Voice of the Diabetic

The Diabetes Action Network of the National Federation of the Blind
A Support and Information Network
Volume 18, Number 1, Winter 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).

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.

VOICE OF THE DIABETIC is offered absolutely free to any interested person upon request. Readers may receive the publication in standard print, on audiocassette for the blind, or in both formats. To begin receiving the VOICE, please complete the subscription form (or a facsimile), found at the end, and mail it to the editorial office.

Please Note: We have a special bulk-mailing permit that we use to ship the VOICE to you at low cost--it does not allow for free re-mailing. The Post Office requires you place first class postage on any VOICE you mail to others.

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 316,215, offers such an outlet. Make your voice heard. For VOICE OF THE DIABETIC advertising information contact:

Eileen Rivera Ley
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804 Hatherleigh Rd
Baltimore, MD 21212
Phone: (410) 296-7760 Fax: (410) 296-7645

LEADERSHIP AND THE MATRIX OF POWER
by Marc Maurer ....

INSULIN MISDOSAGE: REVIEWING THE ERRORS
by Peter J. Nebergall .....

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

Maybe you still think diabetes means a shortened life, serious complications, and a great deal of pain and difficulty? Not necessarily. Suppose I could put someone in front of you, who's had type 1 diabetes for not 50, or 60, but a full 75 years? And she doesn't have any complications worth mentioning ...

They say "the world's best proof is somebody who's already done it." Here she is!

Violet ("Vi") Shugrue, from Norwich, Connecticut, is the same age as insulin. She was born May 22, 1922, the year Drs. Banting and Best, from Ontario, Canada, successfully isolated insulin from dogs' pancreases and used it to successfully treat diabetes.

When Vi was five, in the spring of 1927, she developed familiar symptoms, and was diagnosed with diabetes. "The doctor told my mom he doubted very much I would make it to the age of 12. They didn't know how to treat it," she says.

Her family doctor missed by a mile, of course (she's 80 now), but it's hardly surprising. Not many doctors were aware of insulin, back in 1927! Too many remembered the days before insulin, when a diagnosis of diabetes was a death sentence.

But Vi did the right things, the things you have to do to get by, when you have diabetes. Guided by diabetes pioneer Dr. Elliot Joslin, founder of the Joslin Diabetes Clinic, she took regular insulin, three shots a day. She tested her sugars. She watched her diet.

"Mom couldn't handle it, giving me my injections, three times a day -- so I learned how to inject myself, when I was very young. And, the syringe and needle had to be boiled, three times a day."

There were no home blood glucose monitors, of course, so Vi did urinalysis: "Seven drops of urine in the test tube; blue was 'negative,' and green meant 'a trace'."

And there were the dietary restrictions: No potatoes, no bread, no sweets ... "I could have two biscuits with each meal," says Vi.

And the insulin. In the beginning, there was only Regular. Protamine zinc (PTZ), the first "longer-acting" insulin, arrived in 1936, and NPH insulin in 1938. Lente insulin arrived in 1952, and Humalog in 1996.

But what about the lifestyle? She describes it as "rather restricted," for Vi's mom kept a close watch on her as she was growing up. She wasn't allowed to go to birthday parties, and only a few close friends knew she had the disease. "I didn't advertise it," she says. "I wasn't ashamed, of course; I just didn't think it was good to advertise."

In those days, before blood glucose monitors and quick-acting insulin, "staying on your diet" was critical. Things are easier now. And experience has taught us that it is better if your friends and associates know ...

When Vi started high school, she was switched to the longer-acting insulin, so she would not have to walk a mile home for lunch to take an injection.

The last serious diabetic incident Vi remembers, happened during high school. "One of the pharmacists where we lived at that time gave my mother the wrong kind of insulin for me," said Vi. She wound up in hospital for a week, but, "I came out successfully." There were no long-term consequences.

Vi thrived. She finished her studies, earned her Teacher's Certificate, and began a 35-year career as a first-grade teacher. She met and married William, who she describes as: "a loving, considerate, and supportive husband." They adopted a daughter, Diana, who is now 41 years old.

They even got a chance to visit the farm in Alliston, Ontario, Canada, where Dr. Banting worked to develop insulin.

For about a year, Vi has used an insulin pump. You're never too old to learn something new ...

"I used to have a good number of hypoglycemic episodes -- and I'm very thankful my husband knows exactly how to treat it," she says, "but since I got an insulin pump, I don't have half as many as I'd had before. The pump regulates me much better than the insulin doses I was taking.

"My best advice to other diabetics? Follow your doctor's directions, and watch your diet. And, get as much exercise as you're capable of doing. Other than that, lead a normal life. Once in a while I get down, and say 'Oh gosh, this is a nuisance,' but you can always find things to do."

The Joslin Clinic tells Vi she is one of the four people who have had diabetes longer than anyone in the United States. She's had type 1, insulin-dependent diabetes, for 75 years, and thrived. And she's not finished yet.

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ASK THE DOCTOR
by Wesley W. Wilson, MD
Includes Art: Medical Caduceus

NOTE: If you have any questions for "Ask the Doctor," please send them to the VOICE editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.

Wesley W. Wilson, MD has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals.

Q: My diabetes educator has been telling us about glycosylation. He says much of the damage I've done over years of overweight and high blood sugars is reversible, if I get my blood glucose down to normal and keep it there. How would that work? How can diabetic complications be reversible?

A: I'm sorry to have to discuss what seem to be misconceptions about glycosylation and diabetic complications. It is true that attachment of glucose to protein (glycosylation) seems to have a key role in the development of many of the complications seen in too many persons with diabetes.

Measurement of the glycosylation of hemoglobin, the red molecule in red blood cells that carries oxygen, is useful since it allows estimation of average blood sugar levels over several months. The higher the sugar level, the more attaches to hemoglobin, so a "normal" hemoglobin A1C (the test used to measure glycosylated hemoglobin) is between 4.5 and 6 percent. The red blood cell lives for about 110 days, so, with these test results, we can estimate sugar levels in the preceding two or three months. We'd like to be able to achieve a "normal" (equivalent to a non-diabetic) glycosylated hemoglobin level in all persons with diabetes, but the risk of hypoglycemia is sometimes too great. We try to achieve an A1C of 7, since in many studies, including the landmark Diabetes Control and Complications Trial (DCCT), a 7 percent level greatly decreased the number of persons with diabetes who developed complications, as compared with the 9 percent (A1C results) average found in less aggressively treated groups. No measurement of reversibility was undertaken in these studies.

It is true that in persons with diabetic complications, reduction of sugar level (and therefore also hemoglobin A1C) reduced the progression of complications. There are a few reports that improvement in sugar control improved nerve function, and very early eye changes may show some improvement. Perhaps that is what your diabetes educator is alluding to? The problem is, however, that over time, complications can cause scarring or blood vessel changes, and such tissue destruction does not reverse.

Advanced Glycosylation Endproducts (AGEs) are formed from glycosylated proteins, and do not change as rapidly as other proteins. These materials seem to be important in the persistence of many diabetic complications.

You should not surrender to diabetes, even if you have complications, since you can slow or stop the progression of these problems by controlling blood sugar as carefully as possible and leading a healthy life.

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DO YOU WANT TO CONTINUE RECEIVING VOICE OF THE DIABETIC?
By Ed Bryant, Editor
Includes Photo: Ed Bryant
The VOICE offers support and information to more than 316,000 people interested in diabetes and its complications. All aspects of diabetes are covered in the VOICE, and we show folks they do have options and are not alone.

The VOICE OF THE DIABETIC is offered free upon request, in standard print, and on 4-track audiocassette. The Diabetes Action Network of the National Federation of the Blind spends several hundred thousand dollars each year in publishing the VOICE. In order to spend judiciously, I must ask each reader who wants to continue receiving the VOICE to promptly return the following information to me.

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Please return this form to: Ed Bryant
VOICE OF THE DIABETIC
1412 I-70 Drive SW, Suite C
Columbia, MO 65203
Telephone: (573) 875-8911
Fax: (573) 875-8902
E-mail: [email protected]
E-mail: [email protected]

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WHAT'S UP, DOC?
"To err is human," the Romans said. Sometimes we humans do very strange things -- and the only reason others are not hurt by our inattention, is because somebody caught on in time. There is a moral to the following story: Check and question!

The following is from ISMP MEDICATION SAFETY ALERT, published by the Institute for Safe Medication Practices (www.ismp.org) Used with permission.

Although doctors may mean well, one manner that's being used to order U-500 insulin can lead to serious medication errors. Recently, an endocrinologist wrote an order for 25 units of U-500 insulin to be given in the morning. With 500 units per mL of insulin in U-500 vials (versus 100 units per mL in U-100), nurses correctly calculated that the volume needed for a 25-unit dose was only 0.05mL.

A call was made to the physician, to ask about changing to U-100 insulin, for more accurate measurement. The doctor said that he'd actually wanted his patient to receive 125 units. He simply thought it would be easier for the nurses if he prescribed "25 units," knowing that the "25 units" mark on a U-100 syringe would actually measure 125 units, when U-500 insulin was used with the U-100 syringe!

In another case, a physician changed a patient's insulin to U-500, and prescribed 5 units at noon and 8 units at dinnertime. As in the first case, the doctor meant for the nurses to use a U-100 syringe to prepare these doses of U-500 insulin. Thus, he intended his patient to actually receive 25 units at noon, and 40 units at supper.

Unbelievable? It's true....

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NEW STUDY: VOLUNTEERS NEEDED

A new research drug is now being tested in clinical studies. If you are an insulin-using diabetic (type 1 or 2) and have symptoms of gastroparesis (early or persistent fullness, abdominal distention or bloating), you might be interested in participating. You can find out more about this study, and about the locations of its research sites by going to the following Web site: www.centerwatch.com.

Click on "Trial Listings," and when that page loads, click on "Endocrinology or Gastroenterology," then click on "Diabetic Gastroparesis."

(Editor's Note: centerwatch.com is a great place to find out about many different drug studies.)
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PRECIOUS INDEPENDENCE
by Joyce Kane
Includes Photo: Joyce Kane
From the Editor: Joyce Kane is a positive person who strives to show the sighted community and blind diabetics that blind people can and do independently self-manage their diabetes. Joyce, like thousands of other blind folks in the National Federation of the Blind, knows that with training and opportunity, she can be independent and fully involved in the mainstream. Joyce Kane is Vice-President of the Southern Connecticut Chapter of the NFB of Connecticut, and Secretary for the Diabetics Division of the NFB of Connecticut.

Congratulations, Joyce, for the work you do in educating those around you about blindness and diabetes. Here's what Joyce says:

I went blind five years ago. I woke up after open heart bypass surgery, to total darkness.

I'd been on the heart-lung machine, of course, while the surgeons repaired the consequences of my diabetic small-artery disease - and there had been insufficient blood supply to my optic nerve. No one knew this would happen. They told me in the hospital the only way they could tell of this condition was by an autopsy, which I declined!

I spent three and one half weeks in the hospital; two of those weeks were spent in a rehabilitation unit. I left the hospital, five years ago, with no information on how a blind person with diabetes could handle self-management of the condition. I had understood this would be my husband and children's job from this point forth. I was leaving the hospital blind, recovering from open heart surgery, and on nine medications. I was 46 years old.

I had a visiting nurse, and in the couple of months she visited me, she taught my family members how to draw insulin and how to run the talking glucose monitor. Still no one offered me information on self-management.

Before I went blind, I had been the one responsible for taking care of my diabetes management. I'd done this for 30 years. I was the best-trained person for taking care of myself, for managing my own diabetes, and now I couldn't even draw up my own insulin, or take all these medications in bottles that I now had no way of identifying.

It took me another year to learn about the Count-a-Dose tactile insulin-measuring device, from another blind diabetic. This useful tool enables me to draw up, and accurately mix, my own insulins, without sighted aid. I have just received a Novo Pen, for giving myself Novolog insulin. Both of these devices make a clicking sound for each unit that is drawn up, and you can feel the clicking as well.

I have come a long way, and I have learned a lot about self-management of a blind diabetic. There have been some great tools I have found; one is a talking glucose monitor that can even tell you what kind of insulin is in that bottle. The Accu-Chek VoiceMate does that job for me.

What about my other medications? How can a blind person know which pills are in which bottle? People are developing talking pill containers, and I was asked to help with one, to be a "beta-tester," which means I used a prototype and reported back to the designer about any problems or improvements needed.

The device I worked with is called the Talking Rx. It holds a one-minute recorded message, and your prescription bottle sits atop it. With a push of a button, I now know what medication is in the bottle, how and when I should take the medication, the script name and number, the pharmacy, and the pharmacy's phone number. In the last two years, since I first received my Talking Rx, I am now totally back in control of my own medications. I even call in my refills and just play the Talking Rx for them, over the phone.

The biggest thing I had lost, five years ago, was not my sight, but my independence! Each of these things I speak of here has given me back a piece of that precious independence.

In January, 2002, I went up to the Connecticut state Capitol and testified in front of the Legislature, working to convince them of the need for insurance companies to cover the expense of talking prescription bottles for the visually impaired.

I am determined to educate people and medical professionals about devices like these. I have gone to diabetic support groups, nurses in towns, spoken to doctors involved in diabetic awareness events, and have had the opportunity to lecture to pharmacy students at the University of Connecticut and Northeastern University in Boston. If, in the future, they can help someone care for their own diabetes and blindness because they remember my words and the tools I showed them, then I have accomplished something.

When I went blind, there was a real lack of information about self-management of a blind diabetic. This is something I am working to change. I have started an information group meeting for all diabetics, on the internet. It is held twice a week on the audio-tips Talk Rooms. This is a place where you do not have to know how to type, just pick up a microphone and speak. I hope to have some guest speakers, to let you know about diet, new tools, and maybe a peek into research. Maybe we can even get Ed Bryant, VOICE OF THE DIABETIC editor, to talk to us about the VOICE. Check us out at http://www.audio-tips.comm. I started it the first week of last December, on Mondays at 3:00 PM and again at 8:00 PM, Eastern Time.

I was determined from the beginning that my blindness would not get the best of me and so far so good. Independence is precious.

by A. Paul Chous, M.A., O.D.
Doctor of Optometry (and Type 1 diabetic since 1968)

Many VOICE readers are familiar with, or at least aware of, the importance of diabetic retinopathy as a major complication of both type 1 and type 2 diabetes. In fact, diabetic retinopathy is the leading cause of new blindness for Americans between the ages of 20 and 74 (past the age of 74, other age-related eye diseases surpass diabetic retinopathy as major causes of vision loss; most notably, cataracts, glaucoma, and age-related macular degeneration.) We know that retinopathy becomes more likely the longer a person has diabetes, so that after 10 years, 60% of patients have some retinopathy, while after 20 years, more than 90% do. We also know that keeping blood glucose levels as close to normal as possible delays the onset and progression of retinopathy. What readers may be less familiar with are the various forms of diabetic retinopathy, and some important differences between these forms.

Background diabetic retinopathy (BDR) occurs when chronically high blood glucose levels damage the smallest blood vessels (capillaries) within the retina, causing small amounts of retinal bleeding, as well as protein and fat deposits within the retina; patients typically have no symptoms and vision is usually excellent.) Proliferative diabetic retinopathy (PDR) occurs when abnormal blood vessels begin to develop and grow ('proliferate') on the surface of the retina and the optic nerve, leading to tugging (traction) on the retina, a lot of bleeding, and, in severe cases, retinal detachment resulting in blindness. Yet another form of retinopathy occurs when leaky blood vessels within the most critical and sensitive area of the retina, the macula, cause fluid swelling that interferes with vision, a condition known as diabetic macular edema (DME).

The macula is the part of the retina that gives us good detail vision. It is the area where incoming light is brought to a precise focus (either naturally, or with the help of prescription lenses) allowing us to recognize faces, read words or letters on a road sign or printed page, and appreciate colors. When diabetes or any other disease process damages the macula, we lose at least some of our ability to see detail and perceive color. Side (peripheral) vision is not affected, so people with diabetic macular edema are not totally blinded (as can happen with proliferative diabetic retinopathy), but may lose some ability to read, drive, or recognize faces.

In fact, diabetic macular edema is the leading cause of vision loss associated with diabetes, causing visual impairment at twice the rate of that caused by proliferative diabetic retinopathy. More than 100,000 new cases occur in the US each year, and diabetic macular edema is a leading cause of 'legal blindness' (defined as vision less than 20/200 on the eye chart - unsharp letters just smaller than the big E - with the use of prescription lenses.) Diabetic macular edema does not typically cause as profound a loss of vision as does PDR, but it affects substantially more patients. Incredibly, some patients develop vision-threatening DME, yet have 20/20 vision on the eye chart test and no overt symptoms at the time of diagnosis.

Treatment of DME may include various medications (very often, cortisone type drugs) as well as laser therapy aimed at cauterizing leaky blood vessels and reducing accumulated fluid within the macula. The "Early Treatment of Diabetic Retinopathy Study" (ETDRS) proved that laser treatment of vision threatening diabetic macular edema reduces the risk of substantial worsening of vision by about 50%. In addition, new medications on the horizon may actually interfere with the biochemical processes that allow retinal blood vessels to become leaky in the first place.

As for all forms of diabetic retinopathy, the risk of developing DME, and the risk of it worsening, are reduced by tight control of blood sugar and blood pressure. It is also known that abnormal blood lipid levels (low 'good' HDL cholesterol and high 'bad' LDL cholesterol) worsen DME, as does cigarette smoking. Patients are advised to keep their quarterly glycosylated hemoglobin (hemoglobin A1C) readings below 7%, their blood pressure readings less than or equal to 140/80, to work on improving their blood lipid profiles, and to quit smoking. Most importantly, all diabetics should have an annual dilated retinal examination by an optometrist or ophthalmologist experienced with diabetic eye disease; the sooner DME is detected, the more can be done to keep it from robbing you of any vision.
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LEADERSHIP AND THE MATRIX OF POWER

(Marc Maurer, President of the National Federation of the Blind, delivered the following convention banquet address on July 8, 2002, at the 2002 national convention of the National Federation of the Blind, in Louisville, Kentucky. This article appeared in the BRAILLE MONITOR, August/September 2002 edition, published by the National Federation of the Blind. Copies of this address, and others, are available, without charge, from the National Center for the Blind, in large print, Braille, audiocassette, and on the World Wide Web. Contact: NFB National Center for the Blind, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314; Web site: www.nfb.org)

The acquisition of power has often been regarded as base or disreputable. Francis Bacon said, "The desire of power in excess caused the angels to fall; the desire of knowledge in excess caused man to fall." He went on to assert that "Knowledge itself is power." Hence (according to Bacon), man's search for knowledge is a search for power -- which caused him to fall.

Ralph Waldo Emerson wrote in his journal, "You shall have joy or you shall have power, said God, you shall not have both." He also wrote, "Men ... very naturally seek money or power; and power because it is as good as money." Otto Von Bismarck declared, "He who has his thumb on the purse has the power."

Such statements purport to illustrate that knowledge, money, and power are equivalent. Some people believe that they are all bad. As Lord Acton, in his famous phrase, said, "Power tends to corrupt, and absolute power corrupts absolutely."

Though this aphorism is oft-repeated, and though it has a deceptively learned ring, can any thinking person truly believe it? Power is essential to freedom. John Dewey said, "Liberty is not just an idea, an abstract principle. It is power, effective power to do specific things." Cicero said, "Freedom is participation in power."

The political buzzword of recent time was "empowerment"-- creating power within the disenfranchised. If the theories of Acton and the others who mistrust power were true, empowerment would also corrupt. It would be Machiavellian indeed if the hidden agenda of the politicians was to corrupt the innocent.

Two hours after the close of the afternoon general session the ballroom doors opened to welcome a couple of thousand Federationists to the 2002 banquet of the National Federation of the Blind. Gone were the rows of chairs in theater seating and delegation banners, and in their place stood hundreds of tables set for a festive dinner. This is the way the ballroom looked at the start of the July 8 banquet.

Power denotes the ability to do what the person, organization, or country wants done at the time and in the way that the entity possessing power wants it done with minimal inconvenience. It is neither morally corrupt nor spiritually invigorating. It is neutral.

However, the process of acquiring power (the method used to get it) and the purposes for which it is used undoubtedly affect the quality of the result. Mao Zedong believed that without weapons and force there could be no power in politics. He said, "Political power grows out of the barrel of a gun." However, John Quincy Adams said that the basis for political power is fundamentally different from that of weapons of war. "Individual liberty," he said, "is individual power; and as the power of a community is a mass compounded of individual powers, the nation which enjoys the most freedom must necessarily be, in proportion to its numbers, the most powerful nation." Malcolm X stated, "Power in defense of freedom is greater than power in behalf of tyranny and oppression."

Without power there is no freedom. Without freedom there is no independence. And without independence there is virtually no possibility of leading a productive and fulfilling life. Therefore, we must seek power.

What are the essential characteristics of this elusive commodity? What must we do to obtain it? And, once acquired, how can it best be managed?

Gloria Steinem observed, "Power can be taken but not given. The process of the taking is empowerment in itself." Thus, gaining power cannot be done for somebody else. If an individual or an organization wishes to possess it, that individual or organization must deliberately decide to have it and must act on that decision. This is not to say that a climate cannot be created in which organizations or individuals are encouraged to seek power for themselves. This can be done, and it should be. However, no individual and no group can live the life of another. Those who want power must take it for themselves. As the old expression tells us, each tub must stand on its own bottom.

Power -- being the ability to do specific things -- demands that those who want to have it acquire ability. There is no alternative -- without ability there is no power. Hence, one of the major routes to power is knowledge. For a blind person, learning the skills of blindness helps. Beyond that, gaining mastery of a body of knowledge, which will permit competition with other people, is also of real importance. The possession of knowledge (or for that matter of money) is, however, not enough. There must be something else to ensure that the blind have power.

One element in the matrix of power is the belief by the individual that it is proper for power to reside within that person. This belief might go by the name of "confidence." Another element is recognition by others of the capacity of the blind person. Without this recognition, the power residing within the person (no matter how great) will be rejected as a myth. Can a blind person win the Nobel Prize or serve as the president of the United States? If the answer is "No," if it is believed that sight is essential to these activities, we have not yet received the recognition we deserve. Call this recognition "public understanding." With these -- with ability, with confidence, and with public understanding -- power can exist. However, gaining these elements cannot be accomplished single-handedly; there must be cooperative effort. No one person in a group can attain power without others gaining a measure of it also. Therefore, to assure that a colleague gains power, seek to achieve some of your own. Conversely, to increase your own, help a friend. Members of organized groups encourage one another, and they achieve recognition much more rapidly than those without an established support network.

The most powerful individuals have gained their stature and influence by inviting others to participate in the dream they have of change. They also know that generosity enhances rather than diminishes power.

Though the sighted public cannot gain power for the blind -- cannot give us freedom -- our sighted friends and colleagues can help. Most of the time we encounter enormous goodwill. Our sighted friends want us to gain power because with it we are able both to lead independent lives and to contribute to our society. Power helps us, but it also benefits the broader community. In other words, if our sighted friends and colleagues had known how to do it, it would have been in their best interest to have caused the formation of the National Federation of the Blind.

What does all of this mean for us -- for the National Federation of the Blind, for our members, and for those blind people who have not yet become our members? Have we acquired power? Have we identified ways to increase freedom for the blind? How are the activities and efforts of the Federation structured within the matrix? And what are the prospects for us in the years to come?

In 1940, when the Federation came into being, the time and circumstances for the blind were completely different from what they are today. For many of us that time would be completely unrecognizable. Jobs for the blind were not simply hard to come by, they were nonexistent except in sheltered workshops, and these jobs were at the very bottom of the economic hierarchy. Education occurred at schools for the blind, for those who could get there, but matriculation at college was severely limited and often unattainable. The Books for the Blind Program in the Library of Congress had come into being during the 1930's, but the collection of materials available was not great. For many blind people the brightest hope (and for many it was only a hope) was a tiny amount of welfare, which might be received each month.

In this dreary atmosphere Dr. Jacobus tenBroek, our founding president, and a small group who dreamed with him that conditions might be changed, formed the National Federation of the Blind at Wilkes-Barre, Pennsylvania. Sixteen people were present, representing seven states, but there was almost no money to establish programs for the organization, pay for telephone calls or stamps, or purchase office supplies. It would be many, many years before the thought of reimbursement for travel expenses for officers, members of the board, or anybody else, could be addressed in any practical way. The Wilkes-Barre newspaper carried reports about the founding of the Federation, but otherwise the organization's establishment was virtually unnoticed. No influence, no money, no staff, no office space except in the president's small apartment, no allies in the field of blindness, no recognition by the public at large: this was the National Federation of the Blind at its beginning.

However, there were other characteristics. The delegates who came together at the founding of the organization had knowledge. They knew that blindness had been misunderstood. They had an abiding faith that joint effort could bring opportunity, and they had a shared commitment to each other that nothing would prevent them from seeking the influence needed by the blind to bring independence. They decided that the blind could and would have power.

How does this description compare with the Federation of today? We have grown from a gathering of sixteen delegates from seven states to a convention of some 3,000 delegates representing fifty states, Puerto Rico, and the District of Columbia. Representatives from many other countries also come. Although the unemployment rate remains dramatically high, tens of thousands of us have become employed. Through Braille, recordings, speech technology, and the NFB-NEWSLINE, more information is available to the blind more quickly than ever before in history -- hundreds of thousands of pages of it. Thousands of blind people attend college each year, and the National Federation of the Blind assists by conducting the most extensive scholarship program for blind people in the nation.

The organized blind possess an extensive program of services to blind people. We maintain a headquarters at the National Center for the Blind, and we operate a number of other offices throughout the nation. We have established orientation and training programs in several states, and we are providing leadership in rehabilitation programs both directly and through example. We have conducted a capital campaign to erect a new building, the National Research and Training Institute for the Blind, and we are pursuing the talent and resources for completing and operating it. Programs to support harmony and cooperation among agencies and organizations in the blindness field are being conducted with our leadership. The blind of the nation, the rank and file membership of the National Federation of the Blind, created the structure of our organization and control it. Such is the National Federation of the Blind today.

However, there are also other characteristics. We have the knowledge that blindness has often been misunderstood. We have the faith to believe that by working together we can bring independence to the blind. We possess a shared commitment to each other. We have the confidence to know that our future is what we will make it, and we are determined that the blind can and will have power.

Our comprehension of blindness is not shared by everybody. There are still some who look upon blindness as an unmitigated tragedy and a clear indication of inferiority. Sometimes this misbegotten attitude may be found among the very people who hold themselves out as providing service to the blind. Consider, for example, the Maryland Society for Sight, a nonprofit organization composed largely of eye doctors. The Society is dedicated to promoting proper eye care and service to the blind. In a 1998 letter seeking contributions from the public, this society made a number of statements about the blind. Here, in part, is what the letter says:

"Close your eyes and imagine not being able to see the sky, the face of a loved one, or a beautiful sunset. Imagine the panic and hopelessness you would feel if you were told you were going blind! Blindness afflicts three percent of adults and five percent of the children in Maryland. The good news is that over 50 percent of all blindness can be prevented if people know the proper precautions to take.

[I interrupt to remind you that statistics published in the last few years by Johns Hopkins University indicate that the incidence of blindness in the United States is well under one percent. I don't know where the Maryland Society for Sight got its numbers. One might even suspect them of padding the statistics to beef up the importance of their solicitations, but back to the letter.]

"The Maryland Society for Sight [continues the solicitation] has been working to prevent blindness and preserve sight for all Marylanders since 1909. And we need your help to continue this vital work. With your help, we can . . . .

* Provide free eye examinations and glasses to the homeless. A pair of glasses can often mean the difference between living on the streets and having a job and functioning in society.

* Provide the blind and visually impaired with volunteers to come into their homes and help make their lives a little easier.

"Please send in a contribution today and help us to give the gift of sight to so many Marylanders."

These are the words of the Maryland Society for Sight, which does thousands of vision screenings each year for school children, for adults, and for the homeless. Sight is, of course, a valuable asset, and we applaud the efforts of the Maryland Society to help people maintain or recover it. If they had only left out the dramatic language about the hopelessness of the blind, we would have no complaint to make. However, what they say about us creates a false impression. The Society preys on the fear of blindness to raise money, and they create hardship for the blind in doing so. Their letter says that they provide volunteers to come into the homes of the blind to make our "lives a little easier." What does such a statement imply -- that our lives are hard because of blindness and that we need them to bring us a little comfort? Why don't we volunteer to go into their homes to make their lives a little easier? Perhaps we could provide comfort to them. After all, we have certainly had plenty of people offering it to us; we should know how to reciprocate.

I don't know about you, but I am thoroughly tired of having other people tell me that my life is miserable because I can't see the face of a loved one or the sunset. Although the sunset is undoubtedly worth seeing, its importance has been vastly overemphasized. I have noticed that most sighted people do not interrupt their evening activities to go look at it. If I had to guess, I suspect that the average sighted person would much rather watch television.

The visual image of a loved one's face is clearly more important than the vision of the sunset, but even here the emphasis is misplaced. I ask you, is it the visual image of the face or the love that is more important? Blind people have as much capacity for love as anybody else, and we can find ways to express it, whether we are able to see the faces of the ones we love or not. Many of us possess the deepest, fiercest, most abiding love that exists anywhere in the world. Our blindness changes this not at all.

The image conveyed by this letter is one of hopelessness, but we are here to challenge it, and we know how to speak on our own behalf. Blindness has often been misunderstood, but we are determined that this misunderstanding will change to comprehension. Their letter suggests that we are helpless, but we are not. To the contrary, we have decided that the blind must and will have power.

Researchers, with self-proclaimed objectivity, tell us that they have discovered connections between blindness and other characteristics in virtually endless variation. A newspaper account in the FAIRFAX/ARLINGTON JOURNAL dated December 11, 1997, reported that two professors, Dr. Joel Zaba and Roger Johnson, have conducted a study establishing a link between vision loss and behavioral problems. One of the subjects of their research began to lose vision and, as the reporter says, started pulling pranks such as running through the halls of his school in his boxer shorts. Officials at the school referred him to a behavioral optometrist. When the boy's vision was restored, they say, his behavior and his marks improved.

This boy was not the only one to be studied. In a survey of 81 students in a school for at-risk pupils, Zaba and Johnson found that 97 percent of students with behavioral problems had vision difficulties. The conclusion they reached is that vision loss and behavioral problems are linked.

On the other hand, other researchers tell us that blind people think faster than the sighted. Here are excerpts from the report:

Blind people can pick out the meaning of a spoken sentence more quickly than sighted folks. The finding adds weight to the notion that blind people can hear better than others, their hearing compensating for the loss of their sight.

"They process language faster than sighted people," says Brigitte Roder from the University of Marburg, Germany, who discovered the effect with her colleagues at the University of Oregon in Eugene. She says it may explain why some blind people are so fast at reading books recorded onto tape. "I have a blind student who is speeding up all his tapes," she says. Yet he has no problem understanding the words.

A brain wave pattern that indicates when semantics are being analyzed, known as the N400 signal, was observed in sighted people about 150 milliseconds after the [test] sentence ended. In blind volunteers, the pattern was seen in just half that time.

The researchers also found that in blind subjects, areas at the back of the brain normally devoted to sight were taken over in part by auditory information-processing. Roder isn't certain, but she suspects this might be partly responsible for speeding up blind people's ability to process language.

There you have it. Researchers indicate that vision loss and behavioral problems are connected. They also tell us that we hear better and think faster than the sighted. How many blind people have they met? It may be that blind people are smarter and less stable than the sighted, but my observation conducted over a period of more than thirty years does not make me think so. Of course, the study I have conducted was not accompanied with scholarly papers, expensive calculation systems, or university grants; but it was more extensive than theirs.

We are building a research institute which will incorporate the experiences of blind people in the scientific process. This should help give research about blindness a grounding in reality. We are not against competent research competently performed. We are opposed to research which begins with unfounded assumptions and uses them to reach insupportable conclusions. Knowledge is power, and we are seeking to expand the realm of knowledge possessed by the blind. We will undoubtedly study the nature of blindness itself, but this study must incorporate the daily experiences of blind people if it is to be relevant or cogent. When we have reached sound conclusions, we will provide the information to others, because public recognition of what we are helps us achieve acceptance and understanding. To these we will add confidence in our own capacity to learn and teach. For we in the National Federation of the Blind intend to have power.

Some blind people try to take advantage of their blindness. Equal access to information is important for the blind, but this principle should not be twisted and misused to bamboozle the sighted. Here are portions of a letter from a nightclub owner in England, to the director of Environment and Housing of the Brighton and Hove City Council, the regulatory body determining conditions and standards for nightclubs in the area. Before examining its contents, I wish to point out (even if this seems to be belaboring the obvious) that sight and touch are not the same. There are times when one may be substituted for the other, and there are also times when it is inappropriate to do so. Some of the language of the letter has been modified for the sake of propriety. This, in part, is what it says:

As you are aware, we are presently the only club in Sussex to hold a Public Entertainment License specific to striptease, and that license quite correctly prohibits physical contact between a customer and a dancer, other than the placing of notes in a dancer's garter. I write to seek your opinion as to whether you would consider a variation to this condition for registered blind persons.

Two young men, who happen to be blind, visited the club as part of a very pleasant group of gentlemen enjoying a traditional stag evening. We made arrangements for their visit appropriate to their special needs. We read the club rules to them and designated a staff member to each to assist them entering, moving around the club, and leaving. Finally, we made the dancers aware of their disability but otherwise asked the dancers to treat them quite normally.

Both blind gentlemen enjoyed a number of tableside dances. They said they sensed the proximity of the dancers and in particular enjoyed the smell of feminine perfume. They asked some dancers politely (but seriously) if there were any circumstances in which they could touch, and the dancers refused them.

They pursued their request with me, their point being that, given their disability, controlled touching ought to be permitted for registered blind persons.

Such is the letter written by the nightclub owner. Is this somebody's idea of a joke? What insufferable flimflam! There is a time and a place for touching, and from what I have been able to discover, blind people are as good at it as anybody else. But we should not tolerate using blindness as an excuse to take liberties. That practice will be as damaging to us as the failure of others to recognize the right we have to inclusion in society's activities. Ours is a serious struggle -- as serious as the right of the blind to be free. We must not permit licentious interest coupled with the language of equality to mislead, and we must oppose those who would take advantage of others. If we fail to set the correct standard, somebody else will impose one upon us, and we will lose the capacity to determine the future for ourselves. The misuse of power begins by eroding it and eventually eliminates it. This commodity is too precious to be wasted or belittled or dissipated. It must be treated with respect, or it will be gone. Power implies trust, and we will not fail in our duty to exercise it with reason and decorum.

A newspaper article published in the ROANOKE TIMES depicts the life of a person who has recently become blind and who has been fooled by the popular mythology about his blindness. The article begins with the headline, "Teacher accepts loss of sight without bitterness." Although the headline is intended to be upbeat, the language of the article demonstrates phenomenal misunderstanding. Here is part of what it says:

Phil Boyd has learned to use the human voice and touch to help him see the world.

During the past year, he has come to accept his blindness without bitterness. But some of his friends have found it more difficult. Boyd was eating dinner recently at a Roanoke restaurant when a friend, whom he had not seen in years, came over to his table. The friend asked him how things were going at Craig County High School, where he [Boyd] taught English and drama for ten years.

[I interrupt to say that accepting blindness without bitterness is an excellent first step. Anger, frustration, a sense of loss, sometimes the desire to strike out at the world -- all of these are a part of becoming blind for many people. To accept the blindness without being twisted by it is the beginning of building for the future. But this former teacher has accepted more than blindness. In the name of facing reality, he has accepted the loss of employment. Are there blind teachers? There are hundreds of them--perhaps thousands. The article suggests that the teacher and his neighbors have internalized, without knowing they have done it, the false image of the helpless blind person, and by so doing they have made this stereotype real. Even the reporter who gives us the information is unaware that the story he is telling is tragic; he thinks it's upbeat. Here is further text from the ROANOKE TIMES:]

But Boyd, who lost his vision in the late summer of 2000 because of a rare eye disease, has remained upbeat, adjusting to life without sight.

"I've been depressed only two or three times," he said. "My family, the students and staff at Craig County High, and the people of Craig County have been so supportive. They keep me so busy I can't feel sorry for myself."

[I interrupt once more to wonder with you what they have been asking him to do that keeps him so busy? But the article tells us.]

Boyd was the speaker [the article continues] at the school's commencement in June. He attends football, basketball, and volleyball games at the school frequently. Students and friends describe the action for him.

He stays in touch with the students by e-mail, using a software program that reads information from the computer screen and converts it into speech. He has learned to type so he can answer e-mails.

Boyd has taken trips with his family to Busch Gardens and Las Vegas, and he had roles in two theatrical productions. He played a corpse in the Showtimers' production of "Lucky Stiff" and was a taxi driver in a play by the Gamut theater group in Roanoke.

Boyd goes to the Central YMCA in Roanoke five or six days a week to work out. He enjoys "The West Wing" and other television shows.

He helps with household chores and washes the dishes after the family's meals because he can feel them, but he can't cook because he can't recognize the foods.

Recently, he has been trying out a "Jordy" low-vision enhancement system, but he doubts it will help him.

This is the description in the ROANOKE TIMES of a blind person held out to the community as an example of proper mental attitude. He is fifty years old with the prospect of living for at least twenty more. He exercises, attends the ball games, watches television, does the dishes, appears in a play now and then in which he may be called upon to assume the role of a corpse, and hopes to find some technological device to restore his sight.

All of these activities are worthwhile, but they are peripheral. A job, the tasks of caring for a home, the responsibilities of citizenship -- these are the things that give life its purpose. This blind teacher has accepted his initial assumption that he is unable to work, unable to cook, unable to engage in demanding productive enterprises. Twenty years is a long time to fill the idle hours. What he needs is power -- the kind that comes from knowledge. With training, he could cook and teach and take charge of his life, making of it whatever he wants it to be.

Perhaps a little anger would have been better after all -- enough to stimulate the man to say, "My mind is active and alert, I shall learn the skills required for a blind person to work, and I will be recognized for the talent I possess." He might have had the good fortune to join other like-minded individuals, those in the National Federation of the Blind, who would help him to tell the public at large, the school administrators, and the officials in the locality that his ability is composed of knowledge and the capacity to use it and that this ability must be recognized. If he had come to believe in himself, he could have joined with the blind of the country in our determination that we will do what we must do to gain the power for self-determination.

We receive many thousands of letters each year. Not long ago one came from a blind man in the Midwest who was considering seeking assistance from us in obtaining employment. Helping people find jobs is one of the highest priorities of the Federation, and we put a lot of effort into it. Some blind people are prepared to enter the job market, but a number of others need training in the techniques used by the blind to conduct daily activities or to handle specific employment skills. The blind man in question is in this latter category. Here, in part, is what his letter says:

Thanks so much for calling me regarding the possibility of receiving training for employment. I have been trying to crystallize my thinking about returning to employment, so I hope you will bear with me. In this letter I am trying to analyze the questions you asked.

You wanted to know [continues the letter] whether my state vocational rehabilitation agency would sponsor me for further training. Since I've been long unemployed and have not had contact with my rehabilitation counselor in almost five years, I suppose that my case is, to say the least, inactive. I shall see if it can be reactivated in order to explore this new possibility.

[In these few words the author of the letter expresses a viewpoint that tells us much. The rehabilitation program in his state has apparently written him off. There has been no contact for five years--five years of waiting, of wondering, and of diminishing hope. Nevertheless, the blind man is not angry. He wants to be able to reactivate his case so that he may seek an opportunity. But there is more to the letter.]

You asked [it continues] whether I am willing to take additional training. Assuming I can get sponsorship from the rehabilitation program, I would be more than willing. I do not have formal computer training; however, I have a Braille 'n Speak [a small Braille-based computer notetaker], a printer, and a disk drive, which I use all the time. This technology is most liberating for me. It is the best equipment I have ever owned. From working with it, I've learned a great deal, though I realize that in this field there is always something new to learn. I am willing to do whatever it takes to gain the knowledge and skill which will lead to my eventual reentry into the job market.

[In this portion of the letter the man demonstrates an interest in computers and a willingness to learn more about them. His experience with the Braille 'n Speak is for him liberating, and he is willing to do whatever it takes to learn more so he may become employed. He is not just interested -- he is enthusiastic. Why is he not already employed? His letter lets us glimpse a portion of the frustration that has been a continual part of this man's life.]

You have also asked me [continues the letter] if I am willing to move to a job if a successful placement can be found. My first reaction was one of worry and concern. I don't know if I could just up and move like that. I have a family -- a wife who is employed and who would be searching for another job, and a daughter in school. There is also the mortgage. Many people would say I shouldn't try to return to work. The risks are too great; the possibility of failure is too high. They would say that I should be happy to sit back, read library books, and collect Social Security. But frankly, while I enjoy reading very much, I want to do more with the remainder of my days than that.

In my life and work experience, I've been told "no" so many times that by now it's simply become another challenge to me. My feeling is there is a purpose in all that I endeavor to do. If one thing doesn't work out, something else will. I've never been one to give up on myself. I believe that sometimes "no" simply means that there's another way which we haven't tried yet.

My family is a high priority [continues the letter], but at the same time, I'd like to be able to send my daughter to college. A job would make it possible. I've promised my daughter that we will not make such a move unless it involves positive changes for all of us. In that spirit I'd be willing to move if we can find a successful job placement.

These are the words of a blind father wondering whether there is opportunity for him. They are not angry words or bitter, but he has some hesitation, some doubt. His letter is thoughtful and articulate, demonstrating that it was composed by a man with a competent mind even if he has not had adequate training. He believes in supporting his loved ones, and he hopes to find a way for his daughter to attend college. However, he has been out of work for a long, long time, and he wonders if there is really a job for him.

I understand this man, for I have a family of my own -- a wife, a son, and a daughter. My son will be attending college in the fall, and I very much want my daughter to get a college education when she is finished with high school. I want her to have all of the advantages that loving parents and a good education can provide.

Is it too late for this man, whose patterns of living have been set for so many years? That depends on his spirit and ours. Can we muster the strength to continue to provide encouragement? Can he muster the confidence to continue to pursue the dream? If each of us does our part, I believe there can be no doubt about the outcome. He tells us that he does not give up, and we believe him. Consequently, the future is bright, for we are of the same mind. We never quit until we succeed. We have the knowledge about our abilities; we have the faith to trust one another; and we have the commitment to work together until we have changed forever the prospects for us all. We are determined that the blind can and will have power.

There are other things that might be said of the nature of power. One of these is that it must be exercised to be maintained and strengthened, and that the exercise of power requires leadership. To the extent that an individual or an organization exercises leadership, the power of the individual or the organization is enhanced. This leads to the question, what is required for leadership? Many characteristics are helpful -- energy, imagination, enthusiasm, the capacity to empathize with others, the ability to communicate, and facility with interpersonal relationships. However, one prime element has more significance than all of these. That one characteristic is love--the willingness to care for high ideals and our fellow human beings, the willingness to look beyond the shortcomings and foibles of others to the value that each represents, the willingness to wish good for those who do not wish us good, and the willingness to recognize that generosity is its own reward. An organization which incorporates in its governance the quality of love multiplies its power. Of course, no pretense will do; it must be real. And love freely given is at least as demanding as any other taskmaster.

Dr. Jacobus tenBroek led the Federation from the time of its founding in 1940 when the organization had almost no resources. By the time of his death in 1968, it had gained dramatically in influence and power. Dr. Kenneth Jernigan became its president in 1968 and gave it his leadership until his death in 1998. The influence of the Federation expanded dramatically under his direction, stimulating growth in all parts of the blindness field. How did they do it? Each of them possessed an indomitable spirit, a driving will, and an unquenchable belief in the potential of the future. But each of them also possessed a deep and abiding love.

Now the Federation is in our hands. The eye doctors tell us that our lives are hopeless and that we need their volunteers to make our lot a little easier. The researchers say our vision loss is linked to behavioral disorders and that we hear better and think faster than the sighted. Newspaper reporters suggest we should accept unemployment without bitterness as an example of positive thinking, and that we can't cook because we can't recognize the food. Sometimes the rehabilitation counselors write us off. Nevertheless, despite all the put-downs, despite all of the lack of understanding, despite all the failures of the rehabilitation system, we are not disheartened or discouraged.

Though there are those who misunderstand, there are many more who comprehend us and stand with us in the battle. Though there are those who belittle us, there are many more who reject this thinking and speak the language of equality that we have written. Though there are those who would ignore us, our voice is increasing every day and our influence spreading throughout the land so they cannot help but hear.

We know our strength, and we know what we must do to bring full equality to the blind. We must be willing to work with every ounce of good that is in us; we must be willing to sacrifice for that which we know is right; we must be prepared to meet the challenges wherever and whenever they arise; and we must never interrupt our march to freedom. This is our obligation; this is our opportunity; this is our commitment. We have the power composed of ability, confidence, public understanding, and love; and we will not fail. Tomorrow is ours, for we will never rest until it is. Come, join me, and we will make it come true!

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INSULIN MISDOSAGE: REVIEWING THE ERRORS

The U.S. Pharmacopeia Medication Errors Reporting Program states that approximately 50 percent of all medication errors involve insulin. As the incidence of diabetes is increasing, insulin use can reasonably be expected to increase as well - and the mistakes will no doubt increase. Insulin is a very powerful medication, and some of these mistakes will require the ambulance, the hospital, or worse.

Insulin manufacturer Novo Nordisk (the source of much of this information) estimates that morbidity and mortality rates resulting from medication errors add an estimated $1900 per patient to total U.S. health care costs - and remember, about half of that is mistakes with insulin. Divided among all insulin-using diabetics, rather than "all patients," the figure will be far higher.

What kind of mistakes do we see? There are clinician errors, self-administration errors, and self-monitoring errors. Insulin is the single most frequently misprescribed medication - everything from ill-written orders, badly-labeled vials, to incorrect rates programmed into an insulin pump.

But if the doctor errs, the patient isn't far behind. What about maintaining dose accuracy? A "grave error," defined as a deviation of more than 15 percent above or below the intended dose, can result from confusing instructions, inadequate patient training and education, or improper equipment. In too many settings, the Diabetes Educator is given a desperately short time with the new patient, and is expected to impart an almost impossible volume of life-and-death information, in minutes. If "education is the answer," the chaos and confusion we see in these statistics is no surprise.

Many people develop diabetes late in life, or progress to needing insulin when they are 60 or older. (Note, however, medical professionals under age 40 averaged a 5 percent error rate with their own insulin self-administration - so nobody's perfect.) The Novo Nordisk survey I saw suggested up to half all dosage errors were among the age 60 and older population (though per capita, there's a lot more diabetes there, too). Incorrect needles (sometimes re-used far past all utility) and improper insertion techniques compete with bad drawing-up procedure to cause more errors.

To achieve maximum control over their diabetes, many people mix insulins. This works very well, if you do it right - but if you are uncareful, or if you reverse the ratio (70 of this one; 30 of that, instead of vice versa) you can have greater or lesser degrees of trouble.

What about timing? Your insulin dose needs to come at a specific time of day. If you delay it, you will be "un-covered" for the missed time - leading to higher BG readings and higher A1C's as well. In one study, about a third of participants delayed their morning injection by one to two hours, for whatever reasons.

And, of course there is self-monitoring. "Sliding-scale" insulin dosage, where the diabetic tests his/her blood glucose every few hours, then immediately varies insulin dose to best follow the fluctuations and keep test results in the "normal range," is the ideal, but it requires frequent and accurate finger stick tests. National surveys suggest a great many diabetics do not self-monitor as completely as they should, and one survey stated that 1/3 of all diagnosed diabetics did not self-monitor at all.

Most blood glucose monitors sold in the last 10 years are pretty accurate; but the newer meters are easier to use, more convenient to carry, and require a far smaller drop of blood than their ancestors did. If you need to meter, there's no excuse to be lax - you're hurting yourself.

Insulin delivery devices are getting better all the time, too. Syringe users can use the Count-A-Dose device (now offered by Medicool, of Torrance, California, and by the National Federation of the Blind Materials Center, in Baltimore, Maryland) if they have trouble drawing up. Insulin pens, all fairly tactile, are getting easier to use, and the variety of insulins available for them is growing. And there is now the Novo Nordisk Innolet, a big, easy-to-use insulin pen with an "egg-timer" dial, to help people with low vision or hand-use difficulties accurately set their dose.

So what's the moral of this tale of woe? Several: First, insulin is a powerful medication, with serious consequences if mis-used. Second, there are several ways people make mistakes in their insulin administration. Third, education is important; you CAN learn how to do it right. Fourth, and perhaps the best news of all, equipment is getting better, easier, and more foolproof. Newer insulins work better than the old standbys; newer blood glucose meters are easier and more convenient than their ancestors, and newer ways to administer insulin are more adaptive, better for folks with vision or movement difficulties, than the older syringes, pumps, and pens. Most people get it right, and it's getting easier and easier to join the majority.

+++++++++++++++++++++++++++++++++++++++++++++++
WHICH INSULIN PUMP?
Choosing the correct insulin pump is like choosing a good pair of shoes. There are a lot of choices, and much has to do with your lifestyle. Just as there's no "best for everything and everyone" pair of shoes, there's no one "best" insulin pump. Deciding which one should be a careful process.

Many private insurance carriers (and Medicare!) will honor a doctor's prescription for an insulin pump. Talk to your insurance carrier, your state Medicare carrier, or call: 1-800-772-1213.

Several new manufacturers have entered the U.S. insulin pump market in the past few months. Established manufacturers have brought out new products and updates. If you're an insulin-using diabetic ready for a pump, ready for the discipline it requires and the freedom it provides, you should start by contacting these manufacturers and reviewing what the different pumps can do for you.

Animas Corporation
The ANIMAS R1000
Animas Corporation, 590 Lancaster Avenue, Frazer, PA 19355; telephone: 1-877-937-7867; Web site: www.animascorp.com

Dana Diabecare
The DIABECARE-II
Dana Diabecare, 2601 N. Hullen Street, Metairie, LA 70002; telephone: 1-866-342-2322; Web site: www.danapumps.com

Deltec
The DELTEC COZMO
1265 Grey Fox Road, St. Paul, MN, 55112; telephone: 1-800-826-9703; Web site: www.delteccozmo.com

Disetronic
The H-TRON PLUS and the D-TRON PLUS

Disetronic Medical Systems, 5151 Program Avenue, St. Paul, MN 55112-1014; telephone: 1-800-280-7801; Web site: www.disetronicusa.com

Medtronic Minimed
The MINIMED 508 and the PARADIGM
Medtronic Minimed, 18000 Devonshire Street, Northridge, CA 91325-1219; telephone: 1-800-646-4633; Web site: www.minimed.com

Although Disetronic (see above) is the manufacturer of the tiny "basic" DAHEDI 25 insulin pump, the Dahedi does not appear on their Web site, and its U.S. distribution is handled by Logimedix, a Florida-based distributor (the Dahedi 25 can also be special-ordered from Disetronic). Contact: Logimedix, 1675 North Commerce Parkway, Weston, FL 33326; telephone: 1-800-821-8241; Web site: www.logimedix.com

Greetings and welcome to the New Year! It's January and the pressure's on to get rid of those unwanted holiday pounds; and, if you're newly diagnosed, to learn how to eat differently. I've always advocated good nutrition as the medicine of the future, and this is your time, my friends; only you can make the choice!

Since we're in the middle of winter and still in the cocooning mode, this is a good time to review some of the outstanding books (and cookbooks) which have landed on the review shelf. Two things come to mind when I mention the word cocooning: Cooking and reading. There's no reason we can't do both, so let's get busy!

Not ready for heavy reading? Start with a little humor -- with a very serious undertone. Find both in Stephen Furst's CONFESSIONS OF A COUCH POTATO (Or, If I'm So Skinny, Why Do I Still Feel Like FLOUNDER?).

If you're not familiar with Stephen Furst, think Animal House, St. Elsewhere, or Babylon 5, some of his better-known cinematic projects. Furst has spent his life "living large," overweight as a child, tipping the adult scales at over 320 pounds, an obese person with diabetes. Stephen was 17 when his father died of diabetes complications at age 47.

Furst focuses on his food addictions, and the struggle he's had to overcome them. He's found his way to good health, losing 150 pounds and keeping it off for the last six years! He's very proud of the recipes he's developed to achieve this, including a complete Thanksgiving menu with made-over versions of the traditional favorites.

This book is a wonderful gift idea for a newly diagnosed friend or relative. It will make you laugh, and it may even make you cry; but if you've ever been there yourself, you will understand Furst's struggle with food addictions. It is a success story, sprinkled with the recipes he developed so he could stay within his diabetic meal plan, while still being able to eat healthier versions of his favorite foods.

Published in 2002 by the American Diabetes Association, CONFESSIONS OF A COUCH POTATO by Stephen Furst is a real winner! Two thumbs up from this reviewer!

We are FINALLY beginning to see more "ethnic" cookbooks for diabetics. COCINANDO PARA LATINOS CON DIABETES (Diabetic Cooking for Latinos), by Olga V. Fust, MS, RD, CDE, (c)2002 by the American Diabetes Association, is one of the most recently published cookbooks in this category. DIABETIC COOKING FOR LATINOS is bi-lingual, written in both English and Spanish, and is representative of the culinary cultures of Mexico, the Caribbean, Puerto Rico, Costa Rica, Ecuador, Central and South America.

Each recipe has a complete nutritional analysis, including dietary exchanges, and tips for reducing fat, sodium, and calories can be found in the Introduction. You'll read about the advantage of counting carbohydrates, and how to gradually retrain your taste buds to appreciate the natural flavor of the foods. On a scale of one to five, this cookbook definitely rates a five.

**************************************

Ready for another good "find?" If you're looking for great recipes -- and have no time to cook, look no further! LIGHT & EASY DIABETES CUISINE, by Betty Marks, will serve you well. Introductory remarks and nutritional analyses by one of my favorite authors, Hope S. Warshaw, MMSc, RD, CDE, are included in the opening pages of this cookbook.

According to Warshaw, "The most common complaint I hear is that the diabetes meal plan lacks interest. The lists of allowed foods appear limited, and the methods of preparing these foods result in tasteless, unimaginative meals. Just glancing at some of the recipes in LIGHT & EASY DIABETES CUISINE disproves this notion. Betty Marks incorporates many unique ingredients and utilizes a wide variety of quick cooking methods to provide new ideas for creative meal planning, often the most difficult part of diabetes management."

Ms. Marks speaks from experience as an insulin-dependent diabetic for 26 years. She's maintained a lifestyle that includes work, travel, theater, reading, dancing and sports, as well as making delicious meals for friends and family. What a testament to what CAN be done despite diabetes!

I like the larger print format and limited ingredient lists in this cookbook. We get all the essential nutritional elements in the analysis (including the sodium and cholesterol), as well as the exchanges. The majority of recipes can be prepared and served in under 30 minutes, a bonus for the working mom.

LIGHT AND EASY DIABETES CUISINE brings you over 200 dishes, to tempt your palate and get you in and out of the kitchen FAST! I can't wait to try the Mexican Corn Chowder, Chili Chicken with Hash Brown Potatoes, Teriyaki Beef and Vegetables, Rosemary Pork Chops (served with pan juices), Sauteed Sea Scallops, Orzo & Pignoli (small pasta & pine nuts), the Cranberry Corn Muffins at Thanksgiving, and Peanut (Butter) Custard or Baked Apples Burnette for dessert.

Betty's recipes don't shy away from using moderate amounts of alcohol as a way to intensify and bring out the flavors of complementary recipe ingredients. If cooking with alcohol presents a problem for you, there is a current feature on "Cooking with Alcohol" on my CINNAMON HEARTS Web site (www.cinnamonhearts.com), which offers substitutions for alcohol as a recipe ingredient.

Rest assured, readers, you definitely CAN eat well, live fast, and manage your diabetes with LIGHT AND EASY DIABETES CUISINE. Two thumbs up for recipe creativity, ease of preparation and taste-full meals!

OK, the Exercise-Police finally found me!! I knew it had to happen sooner or later, and someone has FINALLY written a do-able book on exercise (I call it the Big E-word!). Make note of this title: THE "I HATE TO EXERCISE" BOOK FOR PEOPLE WITH DIABETES (Or, How to Turn Your Every Day Home Activities Into A Low-Impact Fitness Plan). That "someone" is Charlotte Hayes, MMSc, MS, RD, CDE, a nutrition and fitness consultant in Atlanta, Georgia.

Ms. Hayes understands most of us have a hard time sticking to an exercise plan, and she emphasizes the key to good diabetes self-care is simply staying active by making the most of YOUR daily activities: walking, cleaning the house, gardening -- ANYTHING that keeps you moving! I've noted when I do a couple of hours of housework non-stop, it makes a significant difference in my blood glucose readings.

Author Hayes starts out with what I call the "scary stuff," the complications of diabetes that can follow "sitting your way through life," things like: heart disease, high blood pressure, high blood fat levels, overweight, and obesity, and of course the ultimate prize: type 2 diabetes! Hayes also enumerates the positive effects of exercise: lifting your mood, building muscles (which burn calories even at REST!); reducing stress, anxiety and depression; improving your sex life; giving you MORE energy; and making you feel great, look great and proud of yourself!

This is a great little book for those of us who need a little extra motivation to get up off of our you-know-whatsis and get busy! I love this book because it's filled with lots of good tips and ideas to help you ease your way into a more active lifestyle. And as you all know by now, good nutrition and exercise go hand in hand and MUST work together -- one just won't work without the other!

Pick up a copy of the "I HATE TO EXERCISE" BOOK FOR PEOPLE WITH DIABETES, 2000 by Charlotte Hayes. I give it a hearty endorsement and I plan to implement some of the ideas in Charlotte Hayes's low-impact fitness plan!

That's a wrap for this time around folks; please join me again in April for more reviews and suggestions for your commitment 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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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."

(This story appeared in MIZZOU magazine, Vol. 91, No. 2, Winter, 2002, published by the University of Missouri. Reprinted with permission.)

Along with a sensible diet, regular exercise has long been touted as the only surefire way to shed extra pounds. Now, Michael Sturek, professor of physiology, is finding that, for people with diabetes, the benefits of exercise extend beyond weight loss.

"People with diabetes are four times as likely to develop heart disease as are people who aren't diabetic," Sturek says. "We have found that exercise may play a role in preventing this."

In his research, Sturek uses specially-bred diabetic Yucatan pigs. Sturek divides the pigs into a control group, which leads a sedentary lifestyle, and an experimental group, which runs on treadmills for 30 to 40 minutes, four days a week.

"Pigs are a lot like us," Sturek says. "Their hearts are similar in size, anatomy, and function, and they are omnivorous, like we are. When we put them on a treadmill, they run like us, too."

Sturek has found that exercise alters some of the cellular properties of the pigs' arteries, causing them to open and increase the flow of blood. He's also found that exercise decreases intracellular calcium, which he says causes muscles around blood vessels to grow and, in turn, impede blood flow.

"Eventually, we'd like to be able to develop a drug that can mimic these effects, so diabetics who are morbidly obese or unable to exercise can still protect themselves from heart disease," Sturek says.

Includes Artwork: Fruits and Vegetables
This issue, all recipes are taken from THE DIABETIC'S HEALTHY EXCHANGES COOKBOOK, by JoAnna M. Lund, published by Perigee. Reprinted with permission. Contact Healthy Exchanges at telephone: (319) 659-8234; Web site: www.healthyexchanges.com.

Ingredients:

4 cups reduced-sodium tomato juice
2 cups purchased coleslaw mix
1/2 cup chopped onion
8 ounces diced Healthy Choice 97% fat-free frankfurters
1 teaspoon chili seasoning mix
1/4 teaspoon black pepper
1/3 cup (1 ounce) uncooked regular rice
1 teaspoon dried parsley flakes

In a large saucepan, combine tomato juice, coleslaw mix, and onion. Bring mixture to a boil. Stir in frankfurters, chili seasoning mix, black pepper, rice, and parsley flakes. Lower heat. Cover and simmer 20 minutes, stirring occasionally. Hint: 1-3/4 cups shredded cabbage and 1/4 cup shredded carrots may be used in place of purchased coleslaw mix. Makes four, 1-1/2 cup servings.

141 Calories, 1gm Fat, 10gm Protein, 23gm Carbohydrate, 1466mg Sodium, 2gm Fiber. Exchanges: 3 Vegetable, 1 Meat, 1/2 Starch.

Ingredients:
1 cup frozen whole kernel corn
1 cup frozen peas
1/2 cup water
1/4 cup Land O' Lakes no-fat sour cream
1/4 teaspoon dried parsley flakes
2 teaspoons dried onion flakes

In a medium saucepan, combine corn, peas, and water. Cook five minutes or until vegetables are just tender. Drain. Return vegetables to pan. Stir in sour cream, parsley flakes, and onion flakes. Mix gently to combine. Serve at once.

80 Calories; 0gm Fat; 4gm Protein; 16gm Carbohydrate; 24mg Sodium; 3gm Fiber. Exchanges: 1 Starch.

CORNED BEEF PIZZA

1 (8-ounce) can Pillsbury refrigerated crescent dinner rolls
2 (2.5-ounce) packages Carl Buddig 90% lean corned beef, shredded
1/2 cup chopped onion

2-1/2 cups purchased coleslaw mix
1 cup chunky salsa
2 tablespoons sloppy joe seasoning mix
1 (8-ounce) package Philadelphia Fat-Free Cream Cheese
1/3 cup Kraft Fat-Free Thousand Island Dressing
3/4 cup (3 ounces) shredded Kraft Reduced-Fat Cheddar cheese

Preheat oven to 450 degrees. Spray a rimmed 9-by-13-inch cookie sheet with butter-flavored cooking spray. Pat rolls into prepared pan, being sure to seal perforations. Bake five to seven minutes or until light golden brown. Place cookie sheet on wire rack and allow to cool. In a large skillet sprayed with butter-flavored cooking spray, saute corned beef, onion and coleslaw mix until cabbage is tender, about five minutes. Add salsa and Sloppy Joe seasoning mix. Mix well to combine. Simmer five minutes, stirring occasionally.

In a medium bowl, stir cream cheese with a spoon until soft. Add Thousand Island Dressing. Mix well to combine. Spread cream cheese mixture evenly over cooled crust. Layer cabbage mixture over cream cheese mixture. Sprinkle Cheddar Cheese evenly over top. Return to oven. Continue baking three to five minutes or until cheese starts to melt. Place cookie sheet on a wire rack and let set two to three minutes. Cut into 12 servings. (Hint: two cups shredded cabbage and 1/2 cup shredded carrots can be used in place of purchased coleslaw mix.)

129 Calories, 5gm Fat, 8gm Protein, 13gm Carbohydrate, 537mg Sodium, 1gm Fiber. Exchanges: 1 Vegetable, 1/2 Starch, 1/2 Fat, 1 Meat.

1 (4-serving) package JELL-O sugar-free instant vanilla pudding mix
2/3 cup Carnation Nonfat Dry Milk Powder
1-1/4 cups water
1 cup Cool Whip Lite
2 cups peeled and chopped fresh peaches
1 (6-ounce) Keebler butter-flavored piecrust
1/4 cup raspberry spreadable fruit spread

In a large bowl, combine dry pudding mix and dry milk powder. Add water. Mix well using a wire whisk. Blend in 1/2 cup Cool Whip Lite. Add chopped peaches. Mix gently to combine. Spread mixture evenly into piecrust. Refrigerate while preparing topping.

In a small bowl, stir raspberry spreadable fruit until soft. Add remaining 1/2 cup Cool Whip Lite. Mix gently to combine. Spread topping mixture evenly over set filling. Refrigerate at least two hours. Cut into eight servings.

194 Calories, 6gm Fat, 3gm Protein, 32gm Carbohydrate, 323mg Sodium, 2gm Fiber. Exchanges: 1 Starch, 1 Fruit, 1 Fat.

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The morality of stem cell research has been the subject of much recent debate, but the efficacy of its results is undeniable. And this research may have great implications for type 1 diabetics.

Remember that in type 1, the Islets of Langerhans, groups of cells in the pancreas, stop producing insulin - so insulin must be injected, or death will shortly follow. The only alternative to parenteral insulin injection has been transplantation, either of a complete pancreas, or of islet cells (as is being tested under the Edmonton Protocol).

Researchers from Stanford University suggest there may be another alternative. They have collected embryonic stem cells - from mice - and developed them into a tissue that, like the Beta cells of the pancreas, made insulin. Pieces of this tissue were then transplanted into diabetic mice, where they started producing insulin. The mice survived without further insulin injections.

The Stanford researchers were quick to point out that although what they've done has not been achieved before, they have not "manufactured Beta cells." Not yet.

Animal research is a necessary precursor to clinical testing of new drugs and surgical procedures on human subjects. There are a great many steps to take, and hurdles to cross, before a procedure such as this can become part of the doctor's arsenal. Research continues; there's a long way to go.

Coffee drinkers are half as likely to develop diabetes as adults, research has found. The study has caused controversy as caffeine is known to reduce the body's sensitivity to insulin, the hormone diabetics need to treat their condition. But the Dutch team behind the work say other components in coffee, such as magnesium and chlorogenic acid, could help prevent people developing type 2 diabetes.

They say their findings should be examined in further studies, and that decaffeinated coffee could offer the same benefits, without the concerns over the effects of caffeine.

Diabetes experts in the UK said more needed to be known about why coffee drinkers had a reduced risk of developing type 2 diabetes, and warned there were risks in drinking too much coffee.

Type 2, or non-insulin dependent diabetes is the most common form of the disease and usually occurs in people who are over 45 and overweight. They do not make enough insulin, or cannot make proper use of it. This means they cannot move blood sugar into the cells. Sugar builds up in the bloodstream and causes health problems

Researchers from the Dutch national Institute for Public Health and the Environment in Bilthoven, Netherlands, asked over 17,000 how much coffee they drank each day. Those who drank seven or more cups of coffee a day were 50% less likely to develop type 2 diabetes compared with those who drank two cups a day or less. The association was still seen when factors such as smoking, alcohol consumption and body mass were taken into account.

This study backs up previous research which showed that when people increased their coffee consumption for 14 days, their blood glucose levels were reduced, but substituting regular coffee for decaffeinated coffee for 20 days did not affect glucose levels. That study did not include a control group, but the results suggested components of coffee other than caffeine could be beneficial for glucose metabolism.

Rob van Dam, who led the research, said: "In view of the widespread use of coffee and the large health burden of type 2 diabetes, our finding of an inverse association between coffee consumption and risk of type 2 diabetes could have important public health implications. However, our findings need to be replicated and possible adverse effects on other health aspects should be considered in the choice to consume coffee."

He told BBC News Online: "It has been shown over and over again that caffeine lowers insulin sensitivity. But they only study people for a few hours. If you look over several days, then there's not such a clear effect -- a tolerance of caffeine could develop. Decaffeinated coffee might have the same effects, and other types of coffee with more of the beneficial ingredients could be developed."

Amanda Vezey, a care advisor for Diabetes UK, said: "These are surprising results, and we don't know if this could really help people avoid diabetes in future. We need to find out what caused these results and that will need more research. Drinking more than seven cups of coffee a day will also have other side effects. If people really want to reduce the risk of diabetes regular exercise and a healthy diet are a safer and more reliable bet."

All Rights Reserved
From the Editor: The process of obtaining Social Security disability benefits is not automatic. There are very specific criteria to be met, and administrative procedures to be followed. Departure from "the rules" can lead to denial of benefits. You may find it wise to consult a lawyer specializing in this area of legal expertise. Stanley Rosenberg is one such attorney.

Social Security Disability and diabetes have been the subject of significant litigation since I last wrote on this subject for VOICE OF THE DIABETIC (Vol. 13, No.2, April 1998). It is time for an update. In the following text, I will first attempt to lay out the entitlement, and then comment on the current state of the law.

Since all law dealing with Social Security is Federal, there are no state-to-state variations. The beginning of all Social Security cases, if you become disabled, is to go to your local neighborhood office, with your birth certificate in hand, and apply for benefits. If you have worked for the last ten years, and have at least 40 Quarters, you are covered for regular Social Security. If not, you can only receive SSI, which is payable only to people with limited assets and children under 18. The maximum monthly payment for SSI is $520.00, while regular SSA benefits can go to $1750 per month.

The SSA gives you a Medicare Card while SSI gives you a Medicaid Card. Under either of these entitlements, you must show that you suffer from a severe disability that will disable you for at least one year. Thus is born the requirement that whoever seeks a disability claim need only "approach the gate" if his disability is severe.

The question of Severity must go through a five step process to see if payment can be made. This is officially done at the hearing when the judge issues a decision on the case. The steps are:

1. An individual who is working and engaging in substantial gainful activity will not be found to be disabled regardless of medical findings. 20CFR404. 1520(B)

2. An individual who does not have a severe impairment will not be found to be disabled. 20 CFR Sec. 404. 1520

3. If an individual is not working, and is suffering from a severe impairment which meets the duration requirements and which meets or equals a listed impairment in appendix I, Subpart P, Reg. 4, a finding of "Disabled" will be made without considering vocational factors. 20 CFR Sec. 404, 520

4. If an individual is capable of performing work she or he has done in the past, a finding of "not disabled" must be made. 20CFR Sec. 404. t 520(E)

5. If an individual, given his or her age, education, and past work experience, can perform any other work that exists in substantial numbers in the national economy: if' "yes," the claim is denied; if "no," the claimant is disabled and the claim approved.

Listings published by the Federal Government cover all types of known disabilities. For more information, call the Social Security Administration, Office of Disability, telephone: 1-800-772-1213; Web site: www.ssa.gov; or contact your local Social Security office. Ask for SSA PUB No. 64-039, ICN 468600.

The listings for diabetes and the endocrine system are found under Sec. 900. Briefly, the listings require: A. Neuropathy (significant and persistent disorganization of motor function which disturb gait and movement) or, B. acidosis occurring once every two months, confirmed by chemical tests or; C. amputation at or above tarsal region (foot) or; D. visual impairment requiring blindness in one and significant reduction in the other (see your MD, as he is familiar with the Social Security Blindness Requirements).

So it is not enough to have any of the 500 other things that diabetics suffer, such as brittleness, dizziness, poor circulation; but there are add-ons such as strokes, peripheral vascular disease and bone conditions that can push you over the line.

What the courts say is always important. Each year thousands of your neighbors go before the courts to seek the sustenance of Social Security, with widely varying results. There is usually a judge waiting at the end of the tunnel unless you are really sick. Get some help before you go in there, because he may not be your friend, and losing is more expensive than paying a lawyer. For God's sake don't go in there if you are working part-time. It is very difficult to get a judge to look seriously at you if you are working. You will get the "fish eye."

Finally, new cases come out of the courts continuously, reshaping and evaluating the process. Here are a few, as space does not permit a Law Review length article:

A 50 year old diabetic woman who needed a kidney stent in 1991 because of poor kidney function due to diabetes was ruled "not disabled" after the stent improved and she stated she could do limited sedentary work and only miss three weeks per year. The Administrative Law Judge correctly terminated benefits for SSI. (Note: SSI benefits are for people who do not meet the insurance requirements or have not worked significantly or are children under 18. The maximum monthly benefit is $545.00, whereas regular Social Security has a current maximum of $1800.00 per month.)

Kidney diseases are not treated under Sec. 9.00 but are separately considered under 6.02. Kidney diseases and conditions are almost always awarded benefits. Cunningham V. Apfel 222 F2ND496 (8th Circuit 2000) deals with the important issue of end-organ damage and ocular disease. Cunningham, a 60-year-old woman electronics assembler, was denied benefits for hypertension, diabetes, back and leg problems and pain, heart disease, carpal tunnel syndrome, chronic COPD. Her right hand constantly would fall asleep since 1994. There was no end-organ damage or neuropathy, and at the hearing she was found able to do her prior work. On appeal, to the Federal District Court, the ALJ decision was reversed by the Federal Judge as the record did not support Cunningham's ability to use her hands or consider the combined effects of all her impairments, and it improperly disregarded testimony of the Treating Physician (Note: The treating physician must be given preference over non-treating physicians or those who do not examine the claimant. Often judges will pick the conclusion least favorable to the claimant, to beat him in his claim.)

I have attempted to cover a very wide subject, and to fit my material into a small space allowance. If you have further questions about diabetes and social security, call my law office at: 305-932-0350, or write to: Stanley M. Rosenberg , 2450 NE Miami Gardens Dr., Miami FL 33180; email: SSEM [email protected]. There are no charges for these services. If the case merits, I often take cases outside my jurisdiction. Also, please remember, I have not treated herein any of the diabetes complications -- such as stroke, heart disease, neurologic disease, etc.

ANOTHER LOOK AT INSULIN RESISTANCE

by Peter J. Nebergall, PhD
Includes Photo: Peter J. Nebergall

Almost daily we are reminded there is an epidemic of obesity in the United States. Whether you read bulletins, or follow the evidence of your own eyes, it is true: Americans are fat and getting fatter all the time.

We know why: The wrong kinds of food, and far too much of them; sedentary employment, in ever-shrinking cubicles; a "falling out of fashion" of participatory athletics (the reasons for which would make a long paper of its own), not to mention a near-total lack of organized exercise. We eat too much, of the wrong food, and we sit on our tails. So we get fatter.

We can count the cost: An estimated 250 million clinically obese people worldwide, 300,000 preventable deaths per year in the United States, and the new finding that one in three adult Americans has insulin resistance.

What is insulin resistance (IR)? The American Association of Clinical Endocrinologists defines it as a syndrome in which there is decreased tissue sensitivity to the action of insulin, leading to a compensatory increase in insulin secretion. Where once this condition was seen merely as a precursor (in about 50% of cases) to type 2 diabetes, it is now known to increase risk of serious, primarily cardiac, ramifications.

What causes insulin resistance? We're not exactly sure. We know there are two components: Genetic and Environmental. We know that, like type 2 diabetes, IR runs in families. We know that certain ethnicities have a higher proportion (though this may reflect environment, not genetics at all - see the Pima study), and we know that increasing age (read:decreasing activity) increases the risk. The second half of IR, the part we understand better, has to do with obesity. Although all obese people do not have insulin resistance, or type 2 diabetes, if you are genetically predisposed to IR (if you "carry the trait"), and you let your weight climb up into the "obese" range (Body Mass Index >= 25), insulin resistance will express, to a greater or lesser degree. And you don't want the consequences.

Fortunately, the converse is true: If you are overweight and insulin resistant, and you lose weight, reducing your body mass index, you can cut your insulin resistance, and the risks that go with it - including the risk of developing type 2 diabetes. If you already have type 2, the same weight loss can reduce its severity - perhaps into insignificance.

We haven't changed our genetic make-up much in the last few centuries, but IR has rocketed 61% in the last decade - congruent with the big rise in type 2 diabetes. Possible clues come from the Pima Study.

The Pima are a Native tribe of the American Southwest. The tribal area crosses the Rio Grande; there are Pimas on both sides of the border. Several years ago, concerned that their people had the highest percentage of diabetics anywhere (approximately 51 percent of the tribe, on the U.S. side, had type 2), the tribe asked researchers to come and see if they could explain why, and describe what they should be doing different. Results were startling.

On the American side, a cash economy had replaced the old ways. There was a lot of inactivity; people cooked high-carbohydrate "white man's food," and watched a lot of television. A majority of American Pimas had overt type 2. Even more were insulin-resistant.

On the Mexican side, Pimas tended to follow their traditional subsistence-farming lifestyle. They tilled their fields with animals, and ate the fresh produce they grew themselves. What was the percentage of diabetes for Pimas on the Mexican side? About 5 percent - less than their Gringo neighbors! Remembering that these people were genetically identical to the U.S. Pimas, the differences were entirely attributable to lifestyle - to how they worked and what they ate.

How do you work? What do you eat? Odds are your work is pretty sedentary - more like the U.S. Pimas than their Mexican brethren. Odds are you watch more and move less than you used to ... and ever notice how the clothing adverts all assume you're getting heavier than you used to be?

What about food? There's a reason for the term "junk food" (and Ralph Nader recently called the double cheeseburger "a weapon of mass destruction") - it's not very good for you. The sedentary adult male working in his cubicle requires 1800 calories a day, to maintain. A double cheeseburger is 600-plus calories, and the "deluxe" burgers can run over 1000 calories. A 40-ounce drink can be 600 more calories, and "don't forget the fries!" You're over your allotment - and that was just lunch!

For dinner, do you have a 12-ounce steak? Fried chicken, chicken-fried steak, pizza with everything? For breakfast, pancakes, bacon, sausage, scrambled eggs ... Count the calories, just for fun, and you'll see just what is "over easy" - it's your calorie count.

Dieting, no matter how successfully, cannot remove the genetic predisposition to insulin resistance - but if you remember that the excess food has to go somewhere, and that what you don't eat won't raise your IR or your blood sugars - then you're on the way.

There are tests to diagnose insulin resistance, and medications to reduce its severity. Still, the best approach is the one advocated by Hippocrates the Physician, thousands of years ago: a healthy lifestyle. You can prevent or reduce so much of the impact of insulin resistance, by yourself, by increasing your activity, and eating wisely. Good luck.

ACCESSIBILITY OF SOCIAL SECURITY NOTICES: THE NFB NEEDS YOUR FEEDBACK
Includes Photo: James McCarthy

The National Federation of the Blind is planning an effort to obtain distribution of important Social Security notices in accessible formats. This includes notices containing determinations about eligibility for benefits or the amount of benefits, notices pertaining to overpayments, availability of new programs (such as the Ticket to Work), and generally any other kind of notices (including SSI notices) which the Social Security Administration sends to beneficiaries.

Specific information is needed for this effort. We are particularly interested in situations where individuals may have lost benefits or rights to appeal because a printed notice was not read in time. Also, there may be situations where portions of a printed notice were skipped by a reader who thought that the information would not be important. Cases where confidentiality was compromised by having someone, such as an employer, supervisor, or co-worker read a notice should also be reported.

Written policies of the Social Security Administration provide blind persons with certain alternatives to choose from in receiving notices. These include use of registered mail as an alert that the communication is important, having a telephone call from a Social Security representative to read a printed notice, and having notices prepared in Braille upon request.

It would be helpful to have information indicating whether or not these options are being offered. Also, are the alternatives actually implemented when requested? Are there instances when requests for accessible notices have been made but ignored or denied? Information relating to this issue should be as specific and as current as possible. Please include contact information for follow-up as well.

All responses should be directed to James McCarthy, Assistant Director of Governmental Affairs, National Federation of the Blind, by e-mail at: [email protected]; by phone at: (410) 659-9314, extension 240; by fax at: (410) 685-5653; or by mail at: The National Federation of the Blind, 1800 Johnson Street, Baltimore, MD 21230.

2003 NFB SCHOLARSHIP AWARDS

The National Federation of the Blind will award more than $100,000 in scholarships this year. Individual scholarship amounts range from $3,000 to $10,000, and the competition is open to any legally-blind individual who will be a full-time, post-secondary student in Fall 2003.

All 30 scholarships are merit-based, and most are unrestricted. Entries will be judged on the criteria of academic excellence, financial need, and service to the community. The committee making the award decisions will be composed of blind citizens with distinguished academic and community backgrounds from across the country.

The scholarship winners will be presented their awards in July, at the 2003 convention of the National Federation of the Blind, in Louisville, Kentucky. The NFB will also pay all expenses of scholarship winners to attend the convention.

The National Federation of the Blind is an organization dedicated to creating opportunity for all blind persons. With more than 50,000 members, it is the largest organization of blind citizens in existence, and it awards more scholarships to the blind than does any other group or organization. Recipients of Federation scholarships do not have to be members of the NFB.

Applications for the 2003 NFB Scholarship program must be received by March 31, 2003. Scholarship winners will be notified by June 1. We receive approximately 500 scholarship applications each year, so don't delay! Anyone interested may request as many application forms as needed from:

1. Mrs. Peggy Elliott, Chairman, National Federation of the Blind Scholarship Committee, 805 5th Avenue, Grinnell, IA 50112-1653; telephone: (641) 236-3366.

2. National Federation of the Blind Scholarship Committee, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314.

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.

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

On July 6, 2002, at our annual Diabetes Action Network seminar, held in Louisville, Kentucky, as part of the annual convention of the National Federation of the Blind, podiatrist Kenneth B. Rehm, DPM, gave the keynote address, titled: "The Importance of Treating Diabetic Feet." Dr. Rehm limits his practice to the diabetic foot, and he had a great deal of useful information to impart. We recorded his speech, and 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.

A new service is now available: You can now receive VOICE OF THE DIABETIC electronically, by e-mail, four times a year. The file will be TXT, and will closely resemble the VOICE files available on the Web at www.nfb.org/voice.htm.

By offering this service, we hope to save money on paper and postage. To receive the VOICE by e-mail, write or call the VOICE office, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911; e-mail: [email protected]. We'll sign you up.

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 8:30 pm to 5 pm, Eastern Time, weekdays.

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 Accu-Chek 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

Northbridge Productions presents a special edition of the national TV series: "Today's Woman." This edition will focus on diabetes, and on advances in diabetes care -- in blood glucose testing, new medications, and insulin delivery systems. What is diabetes? How do you know if you have it? What can you do about it? What new products will make it easier? Education is the answer. For scheduling/airing information, contact: Northbridge Productions; telephone: 1-800-918-5049; Web site: www.northbridge.tv

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.

New Talking Blood Glucose Monitor

Roche Diagnostics has developed a new talking blood glucose monitor. Based on the proven Accu-Chek Advantage meter, the Accu-Chek VoiceMate provides the following: Clear, high-quality speech synthesis, talking the user through preparations, test procedures, and results, without the need for sighted assistance; an "insulin vial identifier" which reads Eli Lilly insulin vials and speaks their type, as a safety aid in tactile insulin mixing; a new, improved, "touchable" test strip -- the Accu-Chek Comfort Curve (no more "hanging drop of blood" needed!); no meter cleaning required; and a new, tactile "code-key" system for programming test strip codes. The VoiceMate is the most "blind-friendly" talking glucose monitor available today, and the only one whose regular operations require no sighted assistance at all.

The VoiceMate comes with an adjustable over-the-shoulder carrying case, with meter, voice box, battery, adapter cord, 10 Comfort Curve strips, earphone, insulin check-vial, manual and quick-reference guide (in print), and instructions on audiocassette. Also included is the Accu-Chek Softclix lancing device, and a packet of 10 lancets. The new meter (catalog # 2030802) can now be ordered through any pharmacy (suggested retail price $495-525). To do so, have your pharmacist contact Roche Diagnostics, 9115 Hague Road, Indianapolis, IN 46250; telephone: 1-800-428-5074, For direct purchase, and a price below $500, contact any of the following retailers: BeyondSight, Inc., Littleton, CO: (303) 795-6455 ($498); Independent Living Aids, Inc., Plainview, NY ($495): 1-800-537-2118; or the National Federation of the Blind Materials Center Baltimore, MD ($475): (410) 659-9314.

American Diabetic Supply, Inc., will ship your diabetes supplies to your door. They handle all insurance claims and provide free delivery. Folks with Medicare and/or private insurance (no HMOs) may receive supplies with no further cost. For information, contact: American Diabetic Supply, Inc., 400 S. Atlantic Ave., Suite 108, Ormond Beach, FL 32176; telephone: 1-800-453-9033.

Sherlock Holmes and Dr Watson went on a camping trip. After a good meal and a bottle of wine they were exhausted and went to sleep.

Some hours later, Holmes awoke and nudged his faithful friend. "Watson, look up and tell me what you see."

Watson pondered for a minute. "Astronomically, it tells me that there are millions of galaxies and potentially billions of planets. Astrologically, I observe that Saturn is in Leo. Time wise, I deduce that the time is approximately a quarter past three. Theologically, I can see that the Lord is all-powerful and that we are but insignificant specks of dust. Meteorologically, I suspect we'll have, a beautiful day tomorrow. What does it tell you?"

Holmes was silent for a moment, then spoke -- "Watson, you idiot, some rascal has stolen our tent!"

We have been asked to announce: "Talk the Talk" is a computer program that allows the user to record spoken messages, in an e-mailable format. Recordings can be any length; you can record seminars and lectures - and send them to anyone who can receive attached files. This is not a "voice-to-text" program, but a means to communicate naturally. You do not need the keyboard. Thus, people who are blind or losing vision may find this program a convenient way to let their voice be heard. Price: $29.95, including software, lapel microphone, and user's manual. Contact: Redtin Direct, telephone: (954) 956-7719; Web site: www.redtin.biz.

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 DNA insulin 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

Pharmacist Bryan Luna, RPh, 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.

The English Web site www.vipnews.org.uk daily collects news stories from around the world about blindness and visual impairment issues. These it presents in a simple, screen-reader-friendly manner. It is also a first-rate collection of cross-links to world media. And, of course, access is free.

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.

For assistance with completing your year 2002 tax forms, you can telephone the Internal Revenue Service, toll-free: 1-800-829-1040; Web site: www.irs.ustreas.gov/prod/forms_pubs.

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.

Access Diabetic Supply promises free delivery, no paperwork, and free in-home training in the use of blood glucose testing devices. Your private insurance is welcome, and they accept Medicare, too. They offer free blood glucose monitors to folks who sign up. Check them out online: www.diabeticsupply.com or call: 1-800-276-5712.

The 1995 EXCHANGE LISTS FOR MEAL PLANNING is now available in Braille (74 pages) and on four-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.

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

It seems impossible that a car battery could cause an explosion loud enough to be mistaken for several large firecrackers exploding - or powerful enough to blind or maim someone. However, in fact, improper procedures in jump-starting a dead battery can turn the battery into a lethal bomb, causing thousands of serious eye injuries each year. All vehicle batteries contain sulfuric acid and produce hydrogen and oxygen gases. If the gases come into contact with a spark, flame or lighted cigarette, the battery can explode, sending battery fragments and acid flying.

Every year, dead batteries cause millions of cars and trucks to fail to start. In addition, because vehicle failures seldom happen at a convenient time or spot, motorists and workers should educate themselves on basic auto mechanics and jump-starting procedures before the battery dies. If you don't feel comfortable jump-starting or replacing a dead battery yourself, by all means call a professional, as it is not worth taking the risk.

Businesses and individuals alike should have an emergency plan in place in case a vehicle battery explodes. Most people panic if battery acid splashes into their eye - The immediate thing the injured person should do is to flush the eye with any 'drinkable' liquid on hand, such as water, milk, juice or any soft drink. Every second counts, because the longer the acid stays in the eye, the greater the chances of a serious corneal burn or blindness.

According to statistics, there were an estimated 276,000 product-related eye injuries, which were treated in U.S. hospital emergency rooms in 2001. Thousands of these injuries were related to automotive products such as antifreeze, cleaners, and chemicals. Automotive-related eye injuries associated with batteries and chargers accounted for the highest total. There are measures of protection that people should follow when working on their vehicles, particularly under the hood. Professionals working in the auto repair business, as well as motorists, are encouraged to wear safety glasses or goggles when jump-starting vehicle batteries.

Founded in 1908, Prevent Blindness America is a volunteer eye health and safety organization dedicated to fighting blindness and saving sight. Focused on promoting a continuum of vision care, Prevent Blindness America touches millions of people each year through public and professional education, certified vision screening training, community and patient service programs and research. These services are made possible through the generous support of the American public. To receive a free Auto Battery Safety sticker call 1-800-331-2020 or visit us on the web at www.preventblindness.org.

So you want a day off. Let's take a look at what you are asking for. There are 365 days per year available for work. There are 52 weeks per year in which you already have two days off per week, leaving 261 days available for work. Since you spend 16 hours each day away from work, you have used up 170 days, leaving only 91 days available. You spend 30 minutes each day on coffee break which counts for 23 days each year, leaving only 68 days available.

With a one hour lunch each day, you used up another 46 days, leaving only 22 days available for work. You normally spend two days per year on sick leave. This leaves you only 20 days per year available for work. We are off five holidays per year, so your available working time is down to 15 days. We generously give 14 days vacation per year which leaves only one day available for work and I'll be damned if you are going to take that day off!

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

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 316,215 VOICE readers could benefit from your story.

For information and article submission guidelines, contact: VOICE OF THE DIABETIC, 1412 I-70 Drive, Suite C, Columbia, MO 65203; telephone: (573) 875-8911.

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Developed by the National Federation of the Blind, NEWSLINE is a free service used by blind subscribers to read newspapers through any touch-tone telephone. Thanks to a one-year grant through the Institution of Museums and Libraries, subscribers in all 50 states, the District of Columbia, and Puerto Rico, can now access every newspaper that NEWSLINE currently supports. Although NEWSLINE has covered large population areas in over 30 states for the past few years, over half of our country has not been able to access it without calling long distance. Any blind person registered for NEWSLINE can dial the toll-free number, 1-888-882-1629, to access all the newspapers carried on the service.

Readers already using NEWSLINE will find the new, expanded service easy to use. Pick up any touch-tone phone, dial the NEWSLINE number, listen to the menu, and choose options by tapping numbers on the phone keypad. Instead of the usual three national papers available each morning, subscribers can read over 85 newspapers, from across the country. Consider how interesting it will be to read the newspaper from a city in which a big story is breaking. In addition, NEWSLINE's non-newspaper features, which are currently available in each area, will now be available with all of the newspapers.

NEWSLINE is available, free of charge, to anyone at least legally blind. To register for this new nationwide service, or to check for updated information, contact the National Federation of the Blind, at the National Center for the Blind in Baltimore, see the NFB's monthly magazine, the BRAILLE MONITOR, call the local news option on your local NEWSLINE, or contact a local leader of the NFB in your community, or visit the NFB Web site: www.nfb.org

The NEWSLINE application is a one-page form. Get a copy of the form, fill it out completely, and return it to: NEWSLINE, National Center for the Blind, 1800 Johnson Street, Baltimore, Maryland 21230. Because NEWSLINE service requires a signature, prospective subscribers must acquire or copy a print NEWSLINE application form. A copy may be downloaded from www.nfb.org Forms are often available from public libraries, or may be requested from local leaders of the NFB or from the National Center for the Blind in Baltimore.

NEWSLINE hereby requests all subscribers -- help us to spread the word about this wonderful opportunity. Please help us spread the word to special education departments, teachers, or schools serving blind students, and anywhere else Americans can be found who cannot read the newspapers because of their eyesight. National headlines or local stories, sports, Ann Landers, or letters to the editor and social commentary--there is much that our sighted neighbors and co-workers are enjoying, thinking about, and talking about. Now we can, too.

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.

[ ] 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.)

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

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

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

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.

I received your publication and reviewed it thoroughly. I can see how valuable the information might be to our service population, which has a high percentage of diabetics. I would like to include this publication in our literature racks for our patients. I believe we might be able to move 50 to 100 copies of your publication each quarter, and I would like the opportunity to offer this service at our facility. I appreciate your offer and assistance in this matter.

Thank you,
Samuel L. Miller
Education Director
North Sunflower County Hospital
Ruleville, Mississippi

To whom it may concern:

I am a Registered Dietitian, also a Diabetic Educator, here in Okanogan County, North Central Washington. We are currently operating Self-Management Diabetes classes each month in different parts of the county.

I am pleased to learn that VOICE OF THE DIABETIC is being offered free to distribute. I would like to have 100 copies each quarter to distribute with our classes. This would be so beneficial for our patients!

Sincerely yours,
Dede Lavezzo, RD, CDE
Mid-Valley Hospital / Diabetic Clinic
Omak, Washington

As a diabetes nurse educator here at Saints Memorial Medical Center, I have been receiving copies of the VOICE OF THE DIABETIC for the past year. I have shared many of the articles with my patients, and with the members of our Diabetes Support Group.

I would now like to be able to share the magazine with all of our clients, so I'm requesting an increase in our shipment to 150 copies per quarter. I plan to distribute the copies at our monthly support group meetings, as well as place them in the waiting rooms here at the medical center.

I look forward to each new issue, and the information it provides -- so I'm sure our clients will soon feel the same way.

I have no idea where I obtained a copy of THE VOICE -- but I must tell you it is an outstanding publication. I take several diabetic magazines and yours is right at the top of all of them in content. I plan to save the copy that I received as a reference. The articles were outstanding.

The issue that I have is for spring, 2002. I would like very much to have the summer edition and tape if possible. If the tape for the spring edition is still available I would greatly appreciate getting it also.

I am a huge fan of VOICE OF THE DIABETIC, and have distributed it in my office for the last three years. I am a type 1 diabetic of 34 years, and a doctor of optometry with a practice emphasizing 'diabetic eye disease' and diabetes education. I give the VOICE to every single diabetic patient I examine (about five each clinic day).

I have written a book titled DIABETIC EYE DISEASE: LESSONS FROM A DIABETIC DOCTOR -- How to Avoid Blindness and Get Great Eye Care, which is due to be released this next March or April (Fairwood Press). It is exactly the book I needed, as a child growing up with diabetes, and in my personal battle with proliferative diabetic retinopathy. As you know, education is the key.

I thank you for your time and consideration, and congratulate you on receiving NFB's Distinguished Service Award, an honor which, based upon my avid reading of VOICE, you so richly deserve.