Food For Thought

Food For Thought

FOOD FOR THOUGHT

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.
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: http://chid.nih.gov
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.
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.
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.
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: http://www.niddk.nih.gov/

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: http://qni.com/~homeread
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.
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: http://www.lilly.com/diabetes

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.