The
Diabetes Action Network of the National Federation of the Blind
A Support and Information Network
Volume 16, Number 2, Spring Edition 2001
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, 811 Cherry Street, Suite 309, Columbia,
Missouri 65201-4892; Phone: (573) 875-8911; Fax: (573) 875-8902.
Find us on the World Wide Web at: http://www.nfb.org and follow the links for
"diabetes."
Copyright 2001 Diabetes Action Network, National Federation of the Blind.
ISSN 1041-8490
Note: The information and advice contained in VOICE OF THE DIABETIC are for
educational purposes, and are not intended to take the place of personal instruction
provided by your physician, or by your health care team. Discuss any changes
in your treatment with the appropriate health professionals.
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 290,315+, offers such an outlet. Make your voice heard. For VOICE OF THE DIABETIC advertising information contact: Eileen Rivera Ley National Advertising Sales Manager 804 Hatherleigh Rd. Baltimore, MD, 21212 Phone: (410) 435-3648 Fax: (410) 435-6159 or find us on the Web at: http://www.nfb.org/voice.htm For SUBSCRIPTION information, see the end of this document.
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Photo: portrait. Caption: Richard Donnell
Photo: portrait. Caption: Evelyn Engelhardt
Photo: portrait. Caption: Harold Felender
Photo: portrait. Caption: Helen Olson
Decades ago, when diabetes care was not as advanced, or as convenient, as it is today, many medical professionals believed that a diagnosis of diabetes invariably meant a limited, shortened life. Diabetics were told things like: "Don't exert yourself, don't drive, don't work in a factory, and don't get married." Too many doctors told their diabetic patients this.
Was it true? Of course not! Insulin manufacturer Eli Lilly and Company gives an award to diabetics who've used insulin more than 50 years -- and more than 1000 people have collected this award. But some people have been using insulin a lot longer than 50 years.
In past issues of the VOICE, I interviewed a number of veteran type 1 diabetics, people who were diagnosed way back in the days of urinalysis, reusable needles, and widespread ignorance. They spoke of their childhood, of the elaborate chemistry needed to test their sugars, and of learning to give themselves injections. They spoke of their success, of their full, rich lives.
Recently, I contacted them again. Remembering these are all elderly people, prone to the same age-related issues as non-diabetics, how were they doing?
Irving Mushlin
Mr. Irving Mushlin, from Astoria, NY, was diagnosed with type 1 diabetes in January of 1931. He'd had the symptoms of diabetes for several months, and his first doctor, missing the symptoms, had actually prescribed a mouthwash to take care of the bad taste in his mouth.
But New York City doctors got it right, and taught Irving how to take insulin. They taught his mother how to manage a diabetic diet, "more than she needed to know," he says. He met Rose, the lady who'd become his wife, when he was 17, but waited ten years to tie the knot. Shortly before the wedding (which took place the day Japan's surrender ended WWII), the couple went to see a "diabetic specialist" who assured them that "all diabetic men are sterile," but they didn't take it to heart -- and now have two children and five grandchildren.
Irving retired at 65, and promptly began a new career, as a paralegal. He still works several days a week. He says: "Controlling your diabetes, taking your tests and shots, once you get accustomed to it, is a burden, not a problem. It only looks like a problem the first time you hear about it, because it's such a radical change... I just went ahead with it, and did what they told me to do... There's no reason to stop learning at any age."
Evelyn Engelhardt
Mrs. Evelyn Engelhardt, now 80 years old, from Cincinnati, Ohio, developed her diabetes in September 1931. Her first doctor hadn't even heard of insulin (it had been out 10 years), and put her on the old "diabetic diet" of gluten bread. A year later she was in a near-fatal diabetic coma. Again, hospital doctors "figured it out."
Those were the early days. Still Evelyn followed her doctors' instructions, watched her diet, and kept up with her exercise (she loved dancing.) Evelyn's daughter told her: "You really do take care of yourself..." And it has been almost 70 years.
Evelyn reports she received many letters after her interview, from younger people who were so pleased to hear from someone who could win over diabetes." And she has won. Diagnosed in a time when many believed diabetes invariably meant a shortened life, she now has one great granddaughter, and a second is on the way.
Harold Felender
Mr. Harold Felender, born in 1918, can't remember whether he was 12 or 13 years old when his diabetes was diagnosed, but he knows it was at Christmastime. "My mother had tuberculosis," he said, "and my grandmother was there, but she didn't know too much about these things, so I had to do everything myself."
Harold learned well. He mastered diet and exercise, as well as insulin injection -- this back in the days when "Regular" was all the insulin we had. There were no blood glucose monitors (not until the 1960s), so Harold, like his contemporaries, regularly tested his urine.
Harold's work was the aircraft industry. He started as a sheet-metal worker for North American Aviation (maker of the P51 Mustang), and went on to be a "quality assurance engineer." He reports he found being a Jew more trouble than being diabetic.
Harold had some problems; he went through a time when his sugars fluctuated a lot. He's stabilized now, and trying to decide about whether to remain in an assisted living facility, or return to his house.
Harold Felender's diabetes has neither shortened his life nor limited his ability to participate fully. "It isn't torture to have diabetes," he says.
Helen Olson
Mrs. Helen Olson is 75 years old, and has had diabetes 69 years. She's had some problems (two single heart bypass surgeries) but hopes to recover, to be "back on the ball in the near future." Before her heart surgery, she was planning to switch from insulin injections to the insulin pump. "When I recover, I'll ask for the pump," she says.
Helen proves that along with diligent self-management, positive attitude is very important! "I really try to keep my diabetes under control," she says, "My best advice to you is to follow the rules of being a good diabetic... Follow your diabetic regime, and then live a normal life. After all, what is life for? Its to be enjoyed!"
Richard Donnell
Mr. Richard Donnell, from Columbus, Indiana, has had type 1 diabetes since 1935. He has many stories from the early days, of drinking black coffee at the sweet shop "like one of the big boys," while his friends ate sodas and floats, of weighing and measuring his diet ("it was very difficult to calculate a diet while going into a reaction," he reports), and about his three shots a day insulin regime ("still doing it"). He has been successful. "I still have all my fingers and toes," he says, and he still drives his car, and lives at home. His wife died several years ago, and he has recently remarried.
All of these people are "living proof" that with the exercise of reasonable diabetes care and positive attitude, the complications, tragedies, and foreshortened life are NOT "inevitable." And note, these people started with diabetes a long time ago. We know far more now, and have vastly better tools to treat it. If you're a veteran diabetic, you can do as well as these folks -- and if you are just starting with diabetes, your outlook is even better!
(A news release from NATIONAL INSTITUTES OF HEALTH, National Institute of Diabetes and Digestive and Kidney Diseases)
Doctors who give their afternoon patients the fasting plasma glucose test are likely to miss half of the diabetes cases in this group, according to research published in The Journal of the American Medical Association on December 27. The American Diabetes Association currently recommends the fasting plasma glucose test for detecting type 2 diabetes. The test is diagnostic for diabetes if a person has a blood glucose level of 126 milligrams per deciliter (mg/dl) or higher, and a second test on another day confirms the same high level of blood glucose.
The recommendation is based on studies of plasma glucose measured in the morning after an eight-hour fast. However, many patients are seen in the afternoon after variable periods of fasting. In the JAMA study, researchers from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and Social and Scientific Systems, Inc., analyzed fasting plasma glucose levels taken at different times of day from adults participating in the Third National Health and Nutrition Examination Survey (NHANES III) conducted from 1988 to 1994. The researchers compared the plasma glucose levels of 6,483 people tested in the morning after a median fasting time of 13.5 hours to the glucose levels of 6,399 people tested in the afternoon after a median fasting time of 7 hours. Participants in both groups were otherwise similar in age, sex, race, weight, physical activity, waist-to-hip ratio, family history of diabetes, and other factors that may affect blood glucose levels.
The researchers found that fasting plasma glucose levels were consistently higher in the morning group compared to the afternoon, with an overall mean difference of 5 mg/dl. Moreover, the afternoon patients had blood glucose levels suggestive of diabetes at half the rate of the morning group. "If the current recommended criteria for diagnosing diabetes were applied to the afternoon patients, about half the cases of diabetes would be missed," says NIDDK's Dr. Maureen Harris.
To accurately detect diabetes in afternoon patients, the researchers suggest that the diagnostic standard of glucose levels for this group should be lower -- 114 mg/dl or greater instead of the current standard of 126 mg/dl or greater. In any case, the researchers advise physicians to confirm the diagnosis by repeat testing on a different day, preferably in the morning.
About 16 million people in the United States have diabetes, the most common cause of blindness, kidney failure, and amputations in adults. Type 2 accounts for about 90 percent of diabetes cases in the United States, and a third of these cases are undiagnosed. Type 2 is most common in people who are overweight, inactive, age 40 and older, and have a family history of diabetes. The disease is also more common in minorities: African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2. Many people can control their blood glucose by following a careful diet and exercise program, losing excess weight, and taking oral medication. However, the longer a person has type 2 diabetes, the more likely he or she will need insulin injections, either alone or combined with oral drugs.
About 10 percent, or 1.6 million of people with diabetes, have type 1, formerly known as juvenile onset diabetes or insulin-dependent diabetes. This form of diabetes, which usually occurs in children and adults under age 30, develops when the body's immune system attacks the insulin-producing cells of the pancreas.
(This story appeared in VOICE OF THE DIABETIC, Volume 16, No. 2, April 2001, published by the Diabetes Action Network of the National Federation of the Blind.
If you have diabetes type 1 or 2, you are at risk for diabetic eye diseases. These may include diabetic retinopathy, cataracts, and glaucoma. The most common of these complications is diabetic retinopathy. Nearly half of all people with diabetes will eventually develop some degree of diabetic retinopathy. A diabetic is also twice as likely to get cataracts, or develop glaucoma, as is a person who does not have diabetes.
Loss of vision in diabetes occurs generally because of damage to the eye's small blood vessels, causing leaking, blockages and abnormal capillary growth all due to high blood sugars of diabetes.
How to avoid eye problems:
Find and treat your diabetes early. Your risk of diabetic retinopathy can be greatly reduced by controlling your blood sugar level, which slows retinopathy's onset and progression. High blood sugar causes damage, and fluctuating blood sugar causes the lens of the eye to swell and shrink, resulting in fluctuating vision and more damage.
If you have diabetes, make it a point to have an eye examination at least once a year. You should have your eyes dilated during the exam so that the eye doctor can check for signs of eye disease. Some eye diseases may progress a long way without symptoms and you wouldn't know you had a problem without an eye exam. It is very important to start treatment before sight becomes seriously damaged.
Bring your blood pressure down. High blood pressure can make eye problems, and other diabetes complications, worse.
Stop smoking.
Eat a healthy balanced diabetic diet.
In bright sunlight, wear sunglasses with UV protection.
Exercise regularly, and keep your weight at a healthy level.
If you have vision problems, get a low vision evaluation. Modern technology can help people with vision loss through magnification, contrast and illumination. There are also many "tactile" devices that work without sight, helping blind individuals achieve and retain their independence.
Video Magnifiers as an aid to Low Vision Diabetics:
One of the items that may be recommended to you if you have low vision is a CCTV or video magnifier. Video magnifiers offer the user an enlarged image of any object (such as a page of small print) the camera is focused on so that a user with low vision can clearly see the details. The magnified image is projected onto a monitor, usually a television screen. It could also be a computer, an LCD screen (as in a laptop computer) or head-mounted glasses. Controls on the video magnifier allow the user to zoom in and out on the item and adjust the contrast.
Current video magnifiers offer full color, black and white and inverse modes. Manufacturers have designed video magnifiers that help low vision individuals to read, write, enjoy hobbies and crafts and retain the ability to stay in the work force.
One of the manufacturers in the forefront of CCTV development is CLARITY SOLUTIONS of Santa Rosa, California, manufacturers of true Auto-Focus CCTVs. In addition to the usual Inline CCTVs, they have developed the innovative CLARITY Flex systems. Most of these have a swiveling camera, which can magnify objects at a distance in addition to those on the desktop. This means students can see teacher and chalkboard, business people can see presentations, and a low vision diabetic person can use it to check their feet and draw up insulin, in addition to the normal reading and writing functions it supports. On a 20" monitor, desktop viewing is 4X-60X and distance viewing is 24X. Only three simple switches allow for ease of use. Clarity Solutions' Capture USB device allows the system to connect to a laptop or a desktop computer.
This modular device can be made portable with a lightweight clamp mount or rolling stand, a battery pack, and lightweight monitors such as a laptop, an LCD screen or head-mounted glasses. Foam padded carry bags are available.
For further information, contact Clarity Solutions at 800-575-1456 or visit their web-site at www.clarityaf.com
For advice on tactile devices that allow blind individuals to independently perform life's activities, contact the National Federation of the Blind; telephone: (410) 659-9314; website: www.nfb.org
The topic of medical errors is frequently in the news today. Various estimates suggest as many as 98,000 people die in U.S. hospitals as a result of misdiagnosis, misprescription, and inappropriate or botched procedures. What can you, the patient, do, to help keep yourself from becoming a statistic?
First, COMMUNICATE with your doctor. Do you understand your treatment? What your prescriptions are for? Does your doctor have a list of EVERY medication and "herbal/dietary supplement" you are taking?
Eighty-eight percent of medical errors involve medications. Do you know the names of your medications? Are you clear on what each is supposed to do? Have you asked about possible side effects and drug interactions? Have you asked about dosage amounts? Would you recognize a prescription error, at least enough to ask why the change?
Some conditions, treatments and/or medications can be disorienting. Do you have a family member or friend who can be your "advocate," when you are unable to speak for yourself?
When something feels excessive, unreasonable, or just "a big step to take," you have a right to seek a second opinion. Do you know how to do this? You have a right to hear or see your test results. Ask for an explanation.
A more complete outline of what you can do to help prevent medical errors is available online at: www.ahrq.gov/consumer/20tips.htm
Photo: portrait. Caption: Peter J. Nebergall, PhD
There are a lot of "experts" out there, talking about your diet. They have an almost inexhaustible set of "facts," "figures," and "theories" to cite -- and the end result is confusion. These folks don't even agree! Who should you listen to? Which "facts" are appropriate, if you have diabetes?
Listen to the call-in radio "health" shows, and the problem becomes more apparent. There is a serious shortage of basic food knowledge. I heard one "expert," apparently using the words "value" and "quality" as equivalents (they're not), tell a caller: "Beer has no nutritional value."
Not so. Beer is carbohydrate. It is not "free food." Whether you are carb-counting, or using the Exchange List, that glass of beer must be counted. It may not have nutritional quality, in that it's hardly a "balanced diet," but it has measurable value, in that it contains carbohydrates, which will affect your blood sugar levels.
I heard one caller ask if there were "an antidote for the lethargy her family feels after a big meal?" I think we're familiar with that lethargy? The commentator did speak of carbohydrates, but I didn't hear him ask the caller: "How much does your family eat?"
Some things have no "antidote." Some problems are best treated by prevention. The lethargy that follows overeating is best avoided by not overeating. If you have diabetes, that means sticking with your meal plan. Uncertain about a "diabetic diet?" Many diabetes educators are also "RDs," Registered Dietitians, and the American Association of Diabetes Educators would be happy to help you find one. Telephone them at: 1-800-832-6874.
Then there is the word "theory." Considerable literary license is taken with that word! It is often used incorrectly, especially in matters of diet and diabetes. A hypothesis is a testable statement of belief about the facts -- this researcher believes that this substance will have this effect. Anyone can hypothesize -- it's free speech.
A theory is different. Properly, a theory is a hypothesis that has been tested, and found to best fit the currently available scientific evidence. To speak of an "untested theory" is incorrect. "Benefits" one may gain from consuming a "dietary supplement" labelled: "Not intended to diagnose, treat, or cure any disease" are not proven -- they are hypothetical -- and testimonials from believers are not scientific proof of efficacy.
The U.S. Food and Drug Administration (FDA) evaluates all claims of medical efficacy, for device or medication. Items its expert committees find unsafe, unreliable, ineffective, or false and misleading, will not be "approved." Some "alternatives" will pass the tests, and will be approved for use as medications. Others will fail the tests. Many will never see, have never seen, the inside of a modern test laboratory. "Approved by the FDA" has value. It means real experts, folks not on a company's own payroll, agree the item works. That approval is the best "guarantee" we have.
We all want a cure, preferably a quick, painless and inexpensive one. We want to live our lives free from the constraints of diet, schedule, and medications, and sometimes we listen to the wrong people. When someone says: "MY pill will cure what MY theory says causes your diabetes, and all YOU have to do is buy it," be careful. Listen to the right experts -- not the salesmen. Learn the right information, yourself. Don't be a passive consumer -- you are the most important member of your health care team -- ask their help. I suggest you become the ultimate expert on YOU.
Photo: Portrait. Caption: Ed Bryant.
We know blood glucose monitoring is important because it helps us keep our diabetes under control. You should test often. How you test matters too, as poor technique wastes strips and can give you inaccurate readings. Good testing techniques will also minimize the number of times we must stick our fingers. If you have not achieved good finger-sticking techniques, I recommend the old adage, Practice makes perfect.
I am a type 1 diabetic, and I empathize with individuals whose fingertips are bruised and sore from testing, and with others who have trouble getting enough blood from the puncture site. Test strips are extremely expensive, and it is frustrating for people who must stick themselves over and over while trying to get enough blood for a good reading.
Finger Sticking Locations
You should use the sides of your fingers for sticking sites. More nerves are present in the center of fingers, so lancing in this location may bring more pain.
I use all ten fingers for blood sugar testing, and on each finger I have four penetration sites. Some people occasionally use the middle of a finger if the sides have become too sore.
Ann S. Williams, MSN, RN, CDE, herself a type 2 diabetic, chooses her test sites by day of the week and time of day. Her left index finger is for Monday, left middle finger for Tuesday, left ring finger for Wednesday, etc. On each finger, the side toward the thumb, opposite the base of the fingernail is for suppertime, and the same side, opposite the middle of the fingernail, is for bedtime. Any extra tests are done in the area around the top of the fingernail.
She writes: "By using this method, you end up lancing the same site only once a week. I like doing it this way because I have such a hard time remembering where I last lanced, and this way I can figure out where I am supposed to be by day of the week and time of day."
Cleaning Fingertips
If possible, wash your hands with warm, soapy water, which will, besides cleaning, bring additional blood to the fingers. Rubbing alcohol can of course be used; but alcohol may cause fingers to become dry, which might cause more pain when lancing. The fingers should be totally dry before testing.
Ronald James, MD, has had type 1 diabetes for 51 years. This diabetologist says, "If your finger is dry and clean, I see no reason you have to use rubbing alcohol."
Note: Using a good skin cream may help soften your fingertips, and will help with appearance. Apply it after you test.
Blood Clotting
If the stick location doesn't clot thoroughly, you may experience bruising and soreness. After putting blood on the test strip, you should use a tissue and apply firm pressure directly on the puncture site. Some diabetics will thoroughly clot after a few seconds, while others may take longer. Once the bleeding stops, you should again use a tissue and apply firm pressure directly over the puncture location. If blood is on the tissue, you know bleeding is still occurring under the skin. So firm pressure is needed a bit longer.
Once a diabetic (blind or sighted) regularly tests his or her blood glucose, they will know roughly how long they take to clot. Also, if blood is seeping from the puncture spot, it can usually be felt because it is sticky. If you are not sure if the blood has thoroughly clotted, you need only to apply firm pressure a short while longer.
Getting Enough Blood
When lancing, you should strive for a sample just big enough, just enough blood to make your meter work, thus minimizing pain and bruising. If you are a good bleeder, this works fine; but if not, try altering the procedure. Instead of gently milking the lanced finger, you may need to vigorously milk. By "milking the finger," I mean stroking and pulling downward, from the base of the finger toward the tip and the sample site.
One class of people, those suffering from edema (excess fluid in the tissues) needs to be cautious with vigorous finger-milking. As kidney problems are one cause of edema, check with your doctor about this condition.
I have talked to many diabetics who have trouble getting enough blood after the finger stick. If there is not enough blood on the test strip, the test result could be skewed. I have experimented several times, by very gently milking blood from my punctured finger, and within two to three minutes I pricked another finger and vigorously milked the sample site. Guess what? In every test there was no appreciable difference in sample results.
The rubber band method may be helpful too. Wrapping a doubled rubber band between the first and second joint of the finger to be lanced will cause the finger to become engorged with blood. This will help a larger drop of blood to form. Hold the rubber band down with the thumb while lancing. Remove the band as soon as lancing is completed.
Many diabetics have for a long time vigorously milked their fingers to get an adequate blood sample. The clinical difference between gentle milking and vigorous milking is not significantly different. If enough tissue fluid is milked out, blood may be more like a plasma sample than like a whole blood sample. If you have a meter that reads "plasma" values, that is not going to make any difference, and if you have "whole blood" glucose monitor, the result in all likelihood will not be significant enough to alter any insulin dosage. Again, we should try to get an adequate blood sample by very gently milking the puncture site.
Many lancing devices allow you to adjust the depth of penetration. Shallow penetration should minimize any pain. The same thing can usually be accomplished by holding the lancet more lightly against the skin. Use the shallowest penetration that provides you enough blood for the test.
In the mailbox section of Diabetes Forecast, December 1998, Adam Bloom, MD, discussed obtaining blood samples by milking the fingers, and that the NCCLS, the National Committee for Clinical Laboratory Standards, states one can enhance blood flow from the puncture "by holding the puncture site downwards and gently applying continuous pressure...proximal to the puncture site," but that (states the NCCLS) "Strong repetitive pressure (milking) should not be applied; it may cause...contamination of the specimen with tissue fluid."
Although such "zero-error" considerations are important for the research scientist in his/her laboratory, in practice, however, this mixing of tissue fluids with blood does not appear to affect the readings obtained on home blood glucose meters significantly enough to be of concern. "I know of no studies that have been done specifically to prove this point (states Dr. Bloom), but I do know from experimenting with my own meter that the readings I obtain when I milk, even vigorously, are not meaningfully different."
Remember that even if you use perfect testing technique, a glucose meter will most likely not give you the same results twice in a row.
Wiping Blood Off After Lancing
Many diabetics do not wipe off the first drop of blood after lancing. Years ago, the health community recommended the first drop of blood should be discarded, because it was believed impurities or contamination from rubbing alcohol could affect the test. If your hands are clean, there is no reason to remove the first drop, and if you use rubbing alcohol, there is still no good reason to remove the first drop of blood, because the difference between sample results is insignificant. Many health care teams who deal with diabetes do not wipe off the first sample, but some do. As I said earlier, if alcohol is used, you need to be sure the site is absolutely dry before lancing.
Ronald James, MD, says, "I think if your finger is clean, you don t need to wipe the first drop off."
Note also that folks who find it difficult to get enough blood for the test will find it that much harder if they wipe away the first drop!
Lancing Devices
Find which lancing device makes finger sticking least painful for you. I like the Softclix made by Roche Diagnostics, but there are many others on the market. Bloodborne diseases can be transmitted by fingerstick, so never use someone else's lancet. Be aware lancet points dull fairly rapidly, and if you re-use, things can get painful.
Health care practitioners should show patients how to properly test for blood glucose, because many have not mastered correct testing technique. My physician asks all diabetic patients if his staff can show them proper blood glucose testing techniques, which include finger sticking.
There is one lancing device that does not require lancets. The Personal Lasette, from Cell Robotics, is a laser lancet. It burns a small, clean hole sufficient for a blood test. The company says there is no pain. This device costs $995. For information contact: Cell Robotics, Inc., 2715 Broadbent Pkwy. NE, Suite A, Albuquerque, NM 87107; telephone: 1-800-846-0590.
Another alternative is the Microlet Vaculance, from Bayer, an unusual combination of lancing device and small pump. Designed to obtain blood samples from sites other than the fingers, it is not meant for finger use. The device costs $25, and is available from Bayer Corporation; telephone: 1-800-348-8100; website http://www.glucometerdex.com
Several home glucose monitors are designed to test sites other than the fingers. Bayer's Glucometer Dex actually combines the lancing and testing operations. These newer meters also require smaller blood samples than before.
Good finger sticking techniques are an important aspect of diabetes self-management. Blood glucose testing should be made as simple as possible because far more patients will test, and test more often.
NOTE: If you have any questions for "Ask the Doctor," please send them to the VOICE editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.
Wesley W. Wilson, MD has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals.
Q: I have heard there is now a continuous blood glucose monitor worn at the belt like an insulin pump. I use an insulin pump. Does this mean there is soon going to be a pump that meters my blood and then sets itself?
A: At the scientific meeting of the American Diabetes Association, held June 2000, in San Antonio, Texas, there was a great deal of excitement about this development, "constant glucose monitoring," and at least one manufacturer had an attractive female wearing a constant glucose meter as a demonstration. One of the insulin pump manufacturers is now selling a highly specialized constant glucose monitoring device, meant to be used only by physicians to determine patient glucose profile. The other two pump manufacturers claim to be working on constant glucose monitoring systems.
Clearly, the intention is to have the ongoing glucose sensor coupled with an insulin pump, so some degree of automated insulin delivery can be provided. It's not here yet, but should arrive in the near future.
Such an automated device would not in fact be an "artificial pancreas," for there is a great deal of difference in insulin action between insulin administered by subcutaneous injection or infusion and insulin normally secreted from the beta cells of the pancreas directly to the portal vein and then transported to the liver. The liver is our main regulator of glucose metabolism, and insulin has a far greater effect on glucose metabolism in the liver than when it circulates in the peripheral arteries and veins. Blood insulin levels are much higher in well-controlled diabetes treated with sub-Q insulin than in non-diabetic individuals, and insulin effect is delayed and blunted when the insulin is given subcutaneously. We will need to know how to adjust our treatment, when we go from today's "tight control" to a regime of constant glucose monitoring and automatic insulin administration. Pump manufacturer Disetronic is working on a method of administering insulin by way of a cannula directly into the abdominal cavity so that the insulin is quickly picked up and taken to the portal vein. This should allow a more "normal" insulin action (more closely resembling that of endogenous insulin), but I'd be cautious, since there would seem to be some increased risk of intra-abdominal infection whenever there is penetration of the abdominal cavity.
This perhaps confusing discussion may help us understand that more knowledge and experience are needed before such an "autopilot" system can be widely used. New developments are occurring very rapidly in the diabetes research field, and it is the responsibility of those of us with diabetes to keep ourselves informed. Publications such as , and the ADA's Diabetes Forecast are reliable sources of up-to-date information. Unfortunately, some of the information available online, on the world wide web, is not accurate. It is important to consult reliable sources, to avoid the "sensational," regardless how it may sound in the TV news releases. The American Diabetes Association sponsors a yearly scientific meeting, an excellent place to hear both what is new and exciting and what didn't pan out.
I remain fascinated with the rapid improvements in diabetes management, and for that reason I plan to continue attending the ADA scientific meeting each year.
When your feet hurt, you seem to hurt all over. That is a popular statement among patients with foot pain. We tend to take our feet for granted until they start to hurt. They are literally the furthest thing from our minds. Understanding proper foot care is the key to preventing future diabetic foot ulcerations. Pedorthic care for the diabetic foot consists of proper shoe fit, weight distribution, and reduction of sheer within the shoe.
Proper shoe fit comes by accurate measurement of the foot when purchasing shoes. A Brannock device is the most common measuring device found in shoe stores. As a common side effect of diabetes is peripheral neuropathy, or loss of sensation in the extremities, care must be taken to ensure proper fit due to the possible lack of sensation in the customer's feet. If the shoe is too tight, it could cause pressure ulcers to develop, which in turn may lead to more serious matters. Make sure the shoe bends at the ball area. Take caution, for if the shoe bends in the middle, it may cause undue pressure in certain areas of the foot. During normal gait, our feet bend at the ball, or the metatarsophalangeal joint. The shoe should bend where our feet bend.
Weight distribution is achieved by the use of a custom foot orthosis, an insole made specially to fit the patient's foot, and worn inside the shoe. The primary goal of using custom orthosis is to distribute pressure from any one specific area of the foot.
Reduction of sheer, or movement within the shoe, is accomplished by proper shoe fit as well as using a custom orthosis. Sheer within the shoe can be harmful to a patient with peripheral neuropathy. If the patient's foot is sliding around in the shoe, it could be building calluses, which if left unattended, could eventually lead to pressure ulcers and again, to more serious matters.
If you are a diabetic, always have your feet measured for proper shoe fit. Brand to brand, shoe sizes may vary. If you have decreased sensation, you may not be able to feel the difference. The shoe should not be too tight or too loose. If you have calluses or ulcerations on your feet due to excessive pressure, talk to your doctor. If the areas are on the bottom of your foot, the use of a properly made custom orthosis, along with your doctor's care, may be extremely helpful in healing the affected areas.
Insurance coverage can be confusing and may vary from state to state. Check your benefit plan to see if diabetic shoes and diabetic insoles are covered. Medicaid coverage varies as well. Medicare coverage is the same nationwide. Medicare allows $126 per one pair of diabetic shoes and $32 per each diabetic insole. Of that amount, Medicare will only pay for 80 percent. The other 20 percent is either the patient's responsibility or may be covered by a Medicare supplement insurance. Medicare will only allow coverage of one pair of diabetic shoes and three pair of diabetic insoles per year. Medicare may require a $100 deductible to be met before paying their portion for the shoes and insoles.
Pedorthics: The design, manufacture, modification and fit of footwear, including foot orthosis, to alleviate foot problems caused by disease, overuse, or injury.
Richard Graham is a Board Certified Pedorthist and co-owner of Palmetto Pedorthic Care, in West Columbia, South Carolina.
We all know the importance of regular and frequent blood glucose testing. There are a number of high-quality home blood glucose monitors available, and the new Precision Xtra is one of them. But there's more.
Ketones are a chemical product of normal human metabolism, from the breakdown of stored fat. When one is healthy, their production is not excessive, and they are quickly excreted via the kidney. Someone who is exercising heavily, fasting, perhaps on a hunger strike, or diabetic, may manufacture an excessive amount of these ketones. In combination with high sugars, elevated ketones can produce a lethal condition called "diabetic ketoacidosis," or DKA. If you have diabetes, and have been running a blood glucose above 240, you need your ketones checked.
The traditional test for excessive ketones has been urinalysis. But, The American Diabetes Association Clinical Practice Recommendations for 1999 states: "Urine tests for ketones are now considered unreliable, while blood testing for beta-hydroxylbutyrate (the predominant element in DKA) is appropriate for diagnosis and management of diabetic ketoacidosis."
With these recommendations, and the fact that a hospital pathology lab test for ketones is hardly "immediate," and often not available at all, a pocket-sized monitor that tests for blood ketones, and provides immediate results, is a very good idea.
The Precision Xtra uses two types of test strips -- one for glucose, and the other for ketones. Each package of 100 glucose test strips ($71 suggested retail) also includes four ketone strips. Packages of ketone strips alone (eight strips for $32) are available from MediSense; telephone: 1- 877-2849. The meter's suggested retail is $87.
The test strips are touchable, and the meter can be brought to the test area -- it does not have to be kept level. More blood can be applied to the strip. And, although the ketone-test strips are expensive, this is not a test you will need to perform often.
Although the Precision Xtra incorporates many advanced features, and indeed provides an important new tool for diabetes management, it is not for everybody -- it does not incorporate (nor does any MediSense glucose meter) any provision for speech synthesis, and blind diabetics would like access to this new test too.
As Western medical technology and knowledge grows, a funny transformation is taking place: More and more Americans are retreating from this high-tech world and seeking help from alternative therapies.
In fact, according to a 1993 survey published in THE NEW ENGLAND JOURNAL OF MEDICINE, Americans spent $13.7 billion on alternative treatments in 1990, and most of it was paid for out-of-pocket.
What is alternative medicine? By strict definition, it refers to treatments not widely taught or practiced in the United States. These range from familiar therapies such as chiropractic, acupuncture, and biofeedback to lesser known ones such as homeopathy, naturopathy, and herbal remedies. The common link between most of these therapies is that they have not undergone the rigorous scrutiny of scientific research. In recent years, however, Western researchers have taken a fresh, if skeptical, look at alternative medicine. We are just finding out about its uses as a complement to conventional medicine and its limitations. So far the results are mixed: Some therapies seem to have merit, although they may be much more limited than practitioners claim. Other therapies appear to be useless at best and dangerous at worst. And for some, we just don't know enough to draw conclusions. However, with the newly formed Office of Alternative Medicine at the National Institutes of Health, well-designed clinical trials may slowly clear up the mystery behind these treatments and shed light on what's good, what's bad, and what's a waste.
A Growing Interest
Why, in the face of our vast medical knowledge, are we looking elsewhere for help? Much of the interest stems from our perceptions. Conventional medicine tends to regard humans as a collection of parts, rather than as a whole being. For many, the holistic approach of many alternative practitioners seems less intimidating and more empathetic. People might also feel these therapies are safer (though they are not), less expensive, and more "natural."
Another reason people seek out other therapies is frustration. When difficult-to-diagnose chronic conditions resist cures, many people look outside conventional medicine for help. This is especially true for chronic pain such as arthritis, headache, and back pain, and for insomnia, fatigue, and digestive problems.
Whatever the reasons, Americans are using these therapies in record numbers. Moreover, doctors, researchers, and the insurance industry are taking interest, which means some alternative therapies are edging toward the mainstream. Still, it is important to remember that alternative remedies are not a replacement for conventional medicine.
Western medicine is necessary for treating acute illnesses and infections, trauma, and injuries. And it is the first step in treating diseases such as diabetes, cancer, and AIDS. However, some alternative therapies have use as complements to Western medicine and can promote a healthier lifestyle and relaxation and ease some chronic conditions.
Changes in Coverage
One of the most significant changes in the world of alternative medicine is its coverage by insurance providers. In response to consumer demand, insurance companies are beginning to include selected alternative treatments to their plans. The first company to pay for alternative care was American Western Life, which began coverage in 1982. Others soon followed suit: Already, Prudential covers acupuncture for pain, and Blue Cross of Washington and Alaska offer AlternaPath, a plan that covers both conventional and alternative treatments. Meanwhile, in 1993, Mutual of Omaha instituted its Reversal Program, which provides instruction in diet, exercise, and stress reduction aimed at reversing heart disease. And Oxford Health Plans, a large Northeastern insurer, just added complementary therapy coverage in October 1996. Now their 1.4 million members can choose to see credentialed practitioners of acupuncture, chiropractic, yoga training, naturopathy, massage therapy, and nutrition counseling.
State governments are joining in, too: Washington and Nevada both require that insurers cover acupuncture, and 41 states now require coverage for chiropractic.
What's out there?
Alternative medicine comes in many forms. While many therapies employ one very specific mode of treatment that can be applied to a range of medical complaints, there are some general fields that use a variety of treatments.
Naturopathy. The basic tenet of naturopathy is that sickness is rooted in a disharmony with nature. To treat illness, naturopathic doctors--really, the generalists of alternative medicine--use herbs, homeopathic medicines, dietary advice, massage, and meditation. In some states, naturopathic doctors can act as primary-care doctors and use standard Western diagnostic tools, such as x-rays, blood and urine tests, Pap smears, and breast exams. The difference is that naturopathic doctors spend more time asking questions about diet, sleep, stress, mental outlook, family history, and symptoms. They use fewer drugs, and instead devise health routines that involve different alternative treatments to prevent or cure illness.
Naturopathy does have its downside. Critics worry that naturopathy may underplay the importance of certain proven Western practices, such as immunizations. Another concern is that because people are counseled to give treatments time to work, they may delay seeking diagnostic tests and treatment for serious illnesses. Responsible naturopathic practitioners have a healthy respect for the limits of their medicine.
If you visit a naturopathic doctor, check his or her credentials, because licensing regulations vary from state to state. Ideally, your doctor should have traditional Western medical training and use alternative therapies to complement conventional medicine. There are three accredited universities of naturopathy, as well: Bastyr University in Seattle, Washington; The National College of Naturopathic Medicine in Portland, Oregon; and Southwest College of Naturopathic Medicine in Scottsdale, Arizona.
Ayurvedic medicine. This ancient, holistic approach to health is based on the theory that life experiences (including factors such as diet, lifestyle, stress, work, and relationships) affect health and can cause illness. Practitioners believe that through meditation, massage, aromatherapy (therapy using scented oils), and herbs, people can tap into their body's own natural defenses and heal themselves.
To a degree, as a complement to Western medicine, Ayurvedic medicine works: Recent studies have shown that stress and depression have close links to heart disease and hypertension. Relieving that stress can only help. Other studies suggest that massage and herbs may help to counteract some of the nausea that comes with chemotherapy. Still, while this approach can enhance your health, it is no substitute for conventional treatments.
A Primer on Specialties
If you decide to look into alternative therapy, there are a number of different treatments to choose from. Some have demonstrated usefulness that has earned them the respect of conventional doctors. Others offer questionable claims and possible risks.
Chiropractic. Spinal manipulation has become a common form of complementary therapy. Over the years, a large body of evidence has accumulated showing that for lower back pain, chiropractic treatment can be effective. In fact, a large study done in 1994 by the United States Department of Health and Human Services determined that spinal manipulation was better for treating lower back pain than surgery, bed rest, and drugs. Other studies lend further support: One study published in BRITISH MEDICAL JOURNAL in 1995 found that of 741 people with back pain, those who saw a chiropractor felt better faster and resumed their normal activities sooner than those who visited a medical doctor.
Some chiropractors make further claims that this treatment can cure ills ranging from ulcers to allergies to cancer. These claims are entirely unfounded, however, so stay away from any practitioner who says otherwise. If you visit a chiropractor, remember the limitations of this treatment and make sure your chiropractor does too.
The underlying belief in chiropractic is that pain comes from a misalignment of the spine. To fix this, the chiropractor will "adjust" or pop your spine back into position. In addition, most chiropractors will massage tense muscles and advise you on exercise and nutrition.
Adjustments should never hurt: If you feel pain, stop treatment immediately. Also, avoid any chiropractor who asks you to come for repeated visits, takes multiple x-rays, or claims to cure disorders that are not musculoskeletal. And always check with your doctor before seeing a chiropractor. Acupuncture. In the 1970s, when Americans were allowed entry into China, visitors brought back amazing stories of people undergoing major surgery without anesthetics. Thus, acupuncture made its way into the Western world.
Acupuncture, and its cousins, acupressure and electrostimulation, are based on the belief that channels of energy, which the Chinese call Qi (pronounced "chee"), flow throughout the body. Acupuncturists insert needles at specific points along these channels or meridians to unblock obstructions in the energy flow. Western researchers theorize that acupuncture really works by stimulating the nervous system to release chemicals called endorphins to the brain, spinal cord, and muscles, where they can numb pain and elevate mood.
Although researchers have only recently begun looking at acupuncture in earnest, a few studies have shown that it does have some use. In the 1970s, Dr. Michael Smith, Director of the Substance Abuse Division of Lincoln Hospital in New York, used acupuncture to treat drug addiction. Participants preferred it to methadone and tended to become more cooperative and better able to continue counseling. In another study done in 1991 at Queens University in Belfast, Northern Ireland, 75 out of 100 people undergoing chemotherapy felt relief from nausea after having electrostimulation along their acupuncture points.
Although it looks painful, acupuncture hurts very little because very fine needles are used. Some say it hurts less than having blood drawn or receiving an injection. Symptoms may intensify at first; the Chinese call this a "healing crisis" and take it as a sign that your body is fighting the illness.
As long as you visit a licensed practitioner who maintains a sterile practice, acupuncture is quite safe: A literature review done at the University of Tromso in Norway found only 193 reports of mishaps out of 125 papers, which is remarkably few considering the thousands of people who use acupuncture. It does carry some risks, however. The most serious risks are infections from unhygienic needles, and punctured organs. More common side effects include lightheadedness, scarring, and a temporary increase in pain.
Practitioners should be licensed by the American Academy of Medical Acupuncture or by the American Association of Acupuncture and Oriental Medicine. If you are shy of needles or if you are pregnant, acupressure (in which points on the body are pressed and massaged) is a better choice. Check with your doctor before starting therapy. For a list of certified practitioners, send $3 to The National Certification Commission for Acupuncture and Oriental Medicine, P.O. Box 97075, Washington DC 20090 or call (202) 232-1404.
Hypnosis and Biofeedback
A particularly intriguing branch of alternative medicine uses the link between the mind and the body. Hypnosis and biofeedback both use relaxation and mental focusing to bring about physiological and behavioral changes and healing. Hypnosis is used to reduce pain, lessen swelling and bleeding after surgery, overcome habits, and treat anxiety, phobias, and depression. Usually a psychiatrist, psychologist, or other therapist will lead you through hypnosis, although some people can learn to hypnotize themselves. Techniques vary, but in general, the therapist will ask you to close your eyes and think a relaxing thought, while he or she guides you into further relaxation until your outside thoughts and images disappear. In this state of focused relaxation, it is thought that people are more open to suggestions.
So far, several studies have shown that hypnosis does have a number of uses, including pain management. A study at Case Western Reserve University in Cleveland, Ohio, used hypnosis to treat migraine in children. They found that children who used hypnosis felt better after treatment than those who took drugs or placebos.
Biofeedback also uses focused relaxation, but it adds feedback in the form of heart monitors, thermometers, or other instruments to actually measure whether you are reaching your goals. Using this method, the therapist guides you in picturing a relaxing scene, such as a warm beach, and asks you to concentrate on changing your physical responses, such as slowing your heart rate or warming your toes. The monitors tell you if your body is indeed responding this way. Biofeedback allows people to learn what the correct physical response actually feels like so they can achieve it later without the biofeedback machine.
Studies have shown that biofeedback is an effective tool for controlling bodily processes such as heart rate and circulation. In a study presented at the American Association of Diabetes Educators in 1996, researchers provided standard care to 32 people who had diabetes or peripheral vascular disease and chronic foot ulcers. Half of this group was told to relax for 15 minutes each day on their own. The other half listened to a special tape to guide their relaxation periods, and they measured their toe temperature using a special thermometer. At the end of the study, the people who used biofeedback experienced faster healing as well as increased hair growth on their legs and a stronger pulse than those who relaxed on their own. To find a therapist for hypnosis, or to find a biofeedback treatment center, ask your doctor for a referral. Most pain clinics offer biofeedback as well.
Vitamins and Supplements
Most of the vitamins, minerals, and other nutrients we need are found in the food we eat or produced by our own bodies, but supplement manufacturers would have you believe otherwise. According to the claims printed in newsletters and pamphlets and spread by word of mouth, vitamins, minerals, amino acids, and hormone supplements can build muscles; restore vigor; treat angina; AIDS; and diabetes; promote weight loss; and boost brain power. Of course, this isn't the case, but because these supplements are considered nutrients, not drugs, the Food and Drug Administration (FDA) cannot regulate their sale.
While a handful of vitamins are a useful addition to your diet, most of these supplements are unnecessary expenses at best. So what should you choose? Certain vitamins are necessary and we don't always get enough of them from our diets. Evidence is mounting that we could use three supplements, in particular: calcium, folate, and vitamin E. Calcium is vital to preserving bone strength. The recommended dosage is 1200 to 1500 milligrams per day, and more if you are pregnant. Studies have shown that the B vitamin folate can reduce the risk of neural tube birth defects, which cause spina bifida and anencephaly. The United States Public Health Service now recommends that all women of childbearing age get 0.4 milligrams of folate each day. Taking regular doses of the antioxidant vitamin E is safe and inexpensive, and it appears to reduce the risk of heart disease and cancer. The optimal dose for vitamin E seems to be 400 IU per day; studies suggest that the body doesn't process more than that amount.
You can have too much of a good thing, however, so taking megadoses of these vitamins is a dangerous idea. For instance, the maximum safe dose of folate is 1 milligram per day. Beyond that, folate can mask pernicious anemia, which is a serious condition.
Recently, zinc has made headlines for its ability to soften the blow of winter colds. In a study done at Cleveland Clinic in Ohio, 50 people took zinc lozenges and 50 did not. People who took ColdEeze brand zinc lozenges felt relief from fevers, headaches, and coughing about four days sooner than those who didn't take the lozenges. However, for some people, nausea and a metallic taste offset the benefits. If you take zinc, remember that despite what the package says, its benefits are not clinically proven. Also, high doses of zinc can have toxic effects, so don't take the lozenges for more than a week.
Other supplements do not merit regular use. For instance, coenzyme Q-10 supplements, which are touted as a wonder drug for everything from obesity to AIDS, are really just a weak antioxidant that our bodies already make. No studies have found evidence to support manufacturer claims.
Another purported wonder cure is the hormone melatonin. Although studies suggest it may help insomnia, those tests are inconclusive. In the meantime, little is known about proper dosage and timing; so by taking melatonin, you could throw off your sleep cycle even more. Other hormones such as DHEA (dehydroepiandrosterone) and human growth hormone have been touted as elixirs of youth that can restore strength and vigor, beef up muscles, and ward off illness. So far, studies are inconclusive; but the side effects, such as increased risk of some cancers, make taking these hormones riskier than they are worth. (For more on supplements, see "Elixirs of Youth: Which Work, Which Don't Which Might?" in the September/October 1996 issue of Diabetes Self-- Management.)
For people who have diabetes, chromium picolinate is an especially popular supplement, thanks to reports that it can control blood glucose levels and aid in weight loss. So far, though, studies have shown that this mineral only lowers blood glucose levels in people who have a chromium deficiency (which is uncommon in this country), and it doesn't lower blood glucose levels enough to stop other treatments. Now the Federal Trade Commision has taken issue with the claims made by chromium picolinate distributors, and put the kibosh on further unsubstantiated health claims for this product.
The bottom line is that very few dietary supplements are necessary. Vitamin E, folate, and calcium are safe, and research shows they can help. Beyond that, unless you have a particular deficiency, a regular multivitamin will do you. To cut your risk of disease and boost your strength, save your money and try to eat right and exercise instead.
Herbal Medicine
Plants and flowers have been used for medicinal purposes since early civilization. This major component of Chinese medicine is used to treat all sorts of symptoms, from pain and stomach upset to depression and sleep disorders. Herbs can be drunk as teas, smoothed on as lotions, or swallowed as pills. Some herbal remedies, such as echinacea for colds, can be found in health-food stores and pharmacies. Others must be prepared by herbalists who know what each herb is meant to do.
It is true that plants do contain active ingredients that can treat symptoms; in fact, many standard drugs, such as aspirin, originated as plant-based remedies. However, just because something is natural does not mean it is safe. After all, hemlock is natural, but you would never swallow a spoonful of it! The problem with herbal remedies is that it is hard to know what you are really getting.
Herbs can cause allergic reactions, interact with other herbs, and vary widely in potency--not only between brands or mixes, but between individual plants. The FDA does not regulate their production, so it is up to manufacturers and sup pliers to make sure their products are correctly labeled and safe-a task that often goes awry. Herbs can interact dangerously when taken with other drugs, too. Take what happened in Belgium in the early 1990's, for example: A number of young women took several herbs in combination with modern weight-loss drugs at a diet clinic and suffered kidney failure as a result.
If you use herbs, talk to your doctor to be sure the ones you take are safe and won't interact with your other drugs. And if you see an herbalist, make sure you see someone who is knowledgable. But to stay safe, it's generally best to forgo this type of treatment altogether.
Homeopathy
This novel approach to medicine was developed in the late 1700's by a German doctor named Samuel Hahnemann in an effort to find a gentler alternative to the bloodletting, blistering, and purging that was used at the time. The basic belief behind homeopathy is that the body's responses to illness indicate healing and therefore should be enhanced, not suppressed. Homeopathic drugs contain a single substance that induces symptoms similar to the illness. These potions and pills are substantially diluted- -so much so that often you get little more than a sugar pill or a water and alcohol solution. The mixture of active ingredient (or what's left of it) and the base are vigorously shaken so that the water "picks up energy" from the active substance. The resulting "imprint" of the active ingredient is supposed to spur your body to heal itself.
This form of therapy is controversial, and the few studies that have been done have been inconclusive. However, since homeopathic drugs contain infintesimally small amounts of active ingredients, they are generally safe to take as long as you don't substitute them for necessary medical care.
Gadgets, Gizmos, and Potions
The last group of alternative treatments includes the many devices, potions, and treatments that can best be described as "snake oil." Many of these therapies sound openly outlandish. For instance, you can order magnetic earrings, mattresses, and "polarizers" that claim to treat asthma, obesity, arthritis, and any other disease you can think of. However, the theory that magnets can cure ills was discarded 200 years ago, and today the FDA regularly confiscates shipments of these fraudulent devices.
Aromatherapy is another popular treatment that is purported to aid in healing. While it is true that certain smells can evoke memories, help you relax, or put you in a good mood, don't waste your money trying to cure any diseases with these scented oils.
What about bee pollen? Proponents say these little pills can treat obesity, high blood pressure, and rheumatism. No evidence appears to support these claims.
Some bogus treatments do come cloaked in medical terms that make them seem legitimate. Take, for example, chelation therapy as a treatment for heart disease. Researchers hypothesized that since chelation therapy can clear away heavy metals from the blood, it might also be able to remove the plaques that accumulate along artery walls. It was a nice idea, but study after study showed it didn't work. Still, many people swear by it, even though numerous organizations, including the National Institutes of Health, the American Heart Association, and the Centers for Disease Control warn against it. According to the American Heart Association, this treatment can cause kidney failure and death. Furthermore, it is very risky to avoid proven treatments for heart disease in favor of this one.
Making Distinctions
Alternative medicine is a popular option, but it is still a mysterious world we know little about. Some therapies can form an effective complement to Western medicine. Others may be useless or flat-out dangerous. You need to keep a few points in mind to ensure a safe, effective experience with alternative therapies:
Make sure you receive an accurate diagnosis from conventional doctors before you go. Cancer, diabetes, infections, broken bones, and other acute illnesses respond better to conventional care.
Keep your doctor informed. The 1993 survey from THE NEW ENGLAND JOURNAL OF MEDICINE found that 72% of Americans who use alternative therapies do not tell their doctors about it. This is a mistake. Alternative therapies usually will have some effect on you. Some therapies may improve the way you feel, and your doctor can then adjust your conventional treatment to match. Or your alternative therapies may interact with or even counteract your conven- tional care. Certain vitamins, supplements, and herbs can interact with drugs, heightening or diminishing effects or causing toxic combinations. Your doctor can advise you on what to take and what to avoid. Also, some treatments should be avoided if you are pregnant, or if you have a condition that could be worsened by the new therapy.
Be wary of miracle cures, exaggerated claims, and treatments that purportedly have no side effects. Trust your instincts: If it sounds too good to be true, it is. If a treatment is legitimate, practitioners will be open about discussing its uses, limitations, and side effects. Read up on any new therapy to learn about its appropriate uses and its limitations. What are the disadvantages? What are the benefits? Is there scientific evidence, in the form of clinical studies, to back up the claims for these treatments. Do the claims make sense? If it sounds odd to you, it probably is.
Check credentials before choosing an alternative practitioner. Your local department of health or the national association for that specialty can give you information about licensing regulations in your state. Make sure your practitioner was educated through an accredited program, not a phony diploma mill. Talking with doctors, nurses, diabetes educators, family,. and friends can help you learn about a practitioner's reputation as well.
Don't be fooled by jargon. Using technical medical terms such as endorphins," "serotonin," and "neurotransmitters" to beef up dubious claims is a special skill of snake oil salesmen. Look for scientific proof in the form of clinical studies.
Don't judge a therapy by testimomals alone. Remember, the people who peddle alternative treatments will only use the stories of people who believe they had success, not the ones who found the therapies useless. Moreover, while anecdotes may sound convincing, it is difficult to tell if the treatment was a success or if another explanation could account for the change. Some illnesses clear up on their own. Other times, people undergo several therapies at once, so it is hard to tease out the ones that worked. Finally, the placebo effect, in which an ineffective treatment works because the person believes it will, may be enough to get an effect. If you don't see improvement in a reasonable amount of time, check with your medical doctor.
The mysteries that cloud alternative therapy are only starting to lift in the United States. The best option is to use those remedies that have value as an adjunct to conventional care. If you tread carefully and do your research, you should be able to choose treatments that can work effectively and avoid the pitfalls of useless or dangerous treatments. Making Distinctions Alternative medicine is a popular option, but it is still a mysterious world we know little about. Some therapies can form an effective complement to Western medicine. Others may be useless or flat-out dangerous. You need to keep a few points in mind to ensure a safe, effective experience with alternative therapies: Make sure you receive an accurate diagnosis from conventional doctors before you go. Cancer, diabetes, infections, broken bones, and other acute illnesses respond better to conventional care.
Photo: portrait. Caption: Curtis Chong.
(This article first appeared in the January 2001 edition of the BRAILLE MONITOR, published by the National Federation of the Blind)
From the MONITOR Editor: Every year thousands of people ask the staff of the NFB Technology Department for advice in buying just the right computer. Recently Curtis Chong, NFB Director of Technology, compiled his advice into one short handout. We thought that everyone would be interested in reading it. Here it is:
The International Braille and Technology Center for the Blind (IBTC), operated by the National Federation of the Blind, receives thousands of calls each year from blind people who want to buy a computer. Most of our callers want a computer to write letters, keep records, send and receive e-mail, and surf the Web. Some people want to use their computers as reading machines, which can scan and speak printed material. While most people will want voice output from their computers, others would prefer screen magnification. People who need to read highly technical material or who are deaf-blind might prefer reading their computer screens using refreshable-Braille technology. As a totally blind computer user I find that voice output works well for me. Many of my friends with enough vision to read print prefer to have both voice output (to save on eyestrain and dramatically increase reading speed) and screen magnification (to provide visual verification when desired).
If you cannot read your computer screen because of your vision, in addition to the basic computer you will need to add software called screen-access technology. You should start by purchasing a computer that runs the Windows operating system. The following specifications can be used as a guide to determine which built-in features you should get for your new system: at least 128 megabytes of RAM (random access memory), at least 8 gigabytes of hard-disk space, an internal 56K modem with V.90 capability, no less than a 500-megahertz processor speed (nothing slower is sold these days), and a Creative Labs Sound Blaster Live card. While almost any video card will work with screen-access technology for the blind, the blind person using speech output should bear in mind that the more sophisticated, three-dimensional card used for video games is not necessary.
Why do you need the Sound Blaster Live? You will need a multi-channel sound card that will allow screen-access technology and other Windows applications to generate sounds at the same time. Without a multi-channel sound card, sounds generated by Real Audio or by your Windows operating system often conflict with your screen-access program's ability to talk to you through your computer's speakers, and one or the other will generate an error message. In our experience the Sound Blaster Live works well as a multi-channel sound card. However, you can acquire another multi-channel sound card if you wish.
As for software, I would first recommend the Windows 98 Second Edition operating system and (some months after it has been released) Windows Millennium. E-mail and Web-browsing software (Outlook Express and Internet Explorer, respectively) come free with the Windows operating system, but you get only a fairly simplified free word processor (WordPad for Windows). While you can use WordPad to write letters and other simple documents, you may want to consider buying Microsoft Office if you are interested in spell-checking your material. A word processor that works fairly well with screen-access technology is Microsoft Word. Some computer dealers will try to bundle a package called Microsoft Works with your system. While we cannot say for certain that Microsoft Works is not compatible with screen-access technology for the blind, we can say that our experience with it is limited and that we are more confident in the ability of Microsoft Office to work with access technology than Microsoft Works.
The next software item that must be given serious consideration is a screen-access program. Most blind people would prefer to acquire one which converts the information on the screen into speech. Others will want screen-magnification software, and many will want a combination of speech output and screen magnification. See the end of this article for information about how to contact the appropriate screen-access technology vendor.
If you want your computer to be able to read and speak printed material, you will need to buy a piece of hardware called a scanner (for about $200) and a software product which actually speaks the text on the page. You should be prepared to spend at least a thousand dollars to acquire the blind-friendly systems--especially if you do not consider yourself a relatively sophisticated user of Windows. There are two noteworthy products to consider: Open Book from Freedom Scientific and Kurzweil 1000 from the Kurzweil Educational Group of Lernout and Hauspie. Both of these programs come with their own speech and can thus operate without screen-access technology.
In addition to the staff of the International Braille and Technology Center, the National Federation of the Blind has thousands of members willing and able to answer your questions. I urge you to call the president of the NFB affiliate in your state and introduce yourself to him or her. If you do not know how to reach your NFB state affiliate president, call the NFB's general information staff in Baltimore; telephone: (410) 659-9314 (8:00 a.m. to 5:00 p.m. Eastern Time, weekdays).
Now for those who want large print. We are not experts on low-vision software but have heard good things about Zoomtext from a company called AI Squared. This software is particularly helpful if you want to use screen magnification as your primary means of reading information displayed on the computer screen. For those who want speech output most of the time but need some visual verification every once in a while, the combination of JAWS for Windows and the MAGic magnification software (available from Freedom Scientific) seems to work well. There are many other possibilities, so you would be wise to start networking with other blind people. Again, call our NFB state presidents to meet people already using computer systems you'd like to have yourself. Sometimes people new to using computers hire someone to build them a computer. This can include lessons which teach the buyer how to get started once the computer is assembled and ready for use. Such experts often know how to buy good basic equipment during sales or at a reduced rate on Internet Web sites. If you know some blind computer experts, I would suggest you ask what fee they would charge for assembling a system in addition to the cost of the computer parts. Remember that sighted experts may help to build a computer but are unlikely to know how to instruct you to use keyboard commands instead of the mouse. Again, I highly recommend locating local blind computer users to help you through the frustrating early days of learning to use your new system.
At present the average cost for a full system can be broken down like this:
$1,200 Intel-based computer with Windows operating system.
$1,000 Reading Software (Optical Character Recognition software) will let you use your commercial scanner. First, it scans any typeset print you've placed on the scanner; then it will recognize the document and read it aloud to you.
$ 800 Screen-Access Technology, such as Jaws for Windows, Window-Eyes, Window Bridge 2000, or outSPOKEN for Windows will see your computer screen and articulate what is there.
$ 200 A typical commercial scanner. $ 200 A typical commercial color printer.
$ 300 Estimated: state tax, an electrical power surge protector, computer supplies (printer paper, disks, and computer application programs), computer user manuals in Braille or on cassette, Internet service provider fees, ($100 to $200 per year), and other such incidentals.
$3,500 Best estimate (October, 2000).
Screen Access Technology, Top Four Vendors
While JAWS for Windows from Freedom Scientific appears to be the best known screen access program for the blind, we should call to your attention three other programs. Each program has its own unique set of features. The decision as to which screen-access program to buy is based partly on the features which are important to you and partly on the amount of money you have to spend. You should consult with the screen-access vendor to obtain the most current information about features and prices.
JAWS for Windows by Henter-Joyce, a division of Freedom Scientific, 11800 31st Court North, St. Petersburg, Florida 33716-1805. Telephone: (800) 444-4443, (727) 803-8000; Fax: (727) 803-8001; e-mail: [email protected]; Website: http://www.freedomscientific.com. JAWS for Windows ($795) provides speech and Braille access to Windows 95, Windows 98, and Windows Millennium. Another version of JAWS for Windows ($1,495) provides access to Windows NT and Windows 2000. JAWS for Windows is shipped with the Eloquence software speech synthesizer, meaning that it can generate speech through your computer's sound card.
Window-Eyes by GW Micro, 725 Airport North Office Park, Fort Wayne, Indiana 46825. Telephone (219) 489-3671. Fax: (219) 489-2608. BBS: (219) 489-5281. Website: Http://www.gwmicro.com. Window-Eyes ($495) provides speech access to Windows 95 and Windows 98 and, in the future, Braille access to these operating systems and Windows Millennium.
Window Bridge 2000 by Syntha-Voice Computers, Inc., 800 Queenston Road, Suite 304, Stoney Creek, Ontario L8G 1A7, CANADA. Telephone: (905) 662-0565. Fax: (905) 662-0568. BBS: (905) 662-0569. Website: http://www.synthavoice.on.ca. Window Bridge 2000 ($695) provides speech and Braille access to Windows 95, Windows 98, and Windows Millennium. This was the first program that allowed access to Microsoft Windows.
OutSPOKEN for Windows by the Alva Access Group, Inc., 5801 Christie Avenue, Suite 475, Emeryville, California 94608. Telephone: (510) 923-6280. Website: http://www.aagi.com. OutSPOKEN ($595) provides speech- and Braille-access to Windows 95 and Windows 98.
It will soon be time for the 2001 convention of the National Federation of the Blind, to be held at the Philadelphia Downtown Marriott, 1201 Market Street, Philadelphia, Pennsylvania 19107. The Downtown Marriott is a beautiful hotel, in a convenient, central location.
Marriott has a national reservation number: 1-800-228- 9290, or you can phone the Downtown Marriott directly, at: (215) 625-2900 to receive our special NFB National Convention rates. Be sure you tell them you will be attending the annual convention of the National Federation of the Blind. To confirm a telephone reservation, you will need a credit card number, and the reservation charge is $60, applied toward your stay.
Here are our hotel rates for 2001: one in a room, $55 per night; two, three, or four in a room, $65. Local taxes will apply. To receive these special low rates, you will need to make your reservation before May 29, 2000.
Here are the convention dates and schedule:
Sunday, July 1 -- Seminars
Monday, July 2 -- Convention registration
Tuesday, July 3 -- National Board Meeting (open to all)
Wednesday, July 4 -- General Sessions
Thursday, July 5 -- Tour Day
Friday, July 6 -- Banquet
Saturday, July 7-- General and Business Sessions, adjournment.
At the 2001 convention of the National Federation of the Blind, in Philadelphia, Pennsylvania, our Diabetes Action Network will have its seminar and business meeting. It will be held on Tuesday, July 3, from 1:30 to 4 pm. There will be a presentation about a new talking device that will provide information on any prescription medication (insulin included), and an insulin pump company representative will be present.
Our keynote speaker will be a diabetes educator (CDE) who will answer diabetes questions and discuss adaptive equipment for blind diabetics.
Once again, we will have our "Make the President Pay" diabetes quiz game -- and President Ed Bryant says he will give a nice donation to the Division for each right answer! Our seminar is free and open to the public. Its location will be posted in the agenda (provided when you register).
About 90% of all diabetics in the United States have type 2, non insulin dependent diabetes. We know many type 2s are overweight or obese, but what is less well known is that many also have "lipid abnormalities," a high level of fatty acids in the bloodstream. Coronary Heart Disease (CHD) is frequent in type 2 diabetes, and it can be a killer. Lots of type 2s have elevated LDL cholesterol, the bad kind. And a lot of people who aren't diabetic have dangerously high cholesterol levels too.
Hypercholesterolemia, high cholesterol (reports the Archives of Internal Medicine for 1999), can cause a build- up of fatty streaks and plaque deposits on interior artery walls. This condition is also known as atherosclerosis. It is estimated 52 million people in the U.S. have at least mildly elevated cholesterol level (>98 million American adults with total blood cholesterol >200 mg/dL, and 39 million >240 mg/dL). As elevated LDL cholesterol is considered a major risk factor in the development of CHD, this is a life and death issue.
We hear a lot of talk about healthy diet, and about exercise, and these are important for prevention, but with so many folks presenting with elevated cholesterol levels, doctors have needed medical ways to get a patient's cholesterol down quickly. Traditionally, this has meant the class of oral medications called the statins: Lipitor, Zocor, Mevachor, etc.
The statins work, but often they are not effective enough, and, because of the way they spread through the body, and the fact that they can negatively interact with a number of other medications, including certain heart drugs, they can be inappropriate for some.
Responding to this need, Sankyo Pharma, inventor of the statin medications, has developed and tested Welchol, a non- systemic prescription cholesterol-lowering oral medication. Welchol is of interest for a number of reasons. First, some of the statins can have serious side effects, and Welchol does not share them. Second, it does not distribute itself system-wide, but works in the intestine, promptly passing out of the body making Welchol a good choice for folks who already take a lot of medications. Third, where Welchol alone does not drop the cholesterol enough, it can be combined with statin medications like Lipitor, achieving a very high degree of efficacy.
If your cholesterol is elevated, talk to your doctor about Welchol. It could be worth your consideration. If you don't know where your cholesterol is running, perhaps it is time for a test? For more information about Welchol, contact: Sankyo Pharma Inc., Two Hilton Court, Parsippany, NJ 07054; telephone: (973) 359-2600.
During this year's annual convention of the National Federation of the Blind in Philadelphia, Pennsylvania (Sunday, July 1, through Saturday, July 7), dialysis will be available.
Individuals requiring dialysis must have a transient patient packet and physician's statement filled out prior to treatment. Conventioneers must have their unit contact the desired location in the Philadelphia area for instructions, well in advance. NOTE: The convention will take place at the Philadelphia Downtown Marriott, 1201 Market Street. Individuals will be responsible for, and must pay out of pocket, prior to each treatment, the approximately $30 not covered by Medicare, plus any additional physician's fees, and any charges for other medications.
DIALYSIS CENTERS SHOULD SET UP TRANSIENT DIALYSIS LOCATIONS AT LEAST TWO MONTHS IN ADVANCE. THIS HELPS ASSURE A LOCATION FOR ANYONE WANTING TO DIALYZE. There are many centers in the Philadelphia area, but that area is quite large, so early reservation is strongly recommended, to avoid long taxi rides!
Here are some dialysis locations:
* BMA of Central Philadelphia, 417 North Eighth, Philadelphia, PA 19123; telephone: (215) 413-3050. Contact: Alicia Ilagan. Very close to Marriott.
* Gambro Spring Garden, 3836 Spring Garden, Philadelphia, PA 19104; telephone: (215) 382-8511. Contact: Lou Molina, Social Worker. Fairly close to the Marriott.
* Franklin Dialysis Centers, Inc., 700 Spruce Street, #401, Philadelphia, PA 19107; telephone: (215) 829-5650. Farthest from the Marriott.
PLEASE REMEMBER TO SCHEDULE DIALYSIS TREATMENTS EARLY, TO ENSURE SPACE. If scheduling assistance is needed, have your dialysis unit's social worker contact me: Diabetes Action Network President Ed Bryant; telephone: (573) 875-8911. See you in Philadelphia!
Research continues towards the goal of a truly noninvasive glucose monitor. The Cygnus Glucowatch is well into the FDA approval process, and it will be useful, but it is not noninvasive; daily finger-stick calibrations will be required.
Instrumentation Metrics. from Chandler, Arizona, is working to perfect a "near-infrared spectroscopy"(NIR)-based system, one that would be truly non-invasive. The monitor utilizes low-level light, reflected from the patient's forearm, to detect changes in an individual's blood glucose.
This idea, NIR, was tried out some time ago, by another firm, without much success, but company data suggest Instrumentation Metrics is having more luck.
The company says a large "preliminary clinical trial" is underway, and that "analysis of data derived from the first subjects to complete the study" suggest the system is acceptably accurate. The company states what they are developing now is an "office model," for the physician, with a pricetag of around $10,000. They hope to eventually offer a "personal model," with a pricetag closer to $2500 -- assuming all tests are passed successfully.
These are very early findings. There are many details to work out, and then the entire process of Phase 1, 2, and 3 clinicals to negotiate before approval can be considered. If the system is successful, it will be some time before we see it on the pharmacy shelf. For further information, see their website: www.imetricsinc.com
Step Into Spring With Healthier Habits
I just returned from a morning appointment and I'm full of fresh "Spring is in the air" enthusiasm. We're having one of those rare, end-of-winter days on the West Coast, the kind that plays tag with your senses and teases you into believing you can do anything, even exercise!
We diabetics know how important good nutrition is for good glucose control. According to an ADA spokesperson, however, most consumers think of nutrition as a matter of "rules and denial," and that good healthy eating takes "too much time to prepare." With more than 55% of our nation classified as obese, and childhood obesity leading to ever- higher numbers of type 2 diabetes in children, the experts are alarmed. This means that the complications of diabetes, such as heart attack and stroke, can and will show up earlier in adulthood (early 30s)!
Lifestyle changes, such as better eating, come in stages, and you'll be a lot more successful if you start small. Small stage examples would be planning and shopping ahead for meals, eating smaller portions, making your changes enjoyable, and adding new foods to your menu.
We're going to be facing lots of celebrations this Spring: Easter and Passover, Cinco de Mayo, Mother's Day, Father's Day and various and assorted graduations and weddings. All are food-focused, and for the diabetic, will always present a challenge. If you need a little more motivation to get you started in the direction of a healthier lifestyle, visit your local library and check out some of the cookbooks we've described below. Your body will thank you!
I love Robyn Webb's cookbooks, and one of the best is the FLAVORFUL SEASONS COOKBOOK : Great Tasting Recipes For Winter, Spring, Summer and Fall. Published by the American Diabetes Association, Flavorful Seasons is filled with over 400 recipes and a wealth of cooking tips and inspirational quotes. Chef/author Robyn Webb has also included great ideas for holiday decorating and seasonally-appropriate menus for holiday entertaining. (This reviewer wrapped the "Day In Bermuda" menu around a Mother's Day theme for the Cinnamon Hearts website this past Spring. The menu included Pina Coladas, Tropical Chicken Salad, Citrus Rice and Coconut Pudding Squares. All recipes were simple enough for Dad and the kids to prepare while Mom was out of the kitchen for the afternoon).
Full page ingredient information on topics such as Serving Squash, Saucy Stir-Frys, Better Salad-Making, Grilling Techniques, Marinades and Dry Rubs, Grab Some Grains, A Hill of Beans and The Sweet Smell of Spices punctuate each section of the book.
THE FLAVORFUL SEASONS COOKBOOK not only fills a cookbook collector's requisites, but is deliciously healthy and practical. Recipes are easy to prepare, and use readily available seasonal ingredients. I like the "one-liner" anecdotes just under the title of each recipe, which offer serving suggestions for accompaniment or taste descriptions to help the cook in planning the rest of the menu. This is a great gift suggestion not only for diabetics and their caretakers, but for those of all levels of cooking experience who wish to prepare healthy meals, suitable for every occasion. Highly recommended.
THE FLAVORFUL SEASONS COOKBOOK, by Robyn Webb, (c)1996, published by the American Diabetes Association, $16.95.
Brand new on the cookbook scene is COOKING WITH THE DIABETIC CHEF, by Chris Smith. Who better to write a diabetic cookbook than a chef who has personal experience with diabetes? Chris Smith was midway through his culinary training at the Culinary Institute of America and apprenticing at New York's prestigious restaurant Le Cirque, when he gradually becoming unable to keep up with the demands of a fast-paced restaurant kitchen, coupled with the long daily commute to work. He frequently felt drained and fatigued. Constantly thirsty and needing to urinate more than normal, his work was beginning to suffer. After his third week at Le Cirque, he resigned to finish his apprenticeship in a restaurant closer to home.
By the time Chris began his fourth semester at the Culinary Institute of American, he started to develop stomach pains and cramps along with deepened fatigue, and more frequent thirst and urination. After he dropped 30 pounds, Chris' doctor tested him for diabetes and the rest is history. Chris was diagnosed with type 1 diabetes.
Armed with determination after educating himself about his diabetes, Chris learned that he could control his disease with proper care and insulin management, without having to make radical life changes. With enthusiasm and dedication, Chris Smith dedicated his focus, training and experience as a chef, to teaching diabetics how they can still eat healthy and delicious foods while maintaining balance and control of their disease.
COOKING WITH THE DIABETIC CHEF is the culmination of Chris's approach to food: Using natural ingredients which are as fresh as possible and cooking with traditional techniques to bring out the best flavors of the ingredients. Herbs and spices are used throughout the book for complementing the best natural ingredients available. Divided into the four seasons for ingredient availability, recipes such as Tomato and Mozzarella Salad, Cornish Game Hen in Herb Butter, Sauteed Lemon Shrimp with Zucchini and Yellow Squash Julienne, Rosemary Pork Roast, Baked Stuffed Apples, Blackberry Cobbler and Chocolate Cake Celebration are just a few which have piqued my taste buds.
Overall, I applaud Chris Smith for showing us how he was able to turn a potentially devastating diagnosis into a pathway to achieve his goals and dreams. COOKING WITH THE DIABETIC CHEF teaches us all how to create healthy culinary masterpieces by using use the best and freshest possible ingredients. Most of all, Chris Smith teaches us that a diagnosis of diabetes is not a culinary death sentence!
(One admonition only from this reviewer, however: If you are a type 2 diabetic on a weight reduction program, or have high cholesterol levels or heart disease, be aware that some of the recipes contain higher amounts of fat than usual. Just remember to practice balance in your meal planning, i.e., if you want to sample some of Chris's delicious wares which have a bit more fat or carbohydrate in the analysis, plan ahead and work the recipes into your total daily meal plan. If you have any questions or doubts, discuss them with your doctor, dietitian or nutritionist.)
COOKING WITH THE DIABETIC CHEF, by Chris Smith, (c)2000, published by the American Diabetes Association, $19.95.
He's back! Alan L. Rubin, M.D., who authored DIABETES FOR DUMMIES, has now teamed up with Fran Stach, R.D., C.D.E., and Chef Denise Sharf to produce THE DIABETES COOKBOOK FOR DUMMIES. This new cookbook sets out to dispel one of the most common myths about diabetes, which is that people who have diabetes can't eat "regular" food.
In addition to more than 100 delicious recipes and great advice you can use at every meal, Dr. Rubin has included sections on Building a Healthy Lifestyle, Eating Out, and a section titled The Part of Tens: Ten Simple Steps to Improve Your Diet; Ten Easy Substitutions in Your Eating Plan; Ten Strategies to normalize Your Blood Glucose and Ten Tactics for Teaching Children with Diabetes Healthy Eating Habits.
For me, one of the most useful sections of the book was information on how to take a recipe nutritional analysis and manually calculate the dietary exchanges (Starches, Proteins, Fats, Milk, Fruit and Vegetables). This is found at the end of Part 1: Building a Healthy lifestyle. In my experience, I've run across many great healthy recipes, complete with nutritional analysis, but omitting the dietary exchanges so necessary for those diabetics who need to know the exchanges per serving. I plan to reprint this formula as standing information on our Cinnamon Hearts website.
As usual, Dr. Rubin and his team have done an outstanding job in the recipe department, too. Lots of good information on ingredients, creating balanced meals and adding desserts to the diabetic meal plan, as well as the benefits of breakfast, eating out and fast food tips. This book is also a fine teaching tool if your talents in the kitchen are lacking finesse. Recommended. THE DIABETES COOKBOOK FOR DUMMIES, by Alan L. Rubin, M.D., (c)2000, published by IDG Books, $19.99.
Marilyn Helton, type 2 diabetic since 1993, is the publisher of Cinnamon Hearts~The Art of Living A Winning Diabetic Lifestyle, a positive-power online e-zine for diabetics and their families. You can find more of Marilyn's book reviews, articles and recipes online at: http://diabeticgourmet.com, www.fabulousfoods.com, www.practicalkitchen.com, or Cinnamon Hearts website: http://members.xoom.con/cinnhearts/
Send your great food ideas to the editor. Your recipes will be evaluated by dietitians, and if necessary, adjusted to make them more diabetically appropriate. Then he gets to taste them...
This issue, all recipes are taken from Suzi Castle's Deliciously Healthy Favorite Foods Cookbook, courtesy of Diabetic.com. Reach Diabetic.com on the web: www.diabetic.com, or by phone: 1-800-342-2384.
SIRLOIN TIPS IN MUSHROOM-WINE SAUCE
For a delicious, healthful meal that your guests will love, try Sirloin Tips in Mushroom-Wine Sauce!
Ingredients:
1 � pounds lean sirloin tips, cut into 6 serving-size pieces
1 cup beef bouillon
1cup dry white or red wine (dry vermouth is especially good)
1 large clove garlic, minced
1 teaspoon Italian seasoning
2 cups sliced mushrooms
2 tablespoons flour
1/4 cup water
Instructions:
In a large, heavy skillet sprayed with nonstick spray, brown sirloin tips over medium - high heat. Add bouillon, wine, garlic and Italian seasoning, then cover. Reduce heat and simmer, turning every 15 minutes, for 2 hours. Add mushrooms, re-cover, and simmer for � hour longer. Remove meat to a serving dish and keep warm. Pour meat juices from skillet into a large measuring cup. Add enough water to make 1 cup and return to skillet. Add flour dissolved in 1/4 cup water and simmer over medium heat, stirring constantly, until thickened. Pour sauce over meat before serving. Serves six.
Nutritional Information: Per serving: 184 cal. (28% from fat); 25gm protein; 5.7gm fat (2.2gm sat.); 3.3gm carbohydrate; 209mg sodium; 68mg cholesterol; 0.67gm fiber. Exchanges: 3 lean meat, 1 vegetable. Add � fat exchange to meal plan.
CHICKEN-ALMOND STIR-FRY
For a quick-to-fix meal with a lot of flavor but not many calories, try Chicken-Almond Stir-Fry served with plain rice. Your family will love it and so will your waistline.
Ingredients:
1 cup each: coarsely chopped celery and onion
1 pound boneless, skinless chicken breasts, cut into � " cubes
� package (10 oz.) frozen peas, thawed
1 can (8 oz.) sliced water chestnuts, drained
� red bell pepper, seeded and cut into �" pieces
1 cup water
2 packages (1 teaspoon each) chicken bouillon granules
3 tablespoons low-sodium soy sauce
1 teaspoon sesame oil
2 tablespoons cornstarch, dissolved in � cup water
1/4 cup slivered, toasted almonds*
Instructions:
In a large, heavy skillet sprayed with nonstick spray, stir-fry celery and onion over medium heat until crisp- tender. Remove from pan. Spray skillet again with nonstick spray, and brown chicken over high heat, stirring constantly. Return celery and onion to pan. Add peas, water chestnuts, bell pepper, water, chicken bouillon granules, soy sauce and sesame oil. Simmer for 3 minutes. Stir in dissolved cornstarch and cook until thickened. Garnish top with slivered almonds. Serves five. *To toast almonds, bake at 300 degrees on an ungreased baking sheet until golden.
Nutrition Information:
Per serving: 202 cal. (25% from fat); 16gm protein; 5.7gm fat (0.75gm sat.); 13.6gm carbohydrate; 470mg sodium; 48mg cholesterol; 3.5mg fiber. Exchanges: 2 lean meat, � bread, 1 vegetable.
EASY ENCHILADA CASSEROLE
Ingredients:
1 lb. ground turkey breast
1 medium onion, chopped
2 cups each: tomato sauce and enchilada sauce
1 can (15 oz.) pinto beans and juice
12 corn tortillas
3 cups grated fat-free cheddar cheese (10 oz.)
� cup sliced black olives
Instructions:
In a large, heavy skillet sprayed with nonstick spray, brown ground turkey and chopped onion over medium-high heat, stirring constantly. Add tomato sauce, enchilada sauce and beans with juice. Heat until simmering. Put a layer of meat sauce in a large casserole sprayed with nonstick spray. Add a single layer of 3 tortillas. Add another layer of meat sauce. Cover with 1/4 of the cheese and olives. Repeat three more layers of 3 tortillas, meat sauce, cheese and olives. Bake in a preheated 325 degrees oven for 50 to 60 minutes, or until hot. Serves 10.
Nutrition Information:
Per serving: 266 cal. (22% from fat); 24.4gm protein; 6.5gm fat (0.78gm sat.); 26.5gm carbohydrate.; 1,021mg sodium; 33mg cholesterol; 6.7gm fiber. Exchanges: 2 � lean meat, 1 � bread.
APPLESAUCE-RAISIN COOKIES
Ingredients:
1 cup each: unbleached and whole wheat flour
3 � cups uncooked oats, quick or old-fashioned
1 tablespoon baking powder
1 teaspoon baking soda
1 � teaspoons ground cinnamon
� teaspoon each: ground nutmeg and ground allspice
1/4 teaspoon cream of tartar
1 package (3 tablespoons) Butter Buds Sugar substitute equal to 2/3 cup brown sugar (i.e., 2/3 cup Brown Sugar Twin)
� cup raisins
2 eggs
2-2/3 cups unsweetened applesauce
� cup water
1 tablespoon vanilla extract
Instructions:
Mix flours, oats, baking powder and soda, cinnamon, nutmeg, allspice, cream of tartar, Butter Buds, sugar substitute and raisins. In electric blender, mix eggs, applesauce, water and vanilla. Add to flour mixture and stir until mixed. Drop by the tablespoonful onto two cookie sheets sprayed with nonstick spray, and bake in a preheated 375 degree oven for 15 minutes. Makes 48 cookies.
Nutrition Information:
Per serving: 52 cal. (12% from fat); 1.66gm protein; 0.69gm fat (0.08gm sat.); 10.4gm carbohydrate.; 47mg sodium; 8.9mg cholesterol.; 0.32gm fiber. Exchanges: 2/3 bread.
The days of "laser surgery" may be numbered. GenVec, Inc., a Maryland-based pharmaceutical research firm, has obtained exclusive license to PEDF, pigment epithelium- derived factor, a substance developed by researchers at Northwestern University. PEDF appears to inhibit the abnormal capillary growth we know as diabetic retinopathy, which is a leading cause of blindness. PEDF also may be effective against macular degeneration.
Research authored by Dr. Noel Bouck, published January 2001 in Proceedings of the National Academy of Science, suggest that administration of PEDF, now tested at the "preclinical" level, may prevent new retinopathic blood vessel development in the eye.
Although such a development is exciting, note well the word "preclinical." New medications have to pass a battery of clinical tests, demonstrating both efficacy and safety, before they can be approved for distribution. PEDF may be eventually successful, and may well become the treatment of choice for proliferative diabetic retinopathy, but it won't be tomorrow.
For information, contact: GenVec, Inc., 65 West Watkins Mill Road, Gaithersburg, MD 20878; telephone: (240) 632-0740; website: www.genvec.com
(This article appeared in VOICE OF THE DIABETIC, Volume 14, Number 4, Fall 1999 Edition, Published by the Diabetes Action Network of the National Federation of the Blind. Updated April 2000.)
A major aim of the Diabetes Action Network of the National Federation of the Blind is to provide support and information for blind diabetics, so they might better maintain or regain independence and productivity. Our national support and information network allows communication across a wide area, something important for blind or visually impaired diabetics and their families. With the trauma of sight loss, sometimes the newly blinded do not realize that most blind men and women with diabetes CAN self manage safely and accurately, by use of alternative/adaptive techniques.
I became blind from diabetic retinopathy about 24 years ago. When I first lost my sight, I didn't use insulin gauges to help draw my insulin, as I had never heard of such devices! Twenty two years ago, I designed my own insulin gauge, and I used it for approximately three years, with no difficulties. However, I do not advocate the use of non standard or homemade insulin measuring devices, unless they have been checked out by someone knowledgeable in insulin measuring techniques.
Members of the health care community sometimes forget that although a diabetic may be newly blinded, he or she has often been successfully self managing the disease for 15 years or more. Most long term type 1 diabetics have had years of experience drawing their own insulin. Veteran blind diabetics often have more experience with adaptive insulin preparation devices than do many sighted health professionals. The following observations are only a small sample.
Because of my experience with diabetes and blindness and my editorship of VOICE OF THE DIABETIC, I am often asked to evaluate insulin measuring gauges designed for the blind or visually impaired. I have tested numerous measuring devices, and in my opinion the Count A Dose, from Jordan Medical Enterprises, wins the blue ribbon. (Note: The Count A Dose is available from the National Federation of the Blind Materials Center: (410) 659 9314). I hasten to add that no one instrument is ideal for everyone; however, the Count A Dose provides a very easy method of insulin dispensing. Designed for the Becton Dickinson LoDose syringe, the Count A Dose holds two insulin vials and directs the syringe needle into the vials' rubber stoppers. Using the thumb wheel, which clicks for each unit measured (clicks can be both heard and felt), the blind diabetic can reliably draw and mix his or her own insulin.
How to Get Air Bubbles Out of an Insulin Syringe
There are techniques by which a blind diabetic may draw and mix insulin without drawing air into the syringe. Like many others, I have used them successfully for years. I first draw four or five units of regular insulin into the syringe and then inject all of it back into the vial. I then repeat the operation two more times. The fourth time, I draw the full amount of insulin needed from the first vial. Then, when I draw insulin from the second vial, I draw the exact amount needed. I have put this to the test; 100 repetitions without air bubbles. Diabetes Action Network former First Vice President Janet Lee twice performed the same test. In both cases the complete absence of air in the syringe was independently verified.
"Tapping the syringe to remove air bubbles," a common technique used by the sighted, becomes unnecessary. The one to two units of air in the hub of the needle (where needle meets syringe) are expelled during the procedure used with the first vial of insulin. I demonstrate this technique to nurses, who are delighted to see that air bubbles are not present and the insulin measurement is accurate. Of course, long term insulin users will be familiar with the need to inject as much air into the vial as the amount of insulin they withdraw, to facilitate getting the insulin into the syringe. For further information, consult your health care team.
How to Know When an Insulin Vial is Getting Low
Each vial of insulin contains 10cc, 1000 units. The maximum number of units used per day, divided into the vial's 10cc (1000 units) capacity, gives the maximum number of days the bottle can be used. When I open a new vial of Regular insulin, I divide its 1000 units by 20 units, the maximum I use daily, so one supply should last me 50 days, but as a safeguard, I assume that the new bottle contains only 940 units (9.4cc), which should last a maximum 47 days instead of 50. I measure my NPH insulin in a similar manner. As long as at least 60 units of insulin remain in the vial, the needle will remain submerged while filling, and there is no danger of drawing air. In drawing out the insulin, I keep the syringe vertical, needle straight up in the vial, so as not to inadvertently draw out air. Many blind consumers (and diabetes educators) are unaware of this point's importance that the natural tendency is to tilt or slant while drawing, which can lead to inaccurate filling and air in the syringe.
Many methods exist to determine how long a supply will last. One way to keep track of the amount of insulin in the container is to set aside the number of syringes that will be needed for 940 units of insulin. Another might be to employ Braille, large print, tape recorders, or personal computers, to record how much insulin has been used each day. Many blind consumers, like myself, realize the importance of keeping their blood glucose under tight control, and follow regimes of insulin mixing and multiple injections, both of which increase the need for precision. I have found the more precise the record of insulin drawn, the easier to safely predict when it is time for a new supply. Note: Although not as precise, before drawing insulin you can gently shake the vial and, with practice, easily determine whether it is full, half full or nearly empty.
The Possibility of Inserting a Needle into a Blood Vessel
Since injection sites are in fleshy areas, and insulin needles are short, chances of inserting a needle into a blood vessel are minimal. The worst that can be done is to hit a small capillary, which would result in a small area becoming infused with blood a hematoma. Again, it is unlikely the needle will be inserted into a small blood vessel. The amount of insulin entering the bloodstream via a capillary would be insignificant, and would cause no harm.
Something to Think About
I periodically have my insulin gauge checked for accuracy; it has always measured precisely. If the diabetic is careful, difficulty in measuring insulin will not occur. I have found that inaccuracy is often the result of haste or carelessness
It is reported that insulin gauges are more accurate than sight. When the plunger is pushed firmly to the gauge, the same amount of insulin will be obtained every time. Sometimes my sighted friends make errors in drawing insulin. Perhaps they would be more accurate if they used insulin gauges! Note: Syringes are mass produced. Although there is quality control, some errors are made in syringe markings. If a gauge is used, the measurement will be accurate no matter what the syringe shows.
At first hearing, all this may sound like a lot to remember, but it is not difficult. Marla Bernbaum, MD, CDE, Assistant Professor at St. Louis University Medical School Department of Endocrinology, states: "In our experience here, most blind and visually impaired diabetic patients have been capable of drawing their own insulin with complete accuracy."
Janet Lee, former Director of the Independent Management for Blind Diabetics Program at BLIND, Inc., Minneapolis, Minnesota, stated: "In my ten years of working with blind diabetics, hundreds of them, there have maybe been two, who, because of a combination of disabilities, could not measure their own insulin."
Ruth Ann Petzinger, RN, MS, CDE, Diabetes Care Manager/Educator at St. Peters Medical Center, New Brunswick, New Jersey, states: "During the time I have been working with persons with diabetes and visual impairment, I've never had a patient who truly wanted to be independent with insulin administration or blood glucose monitoring who was not able to achieve these goals."
Ann Whittington, RN, MSN, MBA, CDE, with the Medical College of Georgia, states: "In my experience, with proper training almost all diabetics are able to prepare and administer their own insulin safely, regardless of visual impairment."
Ann Williams, MSN, RN, CDE, Diabetes Program Coordinator, Cleveland Sight Center, and her colleague Marylin Teasley, RN, CDE, state: "In the last eight years we have taught about 800 visually impaired and blind people to measure and administer their own insulin independently. Vision loss does not preclude safe and effective insulin self administration."
I have no problems managing and keeping my diabetes under control. I control it through the use of alternative techniques, some of which are described here. Many members of our organization, the National Federation of the Blind, use them daily to live active lives. With alternative techniques, blind diabetics can be as productive as when they were sighted.
Come to us and ask for assistance. We are ready, willing, and able to help. We want you to know that no matter what your diabetes ramifications, you are not alone and do have options. We in the National Federation of the Blind know that blindness is not synonymous with inability.
Resources:
The Eye Dea Shop: Cleveland Sight Center, 1909 E. 101st Street, Cleveland, OH 44106 8696; phone: (216) 791 8118 ext. 278
The Syringe Support Insulin Measuring Device: Uses only the B D 1cc/100 unit disposable syringe, and measures insulin in 1 or 2 unit increments, in doses of 1 to 100 units. To mix insulins, it is necessary to remove vials from the apparatus. To draw a measured dose, the Syringe Support uses a set screw, with a raised flange (its only landmark) at 12 o'clock. One full turn draws two units, and one half turn draws a single unit. Although the dial lacks definite tactile or audio indicators, in most cases any error would be fractional. Still, the Syringe Support performs best for those who must draw doses greater than 10 units. Instructions (standard print only) are bilingual (English and French). Cost: $26 Unit Calibration Aid Tactile
Insulin Measuring Device: Allows tactile draw up of preset insulin doses; has two presets; uses all syringe types; requires sighted aid to change presets. Cost: $26
National Federation of the Blind, Materials Center: 1800 Johnson Street, Baltimore, MD 21230; phone: (410) 659 9314; fax: (410) 685 5653; Hours are 8:00am to 5:00pm EST, weekdays; website: http://www.nfb.org
Count A Dose Insulin Measuring Device: Gauge calibrated for use with U 100 vials and B D �cc (low dose) syringes only. By turning a thumb wheel, clicks are heard and felt for each one unit increment measured; holds 1 or 2 vials of insulin for mixing; needle penetrates vial stopper automatically. Print and audiocassette instructions provided. Suggested retail price: $59.95
Palco Labs, Inc.: 8030 Soquel Ave., Santa Cruz, CA 95062; phone: 1 800 346 4488; fax: (831) 476 1114
Load Matic: Tactile insulin measuring device, accepts B D 100 unit syringes; aligns needle with vial stopper; two separate controls (one for single unit and the other for ten unit increments); tactile prompt to confirm dose setting. Audiocassette instructions included. Individuals with neuropathy may have difficulty with the one unit scale, and it is possible to unintentionally "short stroke" the ten unit loading lever and draw an incomplete dose. Cost: $47.99
On March 22, 2001, The U.S. Food and Drug Administration (FDA) announced that it had completed the approval process for the Glucowatch Biographer continuous glucose monitor. It's passed; it's here; it will now come to market. Worn like a big wristwatch, the Glucowatch is the first working alternative to "lancet and test-strip" blood glucose monitors to reach "approval" status.
Can I buy a Glucowatch? Not yet, but soon. Cygnus, with help from marketing partner LifeScan, will no doubt be getting them out to pharmacy shelves as fast as they can.
Will I need a prescription? Yes. The FDA knows this is a new and different piece of machinery, and, as with Humalog insulin, extra supervision will be necessary, at least at this time.
Will it replace my finger-stick meter? No. The Glucowatch works, and it does some neat things, and will help some people, but it does not replace traditional blood- glucose monitoring. In fact, every time the user changes the replaceable Autosensor (the Glucowatch's "test strip"), a finger-stick blood test is necessary to properly calibrate the meter. That means two sticks a day.
What's the Glucowatch for, then? The Glucowatch is a continuous glucose monitor. Where traditional monitors take "snapshot" readings, and cannot tell you whether your blood sugars are stable, going up, or going down, the Glucowatch tracks patterns. It automatically tests every 20 minutes, allowing you and your doctor an excellent opportunity to fine-tune your blood glucose self management. And, the Glucowatch incorporates a programmable low blood sugar alarm, that can be set to "sound off" if your sugars are diving into hypoglycemia territory.
Cygnus, the manufacturer, states the meter is not intended as a replacement for traditional finger-stick metering, but to provide more complete and on-going information about blood glucose levels. They point out many diabetics now test only a few times a day, possibly missing important information about their glucose levels at other times, such as after meals or while they sleep. The Glucowatch solves this problem, without requiring radical changes in testing habits. Good diabetes management requires the most possible information, and the Glucowatch provides its user more information than has been available before and it does it without a lot of poking and bleeding.
What about cost? While some experimental "no needles" glucose monitors have needed a van to tote them about, and a bankloan to finance them (and never made it to "FDA approved" status) the Glucowatch will cost several hundred dollars, and its "test strip," the Autosensor, should cost $3 or $4 each a lot compared to a traditional test strip, but not compared to the 36 test strips it would replace in a 12-hour period. Note: Final prices are not set, and will probably vary between retailers.
Can a blind person use the Glucowatch? The current model does not incorporate speech compatibility, but Cygnus VP Dr. Russell Potts told the VOICE : "We have every intention of expanding its use, including use by people who are sight-impaired." He stated Cygnus had to launch the basic product first, and intended to provide adaptive products "in the not too distant future."
For more information, contact Cygnus, Inc., telephone: 1-866-459-2824; website: www.glucowatch.com
Artwork: Hand pulling book off shelf.
Inclusion of materials in this publication is for information only and does not imply endorsement by the Diabetes Action Network of the NFB.
INSULIN PUMPS AND SUPPLIES
MiniMed is one of the world's leading manufacturers of insulin pumps -- those precision microdevices that are the closest thing to an artificial pancreas we have. If you are an insulin-dependent diabetic, talk to your doctor about pump therapy -- you might find the MiniMed 508 pump right for you. If you need pump/infusion supplies, Minimed offers a complete line. Minimed also offers (for doctor's use) the Continuous Glucose Monitor -- which can precisely chart three days' sugars, as an aid to establishing better control. And Minimed has the (still investigational) 2007 Implantable Insulin Pump. For information contact: MiniMed, Inc., 18000 Devonshire Street, Northridge, CA 91325-1219; telephone: 1-800-646-4633; website: www.minimed.com
DIABETIC PRODUCTS
Health Care Products makes many over-the-counter medications and supplements for diabetics, including DiabetiSweet sugar substitute and Diabetic Tussin sugar-free cough syrup. Find these products in the diabetic section of Wal-Mart, Rite Aid, Walgreens, K-Mart, and other retailers. For information, contact: Health Care Products, 369 Bayview Avenue, Amityville NY 11701; telephone: 1-800-899-3116; website: http://www.diabeticproducts.com
NEW DIABETES RESOURCE LIST
The Diabetes Action Network of the National Federation of the Blind will soon offer the 2001 edition of Diabetes Resources: Equipment, Services and Information, our comprehensive list of resources for diabetics. Diabetes Resources is a compilation of companies and individuals offering products and/or information to help diabetics, especially those who are blind or are losing vision, to self-manage their diabetes. The list will contain the following subject categories: General and Miscellaneous, Insulin Measurement Devices, Insulin Syringe Magnifiers, Insulin Injection Systems, Diabetic Foot Care, Blood Glucose Monitoring Systems, Insulin Pumps, Products for the Blind, Food and Diet, Literature and Information, Distributors of Diabetes Equipment and Supplies, and Medication Assistance.
Blind diabetics can and do accurately draw up insulin, monitor blood glucose, and perform the other tasks of independent self-management. By using alternative techniques and products, they can continue being independent, and control their diabetes as efficiently as do their sighted peers. Limitations are usually self-imposed--often all that is needed to overcome negative thinking is simply to know where to go for information.
Diabetes Resources: Equipment, Services, and Information will cost $5 per copy, and will be available in Braille, large print, and audiocassette (recorded at 15/16 IPS for the blind). Available July 12, 2001. Please order from: National Federation of the Blind, Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314. Note: the NFB Materials Center is open weekdays 8am to 5:00pm Eastern time.
FRUIT-FLAVORED DRINKS
If you like no-calorie fruit-flavored drinks, check out new Fruit20 Plus, from VERYFINE. Like their Fruit20, the new drinks have a snappy taste that makes the competition taste "diluted." The new "Plus" flavors also include herbs like Ginseng, Kava Kava, Echinacea, Lavender, and Chamomile. All the "plus" drinks contain significant All drinks are sweetened with no-calorie Splenda sweetener,and available in a number of fruit flavors.
For information, contact: Veryfine Products, 210 Littleton Road, PO Box 670, Westford, MA 01886-0670; telephone: (978) 692-0030.
DELIVERED TO YOUR DOOR
Homed Pharmacy Services will deliver your diabetic supplies to your door. If you have Medicare, and/or private insurance, your supplies may come at no cost to you. Homed handles all insurance claims, and delivery is free. For more information, call Homed Pharmacy Services; telephone: 1-800-226-7212; fax: 1-800-381-9929.
UNIQUE GLUCOMETER
There are many fine, accurate glucose monitors out there, but the Bayer Glucometer Dex is unique. Other monitors require you to handle a new test strip each time, and many require a "hanging drop of blood." Some meters must even be held upright, and dead still. Not the Dex. Drop in a 10-test cartridge, and the compact, convenient Dex, a favorite of diabetic athletes, sets itself. Load it in the morning test all day without a pocketful of gear.
The Dex is widely available now, and probably on your pharmacy shelf. For information, telephone: 1-800-445-5901; or find it on the web at: www.glucometerdex.com
ADAPTIVE COMPUTING EQUIPMENT
Freedom Scientific is a powerhouse adaptive equipment maker for the blind and visually impaired computer user. A union of Arkenstone, Blazie Engineering, and Henter-Joyce, Freedom Scientific offers screen magnifiers, talking attachments (voice synthesizers) for your computer, Braille printers and much more. Whether you need software or hardware, check them out: Freedom Scientific; telephone: 1- 800-444-4443; website: www.freedomscientific.com
TREAT MALE IMPOTENCE
Diabetic impotence is one of the nastier side effects of diabetes. Although new oral medications work, for about 2/3 of diabetic men who are experiencing this complication, many need another alternative.
Timm Medical Technologies, successor to Osbon, offers the ErecAid Esteem External Vacuum Therapy System. It is safe, drug-free, easy to use, and has a proven 90% success rate.
For more information on the ErecAid, contact: Timm Medical Technologies, Inc.; telephone: 1-800-435-6780; website: www.timmmedical.com
HEALTHY SUPPLEMENT
Many people believe that "free radicals," chemicals produced by conditions such as diabetic high blood sugar, are dangerous. This line of thinking says that if such oxidants are controlled, health will be improved. Experimenters have isolated "antioxidants" such as alpha- lipoic acid, which they believe raises insulin sensitivity in persons with type 2 diabetes. Glucotize, by MRI, is a "timed release" formulation of alpha-lipoic acid, meant for oral use in association with your regular diabetes medications. NOTE: It has not been approved by the Food and Drug Administration. For information, contact: Medical Research Institute, 1001 Bayhill Drive, Suite 204, San Bruno, CA; 94066; telephone: 1-888-448-4246; website: www.lipoic.com
Diabetes Supplies
Inverness Medical Corporation carries a full line of discount-priced diabetes supplies, including: Dex-4 glucose tablets, skin cream, and Excel test strips for the Glucometer Elite monitor. The company also markets the Monoject line of insulin syringes and lancets. Many Inverness (formerly Can-Am) products are also sold as "house brand" at major pharmacy chains. Their low price in no way compromises their high quality.
For information, contact: Inverness Medical Corporation, 200 Prospect Street, Waltham, MA 02453; telephone: 1-800-461-7448.
Full Service Diabetes Supplier
D & S Medical Supply is a full-service supplier with a catalog of more than 55,000 items, dealing with diabetes, its complications, and many other medical supplies, delivered to your home. Diabetes products range from glucose monitors by Bayer and LifeScan, and the AccuChek VoiceMate talking glucose monitor,strips, lancets and other supplies, to diabetic orthotics/foot care items, and much more. They accept Medicare, private insurance, some HMOs, and, in most states, direct or crossover Medicaid. Contact: D & S Medical, 2105 Newport Place, Suite 600, Lawrenceville, GA 30043-5561; telephone: 1-800-722-2604; website: www.dsmedical.com
SAVE YOUR SKIN
Lantiseptic is a line of skin care products of interest to diabetics. The line includes a cream and a skin protectant, both appropriate for the dry skin diabetics can face. The cream is especially appropriate for dry feet, and has been clinically tested as appropriate for diabetic foot care.
Both products come in tube or jar, and FREE SAMPLES ARE AVAILABLE. For information, or to obtain a free sample, contact: Summit Industries, Inc., PO Box 7329, Marietta, GA 30065; telephone: 1-800-241-6996. For a free sample, telephone: 1-800-347-2456.
DIABETES SUPPLIES
When you need it, you need it. When it's time to test, when it's time for medication, you need it already there. Diabetic Care Center will ship your diabetes supplies to your door, and they do the paperwork. No forms, no trips to the pharmacy. Medicare and most private insurance accepted. Call the Diabetic Care Center, telephone: 1-800-633-7167; website: http://www.diabeticare.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.
READING MACHINE
There are many ways to cope with the problems loss of vision brings to reading. There are optical reading machines, where you scan a printed page into computer memory, from where it is then read by a synthesized voice. Now there is another alternative: the L&H MagniReader.
This device combines CCTV magnification with an optical reader. The MagniReader magnifies text or graphics up to 36x on screen, and reads it aloud, in a clear voice. You can use either or both modes.
To find out more about this reading machine, contact: Lernout and Hauspie Speech Products USA, Inc., Kurzweil Educational Systems Group, 52 Third Avenue, Burlington, MA 01803; telephone: 1-800-894-5374; website: http://www.lhsl.com/educationad/votd
DIABETES SUPPLIES
American Diabetic Supply, Inc., will ship your diabetes supplies to your door. They handle all insurance claims and provide free delivery. Folks with Medicare and/or private insurance (no HMOs) may receive supplies with no further cost. For information, contact: American Diabetic Supply, Inc., 400 S. Atlantic Ave., Suite 108, Ormond Beach, FL 32176; telephone: 1-800-453-9033.
DIABETES MOVIE
Diabetes is no comedy, but DIABETES FOR GUYS is. This video is a spoof of "action" pictures like JAWS, DIRTY HARRY, MISSION IMPOSSIBLE, and more, but it focuses, through comic characterizations and situations, on the class of people most likely to believe diabetes complications can't possibly happen to them men.
Directed by Stephen Furst (of Animal House fame), the story portrays, through humor and slapstick, the tribulations of an overweight, out-of-control diabetic, and the lessons he learns about self-destructive behavior, and the need to achieve good control.
Priced at $17.95, DIABETES FOR GUYS (#1-58040-074-4) is available from amazon.com, or from the American Diabetes Association (telephone: 1-800-232-6733).
NUTRITION SUPPLEMENT
Your insulin or oral diabetes medications are only part of your diabetes self-management. Although food supplements do not replace your medications, and the U.S. Food and Drug Administration has not evaluated their efficacy to prevent or treat any disease, a healthy diet is important, and research is continuing on the role specific supplements may play in controlling diabetes. AlphaBetic Multi-Vitamin Supplement is a food supplement formulated for the special needs of diabetics. A blend of vitamins, antioxidants, and minerals, it is available in sugar-free caplets. Contact: Abkit, Inc. New York, NY 10128; telephone: 1-800-226-6227; website http://www.alphabetic.com
DIABETES SUPPLIES
Diabetic Supply Distributors, Inc., helps you save four ways with your diabetes supplies:
1. Insurance billing. They file the claim, and they pay for delivery. No advance payment needed -- and THEY do the paperwork.
2. Medicare billing. Medicare pays for approved diabetes supplies (and, since last July, that list has covered type 2 diabetics!). Diabetic Supply will handle the details.
3. Free, fast home delivery. Your order comes quickly to your door.
4. Friendly personal service. You're not talking to a computer. Contact: Diabetic Supply Distributors, Inc., PO Box 1820, Laurel Springs, NJ 08021; telephone: 1-800-962-8098.
TALKING COMPUTER
The VoiceNote, from HumanWare, is a laptop note- taker/organizer for blind individuals and those losing vision. It combines the familiar MicroSoft WINDOWS CE operating system, and standard computer keyboard, with voice access. You can create MS Word documents, access your e- mail, transfer documents to and from a standard PC computer, use your VoiceNote as a speech synthesizer for another computer, and access a number of planning and scheduling tools. For more information, about the VoiceNote or other products, contact: HumanWare, 6246 King Road, Loomis, CA 95650; telephone: 1-800-722-3393; website: www.humanware.com
TREAT MALE IMPOTENCE
For men who've had diabetes many years, one possible ramification is impotence, the inability to sustain an erection. This can be treated in a number of ways, but the least invasive is vacuum therapy. The Vet-Co Vacuum Therapy System for male impotence is FDA-Approved, safe, non-invasive, and easy to use. For information, call: Coast To Coast Home Medical; telephone: 1-800-330-6316.
Artwork: Dancing fruit and vegetables.
We invite blurbs and tidbit articles for inclusion in this column. Materials received may be edited and used as space permits. Products and services included in this column are for information only and do not imply endorsement by the Diabetes Action Network of the NFB.
INHALED INSULIN PROGRESS
Generex Biotechnology has been conducting clinicals of its RapidMist oral insulin spray technology and Oralin oral insulin formulation. In February, they delivered several papers about their findings, at the 5th International Congress of Immunology, held in Madras, India. They have carried out tests on both healthy volunteers and type 1 and type 2 diabetics. The research continues, and it will be some time before final U.S. approval is possible.
U.S. insulin manufacturer Eli Lilly and Company is now working with Generex to help develop an oral spray-insulin. Stay tuned; if and when the product reaches approval it will be major news, and you'll hear about it in VOICE OF THE DIABETIC.
FREE EYE EXAMS
We know diabetes is the #1 cause of new blindness in working-age Americans. If you have diabetes, you need regular eye examinations.
The American Optometric Association and the American Academy of Ophthalmology, along with the U.S. Health Care Financing Administration, are sponsoring a new eye-exam initiative. If you are 65 years or older, have diabetes, and have not had an eye exam in the last three years, call the National Eye Care Project Helpline: 1-800-222-3937. You will be put in contact with an ophthalmologist who will provide you a no-cost eye exam, and up to a year of follow- up care for any condition diagnosed at that exam. To be eligible, you must not have HMO or Managed Care coverage that would otherwise cover cost of the exams.
You can also call the American Optometric Association's Diabetes Hot Line: 1-800-262-3947, for information about this program.
VOICE Formats
VOICE OF THE DIABETIC is offered in two formats: standard print, and 15/16 ips audiocassette, "talking book" speed. Anyone who is currently receiving the VOICE in print and having difficulty reading it, may receive it on cassette at no charge. VOICE tapes require the special tape player available free to the legally blind from Regional Libraries for the Blind and Physically Handicapped, which can be obtained by telephoning the National Library Service at: 1-800-424-8567. Note: Attempting to play VOICE tapes (or any other tapes in NLS format) on a conventional music- speed tape player will yield incomprehensible "chipmunk sounds."
Periodically we receive requests for the VOICE in Braille or large print. It is not available in either of those formats at this time.
All a subscriber needs to do, to switch from standard print to tape, or to receive both formats, free of charge, is contact us at the VOICE OF THE DIABETIC Editorial Office.
THE BRAGGART
A strong young man at the construction site was bragging that he could outdo anyone in a feat of strength. He made a special case of making fun of Morris, one of the older workmen. After several minutes, Morris had enough.
"Why don't you put your money where your mouth is?" he said. "I will bet a week's wages that I can haul something in a wheelbarrow over to that outbuilding that you won't be able to wheel back."
"You're on, old man," the braggart replied. "It's a bet! Let's see what you got."
Morris reached out and grabbed the wheelbarrow by the handles. Then, nodding to the young man, he said, "All right. Get in."
Cygnus and LifeScan
Cygnus, Inc., maker of the GlucoWatch Biographer continuous glucose monitor, has signed a marketing agreement with LifeScan, maker of the One Touch, SureStep, and FastTake glucose monitors. If the Food and Drug Administration issues final approval, the two firms will cooperate on a pilot marketing program for the Glucowatch, in which 100-150 units will be released for "out of the lab" day-to-day use, and extensive data will be collected. The objective is to gather data on attitudes, practices, and experiences by both users and their health care professionals.
Stay tuned; this agreement, a sign that LifeScan takes the GlucoWatch seriously, looks very positive.
DIABETES INFORMATION IN BRAILLE
Although diabetes is the biggest cause of new blindness in working-age Americans, and there may be as many as two million Americans coping with both diabetes and serious vision loss, diabetes information in alternative format has been in short supply. Now there is a source for diabetes articles in Braille.
The Braille Group of Buffalo's diabetes collection includes:
101 Tips for Improving Blood Sugar ($11.95 donation)
ADA Complete Guide to Diabetes ($19.95 donation) Carbohydrate Counting (3 booklets) ($5.00 donation)
Diabetes A to Z ($11.95 donation)
Diabetic Cooking ($3.50 donation)
Exchange Lists for Meal Planning (FREE)
First Steps in Diabetic Meal Planning (FREE)
First Things First (set of 10 pamphlets) (FREE)
Magic Menus for People with Diabetes ($14.95 donation)
Quick and Healthy, Vol. II ($16.95 donation)
Simple and Tasty Side Dishes ($8.95 donation)
Southern-Style Diabetic Cooking ($11.95 donation)
Note: They expect to add more titles to their Braille list, so contact them for a full catalog and availability, and spread the word to your Braille-using friends who have interest in diabetes. As these materials are offered at a fraction of real cost, the Braille Group asks for a doctor's certification that the recipient is a Braille-reader either with diabetes, or caring for someone with diabetes. Call them for more information.
Contact: the Braille Group of Buffalo, Jill Pariso and Sue Kahn, 4660 Sheridan Drive, Buffalo, NY 14221; telephone: 1-800-561-8253; fax (716) 633-8952; e-mail: [email protected]
NEW INSULIN MEASURING DEVICE
People who are blind or losing vision, or who have manual dexterity problems, can need help drawing up insulin. There have been several adaptive devices on the market -- and there will soon be another. Novo Nordisk Pharmaceuticals Inc. announces the Innolet, a combination adaptive drawing-up aid and insulin injector. Already available in Denmark, the Innolet features a large "kitchen- timer" style dial, and a large grip/trigger.
The Innolet is not yet available in the United States, but expect it soon.
MORE BOOKS ON TAPE
VISION Community Services, a division of the Massachusetts Association for the Blind, offers a number of books on tape, recorded at talking book speed (NLS Format) on four tracks. Most books are $5 per tape. Their catalog includes a number of nonfiction texts and manuals, not just "literary" materials, and they will record your book or other document, for a nominal fee. They even offer a 4- track tape subscription of the Harvard Business Review, 10 issues, for $118 per year!
To order, contact: Robert Pierson, Recording Studio Coordinator, Massachusetts Association for the Blind, 23A Elm Street, Watertown, MA 02472; telephone: (617) 926-4232; fax: (617) 926-1412; e-mail: [email protected]; website: http://www.mablind.org
DIVISION BOARD
The current (2000/2001) national Board of the Diabetes Action Network of the National Federation of the Blind is:
President: Ed Bryant (Columbia, MO)
First Vice President: Eric Woods (Denver, CO)
Second Vice President: Sandie Addy (Prescott Valley, AZ)
Treasurer: Bruce Peters (Akron, OH)
Secretary: Sally York (Castro Valley, CA)
Board Member: Gisela Distel (Albany, NY)
Board Member: Paul Price (Valley Center, CA)
Board Member: Dawnelle Cruze (Portsmouth, VA)
ARTICLES NEEDED If you have diabetes, are a family member or friend of a diabetic, or a health professional with an interest in diabetes, we invite you to submit an article for publication in the VOICE OF THE DIABETIC.
Our philosophy regarding diabetes is positive. Do you have an inspiring, enlightening story? We, the Diabetes Action Network of the National Federation of the Blind, seek to show people they are not alone, and do have options, regardless of diabetic complications. If you have experienced ramifications, others, who may be facing the same side-effects, could benefit from what you have to say.
Perhaps you have not experienced complications--your unique insight, coping strategies, and lifestyle can still inspire others. Are you a relative, a friend, or a health professional? More than 267,115 VOICE readers could benefit from your story.
For information and article submission guidelines, contact: VOICE OF THE DIABETIC, 811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911.
NEW WEBSITE
Eli Lilly and Company now sponsors the website: www.lillydiabetes.com
Significant features of this site include the "tracking tools," graphs and charts to help the diabetic chart HbA1c test results, Blood pressure test results, and a "height and weight index" to help with calculation of body mass index, a ratio widely used to help determine ideal weight.
The site also includes product information, test results and success stories, as well as news releases about Lilly's many fund-raising activities. Check it out!
HEAR YE, HEAR YE, A RAFFLE
The Diabetes Action Network of the National Federation of the Blind reaches out and provides support and information to thousands of people. Because it costs to operate this valuable network and to produce the VOICE OF THE DIABETIC, we must generate funds to help cover these expenses. Our Diabetes Action Network has elected to hold a raffle, which will be coordinated by our division treasurer, Bruce Peters.
THE GRAND PRIZE WILL BE $500! The winning ticket will be drawn, and the winner's name announced, on July 6, 2001, at the banquet held during the annual convention of the National Federation of the Blind.
Raffle tickets cost $1 each, or a book of six may be purchased for $5. Tickets may be purchased from state representatives of our Diabetes Action Network or by contacting the VOICE Editorial Office, 811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911. Anyone interested in selling tickets should also contact the VOICE Editorial Office. Tickets are available now! Names of persons who sell 50 tickets or more will be announced in the VOICE.
Please make checks payable to the National Federation of the Blind. Money and sold raffle ticket stubs must be mailed to the VOICE office no later than June 10, 2001, or they can be personally delivered to Raffle Chairman Bruce Peters, at this year's NFB convention in Philadelphia, Pennsylvania. This raffle is open to anyone age 18 or older, and the holder of the lucky raffle ticket need not be present to win. Each ticket sold is a donation, helping keep our Diabetes Action Network moving forward.
NFB SCHOLARSHIP PROGRAM
Photo: portrait. Caption: Peggy Elliott
The National Federation of the Blind will award $125,000 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 2001.
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 2001 convention of the National Federation of the Blind, in Philadelphia, Pennsylvania. 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 2001 NFB Scholarship program must be received by March 31, 2001. 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: (515) 236-3366.
2. National Federation of the Blind Scholarship Committee, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314.
3. All NFB state officers.
4. Financial Aid Offices of educational institutions.
HERBAL CAUTION
Herbal medications and "botanicals" are as powerful as many prescription medications, cautions the American Optometric Association, and they can have serious side effects. Although these medications may be "natural," they are not harmless.
Herbs reported as (or suspected of) causing ocular problems include Black Cohash, Ginseng, Bilberry, Kava Kava, St. John's Wort, and a combination, marketed to "fight cellulite," containing Gingko Bilboa, Grapeseed Extract, Sweet Clover and Iodine.
Many herbals are harmless; some are probably beneficial. What is important is to remember they are medicines, and thus need to be reported to the doctor. Certain medicines interact with other medicines, and can have unpredictable side effects. It is vital your doctor know all the medicines you are taking -- including the ones you bought at the health food store.
VOICE FORMATS
VOICE OF THE DIABETIC is offered in two formats: standard print, and 15/16 ips audiocassette, "talking book" speed. Anyone who is currently receiving the VOICE in print and having difficulty reading it, may receive it on cassette at no charge. VOICE tapes require the special tape player available free to the legally blind from Regional Libraries for the Blind and Physically Handicapped, which can be obtained by telephoning the National Library Service at: 1-800-424-8567. Note: Attempting to play VOICE tapes (or any other tapes in NLS format) on a conventional music-speed tape player will yield incomprehensible "chipmunk sounds."
Periodically, we receive requests for the VOICE in Braille or large print. It is not available in either of those formats at this time.
All a subscriber needs to do, to switch from standard print to tape, or to receive both formats, free of charge, is contact us at the VOICE OF THE DIABETIC Editorial Office.
ARTICLES NEEDED
If you have diabetes, are a family member or friend of a diabetic, or a health professional with an interest in diabetes, we invite you to submit an article for publication in the VOICE OF THE DIABETIC.
Our philosophy regarding diabetes is positive. Do you have an inspiring, enlightening story? We, the Diabetes Action Network of the National Federation of the Blind, seek to show people they are not alone, and do have options, regardless of diabetic complications. If you have experienced ramifications, others, who may be facing the same side-effects, could benefit from what you have to say.
Perhaps you have not experienced complications--your unique insight, coping strategies, and lifestyle can still inspire others. Are you a relative, a friend, or a health professional? More than 290,315 VOICE readers could benefit from your story.
For information and article submission guidelines, contact: VOICE OF THE DIABETIC, 811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911.
VOICE DISTRIBUTORS NEEDED
Since the VOICE is now offered free, our Diabetes Action Network will provide extra copies to anyone wanting to help spread the word. We will gladly send from five to five hundred-plus copies each quarter to be used as free literature. Medical facilities can order as needed for patients. Individuals can usually place copies of the VOICE in libraries, pharmacies, hospitals, doctors' offices, or other public locations.
Diabetes education is essential. Anyone who distributes the VOICE will be helping people with diabetes, and their families, to learn about the disease and its ramifications; to learn that they have options; and that their world is far greater than whatever "limits" may be imposed by the disease. If you would like to help spread the word by distributing the publication, please contact: Voice of the Diabetic, 811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911, fax: (573) 875-8902. NOTE: Please provide a phone number so we can reach you.
SUBSCRIPTION/DONATION FORM
The VOICE OF THE DIABETIC is a quarterly magazine published by the Diabetes Action Network of the National Federation of the Blind (NFB) for anyone interested in diabetes, especially diabetics who are blind or are losing vision. An outreach publication, it emphasizes good diabetes control, diet, and independence.
Donations are gladly accepted and appreciated. Contributions are not only tax deductible but are needed to keep the VOICE and the Diabetes Action Network moving forward to help people with all aspects of diabetes.
Members of the NFB Diabetes Action Network enjoy priority services and unique benefits such as a continuous free subscription to the VOICE, automatic access to committees covering all aspects of diabetes, free counseling concerning all facets of blindness and diabetes, as well as access to diabetics who have experienced complications.
The VOICE is free to any interested person upon request. Each subscription costs the Diabetes Action Network approximately $20 per year. To help defray publication expenses, members are invited, and nonmembers are encouraged, to cover the subscription cost.
To begin receiving the VOICE, please check one:
[ ] I would like to become a member of the NFB Diabetes Action Network and receive the VOICE OF THE DIABETIC. (Members are entitled to special benefits.)
[ ] I would like to receive the VOICE OF THE DIABETIC as a nonmember. (Nonmembers are encouraged to pay the institutional rate of $20/one year; $35/two years; $50/three years.)
Send the VOICE in (check one): [ ] print [ ] cassette tape for the blind [ ] both and physically handicapped (recorded at slower-than- standard speed of 15/16 IPS)
Optionally check this box:
[ ] I would like to make (or add) a tax-deductible contribution of $__________ to the Diabetes Action Network of the National Federation of the Blind.
PLEASE PRINT CLEARLY
Name:_____________________________________________________ Address:__________________________________________________ __________________________________________________
City:_______________________ State:______ Zip:__________
Telephone: ( )________________________
Send this form or a facsimile to:
Voice of the Diabetic 811 Cherry Street, Suite 309
Columbia, MO 65201
Telephone: (573) 875-8911 Fax: (573) 875-8902
Please make all checks payable to: NATIONAL FEDERATION OF THE BLIND