Voice of the Diabetic

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 18, Number 2, Spring Edition 2003
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Voice of the Diabetic, published quarterly, is the national news
magazine of the Diabetes Action Network of the National Federation of the Blind.
It is read by those interested in all aspects of blindness and diabetes. We
show diabetics that they have options regardless of the ramifications they may
have had. We have a positive philosophy and know that positive attitudes are
contagious.
News items, change of address notices, and other magazine correspondence should
be sent to: Ed Bryant, Editor, Voice of the Diabetic, 1412 I-70 Drive
SW, Suite C, Columbia, Missouri 65203; Phone: (573) 875-8911; Fax: (573) 875-8902.
Find us on the World Wide Web at: (www.nfb.org). Our direct Web address is
(www.NFB.org/voice.htm).
Copyright 2003 Diabetes Action Network, National Federation of the Blind.
ISSN 1041-8490
Note: The information and advice contained in Voice of the Diabetic
are for educational purposes, and are not intended to take the place of personal
instruction provided by your physician, or by your health care team. Discuss
any changes in your treatment with the appropriate health professionals.
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INSIDE THIS ISSUE
MY DIABETES STORY
by Jane Malone
MOVE YOUR BODY!
BEGINNING TO EXERCISE, PART 2
by Ann S. Williams, MSN, RN, CDE
ASK THE DOCTOR
by Wesley W. Wilson, MD
SIMLYN, AN AMYLIN ANALOG, MAY BE
KEY TO BETTER GLYCEMIC CONTROL
by Ed Bryant
PUMP ACCESSIBILITY
by Donna Blake
INSULIN AND THE FUTURE
by Peter J. Nebergall, Ph.D.
LOUISVILLE SITE OF 2003 CONVENTION
DIALYSIS AT NATIONAL CONVENTION
DIABETES ACTION NETWORK SEMINAR
BLIND DIABETICS CAN DRAW INSULIN WITHOUT DIFFICULTY
by Ed Bryant
BOOK REVIEWS
By Marilyn Helton
RECIPE CORNER
LETTERS TO THE EDITOR
HEAR YE, A RAFFLE
WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK
(Resource Column)
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MY DIABETES STORY
by Jane Malone, RN
Perhaps I could share a little of my story. Everyone has a story. I am no
different.

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

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

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

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

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

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

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

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

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

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

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

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

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MOVE YOUR BODY!
Beginning to Exercise, part 2
by Ann S. Williams, MSN RN CDE
This column focuses on providing information to help people make their diabetes
care fit their needs and their lives.
The last article in this series discussed three major ideas you need to think
about before you actually begin to exercise. To review:
1. Exercise is any form of physical activity, or moving your body;
2. There are many good reasons to include physical activity as part of your
diabetes treatment plan;
3. It is important to think through types of exercise you can do, what sort
of exercise you would like to do, and when you can work exercise into your schedule,
before you begin.
This article will cover the things you need to think about during the first
few weeks of exercise.
Once you have already decided on a type of exercise and a time to exercise,
you will probably also have decided on a day to begin. If not, you need to set
that date. Don’t procrastinate—support your good intentions. Try
telling people close to you about your exercise plans—ask them for encouragement!
You might ask a family member or friend who also needs to move around more to
join you. Try planning your physical activity for first thing in the morning,
before you have a chance to get involved in other things. Or, plan your movement
for a natural break in your schedule, like right after lunch or supper. You
could sign up for a class, like water aerobics or stretching exercises of some
sort, and have the support of an instructor and a group. Try using a treadmill
or other exercise equipment while watching your favorite television show or
listening to your radio program. Pretend your TV or radio receiver won’t
work unless you are exercising, as if you had to generate the electricity. The
possibilities are endless. Use your imagination—and make your good intentions
a reality.
Before starting new physical activity, discuss your plans with your health
care team. It’s a good idea to review the signs and symptoms of low blood
sugar (hypoglycemia), and be prepared to treat it. Signs and symptoms can include:
feeling shaky, sweaty, lightheaded, anxious, weak, hungry, tired, or having
blurred or cloudy vision. You might feel any combination of these, or none of
them. If you do notice signs or symptoms of low blood sugar, you should test
your blood sugar level immediately (and regular testing before, during, and
after exercise is a good idea, whether or not you feel any of the symptoms of
a “low”). If your blood glucose is below 70, you should eat or drink
something with 15 grams of carbohydrate—three or four glucose tablets,
one half-cup of fruit juice or regular (sugared) soda pop, a cup of low-fat
or skimmed milk, six or seven small hard candies, or a slice of bread. Then
wait 15 minutes and check your blood sugar again. If it has not come up, take
15 more grams of carbohydrate. Watch out for over-treating—it’s
easy to overdo it and end up with high blood sugar! Everyone with diabetes should
carry something that can be used to treat hypoglycemia—especially if you
are exercising.
On the first day of a new physical activity, make sure you dress comfortably
and appropriately for that activity. If you will be moving around on your feet,
pay special attention to appropriate shoes and socks. Wearing shoes that fit
you properly and are appropriate for the activity is important for preventing
foot injuries; and wearing absorbent socks is important for preventing athlete’s
foot and blisters. In general, loose-fitting clothing made of absorbent fabric
is good for most forms of exercise.
Right before you exercise, you should check your blood sugar, to make sure
it’s not too low or too high to exercise safely. It’s best if your
blood sugar is between 100 and 240 before beginning your activity. If you are
using insulin, or oral diabetes medications, physical activity could burn enough
blood sugar to drive it too low. Make sure your blood sugar is above 100 before
you exercise. If you know your blood sugar drops quickly with activity, you
may want to make sure it’s about 130 or 150. (Test frequently, and you’ll
learn how you, as an individual, respond to exercise.) On the other hand, if
your blood sugar is over 240, you might not have enough insulin in your system
to allow sugar to move into your cells properly. If this is so, moving your
body could cause your cells to burn fat so quickly you could end up with toxic
by-products—high levels of ketones in your blood. It would be better to
get your blood sugar in control before starting your increased activity. Discuss
this with your health care team.
For the first day of starting new activity, and in general for the first week,
it is important that you simply begin to exercise; how long, how hard, and how
often you move around is less important. So, set a realistic goal; find one
for yourself you are sure to reach. For example, if you think you could probably
begin with a brisk 20-minute walk, you might plan for a moderate 10- or 15-minute
walk, then once you are walking, if you want to go for the full 20 minutes,
go right ahead. But, if you walk only 10 minutes, consider it a success! It
would be best to exercise a little every day for the first week, to help start
a habit; but if you manage to exercise at least three days out of seven, consider
it a success!
After you are finished, you should check your blood sugar again. You might
see it has dropped some. However, if your first time exercising was short and
gentle, you probably won’t see much change, if any. Don’t get discouraged
if this happens to you. After you have begun, you can increase the intensity
and the length of time you spend exercising. Then, you will see more benefit
to your blood sugar, blood pressure, cholesterol levels, and energy levels.
After the first week or two, you should begin to increase the intensity and
length of time you exercise. It’s best to do this gradually. For example,
if you have been using an exercise bike at moderate intensity for 15 minutes,
you might want to increase the intensity just a little, and exercise for 17
or 18 minutes in the third week. By increasing gradually like this, you’ll
eventually reach a level of activity that makes a real difference in your blood
sugar. You should continue to check your blood sugar before and after exercise,
partly to keep yourself safe, and partly to see the difference as you increase
the level of exercise.
It’s good to set yourself long-term goals for increasing your exercise
intensity, duration, and frequency. You’ll want to aim for a level of
exercise that is hard enough to give you many benefits—but you don’t
want to exercise so hard you exhaust yourself, hurt your heart, or end up with
sore muscles. Discuss the level appropriate for YOU with your health care team,
before you begin—and remember, we’re all different! Many experts
recommend exercising until your heart is beating at 60%, or 85%, of your maximum
heart rate after adjusting for your age, for about 30 to 40 minutes, at least
five days a week. The formula to figure out your target heart rate is: 220,
minus your age, times 0.6 or 0.7. To find out whether you are getting your heart
to that rate, after you have exercised for about 10 minutes, you should take
your pulse for 15 seconds and multiply by 4.
There are some easier ways to gauge whether your exercise level is in a good
range. One is simply to exercise as hard as you comfortably can, for as long
as you comfortably can. If you do this regularly, you’ll soon be able
to exercise harder and longer. Another helpful “rule of thumb” is
to exercise at a level that makes you breathe a little harder, but not too hard;
you should be breathing hard enough that you can’t sing, but you can still
talk. And, you should exercise long enough that you are pleasantly tired when
you are done, but not totally exhausted. If you’re totally exhausted,
or if your muscles get sore enough to hurt, you’ve done too much. Next
time, cut back and increase your level of exercise more gradually.
If you take insulin, or any oral medication that increases your body’s
own insulin, as you increase your activity, you’ll need to watch out for
hypoglycemia. This can happen during or right after the activity, and can also
happen several hours later. By watching your own blood sugar patterns as you
increase your activity, you can usually figure out when your blood sugar is
getting lower, and you can plan to prevent hypoglycemia. For example, if you
notice that after 20 minutes of vigorous activity, your blood sugar usually
drops low enough to be uncomfortable, you can plan to begin with a higher blood
sugar level, or to always carry some glucose or juice when you exercise. If
you find that your blood sugar is always lower for about 36-48 hours after you
exercise, and you know you have lower blood sugar in the late morning, you can
always carry some carbohydrates at that time. Or, if this is a consistent pattern,
you can speak to your doctor about lowering your medication, or changing to
a medication regimen that is less likely to produce low blood sugar. There are
many medication choices available now. Exercise is so beneficial it makes more
sense to change the medication to avoid low blood sugar than it does to decrease
the exercise.
As you continue your increased activity, it can become a self-maintaining
habit. Pay attention to your better blood sugar, blood pressure, and cholesterol
readings, increased energy, and overall increased sense of well-being. Notice
how much easier it becomes to move around at a level that would have caused
you fatigue before you started.
I’d love to hear from any of my readers who have found these articles
on exercise useful. If you began to exercise, or increased your physical activity
after reading these articles, please write me a note in care of the Voice
of the Diabetic office. Let me know what you did, and whether you encountered
any problems along the way, and how you solved them. You can write me at: Ann
S. Williams, RN, MSN, CDE, c/o Voice of the Diabetic, 1412 I-70 Drive
SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911; e-mail: [email protected]
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ASK THE DOCTOR
by Wesley W. Wilson, MD
Includes Art: Medical Caduceus
NOTE: If you have any questions for "Ask the Doctor," please send
them to the Voice editorial office. The only questions Dr. Wilson will
be able to answer are the ones used in this column.
Wesley W. Wilson, MD has retired as an Internal Medicine practitioner at the
Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type
1 diabetes in 1956, during his second year of medical school. He remains interested
and involved in diabetes education for patients and professionals.
Question: What is the “ideal” A1C for a diabetic? I always heard
my numbers should be no higher than 7 percent, but now my doctor is saying that
it should be 6.5 percent or lower. What’s right?

Answer: Your question is important, and it needs a good answer. These days,
when we have the ability to measure “glycosylated hemoglobin” (Hemoglobin
A1C) at home, or get the values from our health care provider, we need to know
what we should be trying to achieve. My first answer is: It depends. Perhaps
some background information will help.
The Diabetes Control and Complications study (DCCT) was a multi-year trial
in which the questions asked included: 1) Can careful control of blood sugar
in persons with type 1 diabetes reduce the appearance and/or the progression
of complications? and 2) Is extremely “tight” control of blood sugar
possible without devastating problems from hypoglycemia (low blood sugar)?
The DCCT was set up to compare two groups of persons with type 1 diabetes.
One group was treated “conventionally,” with self blood sugar testing
one or two times a day, occasional contact with the treating team, and avoidance
of excessively high or low sugars. By comparison, the intensively treated group,
who sought to achieve near normal blood sugars, checked sugars three or more
times each day, saw the treating team about every two weeks, and took insulin
three or four times daily, or used insulin pumps. They were truly treated intensively.
The “target” A1C, the point they sought to reach and hold, was a
“normal” A1C, that is 6 percent or less. Despite efforts to carefully
control blood sugar in the intensely treated group, only 5 percent of the group
were able to achieve such a “normal” HbA1C, and the average A1C
was 7 percent, one percent higher than planned. Hypoglycemia limited the ability
to control blood sugar. In contrast, the conventionally treated group had A1Cs
averaging 9 percent.

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

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

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

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

I try to have my A1C as low as possible, but if I’m involved in lots of
physically active sports, I must run blood sugars a little high to avoid the
need to take sugar all the time. There is no one “right” A1C; it
truly does DEPEND.
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If you or a friend would like to remember the Diabetes Action Network of the
National Federation of the Blind in your will, you can do so by employing the
following language:
"I give, devise, and bequeath unto the Diabetics Action Network of the
National Federation of the Blind, 1800 Johnson Street, Baltimore, Maryland 21230,
a District of Columbia nonprofit corporation, the sum of $_______________"
(or "_______________ percent of my net estate" or "the following
stocks and bonds:____________________") to be used for its worthy purposes
on behalf of blind persons."
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SIMLYN, AN AMYLIN ANALOG, MAY BE KEY TO BETTER GLYCEMIC CONTROL
by Ed Bryant
In Voice of the Diabetic Vol. 14, No. 2, April 1999, I reviewed research
into the action of the human hormone amylin, and its relationship to good diabetes
control. Here is a quick review of what we have learned since.

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

We may now have the missing piece. Amylin Pharmaceuticals, Inc., a San Diego,
California based company, has been researching the human hormone Amylin, and
their findings, while still under investigation, are fascinating. Their product,
pramlintide (trade name Simlyn), is now in Phase III clinicals.
Amyloid, the parent compound, was first noted about a century ago, by pathologists
performing autopsies. In the 1980s, the chemical was analyzed, and the peptide
amylin sequenced from it. Because naturally-occurring human amylin is too thick
and viscous to inject, Amylin Pharmaceuticals developed its injectable analog,
pramlintide (Simlyn).

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

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

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

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

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

Many diabetics have experienced episodes of severe hypoglycemia, dangerously
low blood sugars. "Tight control," multiple-test, multiple injection
therapy to keep the blood sugars as close to a non-diabetic "normal"
as possible, increases the risk of "hypos." Animal studies have shown
that pramlintide, which normally retards release of glucose stored in the liver,
suspends its action in the presence of hypoglycemia. This suggests a healthy
supply of Simlyn might help lower the blood glucose without increasing the risk
of hypoglycemia. Some test data suggest a reduction in hypoglycemic episodes
for the duration of amylin therapy.
Amylin Pharmaceuticals conducted a series of clinical tests several years
ago, Phase IIIs involving a graduated series of dosages. Most of the results
from this research were well within acceptable standards; but the group receiving
the highest dosages encountered unexpected difficulties, and the U.S. Food and
Drug Administration, which rules on the safety and suitability of every new
drug to be sold in the United States, understandably ordered more tests before
approval would be considered. This second round of Phase III clinicals is now
under way.
These are not small tests. In the first set of Phase IIIs, over 1700 people
received Simlyn. Both type 1 and insulin-using type 2 diabetics took it, in
different strengths, and with minimal side effects in all but the highest dosages.
In most cases, significant reductions in hemoglobin A1C numbers were noted --
and it has been proven lower A1Cs significantly cut the risk of diabetes complications.

Much work is still under way to determine amylin's exact role in the management
of diabetes. If Simlyn's retests are successful, if the company can answer the
questions its high-dosage results exposed (and deal with the tremendous expense
of retesting the drug), we may well see FDA approval. If they cannot, it will
go into the books as one more idea that didn't quite make it. For the sake of
all diabetics, I hope we see this one happen. Stay tuned.
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Voice Formats
Voice of the Diabetic is offered in two formats: standard print,
and 15/16 IPS audiocassette ("talking book" speed). Anyone who is
currently receiving the Voice in print and having difficulty reading
it, may receive it on cassette at no charge. Voice tapes require the
special tape player available free to the legally blind from Regional Libraries
for the Blind and Physically Handicapped, which can be obtained by telephoning
the National Library Service at: 1_800_424_8567.
Periodically we receive requests for the Voice in Braille or large
print. It is not available in either of those formats at this time. View the
Voice on the World Wide Web at: www.nfb.org/voice.htm

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PUMP ACCESSIBILITY
by Donna Blake
As I sample the literature written on the diabetes epidemic, I often see the
much-quoted phrase, “Diabetes is the leading cause of blindness (age 20
-75) in the United States.” With the increasing number of both type 1
and especially type 2 diabetes cases (particularly in children), it amazes me
that there is little or nothing written by healthcare professionals regarding
the healthcare issues of blind patients. I suppose the reason is as complicated
as the situation that arises when a blind patient walks into an eye doctor’s
office—other patients seeing the eye care professional may then think
the doctor is not good. In many healthcare settings, blindness is considered
a medical failure, and that perception becomes much worse when the blind person
also has diabetes. We know our doctors tried the best they could, and many went
the extra mile for us patients, without success, and we are grateful for that;
but where does this leave us with our ongoing healthcare? No pun intended, but
we’re left in the dark.
When I first lost my vision, and could not read the little numbers on my insulin
pump or the big numbers on my blood glucose machine, I had no resources to turn
to for help. My eye doctors didn’t even know about CCTVs (video magnifiers),
and that was in 1996. Neither my eye doctor nor diabetologist had a notion that
talking blood glucose meters, Count-A-Doses (a tactile insulin-filling device),
or other adaptive items to help me to control my diabetes without sight, even
existed. I had to depend on a four-year-old to read numbers so I could pump
in my insulin and measure my blood glucose.
I went through countless diabetes publications and found no written literature
about patients having diabetes complications, or even from other non-diabetic
causes of vision loss. (Yes, people with diabetes can develop other eye diseases
similar to those in the general population.) Also, I found no resources for
people who were already blind and then developed diabetes later in life. I then
turned to the nation’s leading diabetes organizations, and none of them
could give me an answer about what I could do. None of these organizations encouraged
me at all.
It was only by chance I found out about the National Federation of the Blind
(NFB). Someone gave me a NFB card, and I called the local chapter, which promptly
sent me a copy of Voice of the Diabetic. It was through this publication
I learned that some blood glucose meters had adaptable plug-in voice synthesizers,
items such as Count-A-Doses existed and there were other items which could assist
me with my diabetes management. However, despite this great and invaluable resource,
I found nothing written regarding people who were blind and using insulin pumps.
(Editor’s Note: There have been a number of articles for, and by, blind
diabetics who successfully use insulin pumps. My survey, "Many Blind Diabetics
Successfully Use Insulin Pumps," is also available as a chapter in the
NFB publication titled "Diabetes Action Network Articles," available
free in large print or four-track audiocassette from: Materials Center, National
Federation of the Blind, 1800 Johnson Street, Baltimore, MD 21230; telephone:
(410) 659-9314; Web site: www.nfb.org)
Having been on an insulin pump for many years, I had to “blaze my own
trail” so to speak. Fortunately at the time I was losing my vision, the
company whose pump I used was coming out with a new model, which offered a lighted
screen and an audible beep, to help program in the amount of insulin one needed
(if you were in a poorly lighted area). Although they gave me more access to
a tool I need to manage my diabetes, these new features certainly were not included
to help a blind person with diabetes use this device.
My endocrinologist gave me a prescription for the newer pump, and this turned
out to be a great asset. Though the new pump allowed me to give my meal doses
of insulin with the sound of a beep, I could not use any of its other features.
I still needed sighted assistance to program the pump, and make the changes
in programming as my lifestyle changed and my needs changed. All of this happened
six years ago, and since then there have been three newer model pumps developed
by my pump company. Still, two-thirds of a pump’s features are not available
for a blind user. I don't see how a blind user is supposed to even set up the
pump independently—and I have made many calls to the company explaining
the need and market value for such improvement.
It is great that we can make cars speak, watches speak, computers speak, elevators
speak -- yet we cannot make such an important device audible? Even the epidemic
increase in numbers of patients with diabetes and blindness has not convinced
the pump manufacturers to improve their products to give us access to all the
features, especially the ability to set it up independently. Not only is this
true with pump manufacturers, but many of the blood glucose meter companies,
as well.
Having been on a pump for so long, and using it both sighted and blind, has
led to many phone calls from both potential pump users and healthcare professionals.
Both professionals and patients alike have basic questions regarding how someone
blind could use a pump and perform the necessary basic maintenance pump use
requires. I have spoken to well over 25 people regarding the various issues,
and how I have overcome challenging situations with my pump. Due to the lack
of effort toward making a pump accessible to people who are blind, I put together
a small reference guide to assist people in setting up and taking care of a
pump site as well as some basic tips for operating the pump. I have also written
a list of concerns someone or someone’s healthcare provider may have to
consider when evaluating a pump as an appropriate tool for personal diabetes
management.
If we are not to receive help from the manufacturers regarding their products,
then we need to place pressure on our healthcare professionals to require the
medical industry meet our needs. The ADA was passed to grant equal access for
people with disabilities. Equal access in healthcare is a right for all, and
manufacturers should understand the importance of accessibility for those of
us who depend on their products. In order for blind people who have diabetes
to live independently in our communities, we must demand that both the healthcare
providers and the products they recommend meet our needs.
+++++++++++++++++++++++++++++++++++++++++++++

INSULIN AND THE FUTURE
by Peter J. Nebergall, Ph.D.
Not so long ago, if you used insulin, you didn't have a whole lot of choices.
There was "normal" speed R insulin, slower NPH or Lente, and perhaps
you considered using Ultralente. You used Lilly insulins, or those from Novo
Nordisk. It was that way for decades.
No longer. Insulin innovations have come thick and fast. It is tough for us,
and our doctors, to keep up. It seems every time we turn around there's not
only a new oral diabetes medication, and a new theory about how diabetes works,
but now also a new insulin. What's going on? What's on the way?
The biggest insulin changes of the last decade were two: First, the replacement
of "animal-source" insulins (beef or pork) with recombinant-DNA types.
The new types are cheaper, easier to produce, and, made in a test tube, do not
attract the unwelcome attentions of groups like PETA.
The second change was the arrival of Eli Lilly's Humalog. Two to three times
faster than R insulin, Humalog has enabled diabetics to "inject while looking
at their food." Humalog starts quicker than R, peaks faster, and is gone
from the body sooner. It has proved enormously popular.
Lilly's competitor, Novo Nordisk, has followed suit with Novolog, which, though
different in formulation, is similar in pattern of action.
Another big change has been the arrival of Aventis' Lantus insulin. Much attention
has been paid to "quick" insulins; but Lantus is a very slow insulin,
with a "peak" so flat it's almost a straight line. The first "24-hour"
insulin, Lantus is carving out a niche among type 2 diabetics who need to start
injecting insulin. Lantus is chemically incompatible with other insulins, and
cannot be mixed -- but, as one dose of Lantus lasts 24 hours, there would not
be much occasion to mix it.
Lantus is not available in insulin pen cartridges at this time, but sources
at Novo Nordisk, who confirm the company is working on a competing "slow"
insulin, state: "Once our product is approved, we hope to make it available
for use in a variety of insulin delivery systems."

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

Several new mixes are now available. Lilly offers a Humalog 75/25 (quick-acting
Humalog plus medium-slow PTZ insulin), and Novo Nordisk, maker of Novolin 70/30
premix, offers Novolog 70/30 premix. With their very rapid onset, these new
insulin premixes offer some real advantages; but the Novolog mix (reviewed elsewhere
in this issue) sounds dangerously like Novolin 70/30, opening the ambiguity
door to new possibilities for doctor and pharmacist error. If you expect Novolog
70/30, but receive the older Novolin 70/30, no big deal; you'll catch the error
next time you test your blood glucose -- but, if you expect Novolin 70/30, and
receive the Novolog mix, likely you're going down with a bang.
Amazingly, Novo Nordisk (who's sponsored really good research into insulin-dosage
errors) did not sound particularly concerned, when I confronted them with this.
I don't know why.
There has been a lot of interest in oral, buccal (under the tongue), and inhalable
insulins, whose administration would not require piercing of the skin with a
needle. Many companies are researching such formulations, but none have been
approved at this time. Insulin inhalation works (in that the insulin gets into
the bloodstream and lowers the blood sugar); but the problem has always been
to moderate the insulin's action, to give it a "response curve" similar
to that of injected insulin. Oral and buccal insulins, utilizing the digestive
system for absorption rather than the lungs, have had to contend with the opposite:
too little insulin getting through to the patient's blood.

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

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

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

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

LOUISVILLE SITE OF 2003 NFB CONVENTION
This story first appeared in the January 2003 Edition of the Braille Monitor,
published by the National Federation of the Blind.
The 2003 convention of the National Federation of the Blind will take place
in Louisville, Kentucky, June 28 to July 5. We will conduct the convention at
the Galt House Hotel and the Galt House East Tower, a first-class convention
hotel. The Galt House Hotel, formerly called the Galt House West, is at 140
N. Fourth Street, Louisville, Kentucky 40202. The Galt House East Tower, or
Galt House East, is at 141 N. Fourth Street, Louisville, Kentucky 40202. Room
rates for this year's convention are excellent: singles, doubles, and twins
$57; and triples and quads $63 a night, plus tax. The hotel is accepting reservations
now. A $60-per-room deposit is required to make a reservation. Fifty percent
of the deposit will be refunded if notice is given to the hotel of reservation
cancellation before June 1, 2003. The other 50 percent is not refundable. For
reservations, call the hotel at: (502) 589-5200.
Rooms will be available on a first-come, first-served basis. Reservations
may be made to secure these rooms before June 1, 2003, assuming that rooms are
still available. After that time, the hotel will not hold the block of rooms
for the convention. In other words, you should get your reservation in soon.
Our overflow hotel is the Hyatt Regency, at 320 W. Jefferson Street, Louisville,
Kentucky 40202; phone: (502) 587-3434.
Those who attended the 2002 convention can testify to the gracious hospitality
of the Galt House. This hotel has excellent restaurants, first-rate meeting
space, and other top-notch facilities. It is in downtown Louisville, close to
the Ohio River, and only seven miles from the Louisville Airport.
The 2003 convention will follow what many think of as our usual schedule:
Saturday, June 28: Seminar Day
Sunday, June 29: Registration day
Monday, June 30: Board Meeting and Division Day
Tuesday, July 1: Opening Session
Wednesday, July 2: Tour Day
Thursday, July 3: Banquet Day
Friday, July 4: Business Session and Adjournment

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

DIALYSIS AT NATIONAL CONVENTION
by Ed Bryant
During this year's annual convention of the National Federation of the Blind,
in Louisville, Kentucky (Saturday, June 28, through Friday, July 4), dialysis
will be available. Individuals requiring dialysis must have a transient patient
packet and physician's statement filled out prior to treatment. Conventioneers
must have their unit contact the desired location in the Louisville area for
instructions, well in advance. NOTE: The convention will take place at the Galt
House Hotel, 140 N. Fourth Street, Louisville, KY 40202.
Individuals will be responsible for, and must pay out of pocket, prior to
each treatment, the approximately $30 not covered by Medicare, plus any additional
physician's fees, and any charges for other medications.
DIALYSIS CENTERS SHOULD SET UP TRANSIENT DIALYSIS LOCATIONS AT LEAST EIGHT
WEEKS IN ADVANCE. THIS HELPS ASSURE A LOCATION FOR ANYONE WANTING TO DIALYZE.
There are many centers in the Louisville area; but that area is quite large,
and early reservation is strongly recommended—especially during this holiday
period. Here are some dialysis locations, all about half a mile from the hotel:

* Renal Care Group, Inc., 635 South Third Street, Louisville, KY 40202; telephone:
(502) 561-1314. As of this writing, they are almost full.
* Fresenius Medical Care, 720 East Broadway, Louisville, KY 40202; telephone:
(502) 584-3021.
* U. of Louisville Kidney Disease Program, 615 Preston Street, Louisville,
KY 40202; telephone: (502) 852-7278.
PLEASE REMEMBER TO SCHEDULE DIALYSIS TREATMENTS EARLY, TO ENSURE SPACE. CALL
THEM NOW! If scheduling assistance is needed, have your dialysis unit's social
worker contact me: Diabetes Action Network President Ed Bryant; telephone: (573)
875-8911. See you in Louisville!
+++++++++++++++++++++++++++++++++++++++++++++

DIABETES ACTION NETWORK SEMINAR
by Ed Bryant
At the 2003 convention of the National Federation of the Blind, in Louisville,
Kentucky, our Diabetes Action Network will have its seminar and business meeting,
on Monday, June 30, from 2 to 4:30 pm.
Our keynote speaker will be a Registered Dietitian, who will discuss diabetic
foods, the Exchange List, and carbohydrate counting. There will be plenty of
time for your questions.
Once again, we will have our “Make the President Pay” diabetes
quiz game—and I will give a nice donation to the division for each right
answer! Our seminar is free and open to the public. Its room location will be
posted in the Agenda (which is provided when you register).
+++++++++++++++++++++++++++++++++++++++++++++

BLIND DIABETICS CAN DRAW INSULIN WITHOUT DIFFICULTY
by Ed Bryant
This article appeared in Voice of the Diabetic, Volume 16, Number
2, Spring 2001, published by the Diabetes Action Network of the National Federation
of the Blind.
A major aim of the Diabetes Action Network of the National Federation of the
Blind is to provide support and information for blind diabetics, so they might
better maintain or regain independence and productivity. Our national support
and information network allows communication across a wide area, something important
for blind or visually impaired diabetics and their families. With the trauma
of sight loss, sometimes the newly blinded do not realize that most blind men
and women with diabetes CAN self-manage safely and accurately, by use of alternative/adaptive
techniques.
I became blind from diabetic retinopathy about 25 years ago. When I first
lost my sight, I didn't use insulin gauges to help draw my insulin, as I had
never heard of such devices! Twenty-three years ago, I designed my own insulin
gauge, and I used it for approximately three years, with no difficulties. However,
I do not advocate the use of non-standard or homemade insulin-measuring devices,
unless they have been checked out by someone knowledgeable in insulin-measuring
techniques.
Members of the health care community sometimes forget that although a diabetic
may be newly blinded, he or she has often been successfully self-managing the
disease for 15 years or more. Most long-term type 1 diabetics have had years
of experience drawing their own insulin. Veteran blind diabetics often have
more experience with adaptive insulin preparation devices than do many sighted
health professionals. The following observations are only a small sample.
Because of my experience with diabetes and blindness and my editorship of
Voice of the Diabetic, I am often asked to evaluate insulin-measuring
gauges designed for the blind or visually impaired. I have tested numerous measuring
devices, and in my opinion the Count-A-Dose, from Medicool, wins the blue ribbon.
(Note: The Count-A-Dose is available from the National Federation of the Blind
Materials Center: (410) 659-9314.) I hasten to add that no one instrument
is ideal for everyone; however, the Count-A-Dose provides a very easy method
of insulin dispensing. Designed for the B-D LoDose syringe, the Count-A-Dose
holds two insulin vials and directs the syringe needle into the vials' rubber
stoppers. Using the thumb-wheel, which clicks for each unit measured (clicks
can be both heard and felt), the blind diabetic can reliably draw and mix his
or her own insulin.

How to Get Air Bubbles Out of an Insulin Syringe
There are techniques by which a blind diabetic may draw and mix insulin without
drawing air into the syringe. Like many others, I have used them successfully
for years. I first draw four or five units of regular insulin into the syringe
and then inject all of it back into the vial. I then repeat the operation two
more times. The fourth time, I draw the full amount of insulin needed from the
first vial. Then, when I draw insulin from the second vial, I draw the exact
amount needed. I have put this to the test; 100 repetitions without air bubbles.
Diabetes Action Network former First Vice President Janet Lee twice performed
the same test. In both cases the complete absence of air in the syringe was
independently verified.
"Tapping the syringe to remove air bubbles," a common technique
used by the sighted, becomes unnecessary. The one to two units of air in the
hub of the needle (where needle meets syringe) are expelled during the procedure
used with the first vial of insulin. I demonstrate this technique to nurses,
who are delighted to see that air bubbles are not present and the insulin measurement
is accurate. Of course, long-term insulin users will be familiar with
the need to inject as much air into the vial as the amount of insulin they withdraw,
to facilitate getting the insulin into the syringe. For further information,
consult your health care team.

How to Know When an Insulin Vial is Getting Low
Each vial of insulin contains 10cc, 1000 units. The maximum number of units
used per day, divided into the vial's 10cc (1000 units) capacity, gives the
maximum number of days the bottle can be used. When I open a new vial of Regular
insulin, I divide its 1000 units by 20 units, the maximum I use daily, so one
supply should last me 50 days, but as a safeguard, I assume that the new bottle
contains only 940 units (9.4cc), which should last a maximum 47 days instead
of 50. I measure my NPH insulin in a similar manner. As long as at least 60
units of insulin remain in the vial, the needle will remain submerged while
filling, and there is no danger of drawing air. In drawing out the insulin,
I keep the syringe vertical, needle straight up in the vial, so as not to inadvertently
draw out air. Many blind consumers (and diabetes educators) are unaware of this
point's importance—that the natural tendency is to tilt or slant while
drawing, which can lead to inaccurate filling and air in the syringe.
Many methods exist to determine how long a supply will last. One way to keep
track of the amount of insulin in the container is to set aside the number of
syringes that will be needed for 940 units of insulin. Another might be to employ
Braille, large print, tape recorders, or personal computers, to record how much
insulin has been used each day. Many blind consumers, like myself, realize the
importance of keeping their blood glucose under tight control, and follow regimes
of insulin mixing and multiple injections, both of which increase the need for
precision. I have found the more precise the record of insulin drawn, the easier
to safely predict when it is time for a new supply. NOTE: Although not as precise,
before drawing insulin you can gently shake the vial and, with practice, easily
determine whether it is full, half-full, or nearly empty.
Tactile Insulin Pens
Many blind diabetics make use of the easy adjustability of insulin pens. Pens
combine the insulin drawing and dosing functions, and, though all still bear
the legal disclaimer: “Not for use by blind or visually-impaired individuals
without sighted aid,” most incorporate tactile and audible cues for each
unit drawn, and many blind diabetics successfully use them—without sighted
aid. Some even come “pre-filled,” and are meant to be discarded
when empty. Though pens have their drawbacks (no mixing, higher price), they
work, and one from Novo Nordisk, Eli Lilly, Owen Mumford, or Disetronic might
be appropriate for you. Talk to your doctor and your pharmacist.
The Possibility of Inserting a Needle into a Blood Vessel
Since injection sites are in fleshy areas, and insulin needles are short,
chances of inserting a needle into a blood vessel are minimal. The worst that
can be done is to hit a small capillary, which would result in a small area
becoming infused with blood—a hematoma. Again, it is unlikely the needle
will be inserted into a small blood vessel. The amount of insulin entering the
bloodstream via a capillary would be insignificant, and would cause no harm.

Something to Think About

I periodically have my insulin gauge checked for accuracy; it has always measured
precisely. If the diabetic is careful, difficulty in measuring insulin will
not occur. I have found that inaccuracy is often the result of haste or carelessness.
It is reported that insulin gauges are more accurate than sight. When the
plunger is pushed firmly to the gauge, the same amount of insulin will be obtained
every time. Sometimes my sighted friends make errors in drawing insulin. Perhaps
they would be more accurate if they used insulin gauges! Note: Syringes are
mass-produced. Although there is quality control, some errors are made
in syringe markings. If a gauge is used, the measurement will be accurate no
matter what the syringe shows.
At first hearing, all this may sound like a lot to remember, but it is not
difficult. Marla Bernbaum, MD, CDE, Assistant Professor at St. Louis University
Medical School Department of Endocrinology, states: "In our experience
here, most blind and visually impaired diabetic patients have been capable of
drawing their own insulin with complete accuracy."
Janet Lee, former Director of the Independent Management for Blind Diabetics
Program at BLIND, Inc., Minneapolis, Minnesota, stated: "In my ten years
of working with blind diabetics, hundreds of them, there have maybe been two,
who, because of a combination of disabilities, could not measure their own insulin."
Ruth Ann Petzinger, RN, MS, CDE, Diabetes Care Manager/Educator at St. Peters
Medical Center, New Brunswick, New Jersey, states: "During the time I have
been working with persons with diabetes and visual impairment, I've never had
a patient who truly wanted to be independent with insulin administration or
blood glucose monitoring who was not able to achieve these goals."
Anne Whittington, RN, MSN, MBA, CDE, with the U.S. Navy Medical Center, San
Diego, California, states: "In my experience, with proper training almost
all diabetics are able to prepare and administer their own insulin safely, regardless
of visual impairment."
Ann Williams, MSN, RN, CDE, formerly Diabetes Program Coordinator, Cleveland
Sight Center (now completing her Ph.D.), states: "In the last eight years
I worked at CCS, we taught about 800 visually impaired and blind people to measure
and administer their own insulin independently. Vision loss does not preclude
safe and effective insulin self-administration."
I have no problems managing and keeping my diabetes under control. I control
it through the use of alternative techniques, some of which are described here.
Many members of our organization, the National Federation of the Blind, use
them daily to live active lives. With alternative techniques, blind diabetics
can be as productive as when they were sighted.
Come to us and ask for assistance. We are ready, willing, and able to help.
We want you to know that no matter what your diabetes ramifications, you are
not alone and do have options. We in the National Federation of the Blind know
that blindness is not synonymous with inability.

Resources:
The Eye-Dea Shop: Cleveland Sight Center, 1909 E. 101st Street, Cleveland,
OH 44106-8696; phone: (216) 791-8118 ext. 278
The Syringe Support Insulin Measuring Device: Uses only the B-D 1cc/100-unit
disposable syringe, and measures insulin in 1- or 2-unit increments,
in doses of 1 to 100 units. To mix insulins, it is necessary to remove vials
from the apparatus. To draw a measured dose, the Syringe Support uses a set
screw, with a raised flange (its only landmark) at 12 o'clock. One full turn
draws two units, and one half-turn draws a single unit. Although the dial
lacks definite tactile or audio indicators, in most cases any error would be
fractional. Still, the Syringe Support performs best for those who must draw
doses greater than 10 units. Instructions (standard print only) are bilingual
(English and French). Cost: $26
National Federation of the Blind, Materials Center: 1800 Johnson Street, Baltimore,
MD 21230; phone: (410) 659-9314; fax: (410) 685-5653; Hours are 8:00 a.m. to
5:00 p.m. EST, weekdays; Web site: http://www.nfb.org
Count-A-Dose Insulin Measuring Device: Gauge calibrated for use
with vials and B-D 1/2cc (low dose) syringes only. By turning a thumb-wheel,
clicks are heard and felt for each one-unit increment measured; holds
1 or 2 vials of insulin for mixing; needle penetrates vial stopper automatically.
Print and audiocassette instructions provided. Price: $40.00
Palco Labs, Inc.: 8030 Soquel Ave., Santa Cruz, CA 95062; phone: 1-800-346-4488;
fax: (831) 476-1114
Load-Matic: Tactile insulin measuring device, accepts B-D 100-unit
syringes; aligns needle with vial stopper; two separate controls (one for single-unit
and the other for ten-unit increments); tactile prompt to confirm dose
setting. Audiocassette instructions included. Individuals with neuropathy may
have difficulty with the one-unit scale, and it is possible to unintentionally
"short-stroke" the ten-unit loading lever and draw an
incomplete dose. Cost: $47.99
+++++++++++++++++++++++++++++++++++++++++++++

BOOK REVIEWS
by Marilyn Helton
Henry David Thoreau advises us, "Live in each season as it passes; breathe
the air, drink the drink, taste the fruit, and resign yourself to the influences
of each."
Despite the fact this column is written before we change seasons from winter
to spring, I remain the eternal optimist, with hope that by the time you read
this, world peace will have prevailed.
Here we are in the month of April and there's a mighty load of new book reviews
to bring your way. We have lots of celebrations centered on food this quarter,
which can either be miserable news or eagerly anticipated by those of us with
diabetes.
The parade begins with Passover and Easter in April, followed by Cinco de
Mayo, Mother's Day and Memorial Day in May, and then "Juneteenth"
(the Texas celebration of African American emancipation), Father's Day and graduation
celebrations in June. Don't forget to dot the landscape with birthdays, weddings,
festivals, picnics and other unofficial opportunities to do the
food-dance.
With so many food-oriented occasions ahead of us, it's wise to be ready with
some great new food ideas, tips and recipes for looking forward to each and
every one of them. Remember, your diagnosis of diabetes does NOT have to be
a culinary death sentence!
*************************
Good news! You were introduced to Mealleaniyumm! by Canadian cookbook
maven Norene Gilletz a couple of years ago, and now the updated and revised
edition, Mealleaniyumm! 800 Fast, Fabulous & Healthy Recipes for the
Kosher (or not) Cook is available just in time for Passover.
You don't have to be Jewish to enjoy these healthy, home-style recipes, because
this quick and easy cookbook focuses on low-fat, nutritious cuisine for everyone.
Emphasizing the use of everyday ingredients, Norene's step-by-step recipe directions,
time-saving tips, substitutions, and recipe variations are a real bonus. One
of my favorite features is the complete nutritional analysis for each recipe,
accompanied by healthful hints about fat, fiber, cholesterol, calories, calcium
and more.
Whether you have diabetes, are a cardiac patient, vegetarian or just love
good food, Mealleaniyumm! 800 Fast, Fabulous & Healthy Recipes offers
recipes from family fare to bountiful buffets, perfect for today's time-challenged
cook. Five out of five stars to this cookbook and its author, Norene Gilletz!
************************
You're gonna love the next two cookbooks, folks! Now you can literally have
1,001 Delicious Recipes for People with Diabetes and 1,001 Delicious
Desserts for People with Diabetes in two separate cookbooks. Both
books are published by Surrey Books and they are HUGE (the first having over
800 pages and the DESSERTS over 600 pages). Sue Spitler, a terrific cookbook
author in her own right, teamed up with Linda Eugene, RD, CDE, and Linda R.
Yoakam, RD, MS, to bring us this bonanza of delectable recipes. Wow! Just think,
if you tried a new recipe from one of these great books every day, it would
be almost six years of delicious dining!
Fat is what makes food taste good, and oh, how we all love those zesty pastas
and rich gooey desserts! "For a person with diabetes and no healthy cooking
experience, the larder may look a little lean," says co-editor and professional
cook Sue Spitler (whose other books in the "1,001 Series" are bestsellers).
"It's important to choose foods that are low in fat, moderate in carbohydrate,
low salt, high fiber and rich in vitamins and minerals. The key is the recipe
. . . you need to cook with enough flavor to make you feel satisfied."
And guess what? That's exactly what this cookbook-writing trio has brought to
this magical set of cookbooks!
Promising "no more boring meals," imagine having Artichoke-Stuffed
Appetizer Bread, Roast Chicken with Cornbread Stuffing, Shrimp and Sausage Gumbo,
Vegetable Strudel with Cheese, Crab Melts or Sweet Stuffed French Toast on the
menu. But wait, what about dessert? Well, how about Mississippi Mud Bars, Macadamia
Nut Cheesecake, Pineapple and Double Cheese Upside Down Cake, Banana Cinnamon
Cake with Powdered Sugar Glaze, or Deep-Dish Blackberry Cobbler with Lemon Hard
Sauce? With over 2,000 recipes, these books deliver as promised!
I don't want to hear any more whining about "not being able to eat anymore"
just because you've been diagnosed with diabetes. If your budget was limited
and you could only have two cookbooks, invest in these two and never look back!
Or, put them on your wish list; these books are fabulous! Five enthusiastic
stars out of five!!
*************************
Is time a premium for you? Then take a look at The Diabetes Double-Quick
Cookbook, by experienced cookbook author, Betty Marks. Besides her involvement
with ballroom dancing, photography, swimming and hiking, or pursuing her active
career as a literary agent, Betty Marks has insulin-dependent diabetes.
Betty's secret for managing her time and her diabetes is the microwave! Sometimes
I think we overlook using the microwave as a cooking tool and only use it to
heat or reheat our food. If you're in that category, make time to check out
this cookbook and let Betty show you how to create recipes like Attila's Beef
Goulash, Chicken Crunch, Gourmet Cheese Muffins, Corn and Peanut Pudding, Nutty
Sea Scallops and Orange Cheese Cake in your microwave. You'll get these recipes
plus over 140 more! All are high in taste and low in fat, cholesterol, sodium
and calories. All recipes have complete nutritional information, including breakdowns
for the three types of fat, dietary fiber and diabetic exchanges (for those
of you who still haven't switched over to counting carbs).
In addition to learning more about how to cook with the microwave, I liked
Betty's Microwave Cooking and Kitchen Safety Tips. Here's another bonus: Did
you know that Braille overlays are available for the visually impaired? Many
microwave manufacturers offer these useful aids. I was amazed by how much useful
information is packed into this little book. Betty Marks has written another
winner for Surrey Books, which merits another Five-Star rating from this reviewer!
************************
Continuing on the fast-food roll, are you one of those people whose time is
always premium? I know I am. Although I love to cook, I have to be practical
since I'm always fighting a deadline. Usually, I just want to get in and out
of the kitchen as fast as I can, which is hard to do if you have to be careful
about what you eat.
Nancy Hughes has the answer in Last Minute Meals for People with Diabetes,
a cookbook published by The American Diabetes Association. Last Minute Meals
has more than 100 fast and flavorful recipes using just six ingredients or less.
If the name of the book sounds familiar, the Voice has published some
of the recipes from this cookbook in "Recipe Corner."
Chapters from Last Minute Meals include Stress-Free Starters and
Snacks, No-Chop Salads (great for those of us with arthritic hands), Dump and
Do Dinners (I love that chapter title), Speedy Sides and Easy-Does-It Desserts.
Complete nutritional analyses and Diabetic Exchanges accompany each recipe.
Hmmmm... I think I'd better adopt this cookbook and take it home!
Nancy Hughes is a veteran cookbook author, having six nationally published
cookbooks to her credit. She's also worked extensively on more than 15 others,
including several books for the American Heart Association, Cooking Light, Weight
Watchers, Betty Crocker and Publications International. Her articles have appeared
in Better Homes and Garden, Cooking Light, Diabetic Cooking, Heart Healthy,
and Cooking Pleasures. She's currently working on another cookbook for
the American Diabetes Association.
*************************
I guess that's a wrap for this session, so I'll catch up with you again in
July. In the meantime, continue to stay on your journey to a healthier you in
2003!
Marilyn Helton, diabetic since 1993, is the publisher of Cinnamon Hearts:
The Art of Living a Winning Diabetic Lifestyle, a positive-power E-zine
for diabetics and their families. Visit the CINNAMON HEARTS Web site: www.cinnamonhearts.com

+++++++++++++++++++++++++++++++++++++++++++++

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

IRISH CREAM OF POTATO SOUP
INGREDIENTS
2 cups (one 16-ounce can) Healthy Request Chicken Broth
1 teaspoon dried minced garlic
1/2 cup sliced green onion with tops
1 cup shredded cabbage
1-1/2 cups (one 12-fluid-ounce can) Carnation Evaporated Skim Milk
1 cup skim milk
1-1/3 cups (3 ounces) instant potato flakes
1/4 teaspoon black pepper
1 teaspoon dried parsley flakes
DIRECTIONS
In a medium saucepan, combine chicken broth and minced garlic. Stir in onion
and cabbage. Cook over medium heat, stirring occasionally, until vegetables
are tender, about 10 minutes. Add evaporated skim milk, skim milk, potato flakes,
black pepper, and parsley flakes. Mix well to combine. Lower heat. Continue
cooking, stirring often, until mixture thickens, about three to four minutes.
Makes 4 servings (1-1/4 cups).
201 Calories, 1 gm Fat, 13 gm Protein, 35 gm Carbohydrate, 413 mg Sodium,
1 gm Fiber. Exchanges: 1 Starch, 1 Skim Milk, 1/2 Vegetable.

HONEY DIJON TOMATO SALAD
INGREDIENTS
1 cup shredded lettuce
2 cups chopped fresh tomatoes
1/3 cup (1-1/2 ounces) shredded Kraft Reduced-Fat Mozzarella Cheese
2 teaspoons dried parsley flakes
1/4 cup Kraft Fat-Free Honey Dijon Dressing
DIRECTIONS
For each serving, layer 1/4 cup shredded lettuce on salad plate. Place 1/2
cup chopped tomatoes over lettuce. Sprinkle about 2 tablespoons mozzarella cheese
and 1/2 teaspoon parsley flakes over top of tomatoes. Drizzle 1 tablespoon dressing
over top. Serve at once. Makes 4 servings.
75 Calories, 3 gm Fat, 4 gm Protein, 8 gm Carbohydrate, 225 mg Sodium, 1 gm
Fiber. Exchanges: 1 Vegetable, 1/2 Meat.

ESCALLOPED CARROTS AND CELERY
INGREDIENTS
3 cups diced carrots
2 cups diced celery
2 cups water
1-1/2 cups (one 12-fluid-ounce can) Carnation Evaporated Skim Milk
3 tablespoons all-purpose flour
1 cup (two 2.5-ounce jars) sliced mushrooms, drained
1 teaspoon dried parsley flakes
1/8 teaspoon black pepper
3/4 cup (3 ounces) shredded Kraft Reduced-Fat Cheddar Cheese
6 tablespoons (1-1/2 ounces) dried fine bread crumbs
DIRECTIONS
Preheat oven to 375 degrees. Spray an 8-by-8-inch baking dish with butter-flavored
cooking spray. In a medium saucepan, combine carrots, celery, and water. Cover
and cook over medium heat 20 to 25 minutes or until vegetables are just tender.
Drain. In a covered jar, combine evaporated skim milk and flour. Shake well
to combine. Pour milk mixture into a medium saucepan sprayed with butter-flavored
cooking spray. Cook over medium heat, stirring constantly, until mixture thickens
and starts to boil. Add mushrooms, parsley flakes, and black pepper. Mix well
to combine. In prepared baking dish, make two alternate layers of vegetables,
white sauce, cheddar cheese, and bread crumbs. Cover and bake 30 minutes. Uncover
and continue baking additional 15 minutes. Place baking dish on a wire rack
and let set five minutes. Cut into 6 servings.
164 Calories, 4 gm Fat, 11 gm Protein, 21 gm Carbohydrate, 331 mg Sodium,
2 gm Fiber. Exchanges: 1 Vegetable, 1/2 Meat, 1/2 Starch, 1/2 Skim Milk.

SWISS BAKED CHICKEN
INGREDIENTS
16 ounces skinned and boned uncooked chicken breast, cut into 24 pieces
4 (3/4-ounce) slices Kraft Reduced-Fat Swiss Cheese, shredded
1-3/4 cups (one 15-ounce can) Hunt's Chunky Tomato Sauce
1 teaspoon Italian seasoning
1 tablespoon all-purpose flour
1 tablespoon Sugar Twin or Sprinkle Sweet
1/2 cup (one 2.5-ounce jar) sliced mushrooms, drained and finely chopped
DIRECTIONS
Preheat oven to 350 degrees. Place chicken pieces in an 8-by-8-inch baking
dish. Sprinkle Swiss cheese evenly over chicken. In a small bowl, combine tomato
sauce, Italian seasoning, flour, Sugar Twin, and chopped mushrooms. Pour sauce
mixture evenly over cheese. Cover and bake 30 minutes. Uncover and continue
baking 10 to 15 minutes or until chicken is tender. Place baking dish on a wire
rack and let set five minutes. Divide into 6 servings.
HINT: Good served over pasta, potatoes, or rice.
174 Calories, 6 gm Fat, 22 gm Protein, 8 gm Carbohydrate, 727 mg Sodium, 1 gm
Fiber. Exchanges: 3 Meat, 1 Vegetable.

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

DIRECTIONS
In a large bowl, stir cream cheese with a spoon until soft. Add pineapple,
sugar substitute, and coconut extract. Mix gently to combine. Spread mixture
evenly in bottom of piecrust. Layer sliced bananas over cream cheese mixture.
In a medium bowl, combine dry pudding mix and dry milk powder. Add water. Mix
well using a wire whisk. Blend in Cool Whip Lite. Pour pudding mixture evenly
over bananas. Sprinkle coconut evenly over top. Refrigerate at least two hours.
Cut into 8 servings.
272 Calories, 8 gm Fat, 10 gm Protein, 40 gm Carbohydrate, 546 mg Sodium,
2 gm Fiber. Exchanges: 1 Fruit, 1 Fat, 1 Starch, 1/2 Meat, 1/2 Skim Milk.
+++++++++++++++++++++++++++++++++++++++++++++

VOICE DISTRIBUTORS NEEDED
Since the Voice is now offered free, our Diabetes Action Network
will provide extra copies to anyone wanting to help spread the word. We will
gladly send from five to five hundred copies each quarter to be used as free
literature. Medical facilities can order as needed for patients. Individuals
can usually place copies of the Voice in libraries, pharmacies, hospitals,
doctors' offices, or other public locations.
Diabetes education is essential. Anyone who distributes the Voice will
be helping people with diabetes, and their families, to learn about the disease
and its ramifications; to learn that they have options; and that their world
is far greater than whatever "limits" may be imposed by the disease.
If you would like to help spread the word by distributing the publication, please
contact: Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia,
MO 65203; telephone: (573) 875-8911, fax: (573) 875-8902. NOTE: Please provide
a phone number so we can reach you.
+++++++++++++++++++++++++++++++++++++++++++++

HEAR YE, HEAR YE, A RAFFLE
The Diabetes Action Network of the National Federation of the Blind reaches
out and provides support and information to thousands of people. Because it
costs to operate this valuable network and to produce the Voice of the Diabetic,
we must generate funds to help cover these expenses. Our Diabetes Action Network
has elected to hold a raffle, which will be coordinated by our division treasurer,
Bruce Peters.
THE GRAND PRIZE WILL BE $500! The winning ticket will be drawn, and the winner's
name announced, on July 3, 2003, at the banquet held during the annual convention
of the National Federation of the Blind.
Raffle tickets cost $1 each, or a book of six may be purchased for $5. Tickets
may be purchased from state representatives of our Diabetes Action Network or
by contacting the Voice Editorial Office, 1412 I-70 Drive SW, Suite
C, Columbia, MO 65203; telephone: (573) 875_8911. Anyone interested in selling
tickets should also contact the Voice Editorial Office. Tickets are
available now! Names of persons who sell 50 tickets or more will be announced
in the Voice.
Please make checks payable to the National Federation of the Blind. Money
and sold raffle ticket stubs must be mailed to the Voice office no
later than June 13, 2003, or they can be personally delivered to Raffle Chairman
Bruce Peters, at this year's NFB convention in Louisville, Kentucky. This raffle
is open to anyone age 18 or older, and the holder of the lucky raffle ticket
need not be present to win. Each ticket sold is a donation, helping keep our
Diabetes Action Network moving forward.
++++++++++++++++++++++++++++++++++++++++++++++

LETTERS TO THE EDITOR
Includes Artwork: Fancy Writing Pen
May 31, 2002
Thank you for providing such an informative magazine. Since my husband reads
the print edition and I use the cassettes, we particularly appreciate being
able to receive it in both formats.
Sincerely,
Phyllis Anderson
Durham, NC
* * * * * * * *
September 29, 2002
I have started receiving the Voice of the Diabetic and have greatly
benefited from the same. Thanks so much and congratulations for the superb effort.
Good luck.
Anjali Arora
New Delhi, India
* * * * * * * *
December 3, 2002
I would like to increase the number of magazines I receive from you to 100
issues if that is possible. I have been passing out the issues to my support
group members and leaving some in physicians’ offices, and the response
has been great. I highly suggest your magazine to people with diabetes, even
those without sight difficulties.

Thank you so much for a job well done.
Linda Barndollar
Westmoreland, NH
* * * * * * * *
January 13, 2003
I am pleased to read the information which you are presenting. I have worked
in public health administration for the past 25 years. The information you present
will serve the public well. Thank you for making this available.

Respectfully,
Thomas J. Culver
Peoria, Illinois
* * * * * * * *
January 15, 2003
For many years now you have been sending me 15 copies of Voice of the
Diabetic, and I hope you will continue to send them to me. I run a Diabetic
Support Group for seniors. When I receive your 15 copies I hand them out to
each diabetic senior. Thank you so much. It was so encouraging to read in the
Winter 2003 Edition about a diabetic of 75 years! Wow.
Dorothy Hase
Minneapolis, Minnesota
* * * * * * * *
January 16, 2003
Yes! I want to continue receiving Voice of the Diabetic. Thank you
for a really helpful and excellent publication.
David Goldberg
Sun City, Arizona
++++++++++++++++++++++++++++++++++++++++++++

WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK
(Resource Column)
Inclusion of materials in this publication is for information only and does
not imply endorsement by the Diabetes Action Network of the NFB.

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

Participants in one study will fill out a questionnaire, keep a diary of blood
glucose results, have a free screening physical exam and intravenous glucose
tolerance test, and spend two nights at the General Clinical Research Center
at the University of Pennsylvania Hospital. This test pays $200.
For women with both diabetes and PMS, the second study requires: Daily completion
of menstrual cycle questionnaire and glucose diary for seven months; taking
a new drug treatment for PMS, or a placebo; and four overnight stays at University
of Pennsylvania Hospital. This test pays $500. Note: Although these studies
are open to any women who meet the qualifications, there are no funds to transport
folks to Philadelphia, so the ideal candidate already lives in the Philly area.
For information, contact: Kimberly Trout, RN, University of Pennsylvania Medical
Center, Philadelphia, PA 19104; telephone: (215) 898-6733.

Free Diabetes Literature

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

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

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

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

Hear Your Computer
Computer programs and operating systems are constantly improving. If you are
blind, and use a screen reader, a program that speaks the screen content to
you, so you can work without sight, is it keeping pace? GW Micro, maker of the
Window Eyes series of screen reading software, announces Window-Eyes Professional,
an up-to-date program designed to take full advantage of the newest generation
of Windows’ capabilities. For information, contact: GW Micro, in Fort
Wayne, Indiana; telephone: (260) 489-3671; fax: (260) 489-2608; e-mail: [email protected];
Web site: www.gwmicro.com

Relief
Many diabetics suffer from dry feet. It "goes with the territory."
They hurt, they itch, they dry out and crack, and you need to do something about
it. Sometimes neuropathy, nerve inflammation, in your feet can really drive
you 'round the bend. But Steuart Laboratories offers help. Steuart's Foot Cream,
with Melalenca Oil, is excellent for dry diabetic feet. Steuart's CNS Liposomes
offers relief from neuropathy; also good for back, muscle, and joint pain. Prices
(2-oz. jar): $9.25 plus shipping for the Foot Cream; $19.80 for the CNS Liposomes.
Contact: Steuart Laboratories, PO Box 535, Mabel, MN 55954; telephone: 1-800-210-9665;
Web site: www.steuartlabs.com.

Easy Diabetic Cookbook
If you want to prepare healthy diabetic meals, but find most cookbooks just
too complicated, you need Linda Coffee and Emily Cale's The Diabetic 4 Ingredient
Cookbook. There are over 200 recipes, in all food categories, with complete
nutritional and exchange information, each one using four ingredients. The book
costs $9.95 (+$2.95 shipping), from: Coffee and Cale, PO Box 2121, Kerrville,
TX 78029; telephone: 1-800-757-0838.
Full Service Diabetes Supplier
DS Medical Supply is a full-service supplier with a catalog of more than 55,000
items, dealing with diabetes, its complications, and many other medical supplies,
delivered to your home. Diabetes products range from glucose monitors by Bayer
and LifeScan, and the AccuChek VoiceMate talking glucose monitor, strips, lancets
and other supplies, to diabetic orthotics/foot care items, and much more. They
accept Medicare, private insurance, some HMOs, and, in most states, direct or
crossover Medicaid. Contact: DS Medical, 2105 Newport Place, Suite 600, Lawrenceville,
GA 30043-5561; telephone: 1-800-722-2604, Web site: www.dsmedical.com

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

Diabetic Food Exchange List
The "ADA Meal Planning Exchange List for Diabetics" is now available
in Braille (74 pages) and on 4-track audiocassette.
This publication, the result of a joint effort of the American Diabetes Association
and the American Dietetic Association, reflects the current emphasis on total
carbohydrate intake, rather than restricting specific sugar types. Users find
its orientation simple, and its meal plans flexible. Although it is only one
of several ways to manage diabetic food intake, the “Exchange List”
has been proven to work reliably and well, and will continue to play a pivotal
role.
To purchase, make tax deductible checks payable to: National Federation of
the Blind. Cost: Braille $10, cassette $2. Order from: National Federation of
the Blind, Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone:
(410) 659-9314.

Consider LANTUS Insulin
Lantus (Insulin Glargine rDNA), from Aventis Pharmaceuticals, is very different
from the “rapid acting” insulin types you hear so much about today.
How is this insulin different? Lantus is a very slow insulin. The company describes
it as a “long-acting basal insulin ... providing a relatively constant
profile with no pronounced peak, and a glucose-lowering effect for over 24 hours.”
Company literature states Lantus is for once-a-day administration, at bedtime,
to treat adult patients with type 2 or type 1 diabetes, who require “basal”
insulin.
Lantus is a recombinant DNAinsulin analog specifically formulated to provide
a long, flat response. Because of its special formulation, Lantus cannot be
mixed in a syringe with any other insulin; so if you wished to take it with
Regular, Humalog, or Novolog, you’d have to take two injections.

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

Diabetes Supplies
Do you get tired of having to "shop around" for your various diabetes
items? "Go to this place for these; to that place for those..." Do
something about it. Check out diabetesstore.com, the leading online source for
discount diabetes products. Contact them by telephone: 1-800-891-9399; or Web site:
www.diabetesstore.com

Elections Coming Up
by Ed Bryant
At this year's national convention in Louisville, Kentucky, elections will
be held to fill our Diabetes Action Network divisional board positions. These
are one-year terms, running from July 1, 2003 to June 30, 2004. Positions to
be filled are: President, First Vice-President, Second Vice-President, Secretary,
Treasurer, and three Board Members. If you are interested in a board position,
or know someone who you think would do a good job, then contact me, Diabetes
Action Network President Ed Bryant. Yes, hard work and dedication are prerequisites
for board positions -- but one must lead by good example.
This year is a bit different. I am not going to run for Diabetes Action Network
President again -- it is time for some new blood at the top. I will continue
as Editor of Voice of the Diabetic, and I hope to serve on the DAN
Board (and no, I am not "retiring").
Regarding my replacement as President of the Diabetes Action Network of the
National Federation of the Blind, I make the following recommendation: I would
like to see Paul Price, from Valley Center, California, elected to replace me.
Our entire DAN Board concurs.
I have worked with Paul for a number of years, and found him talented, dedicated,
and a committed Federationist. He currently serves as President of the NFB of
California's Diabetes Action Network, as a Board Member of the NFB of California,
as first VP of his local NFB chapter, and as a national Board member of our
Diabetes Action Network.

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

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

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

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

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

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

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

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

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

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

Articles Needed
If you have diabetes, are a family member or friend of a diabetic, or a health
professional with an interest in diabetes, we invite you to submit an article
for publication in the Voice of the Diabetic.
Our philosophy regarding diabetes is positive. Do you have an inspiring, enlightening
story? We, the Diabetes Action Network of the National Federation of the Blind,
seek to show people they are not alone, and do have options, regardless of diabetic
complications. If you have experienced ramifications, others, who may be facing
the same side-effects, could benefit from what you have to say.
Perhaps you have not experienced complications--your unique insight, coping
strategies, and lifestyle can still inspire others. Are you a relative, a friend,
or a health professional? More than 320,097 Voice readers could benefit
from your story.
For information and article submission guidelines, contact: Voice of the
Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573)
875_8911.

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

+++++++++++++++++++++++++++++++++++++++++++++
SUBSCRIPTION/DONATION FORM
The Voice of the Diabetic is a quarterly magazine published by the
Diabetes Action Network of the National Federation of the Blind (NFB) for anyone
interested in diabetes, especially diabetics who are blind or are losing vision.
An outreach publication, it emphasizes good diabetes control, diet, and independence.
Donations are gladly accepted and appreciated. Contributions are not only
tax deductible but are needed to keep the Voice and the Diabetes Action
Network moving forward to help people with all aspects of diabetes.
Members of the NFB Diabetes Action Network enjoy priority services and unique
benefits such as a continuous free subscription to the Voice, automatic
access to committees covering all aspects of diabetes, free counseling concerning
all facets of blindness and diabetes, as well as access to diabetics who have
experienced complications.
The Voice is free to any interested person upon request. Each subscription
costs the Diabetes Action Network approximately $20 per year. To help defray
publication expenses, members are invited, and nonmembers are encouraged, to
cover the subscription cost.
To begin receiving the Voice, please check one:
[ ] I would like to become a member of the NFB Diabetes Action Network and
receive the Voice of the Diabetic. (Members are entitled to special
benefits.)
[ ] I would like to receive the Voice of the Diabetic as a nonmember.
(Nonmembers are encouraged to pay the institutional rate of $20/one year; $35/two
years; $50/three years.)
Send the Voice in (check one):
[ ] print [ ] cassette tape for the blind [ ] both
and physically handicapped
(recorded at slower than
standard speed of 15/16 IPS)
To receive Voice of the Diabetic by e-mail, go to: www.nfbcal.org/listserv-signup.html
(NOTE: If you want a print or tape copy as well, send this form to the Voice
office).
Optionally check this box:
[ ] I would like to make (or add) a tax-deductible contribution of $__________
to the Diabetes Action Network of the National Federation of the Blind.
PLEASE PRINT CLEARLY
Name:_____________________________________________________
Address:__________________________________________________
__________________________________________________
City:_______________________ State:______ Zip:__________
Telephone: ( )________________________
Send this form or a facsimile to:
Voice of the Diabetic
1412 I-70 Drive SW, Suite C
Columbia, MO 65203
Telephone: (573) 875-8911
Fax: (573) 875-8902
Please make all checks payable to:
NATIONAL FEDERATION OF THE BLIND
++++++++++++++++++++++++++++++++++++++++++++++++++++
END of Voice of the Diabetic, Volume 18, Issue 2 Spring
2003 Edition

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