Voice of the Diabetic
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VOICE OF THE DIABETIC
The Diabetes Action Network of the
National Federation of the Blind
A Support and Information Network
Volume 16, Number 4, Fall Edition 2001
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VOICE OF THE DIABETIC, published quarterly, is the national news magazine of
the Diabetes Action Network of the National Federation of the Blind. It is read
by those interested in all aspects of blindness and diabetes. We show diabetics
that they have options regardless of the ramifications they may have had. We
have a positive philosophy and know that positive attitudes are contagious.
News items, change of address notices, and other magazine correspondence should
be sent to: Ed Bryant, Editor, Voice of the Diabetic, 1412 I-70 Drive SW, Suite
C, Columbia, Missouri 65203; Phone: (573) 875-8911; Fax: (573) 875-8902.
Find us on the World Wide Web at: 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.
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From The Editor:
Please remember all those who lost their lives at the World Trade Center and
the U.S. Pentagon. This senseless tragedy should not, and will not stop America,
and the freedoms we enjoy and value.
GOD BLESS AMERICA!
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WE'VE MOVED
Effective immediately, the Diabetes Action Network, and the VOICE OF THE DIABETIC
editorial office, have relocated.
Our new address:
DIABETES ACTION NETWORK
NATIONAL FEDERATION OF THE BLIND
1412 I-70 Drive SW, Suite C
Columbia, MO 65203
(573) 875-8911
fax: (573) 875-8902
All VOICE correspondence (inquiries, subscriptions, address changes, article
submissions) should now come to this new address.
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VOICE OF THE DIABETIC is offered absolutely free to any interested person upon
request. Readers may receive the publication in standard print, on audio cassette
for the blind, or in both formats. To begin receiving the VOICE, please complete
the subscription form (or a facsimile), found at the end, and mail it to the
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you place first class postage on any VOICE you mail to others.
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INSIDE THIS ISSUE
WHY I EXERCISE (AND WHY YOU SHOULD TOO)
by Sheri Colberg, PhD .....
HEART RISKS TIED TO GLYCEMIC CONTROL .....
ASK THE DOCTOR
by Wesley W. Wilson, MD .....
EXPECTING THE BEST: DIABETES, PREGNANCY, AND BLOOD GLUCOSE CONTROL
by Laura Hieronymus, RN, MSN, CDE, and Patti Geil, MS, RD, LD, CDE
DIABETES CARE IS TEAM CARE
by Peter J. Nebergall, PhD ....
MONITOR MINIATURES ....
ASK JANIS
by Janis Roszler, RD, CDE, LD/N
THE REST OF THE STORY: DIABETIC MANAGEMENT AND PAIN CONTROL
by David Michael Wright ....
BOOK REVIEWS
by Marilyn Helton .....
AMERICA'S JOBLINE FOR THE BLIND ...
COPING WITH TYPE 2 DIABETES
by Peter J. Nebergall, PhD ....
RECIPE CORNER .....
DIABETES STUDY SEEKS VOLUNTEERS ...
FLU SHOTS ....
DIABETES AND BLINDNESS RESOURCES
by Ed Bryant .....
WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK
(Resource Column).....
FOOD FOR THOUGHT .....
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WHY I EXERCISE (AND WHY YOU SHOULD TOO)
Photo: portrait. Caption: Sheri Colberg.
Treatment of diabetes has gone through dramatic changes in the past two decades.
Previously, exercise was often overlooked as a "cornerstone" in its
treatment as it was difficult to maintain blood sugar levels with the additional
variability introduced by physical activity, especially for individuals with
type 1 diabetes. However, with blood glucose meters now being readily available
and affordable, exercise can be done safely and without fear of severely upsetting
an often delicate glucose balance.
Diagnosed with diabetes myself at the age of four in what I call the "Dark
Ages" of diabetes (1968), I went through childhood, adolescence, and early
adulthood without the benefit of a blood glucose meter. I still participated
in a variety of sports and physical activities "pre-meter," including
swimming, running, racquetball, soccer, tennis, weight training, gymnastics,
volleyball, cycling, aerobics, dancing, stair master, hiking and backpacking,
canoeing, football equipment managing, snow shoeing, cross country and downhill
skiing, horseback riding, sailing, snorkeling, and sky diving. I did many of
these activities, however, feeling less than my physical best. Since I could
not test my blood sugars, tightly managing them to prevent highs and lows was
virtually impossible. Growing up I always experienced that exercise of any kind
made me feel better overall, although at the time I did not understand human
physiology well enough to know why. I felt I had more control over my diabetes
when I exercised as well. Consequently, I began exercising regularly on my own
and through participation in sports as a young teen-ager and have continued
this participation (albeit recreational only at this point) throughout my adulthood.
Not until I had my first blood glucose meter in 1986 did I realize how much
better I felt during exercise when my blood sugars were in a more normal range.
Keeping them normal (with the help of a blood glucose meter) has totally been
a trial-and-error learning process! At the time I got my meter, there were very
few guidelines or books that could offer me any guidance on exercise control.
I did eventually learn to control my blood sugars for various activities; but
every time I tried a new or unusual one, it was like starting over again. Over
time, I met a lot of other active individuals who happened to have diabetes.
I discovered I could learn so much from others' experiences that could hopefully
make my trial-and-error process shorter and easier. With this experience in
mind, I eventually got the idea and motivation for my book, THE DIABETIC ATHLETE
(Human Kinetics, 2001), which covers the basics about exercise, understanding
your body's responses, the effects of insulin and other diabetic medications
on exercise, eating for exercise, exercise guidelines for type 1 and type 2
diabetes, and diabetic regimen changes for over 85 sports and physical activities,
including real-life athlete examples of changes they make.
I have always found that knowledge is power when it comes to managing diabetes.
I searched out information for years, which finally resulted in me earning a
doctoral degree in Exercise Physiology from the University of California, Berkeley!
While you do not need a PhD to understand how your body adapts to exercise,
you do need to understand the basics in order to make knowledgeable and safe
changes in your diet or medications to get the most out of your workouts. It
is my belief this combination of basic (the why of exercise) and experiential
(the how of exercise) information can benefit all of us in maintaining blood
sugars during any physical endeavor! For example, when you learn to determine
what energy systems and fuels your body is using during the exercise, then you
can closely predict what your blood sugar response is likely to be and what
action you need to take to maintain normal sugars during and following the activity.
It is important to understand the types of medications and regimens you use
to either replace insulin or improve its production and action. Your body's
level of circulating insulin in your blood will be greatly affected by differing
insulin regimens, timing of exercise, and sensitivity to insulin. For example,
exercise in the morning usually results in a much smaller decrease in blood
sugars compared with later in the day, as your body is more resistant to insulin
after fasting overnight. Also, given the variety of insulin regimens and oral
diabetic medicines that people use now, strategies that work well for one individual
may not work well for another. I, myself, prefer my latest insulin regimen,
the insulin infusion pump. Using my insulin pump (the ANIMAS R-1000), I can
easily decrease the amount of insulin circulating in my blood by altering the
basal rate of insulin delivery, and I can easily compensate for changes in my
body's sensitivity to insulin after exercise by choosing a basal rate profile
programmed with lower rates.
"Fitness" can be defined many different ways. Probably most important
to overall health is aerobic fitness, or physical conditioning resulting from
prolonged aerobic activities such as brisk walking, jogging, cycling, swimming,
rowing, and aerobic dance. An aerobic exercise program incorporates all the
following components in determining the level of fitness you achieve: the type
of exercise you choose to do (mode), how often (frequency), how long (duration),
and how hard (intensity) you exercise, and your rate of progression. The current
recommendations include doing aerobic exercise a minimum of three to five days
a week, for 20-60 minutes (continuously, or for a minimum of 10 minute sessions
throughout the day), at a moderate intensity (one that feels at least "somewhat
hard"), and progressing as able. Try to incorporate some resistance or
weight training into your regimen two to three days as well to help maintain
your muscle mass and insulin sensitivity. An exercise prescription should be
developed with careful consideration of your health status (diabetes control,
complications, and other health problems), risk factors for cardiovascular disease,
personal goals, and exercise preferences. Also keep in mind that while the intensity
of an activity determines most of the overload on your muscles and your subsequent
fitness gains, it additionally influences your blood sugar responses if you
have diabetes.
If you are already an avid exerciser, then you are aware of most of the benefits
of exercise on your physical health and your diabetes control. If you are still
in the thinking stage about incorporating regular fitness activities or sports
into your lifestyle, then you have a lot of positive changes to anticipate.
In addition to the little treats you may be able to allow yourself occasionally
after working out, exercise can help you build muscle and lose body fat, suppress
your appetite, eat more overall without gaining fat weight, enhance your mood,
reduce stress and anxiety levels, increase your overall energy level, improve
your immunity, keep your joints and muscles more flexible, and generally improve
the quality of your life! Individuals who engage in regular moderate exercise
are at lower risk for many chronic health problems as well, including heart
disease, obesity, hypertension, type 2 diabetes, certain cancers, and other
metabolic disorders.
The usual health benefits of exercise apply to individuals with diabetes as
well, perhaps even more than normal. Much of what we attribute to the aging
process really results from disuse (for example, muscle atrophy, or loss of
flexibility in joints). Diabetes, especially when blood sugars are poorly controlled,
accelerates the normal aging process, as well as certain disease processes such
as heart disease. Thus, regular exercise can help slow aging and reduce long-term
complications associated with poor blood sugar control and diabetes. These diabetes-related
benefits can not be understated! Not only can you enjoy your favorite physical
activity, but also you can help your diabetes and health too. In fact, regular
exercise is the most important activity you can do to slow the aging process,
manage your blood sugars, and reduce your risk of diabetic complications.
Diabetic complications are, unfortunately, a reality for many individuals with
diabetes; exercise can usually still be done, but certain precautions may be
needed to make your exercise more safe. If you have any complications such as
eye or heart disease, make sure you follow the exercise guidelines related to
your condition to prevent it from worsening with exercise. It is also important
that you recognize all the potential symptoms of low blood sugar (hypoglycemia),
especially if you have not experienced it often, as its symptoms may differ
during exercise and after you become conditioned. Likewise, remember that proper
warm-ups, cool-downs, and stretching are especially important for diabetic exercisers
for prevention of injuries.
Most of all, lose the excuses! Whether you are interested in just recreating
or want to be a serious competitive athlete, it is time to get out there and
start exercising! Your body will thank you.
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ASK THE DOCTOR
by Wesley W. Wilson, MD
Artwork: medical caduceus.
NOTE: If you have any questions for "Ask the Doctor," please send
them to the VOICE editorial office. The only questions Dr. Wilson will be able
to answer are the ones used in this column.
Wesley W. Wilson, MD has retired as an Internal Medicine practitioner at the
Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type
1 diabetes in 1956, during his second year of medical school. He remains interested
and involved in diabetes education for patients and professionals.
Q: A friend of mine, who has type 1 diabetes, and is now a college freshman,
has complained bitterly that her parents never let her participate in any athletics
at all, out of fear that she would have hypos. Is this overprotective? How much
should parents of diabetic children restrict participation in sports and athletics?
A: The major diabetes magazines all regularly feature stories about successful
athletes, collegiate, Olympian, and professional, who have diabetes. People
with diabetes regularly run 26 mile marathons, climb mountains, play football,
and have babies. It is both possible and beneficial to be physically active
while living with diabetes.
I have worked at a summer camp for diabetic children, here in Montana, and
I have been impressed by how well these children cope with the outdoors activities.
Many times they arrive overprotected, but blossom in camp when they are able
to measure (with help) their own insulin, take their own injections, and play
competitive games with their peers, all of whom are insulin-using diabetics.
The risk of hypoglycemia is real, and is somewhat increased by vigorous physical
activity (such as sports), but that is not a reason to avoid physical activity.
There are many benefits to participating in sports, games, and other physical
activities, so many that I think such must be part of any treatment program
for diabetes. One of the most important benefits may be that the participant
discovers that their diabetes has NOT made them so different from their friends,
neighbors, and associates.
I would strongly suggest that your friend start an exercise and athletic program.
She should discuss this with her doctor and diabetes educator first, of course;
but once she gets moving, she will feel both physically better and better about
herself.
I might add that one of the reasons I am strongly in favor of diabetes camps
for children is to allow some of the overprotected children with the condition
to interact with others with diabetes, and to understand that they, too, can
assume control of their lives. A feeling of independence is a great motivator.
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DIABETES CARE IS TEAM CARE
by Peter J. Nebergall, PhD
In VOICE Vol. 12, No. 2, I wrote of the need to move diabetes care away from
the "primary caregiver/general practitioner as gatekeeper" model of
health service delivery. I pointed out that expecting one GP to be "up"
on all the latest treatment modalities of diabetes (or any other serious and
specialized condition) is unfair to both the patient and the GP.
Now the HMO, the "health maintenance organization," was founded to
control America's rocketing health costs. Its goal was to cut out the unnecessary
treatments (33%, according to the insurance industry) routinely provided to
lawsuit-waving hypochondriacs. Commendable, but such "gatekeeping"
assumes omniscience on the part of the gatekeeper. That's unrealistic.
When someone has diabetes (especially after they've been diagnosed), the best
results come from the tried and true "health care team" approach.
Such a team ideally includes ophthalmologist, dietitian, diabetes educator,
perhaps nephrologist, urologist and exercise physiologist, along with the diabetologist
and the patient. And they all work together.
THE NATIONAL DIABETES EDUCATION PROJECT (NDEP), a joint effort of the National
Institutes of Health (NIH)and the Centers for Disease Control and Prevention
(CDC) has just issued a report titled: TEAM CARE: COMPREHENSIVE LIFETIME MANAGEMENT
FOR DIABETES. In this text they argue the benefits of aggressive, pro-active,
team-based diabetes care outweigh the initial savings inherent in the HMO "gatekeeper"
model. For example, they cite a study in which the average length of hospital
stay (for patients with a primary diagnosis of diabetes) was 56% lower for the
team-managed patients compared to those managed by an internist alone. At least
90% of all diabetes is type 2. Good diabetes self management, especially of
type 2, requires control of many factors. No one generalist, or even one diabetes
specialist, can master it all. We NEED this group approach!
For copies of the report, contact the NDEP at telephone: 1-800-438-5385; website:
http://ndep.nih.gov or the CDC website: www.cdc.gov/diabetes
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HEART RISKS TIED TO GLYCEMIC CONTROL
Evidence continues to mount that poor glycemic control is associated with an
increased risk of heart failure among adult diabetics. Researchers from Kaiser
Permanente, in Oakland, California, recently examined the link between hemoglobin
(Hb)A1c level and risk of serious heart complications in a large sample of young
adult diabetics.
Was there a statistical association? Did it differ by patient sex, heart failure
pathogenesis or hypertension status? The study ran from January 1, 1995 to June
30, 1996, with a follow-up through December 31, 1997, and median follow-up was
2.2 years. Study participants were 25,958 young men and 22,900 women with predominantly
type 2 diabetes, and no known history of heart failure.
A total of 935 cardiac events occurred, 516 among men and 491 among women. Each
1 percent increase in HbA1c (one full A1c number higher) was found to be associated
with an eight percent increased risk of heart failure. A range of factors was
taken into account, including age, sex, race/ethnicity, education, cigarette
smoking, alcohol use, hypertension, obesity, use of beta-blockers and angiotensin
converting enzyme (ACE) inhibitors, type and duration of diabetes and incidence
of interim myocardial infarction.
An HbA1c of 10, relative to the non-diabetic "normal" HbA1c of less
than seven, was associated with a 1.56-fold greater risk of heart failure. The
association was found to be stronger in men than in women. However, there were
no differences by heart failure pathogenesis or hypertension status.
These findings confirm previous evidence that poor glycemic control may be
linked with increased risk of heart failure among diabetic adults, study authors
conclude.
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EXPECTING THE BEST: DIABETES, PREGNANCY, AND BLOOD GLUCOSE CONTROL
by Laura Hieronymus, RN, MSEd, CDE and Patti Geil, MS, RD, LD, CDE
Pregnancy can be a special and exciting time in a woman's life. The anticipation
begins as soon as you hear the words: "You're expecting a baby." Once
you've gotten used to the amazing news, you may wonder about such things as
whether the baby will be a boy or a girl, when the baby is due, and, perhaps
most important, what you need to do in the meantime to make sure the baby stays
healthy and develops normally.
All women feel a certain amount of anxiety and sometimes even fear about how
pregnancy will affect them, and whether their baby will be healthy and normal.
Women with diabetes are no different, but they do have one more thing to be
concerned about: maintaining control of blood glucose levels. This is true whether
a woman has type 1 or type 2 diabetes before becoming pregnant, or whether she
is diagnosed with a condition called gestational diabetes during pregnancy.
The good news is that if a woman who has diabetes (of any type) learns as much
as she can about managing her blood glucose, and puts that knowledge into practice,
she can have a healthy pregnancy and a healthy baby.
Blood glucose control essential
Optimal blood glucose control is important throughout pregnancy, both for the
mother's health and the baby's. Glucose in a mother's blood crosses the placenta
to her baby, affecting the baby's blood glucose level. (The placenta, a flat
circular organ, links the unborn baby to the mother's uterus, to provide oxygen,
nutrients, and the elimination of wastes.) The baby begins making its own insulin
around 13 weeks gestation. If the baby is constantly exposed to high levels
of glucose, it is as if the baby were overeating: The baby produces more insulin
to absorb the excess glucose, resulting in weight gain and an increase in size.
Under these conditions, the baby can become too large, a condition known as
macrosomia. Macrosomia is associated with difficult vaginal delivery, which
can lead to birth injury and/or asphyxia, a condition in which the baby doesn't
get enough oxygen.
Another reason that blood glucose control is important right up to the day
of delivery is that if an unborn baby has high levels of insulin on a consistent
basis, or if the mother's blood glucose level is high during labor, the baby
may experience hypoglycemia (low blood sugar) or other complications when the
umbilical cord (and the maternal blood supply) is cut.
The details of managing blood glucose levels during pregnancy may be different
for women who already have either type 1 or type 2 diabetes before pregnancy
and for those who are diagnosed with diabetes during pregnancy, or gestational
diabetes. (These differences are covered later in this article.) The recommended
blood glucose goals, however, are the same.
It is important to note that the blood glucose goals suggested by the American
Diabetes Association (ADA) for pregnant women are lower than those for the general
population with diabetes. (See sidebar: "Blood Glucose Goals During Pregnancy.")
In addition, the ADA suggests that pregnant women check their blood glucose
levels up to eight times per day: once before each meal, again one hour after
each meal, at bedtime, and once in the middle of the night. (Any woman who is
taking insulin or certain kinds of blood glucose-lowering pills would need to
do additional checks before driving, and if she experienced any symptoms of
low blood sugar.) Your health-care team may recommend a somewhat different monitoring
schedule depending on the type of diabetes you have and how you treat it. However,
frequent self-monitoring is needed to ensure that blood glucose levels remain
within the recommended range.
In addition to blood glucose monitoring, daily urine ketone testing is often
advised for pregnant women with diabetes. Ketones are acid substances that collect
in the bloodstream if the body is unable to break down glucose for energy. This
can occur if there is not enough insulin to break down glucose in the bloodstream
or if there is not enough glucose available to meet energy needs. In either
case, the body begins to use stored fat for energy, a process that yields the
acidic byproducts called ketones. If the body is unable to get rid of the ketones
fast enough (via the lungs and urine), they build up, and can cause a potentially
deadly condition called ketoacidosis.
Ketones in the blood during pregnancy are associated with decreased intelligence
in the baby, and an episode of ketoacidosis during pregnancy greatly increases
the risk of the fetus dying in the uterus. Diabetic ketoacidosis may develop
rapidly, and at lower blood glucose levels in women who are pregnant than in
those who are not. The best approach for preventing this outcome is to closely
monitor blood glucose levels outside the recommended range for pregnancy, and
to promptly treat elevated blood glucose levels, as directed by your diabetes
management team. Notify your diabetes health-care team immediately if you detect
ketones in your urine and have a high blood glucose level.
Ketones that occur when there isn't enough glucose in the bloodstream are called
"starvation ketones." They may occur in women with gestational diabetes,
as well as in those with type 1 or type 2 diabetes. A woman with starvation
ketones would typically have a blood glucose reading in the normal range or
lower than normal. If you are getting starvation ketones, your medical team
may advise you to increase the amount of calories and carbohydrate in your meals
and snacks.
During your pregnancy, if you are not already seeing an endocrinologist, your
obstetrician may refer you to one. Most likely, you would see the endocrinologist
at least once a month during the first and second trimesters (approximately
the first six months of pregnancy) and every two weeks in the third trimester
(the last three months). In addition to your scheduled appointments, you should
discuss specific guidelines for prompt follow-up if blood glucose levels are
not staying within recommended ranges. Your obstetrician will likely evaluate
the growth and condition of your baby throughout your pregnancy with tests such
as ultrasound to monitor your baby's size and the non-stress test, which measures
a baby's heart rate in response to his or her own movements. Additional testing
to monitor your baby's health, or yours, may be recommended by your obstetrician
or by members of your diabetes health-care team.
Insulin needs during pregnancy
During any pregnancy, a woman's insulin needs change, because the normal hormone
production and weight gain that occur during pregnancy increase insulin resistance.
(See sidebar: "Insulin Requirements During Pregnancy.") In women who
do not have or develop diabetes, blood glucose levels remain stable because
the pancreas is able to produce more insulin to accommodate the increased demand.
In women with preexisting diabetes, or who develop gestational diabetes, the
pancreas cannot keep up with the increased demand, so blood glucose levels rise
unless steps are taken to lower them.
In women with preexisting diabetes, insulin needs during the first several
weeks of pregnancy are not usually that different from those before conception.
However, in the latter part of the first trimester, women with preexisting diabetes
may have a higher risk of hypoglycemia because of an increase in sensitivity
to insulin, rapid fetal growth, and a reduction in eating associated with "morning
sickness." Around the 16th week of pregnancy, insulin needs gradually increase,
due to increasing levels of hormones, including human placental lactogen (hPL),
a form of "growth hormone" for the baby.
All women with type 1 diabetes, and most with type 2 either inject or infuse
insulin during pregnancy. Women with gestational diabetes also have to take
steps to control their blood insulin level, but not all will have to inject
insulin. Some women with gestational diabetes can keep their blood glucose at
recommended levels with changes in diet and moderate exercise. Many, however,
must eventually use insulin.
Control before conception
In women with type 1 or type 2 diabetes, optimal blood glucose control is essential
prior to conception, because it is hard to be absolutely certain of when conception
takes place. The incidence of fetal malformations is reduced significantly in
women who have near-normal glycosylated hemoglobin (HbA1c) levels before they
become pregnant. The rate of miscarriage in women with preexisting diabetes
is also reduced by keeping blood glucose as close to normal as possible in the
first trimester.
Ideally, you should strive for a near-normal HbA1c test result at least three
months prior to pregnancy. It is important to discuss any plans to become pregnant
with your diabetes health-care team, particularly if you have vascular complications
related to your diabetes, such as eye or kidney disease. In this situation,
pregnancy is a potential risk to your health. For women with no vascular complications,
a thorough physical exam, good nutrition (including a folic acid supplement),
and excellent blood glucose control before you become pregnant will help minimize
any health risks to you and your baby. Be sure you are using a reliable method
of birth control, as you work toward optimal blood glucose levels.
Gestational diabetes
Gestational diabetes is a form of glucose intolerance (difficulty metabolizing
blood glucose) that is first recognized during pregnancy. It affects almost
7% of all pregnancies. Factors that may contribute to a high risk of gestational
diabetes include overweight, a history of gestational diabetes with a prior
pregnancy, GLYCOSURIA (glucose in the urine, which would be found in a routine
urine test) and a strong family history of diabetes. In addition, women who
are African-American, Hispanic, or from certain Native American groups, as well
as women with polycistic ovary syndrome (PCOS) have shown a higher risk for
gestational diabetes.
Screening tests should be recommended between 24 and 28 weeks gestation for
any woman considered at risk of gestational diabetes by her obstetrician. These
tests usually involve drinking a pre-measured glucose solution, and then having
blood samples drawn and checked for glucose level, to determine if the body
tolerates the glucose load normally. Test levels that are out of the normal
range may indicate that the mother's blood glucose levels are likely to rise
as the pregnancy progresses.
If you are diagnosed with gestational diabetes, your obstetrician may refer
you to a diabetes educator or to an endocrinologist (or both), for help managing
your diabetes and your pregnancy. Because blood glucose control is essential
during pregnancy, weekly follow-ups with the health professional managing your
diabetes are usually recommended.
Most cases of gestational diabetes disappear after delivery because two of
the primary factors that contribute to insulin resistance and high blood glucose
levels are either diminished (the extra weight gained during pregnancy) or gone
(the hormones produced by the placenta). If your blood glucose levels were normal
prior to the pregnancy, they will most likely return to normal after delivery.
However, once you have had gestational diabetes, you are likely to develop it
again in another pregnancy. You also face a greater risk for developing type
2 diabetes later in life.
Tools for control
The tools used to maintain blood glucose control during pregnancy are the same
tools used to control any case of diabetes. They include a meal plan, an exercise
plan, and possibly an insulin plan.
Meal plan. Whether you have preexisting diabetes or gestational diabetes, you
should work with a registered dietitian to design an individualized meal plan
for your pregnancy. The plan should focus on foods that provide good nutrition
for you and your baby, and that help keep your blood glucose level in the desired
range. Because carbohydrate has the most immediate impact on blood glucose levels,
your meal plan should specify how much carbohydrate to eat and when to eat it.
Carbohydrate is found mainly in foods such as breads, cereals, pasta, starchy
vegetables, fruits, and sweets. Frequent blood glucose monitoring will help
you determine the appropriate amount and timing of carbohydrate.
Your dietitian can also suggest how many calories you need each day based on
your recommended weight gain. The amount of weight you should gain during pregnancy
depends on your weight before pregnancy. In general, a woman at a healthy weight
before pregnancy should gain 25 to 35 pounds during her pregnancy. Your health-care
team may advise you to gain more if you are underweight, or less, if you are
overweight. Keep in mind, however, that pregnancy is definitely not a time to
try to lose weight. Most mothers require about 100 extra calories per day during
the first trimester and an additional 300 calories per day during the remainder
of the pregnancy to ensure the ideal weight gain for the mother and birth weight
for the baby. (See sidebar: "Weight Gain During Pregnancy," which
illustrates how pregnancy weight gain is distributed.)
In most cases, your dietitian will recommend that you eat three meals a day
with two to four between-meal snacks. An evening snack is particularly important
to prevent hypoglycemia during the night and urine ketones or nausea in the
morning.
You may be concerned about the safety of consuming sugar substitutes during
pregnancy. At this time, research shows that the four most commonly used sugar
substitutes (acesulfame-K, aspartame, saccharin, and sucralose) are safe to
use in moderation during pregnancy. Some of these sweeteners do cross the placenta,
and can reach the baby, but there is no evidence they cause ill effects. If
in doubt, follow the advice of your obstetrician.
For more specifics on the components of a well-balanced diet during pregnancy,
see sidebar: "Eating for Two."
Physical activity. Regular physical activity is essential to diabetes control
and to general health and well-being Your health-care team can help you determine
a safe level of exercise for you during pregnancy. If you have always exercised
in the past, you may be able to continue to exercise at a more moderate level
while you are pregnant. If exercise was not part of your pre-pregnancy routine,
check with both your obstetrician and endocrinologist before you start, and
choose an activity such as brisk walking or swimming, to incorporate into your
daily routine. Because exercise usually lowers blood glucose, be alert to the
symptoms of hypoglycemia, and check your blood glucose level before and after
you exercise.
Insulin management. Insulin is the most common medicine used for blood glucose
control during pregnancy. Blood glucose-lowering pills are used much less often
because of a lack of data on their safety. However, at least one recent study
concluded that glyburide (brand names DiaBeta, Glynase PresTab or Micronase),
when taken by women with gestational diabetes during the last six months of
pregnancy, did not change fetal outcome.
Women with type 1 diabetes may prefer to stick with their usual insulin delivery
method during pregnancy, or they may decide to try something new, such as insulin
pump therapy. For some, using a pump during pregnancy allows them to fine-tune
their insulin requirements.
Women with type 2 diabetes who take pills as part of their diabetes treatment
plan are usually advised to switch to insulin during pregnancy. In fact, many
health care practitioners recommend that women with type 2 diabetes switch to
insulin therapy before becoming pregnant. This may help them adjust to insulin
therapy and possibly allow them to bring their blood glucose levels into the
ranges recommended during pregnancy before they become pregnant.
As mentioned earlier, women with gestational diabetes usually start by seeing
how well dietary changes control their blood glucose levels, and then add insulin
if blood glucose levels do not stay within recommended ranges. Women who must
learn to use insulin because of gestational diabetes may find that using an
insulin pen is easier than using a syringe. Using premixed insulins, rather
than mixing your own, may also simplify your diabetes management.
The most common side effect of insulin therapy is hypoglycemia. Once insulin
enters the body and begins working, blood glucose levels may drop lower than
recommended if you do not eat to balance the effects, or if you exercise too
much. Women using insulin during pregnancy should make sure they receive information
about the warning signs and treatment of hypoglycemia. In addition, they should
be aware that hypoglycemia unawareness (the inability to detect early signs
of low blood glucose) may be more common in pregnant women, especially those
with type 1 diabetes.
Labor and delivery
Most physicians prefer that women with diabetes deliver as close to their due
date as possible. Babies delivered after their due date tend to be larger and
risk more complications. If natural labor is not timely, and a woman plans to
deliver vaginally, a hormone called oxytocin can be given, usually intravenously,
to induce labor. If a woman is scheduled for caesarian section, oxytocin is
not necessary.
Many women with diabetes are able to deliver vaginally. A caesarian section
may be needed if the baby is too large (macrosomic), if the woman's pelvis is
too small, or if a woman has vascular complications or blood pressure problems.
A caesarian delivery may also be required if a baby is in the breech position
(when the baby's feet or buttocks enter the birth canal first).
Labor is an intense, active process, which can lower a woman's blood glucose
level. A caesarian delivery, on the other hand, may raise a woman's blood glucose
level, because the surgical procedure is a stress on the body. If you have type
1 or type 2 diabetes, your doctor may have you on insulin intravenously during
labor and delivery. The IV apparatus continuously infuses quick-acting insulin,
and may allow for smoother blood glucose control, since adjustments can be made
as necessary. The goal is to keep blood glucose levels as normal as possible
to prevent hypoglycemia in your newborn. Most women with gestational diabetes
do not require any insulin during the labor and delivery process. After delivery,
continuing to maintain blood sugar levels in a near-normal range facilitates
the healing process.
Recovery
If you have type 1 or type 2 diabetes, your insulin requirements may return
to what they were before your pregnancy within a few weeks of delivery. Check
your blood glucose levels frequently, and make adjustments to your insulin dosage
as needed.
If you had gestational diabetes, it is likely that your blood glucose level
will return to normal almost immediately after your baby is born. But since
gestational diabetes puts you at increased risk for developing type 2 diabetes
in the future, you should have your blood glucose level measured at your first
postpartum checkup (usually four to six weeks after delivery) and yearly thereafter.
To minimize your risk of developing type 2 diabetes, eat a balanced diet, exercise
regularly, and keep your weight at a reasonable level.
Breast-feeding
Diabetes is no barrier to breast-feeding. Breast milk provides the ideal source
of nutrition for babies, as well as antibodies that fight certain infections.
Breast-feeding also promotes weight loss in the mother, may help protect the
baby from developing diabetes in the future, and may help to establish a special
mother-baby bond.
If you decide to breast-feed, speak with a registered dietitian about the foods
you need to ea , so you will get enough calcium, fluids, and protein. Breast-feeding
increases a woman's caloric needs, and, because it takes energy, may increase
her risk of hypoglycemia. Episodes of hypoglycemia are more likely to occur
within an hour after breast-feeding, so this is an important time to check your
blood glucose level. Napping after meals and snacks is also recommended to lower
the risk of hypoglycemia. You may need to adjust your insulin dosage, particularly
overnight, to prevent your blood glucose level from dropping during late-night
feedings.
Women with type 2 diabetes who switched from oral pills to insulin during pregnancy
are generally encouraged to stay on insulin for at least a month after delivery.
For many of the newer diabetes drugs, little or no research has been done on
their use in breast-feeding women.
Tough job, big rewards
Managing your diabetes during pregnancy means paying extra attention to your
lifestyle during these important months. Though you may feel overwhelmed at
times, your health-care team is available to answer your questions and help
you attain excellent blood glucose control. The commitment you make now will
pay off with the best results in the future: a healthy, happy baby, and a healthy
you.
Laura Hieronymus and Patti Geil are Certified Diabetes Educators in an ADA-recognized
education service in Lexington, Kentucky. They counsel in the area of diabetes
and pregnancy management, with Kristina Humphries, MD.
Reprinted with permission from DIABETES SELF-MANAGEMENT. Copyright (c) 2001,
R.A. Rapaport Publishing, Inc. For subscription information, call: 1-800-234-0923.
------------------------------------------------------------SIDEBARS:
* * * * * *
WEIGHT GAIN DURING PREGNANCY
Ever wonder why pregnancy usually involves gaining at least 25 pounds, when
a baby usually weighs only 7 or 8? Here's a breakdown of what accounts for the
other 17 or more pounds
WHAT POUNDS
__________________________________________
Developing
unborn baby 7-8
__________________________________________
Placenta 1-2
__________________________________________
Amniotic fluid 2
__________________________________________
Uterus 2
__________________________________________
Increase in
blood volume 3
__________________________________________
Breasts 1
__________________________________________
Body fat 5 or more
__________________________________________
Increased muscle
tissue and fluid 4-7
__________________________________________
TOTAL: 25 or more
__________________________________________
* * * * * *
BLOOD GLUCOSE GOALS DURING PREGNANCY
The American Diabetes Association's recommended goals for blood glucose during
pregnancy are even closer to the normal non-diabetic range than for the general
population with diabetes. These goals have been set with the health of both
mother and developing baby in mind.
WHEN WHOLE BLOOD PLASMA VALUE
Fasting 60-90 Mg/dl 69-104 Mg/dl
Before meals 60-105 Mg/dl 69-121 Mg/dl
1 hour after meals
100-120 Mg/dl 115-138 Mg/dl
2 AM-6 AM 60-120 Mg/dl 69-138 Mg/dl
* * * * * *
MORE READING ON PREGNANCY
For more information on diabetes and pregnancy, you may find the following
resources helpful.
Books:
Books published by the American Diabetes Association can be purchased via the
Internet (http://store.diabetes.org/adabooks) Or by calling, toll-free: 1-800-232-6733.
DIABETES AND PREGNANCY: WHAT TO EXPECT (2000) American Diabetes Association
GESTATIONAL DIABETES: WHAT TO EXPECT (2000) American Diabetes Association
Brochures
These brochures can be read online, or ordered by phone, using the toll-free
numbers listed below.
DIABETES AND PREGNANCY, Juvenile Diabetes Research Foundation, telephone: 1-800-533-2873;
website: www.jdf.org/jdfliving/pages/pregnancy.html
UNDERSTANDING GESTATIONAL DIABETES: A Practical Guide to a Healthy Pregnancy,
National Institute of Child Health and Human Development; telephone: 1-800-370-2943;
website: www.nichd.nih.gov/publications/pubs/gesttoc.htm
* * * * * *
EATING FOR TWO
Eating enough of the right foods is one of the most important things you can
do to ensure your baby is healthy. Although nutrient needs increase during pregnancy,
most women can meet these needs by eating a balanced diet that includes a variety
of foods. However, for some women, prenatal vitamin and mineral supplements,
particularly iron, may be necessary. When planning your meals during pregnancy,
pay special attention to the following nutrients:
Protein.
Pregnant women require an extra 10 grams of protein daily (or a total of 60
grams daily) for a healthy baby and placenta. A three-ounce serving of meat
provides approximately 20 grams of protein.
B Vitamins.
The requirements for B vitamins increase during pregnancy; B vitamins help
to metabolize the energy from food and help protein to make new body cells.
Getting adequate amounts of a B vitamin called folate, or folic acid, is particularly
important in the first three months of pregnancy. Consuming enough folate before
pregnancy and in the early stages may lower the risk of neural tube birth defects
(birth defects that involve the spinal column) in the baby. Pregnant women require
600 micrograms of folate daily. A half-cup serving of boiled navy beans provides
125 micrograms of folate.
Calcium.
Calcium is critical for preserving a mother's bone mass while the baby's skeleton
develops. Pregnant women need 1,000 milligrams of calcium daily. An eight-ounce
glass of milk provides 300 milligrams of calcium.
Iron.
Iron is essential in making hemoglobin, a blood component that carries oxygen
through the body to the placenta. It can be difficult to get enough iron in
the diet because it is not well absorbed from food, and many women start pregnancy
with low iron stores. Pregnant women require 27 milligrams of iron daily. A
three-ounce serving of lean beef has almost 3 milligrams of iron.
* * * * * *
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
AMERICA'S JOBLINE FOR THE BLIND
Blind job-seekers have traditionally been at a disadvantage, for few job vacancies
have been widely posted in accessible format. How were you supposed to find
out about the position in a timely manner? If you didn't have an adaptive computer,
or a sighted reader with you, you didn't find out.
Now, the National Federation of the Blind, the largest organization of blind
people in the United States, has pioneered in developing the technology to access
and search computer database files with a standard touch-tone telephone. To
access AMERICA'S JOBLINE, simply telephone: 1-800-414-5748.
For the user (normally someone who is looking for employment), AMERICA'S JOBLINE
is instantly available on the telephone, 24 hours a day, providing all job announcements
in a high-quality synthesized speech format, instead of printed text. The system
provides all callers the ability to search AMERICA'S JOB BANK (administered
by the U.S. Department of Labor), allows job seekers to create and store in
the system personal job-search profiles for use in quickly locating vacancies
for which they are qualified; and allows users the option to retrieve, if they
wish, only the new and relevant job listings posted since the last call, or
retrieve previously saved announcements.
With AMERICA'S JOBLINE, the user enters a search profile into the system, using
a standard touch-tone telephone keypad, in response to menu choices. As with
the job announcement information, the menu choices are presented in a voice-output
format. To try JOBLINE yourself, call: 1-800-414-5748.
America's Jobline was created to help:
* Persons who do not have or cannot use standard computers, who now have a
convenient and easy-to-use alternative means to obtain job information; and
* Persons who cannot see or cannot read standard video display terminals, who
now have audio access, without expensive adaptive equipment of their own.
What are these jobs? Where do they come from? AMERICA'S JOB
BANK, the database JOBLINE searches, is the set of jobs listed in the U.S. Job
Service, the world's largest job database. At any given time, there may be a
million open positions in there, catalogued by region and job type. If you are
an employer, and you post a job vacancy with U.S. Job Service in your state,
blind users of AMERICA'S JOBLINE can now access that job as soon as it is entered.
(To learn more about AMERICA'S JOB BANK, go to website: www.ajb.org or contact
your local Job Service office.)
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
ASK JANIS
by Janis Roszler
Photo: Portrait
Janis Roszler, RD, CDE, LD/N, is a registered dietitian, certified diabetes
educator, and certified insulin pump trainer. She has counseled individuals
with diabetes for over 14 years, and is currently the diabetes educator for
the website: www.diabetic.com
This column is for educational purposes only. For answers that meet your specific
educational needs, consult your physician.
Dear Janis:
I notice my feet sweat with my tennis shoes on. I am a diabetic; is this a
problem?
Dear S.Y.:
It is important for you to keep your feet dry. Moist skin becomes soft and
more prone to infection. For this reason, foot soaking is not recommended for
individuals with diabetes. Burns from the water can also occur. If you sweat
a lot, be sure to use powder on your feet. If you moisturize your feet, do not
moisturize between your toes.
Dear Janis:
I am thirsty all the time. A co-worker suggested I might have diabetes. What
are the symptoms and what could cause it?
Dear Randy:
The exact cause of diabetes is unknown. Heredity may play a role in developing
both types of diabetes. Eating sweets does not cause diabetes, but must be limited
to help control it. Being overweight, certain medications, and emotional and
physical stress related to medical conditions such as pregnancy, illness and
surgery, can play a role in its development. Also, for reasons not yet known,
certain ethnic groups such as Native Americans, Hispanic Americans and African
Americans tend to have a higher incidence of type 2.
The warning symptoms of [type 1] diabetes include: unusual thirst, frequent
urination, intense hunger, numbness or tingling in hands and feet, blurred vision
and extreme fatigue. If you have any of all of these symptoms, it is important
that you see your doctor.
(Editor's Note: Type 2 diabetes is characterized by slow onset and ambiguous,
low-key symptoms. If you suspect you have diabetes, or if you have a family
history of diabetes, your doctor can tell you for certain, with a blood test.)
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
MONITOR MINIATURES
THE BRAILLE MONITOR is the principal publication of the National Federation
of the Blind. The MONITOR, published 11 times a year, is available in large
print, 4-track audiocassette, Braille, and on the Web at www.nfb.org. Subscription
is free; via the website, by writing: National Federation of the Blind, 1800
Johnson Street, Baltimore, MD 21230; or by calling: (410) 659-9314; fax: (410)
685-5653. "Monitor Miniatures" is a regular feature, and a sampling
is reproduced here.
New Free Braille Christian Publication Available:
We have been asked to carry the following announcement: We have recently begun
publishing our bi-monthly evangelical Christian magazine, THE HIGHER WAY, in
Braille. Each issue contains inspirational and spiritually challenging sermon
excerpts and feature articles, personal accounts of God's life-changing power,
and other items of interest. Subscribe to this free publication by writing to
the Apostolic Faith Church, 6615 SE 52nd Avenue, Portland, Oregon 97206.
Volunteer Braille Transcribing Available:
We have been asked to carry the following announcement: We pride ourselves
on the quality of our Braille, proofread by each other under the direction of
a meticulous proofreading chair with very high standards. We can employ a professional
certified proofreader if the work requires it. For agencies, schools, etc.,
we charge only our cost of production. For private individuals we charge less
than our cost. Contact Beach Cities Braille Guild, P.O. Box 712, Huntington
Beach, California 92648. Contact our assignments chair, Linda McGovern, phone:
(714) 969-7992; or e-mail: [email protected].
Audio Dramas Available on Tape:
We have been asked to carry the following announcement: The National Audio
Theatre/Blue Ridge Radio Players, which provides recorded audio dramas for the
visually impaired without charge, has a new Website: www.main.nc.us/nataudio.
Users may learn there about the 50 audio cassettes of classic and original
dramatic productions available to order as well as the history and mission of
the Theatre. Four new shows are being readied for mailing: "Study in Scarlet,"
"Shooting of Dan McGrew," "Tycoon," and "The Bride
Comes to Yellow Sky." Audio Theatre shows are available in libraries throughout
the U.S., and at V.A. centers for the blind. The Theatre may be reached at P.O.
Box 933, Hendersonville, North Carolina 28793, or at (828) 693-5143.
New Book for Sale:
Lauren Merryfield has asked us to carry the following announcement: Lauren Eckery
Merryfield, author of the title article of our first Kernel Book, WHAT COLOR
IS THE SUN, has been published. HEARTWARMERS OF LOVE, being sold at www.amazon.com,
contains her story "Love Far beyond the Physical." This is an account
of the harrowing yet triumphant qualities of her wedding with Jim Merryfield.
You are invited to purchase as many as you'd like, for yourself and to present
as gifts. The book includes poignant portrayal of issues related to blindness,
life and death, and love - lots of other great stories too.
Poetry Books in Braille:
We have been asked to carry the following announcement: The Louis Braille Center
has Brailled a collection of classical poetry by British and American poets.
The collection includes A SHROPSHIRE LAD ($10) by A.E. Housman; SELECTED POEMS
by Emily Dickinson ($12); RENAISSANCE AND OTHER POEMS ($10) and SECOND APRIL
($10) by Edna St. Vincent Millay; SONGS OF INNOCENCE and SONGS OF EXPERIENCE
by William Blake ($10); SONNETS FROM THE PORTUGUESE AND OTHER POEMS by Elizabeth
Barrett Browning ($12); LYRIC POEMS by Keats ($12); YOU COME TOO by Robert Frost
($12); BEST POEMS OF THE BRONTE SISTERS by Emily, Anne, and Charlotte Bronte
($12); and COMPLETE SONNETS by William Shakespeare ($15). Anthologies include
ONE HUNDRED AND ONE FAMOUS POEMS compiled by R. Cook ($35); GREAT SHORT POEMS
edited by Paul Negri ($12); THIRTY-FIVE FAVORITE POEMS edited by Louis Braille
Center ($8); and LOVE, A BOOK OF QUOTATIONS edited by Herb Galewitz ($10). We
welcome your suggestions of other poetry you would like to have us Braille.
To order, contact the Louis Braille Center, 320 Dayton Street, Suite 125, Edmonds,
Washington 98020-3590. Phone (425) 776-4042, e-mail [email protected].
Our catalog of books is available in large print and Braille and on our Web
site at www.louisbraillecenter.org.
Wireless Web Access by Voice:
We have been asked to carry the following announcement: Now you can surf the
Web by voice. AIRTRAC EVERYWHERE OFFICE VERSION 1 was released in February,
2001. With this wireless system you can surf the Web and send and receive e-mail
easily - all through Voice Recognition.
No more pushing numbers on your phone. No more keying commands on your computer.
No more looking for a place to hookup your modem. Dial the AirTrac Everywhere
Office, enter your user ID and password, then tell AirTrac where you wish to
go. It is all by voice; you talk to AirTrac; AirTrac talks to you. By September,
2001, access additional Web sites for work, pleasure, academic research, or
homework. Built-in voice prompts guide you to your destinations.
You can get real-time quotes from Wall Street and the weather site as well as
restaurant and hotel listings and traffic updates for any city. News, sports,
and shopping guides are also available. By fourth quarter, 2001, you can call
the AirTrac Everywhere Office and make your e-commerce purchases.
All you need for access anywhere is your phone or cell phone. The Everywhere
Office will store valuable data and phone numbers and provide your calendar
schedule, including appointment reminders. Access AirTrac's Web By Voice through
your existing wireless or wire-line service. For more information contact Jim
Smith, Consultant to AirTrac, 1356 South Michigan Avenue, Chicago, Illinois
60605, Voice: (312) 341-0800, Fax: (312) 341-0801, E-mail: <[email protected]>,
<www.airtrac.com>, Customer Service: (877) 874-9656.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
FLU SHOTS
As regular as tax time, flu season is coming around. Just like tax time, there
will be lots of new nastiness we haven't seen before -- and you'd better be
ready. Influenza, "the flu," is not just the aches, fevers, and fatigue
-- it can put you in the hospital, or take your life. According to the Centers
for Disease Control (CDC), each year the flu kills about 20,000 people.
The CDC says most of the people seriously harmed by the flu will be members
of high-risk populations: People over 65, children, pregnant women, people with
chronic lung or heart disease, with asthma, with auto-immune diseases, or with
diabetes.
Why? A serious case of the flu can put anyone on their back for a week or two,
but if you have diabetes, it can cause real problems with your blood sugar control.
The fevers and infections can drive your blood sugars way up, and it is really
hard to self-manage your diabetes when you're that sick.
Prevention is the best cure! The CDC is already tracking the strains of flu
expected to be here this winter (mostly "B" type), and vaccinations
will be in plentiful supply this year. Talk to your doctor, and avoid this complication
-- get your flu shot.
To learn more about the flu, check out the following website: http://www.hcfa.gov/flu.
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
DIABETES STUDY SEEKS VOLUNTEERS
The National Institutes of Health wants about 5000 volunteers, to participate
in a long-term study examining the effects of weight loss on people with type
2 diabetes. Type 2 diabetes, also known as NON-INSULIN-DEPENDENT or ADULT-ONSET
diabetes, significantly increases the risk of dying of heart attach or stroke.
The disease has reached epidemic proportions in the U.S., exacerbated by the
dramatic increase in the number of Americans who are overweight or obese --
and 80 percent of Americans with type 2 diabetes are overweight or obese. Studies
have shown the beneficial effects of short-term weight loss, with diabetes and
heart disease, but until now there have been no randomized trials to measure
the benefits of long-term weight loss. We know there are benefits; this study
should quantify them.
There will be no placebos; all participants will be assigned to either the
Lifestyle Program (weight loss and exercise) or the Diabetes Education and Support
Program (diabetes education and regular support groups). All will benefit, and
the study is scheduled to run for 11.5 years.
If you have type 2 diabetes, are between 45 and 75 years of age, and are medically
classified as overweight or obese (body mass index of 25 or higher), and wish
to volunteer for this study, named "Look Ahead," call, toll free:
1-866-552-4323.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
COPING WITH TYPE 2 DIABETES
by Peter J. Nebergall, PhD
Photo: Portrait
I have this silly t-shirt. It shows a little man, in the middle of a circle
of pointing hands. They're all saying: "Now, Now NOW!" With an unhappy
expression, he's saying: "Later." It's funny, my "procrastinator"
t-shirt, but not if you have diabetes. Years ago, instrumentalist Mike Oldfield
did an album titled "The Consequences of Indecision." There was no
singing, but if you have diabetes, I can tell you all the words.
Diabetes is as sneaky as the taxman, and can be far more deadly. Ignore it at
your peril. In a time when testing is cheap and easy, and knowlege is ample
and freely available (you're in the right place!) there is no reason, and no
excuse, for inaction. And don't be telling me: "It'll never happen to ME!"
It will. It can. It might. Russian Roulette, anyone?
Some diseases have an "air of inevitability." Once you're diagnosed,
that's it -- you know the path it's going to take. Fate. Diabetes isn't like
that, especially not type 2 diabetes -- and remember 90% of all diabetes is
type 2.
Now it's true that a type 1 diabetic has to inject insulin, or he's going to
die pretty quickly. That's pretty serious. People have got this idea that because
type 2 won't kill you quickly like that, that type 2 is less serious. That's
bunk. Did you know type 2 causes more heart problems than type 1 does? Did you
know your body doesn't care how those elevated sugars got there -- if you run
"high" from type 2 diabetes, it's just as damaging as if you ran high
from type 1. It just takes a bit longer to catch up with you....
A majority of Americans are now overweight or obese. Being too heavy doesn't
cause type 2, but it doesn't help things one bit. Plus, if you're type 2, and
you lose some of the excess weight, your blood sugar will be easier to manage.
Likewise exercise. Exercise burns excess blood glucose. Diabetes is about excess
blood glucose. You need to get that sugar down, by whatever means, and exercise
works. Would you rather do something, or pay some doctor to give you a pill,
while you sit back and grow cobwebs? Regular exercise (not a marathon!) is the
best medicine you'll never have to pay for...
Do you like to eat? Do you like good, healthy food, or do you load up on pizza
and beer? Do you know how much is enough for someone of your size, age, and
sex, or do you just eat "til you're full?" It's hard to be thinking
about how much food is "enough," when you're used to stuffing it in
til just short of bursting. "Damn the calories; full speed ahead..."
Right.
Recommendation: Drop that word "full" from your vocabulary -- and
ask instead "have you had sufficient?" Sorta changes how you look
at it, doesn't it? You can change the way you think about food, and learn to
eat reasonable portions of healthy, low-impact foods. You'll feel the difference.
I did.
Now I know it's easy to change your ways when you're hurting -- when your body
sends you clear and unambiguous notice that you'd better do something different
-- but by the time you wait for diabetes (even that "not-so-serious type
2") to knock on your forehead and get your full attention, a lot of damage
could be done. Why wait for the eye damage, kidney damage, and nerve damage?
Why accept the real risk of a shortened lifespan, if you don't have to? Is it
worth so much to be lazy now -- "trade present ease for future pain,"
as the philosophers said? No. You're worth more than that, alive and well.
You can test your blood, cheaply and easily. You should, then take whatever
action you need: lifestyle change, oral medications, even insulin, to keep your
numbers down where they should be, and preserve your health. Your family, your
friends, and your children will thank you.
Diabetes is an irritant, a pain, and a discipline -- but by no means is it
an impossible burden. You can deal with it, you can cope with it, you can master
it, and you can do it now. Remember, the better job you do of coping with your
diabetes, now, the less risk of complications you'll face in the future.
Those pointing hands were right, you know: "Now, now, now." There's
no time like the present.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
THE REST OF THE STORY: DIABETIC MANAGEMENT AND PAIN CONTROL
by David Michael Wright
Photo: Portrait
From the Editor: Neuropathy, nerve disease, is an often-serious complication
of long-term diabetes. It can be excruciating, and there is no sure-fire treatment.
Folks have evolved a lot of ways to cope. Here, David Wright, who is blind from
diabetes, and has also experienced a lot of neuropathy, shares his strategy,
and his positive outlook:
I would like to say a few things about my life, diabetes, and pain, as they
were tough getting through, until I found the way to deal with them. This comes
in three challenging steps.
The first can be tough for some, but I found it quite simple. I put my faith
in God, and in Jesus. The second step, to some, is really tough. This step is
EXERCISE. Exercise is the key to better health and better diabetes control.
It can also ease neuropathy pain. I have found that no matter how tough times
are, one can have a daily or bi-daily exercise plan. We need to be sure to stick
to our exercise plan, to keep our bodies strong and functioning properly.
The third and final step coincides with step two: Watch your diet. We need to
watch what we eat, the right types of meals and amounts. Making sure to eat
a snack between meals and especially before exercise is really important. God
gave us our bodies as our temple to live in, so it is up to us to take care
of our temple.
I began using an insulin pen at the beginning of 2000. It allowed me to control
my own insulin independently, without any assistance. Even though my diabetic
neuropathy is at a point that I do not have much "sense of touch,"
I can adjust insulin with my insulin pen. I even use my Regular insulin, in
a separate insulin pen, for my sliding scale, if my blood sugar reading is 250
or more.
I still need some help in checking my blood sugar reading. Even though my LifeScan
glucose monitor talks, it is difficult to get my blood sample onto the test
strip. I find this meter very difficult for a blind person to use without sighted
aid. I've just been told of a much easier talking meter for blind diabetics,
the AccuChek Voicemate.
I carry an emergency pack with diabetic necessities at all times, including
glucose tablets or tube for hypoglycemic emergency times. Be prepared!
I'm glad I've learned what I know. I only wish I would have known these things
years sooner. What a great help it would have been. I hope that you, the reader,
can be better prepared than I was, by reading my story.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
BOOK REVIEWS
by Marilyn Helton
Here we are again and it's October already! With the changing colors of the
landscape, the return to standard time, football games and tail-gating parties,
Jack O' Lanterns and pumpkin pies in abundance, can winter be far behind?
October kicks off the holiday season, and signals the beginning of food celebrations
from now until January 1st.. With shorter days and colder nights, we tend to
move indoors where our activities center in the kitchen.
In the spirit of autumn, I've selected a number of really good, healthy-eating
cookbooks for my October reviews. You may be surprised to find that many cookbooks
without "diabetes" in the title are great resources for both diabetics
and the caregivers who cook for them.
Two recent releases in this category are Holly Clegg's MEALS on the MOVE: RUSH
HOUR RECIPES, and Evelyn Tribole's newest book, MORE HEALTHY HOMESTYLE COOKING.
MEALS on the MOVE: RUSH HOUR RECIPES, the newest addition to Holly Clegg's
Trim & Terrific series, is yet another gold mine of delicious taste with
corresponding nutritional value. In collaboration with the American Institute
for Cancer Research (AICR), Holly has designed this new cookbook to fit today's
hectic lifestyle while significantly lowering a family's risk of cancer.
How does this cookbook apply to a person who has diabetes? It's been this reviewer's
experience through letters, cards and Emails from newly diagnosed diabetics
or their caregivers, that the recurrent theme is something like, "What
can I eat now that I can't eat anything anymore?" Or, "What can I
cook for my spouse, child, grandchild, etc., now that I have to consider diabetes?"
And, "What is a diabetic diet?" (News Flash: There is no such thing
as a diabetic diet!)
MEALS on the MOVE dispels the myth that a diagnosis of diabetes is a culinary
death sentence. It contains over 200 quick and easy recipes that reflect two
of AICR's guidelines for cancer-prevention -- a diet rich in a variety of plant-based
foods, especially vegetables and fruit, and an emphasis on foods low in fat
and salt. These are common objectives in a diabetic eating plan, as well. According
to author Holly Clegg: "MEALS on the MOVE can be the first step in transforming
your family's eating habits so they can live healthier, longer lives."
One area which is commonly overlooked in "healthy" cookbooks is the
realization of how important a parent's role is in creating healthy eating habits
in their children, and teaching them their food choices will affect their health
for the rest of their lives. Holly Clegg is the mother of three and very aware
of the type food children will and won't eat. She has made a point of designing
MEALS on the MOVE with the whole family in mind. My own 5-year old granddaughter
is a very picky eater and I value Holly's emphasis on finding ways to make healthy
foods " . . . taste like the good stuff."
MEALS ON THE MOVE is packed with recipes using Healthier Approach recommendations
and Food Facts from the American Institute for Cancer Research. Recipes are
simple to prepare and, as in her other cookbooks, high on taste. Chapters include
Rush Hour Dinners, Lunches On The Run, and Easy Entertaining. I have personally
sampled several of the recipes from this book and each has been a "keeper."
MEALS ON THE MOVE, (c) February 2001 by Holly Clegg and printed by The Wimmer
Companies, is published in a user-friendly, spiral-bound format, contains nutritional
analyses and diabetic exchanges. If you want more bang for your bite, this is
a good book with great taste! Highly recommended. Reviewer's note: For more
information on Holly Clegg or to order her cookbooks directly, you can visit
her website: www.hollyclegg.com
MORE HEALTHY HOMESTYLE COOKING, by Evelyn Tribole, MS, RD, invites us to "Enjoy
the full flavor of Real Food again." According to Tribole, "Who cares
how 'good for you' a meal is if it doesn't taste good?"
An award-winning dietitian, Tribole reviews the basics of nutrition and clears
up confusing press surrounding carbohydrates, sodium, fatty acids, and phytochemicals.
The reader learns insider secrets to recipe makeovers (worth the cost of the
book, in my opinion), and here's a hint in that area: Straight substitutions
don't always work!
The best thing about this book, though, are the recipes. You'll absolutely
forget they're healthy once you sink your teeth into them. How about a sweet
slice of Peanut Butter Pie or Apple Carrot Cake with Light Cream Cheese Frosting?
Chocolate TIRAMISU sounds pretty good to me. Carry on with Sausage and Hash
Brown Casserole, Tex-Mex Skillet, Potato-Bacon Clam Chowder or Easy Cheesy No-Knead
Batter Bread. Would you believe there's even a recipe for Chocolate Chip Pecan
Loaf with real butter and chocolate? They're all here in More Hearty Homestyle
Meals, many beautifully reproduced in living color.
In each recipe, Tribole explains exactly how she reduced the fat, calories,
cholesterol, and sodium or increased the fiber. Plus, she provides a complete
nutritional analysis and a Nutrition Scorecard that takes a before-and-after
look at calories and fat. The only thing missing are the dietary exchanges;
but if you can read a nutritional label and apply it to your individual diabetes
meal plan, you can use this cookbook!
MORE HEALTHY HOMESTYLE COOKING, by Evelyn Tribole, (c) 2000, published by Rodale,
$29.95 (U.S.) Highly recommended.
If the title of this next book doesn't make you want to pick it up, you've
probably never been on a diet. FORBIDDEN FOODS -- DIABETIC COOKING, by Maggie
Powers, MS, RD, CDE, and Joyce Hendley, MS, dares us to look beyond the cover!
According to the authors, foods help to identify us --- who we are, where we
come from, and what customs we observe. Special foods are part of our traditions,
life experiences and family histories. They influence what we eat at holidays,
birthdays and other celebrations, all part of the traditions we want to maintain
and pass on to others. Unfortunately, when we have to consider calories, fats,
exchanges or carbohydrates, some of the very foods that meant so much to us
suddenly become "forbidden." Powers and Hendley underscore that "Just
because you have diabetes, you don't have to give up this part of who you are!"
FORBIDDEN FOODS -- DIABETIC COOKING features 150 recipes for the foods we used
to love. Delectable recipes for Cinnamon Coffee Cake, Boston Cream Pie, Devil's
Food Cake, Chicken Pot Pie, Fettuccine Alfredo . . . I could go on all day!
Authors Powers and Hendley have found inventive ways to prepare these foods
and more. Best of all, instructions on how to modify your own family favorites
without sacrificing flavor, are included in the Introduction.
Divided into 12 chapters of mouth-watering recipes, the dessert and bread fans
will not be disappointed. Quick Breads & Muffins, Cookies & Bars, Classic
Cakes, Pies, Crumbles, & Cobblers, Puddings & Creamy Desserts and Chocolate
Magic are there to sate your appetite for something sweet. The other half of
the book includes healthy chapters on Better Beverages, Starters & Snacks,
Sauces, Gravies & Dressings, Faux Fried Foods, Mom's Favorites and Pizza
& Pasta.
Folks, you can't lose with this book! Published by the American Diabetes Association;
(C) 2000; $16.95.
Until we meet again in January, take time to enjoy the blessings of the season
and remember: Love comes from the small things of the heart.
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: www.cinnamonhearts.com
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
RECIPE CORNER
This issue, all recipes are from THE DIABETIC'S HEALTHY EXCHANGES COOKBOOK,
by JoAnna M. Lund, published by Perigee.
DEPRESSION POTATO SOUP
Ingredients:
3 cups (15 ounces) diced raw potatoes
1 cup diced onion
1 cup diced celery
Scant half-cup (3/4 ounce) uncooked fine noodles
2 cups water
1-1/2 cups (one 12-fluid-ounce can) Carnation Evaporated Skim Milk
1 teaspoon dried parsley flakes
1/8 teaspoon black pepper
Instructions:
In a large saucepan, combine potatoes, onion, celery, noodles, and water. Cook
over medium heat, stirring occasionally, until vegetables are tender, about
15 minutes. Drain, BUT reserve liquid. Return one cup of reserved liquid and
drained vegetables back to pan. Stir in evaporated skim milk, parsley flakes,
and black pepper. Lower heat. Simmer 10 to 15 minutes, stirring occasionally.
Makes four 1-1/2 cup servings. 145 calories, 1gm fat, 4gm protein, 30gm carbohydrate,
103mg sodium, 1gm fiber. Exchange: 1 Starch, 1 skim milk and 1/2 vegetable.
MAPLE-COATED CARROTS
Ingredients:
1/4 cup Cary's Sugar Free Maple Syrup
1 tablespoon chopped walnuts (1/4 ounce)
2 cups (one 16-ounce can) sliced carrots, rinsed and drained
Instructions:
In a large skillet, combine maple syrup and walnuts. Bring mixture to a boil.
Stir in carrots. Lower heat. Simmer five minutes or until mixture is heated
thorough, stirring occasionally.
Makes four 1/2 cup servings. 37 calories, 1gm Fat, 1gm protein, 6gm carbohydrate,
51mg sodium, 1gm fiber. Exchange: 1 vegetable.
FRENCH ONION CHICKEN BAKE
Ingredients:
2 cups thinly sliced onion
1/3 cup Kraft Fat Free French Dressing
16 ounces skinned and boned uncooked chicken breasts, cut into 4 pieces
Instructions:
Preheat oven to 350 degrees. Arrange onion evenly in bottom of an 8-by-8 inch
baking dish. Place French dressing in a small bowl. Coat chicken pieces in dressing.
Arrange chicken evenly over onion. Drizzle any remaining dressing over chicken.
Cover and bake 30 minutes. Uncover and continue baking an additional 10 to 15
minutes. For each serving, place a chicken piece on a plate and evenly spoon
onion and "sauce" over top.
Serves four. 176 calories, 4gm fat, 25gm protein, 10gm carbohydrate, 247mg
sodium, 1gm fiber. Exchanges: 3 meat, 1 vegetable.
PUMPKIN CHEESECAKE WITH CRANBERRY GLAZE
Ingredients:
12 (2-1/2-inch square) graham crackers
2 (8-ounce) packages Philadelphia Fat Free Cream Cheese
1 (4-serving) package JELL-O sugar-free instant vanilla pudding mix
2 cups (one 16-ounce can) pumpkin
1 teaspoon pumpkin pie spice
1 1/4 cups Cool Whip Lite
1 (4-serving) package JELL-O sugar-free vanilla cook & serve
pudding mix
1 cup Ocean Spray Reduced Calorie Cranberry Juice Cocktail
½ cup water
3 cups fresh cranberries
Instructions:
Evenly arrange graham crackers in a 9-by-13 inch cake pan. In a large bowl,
stir cream cheese with a spoon until soft. Add dry instant pudding mix, pumpkin,
and pumpkin pie spice. Mix well, using a wire whisk. Fold in 1/2 cup Cool Whip
Lite. Carefully spread pumpkin mixture over graham crackers. Refrigerate. Meanwhile,
in a medium saucepan, combine dry cook-and-serve pudding mix, cranberry juice
cocktail, water, and cranberries. Cook over medium heat, stirring constantly,
until mixture thickens and cranberries become soft. Place saucepan on a wire
rack and allow to cool 20 minutes. Evenly spoon cooled cranberry mixture over
pumpkin layer. Refrigerate at least two hours. Cut into 12 servings. When serving,
top each piece with 1 tablespoon Cool Whip Lite.
Makes 12 servings. 109 calories, 1gm fat, 6gm protein, 19gm carbohydrate, 428mg
sodium, 2gm fiber. Exchanges: 1 Starch, 1/2 meat.
Author JoAnna Lund also publishes the monthly HEALTHY EXCHANGES FOOD NEWSLETTER,
addressing healthy weight loss, cholesterol, and diabetic concerns. For information,
contact: Healthy Exchanges, PO Box 80, DeWitt, Iowa, 52742; telephone: 1-800-766-8961,
website: www.healthyexchanges.com
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
If you or a friend would like to remember the Diabetes Action Network of the
National Federation of the Blind in your will, you can do so by employing the
following language:
"I give, devise, and bequeath unto the Diabetics Action Network of the
National Federation of the Blind, 1800 Johnson Street, Baltimore, Maryland 21230,
a District of Columbia nonprofit corporation, the sum of $_______________"
(or "_______________ percent of my net estate" or "the following
stocks and bonds:____________________") to be used for its worthy purposes
on behalf of blind persons."
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
DIABETES AND BLINDNESS RESOURCES
by Ed Bryant
We've often told you, our readers, that no diabetic is alone, regardless of
complications; all have good, constructive options. Today I want to cover some
of the tools available to help you realize those options.
First is our Diabetes Action Network's principal publication, this paper, VOICE
OF THE DIABETIC. Four times a year, without charge, we bring you our optimistic
message about diabetes, blindness, and the latest and most effective ways to
cope, to maintain or achieve full participation in life's mainstream, regardless
of complications. The VOICE reaches more than 295,000, in standard print, on
4-track audiocassette for the blind, and on the web at: www.nfb.org/voice.htm.
There is no charge for subscription, in either format, and we offer multiple
copies to volunteer distributors, free of charge. Use the Subscription Form
on page 27, or contact us: VOICE OF THE DIABETIC, 1412 I-70 Drive SW, Suite
C, Columbia, MO 65203; telephone: (573) 875-8911.
Diabetes equipment changes rapidly, and lists of products and services are frequently
out of date. Because it is important to have a complete and current list, we
publish and regularly update our Divisional publication: DIABETES RESOURCES:
EQUIPMENT, SERVICES, AND INFORMATION, available in large print, Braille, or
audiocassette, through the NFB Materials Center: 1800 Johnson Street, Baltimore,
MD 21230; telephone: (410) 659-9314; fax: (410) 685-5653; or at the NFB website.
This Resource Guide costs $5 (print, Braille, or cassette) and is free for downloading
from the Web.
Because diabetes is the biggest producer of new blindness and visual impairment
among working-age Americans, we are a division of the National Federation of
the Blind (NFB), the largest organization of blind individuals in existence.
Many of our materials are available through the Federation's's headquarters,
the National Center for the Blind. The Federation has free catalogs, of blindness
literature, and of products for the blind, available in print, in Braille, and
on the Web at: www.nfb.org
The National Federation of the Blind maintains an extensive collection of literature,
on all aspects of blindness, in large print, Braille, and audiocassette, including
the following diabetes articles:
* Arthritis and Diabetes: A Common Association
* Blind Diabetics Can Draw Insulin Without Difficulty
* Can I Eat Sugar
* Cardiovascular Health: Bypass May Be Better For Diabetics
* Check Your Hemoglobin A1c I.Q.
* Diabetic Eye Disease
* Diabetic Peripheral Neuropathy
* Diabetics, Don't Give Up On Braille
* The Emotional Side
* Finger Sticking Techniques
* How I Went Blind ... And Then What
* Hypoglycemia - Low Blood Sugar
* Insulin Measurement Devices
* Insulin Types - A Review
* Keeping Your Feet
* Kidney Disease: Prevention , Dialysis, and Transplantation
* Male Sexual Dysfunction
* Many Blind Diabetics Successfully Use Insulin Pumps
* New Dietary Guidelines For Diabetes Management
* Oral Diabetes Medications Update
* Talking Blood Glucose Monitoring Systems
* What Is Diabetes Mellitus?
These diabetes articles are available, free of charge, individually (in large
print) or together (on one 4-track audiocassette titled "Diabetes Action
Network Articles").
Products carried at the NFB Materials Center include the AccuChek Voicemate
and the LifeScan One Touch talking blood glucose monitors, a talking thermometer,
a talking blood pressure meter, and the tactile insulin-measuring Lo-Dose Count-A-Dose.
Because the NFB and its Materials Center are not for profit, items are priced
substantially below retail.
Many blind individuals, diabetic or not, are unemployed or under-employed.
The NFB runs the telephone-based database search "America's Jobline"
(reviewed elsewhere in this issue), accessible, with any touch-tone phone, at:
1-800-414-5748.
Do not forget that both our Diabetes Action Network and the NFB itself exist
to advise, to offer information. Our network has many Support Committees, including:
* Amputation and Treatment
* Blindness/Visual Dysfunction
* Get Well
* Heart Disease and Stroke
* Insulin Pump
* Legislative Issues
* Pancreas Transplantation
* Resource Library
* Renal Failure - Dialysis and Transplantation
* Male Sexual Dysfunction
* Women's Issues
For information on our Support Committees, or to learn more about our Diabetes
Action Network and the work we do, contact us at Voice of the Diabetic, 1412
I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911; fax:
(573) 875-8902; website: www.nfb.org/voice.htm. To learn more about the National
Federation of the Blind, and its many divisions, contact them at: National Center
for the Blind, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314;
fax: (410) 685-6563; e-mail: [email protected]; or website: www.nfb.org.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK
(Resource Column)
Inclusion of materials in this publication is for information only and does
not imply endorsement by the Diabetes Action Network of the NFB.
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
3-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
Diabetes Supplies
American Diabetic Supply, Inc., will ship your diabetes supplies to your door.
They handle all insurance claims and provide free delivery. Folks with Medicare
and/or private insurance (no HMOs) may receive supplies at no further cost.
For information, contact: American Diabetic Supply, Inc., 400 S. Atlantic Ave.,
Suite 108, Ormond Beach, FL 32176; telephone: 1-800-453-9033.
WINDOWS Screen Reader
GW Micro now offers WINDOW-EYES Version 4 with Braille Support, a screen reader
program that also supports Microsoft WINDOWS ME, WINDOWS 95 and WINDOWS 98 (support
for WINDOWS 2000 will follow later this year). Once equipped with a voice synthesizer
such as the Dectalk (your standard soundcard won't do), any computer that can
run WINDOWS can run WINDOW-EYES. WINDOW-EYES reads the internet too, and provides
you both speech and Braille output! A free demo disk is available, or you may
download the demo program from the Internet. The WINDOW-EYES program is available
from: GW Micro, 725 Airport North Office Park, Fort Wayne, IN 46825; telephone:
(219) 489-3671; fax: (219) 489-2608, e-mail: [email protected]; website: http://www.gwmicro.com
Change Your Ways
Good diabetes management is a lifestyle. Although doctors can prescribe medication
and recommend changes, sometimes "changing your ways," adapting/adopting
a healthy lifestyle, can be a lot of work -- for there is so much to learn.
The NEWSTART Lifestyle Center offers 12- and 18-day in-house, physician-supervised
intensive education programs, that emphasize permanent lifestyle changes designed
to help the participant lose weight, maintain health, and adopt healthier habits
in nutrition, cooking, exercise, and stress management.
Contact: Weimar Institute; telephone: 1-800-525-9192; e-mail: [email protected]
Discount Healthcare
We're all concerned about the high price of health care. Doctor visits and
medications seem to rise faster than a cabbie's counter, and not all of us can
afford health insurance, or qualify for Medicare. There is another alternative,
the "preferred provider organization, " or PPO. Care Entree is a PPO.
Members are entitled to reduced prices from participating doctors, dentists,
pharmacies, and hospitals. It is NOT "insurance," so there are no
exclusions. For information, telephone: 1-877-406-2077.
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 adaptive software or hardware, check them out: Freedom Scientific;
telephone: 1-800-444-4443; website: www.freedomscientific.com.
Escape the Paperwork
If you have Medicare and a supplementary policy, or one of many private insurance
plans, you may be able to get your diabetes supplies, perhaps even insulin and
syringes, delivered to your door at no charge, and with no forms for you to
fill out. Contact: The Diabetic Support Agency; telephone: 1-800-595-0228, and
mention "keycode 162."
New Diabetes Resource List
The Diabetes Action Network of the National Federation of the Blind will soon
offer the 2001/2002 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 October 31. 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
8 am to 5:00 pm Eastern time.
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, 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.
Easy Diabetic Cookbook
If you want to prepare healthy diabetic meals, but find most cookbooks just
too complicated, you need Linda Coffee and Emily Cale's THE DIABETIC 4-INGREDIENT
COOKBOOK. There are over 200 recipes, in all food categories, with complete
nutritional and exchange information, each one using four ingredients. The book
costs $9.95 (+$2.95 shipping), from: Coffee and Cale, PO Box 2121, Kerrville,
TX 78029; telephone: 1-800-757-0838.
Talking Blood Glucose Monitor
Based on the proven Accu-Chek Advantage meter, the Roche Diagnostics 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 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. The 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.
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
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.
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
Full Service Diabetes Supplier
DS Medical Supply is a full-service supplier with a catalog of more than 55,000
items, dealing with diabetes, its complications, and many other medical supplies,
delivered to your home. Diabetes products range from glucose monitors by Bayer
and LifeScan, and the AccuChek VoiceMate talking glucose monitor, strips, lancets
and other supplies, to diabetic orthotics/foot care items, and much more. They
accept Medicare, private insurance, some HMOs, and, in most states, direct or
crossover Medicaid. Contact: DS Medical, 2105 Newport Place, Suite 600, Lawrenceville,
GA 30043-5561; telephone: 1-800-722-2604, website: www.dsmedical.com
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 their many other products, contact: HumanWare, 6246 King
Road, Loomis, CA 95650; telephone: 1-800-722-3393; website: www.humanware.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.
Needle and Lancet Disposal
Careful and safe disposal of used insulin syringes and blood glucose test lancets
is everyone's obligation. Until now, there have been only two choices: something
recycled, like coffee cans, or a large, clumsy "sharps container"
like you might see in a hospital lab. And you can never find one when you need
one... Now there is a third choice, and it is small and practical.
The Voyager Diabetic Needle Disposal System is a personal sharps container
meant to be carried in a pocket. It will hold your used lancets, and up to 100
needles, but it does more. Insert your used insulin syringe into the the device,
and a simple turn removes the needle and destroys the syringe barrel -- hands
don't touch! Contact: Safe Medical Systems, LLC, 315 Bell Park Drive, Woodstock,
GA 30188; telephone: 1-877-723-3633; website: www.safemed.com
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FOOD FOR THOUGHT
We invite blurbs and tidbit articles for inclusion in this column. Materials
received may be edited and used as space permits. Products and services included
in this column are for information only and do not imply endorsement by the
Diabetes Action Network of the NFB.
A New Arrival
On March 21, 2001, Federationists Tom and Eileen Rivera Ley became parents.
Tom is a former president of our Diabetes Action Network, and Eileen is our
VOICE OF THE DIABETIC National Advertising Sales Manager. JonCarlos Rivera Ley
was 21.5 inches at birth, and weighed 7 pounds, 14 ounces. Congratulations to
all!
Oral Insulin Research
We're all waiting for the day an insulin-using diabetic can take a dose without
needing to inject their insulin under the skin. Nobody loves needles, and many
initiatives are underway to develop an insulin that can be swallowed or inhaled.
Although Pfizer's Exubera insulin, formulated to be inhaled (much like an asthma
medication), has run into some difficulties, several oral insulins are moving
forward. Oralin, from Generex, and compounds from Emisphere Technologies are
both reported as successful in early clinicals. It's a long way to go yet, but
the syringe's days may well be numbered.
Inhaled Insulin Troubles
Pfizer's Exubera inhalable insulin has been in clinicals, and the company was
intending to file for FDA approval later this year. That is now on hold. Exubera,
intended for use with devices manufactured by Inhale Therapeutics, works, it
lowers blood sugars efficiently and consistently -- but it has shown some side
effects, like a 4x increase in antibodies against insulin, and one case of lung
scarring. Accordingly, Pfizer has announced it will delay filing its marketing
approval application, and try to solve these problems first.
To Our Readers
To hold down costs, both the VOICE and many of our divisional mailings are
sent via "bulk mail." When we have your current address, this works
very well; but when we don't, the Post Office throws it away, or returns it
to us with a hefty "postage due" attached. They do NOT automatically
forward bulk mail!
If you move, please let us know promptly. If the VOICE doesn't follow you to
your new address, we may not have your new address. Don't miss a single issue.
Marriage Announcement
On July 14, 2001, Eric Woods, our Diabetes Action Network's First Vice President,
who is also Second Vice President of the NFB of Colorado Denver Chapter, married
fellow Federationist Lori Willard. Congratulations to Eric, and to the new Mrs.
Lori Woods!
Fat In Your Diet
We already know that eating too much fat can increase your risk for diabetes
and its complications. A new study, appearing in the September issue of Archives
of Ophthalmology, warns that dietary fat can also lead to age-related macular
degeneration, the biggest producer of new blindness in Americans 65 years of
age and older. A multicenter study, led by Johanna Seddon, MD, from Harvard
Medical School, found that excess dietary fat builds up in capillaries, and
can cause vision loss. She describes the study's findings as suggesting that
a long-term high-fat diet can cause a two-fold increase in the risk of macular
degeneration. The time to change junk-food eating habits is now, study authors
warn. "Macular degeneration is a 30-40 year process; dietary and lifestyle
changes have to be made at an early age."
2001 Raffle Winners
At the keynote banquet for the 2001 annual convention of the National Federation
of the Blind, in Philadelphia, Pennsylvania, the winning ticket was drawn in
the Diabetes Action Network raffle. Winning ticketholder was Ken Staley, of
Chicago, Illinois, who won twice, because he also sold the most raffle tickets.
Lots of people helped sell tickets, and the following folks each sold 50 or
more. In descending order of tickets sold: Ken Staley; Debbie Weston, Brighton,
MI; John Stroot, of Clinton, IN; Gisela Distel, of Albany, NY; Karen Mayry,
from Rapid City, SD; Billie Weaver, of Springfield, MO; Ed Bryant, from Columbia,
MO; Sally York, from Castro Valley, CA; Bill Yates, of Bakersfield, CA; and
Wayne Lyons, from Mitchell, SD. Truly a winning performance -- See you next
time!
New Insulin
Novo Nordisk announces availability of its new Novolog rapid-acting insulin.
Faster than Regular insulin, Novolog is available in U100 vials, and in cartridges
for the NovoPen 3. Available at your pharmacist, by prescription only.
Banquet Address
This year, at our National Federation of the Blind annual convention in Philadelphia,
Pennsylvania, NFB president Dr. Marc Maurer gave the banquet address, titled
"Independence and the Necessity for Diplomacy." This address is available,
free of charge, in large print and audiocassette, or downloadable (in "RealAudio"
format), from the NFB Website: www.nfb.org. This speech, and others by President
Maurer and Dr. Jernigan (and much more!), are available from the National Federation
of the Blind Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone:
(410) 659-9314, open 8:00 to 5 pm. EST, weekdays.
New Diabetes Action Network Board
At this year's NFB national convention in Philadelphia, Pennsylvania, elections
were held for the 2001-2002 Diabetes Action Network Board. Here are the results:
President: Ed Bryant, Columbia, MO.
First Vice President: Eric Woods, Denver, CO
Second Vice President: Sandie Addy, Prescott Valley, AZ
Secretary: Dawnelle Cruze, Portsmouth, VA
Treasurer: Bruce Peters, Akron, OH
Board Members: Paul Price, Valley Center, CA, and Sally York, Castro Valley,
CA
Note: Gisela Distel, from Albany, NY, also won election to our board, but,
sadly, she died on August 3 (see accompanying article).
We congratulate our new board!
Remembering Gisela Distel
by Ed Bryant
On August 3, 2001, Gisela Distel, a member of our Diabetes Action Network National
Board, died of a heart attack. She was a friend, and she will be missed. She
did a lot for our network, and for the National Federation of the Blind. She'd
been president of the NFB of New York state, and she'd held many other leadership
positions. Caring and devoted, she was always willing to help, especially with
fundraising.
Gisela's husband David asks that any memorial donations in her name be given
to diabetes research.
Aspirin and Diabetes Research
The ability of aspirin, in large doses, to lower blood sugars, has been known
for more than a century. Unfortunately, it has been known just as long that
the dose of aspirin high enough to cause useful blood glucose reduction is far
above the safety threshold, and can cause very serious side effects.
Today, researchers from Joslin Diabetes Center in Boston are researching just
what it is about aspirin, and about its chemical class, the salycilates, that
enables it to have blood glucose lowering properties. It may someday be possible
to isolate the elements useful to diabetes treatment, and create new drugs free
from the hazards of aspirin overdose. Stay tuned; there are many such initiatives
underway, and we'll report them as we hear of them.
Thank You! Thank You!
To all of you who responded to our recent donations drive, an enormous THANK
YOU! It costs more than $300,000 per year to publish VOICE OF THE DIABETIC,
the principal communication tool of our Diabetes Action Network. Through the
generosity of the National Federation of the Blind, we offer subscriptions without
charge; but our advertising income covers only a portion of production costs,
so we depend on YOU, our readers, to help us keep on carrying our message to
more diabetics, family members, health professionals, and individuals with an
interest in the condition. As our circulation has now grown beyond 295,000,
our need for your assistance grows more acute. Twice a year we send out requests
for donations. To those of you who responded--Thank You again!
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 295,315 VOICE readers could benefit from
your story.
For information and article submission guidelines, contact: VOICE OF THE DIABETIC,
1412 I-70 Drive, Suite C, Columbia, MO 65203; telephone: (573) 875-8911.
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VOICE DISTRIBUTORS NEEDED
Since the VOICE is now offered free, our Diabetes Action Network will provide
extra copies to anyone wanting to help spread the word. We will gladly send
from five to five hundred-plus copies each quarter to be used as free literature.
Medical facilities can order as needed for patients. Individuals can usually
place copies of the VOICE in libraries, pharmacies, hospitals, doctors' offices,
or other public locations.
Diabetes education is essential. Anyone who distributes the VOICE will be helping
people with diabetes, and their families, to learn about the disease and its
ramifications; to learn that they have options; and that their world is far
greater than whatever "limits" may be imposed by the disease. If you
would like to help spread the word by distributing the publication, please contact:
Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone:
(573) 875-8911, fax: (573) 875-8902. NOTE: Please provide a phone number so
we can reach you.
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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
1412 I-70 Drive SW, Suite C
Columbia, MO 65203
Telephone: (573) 875-8911
Fax: (573) 875-8902
Please make all checks payable to:
NATIONAL FEDERATION OF THE BLIND
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END of VOICE OF THE DIABETIC, Volume 16, Number 4, Fall 2001 Edition
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