VOICE OF THE DIABETIC
The Diabetes Action Network of the National Federation of the
Blind
Diabetes Support and Information
Volume 19, Number 4, Fall Edition 2004
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VOICE OF THE DIABETIC, published quarterly, is the national magazine of the Diabetes Action Network of the National Federation of the Blind. It is read by those interested in all aspects of blindness and diabetes. We show diabetics that they have options regardless of the ramifications they may have had. We have a positive philosophy and know that positive attitudes are contagious!
News items, change of address notices, and other magazine correspondence should be sent to: Ed Bryant, Editor, VOICE OF THE DIABETIC, 1412 I-70 Drive SW, Suite C, Columbia, Missouri 65203; Phone: (573) 875-8911; Fax: (573) 875-8902.
Find us on the World Wide Web at: (www.nfb.org) Our direct Web address is: (www.NFB.org/voice.htm)
Copyright (c) 2004 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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FREE! FREE!
VOICE OF THE DIABETIC is offered absolutely free to any interested person upon request. Readers may receive the publication in standard print, on audio cassette for the blind, or in both formats. To begin receiving the VOICE, please complete the subscription form (or a facsimile), found at the end, and mail it to the editorial office.
Please Note: We have a special bulk-mailing permit that we use to ship the
VOICE to you at low cost - it does not allow for free re-mailing. The Post Office
requires you place first class postage on any VOICE you mail to others.
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Here's the new front cover page for the VOICE.
Includes photo of Della Reese with following overprinted on the photo: Della Reese Says "Change Your Mind!"
WHAT YOU SHOULD KNOW BEFORE JOINING A RESEARCH STUDY
DIABETES: WHERE WE ARE TODAY, WHERE WE WILL BE TOMORROW
CDC's Dr. Frank Vinicor Gives Us the Latest
WHERE'S THE SUGARTRAC?
New Noninvasive Talking Glucose Monitor Goes to the FDA
SORE FINGERS: HOW TO PREVENT AND TREAT THEM
Ann Williams, RN, MSN, CDE, Tells Us the Right Way to Test
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ADVERTISERS
Effective advertising doesn't scream at its audience. It persuades. It sells. The key to cost-effective advertising is making your voice heard where an audience is already listening. VOICE OF THE DIABETIC, circulation 336,050, offers such an outlet. Make your voice heard. For VOICE OF THE DIABETIC advertising information contact:
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For SUBSCRIPTION information, see the end of this document.
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INSIDE THIS ISSUE
CHANGE YOUR MIND: DELLA REESE TALKS ABOUT DIABETES
by Ed Bryant .....
WHERE'S THE SUGARTRAC?
by Ed Bryant .....
SORE FINGERS: HOW TO PREVENT AND TREAT THEM
by Ann S. Williams, MSN RN CDE ..
FIGHTING BACK
by Dan Wingo ...
NEW INVESTIGATIONAL HEART MEDICATION .....
WHAT YOU SHOULD KNOW BEFORE JOINING A RESEARCH STUDY
by Lisa Pacitto .....
DIABETES AND IMMUNOSUPPRESSION, A NEW DEVELOPMENT .....
NONCOMPLIANCE: AN ENDURING ISSUE
by Peter J. Nebergall, PhD
MY LIFE AS A DIABETIC
by Patricia Wolfe .....
UK STEM CELL RESEARCH RECEIVES LICENSE .....
LETTERS TO THE EDITOR ...
DREAM BIG, DIVE DEEP
by Ed Bryant .....
MANAGING LIFE'S STRESSES
by Sally York .....
MEDICATION MIX-UP ...
THE TIM COX STORY
by Bette Cox ....
FLORIDA MAN HAS VISION OF HIS OWN ROLE IN SOCIETY
by Jay Arrington .....
THE MIRACLE OF LIFE
by Lindy Guidry ....
BOOK REVIEWS
by Ruth Mencl, RD CDE
ASK THE DOCTOR
by Wesley W. Wilson, MD .....
RECIPE CORNER .....
DIABETES AND ADULT ATTITUDE
by Peter J. Nebergall, PhD .....
HEALTHY HOME COOKING
by JoAnna M. Lund .....
CHECK YOUR HEMOGLOBIN A1C IQ .....
RESOURCE ROUNDUP .....
FOOD FOR THOUGHT .....
DIABETES: WHERE WE ARE TODAY, WHERE WE WILL BE TOMORROW
by Frank Vinicor, MD, MPH, and Jinan Saadine, MD ....
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CHANGE YOUR MIND: DELLA REESE TALKS ABOUT DIABETES
by Ed Bryant
From the Editor: On July 13, I spoke to actress, singer, and diabetes advocate Della Reese (Touched By An Angel). She only had 15 minutes, but she packed a lot in. Here's what she said:
I was diagnosed with diabetes about 3-1/2 to four years ago. I'm a type 2 diabetic. What happened was, I was on the way downstairs, in the house I was living in. I had no indications, no symptoms; It did not run in my family, so it was not hereditary. I was coming down the steps -- and I'm not given to headaches. It seemed like something hit me on the head -- so hard that I sat down on the steps.
I don't know how long I sat there -- but as quickly as it had come, it left. I got up; the car was there to take me to work; I was doing Touched by an Angel at the time. I went on to work.
I went through hair, make-up, I got dressed, I went on to the set. I was conducting a scene where Wynnona Judd was singing, and there was a choir behind her. I was standing on a box, so that the choir behind her could see me.
I was conducting, and I heard the director say "action," but I don't know what else happened in the scene, because I heard nothing else, no music, Wynnona, nothing, until he said "cut," and when he said that, I had to get down off my box, and two of the gentlemen standing there helped me off the box. About 20 feet ahead of me was a fence, and my instincts, or my intuition (put whatever name on it you want) told me I should get to that fence and hold on.
I made it to the fence, and I didn't just lay on the fence; I grabbed the fence. The director saw me, and he asked: "What's the matter with Della?"
They said: "Nothing, she's fine."
He said: "No, look at how she's holding that fence. Call the paramedics."
They did, and they took me to a doctor's office. He couldn't find out what was wrong with me, so when I left his office, I called my husband, who was in Los Angeles. I told him what had happened, and he said: "Get on the plane, right now; come home."
I did; he put me in Cedars Sinai Hospital, and they discovered type 2 diabetes was attacking my body.
The first doctor didn't catch it, didn't do a blood glucose test. Well, let's look at it. I'm the size that I am, so when they first took me in, they started looking for things that should happen to people who are my size. When all my vital signs were fine, and there was nothing else wrong with me, I am a black woman, an entertainer, so it must be drug related... That's what they were looking for; rather than trying to find out what was wrong with me, just to be candid with you.
But when I got to Cedars, and my husband was with me, they tried to find out what was wrong, and Diabetes is what they found. When they first took my blood sugar level, it was 350. If I ate a cracker, it was 500 or better. Now I took it this morning, and it was 97. That [result] is proof to me that what I have been doing is correct.
I have signed on with Glaxo Smith Kline, to be a spokesman for a product called Avandia, that I take. I took this oral diabetes medication for two years before I signed on to speak about it, so I know it works for me. I tell people: "It works for me; you find out what works for you."
What I do is, I travel, and I speak to audiences, and I talk to them not in doctorese (doctors have a language they use, that we don't understand, though they understand it perfectly when they talk to each other), and I explain it, right down front, in conversation like we're having now. I explain to them what I have done, how I have done it, and what they can do about it. I talk to them; I ask for questions, and they talk to me.
After we have this session, I do autograph signing, which gives me an opportunity to speak to each person individually.
What made the difference for me? What I had to do was change my mind. When you change your mind, you can change your life. I had to change my mind about several things. For example, I used to go to bed every night with a bowlful of butter pecan ice cream. I can't do that anymore. It's not that I'll never have another dip of ice cream, but I can't do that anymore.
My favorite sport is laying down. Not basketball or football or baseball; laying down. I had to change my mind: Laying down's all right, but sometime I'm gonna have to get up, and do what you all call exercise, get some kind of activity. Now I'm not gonna run any miles; If I gotta go miles, I need an automobile; but there are things I can do.
We have a pool. I can do the aqua-exercise. My husband has things we can do. I have a bicycle; I can ride some of that. I can get some kind of movement to help my insulin to work.
And the portions of food -- I don't have to eat straw; I just have to work on the portions of food I eat, and when I eat them. You see, I had to change my mind about a lot of things.
I do everything by the grace of God. I stand by his promises, and he has promised me that I am in charge, that I have power, dominion, and mastery over all things. So, I'm using that on diabetes.
I'm taking oral diabetes medications now, not insulin; I caught it in time. I've lived my life in front of the people; I started when I was six; now I'm 73. I'm hoping that my being a celebrity will make people say: "We've been seeing her all these years, and she's never lied to us. She's not lying to us now. Della can do it -- so we can do it, too. That's what I'm counting on."
There are 17 million people with type 2 diabetes. The horrible thing is, it's now reaching our children, because we've taught them to eat badly. You can get anything in the school cafeteria but a glass of milk. So the children are beginning to have type 2 diabetes.
My advice about diabetes? You can be stronger than it. This is not terminal cancer. You can be stronger than this; you just have to change your mind and change your life.
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WHERE'S THE SUGARTRAC?
by Ed Bryant
In VOICE Volume 18, Number 4, Fall 2003, I made readers aware of the SugarTrac blood glucose monitor. I mentioned how it will be truly non-invasive, small, inexpensive, and it will talk. I published an artist's sketch of the prototype, and an estimated price: approximately $250. And I relayed how the manufacturer, LifeTrac, from Fort Myers, Florida, was hoping for official approval, from the Food and Drug Administration, by January of 2004.
The approval process is complex and unpredictable. There were snags, and the process was delayed. Where was the SugarTrac? Would we ever see it? On August 23, 2004, I contacted Richard Peters, inventor of the SugarTrac, and asked him for an update.
"When we went to go into production and get our parts," he said,"the chip we were planning to use was now unavailable. So, we had to completely redesign it. The prototype was a little bit larger; but this one is the size of a cell phone. It will also be less expensive; we are now shooting for a purchase price of under $100.
"And the earclip [that the SugarTrac uses instead of a conventional test strip], you're not ever going to have to take it off the unit. What you'll do, instead, is call us every 90 days, and we'll give you a code, for about $10 to $15, that will be good for the next 90 days. So for $40 to $60, you'll be able to test as much as you want, all year long. Diabetics who check regularly will realize how much of a savings this is over buying test strips.
"And the voice chip, it's already on the circuit board."
And obtaining final FDA approval? Peters reports the redesigned meter is going to Harvard Medical Center, around September 15, for final testing. He expects approval by the end of the first quarter of 2005.
I hope it passes its exams quickly. We need a practical, inexpensive, easy-to-use, talking, non-invasive,blood glucose monitor, and the SugarTrac, given any luck at all, should be that meter. I'll be waiting, and as soon as I know something more, I'll let VOICE readers know the specifics. For information, contact LifeTrac, from Fort Myers, Florida; telephone: 1-877-768-6978; website: www.sugartrac.net
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SORE FINGERS -- HOW TO PREVENT AND TREAT THEM
by Ann S. Williams, MSN RN CDE
This column focuses on providing information to help people
make their diabetes care fit their needs and their lives.
"I would check my blood sugar more often, but my fingers are too sore."
As a diabetes educator, I have heard this statement from many hundreds of people. Self-monitoring of blood glucose (blood sugar) is a cornerstone of modern diabetes care. And right now, we still don't have any way to check blood glucose without using a drop of blood. So it's certainly true, if you check your blood glucose regularly. it is possible to make your fingertips really sore. And, of course, if your fingers are already sore, you are not going to want to poke them again to get one more drop of blood for one more check of your blood glucose.
But, it's also possible to check your blood glucose frequently without making your fingers sore. In fact, there are many people who do check their blood glucose frequently, and they don't have sore fingers. When this topic came up in a support group I was leading, one of the group members said: "I check my blood glucose at least four times every day. Many days, I check my blood sugar six or seven times. My fingers are not sore. And I personally don't take pain well."
So what is the difference? Through the years, I have heard many ideas for avoiding sore fingers. In this article I will discuss everything I can remember about them. I'll start with some definitions. Then, I'll list the steps you can take to avoid sore fingers, and why each of those steps might help. I'll discuss: getting the right equipment; choosing a less painful site for lancing; preparing the site to make the blood flow better; lancing your finger; getting a large-enough drop of blood; stopping the flow of blood; and what to do if your fingers are already sore.
Definitions
Most people who have had diabetes for a while will already know these definitions, but people with new diabetes may need the terms defined.
Alternate site -- A spot on the body other than the fingers that can be used to get a drop of blood for checking blood glucose. The most commonly used alternate sites are the arms and the legs.
Blood glucose -- Dissolved sugar in the blood. The term blood sugar is a less formal way to say the same thing.
Blood glucose meter -- a small, portable machine used by people with diabetes to check, or monitor, how much glucose is in their blood. After pricking the skin with a lancet, the person places a drop of blood on a test strip in the machine. The meter (or monitor) soon displays the blood glucose level as a number.
Lance -- to poke a small hole in the skin in order to get a drop of blood.
Lancet -- a small, pointed piece of surgical steel, encased in plastic at the end that is not pointed. It is used to poke a small hole in the skin to get a drop of blood.
Lancing device -- a small piece of equipment designed to hold a lancet by its plastic end, and push its point quickly through the skin. Most are made of plastic, are spring-loaded, and pull the lancet back quickly after piercing the skin. Many are shaped like pens.
Self-monitoring of blood glucose (SMBG) -- checking a drop of your own blood to find out how much glucose, dissolved sugar, is in it.
Getting the right equipment
1. The meter: Choose a meter that requires as small a drop of blood as possible. If you need only a small drop of blood, you won't have to poke your finger as deeply to get it. The size of the blood drop needed for glucose monitors currently on the market ranges from 10 microliters to 0.3 microliters. If your insurance only covers certain meters, or if you need a voice attachment or other special feature with your meter, your choices will be limited. Still, if you have a choice between two or more meters, you can choose the meter that requires the smaller drop of blood.
Some people like using a meter that can read a drop of blood from an alternate site. This can be a good choice for some people. However, alternate sites do not work for everyone. Some people have trouble getting enough blood from alternate sites, some develop bruises on their arms and legs when they lance those sites, and for blind people there is no alternate-site meter available that talks. Furthermore, even people who can use alternate sites cannot use them at all times. Alternate sites are not accurate when blood glucose is changing rapidly, such as after a meal or during hypoglycemia. To get an accurate test at such times, it's important to use the fingertips. So alternate-site meters, while helpful to some people, do not solve the problem of sore fingers by themselves.
2. The lancing device: Use a lancing device that allows you to dial the depth. Older lancing devices only had one pre-set depth on them. Newer lancing devices allow you to dial the depth that the lancet will penetrate into your skin, from a very shallow level to a deep level. By using such an adjustable lancing device, one that allows you to dial the depth, you can choose the shallowest level that still gets you a large-enough drop of blood.
3. The lancet: If your lancing device allows you a choice of lancets, for comfort, use a lancet with a very narrow needle. The term used to measure the size of the needle is gauge. The larger the gauge the smaller the needle on the lancet.
Lancets are available with needles from 21 to 33 gauge. You may need to experiment a little to find out what works best for you. Some people find lancets with very small gauge needles make it hard for them to get a large-enough drop of blood. See if your diabetes educator or pharmacist can give you a few sample lancets of different types, so you can try them out.
Choosing a less painful site for lancing
1. Use the sides of the fingers, not the center. The sides of the fingers have fewer nerves than the center pad of the fingertips, so they hurt less when they are lanced. The sides also have more blood vessels close to the surface, so you don't have to lance as deeply to get a large-enough drop of blood.
2. Have a system for rotating where you lance. Many people who complain of sore fingers are lancing the same area over and over again. You can avoid this by rotating the lancing site around all the available sides of all your fingers. However, in the daily routine of life, most people find it hard to remember exactly where they last lanced their fingers. It can help to use a system, assigning a particular finger to each day of the week.
Here's the system I use: Use the left index finger on Monday, the left middle finger on Tuesday, the left ring finger on Wednesday, the right index finger on Thursday, the right middle finger on Friday, the right ring finger on Saturday, and either the small fingers or the thumbs on Sunday. If you check your blood glucose several times a day, you might use the side toward the thumbs for morning and noon, and the other side for the evening and night.
3. Or, you can re-use the same site over and over until you build up a callus there. If you do this, you'll probably have to set your lancet holder to a deeper level. However, some people say this hurts less.
Preparing the site to make the blood flow better
1. Do not use alcohol to clean your fingers before lancing. Regular use of alcohol to clean your fingers can dry the skin, making it more prone to painful cracking. Also, if you use alcohol, and do not let it dry completely before you lance, it stings. Furthermore, if the alcohol does not dry completely and it mixes with your blood, it can cause an inaccurate reading.
2. Before lancing a finger, wash carefully with warm soapy water. The finger you lance should be clean so the lancet doesn't push in dirt or any other surface material. Any foreign material under the skin can hurt, and can cause an infection, which will hurt even more.
Using warm water to wash your hands will help by bringing more blood to the surface. This is especially helpful for people who tend to have cold hands.
Washing your hands is important for another reason that has nothing to do with sore fingers. If even a small amount of food is left on your fingers from your last meal or snack, for example, a bit of juice from a piece of fruit -- it can dissolve in the blood drop and can artificially raise your blood glucose reading.
3. Use any or all of the following tips for bringing more blood into your fingertips:
* Rub the spot on the finger you are going to lance until it becomes warm.
* Shake your hand down at your side, like shaking a thermometer, so the blood collects in your fingertips.
* Wrap a doubled-up rubber band as a small tourniquet around the middle joint of your finger, using your thumb to hold it down while you lance. The tip of the finger will become engorged with blood. After you lance your finger, release the rubber band to let the blood flow in.
Lancing your finger
1. Do not re-use lancets. Many people do re-use lancets, either because they're trying to save money or just to have one less thing to do. In general, as long as you use a lancet only on yourself, and you clean your fingers before you lance them, re-use of lancets does not cause major problems. However, each time you re-use a lancet, the point becomes a little less sharp. Some people find they have less pain when they use a new lancet every time.
2. Set your lancet holder at the shallowest setting you can use while still getting a large-enough blood drop for your meter. The shallower the poke, the less it will hurt. It may take some experimentation to find which setting works for you. I suggest starting with the middle setting, and gradually getting shallower if you bleed a lot, and deeper if you don't bleed enough.
3. Steady your hands so you can poke your finger without moving it. Some people flinch and move their hands slightly when they press the button on the lancing device. If you move your finger while the lancet is poking it, you can cause a small tear in the skin, which can be very painful. This happens most often when someone is lancing a finger with the hands in the air in front of the body. If you have trouble holding your hands steady while you are lancing your finger, it can help to steady your hands on a table or against a wall.
Getting a large-enough drop of blood
1. Hang your hand down. If you have trouble getting enough blood, don't squeeze the fingertip. Squeezing near the lancing site can cause more pain. Instead, hang your hand below your waist to a slow count of five.
2. "Milk" your finger from the base to the tip. If you still don't have enough blood, use your thumb and forefinger of the other hand to grasp your finger at the base of the lanced finger, where it joins to the hand. Applying pressure, pull the thumb and forefinger from the base to the tip of the lanced finger. This movement is like milking a cow, or squeezing the last bit of toothpaste out of a small tube. It usually produces a large drop of blood.
Stopping the flow of blood
1. Apply pressure to the lanced site. If you start doing other things without stopping the flow of blood, you'll have a small hole in your finger that could get infected. Furthermore, you risk getting blood drops where you don't want them! Use a tissue or cotton ball to put pressure on the lanced spot for about 30 seconds, while holding the hand above the level of your heart, until your blood clots.
2. If necessary, cover the site with a small bandage. If you take coumadin or any other medication that thins your blood and prevents clotting, it may take a full minute or two to stop the bleeding. If you can't take the time to wait until your blood clots, you might want to cover the lanced fingertip with a small bandage.
If your fingers are already sore
1. Avoid lancing a sore spot for a few days. After all, if it's already sore, lancing it again will only make it worse. Use your other fingers until the sore spot heals.
2. Get treatment for infection. If the spot is warm, swollen and red, you probably have an infection. Apply antibiotic ointment and keep it covered. If your blood glucose is higher than usual, if the infection is getting worse, or if it does not improve within two days, call your doctor.
3. Try using lotion or creams. Some people report they get relief from creams and gels that are formulated especially for diabetic hands and feet. These products are readily available in pharmacies and from mail-order companies that carry diabetes supplies.
Everything I have discussed here is a field-tested tip. Each tip works for at least one person I know. Most people who do daily blood glucose checks need to do at least a few of these things to prevent sore fingers. On the other hand, I don't know anyone who needs to do all of them. You'll probably want to pick and choose among the suggestions above. Just like everything else in diabetes care, you need to find out what works for you.
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FIGHTING BACK
by Dan "Seeker" Wingo
I'm a baby-boomer. I was diagnosed with type 2 diabetes two years ago. I have a family, two dogs, and a few banks to support, so I thought it best to be physically conservative after I was diagnosed. "Gotta be careful. Don't make things worse. Don't push the envelope. Avoid anything that could cause injury. Live a bland life." That was my mantra.
One day I realized this overly passive lifestyle was allowing the disease to control me, even though I had graduated to a diet and exercise regimen. So I decided to fight back in my own little way -- nothing major, like jumping out of a plane or trying out for a spot on one of the reality TV shows. Sure, I needed to be cautious. But I felt the need to personally assert myself over the disease somehow. Hmmm, I like the woods. I have camping equipment. How bout a solo three-day walkabout? We have a wonderful trail in the Monongahela National Forest that would be just right. Sometime in April, just when Spring has sprung. It would be achievable, despite some concerns.
Of course, there had to be concerns. My wife was concerned because the area is bear country and I would be in there when grumpy, hungry bears would be roaming around. She was concerned I might have a hypoglycemic episode, somehow injure myself, and lie there for days without help. I acknowledged those possibilities, but my concerns were different and personally more worrisome. I had two major concerns: getting blisters on my feet; and/or losing my way along the trail. The bears in the area are shy and avoid man. I would do my best to do likewise. As far as the hypoglycemic situation is concerned, I know what that feels like just before it comes on, and am now more attuned to my body than I was, pre-disease. I would carry glucose tabs. To allay my concerns about blisters, I took along a blister kit, wore my best pair of hiking boots, wool socks, and sock liners. A good map, compass, GPS unit, FRS radio, strobe, and cell phone rounded out my solution for getting lost. Anyhow, good equipment would make even getting lost tolerable.
Equipment consisted of a backpack, my Clark hammock (I sleep above-ground), sleeping bag and pad, pot and stove, lighting, clothing, lots of socks, food, water, low-carb snacks, book, and writing material. I also took along a water purifier, as I assumed even mountain water might have some little nasties that could make life difficult for me. Other than diet, foreseeable problems had been worked out. I was ready to start my trek.
According to my references, a typical hour's worth of backpacking for my weight (175 pounds) is an expenditure of about 520 calories per hour. I planned to do a minimum of four hours of hiking each day which means I already exceed my regular target intake of 1500 calories per day. Great way to lose weight, eh? But still, I wanted to get the right combination of carbohydrates, fat, protein, etc., so I would have energy enough to thoroughly enjoy the trail. My solution was to simply increase the number and size of my snacks with the hiker's secret weapon, gorp "good ol' raisins and peanuts"-- also called "trail mix"). And since I was burning up all that fuel, I would reward myself with an apple, on occasion. Yum!
The day finally arrived and I drove to the trailhead, parked, and started down the trail -- map in hand. The weather was good, but the trail was wet, narrow, and mucky. The mud was about four inches deep in places.
Unlike my walks in urban areas, the trail rarely was flat. It was quite hilly instead, and definitely challenging. I was glad I had chosen to bring along a walking staff. It helped with balance. Unfortunately, I had unintentionally increased my workload by packing way too much stuff. I'm embarrassed to say I was carrying a pack weighing 57 pounds(almost one-third of my own weight. Ten of those pounds was water. Consequently, I had worked up a good sweat after only five minutes hiking. I was breathing hard after about 20 minutes and decided to stop for a timely lunch in the shade near a stream. I ate that first apple. It tasted fantastic. I reached my first destination after about an hour and a half of walking -- so much for four hours hiking per day. I found a good place to hang my hammock and set up camp.
Three experienced hikers, the youngest probably 60 years old, stopped by for a rest before pushing on. They were in good shape and spirits after four days on the trail. Initially, I was somewhat put out by their intrusion on my solitude, but concluded they had no way to know I didn't want any company. Trail etiquette required me to greet them, at least. Upon reflection, I am very happy they stopped by. They prove one can be active in the "golden years." The old adage that "one is as old as one feels," may have some merit after all. I spent the rest of the day just thinking. No enlightening solutions to world or personal problems. No epiphany. Just plain ol' daydreaming. Didn't burn too many calories with that task, I'm sure.
At some point, I turned on my weather radio. The forecast for the rest of the weekend was for lots of rain and thunderstorms. Drat! I put off a decision to cut short my walkabout until the following morning, hoping for a better forecast. It rained during the night, but I was warm and dry inside my hammock. The following morning's forecast was no better, so I decided to change my planned route to get in at least some more walking before I went home that day. The trail I chose turned out to be even more challenging than the previous day. There were steeper ascents and descents. Lots of muck. More sweating, huffing, and puffing. I must have drunk at least a quart of water, perhaps more, in an hour. Quite honestly, I was somewhat relieved to finally arrive at my vehicle.
Did I see any bears? No, not even any tracks or scat. Did I get blisters? No. Did I get lost? No. Did I have a hypoglycemic episode? No. Did my secret weapon (gorp) live up to expectations? Can't say. I only used it once during a particularly challenging ascent. My energy was flagging but picked up quickly soon after I ate that 15 grams of carbohydrate.
So what, then, did I learn? I learned that diabetes no longer has the control over me it had the day before. I learned I should dramatically pare down pack weight. I learned my little walkabout caused me to lose four pounds in one day. I learned my stubborn streak is actually an advantage -- I can do whatever I set out to do, provided I set realistic goals. Would I recommend this to others? Absolutely.
But check with your doctor first to see if you're up to it physically. And another bit of advice: You don't have to go solo. Enjoy Mother Nature with someone you want to be with. The key is to put the disease in perspective. Ignoring it is dangerous. But you can control how it affects the way you live your life. Strive to fight back in your own way. You'll feel better about yourself if you do. I know I do.
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NEW INVESTIGATIONAL HEART MEDICATION
Cardiac complications are frequent in diabetes, and are the single greatest producer of death. For decades, doctors have taught that "prevention was the best treatment," and it is, but there has been little one could do to reverse the heart damage done by high blood sugars. That may be changing.
New Zealand-based Protemix Corporation has announced the discovery of Laszarin, an oral treatment that has demonstrated significant effectiveness in reducing heart size, in diabetic patients who show heart enlargement. There is apparently a linkage between diabetic heart disease and defective copper metabolism, and Laszarin caused increased urinary output of copper.
The chief researchers, Professor Garth Cooper and Dr. John Baker of Protemix, state: "damaged hearts in the preclinical models and humans had substantively regenerated after treatment with Laszarin."
"It has been assumed since the beginning of time that heart muscle will not regenerate. This work refutes that," said Professor Norman Sharpe, Medical Director of the New Zealand Heart Foundation.
Of course the research is in early stages. Protemix is currently applying to the Food and Drug Administration (FDA) for permission to conduct Phase 3 trials. If they are successful, we will have a potent new oral medication for treatment of diabetic heart complications. It's early yet; stay tuned; we'll report when the results of these clinicals are made available.
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WHAT YOU SHOULD KNOW BEFORE JOINING A RESEARCH STUDY
by Lisa Pacitto, Patient Services, CLINICA Medical Research
Chances are you or someone in your family relies on medication to treat a medical condition such as diabetes, high cholesterol, or heart disease. Maybe you or someone you know uses a medical device such as a blood glucose meter, a hearing aid, or a pacemaker to help improve the quality of life. Yet before these beneficial medicines and medical devices can be made available to you and those you love, they must first undergo extensive laboratory and clinical testing to assess their safety and effectiveness.
In 2003, more than 8 million Americans participated in clinical trials, of new drugs and new medical devices. Liz Taylor, Director of Clinical Trials at CLINICA Medical Research in Waltham, Massachusetts, stresses the importance of sound medical research, which helps develop new medicines and find new ways to deliver medicines more effectively.
"We are currently conducting research on a device similar to an asthma inhaler, that delivers insulin orally to people with diabetes. This new delivery system would offer an ease of use and comfort over injecting insulin, making it easier for people to take their medicines and positively affect their health," Taylor said.
Medical research is not only necessary to find treatments and cures for existing medical conditions, it is also crucial for the prevention of disease, such as the diabetes prevention study now under way at CLINICA Medical Research. Currently, diabetes afflicts approximately 18 million people in the U.S. and an estimated 16 million more people are on the verge of developing the disease.
People are motivated to participate in a research study by a desire to help find a cure for a particular disease, to better understand and treat their own disease, or to connect with people who have similar health issues.
If you have ever thought about participating in a research study, here are a few facts you should know before joining a clinical trial.
What are the benefits and risks of participating in a research study?
The benefits can include: access to new medications, expert medical care, medical tests and lab work free of charge. Risks are often minimal, but do vary depending upon the nature of the clinical trial. The purpose for the study, the study procedures, and any potential risks are detailed in a document called the Informed Consent. You need to read the Informed Consent carefully, as it clearly states what your involvement in the study will be.
Bring your questions and concerns up to the study physician and clinical staff as well as your own physician. You should never feel pressured to begin or remain in a study if you have unanswered questions or feel uncomfortable about study procedures.
Who should not participate in medical research?
People who have serious health risks or conditions, such as advanced heart disease or cancer are not typically allowed to join clinical studies, unless those are the conditions being studied, and even then, you should discuss the matter thoroughly with your physician. Other factors for not participating in a study include taking a medication that would interfere with the study drug or cause you to have a negative reaction; being scheduled for surgery before or during the study period; already participating in another clinical trial; and not being able to fulfill the study time commitment.
What types of research are there?
Medical focus groups and opinion surveys require little time and typically seek your opinion about medical devices or new product packaging. Researchers might ask you to evaluate a medical device such as a digital thermometer, wrist brace, or blood glucose meter. Studies of longer duration might involve the testing of a new drug, finding new uses for an existing medication, or comparing a medication to others already on the market.
What are the time commitments and costs?
Time commitments vary, depending upon the study, and can range from three hours to six months, one year, or several years. Typically, all procedures (physicals, EKGs, X-rays, blood work, etc.) associated with a clinical trial are provided free of charge.
Will I be compensated for my participation?
Most clinical trials provide a stipend to participants to compensate them for time and travel expenses. The amount of the stipend depends on the duration and complexity of the study, but generally stipends can run from $500 to $3,000.
What are my rights as a study participant?
Patients' rights and safety are protected by an Institutional Review Board (IRB). The IRB, composed of physicians and lay people, examines each study's protocol to ensure patients' rights and safety. The Informed Consent form also protects patients' rights by detailing all aspects of the study and letting participants know they have the right to leave a study at any time for any reason. Patient privacy is protected by the Health Insurance Portability and Accountability Act of 1996, also known as HIPAA. For more information on patients' right and privacy, visit the patients page on the CLINICA web site: www.trialcenter.com/patients.
How do I get involved in a research study?
Contact CLINICA Medical Research, Waltham, Massachusetts; telephone: (781)-647-7200, or visit our web site: www.trialcenter.com/research for more information and a listing of current research studies. You can also visit two "clearing house" websites: www.centerwatch.com or www.clinicaltrials.gov to find a clinical trial near you.
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NONCOMPLIANCE: AN ENDURING ISSUE
by Peter J. Nebergall, PhD
Includes photo of Peter J. Nebergall, PhD, with cat.
If you were drowning, and someone threw you a life preserver, you'd use it, wouldn't you? If you were jumping out of a burning airplane, and there was a parachute available, you'd use it, wouldn't you? If you had a serious medical condition, one that could shorten or end your life, and the medications to cope were at hand, wouldn't you use them? And what would you call somebody who didn't?
A recent large-scale study conducted by Pharmetrics, part of the industry association PhRMA, found, surprisingly, that between 17 and 33 percent of diagnosed diabetics took no action to control their disease. We are not talking about people with no health insurance, who couldn't afford medications (and God knows there are plenty of them!); they were factored out, as always. We are not talking of the "diet and exercise" folks, either. The study found that up to one third of people who knew they had diabetes, knew they needed medications, and had the means to pay for them -- were ignoring the condition. Jump out of an airplane, and don't pull the ripcord ...Why?
They call it "noncompliance" -- the refusal to "do as the doctor ordered" -- but, as scholar Lewis Binford warns us: "Description is not explanation" -- so to hang a particular label on a piece of aberrant behavior brings us no closer to explaining why people would do such a silly thing. Medical science can diagnose diabetes, and can give you the tools to cope, but for too many folks who should know better, it seems it's a case of "leading the horse to water." Medical science can't make people want to take care of themselves. As a matter of fact, the doctors and researchers are powerless here, and they know it. The health professionals can detail for you all the nasty consequences of inaction, of failing to take care of your diabetes, but that is by no means the same as motivating you to do the right thing. Pharmetrics' research suggests there may be a million Americans who know better, can afford to act, and don't.
Modern strictures upon plain speech, in the name of an ephemeral, fashionable "political correctness," have greatly damaged our ability to motivate and encourage sensible behavior. They have not, however, eliminated the distinction between right and wrong -- just made it harder for us to get it across; to say, of a given behavior: "That's nuts!" If you had a friend, or a relative, who had a family to live for, and the means to cope with a fire, or a flood, plane crash, ship sinking, tornado, or other disaster -- but didn't act -- would you wonder about them? Now, what about your diabetes?
Where do you fit? If you have been diagnosed with diabetes, are you doing what you can to cope, with the means you have at hand? Hopefully, you're not one of that 17 to 33 percent who, by their inaction, amazingly, are "choosing to go down with the ship." Diabetes is not shipwreck; they're not captains -- so WHY?
We know what to do about diabetes, how to diagnose it, and how to treat it, so as to ensure a long and healthy life -- but you, the patient with diabetes, have to faithfully execute your doctor's orders. Medical science can only go so far -- the rest is up to you. Think about it; your life is in your hands.
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DIABETES AND IMMUNOSUPPRESSION: A NEW DEVELOPMENT
People who receive organ transplants need to take immunosuppressive medications, to keep their bodies from rejecting the new organ. This therapy is complex and expensive. Past immunosuppressants, while successful for kidneys, even hearts, have been demonstrated toxic for islet cell transplants. The search is on for better ways to control immunosuppression.
Researchers from the St. Vincent's Institute, of Melbourne, Australia, are following a new line of inquiry. Like an infection, an immunosuppressive/autoimmune attack upon an organ produces inflammation -- and it is that inflammation that damages or destroys the organ.
A molecule named SOCS1 appears to do two jobs: As part of an islet-cell transplantation, it reduces (and may eliminate) the need for traditional immunosuppressants, and, given to mice expected (and bred) to develop type 1 diabetes, it shielded their beta cells from the inflammation that would have destroyed them, producing diabetes. In so many words, SOCS1, given at the right time, prevented the onset of type 1 diabetes.
With luck, these findings will translate into better human immunosuppression, and, perhaps (as current findings are based on animal research) a way of intervening against the autoimmune assault that causes type 1 diabetes, and several other diseases, perhaps Systemic Lupus or Multiple Sclerosis.
It'll be a while. If laboratory testing is successful, look for SOCS1 to be used with islet cell transplants within the next five years.
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U.K. STEM CELL RESEARCH RECEIVES LICENSE
On Wednesday, 11 August, 2004, BBC Online reported the British Government had given permission for UK researchers, at the University of Newcastle, to perform therapeutic cloning, for the purpose of harvesting stem cells to treat diabetes and other conditions. It will use the same techniques used to create Dolly the sheep -- but with a critical difference.
We hear about "embryonic" stem cells, or else about "adult" stem cells - with much politics about "harvesting embryos" leading to the destruction of human life. These are different. BBC reports the cloning technique, known as cell nuclear replacement (CNR) involves removing the nucleus of a human egg cell and replacing it with the nucleus from a human body cell, such as a skin cell. The egg is then artificially stimulated, causing the egg to divide and behave in a similar way to an embryo fertilized by sperm. Conception never takes place -- so no human life is destroyed.
Stem cell research is not the magic bullet some folks think. Many questions remain. The researchers believe this is the first time anyone has received such a license, in the UK, in Europe, and perhaps anywhere in the world. They warn it will be at least five years -- if not many more -- before patients could receive stem cell treatments based on their work. There is a great deal more to do.
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MY LIFE AS A DIABETIC
by Patricia Wolf
I was born in Cleveland, Ohio, in November 1942. At just 18 months old, I had (as I was later told) a severe viral infection. Shortly after that, my mother and I moved to Georgia, where my father was a flight instructor for the men going to war. My mother, at that time seven months pregnant, asked her OB doctor why I was drinking so much and had apparently lost the potty training I had learned. He sent us upstairs to another physician, who took a urine sample from me. After testing it, he told my mother I was probably diabetic, and that she should take me, at once, to see a famous pediatrician, a specialist in diabetes, at the Cleveland Clinic. I grew thirsty later that day, so she gave me a Coke. When we arrived in Cleveland on the train the next day, I was unconscious. This is how my life as a diabetic began.
I was under good control (or at least as good a control as could be expected at that time) and had no complications of diabetes. The Cleveland Clinic put me on a high fat diet, believing that was the way it should be. They told my mother I would be lucky to live until I was 30.
My mother managed to control me as much as possible with, as we now know, the inadequate regimen of urine testing, boiling glass syringes, sharpening oversized needles and chasing me around the house to give me shots. She used to say that she would wait to see why I got crabby -- was it low blood sugar or just me being crabby? As I grew up, I was periodically taken to the hospital in an ambulance with extremely low blood sugars. I was particularly reckless while a teenager, ending up in the hospital a couple of times with diabetic ketoacidosis [from very high blood sugars].
I went to nursing school in Cleveland, graduated in 1964, and then I married. Between partying and working, I managed to keep the diabetes in fair control. At that time, this involved Clinitest tablet testing of urine sugar, and using the test tape that had recently been invented.It also meant several injections a day of either PZI, or later NPH and Regular insulin.
I became pregnant in early 1966, and was absolutely rigid about taking care of the diabetes, as I really wanted a healthy baby. One time during my pregnancy, my doctor's office called my husband, as I had missed an appointment. He came home, and found me unconscious, with very low blood sugar. I was put in the hospital and my insulin was readjusted to much lower doses. I gained only what my baby weighed, and he was born three weeks early at a normal birth weight; not heavy as so many babies of diabetic mothers often are).
Life continued, and I returned to working as an RN a few months later. When my son was about 18 months old, I became pregnant again, and had the same difficulty keeping my glucose level high enough. As it was even worse this time, the doctors decided to deliver him early, with a C-section. I was huge, and they were wondering if I had twins; yet I had gained only five pounds. My daughter was born six weeks early, at exactly five pounds. This hugeness was the extreme amount of amniotic fluid that surrounds the baby -- a symptom of a diabetic mother. However, my daughter was healthy, just small.
When my kids were eight and ten, I started seeing big floaters in my eyes. Sure enough, I had diabetic retinopathy, and within 18 months I was totally blind. My husband and I decided to leave rural Ohio, where we lived, and move to California, hoping it would be easier for me if we escaped the snow. (I had not had any mobility training at that time.) The move to California was wonderful, and I have never regretted it.
I returned to college, and eventually earned a master's degree in Educational and Rehabilitation Counseling. After some struggle, I finally found my first job as a blind person; I worked for 18 months as a counselor in a locked psychiatric facility. Later I became a Counselor Teacher for the Department of Rehabilitation, working in several cities in California. In the meantime, talking glucose meters were invented, and these helped me control my blood sugar better.
However, the years of non-control and unwise eating and the stress of a failed marriage caused two heart attacks. The first one, which was not diagnosed at the time, was while I was at a guide dog school, receiving training for my first guide. Nine months later, in 1990, I had another one, so I underwent a quadruple bypass. I was only 48 years old at the time. Well, that cured me of heavy-duty eating and partying.
Since then I have managed to maintain control of my diet, weight and exercise situation; a new insulin pump also helps a lot. The use of the Accu-Check VoiceMate, although it does have problems, lets me keep more accurate check of my blood sugar (I do at least six checks a day). Having a dog encourages me to walk.
I have always been a busy person, running here and there. I belong to many organizations, worked until I was 60, re-married, and now that I decided to retire, I am extremely busy, volunteering at several places, and teaching diabetic education at the Braille Institute in Los Angeles. I am now 61, and about to celebrate my 60th year as a diabetic, having lived long past the projected time the doctor at the Cleveland Clinic predicted. I still take heart medication, but I have not needed a second by-pass surgery (something very unusual for a diabetic). My kidneys are still working, although at a decreased rate, and I am not yet worried about needing dialysis.
My motto is "eat my dust," and I think that is what keeps me going. I think people today have such a much better chance than I did; it only takes determination to control the disease and not let it control you!
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LETTERS TO THE EDITOR
Includes artwork: quill pen and ink pot.
April 26, 2004
I love your magazine and I think it is the best publication out there on diabetes.
Thanks a lot,
Terry Banner
Franklinville, NJ
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May 3, 2004
Hi there ... I once again do thank you for responding so quickly. We just received a large bundle of Voices ... probably about 50. They are such a GREAT magazine!
Claudia C. Morgan
Belcourt Indian Health Service
Belcourt, ND
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May 5, 2004
I came across Voice of the Diabetic during a visit to my doctor's office today. I am very impressed by the content and the benevolent nature of the publication. I would like to subscribe to it. Also, please let me know how I can help.
Sincerely,
Ravi Gudlavalleti
Whitehall, PA
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May 14, 2004
Thank you so much for the three extra copies of the Voice of the Diabetic paper. I do pass them along, and I praise your paper. It is so helpful to me in so many ways.
I am a nurse, but there are so many new insights and information to understand and deal with my diabetic condition.
Again, thank you for the wonderful work you are doing.
Sincerely,
Billie Jean McKenna
Parma, OH
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June 13, 2004
I love your paper. I have had diabetes for 54 years and I hope to read your paper for many years.
Mrs. Betty J. Losnes
North Branford, CT
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July 21, 2004
It is a pleasure to congratulate you and your staff for such a magnificent edition of the Voice of the Diabetic. Being the one responsible for distributing this wonderful paper among the members of our Father Martinez Nutrition Center, I try my best to disseminate the wonderful information that is contained in the paper, not only among those of us who are diabetics, but also to the rest of the seniors at this center.
Thanking you and all your staff for the wonderful service you have been giving us for the past two or three years, I remain....
Juan M. Roman-Rios
Father Martinez Senior Center
El Paso, TX
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August 16, 2004
Someone gave me a copy of this Voice of the Diabetic to read. I really enjoyed reading it, and got a lot of helpful information from it. I have had type 1 diabetes for five and a half years. Sometimes it is very hard to control. Thank you.
Sincerely,
Rosalie Malota
La Grange, TX
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MANAGING LIFE'S STRESSES
by Sally York
Includes photo of Sally York.
From The Editor: I have known Sally York for years; she is a good friend. She served on our Diabetes Action Network Board and had much to contribute. The article below, she originally presented to social workers at DaVita Dialysis Clinic, in Union City, California. Here's what she says:
September 2004 marked my 15th year on hemodialysis. My kidney failure is due to diabetic complications, which also include severe vision loss and neuropathy. I had an unsuccessful pancreas/kidney transplant in 1989.
I have been looking forward to a second kidney transplant ever since. Because of the immunosuppressant medications and multiple transfusions I have received, finding a compatible kidney is difficult. I am currently working with the University of California, San Francisco, and a new medication to make me compatible with my brother, who has lovingly offered me one of his kidneys.
Despite these circumstances, despite these stresses in my life, I manage to "hang in there" by being diligent and following the rules for healthy living. Most of my stress is a result of, or aggravated by, my health problems. Here is a summary of my secrets to manage that stress.
First, I acknowledge that I feel the stress, and I determine what is the cause. I may take several days to feel it, process it and decide how I'm going to deal with it. I consider this the best way to avoid depression.
Second, I have unconditional loving support from my parents, who live nearby. I call them for advice, sympathy and a friendly ear. And, I can confide in one best friend. I have other friends, but find they are generally not interested in hearing my problems; they are interested in telling me theirs. By listening, I realize I have made them feel better, and this in turn makes me feel I have done something of value for someone.
My relationship with God gives me strength. When I am physically able, I attend my church. I take classes, meditate and read inspirational writings.
In addition to taking care of my spirit, I take more care of my physical being. I prepare healthy meals and eat more of my favorite foods. I attempt to exercise a little every day on my rowing machine and do stretching exercises for flexibility. I try to maintain regular sleeping hours by going to bed at the same time each night and avoiding lounging too late in the morning.
I am extra good to myself and do things I enjoy: listen to music, take long showers, sit in my backyard on sunny days, do computer work, try a new recipe, go shopping with a friend, read a book or magazine on tape, etc. And (this is critical), even at my lowest points, I always believe that the future WILL be better. I refuse to give up hope. I continue to set goals and dream of what in my life I still have to achieve and enjoy.
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MEDICATION MIX-UP
The following comes to us from ISMP Medication Safety Alert, July 1, 2004 issue, Volume 9, Number 13, published by the Institute for Safe Medication Practices. It is reprinted with permission. As so many who take diabetes medications have other issues as well, and these may also require prescription drugs, the issue of mix-ups is with us all. Question your doctors, nurses, and pharmacists. Know what you're taking, and why you are taking it. They're human, and can make errors -- so be vigilant.
Choosing the right name. A physician prescribed an oral antidiabetic agent, ACTOS (pioglitazone hydrochloride), 30mg daily for a newly admitted diabetic patient. Unfortunately, 30mg of ACTONEL (risedronate), indicated for osteoporosis or Paget's disease, was dispensed and administered for 16 days before the error was noticed. When processing the order, the pharmacist entered the first four letters of the drug name, ACTO, into the computer, and then accidentally selected ACTOnel instead of ACTOs from the screen. For more than two weeks, the nurses failed to notice the dispensing error. The label of pre-packaged Actonel tablets listed both the brand and generic name. The handwritten medication administration record correctly stated Actos. On quick glance, the nurses had repeatedly misread Actonel on the label as Actos. The patient's blood glucose levels remained high throughout this period, peaking at over 400mg/dL.
A pharmacist finally noticed the error when reviewing the patient's orders upon transfer to a rehabilitation unit.
Confirming the indication for each medication during order entry and before drug administration usually helps avoid errors when look-alike drug names are an issue. If the first few letters of a drug name are used during order entry, use caution when selecting the correct drug if multiple choices exist on the screen. When available, match both the brand and generic name to confirm that the correct drug has been selected. Consider adding an alert in the (hospital or pharmacy) computer system to help avoid errors.
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THE TIM COX STORY
by Bette Cox
Includes photo of Tim and Bette Cox.
"Tim Cox Sees a Lot More Life than Most Folks Do," reads the headline from the Florence Morning News of Sunday, May 4, 1986.
This is just one of dozens written over the years about the 58-year-old native of Kingstree, South Carolina, who at age five developed juvenile diabetes. Insulin shots became a way of life for this little boy, in the days when there was very little sugar-free anything to satisfy a child's craving for sweets. A constant dietary balancing act became his mother Ora Lee's way of life, as were frequent trips to the doctor's office or hospital.
As Tim grew, he determined to never let diabetes stop him from accomplishing the important things in life. He joined the high school tennis team, played French horn and the trombone in the marching band, he water skiied, and he had a ton of friends.
In 1964, he graduated from Kingstree High School (celebrating their 40th class reunion with Tim as primary instigator this June). He went on to business school, began work as a computer programmer, and got married. His daughter Angelia was born.
And then Tim started having vision problems. He underwent laser treatments, traveled to Dukane University, in Pittsburgh to be trained as a blind programmer, and by Labor Day 1974, Tim began losing his eyesight. A month later his kidneys failed.
Up until that time, diabetics in South Carolina had never been put on dialysis. They were left to die. But Tim wouldn't give up, and after many agonizing days of praying, pleading and waiting, he became the first diabetic ever to be put on dialysis in South Carolina. His wife learned how to do home dialysis, but the many pressures of his illness soon led to separation and later, divorce. Once again, Tim had to rely on his parents, family and friends, and a lot of prayer.
Eventually Tim's mother learned to operate the home dialysis unit, and the family settled into a precarious routine. Tim refused to settle for being "disabled." He got involved in the community, serving on local boards for the American Diabetes Association (ADA), American Cancer Society, Kidney Foundation, and Jaycees. He helped found the Black River CB Club and organized such activities as the "Coffee Club Patrol," calling drivers in from the highway to raise funds for house fire victims. During these years, Tim won many awards: Outstanding Jaycee in South Carolina, 1978; Kingstree Jaycee of the Year 1979, and the Adam Fisher Award of the ADA, 1981. He was a member of the Committee on Computers for the Physically Handicapped, based in Chicago, Illinois, the South Carolina Physically Handicapped Society, and the National Federation of the Blind. He kept very busy between dialysis treatments.
In 1978, after four years of ups and downs with dialysis, Tim and his mother traveled to the New England Deaconess Hospital in Boston and Ora Lee donated a kidney. Tim arrived home from the hospital at 12:05 AM, Christmas Day 1978. A month later, he became public affairs director and talk show host for WKSP radio in Kingstree. He owned a 1976 Datsun 280Z, and with driver Joel Stone, in 1979, he competed in several Sports Car Club of America races, coming home with first or second places.
"He Has Battled Death and Won." So reads a December 17, 1979 Charlotte Observer headline. A state newspaper headline of December 25, 1979, reads, "Christmas Very Special to Tim Cox." And it was, indeed. Tim celebrated by arranging for the Brass Ensemble of the Charleston Symphony to play two public concerts in Kingstree, as a Christmas gift to the community.
"Blindness Didn't Stop Him," reads the headline from a Florence Morning News article of 1983. Tim had determined to get on with his career, so he enrolled in Francis Marion University in Florence. He moved to Florence, rented a room in a boarding house, and still owned a car. "It's a lot easier to bum a ride if you have your own car," he said. He graduated with a Bachelor of Science in Business Administration in December of 1982, and went to work as the only blind instructor in the state's technical college system. He had all his text books audiotaped, and recorded his class notes on tape also. "Talk about a challenge, whew!" he said. He moved into an apartment complex and, "Sometimes I would be known to run into the hall asking my neighbors, what was in the box of Lean Cuisine, and for how long did I set the microwave?"
About that time, Tim met Bette Gaymon at a Full Gospel Businessman's meeting in Florence, where she served as pianist. They began dating and were married on Christmas Day, 1984. Diets and insulin shots became the way of life for yet another person in Tim's life.
When Tim's contract with the technical college ran out, he and Bette opened their own business, Executive Services of the Pee Dee, Inc., a full-line secretarial service. It was May, 1986. Tim and Bette both got involved in their community. With Bette at the wheel of his car, Tim became a popular spokesman for the ADA, speaking to civic and church groups across the state. Both joined the board of Crimestoppers of the Pee Dee, and Tim took up playing his French horn again, joining Bette in the music ministry of their church. Their business grew and expanded along with their community activities.
"Tim Cox Receives President's Trophy," reports a May 1988 headline from the Florence Morning News, as Tim was named Florence's Handicapped Citizen of the Year. This award was followed by being named South Carolina Handicapped Citizen of the Year for 1988, as well as Employer of the Year of the Handicapped, recognized for hiring handicapped employees for his business. But ...
By 1987, Ora Lee's donated kidney had begun to fail. Despite the tightest blood sugar control Tim and Bette could achieve, diabetes had taken a toll on the transplant, and Tim began to study the possibility of a pancreas transplant to stop the diabetes completely. There was one obstacle -- he also had coronary and other major artery disease, likewise a result of diabetes. "Get your arteries fixed, and then we'll talk," said the physicians. That didn't seem to be an option at the time.
But in May of 1987, Tim was admitted to the hospital with unstable angina, and while an inpatient on the cardiac floor, he suffered cardiac arrest. An emergency pacemaker saved his life, and ten days later he underwent triple bypass surgery. Later that year, his right leg had to be amputated, due to gangrene. Diabetes had wrecked the peripheral arterial system in the leg.
After recovering from all that, Tim made another call about the pancreas transplant, and after traveling alone in September 1988 to the University of Minnesota Medical Center for a complete examination, he was accepted as a candidate for a kidney-pancreas transplant, as his weakening kidney needed to be replaced as well.
While Tim awaited a donor, this time he began fund raising efforts for himself. In 1988, insurance companies considered a pancreas transplant "experimental" and wouldn't cover those costs.
"Tim Cox Never Gives In To Fate," said Charlie Walker in a December 14 newspaper column in the Kingstree News. "Tim Cox believes when you're handed lemons, you make lemonade," quipped Charlie. He pointed out all the other people Tim had helped over the years, and the fact that now Tim needed help. Charlie organized a Jail-A-Thon to help out. Civic clubs, church groups, friends, business acquaintances, and even strangers; people all over the state began helping out. Billboards went up all over the county: "Tim Cox Needs $100,000." A trust fund was set up by a local civic club, a beeper was donated, and money started coming in.
On December 23, 1988, the call came in from the transplant center: "We've got a perfect match. You need to get here within 12 hours." But the private planes Tim had lined up weren't available, due to the holidays. And all the major airports connecting to Florence were fogged in, so he couldn't get to Minneapolis on a regular airline, even though Florence skies were clear. Desperate calls went out for a private plane, and one was finally found in North Carolina. Friends, family and news reporters waved goodbye as Tim's parents, Tim, and Bette, flew out of Florence, headed for Minneapolis. By this time Bette's daughter Shelby Powell was helping run the business, a tremendous blessing over the weeks ahead.
The transplants took place on Christmas Eve. All day long Tim's parents and Bette sat, stood, paced the floor, and prayed in the nearly deserted waiting room, and finally Dr. David Sutherland, head of the surgical team, came out with the news -- the pancreas and kidney were working fine. The pancreas fired up immediately when the last stitch went in, and Tim no longer needed insulin shots.
Over the next two days, bleeding problems necessitated two more surgeries, but 30 days later Tim was back home in Florence, and well on the way to recovery. Diabetes was no longer a problem; but fund raising had to resume, with talent shows, gospel sings, auctions, and a myriad of other events. Slowly but surely, the community responded, and enough funds were collected to defray most of the medical bills and medications not covered by insurance.
Today, over 15 years later, Tim is busier than ever. The transplants are still working fine, and Tim is a true advocate for pancreas and kidney transplants, and, of course, organ donation.
The disease was stopped in its tracks, but the damage already caused by diabetes wasn't reversible. Tim lost his other leg in 1989, and later, most of his fingers. He's had several small strokes, which have affected his hearing. However, he still runs his business, still plays his French horn for church, and is still active in community affairs and politics.
In 1991, he organized the UP (for Used Parts) Club, a support group for transplant patients of all types, and established the Carolina Transplant Foundation, a nonprofit organization designed to assist patients in fund-raising. He received WBTW-TV13's "Giving Your Best" Award in 1991. In 1992, he added another division to his company, Advanced Insulation. He was named Florence County Republican Party Volunteer of the Year for 1993-95, and received the James B. Edwards Award of the state Republican Party in 1998.
"Advantage: Attitude" is yet another headline about Tim. "I don't consider myself handicapped, I'm handicapable," declared Tim in the 1992 business article in the Morning News. That really sums it up well. "Tim Cox is Not Special; He's Stubborn," said another Morning News column in 1997. "I like to surprise people. I like to do things they think I can't do."
And, he's still doing it. Tim is now a grandfather, with a two-year-old granddaughter, Bella. He and Bette recently added a new division to their company, Family Memories, which conducts interviews for personal histories, biographies or memoirs. Visit their web site and take a look at Tim's resume. (www.FamilyMemoriesSC.com)
Tim could never have survived, much less accomplished all he has, without the help of his family, his multitude of friends, and his faith in Jesus Christ. Every time there was a medical setback, a call for prayer went out across South and North Carolina, and things took a dramatic turn for the better. A special Bible verse came to Tim's mom Ora Lee during a critical period, and over the years it has been a great source of strength. If you don't remember much else about Tim Cox, remember that verse: "With long life will I satisfy Him, and show Him my salvation." (Psalms 91:16) That is the reason, still today, Tim Cox "Sees" a Lot More Life than Most Folks Do.
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VOICE DISTRIBUTORS NEEDED
Since the VOICE is now offered free, our Diabetes Action Network will provide extra copies to anyone wanting to help spread the word. We will gladly send from five to five hundred-plus copies each quarter to be used as free literature. Medical facilities can order as needed for patients. Individuals can usually place copies of the VOICE in libraries, pharmacies, hospitals, doctors' offices, or other public locations.
Diabetes education is essential. Anyone who distributes the VOICE will be helping people with diabetes, and their families, to learn about the disease and its ramifications; to learn that they have options; and that their world is far greater than whatever "limits" may be imposed by the disease. If you would like to help spread the word by distributing the publication, please contact: Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911, fax: (573) 875-8902. NOTE: Please provide a phone number so we can reach you.
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DREAM BIG; DIVE DEEP
by Ed Bryant
Includes photo of Colleen McCarthy LaPierre, and group photo of divers Josh Pohlman, Ryan Powers, Natalie Held, Sarah Wyss, Danny Kampo, Sarah Gatti, Krista Hoebel, and Marcus Strickland.
For too many years, too many of us with diabetes have translated the demands of our condition into limitations; "thou shalt not's." Doing thus, we turn an inconvenience into a "disability." What if we're wrong? What if we could see a succession of positive examples: folks who didn't let their diabetes get in the way? And what if we could participate in challenging and empowering activities ourselves?
Bayer Diagnostics, maker of the Ascensia line of blood glucose monitors, believes in the power of positive example. Once a year, they sponsor a contest, looking for diabetics with extraordinary personal goals, goals that might in past have been considered "off limits" because of diabetes. The Ascensia Dream Fund provides grant funding, to an individual or team, to place such achievement within attainable reach.
Colleen McCarthy LaPierre was the 2003 winner. Diabetic herself, her dream was to become scuba-certified, and then to offer, without charge, to diabetic teenagers, a scuba-camp program. Diving in one of the world's most beautiful open-water locations, St. John's, in the Antilles, it would be an ultimate empowering adventure.
"Scuba was their tangible challenge; but what I wanted these kids to come away with was the belief that if they could do this, they could do anything," she said.
She was not a certified scuba diver. She hadn't been down before. In fact her whole idea, which she called "Dream Big; Dive Deep," was pulled into shape the last few days before the 2003 Dream Fund contest closed -- but it caught the eye of the judges.
An important point -- Bayer Diagnostics did not fund the participation of these young people; they funded Colleen's idea. It was her generosity that made her scuba camp possible. That makes the story amazing.
Colleen figured she could handle up to ten young divers. She got the word out, and started screening applicants. Who should go?
The process for choosing which diabetic teens would participate in Dream Big; Dive Deep was not unlike the selection process that led to Colleen's victory in the Ascensia Dream Fund. Possible contestants (teens age 16 and 17, all with insulin-dependent diabetes) had a phone interview, wrote an essay (on how participation in the program could change their lives), and had to demonstrate they could keep their blood glucose under very tight control (A1c of less than 8.5 in this case; and note: for most diabetics, not teens involved in intense physical exercise, doctors recommend A1c goals closer to 7).
Colleen got dive-certified just prior to the program. "I'd originally planned to get certified simultaneously with the kids," she said, "but I realized that was too much, to do that and run the program. I wanted to be there to support the kids during their process. So I got certified earlier."
Eight were chosen: Sarah Gatti, from Peabody, Massachusetts; Natalie Held, from Potomac, Maryland; Krista Hoebel, from Plum, Pennsylvania; Daniel Kampo, from Cheyenne, Wyoming; Joshua Pohlman, from Grand Forks, North Dakota; Ryan Powers, from Chicago, Illinois; Marcus Strickland, from Perryburg, Ohio; and Sarah Wyss, from Troy, Michigan.
Professional dive-masters Richard Buonatio, of Southold, New York, and Steve Prosterman, of St. Thomas, U.S. Virgin Islands, would be in charge under water.
Colleen brought her winners to Shelter Island, New York, where they received scuba instruction, and did four dives, prior to receiving open water certification. The process took eight days.
Then it was on to St. Johns, in the Caribbean, to a dive-site called Moha Bay. There was to be diving, kayaking, hiking, snorkelling, and many other activities.
But intense physical activity lowers blood sugars; how did they avoid hypoglycemia? "We followed very strict guidelines, getting into the water," Colleen reported. "We knew we had to prevent hypoglycemia -- and we did not have any hypoglycemic episodes. On average, the kids were testing their blood sugar about 15 times a day. They had to show a stable or increasing pattern in their blood sugars. They had to be over a certain level before they were allowed in the water -- and when they came out, they had to check again and see where they were at. We were able to establish for each kid what their personal trend was. We discovered they almost always dropped 100 points under water. Thus, we knew where to get their blood sugar up to before they got in, so they'd be safe in the water."
The eight participants each made six open water dives. "The most important thing we achieved, and the goal of the program, was to prove to these kids that if they take care of themselves, they can achieve their goals," Colleen told me. "If they could do this, they could do anything."
"I just want to say this is probably the most amazing thing I have ever done, in the history of ever," one of the participants told me.
Did it work? "We achieved our goals, and fulfilled my dream. It was awesome," Colleen reported. "The only thing I would add is that the Ascensia Dream Fund contest will shortly be seeking its third winner, and people with diabetes, whether type 1 or type 2, can enter their own dreams. They may be the next winner, and I encourage them to try. If you miss the deadline, go for the next year -- as I'm sure they're going to keep doing it. The website to look at is: www.ascensiadreamfund.com."
If someone would like to talk to Colleen about her experience, they may contact her: Colleen McCarthy LaPierre, Barton Center for Diabetes Education, 30 Ennis Road, North Oxford, MA 01537. Or, contact the Ascensia Dream Fund, 302A West 12th Street, Suite #227, New York, NY 10027; telephone: 1-800-332-3210; website: www.ascensiadreamfund.com
The 2004 Ascensia Dream Fund competition just closed, on September 10. There will be a 2005 competition, and if you have an idea, for an empowering activity or achievement, one that diabetes would traditionally have limited, you are encouraged to submit it for possible funding. You do not have to be a diabetes professional. Contact the Ascensia Dream Fund for details.
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FLORIDA MAN HAS VISION OF HIS OWN ROLE IN SOCIETY
by Jay Arrington
Includes photo of Rick French at work.
From the Editor: The following appeared in the July 2004 edition of the BRAILLE MONITOR, published by the National Federation of the Blind
From the MONITOR Editor: The following article appeared March 11, 2004, in the Jackson Independent newspaper.
Rick French has a vision for his future--return to his home state of Florida, get more training in the field of auto body repair, get a job, and become a productive member of society. But the 22-year-old will never get to see the fruits of his labors, because a bullet took away his eyesight three years ago.
As part of a program with the Louisiana Center for the Blind in Ruston, French is currently working in Hodge at Smith's Wrecker and Body Shop, doing what he enjoys, working on cars. "I was going to school to be an auto body technician when I lost my sight," he said. "I am really happy that (Wayne Smith) gave me a chance to work. I was at another body shop, and they wouldn't let me do anything."
"He is doing really well," said Smith. "We've been impressed. All the body shops in Ruston turned him down, but we put him right to work."
Smith said French works by touch. He sands damaged cars and trucks, applies Bondo [body dent filler], and tapes areas for painting. "He has a great attitude," Smith said. "He was here two days, and he could find anything in this shop. In fact his first job was sanding a truck. And he reached over and felt the truck and told us what make and model it was. We were amazed."
"Instead of looking at dents and things through my eyes," French said, "I have to look at them through my hands."
"The idea of the program is to find out exactly what kind of work he can do," Smith said. "Every day is a challenge for the student, because he sees just how much more he can do."
Smith said he learned about the Ocala, Florida, native through a woman at his church. She was telling him about the problem she was having placing French in a work environment as part of his studies at the center.
Smith said he told her he was interested, and they contacted him back, saying the program was free to him and that they were fully insured. "We were skeptical at first," he said, "because we do so much with sight. But we have learned about the things he can do."
Smith said at first all the other shop employees didn't want to work with French because they were just not sure what he would be able to do. After a couple of days, however, everyone wanted to work with him. "His attitude is just so good," Smith said. "He came in saying, `what can I do?' and `put me to work.'"
French said it has been hard at times, especially after he went blind. But it didn't take long for him to realize there was more to life than being disabled. "When I woke up in the hospital," he said, "I was just happy to be alive. Being able to see was the last thing on my mind. They told me I was blind, but I was alive."
After getting out of the hospital, he said he sat around his house trying to get his life together. It took him a while to make that decision. "You can only walk around and listen to music for so long," he said. "I decided I needed to learn my Braille and sharpen my computer skills," he said. "Being blind is like starting over. It is like being a child. Everything is a new experience."
French has been at the school for nine months. In a few weeks he will complete his education and head back to Florida. He will try to re-enroll in the auto tech school, graduate, and get a job.
"I want to work," he said. "Seventy percent of blind individuals are jobless. I want to work in the auto body field. It is something I enjoy. I want to be a productive individual in society. Getting a Social Security check is not my idea of a life. You have to be working. The day goes by so much faster. I also want a normal lifestyle. A person with sight is expected to get off his butt and work. It should be the same for a person without sight."
The work has had a positive impact on French. But has French had an impact on his co-workers at the Hodge shop? He believes it has. "I think I have changed their opinion of blindness," he said. "They are still kind of leery, but they are positive about it. In three weeks, when I am finished, I will have completely changed their minds."
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THE MIRACLE OF LIFE
by Lindy Guidry
I am a very fortunate and very grateful woman. I awaken each morning, pinch myself, and marvel in the realization that I am still here! I rejoice in the miracle of being alive, well, and strong.
People who meet me today, look at me and see a healthy, vibrant woman, but 11 years ago, the picture was much different. I was diagnosed with type 1 juvenile diabetes at the age of 11, and in the 23 years following that diagnosis, the disease devastated my body.
Doctors considered me "a brittle diabetic," as I was unable to control my blood sugar despite careful monitoring of diet, exercise, and insulin therapy. I was testing my blood four to five times daily, and taking four insulin injections during the course of a day. I was under the best of medical care; but despite my competent physicians, and my most careful efforts, my blood sugar ran rampant. Sometimes my glucose levels would fluctuate from 50 to 500 then back to 50 in the course of a single day.
Years of struggling with diabetes left me blind, in severe pain from neuropathy, riddled with infections, almost bed-ridden, and unable to walk without assistance. The disease destroyed both of my kidneys, and I was dependent on dialysis treatments to keep my body free of deadly toxins. My weight had dropped to below 70 pounds, and there was little hope for my survival. I wrote my will, made my own funeral arrangements, and waited to die.
Dialysis was a nightmare that happened three times a week. I had to be carried to and from each session, where I spent three to four hours passing out, throwing up, and having severe cardiac complications. I had several strokes while on dialysis, and each ordeal left me weaker, and almost completely unable to carry on with the normal activities of daily living. I remember telling my family, "It hurts just to breathe."
Doctors J. Phillip Boudreaux and Daniel J. Frey, now of the Transplant Institute of New Orleans, Louisiana, were convinced that my only hope for survival was a kidney-pancreas transplant; an experimental procedure that would cure both my renal failure and my diabetes. After the lengthy physical and psychological testing procedure, I was placed on the waiting list for an organ donor. My condition continued to deteriorate, and I spent weeks in the hospital.
I was dying.
On August 8, 1993, a donor match became available. Scott Buhler, the eight-year-old son of Mr. And Mrs. Sam Buhler of Marrero, Louisiana, died from a brain aneurysm, and his family, in their time of great loss and sorrow, chose to pass on the gift of life, through organ donation. After searching for my donor family for ten years, we found each other, and in August of last year, we met for the first time. We have become fast friends, and I will be forever grateful to this wonderful family for giving me a second chance at life.
I was the first patient to receive a multi-organ transplant at the University Hospital of New Orleans. Many of the nurses responsible for my cared dubbed me their "demonstrator model." My transplant surgery, my miracle of life, took over 13 hours.
My renal failure was completely cured by my newly transplanted kidney, and dialysis immediately became a thing of the past. My diabetes was cured by the transplantation of the new pancreas, forever erasing the need for dietary restrictions, daily blood sugar testing, and insulin injections. My blood sugar is now perfectly controlled by my new pancreas, and I am enjoying eating the foods that I missed for over 23 years -- even pecan fudge ice cream and cheesecake!
I've gained weight, and am up to what my physicians consider a healthy maintenance weight of 115 pounds. I have regained some limited vision in one eye, and I am no longer in total darkness The neuropathy has also improved along with every aspect of my physical being.
In the last 11 years, my life has undergone significant, amazing changes. Since my dual transplants, I returned to the University of Louisiana at Lafayette, and earned a Bachelor's of Arts degree in Sociology. I am very proud that I earned a place on the Dean's list every semester of my university program.
Four years ago, I met and married a wonderful man, Raymond F."Skip" Guidry, Jr., and together, we share our lives with our combined family of five children. I am 44 years old now, and lead a very active and busy lifestyle. I ride motorcycles with my husband Skip, and sons Aaron and Jason. I also ride Paso Fino horses with my daughters Amber and Danielle. My daughter Katie, who was only 10 years old at the time of my transplants, is going to make me a first-time grandmother in September! I can't wait!
I am going back to school, to work on my Master's Degree in Rehabilitation Counseling, and eventually hope to work with people who are facing the challenges of significant visual and physical disabilities.
I want to make every day of my life count, and am determined to make the very most of my second opportunity. I have written a cookbook and home management guide for the visually impaired homemaker called "Dinners in the Dark," and am currently working on another autobiographical book. Through this next endeavor, "Laughter in the Dark," I want to share my unusual life experiences, the challenges I have faced, and my first-hand knowledge that despite the difficult challenges, there is always hope! Always!
Every breath I've taken in the last 11 years, every moment I've spent with my husband, my children, and my loved ones, every thing I've accomplished, every dream I've been able to attain, is directly attributable to the miracle of organ donation and transplantation.
Where there is life, there is hope, and both are very beautiful things. Yes! I am a very fortunate and very grateful woman.
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BOOK REVIEWS
by Ruth Mencl, MN, RN, CDE.
Diabetes Program Manager, Saint Luke's Hospital, Kansas City, MO
Includes photo of Ruth Mencl, MN, RN, CDE.
A Field Guide to Type 2 Diabetes: The Essential Resource from the Diabetes Experts. (American Diabetes Association, 2004)
This book delivers as advertised. Its format is similar to a travel guide, which makes it easy to find the destination (or topic) of choice and go directly to it. Tables and charts allow for a quick reference to facts about laboratory tests or medications. The addition of a personal touch, such as comments from actual patients on topics taken from the ADA web site, give it a unique focus as compared to other diabetes fact books.
The Field Guide pays special attention to everyday issues that people with diabetes face, such as finding medical services or dealing with a doctor who is not very interested in diabetes. These are issues it might take several years for a patient to address, especially if they don't attend diabetes classes or support groups. This is a comprehensive resource, written by well-known diabetes experts, which serves as a good beginner's guide to the nuts and bolts of diabetes.
The Inflammation Syndrome: The Complete Nutritional Program to Prevent and Reverse Heart Disease, Arthritis, Diabetes, Allergies, Asthma. by Jack Challem (2003, Wiley)
"Inflammation Syndrome," is the term used by the author, but was not found when our medical librarian searched the professional medical literature. It does not appear to be a standard medical diagnosis. However, as it relates to diabetes and heart disease, the process of inflammation has been linked to the development of insulin resistance and diabetes and plays a key role in heart disease.
Some of the author's dietary recommendations are also being recommended by diabetes and cardiovascular experts, such as fish oil supplementation, flax seed, and general avoidance of processed food in reducing heart disease in this population of patients. Some are more controversial and require more critical thinking by the reader. Mr. Challem's expertise is as a health journalist, not as a medical doctor.
Challem does include extensive references on inflammation from reputable medical journals. This book is for the more experienced reader who already has general diabetes knowledge and is still looking for specific help for individual problem areas. It includes recipes and goes extensively into nutritional supplements. It provides some good "food for thought" but should be taken with a grain of salt".
Dr. Bernstein's Diabetes Solution Revised and Updated: The Complete Guide to Achieving Normal Blood Sugars. by Richard K. Bernstein, M.D. (2003, Little, Brown, and Company)
Dr. Bernstein writes from his own long-term struggles with type 1 diabetes, as well as his experience in caring for patients with diabetes over the years. His background was first as an engineer, which led him to blood glucose monitoring before it became an accepted practice in diabetes treatment. He has utilized his scientific methods to fine tune his own diabetes. He includes the story of these struggles as he goes through the book.
He describes basic information about diabetes and its effects on the body in a clear fashion. His theories about severe restriction of most carbohydrates, extremely frequent blood glucose monitoring and small, frequent insulin injections are controversial and would be quite challenging for most people to achieve. A number of the products he recommends are not readily available, adding expense and inconvenience to the challenging regimen.
Dr. Bernstein recommends patients take his book to their doctor, but since it has no medical references included, most doctors would require more evidence before implementing his treatments. He does include some beneficial suggestions about healthy eating and exercise; but I fear the reader may become discouraged with the complexity of his recommendations. This book appears to be most appropriate for a niche group of people with diabetes, type 1 or type 2, who have not achieved control with conventional methods of diabetes treatment and are searching for alternatives.
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ASK THE DOCTOR
by Wesley W. Wilson, MD
Includes art: Medical Caduceus.
NOTE: If you have any questions for "Ask the Doctor," please send them to the VOICE editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.
Wesley W. Wilson, MD, has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals.
Q: I've had type 2 diabetes for 31 years. Most of that time, I've been pretty overweight, and just recently, my doctor started me on Lantus insulin, and got me on a serious weight loss program. It's working -- I'm losing weight. Am I going to need less Lantus, or other medications, as I lose the weight? What is the relationship between amount of medication and degree of overweight for a type 2 person like me?
A: It's great that you've heard the call and have lost weight and, I suspect, improved your blood sugar levels. I'd encourage you to write an article giving your insights into how you were able, after 31 years, to come to grips with your overweight problem and achieve weight loss. I'll bet your program included at least some increased activity (exercise) since addition of insulin to a diabetes control program makes weight loss even harder. You are proof that with dedication, even difficult goals can be achieved.
Type 2 diabetes is at least, in part, caused by insulin resistance. This means that any given amount of insulin will have less blood sugar lowering effect than in a person without insulin resistance. We have two very powerful ways to reduce insulin resistance: Weight loss and exercise. Both act to make a person more sensitive to the effects of insulin. Weight loss and increased exercise both will reduce your need for added insulin. The problem is -- I can't tell you how much your need for insulin will change with a specific amount of weight loss or increase in exercise. Each person responds a bit differently to weight loss, exercise, or to insulin itself. I can be definite, however, that you will be increasingly sensitive to insulin as long as you continue weight loss and exercise.
Insulin is a powerful drug that can lower the blood sugar to below normal (hypoglycemia) and therefore must be monitored very carefully. I feel that persons who use injected insulin must check blood sugar levels more often than those not using insulin. Symptoms of low blood sugar include nervousness, shakiness, hunger, sweating, and irritability. If not detected and treated with some sugar, the symptoms may progress to confusion, or even convulsions or coma. This is another place where you must take control and check blood sugar if unusual symptoms occur, and then take some sugar if needed. After that, discuss the hypoglycemia with your doctor. I think it's very likely that your dose of Lantus will be reduced as you continue weight loss. I've seen some persons who were able to eliminate insulin injections with exercise and weight loss.
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RECIPE CORNER
Includes drawing of fruits and vegetables.
The recipes for this issue were all evaluated for their nutritive value and exchanges by Mary McCreery, RD, who works for the Freeman Health System in Joplin, Missouri.
FETA JORVIK
By Sandy Nebergall
of Scarborough, England
Ingredients:
4 medium red potatoes, unskinned
4 ounces feta cheese
1 medium onion
4 small sticks celery
14 ounces chopped tomatoes
4 ounces vegetable juice*
Instructions:
Line a greased dish with the thinly sliced potatoes, uncooked. Chop the celery and onion. Crumble the feta. Season lightly with salt, pepper, and garlic powder. Finish each layer by spreading 1/4 of the tomatoes.
Continue layers till all the ingredients are used. Top with a sprinkling of Parmesan cheese. Add the 4 ounces of vegetable juice.
Bake covered in medium oven at 350 degrees for 1-1/4 hours. Uncover, and continue to bake till moisture is absorbed, and dish is slightly browned.
Serve with rounds of toast and lots of salad. Serves four.
Per serving: 254 calories; 45g carbs; 7g fat; 688mg sodium; 25g cholesterol; 3g fiber. Exchanges: 3 carbs.
NOTE: One "round of toast" is one slice cut into halves or quarters for serving.
*I steam all vegetables. The water which is left over after cooking, if not required for making sauce or gravy that day. I cool it, store it in a jar, and refrigerate to use for stock or soups the next day. It contains flavour and vitamins, and is an excellent base for many types of soups, sauces, and gravies.
OAT WAFFLES
By Lois Williams
of Huntsville, Alabama
Ingredients:
4 cups water
3 cups oats
1/4 cup pecan meal
1/2 teaspoon salt
2 tablespoons honey or 4 dates (optional)
1/2 cup coconut
2 tablespoons flavoring (your choice)
Instructions:
Put water and honey (dates) in blender and blend one minute. Add oats, then all other ingredients and blend well. Pour onto hot waffle iron and cook ten minutes.
Strawberry Glaze:
Ingredients:
1 can frozen apple juice
1 bag frozen unsweetened strawberries
3 tablespoons cornstarch
1 juice can of water
Instructions:
Put juice in saucepan and dissolve. Mix cornstarch in water and stir well. Add to saucepan, then add strawberries and cook about 20 minutes. The mixture will be clear when it is done. Serves twelve.
Per serving: 141 calories; 64g carbs; 4g fat, 88mg sodium, 2g fiber. Exchanges: 4 starch; 1 fat.
DIABETIC CAKE
by Linda Carstens
from Virginia, MN
Ingredients:
1 cup raisins
1-1/2 cups water
1/2 cup shortening
1 egg
1 cup oatmeal
1 tablespoon artificial sweetener
1 cup flour
1 teaspoon baking soda
1/4 teaspoon salt
1/2 teaspoon cinnamon
Instructions:
Boil raisins and water. Add other ingredients. Bake in loaf pan at 350 degrees until done (about 45 minutes). Makes 20 slices.
Per Serving: Calories: 115; Exchanges: 1 starch; 1 fat.
CUSTARD SPICE PIE WITH MOCK CRACKER PIE CRUST
by Mary McCreery
Joplin, MO
Mock Cracker Pie Crust
Ingredients:
1 cup All Bran or Fiber One cereal
water
sugar free sweetener
spice
Instructions:
Crush the cereal to fine crumbs in a Ziploc Baggie. Add any sugar-free sweetener and spice to taste (example: cinnamon or nutmeg). Shake together. Dump evenly into a 9-inch pie plate. Drizzle a LITTLE water at a time to moisten the crumbs. Spread and press the crust evenly.
Use as stated in the recipe either by baking it, or simply pouring the filling in and then baking it, or refrigerate.
Custard Spice Pie
Ingredients:
1 cup Splenda
1/2 cup sugar
1 teaspoon of allspice, cinnamon, and nutmeg
1-1/2 cups mashed pinto beans
1 egg, beaten
1 teaspoon vanilla
Instructions:
Combine the sugar and spices into a medium mixing bowl and mix well. Add beans, egg, egg yolks, and vanilla and mix until smooth. Pour into the pie crust.
Bake at 350 degrees for 15 minutes. Reduce heat to 300 degrees and bake for 45 minutes, or until set. Let cool before serving. Makes 6 servings.
Per serving: 172 calories; 24g carbs; 3g fat; 109mg cholesterol; 27mg sodium; 3g fiber; 9g protein. Exchanges: 1-1/4 starch.
You can replace the 1/2-cup sugar with 1/2-cup Splenda, but I thought it turned out better by leaving a little sugar in it. If only Splenda is used there are 91 calories and 8g carbs per slice. The other nutrients remain the same. Exchanges: 3/4 starch.
TIP: Put the beans through a food processor or blender to make them very smooth.
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DIABETES AND ADULT ATTITUDE
by Peter J. Nebergall, PhD
Good diabetes self-management imposes limits on one's behavior. We know this. We understand these limits, and most of us understand (at least intellectually) the reasoning behind them.
But we're stubborn. We don't like anyone "telling us what to do," so we resist. We don't want to "give in to a bully," even one named diabetes. It's a macho thing.
But we have to grow up, if we would keep our eyes, our legs, our kidneys... To the child, "limits" are external. They are "rules" imposed by someone else. To the child, a "limit" is meant to be tested, pushed, overcome. Limits are there to be transcended -- without getting caught.
For the adult, legitimate limits (such as those imposed by a medical condition) are a part of the self. They have mutated from "rules" into limitations. The adult seeks knowledge of his limits as he would of a minefield. They are not flouted, but avoided.
Where do you fit? We all know we should keep to our diet and exercise schedules, test often, and take our prescribed medications on time -- but do you?
If you see diabetes as a bellowing bully trying to "make you behave," perhaps you'll not be as ready to do what you need. You won't be as enthusiastic, about your self-management, as you should be.
Diabetes isn't a bully. We shouldn't think of it that way. It's not "diabolical." It's just a set of circumstances that imposes some limitations -- and if we work within those limitations, if we keep an adult attitude, we can thrive.
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HEALTHY HOME COOKING
by JoAnna M. Lund
Includes photo of JoAnna Lund.
Welcome back into my kitchen, where the cooking is easy and the food is both healthy and tasty! I have more cooking tips to share with you, and a few recipe makeovers I've gladly created, in the Healthy Exchanges way. Hope you enjoy.
Did you know that you can make your own fruit-flavored yogurt by mixing 1-1/2 tablespoons of any flavor spreadable fruit spread with 3/4 cup plain fat-free yogurt. It's every bit as tasty, and much cheaper than "store-bought." I love my homemade fruit yogurt, and it's a great calcium boost at breakfast time or as a late afternoon snack.
Another quick tip for that plain fat-free yogurt, now that you've purchased it to make personalized fruit flavored yogurt: if you want to use it instead of sour cream in baked or cooked recipes, just remember to stir 1 teaspoon of cornstarch into every 3/4 cup of yogurt. This will help to stabilize the yogurt and your finished product will be much creamier!
Any time you're browning ground beef for a soup or casserole and want to get rid of almost all the excess fat, just place the meat loosely in a plastic colander. Set the colander in a glass pie plate and place in your microwave. Microwave on HIGH for 3 to 6 minutes (depending on the amount of meat being browned) stirring every so often. The fat gets trapped in the pie plate, and you're left with flavorful browned meat. You can chop up onion or green pepper and stir into the meat before browning, if you choose. With this quick tip, can a satisfying bowl of chili be far behind?
The secret of making good meringues without sugar is to use 1-1/2 tablespoons of Splenda Granular for every one egg white and a small amount of any flavor extract. About 1/2 teaspoon to 1 teaspoon should be fine. Let's say you're using six egg whites (I've discovered this is the perfect number to make a spectacular looking meringue on just about any baked pie); after whipping them into soft peaks with your electric mixer, carefully add about 1/2 cup of Splenda and one teaspoon of vanilla, almond or coconut extract. Be sure to seal edges of pie when piling this on top, and then bake the meringue in the same way you always did. Didn't think you could enjoy meringue pies any more just because you can't eat all that sugar? You can ... my way!
A few more tricks of the trade concerning meringue pies: Egg whites beat best at room temperature, and, meringue pies cut more easily if you dip a sharp knife into warm water before slicing.
A really good topping for this time of year is to place 1-1/2 cups unsweetened applesauce in a medium saucepan or a four-cup glass measuring cup. Stir in 2 tablespoons raisins, 1 teaspoon apple pie spice and 1/4 cup Log Cabin Sugar Free Maple Syrup. Cook over medium heat on stove or on HIGH in the microwave until mixture is warm, stirring occasionally. Then, spoon about 1/2 cup of this warm mixture over pancakes, French toast or even fat- and sugar-free vanilla ice cream. It should make four (1/2 cup) servings. It's as close as you'll ever get to guilt-free apple pie!
Want a sprinkling of powdered sugar on your brownies or other baked goods? To make an acceptable substitute for powdered sugar, place 1 cup of Splenda and 1 teaspoon cornstarch in a blender container. Cover and process on HIGH for 45 to 60 seconds or until mixture resembles powdered sugar. Store in an air-tight container and use whenever you want a dusting of powdered sugar over the top of anything.
Now for our Recipe Makeovers
LM, of MO, requested a healthy version of a spectacular baked potato soup that she's enjoyed in a restaurant while on vacation. While my version starts with hash browns instead of baked potatoes, being Irish, all potatoes are sacred to me!
Stuffed Spud Soup
Ingredients:
1/2 cup chopped green onion
1 (10-3/4-ounce) can Healthy Request Cream of Mushroom Soup
1 cup fat-free milk
1/2 cup Land O Lakes Fat Free Half & Half
3 cups frozen loose-packed shredded hash brown potatoes
1/2 cup diced Velveeta Light processed cheese
1/4 cup Oscar Mayer or Hormel Real Bacon Bits
1/8 teaspoon black pepper
Instructions:
In a medium saucepan sprayed with butter-flavored cooking spray, saute onion for five minutes. Stir in mushrooms soup, milk, and half & half. Add hash browns, Velveeta cheese, bacon bits, and black pepper. Mix well to combine. Lower heat and simmer for 15 minutes or until mixture is heated through and potatoes are tender, stirring occasionally.
HINT: Mr. Dell's frozen shredded potatoes are a good choice or raw shredded potatoes, rinsed and patted dry, may be used in place of frozen potatoes.
Serves four (1 cup each); each serving equals:
181 Calories, 5gm Fat, 10gm Protein, 24gm Carbo., 816 mg Sodium, 1 gm Fiber; Diabetic Exchanges: 1 1/2 Starch/Carbo., 1 Meat
CW, of IL, sent me an almost unbelievable recipe to make over for her. Believe me, you'll be mighty glad she did, the next time you want a quick frosting for a cake or brownies!
Speedy Baked Frosting
Ingredients:
1/3 cup Splenda Granular
1 tablespoon all-purpose flour
3 tablespoons I Can't Believe It's Not Butter Light Margarine
1 tablespoon water
1/4 cup chopped walnuts
Instructions:
Preheat oven to 350 degrees. In a medium bowl, combine Splenda and flour. Add margarine and water. Mix well to combine. Stir in walnuts. Evenly spread over top of a cake or batch of brownies already baked in a 9-by-9-inch cake pan. Bake for 5 minutes. Place pan on a wire rack and let set for at least 10 minutes. Cut into 8 servings.
Serves 8 -- for topping only -- each serving equals:
48 Calories, 4mg Fat, 1 gm Protein, 2 gm Carbo., 34mg Sodium, 0gm Fiber; Diabetic Exchanges: 1 Fat
I hope you enjoyed our time together in the kitchen. Remember, If you'd like me to revise one of your family favorites so it's healthier, send your request to: JoAnna Lund, Healthy Exchanges, PO Box 80, DeWitt, IA 52742. Also, be sure to visit my website at www.healthyexchanges.com for more "common folk" healthy recipes to try. Until next time ....
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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."
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CHECK YOUR HEMOGLOBIN A1c I.Q.
(The following is reprinted courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the U.S. National Institutes of Health.)
Find out how much you know about the Hemoglobin A1c test (also called HbA1c). Mark each statement true (T) or false (F). Then see how you did by checking the correct answers and explanations, found below.
1. A Hemoglobin A1c test measures the average amount of sugar in your blood over the last three months.
T F
2. It's important to know your Hemoglobin A1c number.
T F
3. All people with diabetes need to have a Hemoglobin A1c test.
T F
4. The Hemoglobin A1c goal for people with diabetes is less than 7 percent.
T F
5. Most people can tell what their blood sugar levels are simply by how they feel.
T F
6. You can have a "touch of sugar" but don't have to do anything about it.
T F
7. You can do something about high blood sugar.
T F
8. A Hemoglobin A1c number over 8 percent is a sign that one or more parts of your treatment plan needs to be changed.
T F
9. A Hemoglobin A1c test should be done about once a year.
T F
10. There's no proof that lowering your Hemoglobin A1c number can reduce your chances of getting serious eye, kidney, and nerve disease.
T F
Answers to the HEMOGLOBIN A1c I.Q. QUIZ:
1. TRUE: The Hemoglobin A1c test shows the average amount of sugar in your blood over the last three months. It is a simple lab test done by your health care provider. The Hemoglobin A1c is the best test to find out if your blood sugar is under control.
2. TRUE: If you know your Hemoglobin A1c number, you will know if your blood sugar is under control. A high number is a sign you should work with your health care provider to change your treatment plan. A good test result is a sign your treatment plan is working and your blood sugar is under control.
3. TRUE: All people with diabetes should have a Hemoglobin A1c test at least twice a year. Regular Hemoglobin A1c testing can help you track your blood sugar levels over time to see if they stay close to normal or go up and down. If your blood sugar levels are too high or too low, work with your health care provider to change your treatment plan and reach your target level of control.
4. TRUE: The Hemoglobin A1c goal for people with diabetes is less than 7 percent. The findings of a major diabetes study, the Diabetes Control and Complications Trial (DCCT), showed people with diabetes who keep their Hemoglobin A1c levels close to 7 percent have a much better chance of delaying or preventing diabetes problems that affect the eyes, kidneys, and nerves than people with Hemoglobin A1c levels 8 percent or higher. A change in treatment is almost always needed if your Hemoglobin A1c is over 8 percent. But, if you can lower your Hemoglobin A1c number by any amount, you will improve your chances of staying healthy.
5. FALSE: Research shows few people can tell their blood sugar levels simply by how they feel. Testing your blood sugar is the only way to know for sure whether you are reaching your blood sugar goals.
6. FALSE: If you have "sugar" you have diabetes. Diabetes is a serious disease that causes the sugar in your blood to build up in your body. This build-up of sugar can cause you to go blind, suffer a heart attack, lose your feet or legs to amputations, stop your kidneys from working, and even kill you. There is no cure for diabetes, but there is a lot you can do to control it. For example, you can see your health care provider more often. You can change some of the foods you eat. You can stay at a weight that is right for you. And you can get regular physical activity.
7. TRUE: You can do a lot to bring down high blood sugar and get it under control. Start by asking your health care provider for a Hemoglobin A1c test. If your Hemoglobin A1c test result is too high, talk to your health care provider about how to lower it. To get your blood sugar under control, follow the meal plan recommended by your health care provider, stick to a physical activity program, take prescribed diabetes medicines, and consult your health care provider often.
8. TRUE: A change in treatment is almost always needed if your Hemoglobin A1c is over 8 percent. Common causes of high blood sugar include eating too much food or eating the wrong foods, lack of physical activity, stress, a need to change medicines, and infection or illness. If your Hemoglobin A1c number is too high, work with your health care provider to change your treatment plan and reach the goal of less than 7 percent.
9. FALSE: You should get a Hemoglobin A1c test at least two times a year if your blood sugar is in the target range and stable. If your treatment changes or if your blood sugar stays too high, you should get a Hemoglobin A1c test at least every three months until your blood sugar level improves.
10. FALSE: The DCCT showed the lower the Hemoglobin A1c number, the greater the chances people with diabetes will slow or prevent the development of serious eye, kidney, and nerve disease. The study also showed that if you can lower your Hemoglobin A1c number by any amount, you will improve your chances of staying healthy.
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RESOURCE ROUNDUP
Inclusion of materials in this publication is for information only; it does not imply endorsement of any product by the Diabetes Action Network of the NFB.
Diabetes and the Tube
(As reported in Diabetes In Control, April 2004): TV watching is (as common sense would suggest) associated with both an increased risk of obesity and increased instances of type 2 diabetes. A six-year study has provided data suggesting each 2- hour increase in "sitting and watching" is associated with a 223- percent increase in obesity, and a 14-percent increase in overt type 2 diabetes.
Diabetes Supplies
American Diabetic Supply, Inc., will ship your diabetes supplies to your door. They handle all insurance claims and provide free delivery. Folks with Medicare and/or private insurance (no HMOs) may receive supplies with no further cost. For information, contact: American Diabetic Supply, Inc., 400 S. Atlantic Ave., Suite 108, Ormond Beach, FL 32176; telephone: 1-800-453-9033, ext. 200; website: www.americandiabeticsupply.com
Diabetic Products
Health Care Products makes many over-the-counter medications and supplements for diabetics, including Diabetic Tussin cough syrup and DiabetiDerm skin cream (with L-Arginine) for the feet. Find these products in the diabetic section of Eckerd, Osco, Sav-on, Target, GNC, and other retailers. For information, contact: Health Care Products, 369 Bayview Avenue, Amityville NY 11701; telephone: 1-866-263-9003; website: http://www.diabeticproducts.com
Now Available
Deltec (now Smith's Medical) announces the Cozmonitor, a compact blood glucose monitor that attaches to and communicates with their Cozmo insulin pump. Co-designed by Freestyle, the monitor uses easily available Freestyle test strips, and displays test results on the pump's screen. Once you test, the pump will display suggested doses for you, cutting the need for computation.
It's free. If you already have a Cozmo pump, you can have the Cozmonitor at no charge. All Deltec Cozmo insulin pumps will accept the Cozmonitor (older pumps may need a free software upgrade), and the monitor is available now, either ready for your pump, or with a new Deltec Cozmo pump. New pumps (with monitor) cost $5595, and come with a four-year guarantee. Contact: Smith's Medical, 1265 Grey Fox Road, St. Paul, MN 55112; telephone: 1-800-826-9703; website: www.delteccozmo.com
Hear Your Computer
Computer programs and operating systems are constantly improving. If you are blind, and use a screen reader, a program that speaks the screen content to you, so you can work without sight, is it keeping pace? GW Micro, maker of the Window Eyes series of screen reading software, announces Window-Eyes 4.5 SP3, its latest update of its program designed to take full advantage of the newest generation of Windows' capabilities. For information or free demo disk, contact: GW Micro, in Fort Wayne, Indiana; telephone: (260) 489-3671; fax: (260) 489-2608; e-mail: [email protected]; website: www.gwmicro.com.
Diabetes Supplies
Do you get tired of having to "shop around" for your various diabetes items? "Go to this place for these; to that place for those ..." Do something about it. Check out diabetesstore.com, the leading online source for discount diabetes products. Contact them by telephone: 1-800-891-9399; or website: www.diabetesstore.com
Easy Diabetic Cookbook
If you want to prepare healthy diabetic meals, but find most cookbooks just too complicated, you need Linda Coffee and Emily Cale's new and improved Diabetic 4 Ingredient Cookbook. There are almost twice as many recipes as before; 350, in all food categories, with complete nutritional and exchange information, each one using four ingredients. The book costs $19.95 (+$3.50 shipping), from: Coffee and Cale, PO Box 2121, Kerrville, TX 78029; telephone: 1-800-757-0838; www.fouringredientcookbook.com
New E-mail Diabetes List
Our Diabetes Action Network now offers its own 'listserv,' [email protected]. Although its primary focus is on blindness and diabetes, any and all discussions concerning diabetes are welcome. We welcome topics like: diet, devices, healthcare, diabetes control, and how to improve the Voice of the Diabetic. Remember, please do not give any direct medical advice, unless you are a medical professional. Membership is free, and open to all.
There are two ways to sign up. You can go to the following website: www.nfbnet.org/mailman.listinfo/diabetes-talk or you can sign up by e-mail, by sending a message to: [email protected] and putting "subscribe" in the subject line.
It's Here
With its long, flat response, Lantus insulin very quickly carved a place for itself in diabetes care. With one shot every 24 hours, it was ideal for veteran type 2 diabetics beginning insulin therapy -- but something was missing: There were no "pen" cartridges -- only vials. That just changed.
Aventis announces Lantus insulin in a pen. The Food and Drug Administration has approved Aventis' OptiClik insulin pen, and it will be distributed, loaded with Lantus. Aventis reports when its new Apidra quick-acting insulin analog becomes available, it will be offered in an OptiClik pen as well. Talk to your pharmacist.
Low Carb Ice Cream
Ice cream is traditionally about the first thing diabetics have to give up, to stay on their meal plan. Oh, but we miss it -- especially when the new diabetic is a kid. Now "low carb" ice creams are easier on your meal plan, but they're not all created equal, and some still cling to the fiction of "net carbs." Many taste "strange" -- ask any diabetic teenager. Or better, get it right the first time. Check out Carb Escapes, from Turtle Mountain. Flavors are Butter Pecan, Chocolate, Chocolate Almond, Mint Chip, Chocolate Peanut Butter, Strawberry, and "White Mousse." Calories vary, but run as low as 110 per serving. They're soy-based, sugar free, low carb, with only 1 gram sugar alcohols. Carb Escapes also offers a line of low-impact ice cream bars. And they pass the taste test! Contact: Turtle Mountain, Inc., PO Box 21938, Eugene, OR 97402; telephone: 1-866-3887; website: www.carbescapes.com
Relief
Many diabetics suffer from dry feet. It "goes with the territory." They hurt, they itch, they dry out and crack, and you need to do something about it. Sometimes neuropathy, nerve inflammation, in your feet can really drive you 'round the bend. But Steuart Laboratories offers help. Steuart's Foot Cream, with melalenca oil, is excellent for dry diabetic feet. Steuart's CNS Liposomes offers relief from neuropathy; also good for back, muscle, and joint pain. Prices (2 oz. jar): $9.25 plus shipping for the Foot Cream; $19.80 for the CNS Liposomes. Contact: Steuart Laboratories, PO Box 297, Harmony, MN 55939; telephone: 1-800-210-9665; website: www.steuartlabs.com
Full Service Diabetes Supplier
Access Diabetic Supply promises free delivery, no paperwork, and free in-home training in the use of blood glucose testing devices. Your private insurance is welcome, and they accept Medicare, too. They offer free blood glucose monitors to folks who sign up. Check them out on line: www.diabeticsupply.com or call: 1-800-713-7062.
America's Jobline
Blind job-seekers have traditionally been at a disadvantage, as few job vacancies have been widely posted in accessible format. In response, the National Federation of the Blind has developed technology to access and search computer database files with a standard touch-tone telephone -- and now anyone can access a million or more current job listings, free of charge, by telephone. To access America's Jobline, simply dial: 1-800-414-5748. America's Jobline is instantly available, 24 hours a day, providing all job announcements in a high-quality synthesized speech format. The system provides callers the ability to search America's Job Bank (sponsored/administered by the U.S. Department of Labor and state workforce-development agencies), allows job seekers to create and store in the system personal job-search profiles (electronic resumes) for use in quickly locating vacancies for which they are qualified; and it allows users the option to retrieve, if they wish, only the new and relevant job listings posted since the last call, or all previously saved announcements. To try Jobline yourself, call: 1-800-414-5748. NOTE: Not all states currently subscribe to Jobline; the list changes frequently -- contact the NFB (410-659-9314, in Baltimore) if the above 800# does not work in your area.
To learn more about America's Jobline, contact: National Federation of the Blind, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314; website: www.nfb.org
New Hypoglycemia Alarm
Diabetes brings with it the risk of hypoglycemia, low blood sugar. Some of us need some help. What many of us need is an alarm, a device to warn us we're going low, when we cannot tell for ourselves. There is now such a device -- FDA approved.
Diabetes Sentry Products, from Bellingham, Washington, offers the Sleep Sentry, a wrist watch-sized device that sounds an audible warning whenever the wearer's blood sugar drops too low. Not a blood glucose monitor, this noninvasive device meters changes in body temperature and sweat consistent with hypoglycemia, and sounds a warning in time for you to take action. Completely noninvasive and continuous, the Sleep Sentry costs $399, shipping included, and may be ordered from: Diabetes Sentry Products Inc., 1200 Dupont St., Suite #1D, Bellingham, WA 98225; telephone: 1-866-270-5675; website: www.sleepsentry.com
New Free Magazine
We have been asked to announce: Nestle's has a new free diabetes magazine. Called Everydayeating, it features food hints, discount coupons, articles, and ads for reduced-calorie and low-carb Nestle' products. To subscribe, telephone: 1-800-634-5508, or go to their website: www.everydayeating.com
Medical Equipment and Supplies
Specialty Shoes and Diabetic Supplies, Inc., from Beaumont, Texas, is a one-stop supplier for your diabetes needs. They stock blood glucose meters, strips, lancets, vacuum erection devices (for diabetic impotence) other diabetes care items, and, of course, specialty pedorthic footwear. They accept Medicare, Medicaid, Blue Cross, Blue Shield, and private insurance. Contact them at: SSDS, 229 Dowlen Road, Suite 15A, Beaumont, TX 77706; telephone: 1-877-817-7737; e-mail: [email protected]
Adaptive Computing Equipment
Freedom Scientific is a powerhouse adaptive equipment-maker for the blind and visually impaired computer user. A union of Arkenstone, Blazie Engineering, and Henter-Joyce, Freedom Scientific offers screen magnifiers (including MAGic 9 software, which both magnifies up to 16x and speaks the words on the screen), talking attachments (voice synthesizers) for your computer, Braille printers and much more. Whether you need adaptive software or hardware, check them out: Freedom Scientific; telephone: 1-800-444-4443; website: www.freedomscientific.com
Healthy Cookbooks
JoAnna Lund writes healthy cookbooks. They are simple, "common folks" recipes, and all contain both complete nutrient counts and diabetic exchanges. There are three titles: Fast, Cheap, and Easy; Grandma Jo's Soup Kettle; and Fresh From the Hearth. Price is $10 each, or $25 for all three. There is no shipping charge. Contact: Healthy Exchanges, PO Box 80, DeWitt, IA 52742; telephone: 1-800-766-8961; website: www.healthyexchanges.com
NEWSLINE for the Blind
The National Federation of the Blind's NEWSLINE is an electronic publication of major daily newspapers, specifically tailored for blind and visually-impaired readers. Newsline electronically "reads" all of each day's edition, which is immediately made available via modem to the local distribution centers. Users listen to the articles they choose, read to them in a synthesized voice. The reader is free to jump between articles, sections, and publications, and to pick the speed of reading to suit their needs. There is no subscription fee, and Newsline is not the Internet, so no computer is necessary to use it, just a touch-tone telephone. Service is available to any person at least legally blind. There is no charge.
For further information, contact NEWSLINE Network, National Federation of the Blind, 1800 Johnson Street, Baltimore, MD 21230; telephone: 1-888-882-1629.
Diabetes Literature from NFB National Center
The National Federation of the Blind maintains an extensive literature collection, with free materials on many subjects available in a variety of formats. The articles listed below make up one part of the collection, the "diabetes" category. They are available, in large print or on audiocassette, in a single volume titled: Diabetes Action Network Articles, or singly, in large print. They are: "Arthritis and Diabetes: A Common Association," "Blind Diabetics Can Draw Insulin Without Difficulty," "Can I Eat Sugar?," "Carbohydrate Counting and the Exchange List," "Cardiovascular Health: Bypass May Be Better for Diabetics," "Check Your Hemoglobin A1c I.Q.," "Diabetic Eye Disease," "Diabetic Peripheral Neuropathy," "Diabetics, Don't Give Up on Braille," "Diabetes, Neuropathy, and the Feet," "The Emotional Side," "Finger-Sticking Techniques," "How I Went Blind...And Then What," "Hypoglycemia -- Low Blood Sugar," "Insulin Measurement Devices," "Insulin Types: A Review," "Keeping Your Feet," "Kidney Failure: Prevention, Dialysis, and Transplantation," "Male and Female Sexual Dysfunction," "Many Blind Diabetics Successfully Use Insulin Pumps," "Oral Diabetes Medications Update," "Talking Blood Glucose Monitoring Systems," and "What Is Diabetes Mellitus?" These are free of charge.
The Materials Center also has a supply, in Braille and on four-track audiocassette, of the new ADA Exchange List for Meal Planning, 2003. In Braille, price is $10; on tape, $2.
To order, or to request a complete NFB literature catalog, contact: NFB Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314. You may also order by e-mail: [email protected] The Materials Center is open 8:30 pm to 5 pm, EST, weekdays.
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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; their inclusion does not imply endorsement by the Diabetes Action Network of the NFB.
VOICE Formats
Voice of the Diabetic is offered in two formats: standard print, and 15/16 ips audiocassette, "talking book" speed. Anyone who is currently receiving the VOICE in print and having difficulty reading it, may receive it on cassette at no charge. VOICE tapes REQUIRE the special tape player available free to the legally blind from Regional Libraries for the Blind and Physically Handicapped, which can be obtained by telephoning the National Library Service at: 1-800-424-8567. Note: Attempting to play VOICE tapes (or any other tapes recorded for the Blind in NLS format) on a conventional music-speed tape player will fail, yielding only incomprehensible "chipmunk sounds."
The VOICE is also available, free, by e-mail, distributed quarterly. Go to: www.nfbcal.org/listserv-signup.html to sign up.
Periodically we receive requests for the VOICE in Braille or large print. It is not available in either of those formats at this time.
All a subscriber needs to do, to switch from standard print to tape, or to receive both formats, free of charge, is contact us at the Voice of the Diabetic Editorial Office.
Antibiotic Can Cause Hypoglycemia
Biaxin (clarithromycin), a very powerful antibiotic now widely used in the United States, has been linked to cases of hypoglycemia, when given to type 2 diabetics who are using sulfonylurea medications to control their blood glucose levels. Be sure, if you have diabetes and need this, or any other antibiotic, to test often, and keep aware; many medicines can interact -- and if you're not ready, you can find yourself in trouble. Talk to your doctor and your pharmacist about drug interactions.
Short Needle Caution
If you use a syringe to inject insulin, you have probably been offered new, shorter, "comfort-length" needles, to reduce injection discomfort. However, any switch in needle length needs to be done with care.
Your doctor can tell you whether shorter, or longer, needles might be better for your insulin injections (that's a medical problem), but needle length will affect your ability to accurately draw up insulin (that's a mechanical problem). If you are blind, and use the Count-A-Dose device, or another insulin gauge, to draw up and mix your insulins, be cautious: switching to the same size syringe, with shorter needles, can cause underdosing. You may think you dialed your usual number of units, but that's not what you got...
Shorter needles are not exactly equivalent to "standard length." Don't interchange them randomly; and if you switch, discuss it with your doctor, and then cross-check, to make sure you are drawing up an accurate insulin dose.
2004 Raffle Winners
At the keynote banquet for the 2004 annual convention of the National Federation of the Blind, in Atlanta, Georgia, the winning ticket was drawn in the Diabetes Action Network raffle. Winning ticket holder was Cathy Haveman, of Rapid City, South Dakota.
Lots of people helped sell tickets, and the following folks each sold 50 or more. In descending order of tickets sold: John Stroot, of Clinton, IN; Bee Walker, of Columbia, MO; Ken Staley, of Chicago, IL; John Barker, of Gary, IN; Karen Mayry, of Rapid City, SD; Marlene Hunn, of San Francisco, CA; Ed Bryant, of Columbia, MO; Tom and Eileen Ley, of Baltimore, MD; and the NFB of Mobridge, SD. Truly a winning performance--See you next time!
Reminder
Medications affect the body. That is their purpose. Used inappropriately, they can be dangerous -- as the only truly "safe" medication would be a very weak one. What, in this life, doesn't have risks, if used incorrectly?
Because old age brings with it so many health issues, the elderly consume a disproportionate number of prescription and over-the-counter medications. Some of these drugs were not specifically tested on seniors; others may be safe when taken alone, but not as part of a given multi-drug regimen. Sometimes the "alternative secret herbal remedy" you bought from the health food store will affect your prescription medications. The more you take, the more likely one pill will alter the action of another -- and seldom for the better.
What you don't know -- can hurt you. Does your doctor know everything you're taking, prescription or otherwise? Does your pharmacist? It's not just the seniors. Regardless of your age, when was the last time you reviewed your medications with either of these professionals? It's like an oil change in your car -- if you can't remember when you last checked, it's time to do it now.
New DAN Board Members
At the annual seminar and business meeting of the Diabetes Action Network, held on July 1, 2004 in Atlanta, Georgia, as part of the annual convention of the National Federation of the Blind, elections were held, to fill national board positions for the 2004/2005 year. Here are the results:
PRESIDENT: Paul Price
Valley Center, CA
FIRST VICE-PRESIDENT: Lois Williams
Huntsville, AL
SECOND VICE-PRESIDENT: Sandie Addy
Prescott Valley, AZ
TREASURER: Joy Stigile
Reseda, CA
SECRETARY: Joyce Kane
Stratford, CT
BOARD-MEMBER: Ed Bryant
Columbia, MO
BOARD-MEMBER: Josie Armantrout
Bemidji, MN
BOARD-MEMBER: Bruce Peters
Akron, OH
Type 2 Diabetes: Reduce Stroke Risk
New statistics show that though diabetes doctors know their patients are at high risk of heart disease and stroke, only approximately half treated their patients to get their LDL cholesterol levels down low enough to meet the guidelines. As high LDL (bad) cholesterol is a major cause of cardiac complications, to ignore it is very serious, to say the least.
High cholesterol is treatable. Along with diet and exercise, doctors routinely prescribe a class of medications called statins, such as Pfizer's Lipitor. And, in one study, diabetics with no previous history of cardiac events, who took statins prophylactically (i.e., before symptoms appeared), were 37 percent less likely to have a heart attack or stroke.
Get your cholesterol checked -- and talk to your doctor about what you can do to keep it down.
New Breath Mint
Diabetes is just one of a great many conditions that can produce bad breath. You know, just when there's someone you need to impress, you're wishing for your toothbrush ... Right. You've probably seen the little packages of breath fresheners -- they look like sheets of paper? This one's different.
We have been asked to announce: Momints, the original liquid-filled breath mint, are now available in two new flavors and a new package. Flavors are original peppermint, plus cinnamon and "Winter Burst." The original package (same size as the competition's little flat sheets) holds 36 mints, and suggested price is $1.69, but there are now also little tubes, each holding eight mints, with a suggested price of 50 cents. No sugar, and no sugar alcohol, either. Get them at 7-Eleven, Barnes and Noble College Bookstores, CVS, Sunoco, and more. Maker is Yosha! Industries, of Westfield, New Jersey. For information, go to their website: www.momints.net
Stories on Tape
Writer Peter Nebergall, whose last book, Raindancers, was published in 2003, has a new collection of stories. Titled Silver Lining, it is available on normal (music speed) audiocassette, for a price of $8. Contact: Peter Nebergall, PO Box 754, Columbia, MO 65205; e-mail [email protected]
Discards
The following was contributed by a New Yorker. Really.
Four guys are driving across the country together. One is from Nebraska, one from Idaho, one from Florida, and one from New York.
Shortly after the trip begins, the man from Idaho starts pulling potatoes from his bag and throwing them out the window.
"What the heck are you doing?" asks the man from Nebraska.
"We have so many of these things in Idaho, I'm sick of looking at them!"
In a few moments, the guy from Nebraska opens his pack, and begins pulling out ears of corn. Out the window they go.
The Floridian asks: "What are you doing that for?"
"We have so many of these things in Nebraska, I'm sick of looking at them!"
Inspired, the man from Florida opens the car door -- and pushes the New Yorker out.
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 Voice of the Diabetic.
Our philosophy regarding diabetes is positive. Do you have an inspiring, enlightening story? We, the Diabetes Action Network of the National Federation of the Blind, seek to show people they are not alone, and do have options, regardless of diabetic complications. If you have experienced ramifications, others, who may be facing the same side-effects, could benefit from what you have to say.
Perhaps you have not experienced complications--your unique insight, coping strategies, and lifestyle can still inspire others. Are you a relative, a friend, or a health professional? More than 336,050 VOICE readers could benefit from your story.
For information and article submission guidelines, contact: Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911.
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NEW SURVEY
Volunteers are needed for a new survey, open to insulin-using or insulin-dependent diabetics, age 50 or older, who are blind, visually-impaired, or experiencing sight loss. This is a "survey," not a test of medical drug, device or procedure. If you're interested, or want more details, contact Voice editor Ed Bryant; Diabetes Action Network, National federation of the Blind, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911; e-mail: [email protected]
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DIABETES: WHERE WE ARE TODAY, WHERE WE WILL BE TOMORROW
by Frank Vinicor, MD, MPH, and Jinan Saadine, MD
From the Editor: Because of its length, the following will be carried in two parts. Look for its conclusion in the January 2005 VOICE, Vol. 20, No.1.
Dr. Frank Vinicor is the director of the Division of Diabetes Translation, part of the U.S. Centers for Disease Control and Prevention. He and his colleague, ophthalmologist Dr. Jinan Saadine, addressed the annual meeting of the Diabetes Action Network, held in Atlanta, Georgia, on July 1, 2004, at the annual convention of the National Federation of the Blind. Dr. Saadine began, with a short presentation, and then took questions from the audience.
I am Jinan Saadine, an ophthalmologist for the Center of Disease Control, Division of Diabetes Translation, and I am heading the effort into eye health problems at the CDC. This is my first time to your convention, and I'm happy to have this experience to talk about eye care and vision problems, and what we are doing at the CDC. I'm not a diabetes expert; I'm not going to be able to replace Dr. Vincor because he's the Diabetes expert and he is the head of the Diabetes Division at the Centers for Disease Control and Prevention.
I'm going to give a brief summary of the extra effort that we are doing at the CDC.
I came to CDC about 4 years ago. I was doing research in diabetic retinopathy, and all eye disease among people with diabetes. I realized there is a gap in the public health at the CDC for eye health and vison problems in general -- not just for people with diabetes. So I made an effort, brought an initiative, to the CDC to create a program for public health and ophthalmology. Your interest might be at the other end, mainly rehabilitation, but I'm interested in the whole spectrum: primary prevention, secondary prevention, treatment and rehabilitation; the whole spectrum from preventing the disease from happening, and then looking into more eye disease and vision health, and how it impacts the quality of life and daily activities that we are doing.
I know the clinical definition of visual acuity for blindness is not really the definition we go by. The functional definition is much better is than the "20/20" or "20/40" or "20/200." I realized we at CDC need to deal with the functioning difficulties and the functioning disabilities, more than the just the numbers clinicians use to define blindness and visual acuity or visual impairment.
As you all know, blindness is a big problem in the U.S. We have about 1.1 million blind people, we have about 3.4 million people classed as blind or visually impaired. And this problem is expected to grow in the future, for several reasons. First of all, our population is aging, and we know all these problems get worse in an aging population. The demographic composition of our population also is changing. We have more minority population -- which have more chronic diseases; one of them is diabetes, another is hypertension; and they all relate to eye disease and visual impairment and blindness. So we really want to increase our efforts into working on the CDC mission: to promote health and prevent disease, and to also deal with disabilities and quality of life. So we are trying to put effort into primary prevention, secondary prevention and treatment.
We are also trying to raise awareness. Like the healthy people objective, we have a healthy objective for the whole nation for all health problems. And for the first time we have ten objectives for eye health and vision. And other people, outside the CDC, like the National Eye Institute of Health - a nonprofit organization -- are also working on this problem. We are all partnering to make people more aware of this problem, and to find a solution for it. Our goal is to really look at the impact of eye issues on quality of life, and try to help people to increase their quality of life and visual functioning.
So I'm here to let you know that we are putting some efforts toward that at the CDC. As I said, Dr. Vincor will be talking about diabetes-specific issues and that is what you're probably interested in. I'm here to hear your concern and see if you have any questions I might be able to answer.
Q: I work for the division of blind services. We are the clearinghouse for services for the blind -- but the doctors, the ophthalmologists, aren't calling us. Its as if "blindness" is this evil word. As soon as it is apparent that a loss of vision is happening, they should contact us. But it's just not happening.
A: This is an excellent concern. Our job as doctors is not, should not be, just not diagnosing the disease and treating it. Because even when sight is lost, and you get to blindness, there are so many other things that can be done. So its not the end, it might be the beginning (such as finding yourself, or creating opportunities, or being creative.) So thanks for raising this and I think maybe we need to raise awareness among people that sight loss is not the end of what's happening, but a beginning, and we need to approach it differently. And that is why I am saying although we are an agency that looks at prevention and promoting health -- and we don't do too much in rehabilitation, we can raise awareness. We are going to be looking into the quality of the life -- at the beginning of something new.
Q: I have diabetes, thus diabetic retinopathy, but I also have retinitis pigmentosa (RP). I ask my doctor what is the relationship between the two conditions -- and she gives me vague answers, like "depending on diabetes development and how well I take care of myself, and how good my sugars are." I try to keep within my numbers. What is the impact on the retinopathy itself? And the impact of the diabetes on the RP?
A: The impact of your diabetes on your RP, I don't think it is any different than anything else in the prognosis. So having a problem to start with -- you are dealing with two problems now. Diabetics are going to deal with issues of diabetic retinopathy; you have RP as well. So you really need to make an extra effort in controlling your diabetes. If you have a good HbA1c, hemoglobin A1c, and you have a good control of your glucose, blood pressure, cholesterol; if you are physical active, if you are doing the right things, then you will delay all the complications that relate to diabetes. As affecting RP by itself, there isn't literature so far to say that, regardless of controlling your diabetes, your RP will get worse. So the best thing to do in your case is to control your diabetes the best way, as well as your blood pressure, cholesterol, everything that needs to be done for diabetes. You have to delay the diabetes, stop the retinopathy from happening, so you can just deal with the RP.
Q: There are so many devices and gizmos that talk; Is there some way the CDC could recommend/control/push/require to make all meters talk? Then it would cost next to nothing. There is real need. It would help a lot more diabetics take better care of themselves.
A: We, the CDC, don't get involved in service deliveries. That is not our brief, more the FDA's. We just try to educate people.
Q: Does the CDC do research about very rare eye diseases? I have congenital toxoplasmosis. The odds are 1 in 234 million, and there is like half a page in the medical literature on that. I'm the only one in the database at the National Institutes of Health. Is there a way that the CDC can educate about certain diseases and send out pamphlets to ophthalmologists and gynaecologists -- about how it can be prevented?
A: We have another center, that I'm going to be collaborating with, not the Division, but the Center for Birth Defects and Developmental Disabilities. My program is really new; in the last six to eight months we started broadening -- covering more than just diabetes and diabetic retinopathy -- so I'll be collaborating with them, making our program broader. We're trying to get more literature on the web page.
Q: I have diabetes in my family; I've been told that if I get diabetes, I will lose the remainder of my sight.
A: There are many trials, all over the world that prove you can delay or even stop diabetes complications from happening. Proper diet, losing weight, all these things could delay diabetes, even just healthy and exercising, not even strenuous exercising -- you can delay diabetes.
Q: Do you have statistics on how many people lose their sight because of diabetes?
A: We don't have very good incidence data, but the figure that's been roaming around is approximately 12-24,000 individuals a year.
Q: My ophthalmologist was telling me about some new treatment in which a steroid is injected into the eyeball. I have macular degeneration and diabetic retinopathy.
A: There are one or two new studies about injecting cortisone in the back of the eye. They're not completed. Until the trials are over, and until the data are in, and look good, it's not 100% recommended you do that. But there are trials going on, so just wait until they are over. Get the results first.
Q: Is there a relationship between diabetic retinopathy and glaucoma?
A: People with diabetes have a higher risk of getting glaucoma than do people without it. It's not "if you have diabetic retinopathy than your going to have glaucoma." It is just statistically, people with diabetes have a higher risk of getting glaucoma.
Q: Isn't glaucoma a genetic disease?
A: Glaucoma has different definitions/forms. You have congenital glaucoma, open-ended glaucoma, and several others. Yes, there is a congenital glaucoma, but there are other forms, and they are different diseases. If you have the older-onset form of glaucoma, that does not mean your child will get the congenital form -- they are unrelated diseases.
(Editor's Note: At this time Dr. Frank Vinicor, Director of the Division of Diabetes Translation at the CDC, came to the podium.)
I'd like to start by very quickly giving you a sense about what is going on with diabetes. First of all, just how common is it becoming? Where is it becoming common? Things like that. Then I'll talk, a little bit, again very superficially, about our three approaches to this epidemic called diabetes. Those three approaches are: to prevent it, or cure it, or care for it better, and how we seem to be doing at them.
First of all, where are we are with diabetes? Diabetes is a bad problem, bad throughout the United States, especially over the last decade or so, and it is going to get worse before it gets better. That is the reality of diabetes.
The U.S. Centers for Disease Control, along with other agencies, collects a lot of information about diabetes, about how many people have it, and about what kind of problems they get into. Here are some statistics for you, based on a nominal 24-hour period. So between when you woke up this morning, and when you wake up tomorrow morning, this is what is happening in the United States: There are going to be 3,400 people diagnosed with diabetes by tomorrow morning, and approximately 500 people (this is an underestimate) will die from diabetes between this morning and tomorrow morning. There are going to be about 200 amputations from diabetes between this morning and tomorrow morning, and about 125 people will enter End Stage Renal Disease (ESRD) kidney programs (go on dialysis or have kidney transplants) in that 24 hour period, and, unfortunately, about 75 people will lose their vision. This is going to happen every day of the week; its going to happen on Sunday, and its going to happen on the fourth of July. That is the average of what happens in the United States, every 24 hours. That is a lot. A lot of hurt, a lot of loss of personal independence, a lot of cost and the like.
The situation is not unique to the United States. It is happening throughout the world. For example, right now there are approximately 175 million people with diabetes in the world -- but the most recent study (that just came out about a month ago) said that by 2030 (roughly 25 years from now), there are going to be 380 million people with the condition. Diabetes is increasing throughout the world.
Just to give you a flavor of where it is taking place, if you had to think to the year 2030, and identify the top five countries in the world in terms of the number of people with diabetes (now we're not talking about "prevalence," or percentage of the population, but total number of people with diabetes), what countries do you think would be in the top five?
India is first, China is second, the United States is third, Indonesia fourth, and Pakistan is fifth. Those are the top five countries. Japan is up there, Mexico is up there, and though no one country in Africa is that high, the continent is getting up there. India has only a billion people, and is very westernized, in a sense. They aren't fat in the same way we see in America. They have what is called "gut obesity" vs. "butt obesity." Gut obesity is the kind of the bad obesity, I have that kind myself.
One of the reasons why China is only #2 is because large parts of China are still very rural. People there are still very active physically, so they're not as heavy.
The other reason is that, in China, people are going to soon be dying of cigarette-related diseases, so they won't be living long enough to develop diabetes.
So to sum it up, diabetes is getting more common, particularly type 2 diabetes, what we use to call adult onset, or maturity onset or NIDDM, but we now call type 2. That is Arabic 2, not Roman numeral II. When we went out to talk to people, they thought there was type 1 diabetes and type 11 diabetes. They thought we were hiding nine types of diabetes. So, for clarity, they actually changed from Roman to the Arabic 1 and Arabic 2.
But most of this is type 2 diabetes; though certainly not all of it, and, as you can tell by the top five countries on the list, the majority of growth of diabetes in future will come from countries that really are struggling in ways we don't struggle; people like India, China, Indonesia, and Pakistan. They have what is known as the "double epidemic." They still have the infectious disease problems, but they also are developing the chronic disease problems -- where in general we just have the chronic disease problems.
So how big a problem is diabetes? It's big, it's now everywhere in the world, and at times it may seem overwhelming. But we aren't paralyzed. We're not without our own responses and our own weapons. Let's talk about what we could do, and about what science says will or won't work.
As I mentioned, we really have only three choices. We could prevent it, and that's good. If you don't have diabetes, you don't have to worry about diabetic eye disease or kidney disease. We could cure it. So you get it, but it goes away through some treatment. Or, we could provide good care. Those are the three choices, and we could do all three. Let me talk about where we are with each of those. It's helpful to talk a little bit about type 1 and type 2 separately.
When we talk about type 1 diabetes, we're talking about a disease in which, for whatever reason, the body decides to destroy its own insulin-producing cells. This is autoimmunity. Ultimately, when you destroy enough of the 1 million insulin producing cells (the Beta cells), diabetes develops. We used to say, for type 1 diabetes, "you're healthy on Tuesday and sick as can be on Wednesday." It was assumed to be an acute disease, sudden in its onset.
We now know that is not the case. We now know that for years people have been undergoing this self-destruction process, this autoimmune attack, and the body has been destroying five of its own insulin-producing cells today, and ten tomorrow and ten the day after, and the process has been going on for years. Now it's true that you may develop what we call "clinical" diabetes over one or two days, but the destructive process has been going on for years and years. So that is what we call type 1.
Now for type 2. We use to think of it as over, under, over: Over 40, under active, over weight. There appears to be a problem, initially, with insulin resistance with our muscle cells and fat cells not responding to the body's own insulin, and eventually the insulin-producing cells peter out, they give out, they get exhausted -- and that is when diabetes comes up. That is what we mean by type 2 diabetes.
It is not accurate anymore to say type 1 diabetes occurs only in the young, and if type 2 diabetes occurs only in people over 40. It's not that simple. We are seeing kids who have type 2 diabetes and adults who have new type 1 diabetes. But, for discussion, lets just think we live in a nice clean world and there is only type 1 in the young and type 2 in the adults. Just for the heck of it. So it would be nice if we could prevent them.
Right now, studies are underway on preventing type 1 diabetes, trying to see if this autoimmune destruction process can be stopped. You can find people who, because of their genetics, or because of what is in their bloodstream, have these antibodies that can destroy the islet cells. You can get very good at predicting who might develop type 1 diabetes, before they develop it.
There have been large studies to see whether or not, if the process of autoimmune cell destruction was stopped, the patient wouldn't develop type 1 diabetes. The sad news is that the studies didn't prove successful. Any effort has not yet worked. It doesn't mean that people are giving up. They are trying to find better ways to stop the immune destruction. But the studies to date have not worked. So, in terms of prevention of type 1 diabetes, we are still very much in the scientific/experimental phase.
With type 2 diabetes, there is a completely different picture. There now been five studies, published in the last two or three years, showing that if you have a situation in which you are at high risk for developing type 2 diabetes, particularly if you have this thing called pre-diabetes, where your blood sugars aren't normal, but they're also not high enough for you to be told you have diabetes. They are in a grey area, but we know there is a high likelihood you will go on to develop regular garden variety type 2 diabetes.
There have been now five studies that show that, particularly with some of what are called "behavioral interventions," such as losing 8 pounds, lets say, walking 150 minutes a week, that's like 30 minutes five days a week -- if you do that, and you are in this high risk category, you can reduce the likelihood of developing type 2 diabetes by over 50 percent. And it worked, whether if you were black, Hispanic, Asian Pacific islander, native American, white...It worked whether you were 20 or were 70. It worked regardless of how much you weighed. So, for the first time, we now have a lot of evidence, scientific evidence, that you can, at a minium, delay the onset of type 2 diabetes by years, if not prevent it outright.
And the challenge for us is to find a way to take these results and make them part of what we all do everyday, and that is not an easy task. But we now know you can prevent a lot of type 2 diabetes.
I have said we have three approaches: Prevention, Cure, Care. Prevention works for type 2 diabetes, but we are still in the experimental studies for type 1 diabetes.
Lets go on to cure. Ok, you didn't prevent my diabetes, can you do something to cure it? So we want to cure diabetes. It's just the opposite of what we know about prevention. We actually have now learned that for type 2 diabetes, it's probably unlikely that we're really ever going to cure it. When you first develop type 2 diabetes, if you lose some weight and get active, you can kind of push it back a little bit, for a few months or maybe even a year or two. But it turns out, from other studies, particularly done in the United Kingdom, in England, it looks like there is a continuing loss of insulin producing Beta cells. We don't know how to stop that loss, so we don't know how to cure type 2 diabetes. But it's different for type 1.
But for type 1 diabetes, since it's a problem with losing insulin-producing cells, and since we know how to transplant kidneys, eyes, and hearts, why we can't we correct it, cure it, by transplanting the insulin-producing cells? Thus the islet cell transplantation study. And our friends in Canada have provided a real boost. It used to be that if you transplanted islet cells, it didn't seem to work; you had to take immune rejection drugs that were so dangerous and powerful that they themselves could cause difficulty or even cause worsening of diabetes -- and the transplanted cells didn't last. Then Dr. Shapiro and colleagues in Edmonton, Canada, developed what's called the Edmonton Protocol. They had an article published about 3 to 4 years ago in which 7 or 8 people with diabetes, really very brittle diabetes, received transplanted islets.
The researchers developed a system of more easily and effectively collecting insulin-producing cells from cadavers (people who perhaps had died in an automobile accident or something similar). They transplanted them, not through major surgery, but by a little catheter, through the abdomen, into the liver vessels -- and they injected just the insulin-producing cells, which would set up housekeeping in the liver, where they would start making insulin. Most of the patients, again a small study initially, actually were able to get off insulin, and all of them, even those who had to stay on it, could reduce their insulin dose.
To prevent the body from rejecting these foreign cells, because they were someone else's islets, the Edmonton researchers used a new combination of anti-rejection drugs, one that didn't cause as many problems. It was very exciting.
Those studies have now been expanded to about 10 centers throughout the world, mostly in the United States, to gain more experience. The studies have just been released, at this year's American Diabetes Association meeting.
There are right now around 60 to 70 people who have had these islet cell transplantations, and there is a learning curve. You have to learn how to safely collect these insulin-producing islet cells; learn how to put the catheter, safely, into the liver -- so there is a learning curve. But for those centers who have learned and done well, they are having equal success. A lot of these studies are sponsored by the National Institute of Health, and there is now a movement to expand it beyond these 10 centers -- to start moving into larger number of people who might be eligible for this study.
So again, I don't want to imply that it is here for everyone today, but it's not ten years down the line either. It will be here soon. There continue to be two major issues. The biggest one is finding enough islet cells, beta cells, insulin-producing cells (same thing) to transplant. When you are born, you have about a million insulin-producing cells in your body. And you probably need 300-400,000 to make it go, to become insulin-independent, if you get a transplant. You probably can get maybe 200,000 viable islets from a cadaver pancreas. To do so, you have to take that pancreas, put it in some kind of safe Waring Blendor, chop it up, get rid of all the other stuff, and only get the insulin producing cells--and you inevitably destroy some of those in the process.
Most of the people in the Edmonton protocol didn't have one injection of cadaveric islet cells; they had two and three and four. Again, its not that likely that there are going to be two, three, or four cadavers, who come in from automobile accidents, who happen to have your particular genetic makeup. So getting the number of islet cells you need is a real challenge. And that is why they are looking at other ways to go to find these islet cells. And that always gets you into politics and such things. But there are several things to think of. Maybe I can get fetal islets and allow them to grow and then those would be a source of beta cells. The whole idea of stem cell research - that is, finding very early cells and training them to be beta cells instead of muscle cells, is another way.
Yet another way might be to create an artificial pancreas -- that is, a machine that does the same thing as a pancreas. It would have a reservoir of insulin, a pump that pumps out the right amount of insulin, and some kind of glucose sensor that says "my blood sugar is going up; you just had some ice cream." Then it would squeeze out some insulin.
A fourth or fifth way; I can't remember how many I've mentioned, is that every cell in your body has the genetic structure and instructions to make insulin -- its just that somehow my bone cells have been turned off; instructed not to make insulin, but to be strong, but they got the message somehow, because we all come from one cell, at conception.
They are trying to find someway to take, for example, fat cells (and I could be the donor source), take a safe virus (to which has been attached an insulin gene) and insert it into the fat cell, which becomes then an insulin-producing cell. They can do that. The problem is they just don't know if they can control the way that new fat cell/insulin-producing cell releases its insulin. The worst thing you'd want, if you didn't eat, is these new cells releasing insulin willy nilly. Finding sources of beta cells is the major challenge. But they are moving there.
And the other big issue, of course, is anti-rejection drugs. I mentioned that they are better now; they're a lot safer, but they are not weak drugs. Will they cause you to be prone for cancers? Will they cause you to be prone for infections, because you're stopping the body's responses? So those are the two main challenges but, for type 1 diabetes, we're getting there. And I'd say within two to three years we'll see more evidence.
Let me quickly conclude with care. If you have diabetes, if you have to have it, its better to have it in 2004 than it was in 1994 or 1984, etc. There are so many more medicines and insulins to mix and match, so many more tablets to take, so many more, and better, blood pressure drugs, so many more, better, cholesterol-lowering drugs. We have so many more and better ways to test blood sugar and blood pressure. We know that aspirin is important now to prevent heart attacks. We basically know that if we can work together, and get the body's metabolism under control: blood pressure, blood cholesterol, blood sugar, that your chances of developing all these complications of diabetes can be reduced by 30 to 50 to 60% by good care. Again, that is for both type 1 and type 2.
So the challenge for care is not, necessarily, brand new breakthrough discoveries (though that's always great), but the real challenge for care is to be sure that everybody can get access to the care we know, that works. That is the challenge.
Even though the problems are getting bigger, in the sense that more people are developing it, we are not paralyzed. We can do things together. And we know now that we can prevent type 2 diabetes to a great degree, but we have a way to go for type 1. We are beginning to learn that we can probably soon cure type 1, but we're not sure about type 2. And for both of them, we must work together to be sure we get the best care we can -- and it'll make a huge difference in people's lives so they can be as healthy as they want to be and not have to worry about these complications.
Editor's Note: At this point Dr. Vinicor took questions from the audience.
Q: I'm a type 2; what should I do? Is it helpful to lose weight? What steps should I take? Lower the blood sugar? Lower the blood pressure? If I lost weight, would my blood sugar levels go down?
A: In general, anytime any of us gain weight, and, lets say, we already have diabetes, we are more likely to have our blood pressure, cholesterol, and sugar to go up. So the heavier we are, the more the body responds with higher blood pressure, sugar, and cholesterol. Getting the weight down, and doing it in a way in which you're physically active (I'm not talking about running a marathon; just regularly walking) -- the more we can do that, the easier it is to control blood sugar, blood pressure and blood lipids. It doesn't mean you won't need medicine -- but the amounts of medicines you'll have to take will be less, and the blood sugar fluctuations will be less. As a general rule, the better we can control our weight, the easier it is to control our diabetes.
Q: Is there an ideal weight for a person of a given size?
A: The more you lose, the better -- but we don't want to make people be like Twiggy -- but in general getting down to reasonable weight is good. There are people who can help you. Again, I want to emphasize that we know clinically, from this important diabetes prevention study, that if you weigh, say 220 pounds, you don't have to get down to 140 pounds to see the benefit. You will see benefit if you get down to 210 pounds. And the more you get down, the more benefit you will see. You don't have to become a skinny mini,--a lean, mean fighting machine,-- to see the benefits.
Q: What is the role of autoimmunity in the development of diabetes? If someone had measles at age two and got diabetes at six, is that an example?
A: It's helpful to think about it this way: Let's say you have identical twins. f one of the twins happens to develop type 2, it is highly likely, 90 to 95 percent of the time, the other twin will also develop type 2 diabetes. What if there are identical twins, and one twin has type 1 diabetes? It turns out that only in 30 to 40 percent of the time will other twin ever develop type 1 diabetes. This says that since they both have the same genetic structure, there must be something outside of the body, perhaps an environmental risk factor, that in one twin triggers this autoimmune process -- and the other twin didn't get exposed to it -- since they've got the same genes. The nature of such process, what it is, is not clear. Whether it's a virus, or something we ate, whether its stress, we don't know what the environmental trigger is that sets up the immune destruction process. A large study is going on now -- it's called the Teddy study, like "Teddy-bear," and I honestly can't remember what it stands for, but it is trying to identify what it is, outside our bodies, that would trigger this autoimmune destruction. I don't know what it is -- jillions of kids develop measles, but only a few go on to develop diabetes. So it's gotta be more than just measles. We still don't know what the trigger is.
Q: Dr. Shapiro from Canada had stated there was a problem with encapsulation of the islet cells. Was that the same study you're talking about?
A: Dr. Shapiro, who heads the Edmonton team, may have been speaking about encapsulation, but no, they don't encapsulate the islet cells in the Edmonton protocol. They just blast them into the liver. Any time someone puts someone else's tissue into your body, your body says: "I don't want it." It tries to reject it. You therefore have to try to protect whatever it was they put in your body -- could be a lens, could be a heart, a kidney, or islet cells. There are different ways to try to protect it. One is to give medicines that shut off your anti-rejection response. Then your body just doesn't have the gumption, the ability, to kick out the foreign tissue.
Another is to put into your body cells that have for whatever reason, lost their "identity" as foreign. I mentioned fetal islet cells. They're generally pretty neutral. They don't have as many foreign components on the outside of the cell. They're not viewed by the body as being "foreign." They're much less likely to be destroyed.
Another way would be to take the islet cells and protect them. For example, put them in a little seaweed-like structure about the size of a small straw, and that little straw, made of seaweed, would have holes in it, of a certain size, that they will allow sugar to come in and insulin to go out....but the holes are too small to allow these big, destructive proteins or white blood cells to get in. That's encapsulation. But the body is so darn smart, when it can't get in and destroy the foreign islet cells, it will start scarring over the encapsulated straw -- just covering it up. These are challenges because your body is so smart -- it knows how to get rid of foreign tissue. So far, encapsulation hasn't worked, and that's probably what Dr. Shapiro was saying. His way doesn't use it.
Q: Regarding non-fetal stem cells, what of the possibility of donating your own? Could such cells be used the same way?
A: Both fetal and stem cell research are very controversial, very political, and people have strong feelings about them. Very few people are neutral. In general, I've been told, stem cells from fetuses are easier to work with, and better to direct one way or another than are adult stem cells.
We all have stem cells in our body. Right now, in my bone marrow, hopefully, there are stem cells there, making decisions to go on to develop red blood cells, platelets, or white blood cells, -- they all come from stem cells. So you can get stem cells from adults, but they're much harder to get, and harder to manipulate. In general, there are political issues here; they relate to abortion issues, and principles and all the like, and it's a very controversial area.
Q: I have pituitary failure, and I was diagnosed with diabetes when I had congestive heart failure. I was struggling with autoimmune deficiency at time. Weren't sure if type 1 or type 2 diabetes at the time. How might they have played on the development of diabetes?
A: It's not as easy as it was earlier to tell who has type 1 or type 2 diabetes. We are trying, and there are many cases in which you know someone has the one or the other, but its just not as easy. So, with your question about which one you have, you join a larger crowd who aren't sure. Is it important to know which one you have? Maybe, in some circumstances. Type 1 diabetes, because it is a autoimmune disease, is some cases associated with other endocrine gland failures (such as your pituitary gland failure, which is unusual, but not unheard of); some people with type 1 diabetes develop thyroid failure, or adrenal gland failure, or skin failure (vitaligo), where they develop white patches. Those are manifestations of a more generalized autoimmune process. It is not common, but no longer do you hear "What's going on here?" Now we know it can happen. So it is possible in your situation you have a more generalized autoimmune process underway.
Q: I have been having neuropathy problems in my hands and feet. Is there anything I can do about that? It is irritating and itchy.
A: Neuropathy is a very common problem for people with diabetes. It is generally viewed as the most common complication, and it can be severe. For some people, if the bedsheet touches their feet, it just sends them through the wall. There are a lot of treatments and medicines, which tells you we really don't know what to do about it. If you go in the bookstore, and go up to the nutrition/diet section, and you see there are 375 books on nutrition and diet control, that should tell you at least one thing: "we don't know how to do it." If you go up there, and you see maybe one or two, and they all say the same thing, that means we've learned something. It's like that with treatment of neuropathy. There is a list of 5, 6, maybe 7 different medicines available. It's trial and error. Try one; see if it works; if it doesn't, then try another. One of them is an anti-seizure medicine; one is a medicine for anxiety. There are different kinds; try them. Usually you can find one that works, for you. But it is not easy, and it is not quick.
To be continued...
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(V19#4)
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