VOICE OF THE DIABETIC

The Diabetes Action Network of the National Federation of the Blind

A Support and Information Network

Volume 18, Number 2, Spring Edition 2003

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Voice of the Diabetic, published quarterly, is the national news magazine of the Diabetes Action Network of the National Federation of the Blind. It is read by those interested in all aspects of blindness and diabetes. We show diabetics that they have options regardless of the ramifications they may have had. We have a positive philosophy and know that positive attitudes are contagious.

News items, change of address notices, and other magazine correspondence should be sent to: Ed Bryant, Editor, 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 2003 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 fax or 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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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 320,097, offers such an outlet. Make your voice heard. For Voice of the Diabetic advertising information contact:

Eileen Rivera Ley
National Advertising Sales Manager
804 Hatherleigh Rd
Baltimore, MD 21212
Phone: (410) 296_7760 Fax: (410) 296_7645

or find us on the Web at:
http://www.nfb.org/voice.htm

For SUBSCRIPTION information, see the end of this document.

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INSIDE THIS ISSUE

MY DIABETES STORY
by Jane Malone

MOVE YOUR BODY!
BEGINNING TO EXERCISE, PART 2
by Ann S. Williams, MSN, RN, CDE

ASK THE DOCTOR
by Wesley W. Wilson, MD

SIMLYN, AN AMYLIN ANALOG, MAY BE
KEY TO BETTER GLYCEMIC CONTROL
by Ed Bryant

PUMP ACCESSIBILITY
by Donna Blake

INSULIN AND THE FUTURE
by Peter J. Nebergall, Ph.D.

LOUISVILLE SITE OF 2003 CONVENTION

DIALYSIS AT NATIONAL CONVENTION

DIABETES ACTION NETWORK SEMINAR

BLIND DIABETICS CAN DRAW INSULIN WITHOUT DIFFICULTY
by Ed Bryant

BOOK REVIEWS
By Marilyn Helton

RECIPE CORNER

LETTERS TO THE EDITOR

HEAR YE, A RAFFLE

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

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MY DIABETES STORY
by Jane Malone, RN

Perhaps I could share a little of my story. Everyone has a story. I am no different.

My diabetes symptoms were subtle, at first. I was a Cardiac RN. I was healthy -- my blood sugar on my fall check-up was normal. During the winter I had a bad viral flu. I began losing weight, which delighted me because I was always trying. I began urinating more often, which didn’t alarm me, because everyone knows RNs drink lots of coffee (a diuretic) on the night shift. Sometimes I couldn’t get a good deep breath - - again, I thought, the stress of working 10-12-hour shifts.

In the spring, I was running around Pigeon Forge, Tennessee, on vacation, eating fried apple pies from the Apple Barn, homemade chocolate and vanilla nut fudge, maple pralines, and lots of biscuits and gravy, with good rich southern cooking. I was still losing weight, looking for restrooms, feeling tired and dizzy, and I had that heavy sweet breath.

Suddenly, I knew why the weight loss! Ketoacidosis - my body was burning the fat. I went to Walgreens and bought a glucose monitor. My suspicions were confirmed -- I had a blood sugar of 500. Now all the symptoms, which before had seemed subtle, came screaming at me. Diabetes!

The Glucophage worked for about a year, then Rezulin was added. You all know what happened to that drug. One day I saw Warner-Lambert stock (they made Rezulin) had dropped suddenly, and I wondered why? The next week, England, calling it dangerous, took it off the market. I refused to take it after that, even though my doctor made light of it, saying, “All pills have side effects.”

The doctors in the United States were prescribing this pill six months after England yanked it from their shelves, and the deaths kept mounting. I still don’t understand. I wish someone could enlighten me on why these deaths happened. Why didn’t the United States ban it sooner?

When they wanted to give me three different diabetic pills, I decided I would do less damage to my body, and spend less money, if I switched to insulin rather than three more pills, which weren’t controlling the sugar anyway. The Humalog insulin has worked well for a tight control. Like the proverbial guest, “It came to dinner and knows when to leave.” It works with a meal well, even with sporadic meal times, and is gone from the blood in four hours. Humulin N as a background, am and pm, works well with the Humalog.

Now even non-compliant people are doing better. We’re not perfect, as Wilfred Brimley says, but we’re trying.

When moving into my new house, I was walking on my new carpet in stocking feet and a carpet nail went into my heel. Within a day or two, the heel was edematous, stretched tightly, white in color, and I knew it probably had staph present.

The doctors in hospital confirmed this. They did an incision and drainage and debrided it, cutting off all the dead skin on my heel. The underpad was painful on that new tender pink skin. The healing continued with IV antibiotic saline, OP gauze, and a lot of difficulty moving.

Let me sing the praises of “Miracle Foot Repair,” a lotion with 60% aloe. It hastened the healing, and I use it every night. Its wonderful healing properties have kept the plantar areas and heels free of ulcers and calluses and kept the dry skin moisturized. The Diabetic Foot Clinic where I went could only offer me Vaseline, which was useless as far as healing.

What did I learn from this? Do not ever walk barefoot, even on carpet. And Miracle Foot Repair is indeed a miracle-working lotion.

Keep up the good work. This paper [the Voice] has more valuable information than many medical magazines/journals. The latest advances in diabetes are so interesting, and it is important we all keep up.

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MOVE YOUR BODY!
Beginning to Exercise, part 2
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.

The last article in this series discussed three major ideas you need to think about before you actually begin to exercise. To review:

1. Exercise is any form of physical activity, or moving your body;

2. There are many good reasons to include physical activity as part of your diabetes treatment plan;

3. It is important to think through types of exercise you can do, what sort of exercise you would like to do, and when you can work exercise into your schedule, before you begin.

This article will cover the things you need to think about during the first few weeks of exercise.

Once you have already decided on a type of exercise and a time to exercise, you will probably also have decided on a day to begin. If not, you need to set that date. Don’t procrastinate—support your good intentions. Try telling people close to you about your exercise plans—ask them for encouragement! You might ask a family member or friend who also needs to move around more to join you. Try planning your physical activity for first thing in the morning, before you have a chance to get involved in other things. Or, plan your movement for a natural break in your schedule, like right after lunch or supper. You could sign up for a class, like water aerobics or stretching exercises of some sort, and have the support of an instructor and a group. Try using a treadmill or other exercise equipment while watching your favorite television show or listening to your radio program. Pretend your TV or radio receiver won’t work unless you are exercising, as if you had to generate the electricity. The possibilities are endless. Use your imagination—and make your good intentions a reality.

Before starting new physical activity, discuss your plans with your health care team. It’s a good idea to review the signs and symptoms of low blood sugar (hypoglycemia), and be prepared to treat it. Signs and symptoms can include: feeling shaky, sweaty, lightheaded, anxious, weak, hungry, tired, or having blurred or cloudy vision. You might feel any combination of these, or none of them. If you do notice signs or symptoms of low blood sugar, you should test your blood sugar level immediately (and regular testing before, during, and after exercise is a good idea, whether or not you feel any of the symptoms of a “low”). If your blood glucose is below 70, you should eat or drink something with 15 grams of carbohydrate—three or four glucose tablets, one half-cup of fruit juice or regular (sugared) soda pop, a cup of low-fat or skimmed milk, six or seven small hard candies, or a slice of bread. Then wait 15 minutes and check your blood sugar again. If it has not come up, take 15 more grams of carbohydrate. Watch out for over-treating—it’s easy to overdo it and end up with high blood sugar! Everyone with diabetes should carry something that can be used to treat hypoglycemia—especially if you are exercising.

On the first day of a new physical activity, make sure you dress comfortably and appropriately for that activity. If you will be moving around on your feet, pay special attention to appropriate shoes and socks. Wearing shoes that fit you properly and are appropriate for the activity is important for preventing foot injuries; and wearing absorbent socks is important for preventing athlete’s foot and blisters. In general, loose-fitting clothing made of absorbent fabric is good for most forms of exercise.

Right before you exercise, you should check your blood sugar, to make sure it’s not too low or too high to exercise safely. It’s best if your blood sugar is between 100 and 240 before beginning your activity. If you are using insulin, or oral diabetes medications, physical activity could burn enough blood sugar to drive it too low. Make sure your blood sugar is above 100 before you exercise. If you know your blood sugar drops quickly with activity, you may want to make sure it’s about 130 or 150. (Test frequently, and you’ll learn how you, as an individual, respond to exercise.) On the other hand, if your blood sugar is over 240, you might not have enough insulin in your system to allow sugar to move into your cells properly. If this is so, moving your body could cause your cells to burn fat so quickly you could end up with toxic by-products—high levels of ketones in your blood. It would be better to get your blood sugar in control before starting your increased activity. Discuss this with your health care team.

For the first day of starting new activity, and in general for the first week, it is important that you simply begin to exercise; how long, how hard, and how often you move around is less important. So, set a realistic goal; find one for yourself you are sure to reach. For example, if you think you could probably begin with a brisk 20-minute walk, you might plan for a moderate 10- or 15-minute walk, then once you are walking, if you want to go for the full 20 minutes, go right ahead. But, if you walk only 10 minutes, consider it a success! It would be best to exercise a little every day for the first week, to help start a habit; but if you manage to exercise at least three days out of seven, consider it a success!

After you are finished, you should check your blood sugar again. You might see it has dropped some. However, if your first time exercising was short and gentle, you probably won’t see much change, if any. Don’t get discouraged if this happens to you. After you have begun, you can increase the intensity and the length of time you spend exercising. Then, you will see more benefit to your blood sugar, blood pressure, cholesterol levels, and energy levels.

After the first week or two, you should begin to increase the intensity and length of time you exercise. It’s best to do this gradually. For example, if you have been using an exercise bike at moderate intensity for 15 minutes, you might want to increase the intensity just a little, and exercise for 17 or 18 minutes in the third week. By increasing gradually like this, you’ll eventually reach a level of activity that makes a real difference in your blood sugar. You should continue to check your blood sugar before and after exercise, partly to keep yourself safe, and partly to see the difference as you increase the level of exercise.

It’s good to set yourself long-term goals for increasing your exercise intensity, duration, and frequency. You’ll want to aim for a level of exercise that is hard enough to give you many benefits—but you don’t want to exercise so hard you exhaust yourself, hurt your heart, or end up with sore muscles. Discuss the level appropriate for YOU with your health care team, before you begin—and remember, we’re all different! Many experts recommend exercising until your heart is beating at 60%, or 85%, of your maximum heart rate after adjusting for your age, for about 30 to 40 minutes, at least five days a week. The formula to figure out your target heart rate is: 220, minus your age, times 0.6 or 0.7. To find out whether you are getting your heart to that rate, after you have exercised for about 10 minutes, you should take your pulse for 15 seconds and multiply by 4.

There are some easier ways to gauge whether your exercise level is in a good range. One is simply to exercise as hard as you comfortably can, for as long as you comfortably can. If you do this regularly, you’ll soon be able to exercise harder and longer. Another helpful “rule of thumb” is to exercise at a level that makes you breathe a little harder, but not too hard; you should be breathing hard enough that you can’t sing, but you can still talk. And, you should exercise long enough that you are pleasantly tired when you are done, but not totally exhausted. If you’re totally exhausted, or if your muscles get sore enough to hurt, you’ve done too much. Next time, cut back and increase your level of exercise more gradually.

If you take insulin, or any oral medication that increases your body’s own insulin, as you increase your activity, you’ll need to watch out for hypoglycemia. This can happen during or right after the activity, and can also happen several hours later. By watching your own blood sugar patterns as you increase your activity, you can usually figure out when your blood sugar is getting lower, and you can plan to prevent hypoglycemia. For example, if you notice that after 20 minutes of vigorous activity, your blood sugar usually drops low enough to be uncomfortable, you can plan to begin with a higher blood sugar level, or to always carry some glucose or juice when you exercise. If you find that your blood sugar is always lower for about 36-48 hours after you exercise, and you know you have lower blood sugar in the late morning, you can always carry some carbohydrates at that time. Or, if this is a consistent pattern, you can speak to your doctor about lowering your medication, or changing to a medication regimen that is less likely to produce low blood sugar. There are many medication choices available now. Exercise is so beneficial it makes more sense to change the medication to avoid low blood sugar than it does to decrease the exercise.

As you continue your increased activity, it can become a self-maintaining habit. Pay attention to your better blood sugar, blood pressure, and cholesterol readings, increased energy, and overall increased sense of well-being. Notice how much easier it becomes to move around at a level that would have caused you fatigue before you started.

I’d love to hear from any of my readers who have found these articles on exercise useful. If you began to exercise, or increased your physical activity after reading these articles, please write me a note in care of the Voice of the Diabetic office. Let me know what you did, and whether you encountered any problems along the way, and how you solved them. You can write me at: Ann S. Williams, RN, MSN, CDE, c/o Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911; e-mail: [email protected]

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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.

Question: What is the “ideal” A1C for a diabetic? I always heard my numbers should be no higher than 7 percent, but now my doctor is saying that it should be 6.5 percent or lower. What’s right?

Answer: Your question is important, and it needs a good answer. These days, when we have the ability to measure “glycosylated hemoglobin” (Hemoglobin A1C) at home, or get the values from our health care provider, we need to know what we should be trying to achieve. My first answer is: It depends. Perhaps some background information will help.

The Diabetes Control and Complications study (DCCT) was a multi-year trial in which the questions asked included: 1) Can careful control of blood sugar in persons with type 1 diabetes reduce the appearance and/or the progression of complications? and 2) Is extremely “tight” control of blood sugar possible without devastating problems from hypoglycemia (low blood sugar)?

The DCCT was set up to compare two groups of persons with type 1 diabetes. One group was treated “conventionally,” with self blood sugar testing one or two times a day, occasional contact with the treating team, and avoidance of excessively high or low sugars. By comparison, the intensively treated group, who sought to achieve near normal blood sugars, checked sugars three or more times each day, saw the treating team about every two weeks, and took insulin three or four times daily, or used insulin pumps. They were truly treated intensively. The “target” A1C, the point they sought to reach and hold, was a “normal” A1C, that is 6 percent or less. Despite efforts to carefully control blood sugar in the intensely treated group, only 5 percent of the group were able to achieve such a “normal” HbA1C, and the average A1C was 7 percent, one percent higher than planned. Hypoglycemia limited the ability to control blood sugar. In contrast, the conventionally treated group had A1Cs averaging 9 percent.

Even though there was less than perfect control in the intensively treated group and the A1C was reduced by only 2 percent, the rate of complications was reduced by more than 50 percent after 6 years. The 2 percent reduction in A1C clearly reduced complications. Unfortunately, the intensively treated group had twice as many episodes of severe hypoglycemia, which required help by some other person to revive the affected individual. The price for extremely tight control is certainly a greater risk of severely low blood sugar.

The question remained: how low was it possible to safely get the A1C in ordinary persons with diabetes? The American Diabetes Association decided that the 7 percent average result achieved in the DCCT should be the target, since it had been achieved in over 700 people, and it did reduce complications.

Of course, we all wonder if a “normal” A1C might not reduce complications even more. Some persons are able to attain normal A1C, and if they can, I’d say go for it! But, be aware that there are greater risks from hypoglycemia. Accidents in diabetics must always raise the question of low blood sugar.

I should mention that similar results are seen in type 2 diabetes. The United Kingdom Prospective Diabetes Study demonstrated similar protection in persons with type 2 disease. The intensely treated group in that study had an A1C that was about 2 percent lower than the less intensely treated one.

I try to have my A1C as low as possible, but if I’m involved in lots of physically active sports, I must run blood sugars a little high to avoid the need to take sugar all the time. There is no one “right” A1C; it truly does DEPEND.

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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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SIMLYN, AN AMYLIN ANALOG, MAY BE KEY TO BETTER GLYCEMIC CONTROL
by Ed Bryant

In Voice of the Diabetic Vol. 14, No. 2, April 1999, I reviewed research into the action of the human hormone amylin, and its relationship to good diabetes control. Here is a quick review of what we have learned since.

For decades, diabetes researchers thought type 1 diabetes was simply about lack of insulin. Their model of euglycemia, normal blood glucose, was a balancing act between two hormones, insulin and glucagon. All diabetes medication either stimulated, replaced, or augmented the action of one of these two, and that there might be another hormone at work, a third piece of the puzzle, was not considered.

We may now have the missing piece. Amylin Pharmaceuticals, Inc., a San Diego, California based company, has been researching the human hormone Amylin, and their findings, while still under investigation, are fascinating. Their product, pramlintide (trade name Simlyn), is now in Phase III clinicals.

Amyloid, the parent compound, was first noted about a century ago, by pathologists performing autopsies. In the 1980s, the chemical was analyzed, and the peptide amylin sequenced from it. Because naturally-occurring human amylin is too thick and viscous to inject, Amylin Pharmaceuticals developed its injectable analog, pramlintide (Simlyn).

There is a lot of research interest in amyloid compounds, and the role they may play in other diseases, most notably Alzheimer's disease. One company, Neurochem, from Quebec, Canada, is even exploring the role of "rogue" amyloids in the destruction of normal amylin response in type 2 diabetes -- but our focus is on the relationship between amylin and insulin.

These two hormones are both produced in the Beta cells of the human pancreas. A type 1 diabetic, deficient in insulin, is equally deficient in amylin. A type 2 diabetic may exhibit a lesser amylin deficit (or dysfunction, Neurochem, above, is researching this issue). But what does amylin do?

Amylin appears to have a moderating effect on blood glucose absorption, from the gut into the blood. It acts as a set of brakes, slowing and managing meal-derived glucose inflow, controlling pancreatic glucagon secretion, and thus regulating hepatic (liver) glucose production. It smoothes the "peaks and valleys" of blood sugar fluctuation, improving overall glycemic control.

In studies where Hemoglobin A1C test results were compared between those who used both insulin and Simlyn, and those who used only insulin, the A1C test results of those who used the injectable amylin analog were significantly lower than those who did not.

Clinical trials also revealed that most overweight diabetics who received Simlyn lost weight, while most lean diabetics, given the same medications, did not lose weight. Although the mechanism that produced these pleasant, unexpected findings is not yet clear, I find it exciting, as achieving and maintaining ideal weight contributes to good health, a sense of well-being, and for some, a reduction in the amount of insulin needed to maintain good control.

Many diabetics have experienced episodes of severe hypoglycemia, dangerously low blood sugars. "Tight control," multiple-test, multiple injection therapy to keep the blood sugars as close to a non-diabetic "normal" as possible, increases the risk of "hypos." Animal studies have shown that pramlintide, which normally retards release of glucose stored in the liver, suspends its action in the presence of hypoglycemia. This suggests a healthy supply of Simlyn might help lower the blood glucose without increasing the risk of hypoglycemia. Some test data suggest a reduction in hypoglycemic episodes for the duration of amylin therapy.

Amylin Pharmaceuticals conducted a series of clinical tests several years ago, Phase IIIs involving a graduated series of dosages. Most of the results from this research were well within acceptable standards; but the group receiving the highest dosages encountered unexpected difficulties, and the U.S. Food and Drug Administration, which rules on the safety and suitability of every new drug to be sold in the United States, understandably ordered more tests before approval would be considered. This second round of Phase III clinicals is now under way.

These are not small tests. In the first set of Phase IIIs, over 1700 people received Simlyn. Both type 1 and insulin-using type 2 diabetics took it, in different strengths, and with minimal side effects in all but the highest dosages. In most cases, significant reductions in hemoglobin A1C numbers were noted -- and it has been proven lower A1Cs significantly cut the risk of diabetes complications.

Much work is still under way to determine amylin's exact role in the management of diabetes. If Simlyn's retests are successful, if the company can answer the questions its high-dosage results exposed (and deal with the tremendous expense of retesting the drug), we may well see FDA approval. If they cannot, it will go into the books as one more idea that didn't quite make it. For the sake of all diabetics, I hope we see this one happen. Stay tuned.

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Voice Formats

Voice of the Diabetic is offered in two formats: standard print, and 15/16 IPS audiocassette ("talking book" speed). Anyone who is currently receiving the Voice in print and having difficulty reading it, may receive it on cassette at no charge. Voice tapes require the special tape player available free to the legally blind from Regional Libraries for the Blind and Physically Handicapped, which can be obtained by telephoning the National Library Service at: 1_800_424_8567.

Periodically we receive requests for the Voice in Braille or large print. It is not available in either of those formats at this time. View the Voice on the World Wide Web at: www.nfb.org/voice.htm

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PUMP ACCESSIBILITY
by Donna Blake

As I sample the literature written on the diabetes epidemic, I often see the much-quoted phrase, “Diabetes is the leading cause of blindness (age 20 -75) in the United States.” With the increasing number of both type 1 and especially type 2 diabetes cases (particularly in children), it amazes me that there is little or nothing written by healthcare professionals regarding the healthcare issues of blind patients. I suppose the reason is as complicated as the situation that arises when a blind patient walks into an eye doctor’s office—other patients seeing the eye care professional may then think the doctor is not good. In many healthcare settings, blindness is considered a medical failure, and that perception becomes much worse when the blind person also has diabetes. We know our doctors tried the best they could, and many went the extra mile for us patients, without success, and we are grateful for that; but where does this leave us with our ongoing healthcare? No pun intended, but we’re left in the dark.

When I first lost my vision, and could not read the little numbers on my insulin pump or the big numbers on my blood glucose machine, I had no resources to turn to for help. My eye doctors didn’t even know about CCTVs (video magnifiers), and that was in 1996. Neither my eye doctor nor diabetologist had a notion that talking blood glucose meters, Count-A-Doses (a tactile insulin-filling device), or other adaptive items to help me to control my diabetes without sight, even existed. I had to depend on a four-year-old to read numbers so I could pump in my insulin and measure my blood glucose.

I went through countless diabetes publications and found no written literature about patients having diabetes complications, or even from other non-diabetic causes of vision loss. (Yes, people with diabetes can develop other eye diseases similar to those in the general population.) Also, I found no resources for people who were already blind and then developed diabetes later in life. I then turned to the nation’s leading diabetes organizations, and none of them could give me an answer about what I could do. None of these organizations encouraged me at all.

It was only by chance I found out about the National Federation of the Blind (NFB). Someone gave me a NFB card, and I called the local chapter, which promptly sent me a copy of Voice of the Diabetic. It was through this publication I learned that some blood glucose meters had adaptable plug-in voice synthesizers, items such as Count-A-Doses existed and there were other items which could assist me with my diabetes management. However, despite this great and invaluable resource, I found nothing written regarding people who were blind and using insulin pumps. (Editor’s Note: There have been a number of articles for, and by, blind diabetics who successfully use insulin pumps. My survey, "Many Blind Diabetics Successfully Use Insulin Pumps," is also available as a chapter in the NFB publication titled "Diabetes Action Network Articles," available free in large print or four-track audiocassette from: Materials Center, National Federation of the Blind, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314; Web site: www.nfb.org)

Having been on an insulin pump for many years, I had to “blaze my own trail” so to speak. Fortunately at the time I was losing my vision, the company whose pump I used was coming out with a new model, which offered a lighted screen and an audible beep, to help program in the amount of insulin one needed (if you were in a poorly lighted area). Although they gave me more access to a tool I need to manage my diabetes, these new features certainly were not included to help a blind person with diabetes use this device.

My endocrinologist gave me a prescription for the newer pump, and this turned out to be a great asset. Though the new pump allowed me to give my meal doses of insulin with the sound of a beep, I could not use any of its other features. I still needed sighted assistance to program the pump, and make the changes in programming as my lifestyle changed and my needs changed. All of this happened six years ago, and since then there have been three newer model pumps developed by my pump company. Still, two-thirds of a pump’s features are not available for a blind user. I don't see how a blind user is supposed to even set up the pump independently—and I have made many calls to the company explaining the need and market value for such improvement.

It is great that we can make cars speak, watches speak, computers speak, elevators speak -- yet we cannot make such an important device audible? Even the epidemic increase in numbers of patients with diabetes and blindness has not convinced the pump manufacturers to improve their products to give us access to all the features, especially the ability to set it up independently. Not only is this true with pump manufacturers, but many of the blood glucose meter companies, as well.

Having been on a pump for so long, and using it both sighted and blind, has led to many phone calls from both potential pump users and healthcare professionals. Both professionals and patients alike have basic questions regarding how someone blind could use a pump and perform the necessary basic maintenance pump use requires. I have spoken to well over 25 people regarding the various issues, and how I have overcome challenging situations with my pump. Due to the lack of effort toward making a pump accessible to people who are blind, I put together a small reference guide to assist people in setting up and taking care of a pump site as well as some basic tips for operating the pump. I have also written a list of concerns someone or someone’s healthcare provider may have to consider when evaluating a pump as an appropriate tool for personal diabetes management.

If we are not to receive help from the manufacturers regarding their products, then we need to place pressure on our healthcare professionals to require the medical industry meet our needs. The ADA was passed to grant equal access for people with disabilities. Equal access in healthcare is a right for all, and manufacturers should understand the importance of accessibility for those of us who depend on their products. In order for blind people who have diabetes to live independently in our communities, we must demand that both the healthcare providers and the products they recommend meet our needs.

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INSULIN AND THE FUTURE
by Peter J. Nebergall, Ph.D.

Not so long ago, if you used insulin, you didn't have a whole lot of choices. There was "normal" speed R insulin, slower NPH or Lente, and perhaps you considered using Ultralente. You used Lilly insulins, or those from Novo Nordisk. It was that way for decades.

No longer. Insulin innovations have come thick and fast. It is tough for us, and our doctors, to keep up. It seems every time we turn around there's not only a new oral diabetes medication, and a new theory about how diabetes works, but now also a new insulin. What's going on? What's on the way?

The biggest insulin changes of the last decade were two: First, the replacement of "animal-source" insulins (beef or pork) with recombinant-DNA types. The new types are cheaper, easier to produce, and, made in a test tube, do not attract the unwelcome attentions of groups like PETA.

The second change was the arrival of Eli Lilly's Humalog. Two to three times faster than R insulin, Humalog has enabled diabetics to "inject while looking at their food." Humalog starts quicker than R, peaks faster, and is gone from the body sooner. It has proved enormously popular.

Lilly's competitor, Novo Nordisk, has followed suit with Novolog, which, though different in formulation, is similar in pattern of action.

Another big change has been the arrival of Aventis' Lantus insulin. Much attention has been paid to "quick" insulins; but Lantus is a very slow insulin, with a "peak" so flat it's almost a straight line. The first "24-hour" insulin, Lantus is carving out a niche among type 2 diabetics who need to start injecting insulin. Lantus is chemically incompatible with other insulins, and cannot be mixed -- but, as one dose of Lantus lasts 24 hours, there would not be much occasion to mix it.

Lantus is not available in insulin pen cartridges at this time, but sources at Novo Nordisk, who confirm the company is working on a competing "slow" insulin, state: "Once our product is approved, we hope to make it available for use in a variety of insulin delivery systems."

To achieve the best results, many people mix their insulins, injecting so many units of a fast insulin plus so many units of a slower. This is generally done in one syringe, by eye or with use of one of several assistive devices (see "Blind Diabetics Can Draw Insulin Without Difficulty" in this issue). Some people instead choose pre-mixed insulin, most often "70/30 (NPH and R)," in vials and insulin pen cartridges.

Several new mixes are now available. Lilly offers a Humalog 75/25 (quick-acting Humalog plus medium-slow PTZ insulin), and Novo Nordisk, maker of Novolin 70/30 premix, offers Novolog 70/30 premix. With their very rapid onset, these new insulin premixes offer some real advantages; but the Novolog mix (reviewed elsewhere in this issue) sounds dangerously like Novolin 70/30, opening the ambiguity door to new possibilities for doctor and pharmacist error. If you expect Novolog 70/30, but receive the older Novolin 70/30, no big deal; you'll catch the error next time you test your blood glucose -- but, if you expect Novolin 70/30, and receive the Novolog mix, likely you're going down with a bang.

Amazingly, Novo Nordisk (who's sponsored really good research into insulin-dosage errors) did not sound particularly concerned, when I confronted them with this. I don't know why.

There has been a lot of interest in oral, buccal (under the tongue), and inhalable insulins, whose administration would not require piercing of the skin with a needle. Many companies are researching such formulations, but none have been approved at this time. Insulin inhalation works (in that the insulin gets into the bloodstream and lowers the blood sugar); but the problem has always been to moderate the insulin's action, to give it a "response curve" similar to that of injected insulin. Oral and buccal insulins, utilizing the digestive system for absorption rather than the lungs, have had to contend with the opposite: too little insulin getting through to the patient's blood.

There have been problems. One company's otherwise-promising clinicals revealed that their inhalable insulin product did work -- but that it scarred the lungs as well -- causing emphysema while controlling diabetes. Naturally, this formulation did not pass its exam. Work continues, with the problem being "packaging" of the insulin, in some sort of micro-droplets that can be absorbed in a reliable, predictable, and controlled manner. And, of course, once a formulation works, they'll have to prove it's safe -- and that will take some time.

An "insulin pill" is of course the ideal. This has been tried, many a time, but the problem is simple: How do you keep the pill from digesting, in the mouth and in the stomach, but get it to open up in the small intestine?

As with the inhalable formulations, there have been many different variations. A lot of different companies are searching for this Holy Grail -- and with luck, one of the experimental formulations will work. Eventually.

None of the inhalable insulins, or of the insulin pills, has completed clinical trials at this time. There are a lot of trials underway -- but we're not there yet.

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LOUISVILLE SITE OF 2003 NFB CONVENTION

This story first appeared in the January 2003 Edition of the Braille Monitor, published by the National Federation of the Blind.

The 2003 convention of the National Federation of the Blind will take place in Louisville, Kentucky, June 28 to July 5. We will conduct the convention at the Galt House Hotel and the Galt House East Tower, a first-class convention hotel. The Galt House Hotel, formerly called the Galt House West, is at 140 N. Fourth Street, Louisville, Kentucky 40202. The Galt House East Tower, or Galt House East, is at 141 N. Fourth Street, Louisville, Kentucky 40202. Room rates for this year's convention are excellent: singles, doubles, and twins $57; and triples and quads $63 a night, plus tax. The hotel is accepting reservations now. A $60-per-room deposit is required to make a reservation. Fifty percent of the deposit will be refunded if notice is given to the hotel of reservation cancellation before June 1, 2003. The other 50 percent is not refundable. For reservations, call the hotel at: (502) 589-5200.

Rooms will be available on a first-come, first-served basis. Reservations may be made to secure these rooms before June 1, 2003, assuming that rooms are still available. After that time, the hotel will not hold the block of rooms for the convention. In other words, you should get your reservation in soon.

Our overflow hotel is the Hyatt Regency, at 320 W. Jefferson Street, Louisville, Kentucky 40202; phone: (502) 587-3434.

Those who attended the 2002 convention can testify to the gracious hospitality of the Galt House. This hotel has excellent restaurants, first-rate meeting space, and other top-notch facilities. It is in downtown Louisville, close to the Ohio River, and only seven miles from the Louisville Airport.

The 2003 convention will follow what many think of as our usual schedule:

Saturday, June 28: Seminar Day

Sunday, June 29: Registration day

Monday, June 30: Board Meeting and Division Day

Tuesday, July 1: Opening Session

Wednesday, July 2: Tour Day

Thursday, July 3: Banquet Day

Friday, July 4: Business Session and Adjournment

Plan to be in Louisville; the action of the convention will be there!

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DIALYSIS AT NATIONAL CONVENTION
by Ed Bryant

During this year's annual convention of the National Federation of the Blind, in Louisville, Kentucky (Saturday, June 28, through Friday, July 4), dialysis will be available. Individuals requiring dialysis must have a transient patient packet and physician's statement filled out prior to treatment. Conventioneers must have their unit contact the desired location in the Louisville area for instructions, well in advance. NOTE: The convention will take place at the Galt House Hotel, 140 N. Fourth Street, Louisville, KY 40202.

Individuals will be responsible for, and must pay out of pocket, prior to each treatment, the approximately $30 not covered by Medicare, plus any additional physician's fees, and any charges for other medications.

DIALYSIS CENTERS SHOULD SET UP TRANSIENT DIALYSIS LOCATIONS AT LEAST EIGHT WEEKS IN ADVANCE. THIS HELPS ASSURE A LOCATION FOR ANYONE WANTING TO DIALYZE. There are many centers in the Louisville area; but that area is quite large, and early reservation is strongly recommended—especially during this holiday period. Here are some dialysis locations, all about half a mile from the hotel:

* Renal Care Group, Inc., 635 South Third Street, Louisville, KY 40202; telephone: (502) 561-1314. As of this writing, they are almost full.

* Fresenius Medical Care, 720 East Broadway, Louisville, KY 40202; telephone: (502) 584-3021.

* U. of Louisville Kidney Disease Program, 615 Preston Street, Louisville, KY 40202; telephone: (502) 852-7278.

PLEASE REMEMBER TO SCHEDULE DIALYSIS TREATMENTS EARLY, TO ENSURE SPACE. CALL THEM NOW! If scheduling assistance is needed, have your dialysis unit's social worker contact me: Diabetes Action Network President Ed Bryant; telephone: (573) 875-8911. See you in Louisville!

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DIABETES ACTION NETWORK SEMINAR
by Ed Bryant

At the 2003 convention of the National Federation of the Blind, in Louisville, Kentucky, our Diabetes Action Network will have its seminar and business meeting, on Monday, June 30, from 2 to 4:30 pm.

Our keynote speaker will be a Registered Dietitian, who will discuss diabetic foods, the Exchange List, and carbohydrate counting. There will be plenty of time for your questions.

Once again, we will have our “Make the President Pay” diabetes quiz game—and I will give a nice donation to the division for each right answer! Our seminar is free and open to the public. Its room location will be posted in the Agenda (which is provided when you register).

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BLIND DIABETICS CAN DRAW INSULIN WITHOUT DIFFICULTY
by Ed Bryant

This article appeared in Voice of the Diabetic, Volume 16, Number 2, Spring 2001, published by the Diabetes Action Network of the National Federation of the Blind.

A major aim of the Diabetes Action Network of the National Federation of the Blind is to provide support and information for blind diabetics, so they might better maintain or regain independence and productivity. Our national support and information network allows communication across a wide area, something important for blind or visually impaired diabetics and their families. With the trauma of sight loss, sometimes the newly blinded do not realize that most blind men and women with diabetes CAN self-manage safely and accurately, by use of alternative/adaptive techniques.

I became blind from diabetic retinopathy about 25 years ago. When I first lost my sight, I didn't use insulin gauges to help draw my insulin, as I had never heard of such devices! Twenty-three years ago, I designed my own insulin gauge, and I used it for approximately three years, with no difficulties. However, I do not advocate the use of non-standard or homemade insulin-measuring devices, unless they have been checked out by someone knowledgeable in insulin-measuring techniques.

Members of the health care community sometimes forget that although a diabetic may be newly blinded, he or she has often been successfully self-managing the disease for 15 years or more. Most long-term type 1 diabetics have had years of experience drawing their own insulin. Veteran blind diabetics often have more experience with adaptive insulin preparation devices than do many sighted health professionals. The following observations are only a small sample.

Because of my experience with diabetes and blindness and my editorship of Voice of the Diabetic, I am often asked to evaluate insulin-measuring gauges designed for the blind or visually impaired. I have tested numerous measuring devices, and in my opinion the Count-A-Dose, from Medicool, wins the blue ribbon. (Note: The Count-A-Dose is available from the National Federation of the Blind Materials Center: (410) 659-9314.) I hasten to add that no one instrument is ideal for everyone; however, the Count-A-Dose provides a very easy method of insulin dispensing. Designed for the B-D LoDose syringe, the Count-A-Dose holds two insulin vials and directs the syringe needle into the vials' rubber stoppers. Using the thumb-wheel, which clicks for each unit measured (clicks can be both heard and felt), the blind diabetic can reliably draw and mix his or her own insulin.

How to Get Air Bubbles Out of an Insulin Syringe

There are techniques by which a blind diabetic may draw and mix insulin without drawing air into the syringe. Like many others, I have used them successfully for years. I first draw four or five units of regular insulin into the syringe and then inject all of it back into the vial. I then repeat the operation two more times. The fourth time, I draw the full amount of insulin needed from the first vial. Then, when I draw insulin from the second vial, I draw the exact amount needed. I have put this to the test; 100 repetitions without air bubbles. Diabetes Action Network former First Vice President Janet Lee twice performed the same test. In both cases the complete absence of air in the syringe was independently verified.

"Tapping the syringe to remove air bubbles," a common technique used by the sighted, becomes unnecessary. The one to two units of air in the hub of the needle (where needle meets syringe) are expelled during the procedure used with the first vial of insulin. I demonstrate this technique to nurses, who are delighted to see that air bubbles are not present and the insulin measurement is accurate. Of course, long-term insulin users will be familiar with the need to inject as much air into the vial as the amount of insulin they withdraw, to facilitate getting the insulin into the syringe. For further information, consult your health care team.

How to Know When an Insulin Vial is Getting Low

Each vial of insulin contains 10cc, 1000 units. The maximum number of units used per day, divided into the vial's 10cc (1000 units) capacity, gives the maximum number of days the bottle can be used. When I open a new vial of Regular insulin, I divide its 1000 units by 20 units, the maximum I use daily, so one supply should last me 50 days, but as a safeguard, I assume that the new bottle contains only 940 units (9.4cc), which should last a maximum 47 days instead of 50. I measure my NPH insulin in a similar manner. As long as at least 60 units of insulin remain in the vial, the needle will remain submerged while filling, and there is no danger of drawing air. In drawing out the insulin, I keep the syringe vertical, needle straight up in the vial, so as not to inadvertently draw out air. Many blind consumers (and diabetes educators) are unaware of this point's importance—that the natural tendency is to tilt or slant while drawing, which can lead to inaccurate filling and air in the syringe.

Many methods exist to determine how long a supply will last. One way to keep track of the amount of insulin in the container is to set aside the number of syringes that will be needed for 940 units of insulin. Another might be to employ Braille, large print, tape recorders, or personal computers, to record how much insulin has been used each day. Many blind consumers, like myself, realize the importance of keeping their blood glucose under tight control, and follow regimes of insulin mixing and multiple injections, both of which increase the need for precision. I have found the more precise the record of insulin drawn, the easier to safely predict when it is time for a new supply. NOTE: Although not as precise, before drawing insulin you can gently shake the vial and, with practice, easily determine whether it is full, half-full, or nearly empty.

Tactile Insulin Pens

Many blind diabetics make use of the easy adjustability of insulin pens. Pens combine the insulin drawing and dosing functions, and, though all still bear the legal disclaimer: “Not for use by blind or visually-impaired individuals without sighted aid,” most incorporate tactile and audible cues for each unit drawn, and many blind diabetics successfully use them—without sighted aid. Some even come “pre-filled,” and are meant to be discarded when empty. Though pens have their drawbacks (no mixing, higher price), they work, and one from Novo Nordisk, Eli Lilly, Owen Mumford, or Disetronic might be appropriate for you. Talk to your doctor and your pharmacist.

The Possibility of Inserting a Needle into a Blood Vessel

Since injection sites are in fleshy areas, and insulin needles are short, chances of inserting a needle into a blood vessel are minimal. The worst that can be done is to hit a small capillary, which would result in a small area becoming infused with blood—a hematoma. Again, it is unlikely the needle will be inserted into a small blood vessel. The amount of insulin entering the bloodstream via a capillary would be insignificant, and would cause no harm.

Something to Think About

I periodically have my insulin gauge checked for accuracy; it has always measured precisely. If the diabetic is careful, difficulty in measuring insulin will not occur. I have found that inaccuracy is often the result of haste or carelessness.

It is reported that insulin gauges are more accurate than sight. When the plunger is pushed firmly to the gauge, the same amount of insulin will be obtained every time. Sometimes my sighted friends make errors in drawing insulin. Perhaps they would be more accurate if they used insulin gauges! Note: Syringes are mass-produced. Although there is quality control, some errors are made in syringe markings. If a gauge is used, the measurement will be accurate no matter what the syringe shows.

At first hearing, all this may sound like a lot to remember, but it is not difficult. Marla Bernbaum, MD, CDE, Assistant Professor at St. Louis University Medical School Department of Endocrinology, states: "In our experience here, most blind and visually impaired diabetic patients have been capable of drawing their own insulin with complete accuracy."

Janet Lee, former Director of the Independent Management for Blind Diabetics Program at BLIND, Inc., Minneapolis, Minnesota, stated: "In my ten years of working with blind diabetics, hundreds of them, there have maybe been two, who, because of a combination of disabilities, could not measure their own insulin."

Ruth Ann Petzinger, RN, MS, CDE, Diabetes Care Manager/Educator at St. Peters Medical Center, New Brunswick, New Jersey, states: "During the time I have been working with persons with diabetes and visual impairment, I've never had a patient who truly wanted to be independent with insulin administration or blood glucose monitoring who was not able to achieve these goals."

Anne Whittington, RN, MSN, MBA, CDE, with the U.S. Navy Medical Center, San Diego, California, states: "In my experience, with proper training almost all diabetics are able to prepare and administer their own insulin safely, regardless of visual impairment."

Ann Williams, MSN, RN, CDE, formerly Diabetes Program Coordinator, Cleveland Sight Center (now completing her Ph.D.), states: "In the last eight years I worked at CCS, we taught about 800 visually impaired and blind people to measure and administer their own insulin independently. Vision loss does not preclude safe and effective insulin self-administration."

I have no problems managing and keeping my diabetes under control. I control it through the use of alternative techniques, some of which are described here. Many members of our organization, the National Federation of the Blind, use them daily to live active lives. With alternative techniques, blind diabetics can be as productive as when they were sighted.

Come to us and ask for assistance. We are ready, willing, and able to help. We want you to know that no matter what your diabetes ramifications, you are not alone and do have options. We in the National Federation of the Blind know that blindness is not synonymous with inability.

Resources:

The Eye-Dea Shop: Cleveland Sight Center, 1909 E. 101st Street, Cleveland, OH 44106-8696; phone: (216) 791-8118 ext. 278

The Syringe Support Insulin Measuring Device: Uses only the B-D 1cc/100-unit disposable syringe, and measures insulin in 1- or 2-unit increments, in doses of 1 to 100 units. To mix insulins, it is necessary to remove vials from the apparatus. To draw a measured dose, the Syringe Support uses a set screw, with a raised flange (its only landmark) at 12 o'clock. One full turn draws two units, and one half-turn draws a single unit. Although the dial lacks definite tactile or audio indicators, in most cases any error would be fractional. Still, the Syringe Support performs best for those who must draw doses greater than 10 units. Instructions (standard print only) are bilingual (English and French). Cost: $26

National Federation of the Blind, Materials Center: 1800 Johnson Street, Baltimore, MD 21230; phone: (410) 659-9314; fax: (410) 685-5653; Hours are 8:00 a.m. to 5:00 p.m. EST, weekdays; Web site: http://www.nfb.org

Count-A-Dose Insulin Measuring Device: Gauge calibrated for use with vials and B-D 1/2cc (low dose) syringes only. By turning a thumb-wheel, clicks are heard and felt for each one-unit increment measured; holds 1 or 2 vials of insulin for mixing; needle penetrates vial stopper automatically. Print and audiocassette instructions provided. Price: $40.00

Palco Labs, Inc.: 8030 Soquel Ave., Santa Cruz, CA 95062; phone: 1-800-346-4488; fax: (831) 476-1114

Load-Matic: Tactile insulin measuring device, accepts B-D 100-unit syringes; aligns needle with vial stopper; two separate controls (one for single-unit and the other for ten-unit increments); tactile prompt to confirm dose setting. Audiocassette instructions included. Individuals with neuropathy may have difficulty with the one-unit scale, and it is possible to unintentionally "short-stroke" the ten-unit loading lever and draw an incomplete dose. Cost: $47.99

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BOOK REVIEWS
by Marilyn Helton

Henry David Thoreau advises us, "Live in each season as it passes; breathe the air, drink the drink, taste the fruit, and resign yourself to the influences of each."

Despite the fact this column is written before we change seasons from winter to spring, I remain the eternal optimist, with hope that by the time you read this, world peace will have prevailed.

Here we are in the month of April and there's a mighty load of new book reviews to bring your way. We have lots of celebrations centered on food this quarter, which can either be miserable news or eagerly anticipated by those of us with diabetes.

The parade begins with Passover and Easter in April, followed by Cinco de Mayo, Mother's Day and Memorial Day in May, and then "Juneteenth" (the Texas celebration of African American emancipation), Father's Day and graduation celebrations in June. Don't forget to dot the landscape with birthdays, weddings, festivals, picnics and other unofficial opportunities to do the
food-dance.

With so many food-oriented occasions ahead of us, it's wise to be ready with some great new food ideas, tips and recipes for looking forward to each and every one of them. Remember, your diagnosis of diabetes does NOT have to be a culinary death sentence!

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Good news! You were introduced to Mealleaniyumm! by Canadian cookbook maven Norene Gilletz a couple of years ago, and now the updated and revised edition, Mealleaniyumm! 800 Fast, Fabulous & Healthy Recipes for the Kosher (or not) Cook is available just in time for Passover.

You don't have to be Jewish to enjoy these healthy, home-style recipes, because this quick and easy cookbook focuses on low-fat, nutritious cuisine for everyone. Emphasizing the use of everyday ingredients, Norene's step-by-step recipe directions, time-saving tips, substitutions, and recipe variations are a real bonus. One of my favorite features is the complete nutritional analysis for each recipe, accompanied by healthful hints about fat, fiber, cholesterol, calories, calcium and more.

Whether you have diabetes, are a cardiac patient, vegetarian or just love good food, Mealleaniyumm! 800 Fast, Fabulous & Healthy Recipes offers recipes from family fare to bountiful buffets, perfect for today's time-challenged cook. Five out of five stars to this cookbook and its author, Norene Gilletz!

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You're gonna love the next two cookbooks, folks! Now you can literally have 1,001 Delicious Recipes for People with Diabetes and 1,001 Delicious Desserts for People with Diabetes in two separate cookbooks. Both books are published by Surrey Books and they are HUGE (the first having over 800 pages and the DESSERTS over 600 pages). Sue Spitler, a terrific cookbook author in her own right, teamed up with Linda Eugene, RD, CDE, and Linda R. Yoakam, RD, MS, to bring us this bonanza of delectable recipes. Wow! Just think, if you tried a new recipe from one of these great books every day, it would be almost six years of delicious dining!

Fat is what makes food taste good, and oh, how we all love those zesty pastas and rich gooey desserts! "For a person with diabetes and no healthy cooking experience, the larder may look a little lean," says co-editor and professional cook Sue Spitler (whose other books in the "1,001 Series" are bestsellers). "It's important to choose foods that are low in fat, moderate in carbohydrate, low salt, high fiber and rich in vitamins and minerals. The key is the recipe . . . you need to cook with enough flavor to make you feel satisfied." And guess what? That's exactly what this cookbook-writing trio has brought to this magical set of cookbooks!

Promising "no more boring meals," imagine having Artichoke-Stuffed Appetizer Bread, Roast Chicken with Cornbread Stuffing, Shrimp and Sausage Gumbo, Vegetable Strudel with Cheese, Crab Melts or Sweet Stuffed French Toast on the menu. But wait, what about dessert? Well, how about Mississippi Mud Bars, Macadamia Nut Cheesecake, Pineapple and Double Cheese Upside Down Cake, Banana Cinnamon Cake with Powdered Sugar Glaze, or Deep-Dish Blackberry Cobbler with Lemon Hard Sauce? With over 2,000 recipes, these books deliver as promised!

I don't want to hear any more whining about "not being able to eat anymore" just because you've been diagnosed with diabetes. If your budget was limited and you could only have two cookbooks, invest in these two and never look back! Or, put them on your wish list; these books are fabulous! Five enthusiastic stars out of five!!

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Is time a premium for you? Then take a look at The Diabetes Double-Quick Cookbook, by experienced cookbook author, Betty Marks. Besides her involvement with ballroom dancing, photography, swimming and hiking, or pursuing her active career as a literary agent, Betty Marks has insulin-dependent diabetes.

Betty's secret for managing her time and her diabetes is the microwave! Sometimes I think we overlook using the microwave as a cooking tool and only use it to heat or reheat our food. If you're in that category, make time to check out this cookbook and let Betty show you how to create recipes like Attila's Beef Goulash, Chicken Crunch, Gourmet Cheese Muffins, Corn and Peanut Pudding, Nutty Sea Scallops and Orange Cheese Cake in your microwave. You'll get these recipes plus over 140 more! All are high in taste and low in fat, cholesterol, sodium and calories. All recipes have complete nutritional information, including breakdowns for the three types of fat, dietary fiber and diabetic exchanges (for those of you who still haven't switched over to counting carbs).

In addition to learning more about how to cook with the microwave, I liked Betty's Microwave Cooking and Kitchen Safety Tips. Here's another bonus: Did you know that Braille overlays are available for the visually impaired? Many microwave manufacturers offer these useful aids. I was amazed by how much useful information is packed into this little book. Betty Marks has written another winner for Surrey Books, which merits another Five-Star rating from this reviewer!

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Continuing on the fast-food roll, are you one of those people whose time is always premium? I know I am. Although I love to cook, I have to be practical since I'm always fighting a deadline. Usually, I just want to get in and out of the kitchen as fast as I can, which is hard to do if you have to be careful about what you eat.

Nancy Hughes has the answer in Last Minute Meals for People with Diabetes, a cookbook published by The American Diabetes Association. Last Minute Meals has more than 100 fast and flavorful recipes using just six ingredients or less. If the name of the book sounds familiar, the Voice has published some of the recipes from this cookbook in "Recipe Corner."

Chapters from Last Minute Meals include Stress-Free Starters and Snacks, No-Chop Salads (great for those of us with arthritic hands), Dump and Do Dinners (I love that chapter title), Speedy Sides and Easy-Does-It Desserts. Complete nutritional analyses and Diabetic Exchanges accompany each recipe. Hmmmm... I think I'd better adopt this cookbook and take it home!

Nancy Hughes is a veteran cookbook author, having six nationally published cookbooks to her credit. She's also worked extensively on more than 15 others, including several books for the American Heart Association, Cooking Light, Weight Watchers, Betty Crocker and Publications International. Her articles have appeared in Better Homes and Garden, Cooking Light, Diabetic Cooking, Heart Healthy, and Cooking Pleasures. She's currently working on another cookbook for the American Diabetes Association.

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I guess that's a wrap for this session, so I'll catch up with you again in July. In the meantime, continue to stay on your journey to a healthier you in 2003!

Marilyn Helton, diabetic since 1993, is the publisher of Cinnamon Hearts: The Art of Living a Winning Diabetic Lifestyle, a positive-power E-zine for diabetics and their families. Visit the CINNAMON HEARTS Web site: www.cinnamonhearts.com

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RECIPE CORNER

This issue, all recipes are taken from The Diabetic's Healthy Exchanges Cookbook, by JoAnna M. Lund, published by Perigee. (Contact HEALTHY EXCHANGES at telephone: (563) 659-8234; or at Web site: www.healthyexchanges.com)

IRISH CREAM OF POTATO SOUP

INGREDIENTS

2 cups (one 16-ounce can) Healthy Request Chicken Broth
1 teaspoon dried minced garlic
1/2 cup sliced green onion with tops
1 cup shredded cabbage
1-1/2 cups (one 12-fluid-ounce can) Carnation Evaporated Skim Milk
1 cup skim milk
1-1/3 cups (3 ounces) instant potato flakes
1/4 teaspoon black pepper
1 teaspoon dried parsley flakes

DIRECTIONS

In a medium saucepan, combine chicken broth and minced garlic. Stir in onion and cabbage. Cook over medium heat, stirring occasionally, until vegetables are tender, about 10 minutes. Add evaporated skim milk, skim milk, potato flakes, black pepper, and parsley flakes. Mix well to combine. Lower heat. Continue cooking, stirring often, until mixture thickens, about three to four minutes. Makes 4 servings (1-1/4 cups).

201 Calories, 1 gm Fat, 13 gm Protein, 35 gm Carbohydrate, 413 mg Sodium, 1 gm Fiber. Exchanges: 1 Starch, 1 Skim Milk, 1/2 Vegetable.

HONEY DIJON TOMATO SALAD

INGREDIENTS

1 cup shredded lettuce
2 cups chopped fresh tomatoes
1/3 cup (1-1/2 ounces) shredded Kraft Reduced-Fat Mozzarella Cheese
2 teaspoons dried parsley flakes
1/4 cup Kraft Fat-Free Honey Dijon Dressing

DIRECTIONS

For each serving, layer 1/4 cup shredded lettuce on salad plate. Place 1/2 cup chopped tomatoes over lettuce. Sprinkle about 2 tablespoons mozzarella cheese and 1/2 teaspoon parsley flakes over top of tomatoes. Drizzle 1 tablespoon dressing over top. Serve at once. Makes 4 servings.

75 Calories, 3 gm Fat, 4 gm Protein, 8 gm Carbohydrate, 225 mg Sodium, 1 gm Fiber. Exchanges: 1 Vegetable, 1/2 Meat.

ESCALLOPED CARROTS AND CELERY

INGREDIENTS

3 cups diced carrots
2 cups diced celery
2 cups water
1-1/2 cups (one 12-fluid-ounce can) Carnation Evaporated Skim Milk
3 tablespoons all-purpose flour
1 cup (two 2.5-ounce jars) sliced mushrooms, drained
1 teaspoon dried parsley flakes
1/8 teaspoon black pepper
3/4 cup (3 ounces) shredded Kraft Reduced-Fat Cheddar Cheese
6 tablespoons (1-1/2 ounces) dried fine bread crumbs

DIRECTIONS

Preheat oven to 375 degrees. Spray an 8-by-8-inch baking dish with butter-flavored cooking spray. In a medium saucepan, combine carrots, celery, and water. Cover and cook over medium heat 20 to 25 minutes or until vegetables are just tender. Drain. In a covered jar, combine evaporated skim milk and flour. Shake well to combine. Pour milk mixture into a medium saucepan sprayed with butter-flavored cooking spray. Cook over medium heat, stirring constantly, until mixture thickens and starts to boil. Add mushrooms, parsley flakes, and black pepper. Mix well to combine. In prepared baking dish, make two alternate layers of vegetables, white sauce, cheddar cheese, and bread crumbs. Cover and bake 30 minutes. Uncover and continue baking additional 15 minutes. Place baking dish on a wire rack and let set five minutes. Cut into 6 servings.

164 Calories, 4 gm Fat, 11 gm Protein, 21 gm Carbohydrate, 331 mg Sodium, 2 gm Fiber. Exchanges: 1 Vegetable, 1/2 Meat, 1/2 Starch, 1/2 Skim Milk.

SWISS BAKED CHICKEN

INGREDIENTS

16 ounces skinned and boned uncooked chicken breast, cut into 24 pieces
4 (3/4-ounce) slices Kraft Reduced-Fat Swiss Cheese, shredded
1-3/4 cups (one 15-ounce can) Hunt's Chunky Tomato Sauce
1 teaspoon Italian seasoning
1 tablespoon all-purpose flour
1 tablespoon Sugar Twin or Sprinkle Sweet
1/2 cup (one 2.5-ounce jar) sliced mushrooms, drained and finely chopped

DIRECTIONS

Preheat oven to 350 degrees. Place chicken pieces in an 8-by-8-inch baking dish. Sprinkle Swiss cheese evenly over chicken. In a small bowl, combine tomato sauce, Italian seasoning, flour, Sugar Twin, and chopped mushrooms. Pour sauce mixture evenly over cheese. Cover and bake 30 minutes. Uncover and continue baking 10 to 15 minutes or until chicken is tender. Place baking dish on a wire rack and let set five minutes. Divide into 6 servings.

HINT: Good served over pasta, potatoes, or rice.
174 Calories, 6 gm Fat, 22 gm Protein, 8 gm Carbohydrate, 727 mg Sodium, 1 gm Fiber. Exchanges: 3 Meat, 1 Vegetable.

IRISH SPRING PIE

INGREDIENTS

1 (8-ounce) package Philadelphia Fat Free Cream Cheese
1 cup (one 8-ounce can) crushed pineapple, packed in fruit juice, well drained
Sugar substitute to equal 2 tablespoons sugar
1/2 teaspoon coconut extract
1 (6-ounce) Keebler butter-flavored piecrust
2 cups (2 medium) sliced bananas
1 (4-serving) package JELL-O Sugar-Free Instant Pistachio Pudding Mix
2/3 cup Carnation Nonfat Dry Milk Powder
1-1/3 cups water
1/2 cup Cool Whip Lite
2 tablespoons flaked coconut

DIRECTIONS

In a large bowl, stir cream cheese with a spoon until soft. Add pineapple, sugar substitute, and coconut extract. Mix gently to combine. Spread mixture evenly in bottom of piecrust. Layer sliced bananas over cream cheese mixture. In a medium bowl, combine dry pudding mix and dry milk powder. Add water. Mix well using a wire whisk. Blend in Cool Whip Lite. Pour pudding mixture evenly over bananas. Sprinkle coconut evenly over top. Refrigerate at least two hours. Cut into 8 servings.

272 Calories, 8 gm Fat, 10 gm Protein, 40 gm Carbohydrate, 546 mg Sodium, 2 gm Fiber. Exchanges: 1 Fruit, 1 Fat, 1 Starch, 1/2 Meat, 1/2 Skim Milk.

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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 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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HEAR YE, HEAR YE, A RAFFLE

The Diabetes Action Network of the National Federation of the Blind reaches out and provides support and information to thousands of people. Because it costs to operate this valuable network and to produce the Voice of the Diabetic, we must generate funds to help cover these expenses. Our Diabetes Action Network has elected to hold a raffle, which will be coordinated by our division treasurer, Bruce Peters.

THE GRAND PRIZE WILL BE $500! The winning ticket will be drawn, and the winner's name announced, on July 3, 2003, at the banquet held during the annual convention of the National Federation of the Blind.

Raffle tickets cost $1 each, or a book of six may be purchased for $5. Tickets may be purchased from state representatives of our Diabetes Action Network or by contacting the Voice Editorial Office, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875_8911. Anyone interested in selling tickets should also contact the Voice Editorial Office. Tickets are available now! Names of persons who sell 50 tickets or more will be announced in the Voice.

Please make checks payable to the National Federation of the Blind. Money and sold raffle ticket stubs must be mailed to the Voice office no later than June 13, 2003, or they can be personally delivered to Raffle Chairman Bruce Peters, at this year's NFB convention in Louisville, Kentucky. This raffle is open to anyone age 18 or older, and the holder of the lucky raffle ticket need not be present to win. Each ticket sold is a donation, helping keep our Diabetes Action Network moving forward.

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LETTERS TO THE EDITOR

Includes Artwork: Fancy Writing Pen

May 31, 2002

Thank you for providing such an informative magazine. Since my husband reads the print edition and I use the cassettes, we particularly appreciate being able to receive it in both formats.

Sincerely,
Phyllis Anderson
Durham, NC

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September 29, 2002

I have started receiving the Voice of the Diabetic and have greatly benefited from the same. Thanks so much and congratulations for the superb effort. Good luck.

Anjali Arora
New Delhi, India

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December 3, 2002

I would like to increase the number of magazines I receive from you to 100 issues if that is possible. I have been passing out the issues to my support group members and leaving some in physicians’ offices, and the response has been great. I highly suggest your magazine to people with diabetes, even those without sight difficulties.

Thank you so much for a job well done.

Linda Barndollar
Westmoreland, NH

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January 13, 2003

I am pleased to read the information which you are presenting. I have worked in public health administration for the past 25 years. The information you present will serve the public well. Thank you for making this available.

Respectfully,
Thomas J. Culver
Peoria, Illinois

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January 15, 2003

For many years now you have been sending me 15 copies of Voice of the Diabetic, and I hope you will continue to send them to me. I run a Diabetic Support Group for seniors. When I receive your 15 copies I hand them out to each diabetic senior. Thank you so much. It was so encouraging to read in the Winter 2003 Edition about a diabetic of 75 years! Wow.

Dorothy Hase
Minneapolis, Minnesota

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January 16, 2003

Yes! I want to continue receiving Voice of the Diabetic. Thank you for a really helpful and excellent publication.

David Goldberg
Sun City, Arizona

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

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

Volunteers Needed

Not enough studies have focused on the unique needs of women with type 1 diabetes. More needs to be learned about the relationship between the menstrual cycle and blood glucose levels, and between diabetes and premenstrual syndrome (PMS). The University of Pennsylvania is seeking volunteers, generally healthy women diagnosed with type 1 diabetes, who have regular menstrual cycles, no plans to become pregnant while enrolled in the study, use a reliable form of birth control, have no serious hypoglycemia problems, and no history of psychiatric treatment.

Participants in one study will fill out a questionnaire, keep a diary of blood glucose results, have a free screening physical exam and intravenous glucose tolerance test, and spend two nights at the General Clinical Research Center at the University of Pennsylvania Hospital. This test pays $200.

For women with both diabetes and PMS, the second study requires: Daily completion of menstrual cycle questionnaire and glucose diary for seven months; taking a new drug treatment for PMS, or a placebo; and four overnight stays at University of Pennsylvania Hospital. This test pays $500. Note: Although these studies are open to any women who meet the qualifications, there are no funds to transport folks to Philadelphia, so the ideal candidate already lives in the Philly area.

For information, contact: Kimberly Trout, RN, University of Pennsylvania Medical Center, Philadelphia, PA 19104; telephone: (215) 898-6733.

Free Diabetes Literature

The National Federation of the Blind maintains an extensive literature collection, with free materials on many subjects available in a variety of formats. Twenty-three articles on aspects of diabetes, all previously published in the Voice, have been assembled into a single volume, available in large print and four-track audiocassette, titled: “Diabetes Action Network Articles.” Both formats are free of charge. To order, or to request a complete NFB literature catalog, contact: NFB Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314. You may also order by e-mail: [email protected]. The Materials Center is open 8:00 a.m. to 5:00 p.m., EST, weekdays.

Diabetic Foot Information on Tape

Podiatrist Kenneth B. Rehm, DPM, limits his practice to the diabetic foot, and he has a great deal of useful information to impart. On July 6, 2002, he addressed the Diabetes Action Network’s annual meeting, and we recorded his speech. Titled: “Diabetes, Neuropathy, and The Feet,” it is now available, on normal-speed audiocassette, for $2 per copy, from: National Federation of the Blind, Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314; Web site: www.nfb.org

Diabetes Supplies

American Diabetic Supply, Inc., will ship your diabetes supplies to your door. They handle all insurance claims and provide free delivery. Folks with Medicare and/or private insurance (no HMOs) may receive supplies at no further cost. For information, contact: American Diabetic Supply, Inc., 400 S. Atlantic Ave., Suite 108, Ormond Beach, FL 32176; telephone: 1_800_453_9033.

Bibles for the Blind

We have been asked to announce: If you are at least legally blind (documentation required), you may purchase a copy of the Theophilos Audio Bible, for $29.95 (USA). Not an audiocassette, this works through your computer’s screen-reading software. The company recommends you use JAWS. For information, contact Audio-Bible, www.audio-bible.com, or telephone: 1-888-262-9977.

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 Professional, an up-to-date program designed to take full advantage of the newest generation of Windows’ capabilities. For information, contact: GW Micro, in Fort Wayne, Indiana; telephone: (260) 489-3671; fax: (260) 489-2608; e-mail: [email protected]; Web site: www.gwmicro.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 535, Mabel, MN 55954; telephone: 1-800-210-9665; Web site: www.steuartlabs.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 The Diabetic 4 Ingredient Cookbook. There are over 200 recipes, in all food categories, with complete nutritional and exchange information, each one using four ingredients. The book costs $9.95 (+$2.95 shipping), from: Coffee and Cale, PO Box 2121, Kerrville, TX 78029; telephone: 1-800-757-0838.

Full Service Diabetes Supplier

DS Medical Supply is a full-service supplier with a catalog of more than 55,000 items, dealing with diabetes, its complications, and many other medical supplies, delivered to your home. Diabetes products range from glucose monitors by Bayer and LifeScan, and the AccuChek VoiceMate talking glucose monitor, strips, lancets and other supplies, to diabetic orthotics/foot care items, and much more. They accept Medicare, private insurance, some HMOs, and, in most states, direct or crossover Medicaid. Contact: DS Medical, 2105 Newport Place, Suite 600, Lawrenceville, GA 30043-5561; telephone: 1-800-722-2604, Web site: www.dsmedical.com

Help Your Feet

If you have had diabetes for any length of time, you probably have sore, dry feet. They're painful, and the cracking and dryness can lead to serious infections. You need to inspect your feet every day, but what else can you do? You can keep them moist, with a quality foot cream. Give them some TLC -- TLC with Peanut Oil, available from podiatrist Dr. William Tenney. Price: $10.70 per 8-oz container (plus $3.95 S&H). Contact: Dr. William Tenney, The Foot Center, 6440 SOM Center Road, Solon, OG 44139; telephone: 1-440-248-3374.

Diabetic Food Exchange List

The "ADA Meal Planning Exchange List for Diabetics" is now available in Braille (74 pages) and on 4-track audiocassette.

This publication, the result of a joint effort of the American Diabetes Association and the American Dietetic Association, reflects the current emphasis on total carbohydrate intake, rather than restricting specific sugar types. Users find its orientation simple, and its meal plans flexible. Although it is only one of several ways to manage diabetic food intake, the “Exchange List” has been proven to work reliably and well, and will continue to play a pivotal role.

To purchase, make tax deductible checks payable to: National Federation of the Blind. Cost: Braille $10, cassette $2. Order from: National Federation of the Blind, Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314.

Consider LANTUS Insulin

Lantus (Insulin Glargine rDNA), from Aventis Pharmaceuticals, is very different from the “rapid acting” insulin types you hear so much about today. How is this insulin different? Lantus is a very slow insulin. The company describes it as a “long-acting basal insulin ... providing a relatively constant profile with no pronounced peak, and a glucose-lowering effect for over 24 hours.” Company literature states Lantus is for once-a-day administration, at bedtime, to treat adult patients with type 2 or type 1 diabetes, who require “basal” insulin.

Lantus is a recombinant DNAinsulin analog specifically formulated to provide a long, flat response. Because of its special formulation, Lantus cannot be mixed in a syringe with any other insulin; so if you wished to take it with Regular, Humalog, or Novolog, you’d have to take two injections.

Lantus insulin is available now. To find out more, contact: Aventis Pharmaceuticals; telephone: 1-866-452-6887; Web site: http://www.lantus.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 Web site: www.diabetesstore.com

Elections Coming Up
by Ed Bryant

At this year's national convention in Louisville, Kentucky, elections will be held to fill our Diabetes Action Network divisional board positions. These are one-year terms, running from July 1, 2003 to June 30, 2004. Positions to be filled are: President, First Vice-President, Second Vice-President, Secretary, Treasurer, and three Board Members. If you are interested in a board position, or know someone who you think would do a good job, then contact me, Diabetes Action Network President Ed Bryant. Yes, hard work and dedication are prerequisites for board positions -- but one must lead by good example.

This year is a bit different. I am not going to run for Diabetes Action Network President again -- it is time for some new blood at the top. I will continue as Editor of Voice of the Diabetic, and I hope to serve on the DAN Board (and no, I am not "retiring").

Regarding my replacement as President of the Diabetes Action Network of the National Federation of the Blind, I make the following recommendation: I would like to see Paul Price, from Valley Center, California, elected to replace me. Our entire DAN Board concurs.

I have worked with Paul for a number of years, and found him talented, dedicated, and a committed Federationist. He currently serves as President of the NFB of California's Diabetes Action Network, as a Board Member of the NFB of California, as first VP of his local NFB chapter, and as a national Board member of our Diabetes Action Network.

Paul has had a busy life. He joined the Navy at age 17, served (during Vietnam) for 14 years, married, and had three children. When he left the navy, he went to the Palomar observatory, where he was an "instrumentation specialist," helping to keep the 200-inch telescope working. He designed an automatic tracking system for the telescope, while he was there.

After 2.5 years, Paul moved on to Devcon Systems, as an engineering technician, and then as a principal engineer. When Devcon "downsized," ten years later, he lost his job, but was promptly rehired as a "consultant." He went on to Berg Systems for another two years. And now, with all his Federation responsibilities, you can hardly call him "retired."

Did You Use Rezulin?

Some diabetics who used the now-banned medication Rezulin experienced complications from the drug. If you used this medication, or were a caregiver for someone who did, you might want to find out more about your legal options. Contact: Dean Spurlock, Attorney, 5601 Bridge Street, Fort Worth, TX 76112; telephone: 1-888-822-3745.

Safe Medication Newsletter

It is not just the responsibility of the doctor, the nurse, or the pharmacist, to see that you, the patient, receive the correct medications. You are also involved, and you need to learn as much as you can, to help guard yourself from dosage errors. This is of course an education issue, and now you have some help. The Institute For Safe Medication Practices (ISMP), an independent watchdog organization, announces a new Internet newsletter, not for the pharmacist (their usual clientele), but for the consumer. They’re absolutely right; preventing medication errors isn’t just a job for health professionals any longer. To sign up, or to learn more about the ISMP, contact: Institute for Safe Medication Practices, 1800 Byberry Road, Suite 810, Huntington Valley, PA 19006; e-mail: [email protected]; Web site: www.ismp.org

Diabetic Supplies Online

Pharmacist Bryan Luna, R.Ph., offers diabetes supplies, including glucose monitors, online at www.diabeticsupplies.com. This convenient Web site is simply laid out, and can be accessed in large print, too. For those without the Internet, telephone: 1-877-787-7543. They will file your Medicare, Medicaid, and private insurance forms. Free product catalog; 30-day money-back guarantee.

One More Reason To Stop Smoking

As if the capillary damage, vasoconstriction, and blood pressure rise smoking causes were not enough, it has emerged that Age-related Macular Degeneration (AMD), the leading cause of blindness among the elderly, is three times as frequent among tobacco-smokers as nonsmokers. Eye surgeon Ivan Suner, MD, studied and researched 400 AMD patients in Miami, Florida, and there laid the groundwork for the new findings that link AMD blindness to tobacco-smoking.

His results add a new cause to the list of "traditional" causes of AMD: Family genetics, fair complexion, blue or green eyes, poor diet, and bad blood vessels. The USA’s 22.5 million cases of AMD, previously called “Senile” Macular Degeneration, afflict the population in the 55_85 year age range. Few smokers live past age 85 because of much earlier smoking-related deaths from heart disease, strokes, cancers, and diabetes complications.

“Forty percent with Wet AMD (blood in macula) still smoke,” said Dr. Suner. “Children and young adults should now be warned by eye doctors and other MDs that tobacco-smoking is known to cause severe reading and driving blindness."

Miracle Foot Repair

The healing power of Aloe Vera has been known for centuries. Many generations have found relief from burns and dry skin. Now you can bring this power to bear on your diabetic feet, and find relief from the itching and cracking, with Miracle Foot Repair. Guaranteed. Available at Walgreens, or from: Ontel Direct, Dept. VOD, 21 Law Drive, Fairfield, NJ 07004; Web site: www.ontelproducts.com

Elephant Stew

Cut one elephant into small bite size pieces. This should take about two months. Add enough gravy to cover. Season to taste. Cook about four weeks at 465 degrees. This will serve 3,800 people. If more are expected, two rabbits may be added. Do this only if absolutely necessary since most people do not like hare in their stew. Note: Diabetic Exchanges unavailable...

Articles Needed

If you have diabetes, are a family member or friend of a diabetic, or a health professional with an interest in diabetes, we invite you to submit an article for publication in the Voice of the Diabetic.

Our philosophy regarding diabetes is positive. Do you have an inspiring, enlightening story? We, the Diabetes Action Network of the National Federation of the Blind, seek to show people they are not alone, and do have options, regardless of diabetic complications. If you have experienced ramifications, others, who may be facing the same side-effects, could benefit from what you have to say.

Perhaps you have not experienced complications--your unique insight, coping strategies, and lifestyle can still inspire others. Are you a relative, a friend, or a health professional? More than 320,097 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.

Medicare Reference Code Change

Medicare has very specific “code specifications” for the various medical devices it will fund. For proper reimbursement, you need to use the correct number. There have always been two such “reference codes” for glucose monitors: EO607 for conventional glucose monitors, and EO609 for talking blood glucose meters, or talk boxes for existing meters. This second number has been changed. For purchase of a talking glucose monitor, or voice synthesizer for a glucose monitor, the correct specification is now E2100. Don’t use EO609 anymore.

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SUBSCRIPTION/DONATION FORM

The Voice of the Diabetic is a quarterly magazine published by the Diabetes Action Network of the National Federation of the Blind (NFB) for anyone interested in diabetes, especially diabetics who are blind or are losing vision. An outreach publication, it emphasizes good diabetes control, diet, and independence.

Donations are gladly accepted and appreciated. Contributions are not only tax deductible but are needed to keep the Voice and the Diabetes Action Network moving forward to help people with all aspects of diabetes.

Members of the NFB Diabetes Action Network enjoy priority services and unique benefits such as a continuous free subscription to the Voice, automatic access to committees covering all aspects of diabetes, free counseling concerning all facets of blindness and diabetes, as well as access to diabetics who have experienced complications.

The Voice is free to any interested person upon request. Each subscription costs the Diabetes Action Network approximately $20 per year. To help defray publication expenses, members are invited, and nonmembers are encouraged, to cover the subscription cost.

To begin receiving the Voice, please check one:

[ ] I would like to become a member of the NFB Diabetes Action Network and receive the Voice of the Diabetic. (Members are entitled to special benefits.)

[ ] I would like to receive the Voice of the Diabetic as a nonmember. (Nonmembers are encouraged to pay the institutional rate of $20/one year; $35/two years; $50/three years.)

Send the Voice in (check one):

[ ] print [ ] cassette tape for the blind [ ] both
and physically handicapped
(recorded at slower than
standard speed of 15/16 IPS)

To receive Voice of the Diabetic by e-mail, go to: www.nfbcal.org/listserv-signup.html (NOTE: If you want a print or tape copy as well, send this form to the Voice office).

Optionally check this box:

[ ] I would like to make (or add) a tax-deductible contribution of $__________ to the Diabetes Action Network of the National Federation of the Blind.

PLEASE PRINT CLEARLY

Name:_____________________________________________________

Address:__________________________________________________

__________________________________________________

City:_______________________ State:______ Zip:__________

Telephone: ( )________________________

Send this form or a facsimile to:

Voice of the Diabetic
1412 I-70 Drive SW, Suite C
Columbia, MO 65203
Telephone: (573) 875-8911
Fax: (573) 875-8902

Please make all checks payable to:
NATIONAL FEDERATION OF THE BLIND

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END of Voice of the Diabetic, Volume 18, Issue 2 Spring 2003 Edition

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