. crumbled bread
1/4 tsp. salt
1/8 tsp. pepper
1 egg white
4 oz. non-fat cream cheese
2 tbsp. non-fat Parmesan topping=20
1/3 cup fine bread crumbs
1/4 tsp. paprika=20
1/4 tsp. garlic powder
1 medium tomato, cut into 8 wedges (optional)
Instructions:
Place each chicken breast half between 2 sheets of heavy-
duty plastic wrap, and flatten to 1/4 inch thickness, using a
meat mallet or a rolling pin. Set aside. Place spinach between
paper towels, and squeeze until barely moist; set aside. Coat a
non-stick skillet with vegetable cooking spray, and place over
medium-high heat until hot. Add diced celery, onion, grated
ginger root and minced garlic; saute mixture until tender.=20
Remove from heat; stir in spinach, crumbled bread, salt, pepper
and egg white. Spread 1/2 oz. cream cheese (approximately 1
tbsp.) thinly on each chicken breast half. Top each with 1/4
spinach mixture and spread evenly. Roll up lengthwise, and
secure with wooden picks. Combine bread crumbs, Parmesan cheese,
paprika and garlic powder. Spray each rolled breast lightly with
cooking spray and roll in bread crumbs mixture. Place chicken
rolls on a rack coated with cooking spray; place rack in a
shallow roasting pan. Bake at 350 degrees for 35-45 minutes
until chicken is done and lightly browned. Remove wooden picks
from chicken. Garnish with tomato wedges, if desired. Makes 8
servings.
Diabetic Exchange: 3 meats (lean), 1/2 carbohydrate; Per
serving: 215 calories, 4g fat, 10g carbohydrate, 1g sat. fat,
340mg sodium, 32g protein.
CORRECTION:
Unbelievable Chocolate Kahlua Cake
from Marylin Helton
"Cinnamon Hearts" Magazine
FROM THE EDITOR: Last issue, VOICE Vol. 13, #2, we
published this recipe, as we received it. Its author just
advised us that its dietary analysis and exchanges were
incorrect, and advised us to print the following correction. The
exchanges are increased, and the serving size has been reduced.
Ingredients:
1 (18.25 oz.) Light Devil's Food Cake Mix
(such as Sweet Rewards)
1 small (1 oz.) box sugar free, instant chocolate pudding mix
1 cup nonfat vanilla yogurt
1/4 cup canola oil
1/3 cup skim milk
1 large egg + 3 large egg whites
1/3 cup Kahula liqueur (may substitute water if desired)
1/3 cup semisweet chocolate chips
Baking Cocoa (powder, sufficient to dust the pan))
Directions:
1. Preheat oven to 350F.
2. Coat a 12-inch Bundt pan with nonstick cooking spray and dust
with cocoa.
3. Place all ingredients except chocolate chips in a large bowl.
Beat with mixer for 2 minutes or until well blended. Stir in
chocolate chips.
4. Pour batter into prepared pan and bake for 50 minutes, or
until toothpick inserted in middle comes out clean. Cool before
cutting. Makes 18 servings.
Nutritional Information:
Per Serving: 205 cal; 8g fat; 31g carb; 3g protein; 13mg
cholesterol; 209mg sodium. Diabetic Exchanges: 2 bread/starch;
1 1/2 fat.
Courtesy of "Cinnamon Hearts--The Art of Living a Winning
Diabetic Lifestyle," PO Box 578340, Modesto, CA 95357-8340.
Published bi-monthly.
COOKING WITH SUZI
by Suzi Castle
Choosing to eat and cook "healthy" is a priority that will
have lifelong rewards. Set realistic goals and make the changes
in your diet that will allow you to lose weight and improve your
health. The following tips will help you to make these changes:
1. Use a food scale to weigh ingredients and food portions.
It's easy to misjudge portion sizes.
2. To become more aware of all foods eaten, it's helpful to
keep a "food diary." Better yet, write down what you intend to
eat, including sensible snacks. This will offer important
guidance when you are tempted by foods not on your diet. Such a
"food log" can help identify ways you may be sabotaging your
healthy eating plan. Learn to make your calories count for good
nutrition.
3. Take pleasure in every bite, and savor the flavor by
eating more slowly. By choosing sensible portions, you can allow
yourself to eat foods that once were "forbidden."=20
It's best not to skip meals. Try this easy-to-fix recipe
for low-fat, sugar-free Banana-Nut Muffins. They can be prepared
ahead of time for a quick, nutritious snack.
Ingredients:
3 cups unbleached flour
1 cup whole wheat flour
1 teaspoon baking soda
4 teaspoons baking powder
1/2 teaspoon each: ground cinnamon and nutmeg
1 package (3 tablespoons) Butter Buds
Sugar substitute equal to 1/4 cup brown sugar (i.e., 1/4 cup
Brown SugarTwin)
4 ripe bananas
3 eggs
2 tablespoons canola oil
1/4 cup honey (or an equivalent amount of sugar substitute --
i.e., 1/4 cup SugarTwin)
2 cups nonfat milk
2 tablespoons chopped walnuts
Instructions:
In a large mixing bowl, combine flours, baking soda and
baking powder, cinnamon, nutmeg, Butter Buds and sugar
substitute. In a blender, mix bananas, eggs, oil, honey and
milk. Pour over premixed dry ingredients. Stir only until
mixed. Add more milk if batter is too dry. Spray muffin tins
with nonstick spray (like Pam). Fill tins 2/3 full. Top with
chopped nuts. Bake in a preheated 400 degree oven for 15 to 20
minutes, or until done. Makes 24 muffins. (Serving size: One
muffin.)
Per muffin: 130 cal. (17% from fat); 4g protein; 2.5g fat
(0.39g sat.); 23.6g carbohydrate; 40mg sodium; 27mg cholesterol;
1.47g fiber. Exchanges: 1-1/2 bread, 1/2 fat.
Suzi Castle's "Deliciously Healthy Favorite Foods Cookbook"
is available now in (or can be ordered at) most bookstores or by
calling 1-800-444-2524. For an autographed copy, please send a
check or money order ($14.95 + $3.95 S&H) to Health Cookbooks,
Rt. 4, Box 208, Porterville, CA 93257.
FOOD HINT
VOICE reader Mrs. Dolores Kossak reminds us good teabags are
very expensive, and we can "spice up" the economy brands, and
vary them creatively. "Shake some powdered cinnamon into your
cup of tea," she writes, "or use Crystal Light (sugar-free, of
course)--in its different flavors."
A DONOR'S STORY
by Debbie Dupree
Photo: family portrait. Caption: Debbie Dupree, with
husband Steve, and children Daniela and Jesse.
After three years on dialysis, my brother Ed needed a
kidney; everybody in the family volunteered to donate. Our
entire family sent the required blood samples to the University
of Minnesota for testing, where the operation would take place if
one of us proved to be a compatible donor. Our parents were
ruled out because of age, so it was narrowed down to Jim (my
second brother), or myself.
Ed's doctor called me at my office to tell me I had been
chosen. My blood tissue was a good match with Ed's and if I were
willing to be the donor, he would not have to undergo the removal
of his spleen prior to the transplantation. (Editor's Note:
Splenectomies are no longer needed for transplantation.) I told
Ed's doctor that he could count on me.
A battery of tests was needed to determine my good health
and the compatibility of our kidneys. Our kidneys turned out to
be a perfect "four antigen" match! The University of Missouri
Hospital did the pretesting. They were very cooperative, working
with and around my own work schedule. Since my sick leave was
limited, I had the testing done as an outpatient.
I was fortunate that my work was within walking distance of
the clinic, and that my supervisor was extremely understanding
and cooperative. I'd like to say here how much I appreciate the
thoughtfulness and consideration my employers showed me at that
time. I worked with the Missouri Department of Mental Health,
and everyone was concerned about me, and worked with me to make
the organ transplant possible. They helped me obtain the
necessary leave time, and were very supportive.
The tests, neither complicated nor painful, consisted mostly
of bloodwork, urine tests, and a few x-rays. I spent about 12 to
16 hours as an outpatient. My husband's employers, considerate
and understanding, allowed him to take as much time off as was
necessary.
In May 1983, the time finally came for us to make the
500-mile trip to Minnesota. We were impressed when we got there.
Minneapolis and St. Paul are beautiful cities and the University
Hospital (now Fairview University Medical Center) is huge, but
the staff was warm and friendly. They did everything they could
to make us comfortable.
All of my test results had been sent to Minneapolis, but
there was one more test needed--the angiogram to determine which
of my kidneys they would use. I must say this was the most
painful test of them all. But, praise the Lord, it didn't last
long.
Then it was discovered that Ed's white blood count was too
low for surgery, and I was released from the hospital. We all
returned home to wait. It seemed like a long wait because I had
been ready and anxious to get the transplant over. It must have
seemed even longer for my brother.
Three months later, in August, we were ready to go again.
This time my son, who was ten years old at the time, was out of
school and went with us. My daughter, seven, stayed with her
granddad while we were gone.
We were admitted into the University of Minnesota Transplant
Center and the routine preparation was done. I felt very
relieved that everything was ready and that the next morning
would be the big day. It's difficult to express how I felt the
night before surgery. I don't like being in hospitals, and the
idea of being cut on didn't thrill me. I thought of my brother--
it would be harder for him because he was not healthy. I had
concerns about the success of the transplant, and I worried about
how my brother would feel if the kidney didn't "take." But,
success or failure, Ed deserved the chance. I had faith that God
was with us in this, and that He was in control. My family,
friends, and many church congregations had been praying, and
continued to pray, for the complete success of the transplant and
for God's peace to be with us. That night I felt the peace of
God and was ready for the next day.
We were in surgery for four to five hours. I don't remember
much of that first day, except waking now and then and seeing
that my family was there. As I gained consciousness, I felt the
pain from the incision and the muscles around it. I discovered
muscles I had never been aware of before. It was agony to move
and especially to cough or sneeze.
The doctor told me I'd be in the hospital seven to ten days
after the surgery, but I recovered quickly and was released after
only four days.
The drive home from Minnesota stands out in my memory as one
of the roughest parts of the entire ordeal. I had four pillows
surrounding me in the car to help cushion me from the bumps and
jolts, but it was an exhausting trip to say the least.
I felt like an invalid for the first week at home. I
couldn't lift over ten pounds, I could barely get out of a chair
by myself, and I couldn't get out of bed by myself. Our waterbed
created quite a problem. Since there is nothing solid on a
waterbed to push or pull on, I found myself marooned in bed more
than once. One time I was stuck in bed half a day until someone
came home to rescue me!
Gradually, faster than I had expected, I was able to get
around and do for myself. I could have gone back to work four
weeks after the transplant but didn't until after six weeks, at
which time the only physical evidence of the transplant was a
numbness around the incision site. =20
There have been no problems since. Now, after almost 15
years, I'm feeling just fine. I just never think about it. My
one remaining kidney does perfectly well.
If you are in need of a kidney and there is a possibility to
receive one from a living related donor, don't be afraid to ask.
If you are related to someone in need of a kidney and you have
two healthy ones of your own, don't be afraid to offer this gift
of life. It is not traumatic. The time and discomfort involved
are minimal compared to the physical and spiritual lift
experienced by donor and recipient.
I honestly do not miss the kidney I gave away. Neither my
life nor my health has been changed, but my brother's has.
Because of a kidney that I didn't need and don't miss, he is a
productive person again.
Postscript from Ed Bryant:
I have felt great ever since having a kidney transplant. I
would be remiss if I did not use this opportunity to say I will
be eternally grateful to my sister. I simply want to convey the
feeling of love I have for her. I strongly recommend that all
people with renal failure consider a kidney transplant. The
National Kidney Foundation is correct when they say the kidney is
the "Gift of Life."
As Debbie has already stated, neither her life nor her
health has changed since her generous gift to me, except that on
March 3, 1986, she gave birth to Daniela Ann Dupree, a beautiful,
healthy baby, 20 inches long and weighing in at 6 lbs., 14 oz.;
and on October 10, 1989, to Jesse Aaron Dupree, 19-1/2 inches
long, 7 lbs., 5 oz.
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.
ROTATING INJECTION SITES
If you inject insulin, you know that the abdomen, as an
injection site, provides consistent and rapid absorption. It is
considered the BEST place to inject, but there can be a problem
with soreness after injection. It is necessary to inject into
different parts of the abdomen, to "rotate sites." Ann Williams,
RN, MSN, CDE, herself an insulin-using diabetic, shares her
system:
"I draw an imaginary line horizontally across my abdomen,
through my navel. Then I draw another imaginary line vertically
through the navel, and two lines vertically down the middle of
each of the resulting rectangles. Now I have eight smallish
rectangular areas defined on my abdomen. I use the upper far
right area for Monday, the lower far right area for Tuesday, the
upper center-right for Wednesday, etc. Within each rectangle, I
use the upper right corner for the breakfast injection, lower
right for lunch, upper left for supper, and lower left for
bedtime. Any necessary extra injections go either into the
center of that day's rectangle, or into the eighth rectangle.
By using this system, each spot gets injected only once
every seven days. Voila! Rapid, consistent absorption, and no
abdominal soreness."
NEW ORAL DIABETES MEDICATION
For several decades, the primary medications for type 2
diabetes have been the sulfonylureas, a class of antidiabetic
agents that stimulate the further release of pancreatic insulin.
There are other oral medications, such as acarbose and metformin,
but they have been seen as adjuncts to the sulfonylureas, where
the type 2 diabetes was well established.
That has now changed. Prandin (Repaglinide), from Novo
Nordisk Pharmaceuticals Inc., received its approval from the U.S.
Food and Drug Administration in December of 1997.
A completely new chemical formulation, Prandin resembles the
sulfonylureas in its mechanism of action, in that it stimulates
the release of pancreatic insulin, improving blood sugar control
(and is of no use in type 1 diabetes). But it differs from the
sulfonylureas in several ways:
* Prandin is short-acting, with quick onset and fast
excretion; allowing more freedom in the timing of meals
(dosages can be taken 0 to 30 minutes before mealtime).
* Unlike the sulfonylureas, Prandin is excreted via the liver.
Individuals with renal insufficiency (kidney disease) should
use caution ("dosage for each patient should be
individualized, to achieve optimal clinical response" says
the manufacturer), but even ESRD, end stage renal disease,
is not a contraindication for Prandin.
* Individuals with hepatic (liver) impairment should proceed
with caution, and with longer intervals between dosages, as
the drug will take longer to clear the body.
Time will tell if Prandin will make us rewrite the textbooks
on type 2 diabetes, but the early data are promising. For more
information about Prandin, have your doctor contact Novo Nordisk
Pharmaceuticals Inc., 100 Overlook Center, Suite 200, Princeton,
NJ 08540-7810; telephone: 1-800-727-6500.
COLOR TESTER
We have been asked to announce: ColorTest is a new hand-
held device capable of distinguishing between up to 150 different
nuances of color. It reports its findings in a clear human
voice. If you are blind, or color-blind, this device can aid
your independence, by: Helping you choose and select a wardrobe,
distinguishing between packages, or computer disks, by color, or
even distinguishing ripe from unripe fruit. The device also
reports intensity of brightness, natural vs artificial light, and
light source. ColorTest (item # 1-03950-00) is priced at $595,
available from American Printing House for the Blind (APH), 1839
Frankfort Avenue, Louisville, KY 40206-0085; telephone: 1-800-
223-1839; website: http://www.aph.org
MEDICATED HUMOR
(compiled by Richard Lederer)
It is ironic that the humor in hospitals, emergency rooms,
and doctors' offices--usually some of the scariest places--can be
exceedingly hilarious. The giddy ghost of Mrs. Malaprop haunts
medical halls and application forms, where we discover all manner
of strange conditions, such as swollen asteroids (adenoids), an
erection (anorexia) nervosa, shudders (shingles!), and migrating
headaches. All the malappropriate terms in this chapter were
miscreated by anxious patients or hassled doctors and nurses.
A man went to his eye doctor, who told him he had a case of
myopera and would have to wear contract lenses. That was a lot
better than his friend who had had a cadillac removed from his
eye. Still, when he worked at his computer, he would have to
watch out for harbor tunnel syndrome. He worried that his
authoritis of the joints might be a signal of Old Timer's disease
and fretted that a genital heart defect was causing trouble with
his duodemon (duodenum).
Another man was in the hospital passing gull stones from his
bladder while the doctor was treating a cracked dish from his
spine. After the operation, his glands were completely
prostrated. A hyannis hernia, hanging hammeroids, inflammation
of the strocum, and a blockage of his large intesticle could have
rendered him impudent.
It was enough to give a body heart populations, high
pretension, a peppery ulcer, and postmortem depression--even a
cerebral hemorrhoid. But at least that's better than a case of
headlights (head lice), sea roses of the liver, cereal palsy, or
sick as hell anemia. Any of these could cause one to slip into a
comma.
A woman experienced itching of the virginia during
administration, which led to pulps all up her virginal area and
they had to void her reproductions. This was followed by a
tubular litigation and, ultimately, mental pause. Mental pause
can cause one to become a maniac depressive and act like a
cyclopath.
She didn't worry about her very close veins, but she thought
that a mammy-o-gram and Pabst smear might show if she had swollen
nymph glands and fireballs of the eucharist. That's "fibroids of
the uterus," and it's something you can't cure with simple
acnepuncture, Heineken Maneuver, or a bare minimum (barium)
enema. Apparently, evasive surgery would be required.
Afterwards, she would recuperate in expensive care.
(Richard Lederer is the author of a number of books,
including "Anguished English" and "Fractured English." Reprinted
with permission.)
NEW DIVISION
The National Federation of the Blind of New Mexico proudly
announces the formation of a new Diabetics Division. Led by the
capable Patrick Johnson, the new division, known as the Diabetics
Organization of New Mexico, should be a valuable resource for the
diabetics of New Mexico and their families. Its board includes:
Patrick Johnson (from Farmington), President; Helen Bakais (from
Las Cruces), Vice President; and Connie Lundstrum (from
Albuquerque), Secretary-Treasurer. Congratulations to the
founding members of the Diabetics Organization of New Mexico, our
newest NFB state division!
NEW LOW-CALORIE SWEETENER
McNeil Specialty Products Company, a subsidiary of Johnson
and Johnson, has received approval to market Sucralose, a new
low-calorie sweetener derived from sugar. Created by British
researchers in 1976, the sweetener has been subjected to more
than 100 scientific studies, and has been widely available in
Europe since 1991. It has no calories, and does not promote
tooth decay, but, unlike some current alternative sweeteners,
works equally well in hot or cold foods.
For more information about sucralose, telephone: 1-800-777-
5363.=20
HEALTH INFORMATION ONLINE
The Combined Health Information Database, or CHID, is a
bibliographic database of more than 101,000 items, including
teaching guides, audio and video tapes, booklets, fact sheets,
newsletter articles, book chapters, and posters. CHID provides
information about health education programs, professional health
associations, patient support groups, policy documents, and
consensus statements. Each listing includes availability
information.
CHID does not duplicate "mainstream" lists such as MEDLINE,
but concentrates on items that would not otherwise be indexed.
Materials in Spanish, materials produced by patient advocacy
groups, materials for people with limited literacy, and materials
for children, are all found in CHID. Find CHID online at:
REZULIN UPDATE
A recent study of insulin-using type 2 diabetics (those
whose diet-and-exercise or oral medication regimes have proved
insufficient) confirmed the efficacy of Rezulin (troglitazone) in
reducing the insulin resistance that is the primary
characteristic of type 2 diabetes. Even though these patients
are injecting insulin, the tests proved Rezulin therapy offered
benefits. =20
The study, carried out at the Diabetes and Glandular Disease
Clinic in San Antonio, Texas, looked at 350 patients, of which
116 received 200 or 600mg per day of Rezulin; 118 received
placebo. =20
Rezulin is a very new medication, and new applications are
being discovered almost by the week. Talk to your doctor, and
stay tuned for the latest information--as last week's information
could soon be out of date.=20
FREE INFORMATION
The National Diabetes Information Clearinghouse (NDIC) is a
service of the National Institute of Diabetes and Digestive and
Kidney diseases (NIDDK), part of the National Institutes of
Health, a U.S. Government Agency. The clearinghouse, established
in 1978, provides information about diabetes to diabetics and
their families, professionals and the public. The NDIC produces
some materials on its own, and carries other materials it has
found accurate and accessible to the public.
Some of the NDIC's publications are only available to health
professionals, but most are free to the public in single copy
(additional copies available at cost). There are "Fact Sheets,"
booklets, "Information Packets" (some in Spanish, others
formatted "Easy Reading"), and special packets like "Feet Can
Last A Lifetime" (which contains the special monofilament sensory
tester used to detect neuropathy). The NDIC even publishes the
quarterly bulletin "Diabetes Dateline."
The NDIC has a catalog, "Professional and Patient Education
Publications," which you may obtain by contacting: National
Diabetes Information Clearinghouse, 1 Information Way, Bethesda,
MD 20892-3560; telephone: (301) 654-3327. Reach them online at:
CATALOGS ON TAPE
We've been asked to announce: Do you need product catalogs
in alternative format? Home Readers offers many different
product catalogs on audiocassette, like the Radio Shack catalog
($7). For a list and prices, contact: Home Readers, 604 West
Hulett, Edgerton, KS 66021; telephone: (913) 893-6939; website:
NEW METER ON THE WAY
German manufacturer Boehringer Mannheim is in the process of
testing an unusual new blood glucose monitor. It clips to the
belt like an insulin pump, and connects to the body through a
catheter. It provides continuous readings, and stores readings
by the hour and day. Alarms warn the user of excessive high or
low readings. Presently in clinicals, this product, the Komo
System, is not expected to reach market before the year 2000.
Its price is unknown. Stay tuned for further information.
=20
VETERANS MAGAZINE
The "Talking American Legion Magazine" is available free of
charge to all blinded veterans. Each month, the magazine covers
most of the topics found in the print edition of "American Legion
Magazine."
The audiocassette version is formatted 15/16 IPS (NLS
format), and you do not have to be a member of the American
Legion to receive it. For more information, or to subscribe,
telephone Lane Cameron at: (317) 630-1272.
INSULIN MIXING CAUTION
Insulin manufacturer Eli Lilly and Company reports that
mixing of "buffered" intermediate-duration insulins such as NPH
with long-acting insulins such as Lente or Ultralente can have an
unexpected consequence! The phosphate "buffer" in the NPH
precipitates the zinc additive out of the longer-acting insulin,
converting it to a "regular type" insulin. This can, of course,
do radical and unexpected things to your control. Talk to your
doctor about insulin mixing. Further information is available
from your pharmacist, or from Eli Lilly's website:
FOR SALE
Karen Mahone-Smith, from Sacramento, CA, is willing to make
crocheted items for you. What do you need? Part of the proceeds
will go to benefit the National Federation of the Blind. Contact
her: Karen Mahone-Smith, 4433 7th Avenue, Sacramento, CA 95820.
FDA RECALL NOTICE
On March 27, The U.S. Food and Drug Administration (FDA)
warned kidney dialysis patients that an adapter for certain
catheters could break apart, putting them at risk of serious
bleeding. FDA reported eight cases of breakage, three resulting
in death. The device in question, MEDCOMP'S TESIO EXTENSION
ADAPTER, was sold between October 1997 and February 1998, in 11
states and 9 foreign countries. In the U.S., the device was
distributed in California, Florida, Michigan, Minnesota,
Missouri, New Jersey, Tennessee, Texas, Utah, Virginia, and
Washington (state).
If you are a hemodialysis patient, with two separate, in-
dwelling, single-lumen catheters, you should closely examine the
fitting. "If the adapter has little wings, like a little wing-
nut, there is no risk," says Dr. Bruce Burlington, FDA medical
device chief.
Any patient whose catheter has a knob-shaped adapter, or who
does not know what kind he or she has, should immediately contact
his hospital or dialysis center. This FDA recall has been
upgraded to highest priority.
VOICE FORMATS
VOICE OF THE DIABETIC is offered in two formats: standard
print, and 15/16 IPS audiocassette ("talking book" speed).
Anyone who is currently receiving the VOICE in print and having
difficulty reading it, may receive it on cassette at no charge.
VOICE tapes require the special tape player available free to the
legally blind from Regional Libraries for the Blind and
Physically Handicapped, which can be obtained by telephoning the
National Library Service at: 1-800-424-8567.
Periodically we receive requests for the VOICE in Braille or
large print. It is not available in either of those formats at
this time.
LIFESCAN SURESTEP NOTES
LifeScan, Inc., maker of the SureStep blood glucose monitor,
will replace (free of charge) any of these meters manufactured
before August 1997 (serial number #L7205** or lower). If you
have one of these early models (or if you are not sure your
SureStep is affected), please call LifeScan; telephone: 1-800-
951-7226.
It seems that people with very high readings, using the
early SureStep, could encounter incorrect screen messages. If
your blood sugars are very high (500mg/dL or above), the meter
may give, instead of a true reading, an "error 1" message --
suggesting you had incorrectly conducted the test. LifeScan's
newer SureStep has improved package instructions, and altered
software, so such a high reading will not trigger an error
message. For more information, or to see if YOUR SureStep meter
is affected by this warning, contact: LifeScan, Inc., 1000
Gibraltar Drive, Milpitas, CA 95035-6312; telephone: 1-800-227-
8862, or use the "hot line" listed above.
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 side effects? Your unique
insight, coping strategies, and lifestyle can still inspire
others. Are you a relative, a friend, or a health professional?
More than 230,115 VOICE readers could benefit from your story.
For information and article submission guidelines, contact:
VOICE OF THE DIABETIC, 811 Cherry St., Suite 309, Columbia, MO
65201; telephone: (573) 875-8911.
MY KIDNEY TRANSPLANT UPDATE
by Ed Bryant
Photo: portrait. Caption: Ed Bryant
Artwork: Blind man walking with a briefcase and cane (located at
the end of the article).
My cross to bear in life is diabetes. I found out how
insidious the disease can be in 1978, when my physician told me I
was undergoing renal failure, "End Stage Renal Disease (ESRD)"
and that soon, when my kidneys could no longer filter waste from
my system, I would have to go on dialysis.
I began dialyzing in December of 1979. My treatments were
three times a week, and each lasted about four hours. I
continued this regimen for the next 3 1/2 years. I was a lucky
diabetic at first. I usually felt great after dialyzing, and
unlike many, could continue my normal daily activities. I
traveled quite a bit during this period, and dialyzed at centers
in other communities. I found that many dialysis patients felt
nauseated and weak after treatments, requiring the remainder of
the day to regain their strength.
After about three years on hemodialysis, my luck started to
run out; I began to feel ill. I lost weight and had a constant
pale look. I was not doing well at all. The somewhat gentler
alternative forms of dialysis, continuous ambulatory peritoneal
dialysis (CAPD) and continuous cycling peritoneal dialysis
(CCPD), were in their early stages, and were not often presented
to diabetics as available options.
When I attended the 1982 convention of the National
Federation of the Blind, I heard a presentation by Dr. John
Najarian, Chief of Surgery at the University of Minnesota
Hospital in Minneapolis. He covered the topic of kidney
transplantation in diabetic patients. Hearing Dr. Najarian
speak, I was inspired; was this an alternative for me? I knew I
needed more information before I could consider transplantation
as an alternative to the dialysis treatments that were causing my
health to fail.
My research supported the viability of transplantation. I
found that the life expectancy of kidney transplant recipients is
significantly longer than that of diabetic dialysis patients.
Although some individuals might not qualify for a transplant
because of other physical factors, I was lucky--the doctor
considered me an ideal candidate. I weighed the evidence,
considered the odds, and decided to "go for it."
For a number of reasons, I chose the University of Minnesota
Hospital (now Fairview University Medical Center) for my
transplant surgery. Although there are more than 239 transplant
centers in the United States, the University of Minnesota
pioneered transplantation for diabetic kidney patients. To date,
they have performed more than 4,000 kidney transplants, and they
do an average of 200 per year. Their success rate is above the
national average.
The transplant center offers an information packet,
explaining kidney transplants, to interested consumers who call
them toll-free at 1-800-328-5465. Upon entering the hospital,
patients are provided a manual explaining transplantation before,
during, and after surgery. Blind patients may receive this
manual on audiocassette.
My sister, Debbie, volunteered to donate one of her kidneys
to me. I will be eternally grateful for this generous act of
love. It is a wonderful gift and my feelings for this act are
indescribable.
My first step was to start taking the immunosuppressive drug
Imuran, which would protect my new kidney against my body's
efforts to reject it. But something went wrong, and on the day I
checked into the hospital to prepare for the transplant, the
doctors found the drug had caused my white blood cell count to
fall to a dangerously low level. Surgery was postponed until my
body could replenish its white blood cells. The Imuran was
stopped, and I went back home.
While waiting for my white blood cell count to rise, I
learned about a new immunosuppressive drug called Cyclosporine.
The Food and Drug Administration (FDA) had not yet officially
approved Cyclosporine, but it was being tested at various
transplant centers, and the results to that point had been
extremely positive. The "kidney survival" (non-rejection) rate
greatly exceeded that of any other drug of its type.
Two months later, in August of 1983, my white blood cell
count finally returned to a normal level. When I returned to the
transplant center, I asked the doctors if I could be a "guinea
pig" in the Cyclosporine tests. The surgeons told me I could,
and that they foresaw no problems with the revolutionary new
drug.
A new kidney, like mine, is placed in the lower abdomen,
where it is best protected. Kidney recipients receive only one
kidney, which is all that is needed to handle bodily functions.
A newly transplanted kidney will grow or diminish in size as
needed to best serve the body into which it is placed.
I received my new kidney on August 9, 1983. My surgery went
very well. I was amazed and pleased at how quickly I recovered
and how minimal the discomforts and complications were. Because
I experienced no rejection episodes, I was able to leave the
hospital after only eight days. Some recipients have "rejection
episodes," and although they probably won't lose the kidney, they
take longer to stabilize and heal. I was lucky.
Like all other transplant recipients, I was placed on
immunosuppressive therapy, which I will continue for life. My
first prescriptions were Cyclosporine (now FDA-approved) and the
steroid Prednisone. Several months later, the hospital began
"triple therapy," yet another University of Minnesota innovation,
a mixed-dose regimen of Cyclosporine, Prednisone, and Imuran. I
continue this same triple therapy today.
My transplant made a tremendous difference in my quality of
life. Almost immediately I felt more energetic, no longer tired
and drained as I was on dialysis. My spirits were high, my
mental processes sharp, and I was ready and able to handle a busy
schedule. Today, almost 15 years later, my transplanted kidney
is doing fine, and I remain as active as ever.
I strongly endorse kidney transplantation. I am a living
example of the improved quality of life after a transplant. I
say "go for it!" Check out the possibilities and get answers to
all your questions before you make a decision. Ask different
doctors. Talk to someone who's had a transplant. Consult a
transplant center or a transplant surgeon. Your nephrologist
should be able to help. Your quality of life, and in fact your
life, may hang in the balance.
I hope my experiences will provide you with food for
thought. If you have any questions, please feel free to contact
me at the VOICE editorial office.
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 EQUIPMENT
Medicool, Inc., maker of insulated diabetes syringe cases,
now features other equipment, like the Wright Prefilled Syringe
Case ($15.95 for two), the Nail Care Plus electric nail file
($39.95), and its own line of medical ID jewelry. For
information about these and other products, contact: Medicool,
Inc., 23520 Telo Avenue, #6, Torrance, CA 90505; telephone: 1-
800-433-2469; website: http://www.medicool.com
ADAPTIVE EQUIPMENT
Independent Living Aids, Inc., is an adaptive equipment
distributor, with years of experience serving blind people and
those losing vision. If you need tactile items, items that talk
(like watches, clocks, diaries, or timers), or other equipment,
give them a look! Their catalog is free, and is available on
audiocassette and in standard print. Contact: Independent
Living Aids, Inc., 27 East Mall, Plainview, NY 11803-4404;
telephone: 1-800-537-2118; fax: (516) 752-3135; e-mail:
[email protected]; website: http://www.independentliving.com
DIABETES SUPPLIES
Tropical Medical Supply, located in Florida, offers diabetes
supplies, direct shipping, fast service, and handles your
Medicare, Medicaid, and insurance paperwork. No waiting in line,
and, if you have supplemental insurance, you may pay nothing.
For more information, call: 1-800-611-2115.
THE WOUND CARE CENTER
One of the consequences of diabetes is the tendency toward
impaired healing of wounds and lesions, especially those in the
feet. This is of course why many diabetics require amputations.
If you suffer a wound or lesion, and it is not healing
properly under normal medical care, there are clinics
specializing in the healing of such wounds. In these places you
will find top specialists and the latest resources.
Curative Health Services runs The Wound Care Center, a
national network of state-of-the-art wound clinics. If you have
a stubborn, non-healing wound, and the alternative is amputation,
have your doctor contact The Wound Care Center at: 1-800-991-
4325, or call them yourself.
DIABETIC SUPPLIES
Diabetics Wholesale Club, Inc., carries a full line of
diabetes supplies, takes care of your paperwork, accepts
Medicare, Medicaid, and most private insurance, and ships to your
door. They also have a full service pharmacy, carry many
specialty and hard-to-find items, and publish their own free
newsletter, the "Sugar Free News." For information, call them
at: 1-800-925-8299.
SKIN CREAM
If you regularly test your blood glucose, you puncture the
skin of a finger with a lancet, once each test. This can lead to
sore, cracked, or callused fingers. Formulated for Fingers Skin
Cream is designed to moisturize and soothe sore fingers. Its
active ingredient is Australian Tea Tree Oil, used around the
world to soothe the skin. For more information about Formulated
for Fingers, or its many other diabetes care products, contact
Can-Am Care, Inc., 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 with no further cost.=20
For information contact: American Diabetic Supply, Inc., 400 S.
Atlantic Ave., Suite 108, Ormond Beach, FL 32176; telephone: 1-
800-453-9033.
TALKING COMPUTERS
Henter-Joyce, Inc., maker of the "JAWS" series of computer
screen readers, offers screen-to-speech software including "JAWS
For WINDOWS" (JFW 3.0), now capable of reading WINDOWS 95. The
company also produces "JAWS for WINDOWS NT," and software for the
DECtalk speech synthesizer. 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-
1805; telephone: 1-800-336-5658 or (813) 803-8000; fax: (813)
803-8001; email: [email protected]
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 RSG glucose monitor just for signing up!
Contact: Heritage Diabetic Supply, PO Box 1270, Marion, NC
28752; telephone: 1-800-267-6509.
EQUIPMENT AND SUPPLIES
Comprehensive Health Services, Inc., offers a customer
direct diabetic supply program. They stock glucose monitors for
the sighted and visually impaired, test strips, syringes, and
other diabetic products. Medicare and private insurance
accepted; free and convenient home delivery; 24-hour toll-free
telephone; training and emergency customer support. Guaranteed
full refund on supplies returned within 30 days of purchase. To
qualifying customers, no "out of pocket" cost for diabetes
supplies; no insurance paperwork to fill out.
For information, call: 1-800-795-6167, or contact:
Comprehensive Health Services, 221 N. Front St., Suite 203,
Wilmington, NC 28401.
TALKING LIFESCAN PROFILE
Myna Corporation, maker of the Voice Touch speech
synthesizer for the LifeScan One Touch II glucose monitor,
announces the Voice Touch Pro speech synthesizer for the One
Touch Profile. The Pro attaches firmly to the base of the
LifeScan monitor, and works entirely through the meter's
controls.
Purchasers may order the Voice Touch Pro with male or female
voice, and English- or Spanish-language speech. Myna Corporation
offers a three-month warranty, with optional one-year warranty
extension. The unit is priced at $189 (9-volt alkaline battery
included). An AC adapter is available for $15 additional, and a
carrying case for another $15. Myna Corporation also offers a
talking laptop computer, the Myna. For information, contact:=20
Myna Corporation, 239 Western Avenue, Essex, MA 01929; telephone:
(978) 768-9000; fax: (978) 768-9911; e-mail: [email protected]
NUTRITION SUPPLEMENT
Your insulin or oral diabetes medications are only part of
your diabetes self-management. Although food supplements do not
replace your medications, a healthy diet is important, and
research is continuing on the role specific supplements may play
in controlling diabetes. Focused Nutritional Therapy is a
dietary supplement formulated for the special needs of diabetics.
A blend of vitamins, antioxidants, and minerals, it is available
in sugar-free caplets (and soon in chewable tablets), cost:
$12.95 for one month's supply. Contact: Quadro Therapeutics,
Inc., 315 S. Allen Street, Suite 126, State College, PA 16801;
telephone: 1-800-347-0308.
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 starting July 1 that list will cover 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
NEW DIABETES BOOK AVAILABLE
"Serving Individuals with Diabetes Who Are Blind or Visually
Impaired: A Resource Guide for Vocational Rehabilitation
Counselors" is the new diabetes and blindness reference produced
by the National Federation of the Blind, in collaboration with
the Rehabilitation Research and Training Center on Blindness and
Low Vision at Mississippi State University. Though written for
rehabilitation professionals and their clients, it contains much
material of use to both diabetics and health professionals.
The book is available in large print, Braille, normal-speed
audiocassette tape, and IBM-compatible computer disk, and costs
$25. Order from: Kelly Schaefer, R.R.T.C., PO Drawer 6189,
Mississippi State, MS 39762; telephone: (601) 325-1363.
DIABETES ADVICE
Regular VOICE contributor Peter J. Nebergall, PhD, has
written a book for the inquiring diabetic. Based on the
questions most asked at diabetes support groups, =FEStraight Talk
About Diabetes=FE is plain, simple, upbeat, and unvarnished
diabetes education. Many of its chapters have already appeared
here in VOICE OF THE DIABETIC. Available in large print,
audiocassette, or IBM-compatible ASCII 3.5" computer disk; cost
$15. Order from: Peter J. Nebergall, 307 East Ash #36,
Columbia, MO 65201; e-mail: [email protected].
MATERIALS IN ACCESSIBLE FORMAT
If you have need of reading materials in alternative format
(large print, Braille, or audiocassette), check out the
following:
* The 1995 edition of the ADA/ADA publication "Exchange Lists
for Meal Planning" is available in Braille and on
audiocassette. To order, contact: National Federation of
the Blind, Materials Center, 1800 Johnson Street, Baltimore,
MD 21230; telephone: (410) 659-9314. They are open 12:30
to 5 p.m., EST, weekdays. Cost: Braille $10, cassette $2.
* Job Opportunities for the Blind (JOB), part of the National
Federation of the Blind, publishes a free job-hunter's
magazine on cassette (the JOB RECORDED BULLETIN, published
six times a year); telephone: 1-800-638-7518, or contact
them at the NFB address (immediately above).
* VOICE OF THE DIABETIC is the free quarterly diabetes
magazine published by: Diabetes Action Network, National
Federation of the Blind, 811 Cherry Street, Suite 309,
Columbia, MO 65201; telephone: (573) 875-8911. Available
in standard print or 15/16 ips audiocassette. You can also
access the VOICE (current and past issues) on the World Wide
Web, at http://www.nfb.org/voice.htm. See page 23 of this
issue for a subscription form.
* "Diabetes Resources: Equipment, Services, and Information,"
the resource guide published by the Diabetes Action Network,
costs $5 per copy and is available in Braille, large print,
and audiocassette, from the NFB Materials Center, 1800
Johnson Street, Baltimore, MD 21230; telephone: (410) 659-
9314. You can also access this resource guide on the World
Wide Web, at: http://www.nfb.org, following the link for
"diabetes" from the NFB home page.
* The National Library Service for the Blind and Physically
Handicapped, Library of Congress; telephone: 1-800-424-
8567. The National Library Service (NLS) has the specific
mission of ensuring free access to published materials, for
individuals unable to read print. Through its network of
Regional Libraries for the Blind and Physically Handicapped,
the NLS circulates materials in Braille, "talking book
record" (an old format now being phased out), and 15/16 ips
audiocassette. The NLS also supervises the free
distribution of special tape players, available to any
individual certified legally blind or otherwise unable to
read print. Pertinent sections of their catalog regarding
diabetes include: "Guides for Living," "Cooking and
Nutrition," "Personal Narratives," "Juvenile," and other
sources (a listing of magazines and organizations).
* Vision Foundation, Inc., 818 Mt. Auburn Street, Watertown,
MA 02174; telephone: (617) 926-4232. The Vision Foundation
is a self-help group for adults coping with sight loss. It
offers information and resources relevant to all types of
blindness. Its "Vision Resource List" is available in
large print and audiocassette, free of charge.
* The Center for the Partially Sighted, 720 Wilshire Blvd.,
Suite 200, Santa Monica, CA 90401-1713, ATTN: Helena
Jefferson; telephone: (310) 458-3501. The Center
publishes: "Large Print Recipes for a Healthy Life"
($19.95). This title is also available, on audiocassette,
from: The Braille Institute, Recording Department, 741 N.
Vermont Avenue, Los Angeles, CA 90020; telephone: (213)
663-1111, ext. 265.
* "The EQUAL Cookbook": EQUAL Consumer Affairs, Box 830,
Deerfield, IL 60015; telephone: 1-800-323-5316. Available
free, on audiocassette, large print, or Braille, this
cookbook contains recipes assembled with NutraSweet instead
of sugar. All recipes include diabetic food exchanges.
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 13, Number 3, Summer Edition 1998.
E-mail address:
Edited July 21, 1998
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