� VOICE OF THE DIABETIC

The Diabetes Action Network of the

National Federation of the Blind

A Support and Information Network

Volume 15, Number 4, Fall Edition 2000

VOICE OF THE DIABETIC, published quarterly, is the

national magazine of the Diabetes Action Network of the

National Federation of the Blind.� It is read by those

interested in all aspects of blindness and diabetes.� We

show diabetics that they have options regardless of the

ramifications they may have had.� We have a positive

philosophy and know that positive attitudes are contagious.

News items, change of address notices, and other

magazine correspondence should be sent to:� Ed Bryant,

Editor, VOICE OF THE DIABETIC, 811 Cherry Street, Suite 309,

Columbia, Missouri 65201‑4892; Phone:� (573) 875‑8911; Fax:

(573) 875‑8902.

Find us on the World Wide Web at:� http://www.nfb.org

and follow the links for "diabetes."

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

��

�� ISLET CELL TRANSPLANTATION: IS THIS THE CURE?

�� by Peter J. Nebergall, PhD

�� YOU KEEP YOUR EYE ON THE BALL

�� by Gord Paynter

�� NIGHTWATCH ALERTS WEARER OF HYPOGLYCEMIA

�� by Ed Bryant

��

�� NEW STUDY NEEDS VOLUNTEERS

��

�� ASK THE DOCTOR

�� by Wesley W. Wilson, MD

�� INSULIN MEASUREMENT DEVICES

�� WHERE'S THE GLUCOWATCH?

�� I'M PUMP‑POSITIVE

�� by Sally York

�� DIABETES PREVENTION TRIAL FINDINGS

�� INSULIN TYPES: A REVIEW

�� BLINDNESS CAN'T STOP SKYDIVERS

�� by Mike Patty

�� MALE SEXUAL DYSFUNCTION

�� by Ed Bryant

�� KIDNEY TRANSPLANTS LAST LONGER NOW

�� TIGHT CONTROL: LONG‑TERM BENEFITS

�� NUTRITION AND DIABETES

�� by Jennifer Layton, RD

�� COOKING WITH SUZI

�� by Suzi Castle

�� RECIPE CORNER

�� TALKING MEDICINE IDENTIFIER UPDATE

�� by Ed Bryant

�� NINE YEARS AS A VISUALLY IMPAIRED PUMPER

�� by Anne Whittington, MBA, MSN,RN, CDE��

�� BOOK REVIEWS

�� by Marilyn Helton

�� ADAPTIVE INSULIN PUMP TECHNIQUES

�� by Tom Tobin

�� WHAT YOU ALWAYS WANTED TO KNOW BUT

�� DIDN'T KNOW WHERE TO ASK

�� (Resource Column)

�� FOOD FOR THOUGHT

��

ISLET CELL TRANSPLANTATION:� IS THIS THE CURE?

��

�� by Peter J. Nebergall, Ph.D.

��

�� When a Canadian research team recently announced that

they had successfully transplanted cadaveric insulin‑

producing islet cells into type 1, insulin‑dependent

diabetics, a good many were quick to proclaim the cure was

at hand. �Is it?� Let's look at the evidence.

�� Ever since the pancreatic islet cells were identified

as the source of endogenous insulin production, and islet

cell deficiency identified as the physical source of type 1

diabetes, doctors have explored the issue of

transplantation.� Whole pancreas transplantation is

available, and, while still radical surgery, it is enjoying

increasing acceptance.

�

�� A number of researchers have tried various ways to get

new islet cells into the diabetic's body, without the major

surgery of pancreas transplantation.� The procedure is

simple:� Obtain a sufficient number of viable islet cells

from a cadaveric donor, then induce them into the pancreas,

or the liver, of the diabetic.� We can get them in there.

�� The problem has been huge:� Rejection.� The body

attacks and destroys cells it perceives as "foreign."� All

transplantation surgery must take this into account.

Traditionally, transplantation has followed careful genetic

matching (the closer the match, the less the risk of

rejection), and has itself been followed by a lifetime

regimen of immunosuppressive medications.

�� There have been many different attempts to transplant

islet cells.� Until now, almost none of the transplanted

islet cells have remained viable, have continued to "produce

insulin", for more than a week.� The Canadian researchers

point out that many current immunosuppressive medications,

while otherwise perfectly functional, damage beta cells or

induce peripheral insulin resistance.

�� The Canadian researchers followed a different strategy.

Viewing the traditional mix of immunosuppressants as "the

problem," they developed a new "cocktail," utilizing

Rapamune (Sirolimus, from Wyeth‑Ayerst), Prograf

(Tacrolimus, from Fujisawa), and Zenepax (Daclizumab, from

Roche).�

�� The team, doctors Shapiro, Lakey, Ryan, Korbutt, Toth,

Warnock, Kneterman, and Rajotte, selected seven candidates

for a test of their new "protocol."� These seven were all

uncontrolled "brittle" diabetics (average 35 years with

diabetes) who'd had a history of severe hypoglycemia and

diabetic coma, and for whom the risks of transplantation and

immunosuppression were judged less than the risks of

remaining uncontrolled.

�� These people were carefully selected, and so were the

donors, all brain‑dead individuals, "selected according to

the results of a multivariate analysis of the factors that

influence the success of islet transplantation."� The

researchers note that no "xenoproteins", no "animal

products," were used at any time.

�

�� Results have been promising:� All seven patients had a

history of repeated episodes of severe hypoglycemia before

the transplantation.� None have had any episodes since.� All

seven patients have ceased injecting insulin, as the

transplanted islets are providing sufficient insulin of

their own.

�� None of the patients have died, and none of the

patients have experienced acute rejection, but the

researchers note that six of the seven patients required a

second transplantation, to become insulin‑independent, and

one of the patients required a third.�

�� Using normal testing criteria, none of the seven

patients are currently "diabetic."� Is this a cure, then?

�� Not yet.� There are a number of problems.� First, it is

a very small test, seven people in one place.� Another test,

of more than forty individuals, at ten different

institutions, is now underway, thoroughly checking the

findings of the original team.

�� Second, transplantation is expensive, so it is

important that the technique not only work but that it last.

How long will these people remain insulin‑independent?� If

this new approach proves to yield a durable "cure," look for

wide acceptance.

�� Third, like many forms of transplantation, this one is

now dependent on the availability of donors.� The Canadian

researchers strictly used human donors, but until there is

some other source (perhaps pig islets, xenotransplantation),

there will simply not be enough islets for all who could use

them.

�

�� For now, islet transplantation is an experimental

technique.� This new method, the "Edmonton Protocol," shows

promise, but has not yet been sufficiently tested to know if

this is it.� Remember, the only way we'll know if it lasts

for years ‑‑ is to study it for years.� This will be done.

�� The Immune Tolerance Network needs volunteers to

participate in the study of islet cell transplantation.

There are very specific requirements, and only a few dozen

individuals can be selected at this time.� Selection will

close on January 1, 2001.� If you are interested in

participation, and are a United States citizen, you'll need

to contact:� The Immune Tolerance Network, Suite 200, 5743

South Drexel Ave., Chicago, IL 60637.� Application material

is downloadable from their website:

http://www.immunetolerance.com

�� For further information, see the NEW ENGLAND JOURNAL OF

MEDICINE, for July 27, 2000.� The article is titled:� "Islet

Transplantation in Seven Patients with Type 1 Diabetes

Mellitus Using a Glucocorticoid‑free Immunosuppressive

Regimen," by Shapiro, Lakey, Ryan, et. al.

�

��

�� YOU KEEP YOUR EYE ON THE BALL:

�� MY LOVE AFFAIR WITH GOLF

��

�� by Gord Paynter

��

�� Forty‑eight ‑‑ an age?� Forty‑eight, a failing grade?��

Or forty‑eight, the projected value of our Canadian dollar?

Possibly.� But, in this case, "48" refers to my best score

for nine holes of golf.

�� Granted, it's no Tiger Woods.� But pretty damn good for

a 43‑year‑old passionate about the game and playing without

his sight.

�� At 22, I began losing my eyesight as a result of

complications from diabetes.� With that came a loss of

drive, desire, and dreams ‑‑ dreams of career, of sports

and, in particular, of golf.

�� The acceptance of my new blind state was slow, but

eventually I found myself back doing chores, and

participating in games and events.� I was not aware that I

was growing and accepting my environment.

�� One day I tagged along with a friend to a driving

range.� Smack!� His driver connected with the little white

ball.� The sound stirred feelings deep within me.

�� My friend must have sensed my keenness, because he

asked me if I wanted to hit a few.� We fidgeted about 'til

he had me all lined up, club squared behind the ball and no

longer aimed towards the parking lot.� "Swoosh!"� I missed.

Not once, but several times.

�� Even if you're not a golfer, you've heard the phrase,

"keep your eye on the ball."� Eliminate the "eye" part from

the equation, and this simple task becomes more difficult!

However, with perseverance and the moon rising, contact was

made, the sound sweet and the feeling through the club shaft

exhilarating.

�� "Where'd she go?"

�� "About 240 yards, dead straight."

�� "Now the truth."

�� "Ah, just over there....Should I get it?"

��

�� And with that, the love affair was rekindled.

�� As a blind golfer, I need to orchestrate my games and

companions to caddy‑slash‑assist well in advance.� Sometimes

I enlist a friend or a junior member...a niece...a mother...

somebody...ANYBODY!� Anybody willing to trudge a course and

endure the occasional curse.� And while many golfers carry

their clubs around in the trunk of a car, mine are often

found in the trunk of a cab.

�� Days when I can find no companion or cab fare, I am

reduced to taking a five‑iron to the back yard and swing,

swing, swing away.� Feel my stance.� Check my grip, my

balance and swing.

�� Chomp!� Another clump of sod sails off into the blue

sky.

�� I wish my wife Catherine shared my love for golf.� She

encourages me to play and tolerates my long absences on

those days.� For this, I am grateful.� But she neither

thrills with me after a good round nor understands my

frustration over a lousy outing.� Even today I can hear her

words echoing, "I don't know why you play if it's going to

make you so angry.� I thought this was supposed to be fun."

�� Only a non‑golfer would make a silly statement like

that.

�� Only a golfer would respond, "I do love it. That's why

I hate it."

�� Catherine was the first to see that my addiction to the

game was complete when I overruled her decision not to get

the additional cable channels.� "What?!" I exploded.� "No

golf channel?"

�� To Catherine, the channel is "stupid."� She says this

as she flips to The Y & R.

�� In the cold winter months, I nestle into my easy chair

and switch on the golf channel.� Tournament play from sunny,

hot Australia and, later, putting tips.� Ahh, but life is

good.

�� I'm tempted to clear a patch of snow from the back yard

and swing, swing, swing.....and dream of forty‑eights.

�� Gord Paynter is based in Brantford, Ontario, Canada.

He tours as a motivational speaker and stand‑up comic.� For

booking information, call (519) 758‑0236.

�� NIGHTWATCH ALERTS WEARER OF HYPOGLYCEMIA

��

�� by Ed Bryant

��

�� A new product is under development.� Worn like a

wristwatch, it sounds an alarm to alert the wearer to "ionic

moisture," body changes that often accompany a hypoglycemic

reaction.� Not a glucose monitor, the NightWatch is intended

strictly to warn the user that he or she could be going into

a "low," and that action should be taken.� Any type 1

diabetic, or anyone with hypoglycemia unawareness, could

benefit.

�� A prototype has been completed.� Members of the

development team have informally tested it, and there will

be further tests.� So far, everything has been successful.

�� All team members are "techies," and the business aspect

is still indefinite ‑‑ there is still no corporation,

headquarters, or business address, and the team is actively

seeking financial backing.

�� There was such a device several years ago, selling for

several hundred dollars, but team members have told me they

intend to offer the NightWatch for approximately $75.

�

�� I regularly communicate with the NightWatch development

team (they're going to send me a prototype which I will test

personally), and I hope to have more to tell you next time,

in VOICE, Vol. 16, No. 1.� Note:� I have no financial

involvement with the NightWatch or its research team; but if

you are interested in becoming financially involved with

this project, you may write to:��

�� NightWatch

�� c/o Ed Bryant

�� 811 Cherry Street, Suite 309

�� Columbia, MO 65201

��

�� NEW STUDY NEEDS VOLUNTEERS

�� Heart Disease is one of the more serious complications

of diabetes, especially type 2 diabetes, and it is the

leading cause of death from diabetes.� Doctors know that

diabetogenic ischemia (constriction of blood vessels) can

progress undetected for years before obvious symptoms

(angina, heart attack) occur.� Quick and timely intervention

saves lives.

�� The problem has been to detect diabetic heart disease

in its early stages, before the obvious symptoms manifest

and major damage is done.

�� Yale University and DuPont Pharmaceuticals announce the

start of the "DIAD" (Detection of "Ischemia in Asymptomatic

Diabetics) study, to evaluate the role of cardiac imaging in

screening these at‑risk patients, and the role of DuPont's

Cardiolite in assisting that detection.�

�� The study is expected to take three years.� The

researchers are seeking 1000 adult type 2 diabetics who have

no previous diagnosis of heart disease, and are not

exhibiting clinical signs of heart disease.� If you meet the

conditions, and are interested in volunteering, please

contact the nearest center and individual named below:

�� Yale University� (New Haven, CT)

Janice Davey MSN, APRN, Study Coordinator; telephone: (203)

688‑6482

�� Norwalk Hospital/Soundview Research Associates

(Norwalk, CT)

Gin Hoenig, RN, Nurse Coordinator; telephone: (203) 838‑

4000, ext. 205

�� University of Alabama� (Birmingham, AL)

Dare Hartsell, RN, BSN, Nurse Coordinator; telephone: (205)

934‑0821

�� Tulane University (New Orleans, LA)

Vivian Fonseca, MD, Tulane Alumni Chair in Diabetes;

telephone: (504) 585‑4026

�� University of Chicago (Chicago, IL)

Maureen McCormick, RN, Nurse Coordinator; telephone: (773)

702‑0204

�� University of Rochester (Rochester, NY)

Mary Kelly, RN, Nurse Coordinator; telephone: (716) 273‑4072

�� University of Virginia (Charlottesville, VA)

Wendie Price, RN, Nurse Coordinator; telephone: (804) 924‑

5869

�� ASK THE DOCTOR

��

�� by Wesley W. Wilson, MD

Artwork:� Medical caduceus

�� NOTE:� If you have any questions for "Ask the Doctor,"

please send them to the VOICE editorial office.� The only

questions Dr. Wilson will be able to answer are the ones

used in this column.

�� Wesley W. Wilson, MD, has retired as an Internal

Medicine practitioner at the Western Montana Clinic in

Missoula, Montana.� Dr. Wilson was diagnosed with type 1

diabetes in 1956, during his second year of medical school.

He remains interested and involved in diabetes education for

patients and professionals.

�� Q:� I work in a high‑stress environment (I'm a coach)

and I'm worried about my blood pressure.� How damaging is

high blood pressure to a diabetic like me?� What should I be

doing to keep my blood pressure down in a healthy range?

��

�� A:� Dear coach:

�� I share your concerns about blood pressure.� It is

important to differentiate "hypertension" from "high stress"

since many persons confuse the terms.� There is some

connection between stress and elevated blood pressure, but

each can occur without the other and both may occur

together.�

�� Hypertension is defined as "an abnormally high blood

pressure."� The first point then, is what is your blood

pressure now?� If it is above 130/85 and if you have

diabetes you would be classified a "hypertensive."� Most

authorities feel the blood pressure must be 140/90 to be

classed as hypertension in non‑diabetics.� The difference is

related to the extreme damage that elevated blood pressure

can cause in persons with diabetes.� Persons who don't have

diabetes are harmed by elevated blood pressure with

increased risk of stroke, heart disease and kidney problems.

The risks are much greater in persons with diabetes.�� The

United Kingdom Prospective Diabetes Study showed that

careful control of blood sugar reduced the risk of

development of microvascular complications in persons with

type 2 diabetes similar to that seen in the DCCT with type 1

diabetes.� I found it interesting that careful control of

blood pressure gave even greater protection from

microvascular diseases than did blood sugar control in the

UKPDS Study results.� In addition, the reduction of heart

disease and stroke was far greater with blood pressure

control than with blood sugar control.

�� The question of how to control your blood pressure (I

presume it is over 130/85) is more difficult and will

require more input from your "health care provider" (I

prefer doctor).� You should exercise regularly and maintain

a "lean and mean" ideal weight.� Your blood sugars should be

controlled and you should test often enough to obtain a

hemoglobin A1c level of 7% or less.� You should unwind and

get away from the stress and conflict at least several times

each day.� Dietary salt reduction may not reduce your blood

pressure much, but it should help make the control a bit

easier.

�� Your doctor will need to evaluate your physical and

laboratory status.� Your eyes should be checked for any sign

of retinopathy, as the presence of diabetic retinopathy

strongly suggests nephropathy, kidney disease, may be

present as well.

�� The degree of blood pressure control seems more

important than the choice of drugs used to achieve that

control.� A group of drugs called ACE (Angiotensin

Converting Enzyme) inhibitors seem to offer particular

protection to the kidneys in persons with diabetes.� Control

of blood pressure is vital for people with diabetes, and

testing blood pressure by the patient is as important as

treating blood sugar.� The target blood pressure is 135/85

or less.� Home blood pressure monitoring is essential to

allow you to know how you are doing.� There are a variety of

devices that can give you reliable blood pressure readings.

It is essential that you receive instruction on how to use

the equipment when you purchase it.

��

�� INSULIN MEASUREMENT DEVICES

�� Most diabetics, blind or sighted, want and need to

achieve control, independent self management, of their

diabetes.� But if a diabetic cannot rely on vision to

accurately measure insulin, then, to maintain independence,

he or she MUST have effective alternative techniques,

specifically designed for individuals with partial or

complete vision loss.� Many manufacturers have risen to the

occasion, and with the appropriate adaptive equipment,

nonsighted self management is a reality.� People's abilities

(and ramifications) vary, and it is important to remember

that different devices best meet different needs.

�� Some diabetics, with fluctuating vision, will find that

at certain times of the day they can rely on their vision to

accurately measure insulin.� At other times their visual

acuity may diminish, leaving them guessing at their dose of

insulin or relying on sighted aid.� A diabetic's eye

condition can change daily, making reliance on visual

techniques unsafe.

�� The following is a catalog of alternative devices for

insulin measurement.� Some are designed for those with

partial sight.� Others are intended from the start for

nonvisual operation.� A few are the simplest of home made

aids, some designed by resourceful blind diabetics.� Note:

Prices quoted do not include shipping charges.

Insulin Measurement Systems

�� The Count A Dose:� This insulin measuring device is

manufactured by Jordan Medical Enterprises, of South

Pasadena, CA, and is available from the National Federation

of the Blind (NFB).� Cost:� $40.� Cassette instructions are

available.� Order from:� Aids, Appliances, and Materials

Center (hours of operation are 8:00 am to 5:00 pm EST,

weekdays), National Federation of the Blind, 1800 Johnson

St., Baltimore, MD 21230; telephone:� (410) 659 9314.

�� Designed for the Becton Dickinson (B D) .5cc LoDose

(50 unit) syringe, the Count A Dose holds two insulin vials

and directs the syringe needle into the vials' rubber

stoppers.� The user can easily mix two different insulins,

and the "T bar" that holds the vials has clear and obvious

tactile marks to aid insulin differentiation.� Dose size is

adjusted with the thumb wheel, which clicks for each unit

measured (clicks can be both heard and felt) up to 50 units.

The device provides easy, reliable, and accurate nonsighted

insulin measurement.

�� The Syringe Support:� This device is manufactured in

Canada, and its instructions (standard print only) are

bilingual (English and French).�� In the U.S., the Syringe

Support may be purchased (Cost:� $26) through: The Eye Dea

Shop, Cleveland Sight Center, 1909 E. 101‑st Street,

Cleveland, OH 44106 8696;� telephone:� (216) 791 8118, ext.

278.

�� The Syringe Support uses only the B D 1cc/100 unit

disposable syringe, and measures insulin in 1� or 2 unit

increments, in doses of one to 100 units.� To mix insulins

with the device, it is necessary to remove vials from the

apparatus.� To draw a measured dose, the Syringe Support

depends on a set screw with a raised flange, its only

landmark, at 12 o'clock.� One full turn draws two units.

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 of greater than

10 units.

�� The Load Matic:� This device is available (Cost:

$49.95) from Palco Labs, Inc., 8030 Soquel Ave., Santa Cruz,

CA 95062; telephone:� 1 800 346 4488.

�� The Load Matic allows two different measurement

increments:� 10 unit and/or single units of insulin.� It

uses only 1cc/100 unit B D syringes.� Depressing the lever

measures a 10 unit increment, and turning the dial one click

measures a single unit.� To mix insulins with the

Load Matic, as with the Syringe Support, it is necessary to

remove and replace insulin vials from the device.

�� Although an intriguing design, the Load Matic features

an overly complex operating drill, with many opportunities

for user error.� Ambiguous and incomplete instructions take

a high degree of familiarity for granted, and may confuse

the inexperienced.� Its 10 unit lever, if incompletely

depressed, is capable of dispensing the unwary user an

incorrect dose.� The Load Matic's cassette instructions tell

the blind user to draw only about 700 units out of an

insulin vial with the device, as "this assures that you will

never draw air into your syringe instead of insulin."� The

printed instructions lack this statement.� The instructions

make no provision for removing air bubbles from the syringe,

which can easily be accomplished by drawing four or five

units of insulin, reinjecting them into the vial, three

times, and drawing the full measured dose the fourth time

(insulin mixers need do this only with their Regular

insulin, the first they draw).

Homemade Insulin Measurement Gauges

�� The simplest insulin gauges are devices which allow the

plunger on an insulin syringe to descend a set distance and

no more.� The distance corresponds to a measured dose of

insulin, and the gauge enables that dose to be reliably

duplicated without sight.� To draw a different dose, you

must use a different gauge.� You may need quite a

collection!� Gauges may be of a number of shapes (flat,

corner molding, tube ...), and can be constructed of many

different materials (wood, plastic, metal, old credit

cards...), but most of them will be rigid, flat, several

inches square, and on one end of the gauge there will be an

L shaped notch.� This L notch will fit on the plastic collar

located between the flanges and the plunger of the insulin

syringe.

�� Further down the insulin gauge will be the small slot

where the plunger seats, once you have reached the correct

dose for that particular gauge.� When making an insulin

gauge, keep the slot very narrow, to insure that when the

plunger is seated in the slot there is no play (which would

allow a variation in the dose).� The L notch and the slot

must both be on the same side of the insulin gauge.

�

�� The best insulin gauges are those most durable.

Insulin gauges constructed from cardboard or staples,

however inexpensive, are NOT RECOMMENDED.� They distort and

break too easily.� The use of nonstandard or homemade

insulin measuring devices should only follow a thorough

checkout of such devices.

�� It is important to understand that insulin gauges are

"cut" for a specific brand and size of syringe.� Therefore,

an insulin gauge that has been cut for a Monoject, Terumo,

or other type syringe cannot be used, will not produce an

accurate reading, on a B D syringe and vice versa.� An

insulin gauge cut for a 1cc B D syringe cannot be

successfully used on the 1/2cc (Lo Dose) or 30 unit B D

syringe, for the same reason.

�� Other Alternatives

Appliances and Holders

�� The Insulcap, a color coded, tactile cue equipped

plastic fitting, attaches to an insulin vial and guides

insertion of the syringe, holding the needle at the correct

depth.� The syringe won't shift and bend the needle, as the

Insulcap holds the bottle to the syringe, freeing both hands

for the filling operation.� Manufactured by Palco, sold by

Diabetic Promotions, Inc., of Cleveland, OH; telephone:

1 800 338 4656, the Insulcap is sold in sets of two:� one

blue, without tactile cues; and one orange; with tactile

cues.� Cost:� $6.95.� Individuals with low vision,

arthritis, or other conditions causing unsteadiness, may

benefit, though those without sight would be better served

by devices such as the Count‑A‑Dose.

�� The Ident‑A‑Cap, similar to the above, offers a

selection of color coded and tactile cues.� Each package

includes two different vial caps, which also attach to the

neck of the vial, providing some nonvisual identification of

the contents.� (There are six choices when you order, they

will send you the right caps.)� Until tactile marked insulin

vials become widely available, this product may be of

benefit.� Cost:� $1.99 for a package of two.� Available from

Diabetic Promotions; telephone: 1 800 433 1477, or from

Terron, Inc., P.O. Box 958, Sanger, TX 76266; telephone:

1 800 862 2348.

�� The Uni‑Cal‑Aid allows tactile draw up of preset

insulin doses, incorporates two adjustable preset stoppers,

allowing two different doses or insulin mixing (resetting

the doses requires sighted aid).� It accepts all syringe

types, but any adjustment of dose requires sighted aid.

Cost:� $26, available from:� The Eye Dea Shop, Cleveland

Sight Center, 1909 E. 101‑st Street, Cleveland, OH

44106 8696; telephone:� (216) 791 8118, ext. 278.

Pen Injection Devices

�� The Novolin Pens:� Novo Nordisk Pharmaceuticals Inc.,

100 Overlook Center, Suite 200, Princeton, NJ 08540;

telephone:� 1 800 727 6500, currently produces two pen type

devices.� They offer the "Novo Pen 3,"� which retails at $29

(excluding insulin cartridge), and uses 300 unit "Novolin

System" insulin cartridges (R, N, or 70/30 mix) and

"Novofine 30" disposable replacement needles.� This device

delivers a measured dose of between one and 70 units, in

one unit increments.� Novo Nordisk also offers "Novolin

Prefilled" disposable syringes.� These devices are smaller

than a pen injector, hold 150 units of R, N, or 70/30 mix

insulin, and are packed five syringes to a package.

Suggested retail price (package of five syringes):� $25.00;

comparable to the cost of cartridge replacements for the

Novolin Pen.

�� Novo Nordisk also offers insulin cartridges for the

older� "Novo Pen 1.5"� insulin pens, and for other pens

licensed to use their system.

�

�� According to the manufacturer of the Novo Nordisk pens

and the prefilled Novolin syringes:� "None of our devices

are recommended for use by blind or visually impaired

persons without sighted aid."

�� The Autopen is a British made insulin pen injector,

designed to use either the Novolin system cartridges and

disposable needles or those made by Eli Lilly and Company.

In the U.S., marketer is Owen Mumford, Inc., 849 Pickens

Industrial Drive, Suite 12, Marietta, GA 30062; telephone:

1 800 421 6936.� The Autopen is available in two versions: a

one unit increment (administers up to 16 units) and two unit

increment (up to 32 units) pen, differentiated only by

color.� Each pen features audible clicks for each increment

drawn.� Cost:� $40 each.

�� Becton Dickinson Corporation (in partnership with Eli

Lilly and Company) offers the B D Pen.� Similar to the Novo

Nordisk and Mumford pens, the system dispenses 150 units of

R, N, Humalog, or 70/30 insulin, in one unit increments,

from one to 30 units.� Although B D does not specify a

"suggested list price," the pen should cost about $40. �B D

also offers a "pen magnifier" (similar to the syringe

magnifiers described below) that clips to the pen to aid

low vision operation.� This magnifier is available free of

charge, by calling Becton Dickinson at:� 1 800 237 4554.

Available at most pharmacies.

�� Eli Lilly and Company (Lilly Corporate Center,

Indianapolis, IN 46285; telephone:� 1 888 885 4559 (website:

http://www.humulinpen.com)� offers the Humulin and Humalog

pens, and the new Humalog 75/25 pen.� These are disposable

prefilled syringe devices, holding 300 units of Lilly's

Humulin 70/30, Humulin N, Humalog, or Humalog 75/25 insulin.

These pens (which require detachable pen needles such as the

Becton Dickinson Insulin Pen Needles, sold separately)

adjust in single unit increments, with an audible click for

each unit.� They have a clear plastic barrel, and a

magnifying dose window to help show the correct dose.

Suggested retail price:� $40 (package of five pens).

�� The Disetronic Pen is a very different device, with an

"open system" 315 unit cartridge that the user fills with

any prescribed insulin.� This pen does not use specialized

needles, but rather any conventional syringe needle (27

through 30‑gauge recommended).� The company claims the

load it yourself feature makes it cheaper to use in the long

run.� Cost:� $95.� Available from:� Disetronic Medical

Systems, 5201 E. River Road, Suite 312, Minneapolis, MN

55421 1014; telephone: 1 800 280 7801; website:

http://www.disetronic usa.com

Syringe Magnifiers

�� The Insul‑Eze 6000, manufactured by Palco Labs (listed

above) is a syringe and vial holder incorporating a

full length 2x lens, allowing the insulin drawing operation

to be closely monitored. Insulin vials can be changed for

mixing without disturbing the syringe.� Adaptable, the

Insul‑Eze works with most types of syringes in the 30 , 50 ,

and 100 unit size.� Cost:� $11.

�� The Truhand, a device similar to the Insul Eze, is

offered by� Whittier Medical, Inc., 865 Turnpike Street,

North Andover, MA 01845; telephone:� 1 800 645 1115.� It

allows use of different syringe types and sizes, and firmly

holds the vial, while providing a 3x magnified view of the

scale.� Vials can be changed for mixing without disturbing

the syringe.� Cost:� $29.95.

��

�� The Magniguide, offered by Becton Dickinson Consumer

Products, One Becton Drive, Franklin Lakes, NJ 07417 1883;

telephone:� 1 800 237 4554, is another syringe magnifier.

It attaches to the insulin vial, and provides 2.5x

magnification, to aid needle insertion, precise dose

measurement, and location of bubbles in the syringe.� The

Magniguide is available (Cost:� $3.95) from Independent

Living Aids, Inc., 27 East Mall, Plainview, NJ 11803 4404;

telephone:� 1 800 537 2118.

�� The Syringe Magnifier fits all 1/2cc and 1cc syringes,

and clips to the syringe barrel, magnifying the scale 2x to

aid precise dose measurement.� Manufactured by:� Apothecary

Products, Inc., 11750 12‑th Ave. South, Burnsville, MN

55337; telephone:� 1 800 328 2742.� The device does not

affect needle insertion, which must be done visually.� Cost:

$3.95.

�� The Diabetes Action Network of the National Federation

of the Blind is a support and information network for all

diabetics.� We have many members willing to share their

expertise in nonsighted techniques of diabetes

self management.� If you have any questions about diabetes

and/or blindness, feel free to contact us.

��

�� WHERE'S THE GLUCOWATCH?

�� Various companies have been working for years to

provide a viable alternative to fingerstick blood glucose

monitoring.� They're still working.� The problem has been to

develop a reliable alternative to reading the saturated

glucose in blood ‑‑ and then develop practical equipment for

the mass market.

�

�� Many have tried, and most products have been

inaccurate, prohibitively expensive, or both, but Cygnus,

Inc., of Redwood City, California, has jumped to the head of

the pack, with their Glucowatch Biographer blood glucose

monitor.�

�� In VOICE Vol. 14, No. 3, Summer 1999, we reviewed the

Glucowatch.� At that time, we quoted Dr. Russell Potts,

Cygnus' VP for Research, as saying in March 1999:� "With a

little luck, and some good will, I'll be standing here next

year with some Glucowatches you can buy."

�� They're not here yet, but on December 6, 1999, the U.S.

Food and Drug Administration's Clinical Chemistry and

Clinical Toxicology Devices Panel, part of the FDA's Medical

Devices Advisory Committee, voted to approve the Glucowatch

Biographer for marketing in the United States.� The biggest

hurdle was passed.

�

�� On May 9, 2000, Cygnus announced receipt of an official

"approval letter" from the FDA.� The company stated:� "An

approval letter means the FDA has reviewed the Company's

pre‑market approval (PMA) petition, as well as its own

Advisory Committee's report and recommendation, and that the

FDA believes it will approve the application, pending

specific final conditions."

�� Cygnus has also filed for marketing approval with the

European Union, and received a "CE Certificate," granting

such approval, from the EU, on December 2, 1999.

�

�� Assuming final U.S. approval is granted, Cygnus

anticipates "broad product introduction in early 2001."� Of

course, no company is going to tool‑up for large‑scale

manufacture, or seek marketing/distribution partners, until

all regulatory hurdles have been passed.

�� Is the Glucowatch "noninvasive?"� Not completely.� The

user will still need to fingerstick, once every 12 hours,

when changing the disposable sensor (the Glucowatch's

equivalent of a test strip).� But ‑‑ that's the last

fingerstick for 12 hours ‑‑ so you can get multiple

readings, after a minimal number of fingersticks.

�� Is it accurate?� The FDA is satisfied with its

accuracy.

�� Is it inexpensive?� Final prices have not been set ‑‑

not until marketing agreements are finalized ‑‑ but the

meter should cost several hundred dollars, and each sensor

(disposable pad) should cost $3 to $4 each.� That's not low‑

budget ‑‑ but if you need repeat tests, without repeat

fingersticks, it may be your best choice.

�� Another thing:� Because the Glucowatch is continuous,

and it has a programmable low‑blood‑sugar alarm, it should

be good for folks who have hypoglycemia unawareness.� Set it

at the top of the danger zone, and it can warn you to get

yourself a snack ‑‑ before you get into trouble.

�� Is the Glucowatch "adaptive?"� No.� It depends on sight

to manipulate it and to read it.� It does not talk, and it

does not incorporate tactile aids.

�� From the Editor:� I contacted Cygnus' VP Dr. Russell

Potts, several times, by phone and letter, to urge him to

consider making the Glucowatch speech‑compatible, so blind

diabetics could enjoy its benefits.� I find it disturbing

that neither he nor any other Cygnus representative got back

to me.� And, I would point out that the total mailing of

this Voice issue will be more than 300,000 copies.� Cygnus

should not ignore the many blind diabetics who might benefit

from the Glucowatch.�

�� For more information, contact Cygnus, Inc., telephone:

(650) 369‑4300; website: http://www.cygn.com�

��

�� I'M PUMP‑POSITIVE

�� by Sally York

��

�� From the Editor:� Sally York is on the Board of our

Diabetes Action Network, where she energetically works to

help blind diabetics.��

�� I am an insulin‑dependent diabetic, and have been a

"pumper" since August 1997.� My MiniMed insulin pump has

given me back my independence, and I can't imagine going

back to multiple injections.� When I started using the pump,

my glycosolated hemoglobin (A1c numbers, the best test for

how well you are managing your diabetes) went down into the

non‑diabetic "normal" range.� The pump can do that for you.

�

�� My diabetes has a complication: " gastroparesis",

delayed, unpredictable stomach emptying.� That makes my

eating irregular, and makes it hard to keep my blood sugars

so tight.� At first, I had quite a few hypoglycemic

reactions.� Then my doctor has advised me to try to keep

them slightly higher than I was doing, and things are now

OK.� As we all know, it's a challenge to walk that tightrope

between being too low and too high!� My pump has made it

easier to be more in control, given me more peace of mind,

and more flexibility in my meal and exercise schedules.

�� It took me awhile to convince my medical team that a

blind person, living alone, could use the pump.� I didn't

give in ‑‑ they did.� My doctor sent me for training.� I

went to my dietitian to learn about carbohydrate counting.

Then my diabetes nurse educator provided me with literature

and videos.� Finally, when she felt I understood its

concept, and the pros and cons of its use, I was taught how

to operate the insulin pump.�

�� My team and I brainstormed together, and came up with

ways for me to use the pump with my limited vision.� When

filling the insulin reservoir, I use plenty of light, and

then check for air bubbles with my magnifier.� Inserting the

thin needle under my skin and attaching the tubing can be

done by feel.� Giving myself a dose of insulin (a bolus), is

easy, as the pump has an audible beep for each half unit

taken.� I sometimes require the eyes of a family member, to

help me read the display screen, when I make infrequent

adjustments to my dosage regimen.� (Editor's Note:� Many

totally blind people successfully use insulin pumps, and

have evolved techniques to adjust them without sighted aid.)

�� If it appears that the pump is the answer to perfect

blood sugar control, it is not.� It is also not for

everyone.� It requires a good deal of commitment in the

education process, and then being vigilant in doing frequent

(even more frequent) blood sugar monitoring.

�� I can honestly declare my pump has given my life a

positive boost.� We are partners in living with this

challenge, in the truest sense of the word.

��

�� DIABETES PREVENTION TRIAL FINDINGS

�� The Diabetes Prevention Trial ‑ Type 1 is a multi‑

center study of ways in which the onset of type 1 diabetes

might be prevented, delayed, or minimized.� One of the

hypotheses tested was whether "oral tolerization," oral

administration of insulin not to control blood sugar but to

"distract" the autoimmune attack on the pancreatic Beta

cells, might measurably slow the onset of diabetes.

��

�� The results have begun to come in.� A French medical

team tested 131 antibody‑positive diabetic patients, age 7‑

40, within two weeks of their diagnosis.� Participants were

randomly assigned 2.5mg of oral insulin, 7.5mg of oral

insulin, or placebo, for a period of one year.

�

�� Findings strongly disproved the tested hypothesis ‑‑

A1c results and other tests were similar in all three

groups.� The researchers interpret the results as follows:

Oral insulin, administered (in these dosages) at clinical

onset of type 1 diabetes, intended to slow or halt further

autoimmune attack on the pancreatic Beta cells, did not

prevent the further deterioration of Beta cell function.

�� INSULIN TYPES:� A REVIEW

�� Earlier articles have discussed insulin's role in our

bodies, what happens when we don't have it, and why some of

us have to take it by injection.� But all insulins are not

the same.� How are they different?� WHY are they different?

And, how can we use their differences to better self manage?

�� Insulins are described and subdivided by concentration

strength, source, and time of onset/peak.� This last

category is most critical, but we really need an

understanding of all three criteria.

Concentration Strength

�� All insulins sold in the United States today are of

U 100 strength, 100 units of insulin per cc of fluid.� But

there are other dilutions in other countries, and if you

were to encounter one of these (all perfectly usable), and

inject your usual volume of insulin, you'd get a different

amount of insulin.� You'd get the wrong dosage.

Source

�� At one time, all insulin was produced by laboratory

animals, most often cows and pigs.� In the last decade,

however, American insulin manufacturers have almost

completely shifted to use of "recombinant DNA" (Rdna)

technology, enabling laboratory production of a close analog

to real human insulin.� This "human" insulin is said to more

closely match� our endogenous (pancreatic) insulin.

�� Although labelled much like "animal source" insulins,

recombinant DNA insulins are not quite the same, either in

time of onset or in amount of insulin required.�� Experience

shows that any switch between the one and the other must be

done with care, and under your doctor's supervision the

types might be different enough to cause you trouble

otherwise.

Time of Onset/Peak

�� The different insulin types:� "Humalog, Regular, NPH,

Lente, Ultralente, Lantus", and the pre mixes: 70/30, 50/50,

and Humalog 75/25, are divided and distinguished by their

time of onset and duration.� As shown in the chart below,

critical questions are:

1.�� When does this insulin begin to act in my body?

2.�� When does it reach its peak?

3. ��When does it fade to insignificance?

�� NOTE: " We're all different!� Charts reflect

averages you may well find a given insulin is different for

you.� Test frequently, keep good notes, and make your own

chart!"

�� The chart below is a general approximation, derived

from data furnished by all three U.S. insulin manufacturers,

Eli Lilly and Company, Aventis Pharmaceuticals,� and Novo

Nordisk Pharmaceuticals Inc.�

�� INSULIN�� START�� PEAK�� END

�� Humalog�� 10 min.�� 1 hr.�� 4 hr.

�� Regular�� 30 min.�� 2 5 hr.�� 8 hr.

�� NPH�� 1.5 hr.�� 4 12 hr.�� 22 hr.

�� Lente�� 2.5 hr.�� 6 16 hr.�� 24 hr.

�� Ultralente�� 4 hr.�� 8 18 hr.�� 30 hr.

�� Lantus�� 1.5 hr.�� 2‑23 hr�� 24 hr

�� 70/30�� 2 hr.�� 2 12 hr.�� 24 hr.

�� 50/50�� 2 hr.�� 2 6 hr.�� 24 hr.

�� Humalog 75/25�� 15 min.�� 1 6.5 hr.�� 18/26 hr.

�� Where Humalog, Regular, and 50/50 premix have sharp and

definable "peaks," the long acting Lente insulins come on

slowly, and have long, flat "peaks," and a slow rate of

decline.� New Lantus insulin (insulin glargine Rdna) is even

flatter, and is meant, like the Lente insulins, to provide

"basal" insulin coverage.�� Discuss your insulin choices

with your doctor and your diabetes educator they will help

you find which is best for you.

�� There are a number of insulins not charted above.� Some

are "buffered insulins" (from both Lilly and Novo Nordisk),

and there is a special U 400 insulin from Aventis.� These

are strictly for use in insulin pumps, and should not be

used for any other purpose!� There are also insulins not

available in the United States (or not yet available), such

as the complete line of Hypurin animal source insulins

manufactured by CP Pharmaceuticals of Great Britain, Novo

Nordisk's rapid acting Novolog, or Lilly's� 50/50 Humalog

pre mix.��

Avoid Rigid Thinking

�� The most accurate chart will still be imprecise.

Short term, things will vary because diabetes, like life

itself, is like riding a surfboard no one can control all

factors!� Novo Nordisk says it best, on their chart:� "The

time course of action of any insulin may vary in different

individuals, or at different times in the same individual.

Because of this variation, time periods indicated here

should be considered as general guidelines only."

�� Long term, things will vary because your body is not

the same from one decade, or one year, to the next.� Your

chart will need regular updating.� Use it as guide, not

gospel.

Mixes and Mixing

�� Although users of the insulin pump generally take only

short acting insulin, most insulin using diabetics employ a

mix of faster and slower insulins, to provide best control.

The idea is to let the fast insulins (Regular or Humalog)

cover meals, and let the longer acting types (NPH, Lente,

Ultralente) cover the period between meals.� There is quite

an art to insulin mixing, as you must consider diet,

exercise, injection frequency, total insulin volume, ratio

of slow to fast insulins, general health (including other

medications you might be taking!), and your own unique

intangibles.� NOBODY is exactly "average."

�� Some folks employ commercially prepared "pre mixes,"

like "70/30" (70% NPH to 30% R).� While these pre mixed

insulins provide a convenience (precise and consistent

mixing) they also come with a liability:� What if, to

achieve optimal control, your best mix, right now, is 68/32,

or 75/25?� And what if tomorrow, due to variations in your

diet, activity level, and general health, it's 60/40 or

81/19?� You can't make fine adjustments with a "pre mixed

insulin" you're stuck with the mix the doctor gave you and

for some, that means less than optimal control.� Yes, you

can vary your total dosage, total volume, and injection

frequency; but, as the different insulins are really there

for different purposes, adjusting insulin with a pre‑mix can

be like scratching an itch with a sledgehammer.� There can

be consequences.

A Caution

�� The insulin manufacturers report that one insulin mix

could have dangerous consequences, and should be avoided.

The Lente� insulins, long acting insulins, should never be

combined with intermediate speed NPH insulin.� Chemicals in

the NPH would alter the Lente or Ultralente, turning it into

an approximation of fast acting Regular insulin!� Mix those

two, and you'll have a very different result than you might

expect!� Also, notes supplied with new Lantus insulin state:

"Lantus must not be diluted or mixed with any other insulin

or solution, as it may result in a delayed onset of action."

�

�� Be sure to talk to your doctor about appropriate and

inappropriate insulin combinations.

Adjusting Insulin

�� People's bodies, and their insulin needs, change.� Not

only by the year, the month, or the decade, but, to achieve

the best possible control, you may choose to vary your

dosages by day, linking them to results of your blood

glucose monitoring.� To preserve optimal control, you will

need to adjust your insulins, to compute, draw up, and

inject different amounts and mixture percentages.� Some

folks, working with the full potential of "tight control,"

use a "sliding scale", adjusting their insulins every day,

in close step with their diet, exercise, and blood glucose

test results.� The rewards of their discipline greatly

reduced chance of complications can be great.

�

�� Once you realize the role played by the different types

of insulin, and how you can optimize your control by

utilizing the most appropriate blend, right here, right now,

you're well on the road to staying healthy.� Knowledge is

power!

�� Blind diabetics, and those losing vision, need to

adjust insulin as well, and the technology to do so is

available:� Tactile insulin measuring devices like the

Jordan Count A Dose enable reliable non visual insulin

measurement and mixing.� Lack of sight is no bar to good

control!

�� The Count‑A Dose (Low Dose model, B D 50 unit syringe)

from Jordan Medical Enterprises (of South Pasadena, CA), is

available� from the National Federation of the Blind,

Materials Center, 1800 Johnson Street, Baltimore, MD 21230;

telephone:� (410) 659 9314.� Cost is $40.� The Materials

Center is open 8:00 am to 5:00 pm EST, weekdays.

��

BLINDNESS CAN'T STOP SKYDIVERS

��

�� by Mike Patty

��

Photo: Two skydivers.� Caption:� Chip Johnson and his jump��

�� instructor

��

�� From the Editor:� This article appeared in the BRAILLE

MONITOR, Vol. 43, No. 7, July 2000 edition, published by the

National Federation of the Blind.

�� From the MONITOR Editor: NFB adult training centers

make a point of helping their students push their limits.

Once you have succeeded at white‑water rafting, rock

climbing, carpentry, or� single‑handedly feeding 40 people,

you find it hard to picture yourself as incompetent and

helpless. So, when several students began talking last

winter to Colorado Center staff about their wish to go

skydiving, it was hard to think of reasons for not doing it.

Julie Deden, Center Director, didn't even try. In fact, she

agreed to go along. After all, it's healthy now and then for

everyone to push back the limitations we place on ourselves.

�� So Colorado Center students and staff began making

arrangements to go skydiving for the first time on April 15.

Unfortunately, Mother Nature had other ideas. A mid‑spring

snow storm put an end to the outing, and it was rescheduled

for Sunday, May 21. This time, no snow appeared, so off the

group went.

�� I asked Julie Deden afterward, whether she had enjoyed

the experience. The best she could say was that she was glad

she had done it. She had not been prepared for the noise

during the free‑fall portion of the jump.� But if Julie

Deden was less than euphoric about the experience

personally, others in the group made up for it with their

enthusiasm and delight. The press, as well, found the notion

of 26 blind people jumping out of an airplane worthy of some

attention. Moreover, they got the story right. This was not

a nine‑days' wonder with no connection to good

rehabilitation‑‑this was part of an extraordinary program

that enables blind people to regain their self‑confidence

and return to their lives as fully participating,

contributing members of their families and communities.

�� On Tuesday, May 30, MSNBC conducted a five‑minute

interview with Julie Deden and Buna Dahal, a member of the

staff. It provided Julie and Buna an excellent opportunity

to describe their experience and explain its value in the

context of an effective rehabilitation program.

�� The following is an article that appeared in the May

22, 2000, edition of the ROCKY MOUNTAIN TIMES. Here it is:

�� Twenty‑six students and staff members of the Colorado

Center for the Blind jumped Sunday from an airplane more

than two miles above Longmont's Vance Brand Airport. They

did it for the same reasons sighted people skydive: to test

their character and for the plain thrill of it.

�� Julie Deden, the center's executive director, said

Sunday's jump at the Mile‑Hi Skydiving Center was the first

for all 26. "As far as I know, it's the first time anywhere

so many blind people have skydived on one day," Deden said.

�� All made tandem jumps with Mile‑Hi instructors.

�� The idea for a skydiving outing came from David James,

a recent graduate of the Colorado Center for the Blind. "I

used to ride Harleys before I lost my sight two years ago,"

James said. "I can't do that anymore, but I miss the

adrenaline rush."

��

�� James said losing his sight in his late forties nearly

destroyed him. "There was a time when I would get up every

morning and had to look hard for reasons not to put a bullet

in my brain," James said. "But the people at the center knew

what I was going through. I wouldn't have made it except for

them.� My first week at the center I had to hang sheet rock,

cut a Christmas tree, and make quiche."

�� Soon, James said, he regained his sense of hope. "I

learned how to do all the things required of living," James

said. "I figured, if others can do it, so can I."

�� Eddie Culp, a blind instructor at the center, was the

first one out of the plane Sunday. "At first there was a

tremendous rush, then it felt like I was floating in a

dream," Culp said. "It was over too soon."

�� Culp said it is important for blind people to push

their limits and learn to overcome self‑doubt. "Most of life

is about believing in yourself," Culp said. "My philosophy

is don't let fear put out the fire."

�� Laura Connors, who lost her sight 16 months ago, said

she had long fantasized about skydiving.

�� "It was always in the back of my mind if I had the guts

to do it," Connors said. "When I had the opportunity, I

didn't want to let it pass."

�� Connors said it got very scary at the door of the

airplane over the drop zone. "But I did what you do when you

are scared: just take some deep breaths and do it," Connors

said.

��

�� MALE SEXUAL DYSFUNCTION

�� by Ed Bryant

�

�� One of the most feared complications of diabetes,

"erectile dysfunction", commonly known as "impotence", is

also one of the most treatable.� More than 50% of diabetic

men may experience this complication, but over 95% of cases

can be successfully treated.� With proven treatment

available, and new treatments appearing, a diabetic

experiencing this problem does have options.� It isn't

something he or any other man or his partner should have to

live with.

�� Many men do not feel their difficulties, especially

with their sexual performance, are a fit subject to discuss

with their partners.� They couldn't be more wrong.� To avoid

making things worse, a man needs to move beyond the old idea

that the sex act is something he does.� He is part of a

relationship, and what interferes with one affects both.� A

man's partner is equally involved.

�� Achieving and sustaining an erection requires

interaction between the neurological, arterial, hormonal,

and psychological functions of the body.� Simply, a lot of

different parts have to work right.� Proper hormonal

balance, normal sex drive and emotional make up, functioning

nerves and blood vessels, and healthy penile tissue are all

required.� Libido, the interest in sexual activity, and

potency, the ability to perform, must both be present.

Several different sets of nerves are involved.� Erection is

a function of the parasympathetic nervous system, but orgasm

and ejaculation are controlled by a different set of nerves:

the sympathetic system.� Both orgasm and ejaculation can

occur without erection.

�� "Erection is a hydraulic phenomenon, that occurs

involuntarily," says Arturo Rolla, MD, of Harvard University

School of Medicine.� "Nobody can will an erection!"

Anything that limits or impairs blood flow can interfere

with the ability to achieve an erection, no matter how hard

a man tries, or how much he wants to achieve one.

�� Although sexual vigor declines with age, a man who is

healthy, physically and emotionally, is able to produce

erections, and enjoy sexual relations, regardless of his

age.� Impotence is not an inevitable part of the aging

process.

�� On occasion any man may experience the inability to

achieve or sustain an erection.� Such transient episodes are

common and may be attributed to illness, fatigue, stress,

etc.� The occasional inability to perform, however traumatic

to both partners, is normal.

�� Repeated inability to achieve and sustain an adequate

erection can be caused by anything that affects a man,

psychologically or physically.� Psychological, or

"psychogenic," impotence can follow major life changes,

stressful events, or even the fear of becoming impotent.

The physiological changes associated with fear can

themselves cause erectile dysfunction!� When a diabetic

discovers the source of his difficulties is not

physical that it is due simply to a fear of the

ramifications sexual function is usually restored.� But to

tell the difference between physical and psychogenic

impotence, and to make any progress against it, requires

that you TALK about this sensitive issue with your partner,

your physician, and, ideally, with a urologist specializing

in male impotence.

�� Sexual dysfunction can contribute to psychological

problems such as feelings of inadequacy, frustration, loss

of self esteem, and despair.� Strained relationships with

partners may well result.� It is important for men to

discuss the problem with their partners and to promptly seek

medical attention.� Many may find counseling helpful.

�� Diabetic impotence is generally a result of the

blockage of blood vessels responsible for erection, damage

to the nerves that dilate those blood vessels, or a mixture

of the two.� In some cases, re establishing good glycemic

control may decrease the impotence, though permanent damage

to nerves and vessels may not be reversible.

�� A diabetic man can decrease his risk of impotence by

carefully controlling his diabetes.� Poorly controlled

diabetes and high cholesterol increase the chances of

vascular complications, especially vessel blockage, which

may lead to erectile dysfunction, or to other circulatory

problems.

�� Exercise regularly, and avoid nicotine and alcohol.

Smoking causes constriction of the blood vessels and

contributes to arterial blockage.� Good health practices

help men prevent impotence.

�� Impotence, the chronic inability to have and sustain an

erection adequate for sexual intercourse, may be a symptom

of a more serious disorder.� Seeking prompt medical help for

sexual dysfunction can lead to early diagnosis of other

problems.� Identification of the source of impotence can

point the way to the prevention of strokes, heart attacks,

and other life threatening illnesses.� Learning is the first

step to recovery, especially when fear is the culprit.

�� Regardless of the cause, if a man does not have or

cannot sustain erections adequate for vaginal penetration,

and the problem continues over a period of four to five

weeks, he should recognize a problem exists, and seek

medical help.� Don't delay erectile dysfunction doesn't just

go away!

�� In treatment of impotence, the choice of doctors is

most important.� Among the best choices are those practicing

at centers specializing in erectile dysfunction, urologists

who subspecialize in the treatment of impotence, and other

physicians specifically trained in this field.� Most

people's first contact is with their family doctor.� Ask

that first physician for a referral to a medical

professional who is particularly familiar with this

disorder.� Local hospital referral services may keep lists

of such experts who practice nearby.

�� After the interview and physical exam, the doctor will

determine whether the erectile dysfunction is psychological

or physical in nature.� Where diabetes is present, a vast

majority of instances of erectile dysfunction have a partly

or completely physical cause.� But based on examination and

interview, the doctor may determine the cause to be

psychological, and if so, refer the man to a qualified

health professional specializing in psychologically‑induced

erectile dysfunction.� This may be a psychiatrist,

psychologist, sex therapist, or marital counselor.

�� Troy A. Burns, MD, formerly Medical Director of the

Diagnostic Center for Men, in his GETTING HELP:� A Patient's

Guide for Men With Impotence (1994, now out of print)

reported that an old at home test for erectile activity

during sleep (the lack of which would suggest

physically caused impotence) was the postage stamp test.

The patient was instructed to wrap several stamps snugly

around his penis at bedtime.� If the stamps had perforated

by the time he awakened, some penile tumescence probably

occurred!� Of course more sophisticated tests are used

today.

�� Impotence is sometimes a side effect of medications

prescribed for other disorders.� Such medications include:

some antihypertensives (diuretics and beta blockers), ulcer

medications, the heart medication Digoxin, antihistamines

used for allergy control, antipsychotics, commonly used

tranquilizers such as Diazepam, certain antianxiety drugs,

certain narcotics, anticholinergics, tricyclic

antidepressants, and many illegal drugs.� Elavil and other

tricyclic antidepressants, sometimes used to treat the pain

of neuropathy, can cause, trigger, or aggravate impotence.

Be careful of interactions between your medications and any

"alternative" herbal supplements too�� tell your doctor what

you're taking.� A person's unrelated disorders may also

contribute to the problem, as over the counter medications,

including certain eye drops and nose drops, have been

associated with erectile dysfunction.

�� If you experience erectile dysfunction, and you are

using other medication(s), discuss it with your doctor.� By

adjusting the dosage of current medication(s) or by

switching to alternates, erectile dysfunction may be

alleviated.� Ask your doctor or pharmacist for information

about side effects, and be sure to read the package insert

in the container.� Consult a physician before discontinuing

any medications.

�� Much is now known about the causes and treatments of

erectile dysfunction, and impotent men should be aware of

their various treatment options.� Although surgery is one

choice, 95% of cases are resolved by nonsurgical means, and

the National Institutes of Health recommends trying

nonsurgical treatments before more invasive methods.� All

options should be considered, but the man's personal

preferences and those of his partner are vital in the choice

of treatment.� For purpose of discussion I've divided

treatments into three categories:� medications, external

mechanical devices, and surgery.

Medications

�� Topical "Vasodilators" May Improve Blood Flow:� When

diagnosis indicates a problem in the vascular system,

particularly arterial insufficiency, externally‑applied

vasodilators (example:� nitroglycerine ointment) can be used

to dilate arteries, improving blood flow into the penis.

Commonly used in treatment of high blood pressure and

associated heart disease, such ointment is applied to the

penis to increase penile arterial flow and improve

erections.� The most notable side effect of nitroglycerine

ointment is that it may give the female partner headaches,

as it is absorbed into her bloodstream through the vagina.

To prevent this, the man should use a condom. Another

topically applied vasodilator, Minoxidil, was found to have

fewer side effects and be more effective than nitroglycerine

cream.� Although some cases of erectile dysfunction respond

well to this kind of therapy, the effectiveness of

vasodilator products has not yet been determined by the

scientific community.

�� Yohimbine Therapy Shows Promise:� Yohimbine medication

comes from the bark of a tree that grows in Africa and

India. The extract, long used as an aphrodisiac and folk

remedy for impotence, has proved effective in some impotence

cases.� It is not known exactly how the medication works,

but it seems to affect the central nervous system by

suppressing nerves that normally restrict erection.� It's

thought that yohimbine may also increase libido desire in

some men.� The few side effects of yohimbine tablets can be

easily alleviated.� Many doctors prescribe this therapy for

cases of very mild, physically caused dysfunction or for

psychological impotence.� This therapy does have merit and

should be considered.

�� Viagra, Pfizer, Inc.'s oral medication for the

treatment of male erectile dysfunction (impotence) was

approved by the U.S. Food and Drug administration on March

27, 1998.� Viagra is a simple pill, priced about $7 per

dose, and appears to successfully treat a wide percentages

of cases.� Although sometimes contraindicated where

circulatory disease is present (talk to your doctor first!),

for some, it may be the most convenient treatment of all.

�

�� Uprima, manufactured by TAP Pharmaceuticals, works in a

similar manner,� but where Viagra acts directly on the

circulatory system, Uprima stimulates the appropriate

neurotransmitters in the human brain.� It appears to work

more quickly than Viagra.� An FDA advisory committee,

meeting in April 2000, has recommended that FDA approval be

given for this medication.� It should be available shortly.

�

�� Vasomax, by Zonagen Pharmaceuticals, is still another

anti‑impotence oral medication.� An oral form of the proven

anti‑impotence injectable medication phentolamine, it is

already approved in Mexico, it is in final clinical tests in

the U.S.� If all goes well, it should be available late in

2000.

�� Penile Injection Therapy:� Many sources report that

penile injection therapy has an estimated 80% rate of

success.� Injected directly into the penis, the medication

produces erection by relaxing certain muscles, increasing

blood flow into the penis and restricting outflow.� The

therapy has disadvantages, such as risks of infection, pain,

and scarring fibrosis in the penis, and it may create

"priapism," a prolonged, painful erection lasting six hours

or more (although reversible with prompt medical attention).

The most popular medication is Upjohn Corporation's

Caverject, the first to be approved for such use by the FDA.

Note: The MUSE system, described below, administers the same

medication, without needles.

�� Drug Combination Injection Therapy:� Therapies using

combinations of drugs have been developed and are proving to

be a good "fallback" for individuals who experience

difficulties with Caverject alone.� "About 15% of all

individuals who try therapy with� Caverject experience

significant pain at the injection site,"� says Troy A.

Burns, MD.� "For these 15%, a combination of Caverject,

Papaverine, and Phentolamine produces less or no pain."

Alternatives

�� The MUSE System, by VIVUS, is a noninvasive alternative

to penile injection.� The user dispenses his medication (a

pellet of alprostadil/Caverject) with an eye dropper like

applicator, directly in the urethra.� No needles are

required.� Both the drug and the delivery system have been

approved by the Food and Drug Administration for this use.

For many impotent men, the MUSE may be the therapy of

choice.

��

�� "Rejoyn" is an inexpensive, nonprescription alternative

to the many vacuum actuated devices described below.

Described by its manufacturer as a "support sleeve," it does

not "cause" an erection, but rather supports the flaccid

penis as if it were erect.

External Mechanical Devices

�� This category of treatments for erectile dysfunction

includes external vacuum therapies; noninvasive external

mechanical devices that produce painless erections by

causing blood to flow into the penis while constricting

outflow of blood.� Such devices imitate a natural erection,

and do not interfere with orgasmic experience.� External

vacuum therapy mechanisms are approximately 90% successful

in causing and sustaining an adequate erection.� All are

portable, and costs range between $200 $500, covered under

most insurance plans, and Medicare Part B.

�� The vacuum constriction device consists of a vacuum

cylinder, various sizes of tension rings, and a vacuum pump,

either hand operated or electric.� The penis is placed in a

cylinder to which a tension ring is attached.� Air is

evacuated from the cylinder by means of the pump, creating a

vacuum, which produces the erection. The cylinder is

removed, leaving the tension ring at the base of the penis

to maintain the erection.

�� Vacuum therapy devices have a few minor disadvantages.

One must interrupt foreplay to use them.� THE TENSION RING

MUST BE REMOVED AFTER SUSTAINING THE ERECTION FOR 30

MINUTES, TO PREVENT PENILE BRUISING.� You must use the

correct size tension ring.� Although considered to be

basically pain free, initial use may produce some soreness.

Such devices may be unsuitable for men with certain

disorders related to blood clotting.� In general, vacuum

constriction devices are successful in management of

long term impotence, and they enjoy wide physician

acceptance.� They are relatively inexpensive, and they work

on simple principles, so they are easy for patients to

understand.�

�� "At our institute," says Troy A. Burns, MD, founder and

former medical director of the Diagnostic Centers For Men,

"each doctor regularly prescribes such devices 20 to 30

times a month.� Complaints are rare; and very rarely do we

have anyone bring them back.� They usually work really

well."

Surgical Treatments

�� There are many other less invasive and less expensive

options, and surgery should be considered only after all

others have proved unsatisfactory.� Of the two kinds of

surgery performed, one involves implantation of a penile

prosthesis; the other attempts vascular reconstruction.

Less than 5% of impotent men may benefit from vascular

surgery.� Expert opinion about surgical implants has changed

during recent years; today, surgery is no longer so widely

recommended.� Even though it is 90% effective, surgery is

expensive in both monetary and human terms, but it is one

available option for impotent men.� The decision to have or

not have surgery is one that should be made by the man and

his sexual partner.

�� Companies that market surgically implanted prosthetic

devices sell only to hospitals and physicians and will not

provide the selling price to consumers.� Some years ago, I

checked prices, and found that the malleable prostheses cost

about $1400, and inflatable devices cost about $4000 ‑‑ just

for parts.�� If the man elected to undergo the surgery, and

fees were totaled (surgical, operating room, and the markup

on the prosthesis), the cost would be thousands more.

�� The main risk associated with penile surgery is

infection.�� Although every attempt is made during the

procedure itself to prevent infection, it can develop, and

may force removal of the prosthesis.� As with all invasive

procedures, there may be some pain, bleeding, and scarring.

I also note that the device itself might fail to work

properly and may have to be removed.� If for some reason the

prosthesis or parts become dislocated, surgical removal may

also be necessary.� With a general success rate of about

90%, any of the devices will restore erections, but they

will not affect sexual desire, ejaculation, or orgasm.

�� Prostheses:� Many different types of penile prostheses

are available, in three categories:� rods, inflatable

prostheses, and self contained prostheses.� Semi rigid or

malleable rods are the simplest and least expensive of all.

Their main disadvantage is that the penis remains constantly

erect, which may cause problems with concealment.

�� Inflatable prostheses are complex mechanical devices

that imitate the natural process of erection.� Parts are

inserted surgically into the penis and scrotum, and

activated by squeezing.� When erection is no longer desired,

a valve on the pump is pressed, and the penis becomes

flaccid. Disadvantages include risk of mechanical breakdown

or leakage.� Fully inflatable devices are the most expensive

of the three categories, because of the complicated surgery

necessary to implant the parts.

�� Self contained single unit prostheses are similar to

the inflatable types, but more compact.� The entire device

is implanted into the penis.� When erection is desired, the

unit is activated by either squeezing or bending, depending

on which of the two types of self contained prostheses is

used.� Some of the mechanical types have been known to fail

during intercourse; the inflatable device can sometimes be

difficult to operate.

�� All penile implants will produce erections suitable for

intercourse.� When decisions are being made regarding the

kind of surgery, other factors should be considered.

According to Bruce A. MacKenzie in IMPOTENCE WORLDWIDE

(Volume 7, No.2), purpose is only one of several elements

considered when selecting an implant.� MacKenzie said, "To

those who wish to simulate nature to the furthest

extent then a fully inflatable would be their choice; for

those who wanted something relatively simple, ready to use,

lower cost, one day less in the hospital their choice would

be the hinged or malleable; to those who wanted a compromise

between the two a hybrid they would choose a self contained;

and for those who wanted the least expensive (low end of the

line) the semi rigid would fit the bill."

�� Vascular Reconstructive Surgery for Impotence uses

highly sophisticated techniques and equipment to physically

correct the underlying causes of impotence in the penis.

The surgeon may attempt reconstruction of the arterial blood

supply, or remove veins when the cause is due to leakage.

Less than 5% of men with erectile dysfunction have such

surgically treatable impotence!

�� When quality of life is affected by erectile

dysfunction, a man should seek a physician's help preferably

that of a carefully chosen specialist.� Don't wait for your

doctor to ask you about sexual functioning talk about it!

Nothing is cured by silence.� Talk about it with your

partner/spouse too, as she is equally affected by this

condition.� Remember you're both involved, so she is

integral to the relationship, and deserves complete honesty.

�Relationships are solid only when couples consider each

other's feelings, so COMMUNICATE WITH YOUR PARTNER.

�� COMPANIES THAT MARKET IMPOTENCE THERAPY SYSTEMS

�� American Medical Systems, 10700 Bren Road West,

Minnetonka, MN 55343; telephone: 1‑800‑328‑3881; website:

(www.visitams.com).� They offer prosthetic devices.

�� American MedTech Corporation, 5217 Wayzata Blvd., Suite

140, Minneapolis, MN 5541627; telephone:� 1 800 524 8014;

website: (www.rejoyn.com).� They offer the "Rejoyn Support

Sleeve" and other external/vacuum devices and impotence

treatments.

�� Coast to Coast Home Medical, Inc., 12773 Forest Hill

Blvd., Suite� 102B, Wellington, FL 33414; telephone: 1‑800‑

330‑6316.� They distribute� vacuum constriction devices.

�

�� Encore, Inc., 2300 Plantside Drive, Louisville, KY

40299 1928; telephone:� 1 800 221 6603.� They offer vacuum

constriction devices.

�� Mentor Corp., 501 Mentor Drive, Santa Barbara, CA 93111;

telephone: 1‑800‑235‑5731; website: (www.mentorcorp.com).

They offer prosthetic devices.

�� Mission Pharmacal Co., 10999 IH‑10 West Suite 1000, San

Antonio, TX 78230; telephone: 1‑800‑531‑3333; website:

(www.missionpharmacal.com).� They offer the VED line of vacuum

constriction devices.

��

�� Soma Blue Corp., PO Box 10026, Augusta, GA 30903;

telephone: 1‑800‑827‑8382; website: (www.somablue.com).�� They

offer vacuum constriction devices.

�� Pfizer, Inc., 235 East 42nd Street, New York, NY 10017;

website: (www.viagra.com).� They offer the oral impotence

medication Viagra.

�� Pos‑T‑Vac, 1701 N. 14th Street, P.O. Box 1436, Dodge City,

KS 67801; telephone:� 1 800 627 7434; website:

(www.postvac.com).� They offer vacuum constriction devices.

�� TIMM Medical, Po Box 5679, Hopkins, MN 55343; telephone:

1‑800‑438‑8592; website: (www.erectionsolution.com).��

Successor to Osbon Medical Systems, they offer both vacuum

constriction and prosthetic devices.

�� VIVUS, Inc., 605 E, Fairchild Drive, Mountain View, CA

94043; telephone: (650) 934 5200; website: (www.vivus.com).

They offer their noninvasive MUSE delivery system for the drug

alprostadil (Caverject).

�� RESOURCE LIST OF INFORMATION AND SERVICES

�� Diabetes Action Network of the National Federation of the

Blind, 811 Cherry Street, Suite 309, Columbia, MO 65201;

telephone:� (573) 875 8911; website:� (www.nfb.org/voice.htm).

�They offer other information pertinent to diabetes and its

ramifications.

�� Impotence World Association/ The Impotence Institute of

America, P.O. Box 410, Bowie, MD 20718‑0410; telephone:

1 800 669‑1603 or (301) 262‑2400; website:

(www.impotenceworld.org).� An educational/charitable

foundation, they disseminate information about male impotence

and treatment options, and publish a periodical titled

IMPOTENCE WORLDWIDE.

�� National Federation of the Blind, Materials Center, 1800

Johnson Street, Baltimore, MD 21230; telephone: (410) 659‑

9314; website: (www.nfb.org).� Hours: 8:am to 5. pm.� They

offer advice about blindness, and copies of this and other

articles about ramifications of diabetes, singly in large

print, or together on an audiocassette titled:� "Diabetes

Action Network Articles."

�

�� National Kidney and Urological Diseases Information

Clearinghouse, #3 Information Way, Bethesda, MD 20892‑3580;

telephone: (301) 654‑4415; website:

(www.niddk.nih.gov/nkudic.htm).� Part of the National

Institutes of Health, they publish an "Impotence Fact Sheet,"

free upon request.

��

�� KIDNEY TRANSPLANTS LAST LONGER NOW

��

�� About 10,000 kidney transplants have been done in the

United States so far.� How long should a donated kidney,

cadaveric or from live donor, last?

�� In 1998, the best average, from a living related donor,

was 17 years, according to government statistics.� The

typical cadaveric kidney, from a dead donor, lasted about 11

years.� But a study, led by Dr. Sundaram Hariharan, at

Medical College of Wisconsin, has found major improvement

where it matters, in "graft survival," the amount of time

the new organ works in the recipient's body.�

�� This study, published February in the New England

Journal of Medicine, states that a kidney transplant, from a

living related donor, that once might last 17 years, has

more than doubled its "life expectancy," to 36 years.� A

similar transplant, but from a cadaveric donor, now lasts an

average of 20 years.

�� What has changed?� Once the surgical techniques of

transplantation were mastered, the biggest problem has been

rejection, the body's attempt to destroy invading tissues.

"Anti‑rejection drugs," necessary to keep the organ alive in

the face of the body's attempt to reject it as "foreign,"

have been coarse, powerful, and fraught with side effects.

But they are getting better, and as they do, transplants

last longer.

��

�� Over all, the results "show a continuous trend toward

improved long‑term graft survival in recent years," the

researchers said; and, "The survival rate for someone who

receives a transplant today is probably even better."

��

�� TIGHT CONTROL:� LONG‑TERM BENEFITS

��

�� Recently, the authors of the Diabetes Control and

Complications Trial (the "DCCT Group") published an article

titled "Retinopathy and Nephropathy in Patients with Type 1

Diabetes Four Years after a Trial of Intensive Therapy," in

the February 10, 2000 New England Journal of Medicine.�

�� Background:� The DCCT and its British equivalent, the

United Kingdom Prospective Diabetes Study (UKPDS) proved

that for patients with diabetes mellitus, intensive therapy,

"tight control" (meant to achieve near‑normal blood glucose

and glycosylated hemoglobin concentrations),� significantly

reduces the risk of diabetic complications, as compared with

conventional therapy.� To test whether these benefits

persist, the authors "compared the effects of former

intensive and conventional therapy on the occurrence and

severity of retinopathy and nephropathy for four years after

the end of the Diabetes Control and Complications Trial."

Note:� Participants in this study were all type 1, insulin‑

dependent diabetics, but the UKPDS' findings strongly

suggest the same will be true for type 2 diabetes.

�

�� Methods:� At the end of the DCCT (1993), the patients

in the conventional‑ therapy group were offered the chance

to switch to intensive therapy, and all patients' care was

transferred to their own physicians.� The occurrence of

diabetic retinopathy was evaluated in 1208 of these patients

during the fourth year after the DCCT ended, and nephropathy

was evaluated with urine specimens obtained from 1302

patients during the third or fourth year, approximately half

of whom were from each treatment group.

�

�� Results: The difference in the median glycosylated

hemoglobin (HBA1c) values between the conventional‑therapy

and intensive‑therapy groups during the years of the DCCT

(average, 9.1 percent and 7.2 percent, respectively)

narrowed during the follow‑up (median during four years, 8.2

percent and 7.9 percent, respectively). Nevertheless, the

proportion of patients with worsening retinopathy,

proliferative retinopathy, macular edema,� and the need for

laser therapy, was lower in the intensive‑therapy group than

in the conventional‑therapy group.� The proportion of

patients who had raised urinary albumin was significantly

lower in the intensive‑therapy group.

�

�� Conclusions: The reduction in the risk of progressive

retinopathy and nephropathy that comes from "tight control"

of blood sugars persists for at least four years, despite

increasing hyperglycemia.

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

�� NUTRITION AND DIABETES

��

�� by Jennifer Layton, RD

��

�� The following was the keynote address at the March 24,

2000, Diabetes Action Network seminar, held at the National

Federation of the Blind of Missouri State Convention, in

Jefferson City, Missouri.� Jennifer is the Clinical

Nutrition Manager at the Capital Region Medical Center, In

Jefferson City.

�� I'm Jennifer Layton, a Registered Dietician at Capital

Region Medical Center.� I'm going to talk about basic

diabetes and nutrition, pointing out the differences between

food guide pyramids, the exchange system, and the new

carbohydrate counting.�� I have some food models to pass

around, to give you a feel for what different portion sizes

should be like.� I've got some bottles with mixtures in

them, to show you the consistency of your blood when blood

sugars are normal, or when they are higher than they should

be.�

�� When we eat food, and it is digested, everything is

broken down into different nutrients: carbohydrate, protein,

or fat.� Those are the three main nutrient groups.

Carbohydrates turn into glucose, and we need glucose in our

cells for energy.� When glucose cannot enter the cells

because we don't have enough insulin, that's when we see the

high blood sugars, which I'm sure you are all familiar with.

�� So when and how much you eat is going to affect your

blood sugar level.� Food is a very important aspect of

controlling diabetes.

�

Reasons for Meal Planning

�� We want to maintain our normal blood glucose levels;

we want to maintain normal blood fat (when I talk about

blood fat, I mean triglycerides and cholesterol).� For some

of us, losing weight can actually improve� our diabetes,

prevent complications such as renal disease, hypertension,

high blood pressure, abnormal lipid levels, including

cholesterol, nerve damage, blindness.� So those are all

complications we want to prevent.

�

�� Controlling diabetes is important.� We want to improve

our overall� health.� We want to get enough nutrients,

vitamins and minerals that our body requires every day.

Some reasons will be more important to you, as an

individual.

The Basic Eating Guidelines

�� We definitely want to eat regularly.� Do not skip

meals.�� I know it's hard to avoid doing that sometimes, but

we need to be getting at least three meals a day.� Some of

us will need snacks in between and at night.� So we want to

carry food for emergencies.� If we know we're getting low

blood sugars, we need to have something on hand to keep from

passing out.

�� Choose a variety of foods, from all food groups, not

just one.� I know there's a diet out there that just focuses

on high protein, and eliminates most carbohydrate foods.

But that's not a good diet, because it's not balanced.

�� Portion sizes are very important.� The first food model

I have is a cup of spaghetti and meatballs.� If you pass

that around, you'll see one cup of spaghetti and meatballs

is actually two servings of spaghetti.� And the next one is

a small to medium‑sized apple.� A lot of the apples we get

in the grocery store are huge, and would be at least two

servings.� My apple is actually about the size of a tennis

ball, which is a serving size.� Now we've got a three‑ounce

portion of pork.� Your meat portions shouldn't be any bigger

than that ‑‑ three ounces of meat ‑‑ the size of a deck of

cards, or of� the palm of your hand.�� Mashed potatoes ‑‑

one half cup of mashed potatoes is one serving.� What we've

got next is a handful of popcorn.� It just about fits in the

palm of your hand.� It's one cup.� That's actually only one‑

third of a serving.� Three cups of plain popcorn (no butter)

counts as one serving.� Then we've got a serving of

vegetables, actually a half‑cup of spinach.� Then we've got

a hamburger, three ounces of beef.� Again, it fits in the

palm of your hand.� It shouldn't be any bigger than that.

And the final one is a tablespoon of peanut butter.� Two

level, not heaping, tablespoons count as one meat exchange.

So that tablespoonful is� half of a meat exchange.� Peanut

butter is high in fat too.

�

�� A lot of our servings are bigger than that, especially

if we go out to eat.� Restaurants are very good about giving

us a lot of food, which isn't so good for some of us.� So

when you go out to eat, try to eat half of what you've got,

and take the other half home to eat the next day, or share

it with somebody you go with.

�� Weighing and measuring foods at home can help you out.

I don't expect anyone to do it for the rest of their lives,

but getting a grasp on portion size would be helpful to you.

�� Getting back to the three main nutrients in our diets,

your body requires these nutrients to live.� Protein, fat,

and carbohydrates�� those are the three nutrients.� Protein

builds and repairs muscles, builds and repairs skin and

other cells.� So our body requires protein.� Only half of it

turns into sugar when it is digested and absorbed in our

system, so it doesn't have a great deal of effect on our

blood sugars.� Proteins should make up about 20% of our

total calories, and a gram of protein has four calories.� We

find our protein sources mainly in our meats and milk

products.

� ��Then we've got fats, our second nutrient. Fat supplies

energy, maintains healthy skin, and carries some of the fat‑

soluble vitamins through our body.� It provides flavor to

our foods, so we definitely want fat, we just don't want too

much of it.� Excess fat will cause heart disease and weight

gain.� Very little of the fat we eat is broken down into

sugar, less than 10%.�� As� I said, about 50 percent of your

protein intake turns to sugar, and fat is even less.� Fat

should make up less than 30% of your total calories.� Fat

has nine calories per gram, over twice as many calories as

your protein.� And fat is found mostly in high‑fat meats,

whole milk products, and breads, like biscuits, waffles, and

pancakes.

�� Then we get to carbohydrates.� This nutrient is going

to greatly affect your blood sugars.� One hundred percent of

carbohydrates turns into sugar when it is digested and

absorbed in your body.� It is our main source of energy.� It

also provides some fiber and vitamins, and should make up

about 50%� of our total calories.� Most of our diet should

come from carbohydrates ‑‑.we just need to know how much to

have at what time.� Carbohydrates are just like protein:

four calories per gram.� Most of your carbohydrates are

going to be from bread, fruits, and milk, along with your

sweets.

�� I have two bottles to pass around.� You can hear them

shake.� The first is what your normal blood sugars would be

like.� Now this second bottle I've got, you can't even hear

it shaking because the fluid is so thick (it looks like

syrup), and it takes a long time for any nutrients or any

oxygen to get through your blood when it's that thick.� You

can see the effect� high blood sugars have on your blood,

and on the ability of your nutrients and oxygen to get

through to your cells.

�� I have handouts for you.� The first one is the FOOD

GUIDE PYRAMID.� The food guide pyramid is a chart in the

shape of a pyramid.� At the bottom, the base of the pyramid,

the biggest part is your breads and cereals.� They should

make up 50% of your diet.� The next range up we have fruits

and vegetables.� We need five servings of fruits and

vegetables a day to get adequate amounts of vitamins and

minerals.� Then the next tier up we've got milk, yogurt, and

cheese on one side, and meat on the other.� For both, we

want two to three servings a day.� And at the very top,

we've got fats, oils, and sweets, the very smallest part of

our diet.� The main difference between food guide pyramid

and exchanges is that cheese is included in your milk group

on the food guide pyramid.� Cheese is on your meat group on

the Diabetic Exchange List.� I usually try to cross out

cheese on the food guide pyramid when I'm handing these out,

and move it over to the meat group.� Cheese actually

provides protein like the meats do, and cheese is actually a

high‑fat meat, unless you're choosing your reduced‑fat or

non‑fat cheeses.� The Food Guide Pyramid is one of the most

basic, general guidelines.� It gives you how many servings

you should have a day, and on the back it explains what a

serving size is.

�

�� The EXCHANGES, the other handout I have here, has each

food group boxed off, and has a space where the dietician

can fill in the choices you get each day, starches,

vegetables, meats, milk, fruit, and fats.� These boxes

aren't arranged in the same way the pyramid is.� But again,

emphasizing the similarity between the two is that you want

a variety of foods.� And again, on the food exchanges, your

serving sizes are listed for you in each food group, since

knowing your portion size is a very key part of controlling

your diet.

�

�� Remember, the point of all this planning and counting

is to help keep your blood sugars down, as close to a normal

blood sugar range as possible.� That's what you really need

to shoot for.� And diet, my field, is only one aspect.

�� For a balanced diet, everyone is an individual.� What

one person needs is going to be different from what somebody

else needs.� I see a lot of people on an outpatient basis,

and I work one‑on‑one with them.� It's great to do a group

setting; but when you have a group of people, you've got so

many different personalities and different lifestyles that

you've got to take into consideration.� It's best to be one‑

on‑one, to get a really good start.

�

�� I was asked about special diets, and I would absolutely

not recommend the Atkins Diet, if you have diabetes.� This

diet is okay short term, but� I would never do it for a long

term diet.� It's not something that's healthy for you long

term.� It was originally developed for patients who were

going to undergo heart surgery and needed to lose weight

quickly, and they weren't meant to be on it for a long time.

�� The Atkins diet will give you about 15 grams of

carbohydrates a day, which is one serving of a carbohydrate.

You need� carbohydrates, even if you have diabetes and the

high blood sugars that comes with carbohydrates.� That's

what gets confusing, I think.� You need a constant source of

carbohydrates.� Fifty percent of your diet should be

carbohydrates.� And from the Atkins diet, you're definitely

not getting that.� A high‑protein diet can cause

dehydration,� can cause heart problems,� and can overtax

your kidneys, which is risky if you're dealing with kidney

complications from diabetes.� So if you're eating high‑

protein, you're putting your kidneys at risk.� If you don't

get the carbohydrates, you're missing out on a� lot of fiber

in your diet, plus some of the vitamins and minerals they

provide.� A low‑carbohydrate diet deprives the brain of

energy it needs to function properly, and when there is a

deficiency of glucose, the body produces ketones.� Excess

ketones result in ketosis, a lowering of the blood's pH.

This is potentially toxic.

��

�� Getting on to carbohydrate counting.� On an 1800‑

calorie diet, you can have about 225 grams of carbohydrate

per day, about � your total food budget.� That's about 15

choices.� Since 100% of carbohydrates is converted into

sugar, we need to control how much carbohydrate we take in.

Each serving is 15 grams of carbohydrates, though calories

vary.� One serving of starch would be about 80 calories.

One serving of milk, skim milk, would be about 80 calories.

Your fruits would be a little less, at about 60 calories.

When you're counting carbohydrates, what you're doing

basically is lumping your starches, fruits, and milk

together.� So normally on an exchange diet, if I say you can

have two starches, a fruit, and a milk in the morning,

switching over to carbohydrate counting, I would say you

could have four carbohydrates. �Then you choose how many

starches you want.� You choose how many fruits and how many

milks, as long as they all total up to four.� Each of those

servings has approximately 15 grams, and we want a total of

60, or four servings per meal.

�

�� Reading food labels gets kind of tricky when you're

trying to� decipher the sodium, sugar, and calories.� You've

got so many things to consider.� When you're doing

carbohydrate counting, pay attention to the total

carbohydrates on your food labels.� Even if there is sugar

listed on the labels, the total carbohydrates number

includes that sugar�� sugar is a carbohydrate.� When you're

looking at the label, every 15 grams, you count that as one

carbohydrate exchange.� So one fruit, one starch, one milk,

equals the same thing as one carbohydrate exchange.

�� Carbohydrate counting is good because it gives you more

control, and more variety in your meal planning, because I

wouldn't tell you how many starches, fruits, and milks to

have.� That's up to you.� But the problem is that you don't

always get as much variety in your diet.� Maybe you're

someone who doesn't like fruits.� Then you might say, "I can

get away with not getting my fruits today.� I'll just eat

them all as starches,"� which essentially you can do,

because your body reacts to those food groups the same, but

you're not getting the vitamins and minerals from those

fruits.� Often with carbohydrate counting, as well, you see

weight gain, because you're focusing in on your

carbohydrates so much that you lose sight of controlling

portion sizes of meat and fat, because you're just looking

at fats.� So I caution you against that.� I think

carbohydrate counting is a wonderful thing, and I've used it

for the past three years I've been at the hospital, and have

had some pretty good results with the patients� I've seen.

I've had many physicians very excited.� They love the way

that it's being taught.� They see the effects more than I

do, since often I don't see people for the follow‑up; but

they often tell me to keep doing what I'm doing, because

it's working.� So carbohydrate counting, if you don't know

it or aren't using it yet, continue to seek information.

�� Vitamin supplements are fine.� If you don't get a good,

balanced variety of foods, I would recommend taking vitamin

supplements.� Although we often want to buy the more generic

brands of vitamins, our bodies often don't utilize them as

well as the name brands.� I would recommend at least a

multivitamin.

�� Editor's Note: Your diet is an important part of

diabetes management�� and its in your hands.� Your dietitian

will help you design a diet that is appropriate for you.

��

�� COOKING WITH SUZI

��

�� by Suzi Castle

��

�� We're all concerned with healthful eating, but none of

us want to give up occasional treats.� Although care and

moderation are necessary in your diet, it is possible to

create sinfully rich‑tasting, yet very low‑in‑fat and

sugar‑free quick‑to‑fix desserts the whole family will

enjoy.� Here is one favorite we decided to run again!!

�� Lite Pumpkin Pie

��

�� Serve with a dollop of fat‑free whipped topping.

Crust:

1� cup unbleached flour

�� Sugar substitute equal to 1 1/2 tablespoons sugar

�� (i.e., 1 1/2 tablespoons Brown SugarTwin)

1/4� teaspoon Morton Lite Salt mixture

2� tablespoons Butter Buds

2� tablespoons chilled stick butter or margarine, cut into

�� small pieces

1/4� cup ice water

1� egg white, lightly beaten

1� teaspoon cider vinegar

Filling:

2� cups canned pumpkin

2� cups water

1� cup low‑fat (1/2% fat) milk powder (equal to 4 cups��

�low‑fat milk)

1/2� fat‑free egg substitute

�� Sugar substitute equal to 3/4 cup brown sugar (i.e.,

3/4 cup Brown SugarTwin)

1/2� teaspoon Morton Lite Salt mixture

1� teaspoon ground cinnamon

1/2 teaspoon each: ground ginger, nutmeg and

allspice

1/4 teaspoon ground cloves

�� Crust: In a mixing bowl, combine flour, sugar

substitute, Morton Lite Salt mixture and Butter Buds.� Using

a pastry blender or two knives, cut in butter until mixture

resembles coarse crumbs. Combine ice water, beaten egg white

and vinegar.� Using a folk, stir in ice water mixture 1

tablespoon at a time.

�� Gather the dough into a ball and press into a flat

circle. Place two overlapping pieces of plastic wrap on a

flat surface. Set the dough in the center.� Cover with two

more overlapping pieces of plastic wrap. Using a rolling

pin, roll the dough into a 12" circle. Remove the top pieces

of plastic wrap.� Invert the dough over a 9" or 10 " pie pan

sprayed with nonstick spray.� Gently press the dough into

the pan.� Remove the remaining plastic wrap.� Fold in the

overhanging edge of the crust to form a sturdy edge. Patch

any thin spots with scraps.�

�� Filling:� Mix all ingredients. Pour into a crust‑lined

pie pan.� Bake in a preheated 350 degree oven for one hour,

or until knife inserted in center of pie comes out clean.

Serves 8.

�� Per serving:� 145 cal. (14% from fat); 8.2gm protein;

2.33gm fat (1.37gm sat.); 23.6gm carbo.; 258mg sodium; 7mg

chol.; 1.4gm fiber.� Exchanges: 1 bread,� 1/2 vegetable, 1/2

low‑fat milk, 1/2 fat.

�� From the DELICIOUSLY HEALTHY FAVORITE FOODS COOKBOOK by

Suzi Castle.� Available in most bookstores, or by sending

$18.90 (14.95 + $3.95 S&H) to:� Health Cookbooks, Dept. M,

3520 McCourry Street, Bakersfield, CA 93304.

��

�� RECIPE CORNER

Artwork:� Fruits and vegetables

�� Send your great food ideas to the editor.� Your recipes

will be evaluated by dietitians, and if necessary, adjusted

to make them more diabetically appropriate.� Then he gets to

taste them...

�

�� Note:� This issue, all recipes are from COOKING WITH

THE DIABETIC CHEF, by Chris Smith, Published July 2000, by

the American Diabetes Association.� Price $19.95.

�� Grilled Portobello Mushrooms

Ingredients

1� Tbsp garlic, minced

2� tsp fresh rosemary, minced

2� Tbsp olive oil

2� Tbsp balsamic vinegar

2� Portobello mushroom caps

Instructions

�� In a small bowl, combine the garlic, rosemary, olive

oil, and vinegar.� Mix well.� Using a pastry brush, cover

both sides of the Portobello mushrooms with the mixture.

Cover and refrigerate for 30 minutes.

�� Preheat the grill or oven broiler.� Grill the mushrooms

on low heat, or place them on a rack that is low in the

oven.� Cook each side of the Portobello for five minutes.

Serve immediately.

�� Makes 4 servings.� Per serving:� 86 calories; 61

calories from fat; 6gm fat (0gm saturated); 0mg cholesterol;

9mg sodium; 6gm carbohydrate; 2gm protein.�� Exchanges:� �

vegetable, 2 fat.

��

�Chicken Tenders with Roast Garlic, Mushrooms, and Onions

Ingredients

1� garlic bulb

2� tsp olive oil

1� lb chicken tenders, or boneless, skinless chicken

�� breasts, cut up into 3/4 inch strips

1� tsp salt

1� tsp pepper

�� cup all‑purpose flour

�� Tbsp olive oil

1� medium onion, sliced

�� lb mushrooms, sliced

3� green onions, chopped

Instructions

�� Preheat the oven to 350 F.� Slice the top of the garlic

bulb so that the garlic pieces are just exposed.� Place the

bulb on a small baking dish, and rub 1 tsp of olive oil over

the skin.� Put the garlic in the oven, and bake for 20‑30

minutes, or until the garlic bulb is soft to the touch.

Remove the garlic and allow it to cool.

�� Once cool, break open the garlic bulb, and squeeze the

garlic pulp from the skin.� Discard any skin or peel.� Puree

the roasted garlic in a food processor, until it is a paste.

�� Season the chicken tenders with salt and pepper.� Place

the flour in a separate shallow bowl, then dredge the

chicken through the flour until it is coated.� Heat 1 Tbsp

of olive oil in a pan, over medium‑high heat.� Add the

chicken to the pan, and cook until all sides are golden

brown, and the chicken is thoroughly cooked, about 8�� 10

minutes.� Remove the chicken from the pan, and set it aside.

�� Add 1/2 Tbsp of olive oil to the pan, and add the onions.

Cook until tender, about 5 minutes.� Add the mushrooms, and

cook for an additional 3 to 5 minutes, or until the mushrooms

are tender.� Add the chicken tenders and roasted garlic

puree to the pan.� Stir the contents together.� Serve

immediately, and garnish with chopped green onions.

�� Makes 4 (1 cup approx.) servings.� Per serving:� 268

calories; 99 calories from fat; 11gm total fat; 2gm

saturated fat; 63mg cholesterol; 26gm protein.� Exchanges:

3 very lean meat, 1‑12 vegetable, 2 fat.

�� Grilled Marinated Pork Tenderloin

Ingredients

1/4� cup balsamic vinegar

2� Tbsp olive oil

1� Tbsp garlic, chopped

1� Tbsp fresh rosemary, minced

1� Tbsp oregano, minced

2� pork tenderloins, about 1‑1/4 lbs total

Instructions

�� In a medium bowl, combine the balsamic vinegar and the

garlic.� Add the olive oil slowly, while whisking to fully

combine.� Add the rosemary and oregano, and whisk for

another minute.� Place the pork tenderloins in a shallow

dish, and pour the marinade over them.� Refrigerate,

covered, overnight.� Turn the tenderloins periodically, to

allow marinade to soak in.

�� Preheat a grill or broiler to medium heat.� Place the

tenderloins on the grill, and discard the marinade.� Turn

the tenderloins periodically to cook fully.� Cook for 20�

25 minutes, or until the tenderloins reach an internal

temperature of 155� F.� Allow the meat to rest for 3�� 5

minutes before serving.

�

�� Makes four (4‑oz) servings.� Per serving:� 252

calories; 120 calories from fat; 13gm total fat; 3gm

saturated fat;� 84mg cholesterol; 61mg sodium; 1gm

carbohydrate; 30gm protein.� Exchanges:� 4 very lean meat, 2

fat.

�� Easy Blueberry Muffins

Ingredients

2/3� cup sugar

1/2� cup salt

2‑1/2 cups all‑purpose flour

1� Tbsp baking powder

1� large egg

1/4� cup reduced‑fat (2%) milk

1� tsp vanilla extract

1� cup fresh or frozen blueberries

Instructions

�� Preheat the oven to 400 F.� Combine sugar, salt, flour

and baking powder.� In a separate bowl, combine the liquid

ingredients.� Make a well in the center of the dry

ingredients, and add the liquid ingredients and the

blueberries.� Mix with a fork until it forms a loose batter.

�

�� Lightly coat a muffin pan with nonstick cooking spray.

Spoon the batter into the pan, until the cups are 3/4

filled.� Bake for 18�� 20 minutes, or until the tops are

golden brown and the centers are firm.

�

�� Makes 12 servings.� (Serving size:� one muffin):� Per

serving:� 227 calories; 65 calories from fat; 7gm total fat;

1gm saturated fat; 19mg cholesterol; 193mg sodium; 37gm

carbohydrate; 4gm protein.� Exchanges:� 2 starch, 1/2 fruit,

1‑1/2 fat.

��

�� NEW TALKING MEDICINE IDENTIFIER UPDATE

�� by Ed Bryant

��

�� Last July, in VOICE, Vol. 15, No 3, I discussed the

pending availability of the new ALOUD Model 100 Audio

Labelling System.� From ASKO Corporation, this new product

can best be described as a "talking prescription container,"

something that should interest any blind person, or anyone

with significant sight loss, who needs to� take prescription

medications.� Here is how it works:

�� When a pharmacist dispenses your medication, an audio

version of the printed prescription label� (called an "Audio

Label") is also produced, and attached to the medication

container.� When the Audio Label is placed into your ALOUD

Replay unit, the Audio Label information recorded by your

pharmacist is replayed.� As this is a recording, not voice

synthesis, any language your pharmacist speaks can be

recorded!

�� Each medication will have its own Audio Label, and can

be played over and over, as many times as you like.� Any

medication dispensed from a rigid container can utilize the

system, and the only person who can change the message is

your pharmacist, who has a special recorder in the pharmacy.

The Audio Label is reusable, so when you need to have your

prescription refilled or changed, the message can be changed

also and attached to your new prescription.

�� For years I have been searching for alternatives to

sighted identification of insulin vials.� There have been a

number of partial solutions, but the ALOUD System appears

functional with any insulin from any manufacturer, and any

language.� ASKO has been most willing to work with the

National Federation of the Blind, and with our NFB Diabetes

Action Network, in this matter ‑‑ and, as no approval from

the Food and Drug Administration is necessary, action should

come soon.� The ALOUD System may well be in your pharmacy

before January 2001 ‑‑ and I will update you in the next

VOICE issue, Vol. 16, No. 1.

�

�� Further information about the ALOUD system can be

obtained from:� ASKO Corporation, 2 South Street, Stamford,

NY 12167; telephone, toll‑free: 1‑877‑732‑9227; website:

www.askocorp.com�

��

�� NINE YEARS AS A VISUALLY‑IMPAIRED PUMPER

��

�� by Anne Whittington, MBA, MSN, RN, CDE

�Board Member, American Association of Diabetes Educators

��

�� Initially I was on the MiniMed 504 insulin pump.� I

found its buttons cumbersome (for my rheumatoid arthritis)

and the contrast poor on the pump's display screen.� In

1993, I switched to the Disetronic pump.� Its audible

alarms, and the crisp contrast on its screen met my needs

well.

�� Beginning in 1997, I was anxiously awaiting the release

of MiniMed's new 507c pump.� Their discussion about

interfacing with a home blood glucose monitor was very

appealing.� But in 1998, when I decided the time had come to

replace my five year old (but fully functional) Disetronic

pumps, I examined, through customer service representatives,

the new 507c.

�� I found the background color on the 507c's display

screen was greenish‑blue (not the customary gray of most

LCDs).� Even though my visual acuity is fair, my contrast

vision is extremely poor.� In order for me to read the

numbers, I needed the room to be completely darkened.� Given

that most of the time, I am wanting to read my pump in a

well‑lit room (since I function very poorly in the dark), I

opted for the Disetronic pump.

�� The take‑home message is, before making your selection

of the best pump for you, consult your diabetes team

members.� These� team members go beyond your doctor, and

include nurse, dietitian, blind rehab specialist, diabetes

educator, and whoever else may be assisting you in learning

about the pump and its day to day operation.� Also, please

speak with customer service representatives from the major

companies before you select a pump.� Explain your needs as a

blind person.� Both Disetronic and MiniMed have very helpful

service personnel.

��

BOOK REVIEWS

��

by Marilyn Helton

The Magic of the Season

�� The frost is almost on the pumpkin and our grapes are

sweet and lush this year!�� Autumn is my favorite season and

I think it is because I have always loved the start of� the

new school year and the anticipation of reading new books.

��

�� Appetites dwell on things long remembered.� I am

intoxicated with the magic of the season and the memories of

the heart.� Now it's time to move inside, a little closer to

the fire, and enjoy the comfort of some wonderful autumn

reading.

�� The "best of the best" of my autumn reviews must be

reserved for DIABETES BURNOUT:� WHAT TO DO WHEN YOU CAN'T

TAKE IT ANYMORE, by William H. Polonsky, PhD, CDE.

�� If you're depressed about having to deal with diabetes

day in and day out, worried about complications, getting

angry about the never‑ending chores of self‑care, or

frustrated by poor� results, when it feels like you've

worked so hard, then you MUST read this book.

��

�� Other than being a diabetic, I cannot imagine a better

combination of credentials for a knowledgeable author on the

topic of diabetes than a degree in psychology plus

experience as a Certified Diabetes Educator.� William

Polonsky has both, along with� brilliant insight and

perception that makes you swear he can read the "diabetic's

mind."

�� I was so impressed with this book, which speaks to me

in my own language of experience, that I read and re‑read

certain sections more than once.� Dr. Polonsky addresses

such issues as how to overcome a hate for blood sugar

monitoring; the uses and mis‑uses of fear‑of‑complications;

the tough combination of depression and diabetes; the

"diabetes police" (friends and family); and how stress

influences diabetes, and what you can do about it.

�� This book shows the rollercoaster of emotions a

diabetic has to live with, and how easy it is to get

discouraged, frustrated, depressed and just plain burned

out.� More than once I found myself saying, "I never thought

of looking at it THAT way,"� in response to Dr. Polonsky's

solutions for overcoming barriers.

�

�� Give this book as a gift to yourself� and to others ‑‑

It's wonderful! DIABETES BURNOUT: WHAT TO DO WHEN YOU CAN'T

TAKE IT ANYMORE, by William H. Polonsky, PhD, CDE (1999),

$18.95, American Diabetes Association.

�

�� Managing diabetes is more than insulin regimens, diet,

exercise and preventing or treating complications of the

disease.� In her book, WHEN DIABETES HITS HOME:� THE WHOLE

FAMILY'S GUIDE TO EMOTIONAL HEALTH,� Wendy Rapaport, LCSW,

PsyD, addresses the importance of coping with the range of

emotions you and your� family will encounter when someone in

your home has diabetes.

�� Packed with case studies, Rapaport offers examples of

how people with diabetes can successfully cope with the

emotional challenges of the disease.� I'm always drawn to

good books which explore the development of your spiritual

self in discovering the meaning of living with disease; not

only is the process enlightening, it's almost essential for

success in coping with chronic disease.

�

�� Consider this little‑known statistic: According to

author Rapaport, "People who worship regularly are nearly

twice as likely to quit smoking and one‑third more likely to

start an exercise program."� She further states:

"Spirituality can help you make more sense of your life and

health.� It can help you to find meaning in your life which

will lead to better emotional and physical health.� When

you're curious about spiritual matters, you are more likely

to follow your diabetes care plan, too."

�� Providing practical examples of how other people with

diabetes have successfully coped with the emotional stages

they experience throughout their lives,� Wendy Rapaport

addresses the importance of living a healthy lifestyle while

exploring the entire spectrum of emotional issues which

present a struggle to many diabetics.� WHEN DIABETES HITS

HOME, by Wendy S. Rapaport (1998), published by The American

Diabetes Association, $19.95.

�� THE FAMILY AND FRIENDS' GUIDE TO DIABETES, by Eve

Gehling, is written for those of us who want to learn how to

best help someone we know or live with cope with diabetes.

From my own personal experience with diabetes, it's been a

continual curve of learning all I can about the disease,� so

I can teach my family and friends what they need to know to

better understand how to live with me while I live with

diabetes.

�� According to Gehling, in order� to learn how to best

help someone with diabetes, a person first has to learn what

diabetes is and how it's treated. This involves learning how

to help your loved one manage low blood glucose and get

through periods of illness, how to prepare healthy meals and

plan special events, and how to create positive work and

home environments for both� the person with diabetes and the

family.

�� Equally important is knowing how the emotional aspects

of chronic disease management can affect the caregiver,

i.e., how to cope better with the day‑to‑day challenges of

living and working with someone who has diabetes.

�� Written in an easy‑to‑understand question and answer

format, Eve Gehling has successfully drawn upon her own

personal experience with family members having type 1, type

2 and gestational diabetes, as well as her professional

expertise as a Registered Dietitian and Certified Diabetes

Educator, to design THE FAMILY AND FRIENDS' GUIDE TO

DIABETES.

�

�� I admire the simplified format of this book, the easy

to understand frequently asked questions and answers, useful

resources (including some sample menu plans), and intuitive

approach to surviving life living with someone with a

chronic disease.� THE FAMILY AND FRIENDS' GUIDE TO DIABETES

by Eve Gehling, M.ed., RD, CDE (2000), John Wiley & Sons,

$14.95.

�� That's all for this go‑around, folks!� The next time we

meet, we will have successfully and peacefully completed our

first year of the new millennium. Until then, I wish you all

the warmth, love and joy of a beautiful holiday season!

�� Marilyn Helton, type 2 diabetic since 1993, is the

publisher of CINNAMON HEARTS~THE ART OF LIVING A WINNING

DIABETIC LIFESTYLE, a positive‑power online e‑zine for

diabetics and their families.� You can find more of

Marilyn's book reviews, articles and recipes online at:

http://diabeticgourmet.com, www.fabulousfoods.com,

www.practicalkitchen.com, or Cinnamon Hearts website:�

http://members.xoom.con/cinnhearts/

��

�� ADAPTIVE INSULIN PUMP TECHNIQUES

��

�� by Tom Tobin

��

�� I use the MiniMed 507 insulin pump, and I make use of

its audible bolusing feature, which provides audible

feedback when programming a bolus.� It can be set for either

half‑unit or full‑ unit increments.

�� With respect to filling the pump's syringe, I have

developed a system that works well for a blind person,

without any sighted assistance.

�� First, when filling the syringe, I pull down on the

plunger until the bottom of the syringe barrel and the

plunger are about the distance from the tip of my index

finger to my first knuckle; as a measuring device, you

always have your knuckle.

�� Then, just as with a regular syringe, I tap the sides

of the syringe barrel, and then push the insulin back into

the vial.� I repeat this step until I cannot hear any

"bubbles" escaping when pushing the insulin back into the

vial; there should be a "smooth" sound.

�� Since air may trap at the top of the syringe itself,

next I pull a little air into the syringe and push up on the

plunger ever so slightly, until insulin comes out the tip of

the needle; just a little push.� That completes filling the

syringe.

�� Next, while holding the syringe in my left hand, I take

the infusion tubing and remove the cover at the end of the

tubing that goes over the neck of the syringe, where the

needle once was.� Make sure that there is a snug fit as you

tighten down the collar of the infusion set over the neck of

the syringe. (I sometimes use my teeth to make sure it is

really tight.)

�� Then I put the plunger of the syringe on a flat

surface, usually a table top, and begin pushing down on the

barrel of the syringe, thus filling the infusion set.� I

want to stress that this should be done very slowly, to

avoid any air pockets in the tubing.� If it is done right,

there should be no air bubbles at all in the tubing.

Letting a drop of the insulin fall on the back of your hand

is fine, although I put the needle guard at the other end of

the infusion set between my teeth and use my tongue to feel

when the drop falls.� Whatever works for you.

�� I am using MiniMed's softset infusion set, which has an

introducer needle that you remove after the cannula is

properly inserted.� If using regular bent needle infusion

sets, you� merely need to develop a system of inserting the

needle.� However, with these softsets, I strongly recommend

using the "soft‑serter" device which is a similar in concept

to a lancing device, with a spring loaded mechanism, which

will properly insert the softset.� Basically, after you fill

the syringe, attach the infusion set and prime it; then you

put the syringe into the pump and prime the pump so the

"arms" on the pump (which push up on the syringe plunger)

are set properly.

�� Then load the soft‑serter, by placing in it the end of

the infusion set with the introducer needle, and "cock" the

soft‑serter.� Remember, keep the tubing of the infusion set

pointing "out" (toward your hip rather than your

belly‑button), as this makes dealing with the tubing easier.

�� Make sure before you insert the infusion set, that the

"feet" of the soft‑serter are flat against your stomach.

This will give you a "clean" entry for the introducer

needle.

�� Note: Before I inject the introducer needle, I have my

tape all ready to go, usually held between my teeth.� Once

you "pull" the trigger of the soft‑serter, you will want to

make sure you keep downward pressure on the needle as you

guide the tape over the introducer needle and tape it down

around the "wings" of the infusion set.� It can be somewhat

tricky to remove the soft‑serter from the top of the

introducer needle, but with practice you should be able to

do it.� Remember, don't pull up on the soft‑serter when

taking it off the introducer needle!� Also, keeping downward

pressure on the introducer needle is very crucial, so the

cannula cannot "creep" up and possibly become dislodged, as

this would result in no insulin delivery.� It will take some

practice; but over time, you should be able to learn the

acrobatics of holding the needle down while putting the tape

on.� Be patient with yourself ‑‑ it does take a lot of time

and practice to get it right.� Once the tape is properly in

place, then you can remove the introducer needle, and you

should be OK.

�� I just taught a Cleveland Sight Center client this

technique and, three months later, she is now doing all of

it on her own, with tremendous success and better overall

control.

��

WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK

��

�� (Resource Column)

��

Artwork:� Hand pulling a book from a shelf of books

�� Inclusion of materials in this publication is for

information only and does not imply endorsement by the

Diabetes Action Network of the NFB.

�� Diabetes Supplies

�� Diabetic Supply Distributors, Inc., helps you save four

ways with your diabetes supplies:

�� 1.� Insurance billing.� They file the claim, and they

pay for delivery.� No advance payment needed ‑‑ and THEY do

the paperwork.

�� 2.� Medicare billing.� Medicare pays for approved

diabetes supplies (and, since last July, that list has

covered type 2 diabetics!).� Diabetic Supply will handle the

details.

�� 3.� Free, fast home delivery.� Your order comes quickly

to your door.

�

�� 4.� Friendly personal service.� You're not talking to a

computer.

�� Contact:� Diabetic Supply Distributors, Inc., PO Box

1820, Laurel Springs, NJ 08021; telephone: 1‑800‑962‑8098.

�� Life Insurance For Diabetics

��

�� If you have diabetes, you know it can be very difficult

to find life insurance.� Empire Financial, based near

Baltimore, Maryland, specializes in insuring people with

"high‑risk" conditions, especially diabetes and its

complications.� "We are specialists in high risk," says

Gardner Redd, their CEO.� "For 18 years we have covered all

ages, 0 to 90, and all impairments, even people who have

transplants."

�� Contact: Empire Financial Insurance, 600 Reierstown

Road, Pikesville, MD 21208; telephone: 1‑877‑263‑8603.��

�� 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.

�� Needle‑Free Insulin Injection

�� There is a way to inject insulin without a needle!� The

Vitajet 3 administers a fine jet of insulin through the skin

without need for a needle.� It works, and users report less

discomfort.� Try it yourself; 30‑day money back guarantee.

Contact:� Bioject, Inc., 7620 SW Bridgeport Road, Portland,

OR 97202; telephone: 1‑800‑848‑2538; website:

http://www.vitajet.com

�� New Software

�� Arkenstone OPENBook 5.0 is scanning and reading

software for blind and visually impaired people.� It now

includes e‑mail features, and improved description and

navigation features.� For low‑vision users, there are new

functions to customize size, color, font and spacing.� For

information, contact:� Freedom Scientific; telephone: 1‑800‑

444‑4443; website:� www.freedomscientific.com

�� Delivered To Your Door

�� Homed Pharmacy Services will deliver your diabetic

supplies to your door.� If you have Medicare, and/or private

insurance, your supplies may come at no cost to you.� Homed

handles all insurance claims, and delivery is free.� For

more information, call Homed Pharmacy Services; telephone:

1‑800‑226‑7212; fax: 1‑800‑381‑9929.

�� Diabetic Skin Care

�� Diabetes frequently leads to dry, cracked feet.� Since

untreated, this dryness can lead to dangerous wounds and

infections, prevention is the best cure.� Neoteric Diabetic

Skin Care encourages healthy skin, and helps heal the small

lesions that might otherwise progress.� Available in lotion

or cream, suggested price $12.29 each.� To find a retailer

near you, or to order on line, contact:� Neoteric Cosmetics,

Inc., 4880 Havana Street, Denver, CO 80239; telephone: 1‑

800‑343‑9555; fax: (303) 576‑6151; website:

http://www.neotericdiabetic.com

�� Sugar‑Free Candies

�� In our experience, most food defined by what it is not

(like "fat free," or "sugar‑free") tastes the part.� It

never lets you forget what you're missing.� Liberty

Orchards' candies are a very pleasant exception.� Based on

the ancient recipe for Rahat Locum (Loukoumi, or Turkish

Delight), these candies lack nothing but a bit of sugar.

It's hard to describe them, full of fruit and nuts, but you

can get a free sample ($1 shipping charge), and a free

catalog, by contacting them:� Liberty Orchards, PO Box 179,

Cashmere, WA 98815‑0179; telephone: 1‑800‑888‑5696; website:

http://www.libertyorchards.com�

�� Treat Male Impotence

�� For men who've had diabetes many years, one possible

ramification is impotence, the inability to sustain an

erection.� This can be treated in a number of ways, but the

least invasive is vacuum therapy.

�

�� The Vet‑Co Vacuum Therapy System for male impotence is

FDA‑Approved, safe, non‑invasive, and easy to use.� For

information, call:� Coast To Coast Home Medical; telephone:

1‑800‑330‑6316.

�� The Type 'n Speak

�� The Type 'n Speak 2000 is a small, portable, adaptive

computer/notetaker for the blind, that provides speech

access (in a number of languages), Braille translation

compatibility,� and industry‑standard connection ports to

your other equipment.� The unit does all this with a

standard "typewriter" keyboard, and its rechargeable battery

gives you 25 hours between charges.� Prices start at $1395.

For information, telephone: 1‑800‑444‑4443; website:

http://www.freedomscientific.com

�� JAWS for Windows

�� There is a new version of JAWS For Windows.� Henter‑

Joyce's Job Access With Speech has advanced to Version 3.7,

to support new software such as Quicken 2000, Visual Basic

6.0, Microsoft Project 2000, Cakewalk Pro Audio 9.0, and

more.� For information, contact:� Freedom Scientific,

telephone:� 1‑800‑444‑4443; website:

www.freedomscientific.com

�� 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.� The articles

listed below make up one part of the collection, the

"diabetes" category:� "Insulin Measurement Devices,"

"Diabetic Peripheral Neuropathy,"� "Diabetics, Don't Give Up

on Braille," "How I Went Blind ... And Then What," "Review

of Oral Diabetes Medications," "Preventing, Minimizing, or

Delaying Kidney Failure," "Impotence, and How to Prevail,"

"Can I Eat Sugar?," "Cardiovascular Health:� Bypass May Be

Better for Diabetics," "Arthritis and Diabetes:� A Common

Association," "Blind Diabetics Can Draw Insulin Without

Difficulty," "New Dietary Guidelines for Diabetes

Management," "Keeping Your Feet," "What Is Diabetes

Mellitus?," "Talking Blood Glucose Monitoring Systems,"

"Diabetic Eye Disease,"� and "Kidney Failure, Dialysis, and

Transplantation."

�� These articles are available in large print and four‑

track 15/16 IPS audiocassette for the blind (all the

diabetes articles are on one tape).� All 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.� The

Materials Center is open 12:30 pm to 5 pm, EST, weekdays.

�� New Oral Diabetes Medication

��

�� If you have type 2 diabetes, and need oral medications

to keep your blood sugars down in the safe "normal" range,

you should ask your doctor about ACTOS.� This new medication

directly attacks the problem of insulin resistance, the

increasing inability to process insulin, that is the chief

component of type 2 diabetes.� Its use has enabled many

diabetics to reduce volume and frequency of insulin

injections.� ACTOS can be taken alone, or in conjunction

with other oral diabetes medications.

�� At this time, there is no evidence that ACTOS

(pioglitazone hydrochloride) causes the same permanent liver

damage, but doctors have been advised to follow the same

liver monitoring routines as for Rezulin, in case a similar

pattern of damage appears.

�� To learn more about ACTOS, please telephone (toll‑

free): 1‑888‑290‑3299; or visit the ACTOS website:

www.actos.com

�� Banquet Address

��

�� This year, at our National Federation of the Blind

annual convention in Atlanta, Georgia, NFB president Dr.

Marc Maurer gave the banquet address, titled "The

Personality of Freedom."� This address is available, free of

charge, in large print and audiocassette.� This speech, and

others by President Maurer and Dr. Jernigan (and much

more!), are available from the National Federation of the

Blind Materials Center, 1800 Johnson Street, Baltimore, MD

21230; telephone: (410) 659‑9314, open 8 to 5 pm. EST,

weekdays.�

�� Insta‑Glucose

�� If you have type 1 diabetes, you know low blood glucose

can be a sneaky enemy.� Diabetes medications are powerful

but imprecise; and, if you misdose, if you miss a meal, if

you are ill, or if you have unexpected, unscheduled

exercise, you can find yourself going down.� You need sugar,

fast!� You need to be carrying it with you, before trouble

hits.

�� Many people carry sugar candy, or diabetic glucose

tablets, but one practical alternative is Insta‑Glucose, by

ICN Pharmaceuticals.� Insta‑Glucose is stronger (one tube,

one treatment, equals 24 grams of glucose), and it works

faster than glucose tablets.� It is easy to use, and very

easy to carry.� Be prepared!� It is available at many

pharmacies and discount chains.� For information, contact:

ICN Pharmaceuticals, ICN Plaza, 3300 Hyland Ave., Costa

Mesa, CA 92626; telephone: 1‑800‑711‑9486; website:

http://www.instaglucose.com

�� Diabetes Supplies

�� Can‑Am Corporation carries a full line of discount‑

priced diabetes supplies, including: Dex‑4 glucose tablets,

skin cream, and Excel test strips for the Glucometer Elite

monitor. The company also markets the Monoject line of

insulin syringes and lancets.� Many Can‑Am products are also

sold as "house brand" at major pharmacy chains.� Their low

price in no way compromises their high quality.

�� For information, contact:� Can‑Am Care Corporation,

Cimetra Industrial Park, Box 98, Chazy, NY 12921‑0098;

telephone:� 1‑800‑461‑7448.�

�� Male Impotence Products

�� As many as 50% of diabetic men may experience

impotence, the inability to sustain an erection.� This can

be treated in a number of ways, but the least invasive, and

least expensive, is vacuum therapy.�

�� Post‑T‑Vac products for male impotence are safe, non‑

invasive, and easy to use.� They can be combined with other

impotence therapies.� For information, contact:� Post‑T‑Vac,

Box 1436, Dodge City, KS 67801; telephone:� 1‑800‑279‑7434;

fax:� 316‑227‑8474.

�� 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.

�� Reading Machine

�� There are many ways to cope with the problems loss of

vision brings to reading.� There are optical reading

machines, where you scan a printed page into computer

memory, from where it is then read by a synthesized voice.

Now there is another alternative: the L&H MagniReader.

�� This device combines CCTV magnification with an optical

reader.� The MagniReader magnifies text or graphics up to

36x on screen, and reads it aloud, in a clear voice.� You

can use either or both modes.�

�

�� To find out more about this reading machine, contact:

Lernout and Hauspie Speech Products USA, Inc., Kurzweil

Educational Systems Group, 52 Third Avenue, Burlington, MA

01803; telephone: 1‑800‑894‑5374; website:

http://www.lhsl.com/educationad/votd

�� New Talking Blood Glucose Monitor

�� Based on the proven Accu‑Chek Advantage meter, the

Roche Diagnostics Accu‑Chek VoiceMate provides the

following:� Clear, high‑quality speech synthesis, talking

the user through preparations, test procedures, and results

(English‑ or Spanish‑speaking voice now available), without

the need for sighted assistance; an "insulin vial

identifier" which reads Eli Lilly insulin vials and speaks

their type, as a safety aid in tactile insulin mixing; a

new, improved, "touchable" test strip ‑‑ the Accu‑Chek

Comfort Curve (no more "hanging drop of blood" needed!); no

meter cleaning required; and a tactile "code‑key" system for

programming test strip codes.� The VoiceMate is the most

"blind‑friendly" talking glucose monitor available today,

and the only one whose regular operations require no sighted

assistance at all.

�� The VoiceMate comes with an adjustable over‑the‑

shoulder carrying case, with meter, voice box, battery,

adapter cord, 10 Comfort Curve strips, earphone, insulin

check‑vial, manual and quick‑reference guide (in large

print), and instructions on audiocassette.� The new meter

(catalog #2030802�� English, or #3040208�� Spanish) can now

be ordered through any pharmacy (suggested retail price

$495‑525).� To do so, have your pharmacist contact Roche

Diagnostics, 9115 Hague Road, Indianapolis, IN 46250;

telephone: 1‑800‑428‑5074.� For direct purchase, and a price

below $500, contact any of the following retailers:

BeyondSight, Inc., Littleton, CO: 303‑795‑6455 ($498);

Independent Living Aids, Inc., Plainview, NY ($495): 1‑800‑

537‑2118; or the National Federation of the Blind Materials

Center, Baltimore, MD ($475): 410 659‑9314.

�� Adaptive Equipment Convention

�� The Assistive Technology Industry Association, an

organization of adaptive equipment manufacturers,

distributors and related service personnel, is having a

conference and exposition, in Orlando, Florida, January 24

through 27, 2001.� In their words:� "The purpose of this

conference will be to provide a forum for education and

communication to professional practitioners serving those

with disabilities (teachers, occupational therapists,

rehabilitation counselors, physicians, psychologists,

speech‑language pathologists, etc.), with the overarching

goal of providing enhanced benefits and opportunities to

people with disabilities."

�� The organizers expect more than 100 presentations, more

than 100 exhibitors, and many networking opportunities.� For

more information, contact:� ATIA; telephone: 1‑877‑687‑2842;

e‑mail: [email protected]; website:� http//www.atia.org

�� Diabetes Supplies

�� When you need it, you need it.� When it's time to test,

when it's time for medication, you need it already there.

Diabetic Care Center will ship your diabetes supplies to

your door, and they do the paperwork.� No forms, no trips to

the pharmacy.� Medicare and most private insurance accepted.

Call the Diabetic Care Center, telephone: 1‑800‑633‑7167;

website: http://www.diabeticare.com

�� WINDOWS Screen Reader

�� GW Micro now offers WINDOW‑EYES for WINDOWS 98, a

screen reader program that also supports Microsoft WINDOWS

3.1 and WINDOWS 95. Once equipped with a voice synthesizer

such as the Dectalk (your standard soundcard won't do), any

computer that can run WINDOWS can run WINDOW‑EYES.� A free

demo disk is available, or you may download the demo program

from the Internet.� The WINDOW‑EYES program is available

from:� GW Micro, 310 Racquet Street, Fort Wayne, IN 46825;

telephone:� (219) 489‑3671; fax:� (219) 489‑2608, e‑mail:

[email protected]; website:� http://www.gwmicro.com

�� Diabetic Products

�� Health Care Products makes many over‑the‑counter

medications and supplements for diabetics, including

DiabetiSweet sugar substitute and Diabetic Tussin sugar‑free

cough syrup.� Find these products in the diabetic section of

Wal‑Mart, Rite Aid, Walgreens, K‑Mart, and other retailers.

For information, contact:� Health Care Products, 369 Bayview

Avenue, Amityville, NY 11701; telephone: 1‑800‑899‑3116;

website:� http://www.diabeticproducts.com

�� Diabetes Supplies

�� iCARE Medical Supply helps you save time and money.

They serve both Medicare and private insurance patients, and

offer free delivery, free insurance billing, and no up‑front

cost.� Call for� a consultation, or check out their website.

iCARE Medical Supply; telephone: 1‑800‑324‑6271; website:

www.icaremedical.com

�

�� Treat Male Impotence

�� Diabetic impotence is one of the nastier side effects

of diabetes.� Although new oral medications work, for about

2/3 of diabetic men who are experiencing this complication,

many need another alternative.

�� Timm Medical Technologies, successor to Osbon, offers

the ErecAid ESTEEM External Vacuum Therapy System.� It is

safe, drug‑free, easy to use, and has a proven 90% success

rate.

�� For more information on the ErecAid, contact:� Timm

Medical Technologies, Inc.; telephone: 1‑800‑435‑6780;

website:� www.timmmedical.com

��

�� FOOD FOR THOUGHT

��

Artwork:� Dancing fruits and vegetables

��

�� We invite blurbs and tidbit articles for inclusion in

this column.� Materials received may be edited and used as

space permits.� Products and services included in this

column are for information only and do not imply endorsement

by the Diabetes Action Network of the NFB.

�� Drug Substitution Errors

�� The Institute for Safe Medication Practices (ISMP)

reports that prescriptions for the popular diabetes

medication Diabeta (glyburide) have been mistaken for the

beta‑blocker Zebeta (bisoprolol fumerate).� They look and

sound alike, and substitution errors have been reported.

ISMP advises doctors, nurses, and pharmacists to consider

the patient's diagnosis, to determine whether the drug is

indicated, and to use print, not cursive script, to

communicate drug names.� Patients should also be observant.

�� New Type 2 Diabetes Information

�� Those of us who have diabetes, either type 1 or type 2,

are aware of the "post‑prandial spike," the sharp rise in

blood sugars that can occur after a meal.� We chart it, we

detect it with our monitors, and, hopefully, we take action

to bring the sugars back down, with exercise, medications,

and modifications to diet next time.

�� Type 2 diabetes, more than 90% of all diabetes, is

characterized by slow and ambiguous onset.� By the time the

symptoms are obvious and apparent, diabetes may have been

present for years ‑‑ causing damage and increasing the

chance of complications.� The problem is one of early

detection.

�� New studies suggest a post‑meal blood sugar "spike" may

well be a sign of early type 2, even if the FPG (fasting

Plasma Glucose) test is still within the normal range.

Research suggests that such "post‑prandial" diabetes needs

intervention, to reduce the risk and rate of complications,

and that some of the newer oral medications, such as Glyset

and Acarbose, are effective "spike reducers."

�� Remember to discuss your blood glucose test results

with your doctor and diabetes educator.

�� 2000 Raffle Winners

�� At the keynote banquet for the 2000 annual convention

of the National Federation of the Blind, in Atlanta,Georgia,

the winning ticket was drawn in the Diabetes Action

Network raffle.� Winning ticketholder was Aaron Hartman, of

Shelby, South Dakota.

�

�� Lots of people helped sell tickets, and the following

folks each sold 50 or more.� In descending order of tickets

sold:� Karen Mayry, from Rapid City, SD; John Stroot, of

Clinton, IN; Gisela Distel, of Albany, NY; Billie Weaver, of

Springfield, MO; Betty Walker, of Jefferson City, MO;

Bernadette Jacobs, of Baltimore, MD; Sally York, from Castro

Valley, CA; Ed Bryant, of Columbia, MO; Sandie Addy, from

Prescott Valley, AZ; The NFB of South Dakota;� Bill Yates,

of Bakersfield, CA; and Paul Price, of Valley Center, CA.

Truly a winning performance ‑‑ See you next time!

�� More About ACE Inhibitors

�� There are many classes of medications to reduce blood

pressure.� Research has shown that one class, the ACE

inhibitors, is most appropriate for diabetic use, especially

where kidney damage (nephropathy) is present.

�� But all ACE inhibitors are not quite the same.� While

they all show clear cardiac benefits, and all help reduce

fluid pressure in the kidney (making the ACE inhibitors a

good choice for treatment of nephropathy, kidney disease),

They are not equally effective in their primary role, the

treatment of certain cardiac conditions.� Comparison of

findings from two studies, the HOPE ("Heart Outcomes

Prevention Evaluation") and the QUIET ("Quinapril Ischemic

Event Trial") strongly suggest that newer ACE inhibitors,

such as Altace (ramipril) are more effective against cardiac

events.� So, if you need an ACE inhibitor, be sure you are

using the correct one for you ‑‑ they're not all the same.

Talk to your doctor about the ACE inhibitors.

��

�� New Islet Cell Study

�� The "cure" for type 1, insulin‑dependent diabetes, may

well come from islet‑cell transplantation, from replacement

of the diabetic's own defective islet (Beta) cells by new,

healthy, insulin producing islet cells.� The problem has

been to deal with the body's immune response, with the

problem of rejection.� Many strategies have been tried.

What follows is a new one.

�� An Israeli team, led by Dr.� Shimon Efrat, from Tel

Aviv University, is attempting to genetically re‑engineer

islet cells so they will resist autoimmune attack, by

splicing viral proteins into their DNA.� Where other

researchers are exploring shielding islet cells by

surrounding them in porous polymers, Dr.� Efrat's team is

perhaps the first to combine such shields with genetic

manipulation.�

�� The study is still working with animals at this time,

and there is not yet a date for commencing clinical tests on

humans.� The team expects such clinical tests could start in

the next few years.

�� Talking Telephone Caller ID

�� We have been asked to announce:� The CIDney Model 560

Talking Caller ID will "speak" an incoming caller's 10‑digit

phone number (or custom caller category), between the first

and second ring.� If that number is blocked or

unidentifiable, it will announce "number blocked," or "number

unidentifiable."� The unit stores the last 99 incoming phone

numbers, and speaks them back to you on command, along with

date and day of the call.� It has a visual and audible

"message waiting" indicator, and its three‑line LCD displays

name, number, date and time.� The 560 also has a new "dial

back" feature.� Priced at $49.95, contact:� Full Life

Products, PO Box 490, Mirror Lake, NH 03853; telephone: 1‑

800‑400‑1540; website: http://www.superproducts.com

��

�� New Division Board

��

�� At this year's NFB national convention, in Atlanta,

Georgia, we, the Diabetes Action Network of the National

Federation of the Blind, elected our new Board.� All veteran

diabetics, they are:�

President:� Ed Bryant (Columbia, MO)

First Vice President:� Eric Woods (Denver, CO)

Second Vice President:� Sandie Addy (Prescott Valley, AZ)

Treasurer:� Bruce Peters (Akron, OH)

Secretary:� Sally York (Castro Valley, CA)

Board Member‑At‑Large:� Gisela Distel (Albany, NY)

Board Member‑At‑Large:� Paul Price (Valley Center, CA)

�

Board Member‑At‑Large:� Dawnelle Cruze (Portsmouth, VA)

�� Dawnelle, our newest member, is president of the NFB of

Virginia's Diabetes Action Network.� She also works for the

Red Cross.

��

�� VOICE DISTRIBUTORS NEEDED

�� Since the VOICE is now offered free, our Diabetes

Action Network will provide extra copies to anyone wanting

to help spread the word.� We will gladly send from five to

five hundred‑plus copies each quarter to be used as free

literature.� Medical facilities can order as needed for

patients. �Individuals can usually place copies of the VOICE

in libraries, pharmacies, hospitals, doctors' offices, or

other public locations.

�� Diabetes education is essential.� Anyone who

distributes the VOICE will be helping people with diabetes,

and their families, to learn about the disease and its

ramifications; to learn that they have options; and that

their world is far greater than whatever "limits" may be

imposed by the disease.� If you would like to help spread

the word by distributing the publication, please contact:

Voice of the Diabetic, 811 Cherry Street, Suite 309,

Columbia, MO 65201; telephone:� (573) 875‑8911, fax: (573)

875‑8902.� NOTE:� Please provide a phone number so we can

reach you.�