Volume 18, Number 4, Fall Edition 2003

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Voice of the Diabetic, published quarterly, is the national news magazine of the Diabetes Action Network of the National Federation of the Blind. It is read by those interested in all aspects of blindness and diabetes. We show diabetics that they have options regardless of the ramifications they may have had. We have a positive philosophy and know that positive attitudes are contagious!

NEW NON-INVASIVE METER

Includes sketch of new meter prototype.

Every diabetic has dreamed of painless, non-invasive blood sugar testing; blood sugar readings without the need to bleed. Many companies have tried, and the SugarTrac seems to be near FDA approval.

SEVENTY YEARS WITH DIABETES: BILL STACEY REMEMBERS

Includes photo of Bill Stacey

I'm William Stacey, from Athens, New York. Call me Bill. I'm 77-years-old, and I've had diabetes for 70 years. I was born on August 28, 1925. My wife's name is Elizabeth, and my son's name is George. I remember when I was diagnosed, it was March 25, 1933.

My parents figured it out; I was going to the bathroom, and I urinated a lot, so it probably became clearer over time. They took me to the doctor, who diagnosed me with diabetes.

Back then, to test my blood, I used to have to get what they called the Benedict Solution. It had a regular kit that came with it, which had a little test tube in it, and a dropper to put the Benedict Solution in. I think it was five drops of the Benedict Solution, and five drops of urine into the little test tube. Then, I had to have a little burner that burned the alcohol in the test tube. There was nothing to throw away with it.

We used glass syringes. They were "reusable." We had to boil the syringes and everything every time we used them. We also had to keep an extra one, in case we happened to break the syringe. I know some people even re-sharpened the needles, but we didn't sharpen them; my mom just bought new ones.

When I first began, I took shots three times a day -- in the morning at about 8 am, about noon time, and at night, all Regular insulin. When I lived near school, I used to walk home for my meals, I mean, at noon time. I lived about two blocks from school.

Well, there was a girl who lived next door. She was about my age, and every time my mother would call, "it's time to take your insulin," she'd run over, you know, and watch. Later, she moved, about a half a block from me. Every once in while she'd ask me, "do you remember that?" and I would say, "Yeah, I remember that. Every time my mother used to call me in and say 'it's time to take your insulin,' you'd run over."

She called here once, and told me she was having problems. She was diabetic, too. You know some of these people would tell me: "oh, you can eat that," and I'd say, "no, I can't eat that." You must realize that she's dead, now. I mean, you know, if she took care, she might be living today, like I am.

I had insulin reactions every once in while. My mother kept pretty good track of that. I used to carry little cubes of sugar with me. Well, you had to do something. Now it's a lot easier. Now, I carry glucose tablets with me, and if I get to feeling a little funny someplace, I just chew a couple of them. They bring my blood glucose back up in a hurry.

I told my wife, I says, you know, you gotta learn to give me insulin. She says, "I can't do that. I can't watch." I said, "Well, why don't you do like my mother did. She practiced on an orange."

I learned how from my mother. I can't remember that well, really. She just showed me. I guess I must have caught on pretty quick.

But anyhow, my wife asked the doctor for advice. The doctor told her that in the hospital, if the kid didn't like a needle, they'd just throw a towel over the patient's head. The nurse in the hospital would do it. They had to give a needle, you know. I can't give you any details about what I didn't see. The doctor said the nurse would throw a towel or something over their head, but I can't see how they would give the needle.

I had a reaction once with my coach. My wife said, "you really ripped into him." I was stronger than anything. So the next day, I said to him, "George, I want to apologize for what I did last night." He says, "That's all right, just watch it." You know, my wife gets excited about it.

I was pretty much a "brittle diabetic," 10 or 15 years ago. I got afraid to travel without taking my son with me. I was having problems, you know, low blood sugars and everything. I got a good doctor at over at Columbia County. But, I remember going there, and the first thing he says to me, "Now I want you to do what I tell you to do, otherwise, don't come back again." He was pretty stern, you know.

So I went back. He really got me straightened out. He's a lot better than the doctor I see now.

This new doc had me try this different stuff, like this 70/30. I couldn't take it. I wasn't doing at all well with that. That was too much, you know? So now I'm on humulin R, and humulin NPH. So in the morning, I take 14 units of N, and three units of R. At nighttime, I usually take four units of N and three units of R with my main meal.

I test it four or five times a day, and five times a day I take a pill, after the test. I have to keep track of it in a log book. Whenever I go to the doctor, I take that log book with me. He says "Well, you're pretty good. You seem to adjust it yourself everyday." I've had a lot of practice at it.

I've had bad hypoglycemia, bad reactions, where I had to go to the hospital -- but only once or twice. No real diabetic complication problems, though I had a cataract operation.

My doctor gave me a prescription for Glucagon. I have two of them on hand right by the night stand. My wife give me one of them once.

I go to the eye doctor every six months, and he checks my eyes. Every time I go, they say, "you're a diabetic? How long have you been a diabetic?" The last time I was in the hospital they said: "Well, you ought to get a prize for that. I can't believe it," to look at me, you know. Yesterday I got a thing from the Joslin Diabetes Center in Boston. I got a little scroll like thing. So, I made a donation to them, and I wrote on it how long I've been a diabetic, and all that. It's the first I've ever heard of them. I got it yesterday and sent the donation out this morning.

I worked for a while on an ice cream truck. I used to transport ice and everything, too. I never had any trouble there. I would always carry sugar pills with me during those days. I always kept sugar in my pocket. When I worked in a place, I kept some in a jar.

I'd like to tell people that if they've got diabetes, take care of themselves, and they can live to be like anybody else. I worked with this fellow once, he used to ride back and forth to work, and he asked: "I can't understand why you're working? You can work?"

I said, "What do you mean? Just because I'm a diabetic?"

He said, "Yeah."

I said, "Well, that don't mean nothing. You take care of yourself, and you can work like anybody else."

A diabetic is like anybody else, I mean. I worked with this one fellow, in a drugstore once, and I was behind a soda fountain. You know, we had a soda fountain. He was diabetic too. I asked him, when he'd come in and get a big soda, or banana split, "how do you eat that stuff?"

ASK THE DOCTOR

by Wesley W. Wilson, M.D.

Includes art: Medical Caduceus

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

Q: I am a 39-year-old male with type 1 diabetes. What I want to know is where does it come from? I've done some reading, and I know type 2 runs in families, and has to do with being overweight, but I have type 1, and can't find anyone else in my family with it. Where does type 1 diabetes come from? Is there any new information about this?

A: I'll admit that when I read your question, I put it aside and hoped for inspiration. Finally, in that famous medical journal, The WALL STREET JOURNAL, I came across an article written by Sharon Begley, titled "DNA's Double Helix isn't So Golden Now, but Happy 50 Anyway." The article appeared February 28, 2003, and I feel it is an excellent explanation, for the layperson, about the new ways of looking at inheritance and heredity. The article provided a stimulus for me. Here it goes. It is clear that inheritance of type 1 DM as a trait is more complicated than the colors of sweet peas that Gregor Mendel used in his study of inheritance patterns so many years ago. Factors other than Mendelian are involved.

Very active research is underway into the causes and factors that trigger type 1 diabetes. It seems clear type 1 diabetes results from immune destruction of the pancreatic Beta cells by misdirected antibodies. These faulty antibodies are directed against a person's own cells, attacking these host cells as if they were invading viruses or bacteria. Thus they are called "auto antibodies." It seems persons who develop type 1 diabetes have some problem with antibody formation. It appears persons with type 1 are also at increased risk of antibody attack directed against their own thyroid glands. This explains why so many persons with type 1 also have underactive thyroid glands, and must take supplemental thyroid.

One recent study demonstrated some of the inheritance of type 1. The Diabetes Prevention Study, the DPT1, was designed to determine if small doses of insulin, given to persons at very high risk of developing type 1 diabetes, could prevent development of the disease. The study's background was earlier work suggesting some animals (and some humans) could perhaps be prevented from developing diabetes. Candidates for the DPT1 study were close relatives of a known case of type 1 (sibling, children, or grandchildren). These individuals were checked for antibodies against beta cells or insulin, and, if positive, their ability to secrete insulin was measured. If they were antibody-positive, and showed some impairment of insulin secretion, they were considered to be at high risk of developing type 1 diabetes within the year.

They were then either given a low dose of insulin (to "misdirect" any autoimmune attack, not to lower blood sugars) or placebo, and followed carefully.

One of the hypotheses tested in this investigation was that the close relatives of type 1 diabetics would include a higher percentage of "prediabetic" individuals. It turned out such "clumping" was on the order of no more than three or four per hundred family members - far greater than in the general population, but still quite low (far lower than the likelihood of inheriting type 2 diabetes). Type 1 is to some extent hereditary, but still infrequent in most families.

TYPE 2 DIABETES AND CHILDREN

by Peter J. Nebergall, Ph.D.

We are regularly bombarded with the alarming news that type 2 diabetes (also known as "Non-Insulin-Dependent" or "Adult-Onset" diabetes) is on the rise among children. We are regularly warned of its consequences. Getting past the alarm bells, what is happening? What do we really know?

We hear that type 2 is "genetic" (it passes down through families), and that it has something to do with being fat, and with inactivity. We note that some "ethnicities" show higher percentages of type 2 than do others. But we have many questions.

First, if a disease "runs in a family," does that prove it is "genetic?" If you live where your parents and grandparents lived, live as they lived, and eat what they ate, any environmental pathogens they were subject to, you will be subject to as well. This is the influence of environment and lifestyle.

Also, what's an "ethnicity?" We're all "mixes," these days. Especially in the United States, we're all part this, part that and part the other, not genetically "pure" anything -- so there is really no "ethnic inevitability" on one side or the other. The "ethnicities" that show more disease -- are of course the ones that have less access to healthy food and good health care.Second, we know our lifestyle is changing, in many ways for the worse. Our bodies are evolved to labor.

We need to run, to climb, to swim, to wrestle. When we don't; when we sit back, punch buttons, and watch, we grow -- 'round the middle. Ride a horse, push a plow, swing an axe, kick a ball, run a race -- or watch football, and play a computer game?

We know that type 2 diabetes is a result of something called "insulin resistance (IR)," and when this IR is combined with obesity and inactivity, in child or adult, type 2 has a good chance of expressing. BUT -- we still don't know what causes insulin resistance. Once we do, we will have more options for treatment, maybe even for prevention and cure.

Until then, there are two things we can all do. First, we can accept that obesity is both treatable and preventable, and lead by positive example. Children who see their parents, teachers, and adult role models are fit, are active, and eat sensibly -- are likely to do the same themselves, just as children with diabetic parents, whose parents are doing a good job of self-managing the condition, will do a better job themselves, should they develop it later. We follow our role models -- so the role models have a responsibility to lead well.

Above all else, remember, the test for diabetes is cheap and simple, and if there's any doubt, your child should have it, and it mightn't be a bad idea to get tested yourself.

AROUND ALONE: JOHN DENNIS SAILS WITH DIABETES

by Ed Bryant

From the Editor: Very few people have sailed a small boat around the world. Fewer have done it alone. No one with diabetes has ever even tried before.

Long voyages alone offer many challenges -- serious demands on equipment, on stamina, on skill. The solo sailor has to be all things, all the time. About 50 people have done it -- a select, illustrious company.

John Dennis is 57-years-old, from Markham, Ontario, Canada. While not a professional sailor, members of his family were, and he knows the sea well. Unwilling to see his diabetes as a disqualification, he worked hard to be the first diabetic to successfully complete the demanding round-the-world sailboat race called "Around Alone."

I reached him at a stop in Brazil. He'd made it most of the way, and had just experienced an equipment failure. I talked to him about the race, about his life, his future plans, and about his diabetes. Here's our conversation:

EB: I understand your boat broke down on the fourth leg of the race.

JD: No. On the third leg. I was on the way from Cape Town, South Africa, to New Zealand. Basically, ever since I was eight- or nine-years-old, I've had a dream of sailing single-handed around the world. In fact, my original dream was to sail, single-handed, non-stop around the world. And, as I grew up and sailed, I never lost sight of that dream. It has always been my intention that I would sail single-handed around the world. So, when the "Around Alone" race was developed 20 years ago, I thought, well, that would be a fun race to do and fulfil my dream.

It was a real race just getting ready -- because, normally one should have their boat at least 18 months before the race. I didn't get my boat until the middle of June, and the race started in September. Not only did I have to get it ready in time for the race, I had to get it ready in time to sail the trans-Atlantic qualifiers.

August 1st, I had to sail across the Atlantic in order to qualify the boat for the race. So I did that, and started the race, and raced to England. I raced from Newport to New York to England; then from England to Cape Town, South Africa. Then I left Cape Town, but, unfortunately, when I was in Cape Town, I only had five days to prepare for the next leg.

A number of repairs that were done in Cape Town were done poorly. The first thing I found out after leaving Cape Town was that my electronic communications, both my Iridium Pisces, satellite telephone, and my Immersat System were not working properly because, when they were doing some work on it in Cape Town they cut the shielded coaxial cable antenna. Whenever you do that, you have to put a new coax connector on it. What they did was solder it and tape it up, instead of replacing it. Of course it failed within 20 minutes of my leaving port.

I didn't want to turn back to Cape Town, so I went down the coast about 150 miles, to a place called Struisbaai. I anchored there and waited for parts. Unfortunately, the wrong parts came down, and while I was waiting a gale came up. I lost my two anchors plus two more that were provided to me. At that time, I had to have a boat tow me to prevent me from going aground. When that was being done, I had further damage to the boat in that I lost my bow pulpit, my life lines, and my bobstay. I went 190 miles further down the coast, fixed that, and then left again. I ended up about 700 miles out.

Then I lost the engine and the ballast pump system for the boat. At that point, I decided that I have a wife and children, and if I carried without the engine and the ballast system, I would have had no electrical power very quickly. That's too dangerous.

If I had gotten into serious trouble without a ballast system in the Southern Ocean, the boat would have been extremely unsafe. So, I made the decision to go on back and make the repairs. That did not give me enough time to reach the next stop in time to be there within the limits that the race had set. You have to be at the next stop five days before the next start. They waived that rule on the last leg for somebody else, but at that time I wasn't aware they would waive it. I went back to Cape Town.

At the same time, since August 1st, I have crossed the Atlantic now six times. August 1st, I went out and back, then in September, I went across to England -- that's three. Then, when you sail to South Africa, you actually sail back across the Atlantic to the Brazilian coast. And then over to South Africa, because that is the way the wind pattern is. So, that was five times. Then I sailed from Cape Town to Brazil in March, which is my sixth Atlantic crossing since August. And now I'm leaving on the 16th of April, to sail back to Newport, Rhode Island.

I'm out of the race, but I'm still sailing the course, and doing it alone. I'm doing this as an ambassador of diabetes. My whole goal has been to prove that diabetics can compete, if we look after ourselves and take responsibility for our health and our management of our diabetes.

EB: How have your blood sugars been running during the race?

JD: On the leg from England to Cape Town, which is 55 days, 92 percent of my readings were in normal range. It's just a matter of working on it. I call my Dex meter "Wilson," as in the Tom Hanks movie, "Castaway." My Dex meter has worked absolutely perfectly the whole time. It's amazing, because in saltwater environments, lots of electronics fail. I've had failures on the boat, because of saltwater. But that little Dex meter has worked absolutely perfectly, from start to finish so far. I live by it.

EB: You said you take four medications.

JD: I take Gliburide, Metformin, Avandia, and Altace. Basically, I don't have a blood pressure problem, but my doctor feels that, by taking that ACE inhibitor now, it will forestall any kidney damage from my diabetes.

I constantly am monitoring myself. On the first leg of the race I was having problems, because my glucose levels were getting way too low, dangerously low. So I upped the number of times I monitored and I consulted with my physician in Canada and a physician in England, and we decided to cut back one of my four medications. Then, on the leg from England to Cape Town, I was monitoring on average five times a day, and I found my glucose levels starting to creep back up. So, I went back to my normal medication level. Since I've been here in Brazil, I have found my glucose levels to be in the normal range. It's just a matter of constantly monitoring and adjusting my diet and exercise as much as I can get on the boat. At times, I get a tremendous amount.

EB: I believe your boat is 50 feet long.

JD: Yes, my boat is called an "open 50." Open class; it's not an "open boat." That puts me in class 2, boats 40 to 50 feet in length. Class 1 is "open 60," boats up to 60 foot length.

JD: No, not at all. We're spread out, literally, over hundreds of thousands of square miles when we're racing.

Bayer has been absolutely great. I could never have gotten underway without their help and assistance. I guess my next project will be called "unfinished business." Since I didn't make it all the way around, I feel I should go back and finish it.

There's another race in four years, but I don't necessarily have to wait for a race. What I would like to consider doing is going back and leaving Newport and going non-stop from Newport all the way around back to Newport. I figure if I went non-stop, it would take me about 120 days.

I don't know if Bayer will sponsor this second attempt or not, but I certainly intend to try and pursue my dream. I'm not going to give up a life dream because I wasn't successful the first time.

I consider this past trip a real learning experience. Unfortunately, as I say, it took me a long time to work the bugs out of this boat, and in hindsight, had I had the boat several months earlier, I might have been more successful. I don't consider what happened a failure, by any stretch of the imagination. In fact, I consider it a huge success to date. Man is not measured by his victories but he is measured by how he handles his defeats. To me, this is not a defeat, but it is a temporary setback.

If nothing else, I hope I inspire people to take responsibility for their health care; because, if they can live long, productive lives and do what they want to do, they can live their dreams. When they don't, it's so self-destructive.

EB: Do you have any advice you want to leave me with?

JD: I want to thank Bayer for everything they've done to help me. I want to thank all the different diabetics around the world, who have been emailing me telling me how inspired they've been. I just hope people will not look at this as a defeat but a temporary setback, and that they'll wish me luck in the next attempt to get around solo and non-stop.

EB: Would you like us to publish your email?

JD: I get my email at home. It is [email protected]

I've been talking to a lot of people. I've got a young class in New Jersey that I went to visit in January, back in the United States. They're coming up to Newport to see all the boats and to see my arrival. I've got a young, 7-year-old lad from Boston who read about me just before the start of the race, and arranged to come down to see me. He's going to meet me in Newport. There have been some diabetics in England, and I was speaking in Cape Town. And, unfortunately, in South Africa diabetes is the third leading cause of death, right behind HIV and tuberculosis.

I was speaking at a hospital, and I met a gentleman there who was a few years younger than me, and he was having tremendous difficulty getting his diabetes under control. The nurse asked me to speak with him, and we chatted for awhile. Then his two children came by, and they were, I would guess maybe five and seven, and I looked at the children and I looked him in the eye and I said, "Do you want to be at your daughter's wedding?" The tears started to flow in his eyes, and then they started to flow out of my eyes. I hit a soft point with him. It seemed to break through. I said, "Look, your wife has got to attend your sessions with you, with the dietitians and the diabetes specialists. Your wife has to learn how to cook for you, and prepare proper diet for you."

I said, "When I was first diagnosed, it took me almost four years before I got my diabetes even close to being under control. And it took me seven years before I had it under control properly."

I said, "It's not going to happen over night. Don't get discouraged, keep at it, work hard at it." Those kinds of things are the things that make me feel really good when I know I've touched somebody, and I've motivated somebody.

My boat's temporary setback is not life-threatening. It's not the end of the world. But, it's not the end of the dream, either.

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HYPOGLYCEMIA: WHAT IT IS, AND HOW TO TREAT IT

by Ann S. Williams, MSN RN CDE

This column focuses on providing information to help people make their diabetes care fit their needs and their lives.

Hypoglycemia, or low blood glucose (sugar), is one of the most unpleasant, and at times frightening, experiences that diabetes can bring to the people who live with it. Most people who use insulin have had hypoglycemia. Many people who use oral medications have also experienced it. A few people who use no diabetes medications have encountered it.

In general, hypoglycemia is the result of having an imbalance between the factors that lower blood glucose (insulin and exercise) and those that raise it (food and release of stored sugar). Before the late 1990s, most diabetes professionals believed some hypoglycemia was an unavoidable consequence of trying to keep blood glucose close to normal by using insulin or oral diabetes medications. However, we now have medications that allow us to fine-tune diabetes control, and we also have improved techniques for preventing hypoglycemia.

If you are having a problem with frequent hypoglycemia, you should know that with modern medications and tools, most people can either eliminate or greatly reduce this distressing experience. It usually takes some effort to do this. You will probably need to do frequent blood glucose checking, and careful analysis of the results. In consultation with your doctor or diabetes educator, you might need to change your medication, eating habits, or your activity patterns. Since hypoglycemia is very individual, what works for you may not work for someone else. But there are some common causes of hypoglycemia, and general patterns to look for that can give you clues about what you can do to prevent it from occurring.

This article will explain what hypoglycemia is, how to treat it, and (next issue) some ideas about what you can do to prevent it.

feeling shaky, nervous, or anxious.

feeling sweaty, and either hot or cold.

having a fast pulse or a pounding heart.

having tingling in the feet or hands.

These are just like the feelings you would have with intense fear. There is a good reason for this. When your blood sugar drops too low, your body reacts in exactly the same way as when confronted with a frightening emergency. Your body gets ready for action, goes into the "fight or flight" response, and sends a lot of adrenaline all around the body. It is the adrenaline that causes the symptoms mentioned above.

How To Treat Hypoglycemia

It's best if what you eat or drink is made of simple sugars, so your body can absorb it quickly. Some good choices are:

HELP WITH TRICARE BENEFITS: ADVICE FOR VETERANS

by Willie Lowe, Jr.

(This article appeared in MILITARY Magazine, Vol. XIX, No. 8, January 2003 Edition. Reprinted with permission.)

NEUROPATHY AND AMPUTATION

Data presented to the American College of Foot and Ankle Surgeons (ACFAS) link diabetic peripheral neuropathy with heightened risk of lower extremity amputation. Aggressive screening for peripheral neuropathy, the researchers report, can identify patients most at risk, before they present with serious ulcers, non-healing wounds, and the deformity called Charcot foot.

"Severity of numbness is the critical factor," the researchers report. "Use of the simple, noninvasive, monofilament test can detect diminished nerve sensation."

Researchers recommend screening all diabetes patients for peripheral neuropathy, and educating all with neuropathy about their elevated risk for complications, especially Charcot foot. "Thus, practitioners can more readily identify high-risk patients, and intervene to prevent these complications," say researchers.

What is Charcot foot? Occurring in approximately 30 percent of diabetic patients with peripheral neuropathy, Charcot foot can be misdiagnosed as gout, septic arthritis, or osteomyelitis. The foot becomes painful and hot, swollen and red. Bones soften, and become more prone to fractures. Balance can be affected. Many patients become unable to wear shoes.

In advanced stages, Charcot patients lose most sensation in the feet. They cannot feel pain. Muscles fail to support the foot properly, the arches fall, and a reverse arch, a "rocker foot" can develop. Walking worsens the condition, as inflammation from pressure leads to instability, ulcers, and dislocations. The foot can collapse. Surgery can be the best option to rebuild the arch.

Of course, if deep ulcers develop, if infection cannot be conquered, amputation of the foot may become necessary. That such extreme measures might have to be considered is a ringing endorsement for prevention, for regular foot inspections, neuropathy screenings, and prompt intervention before serious foot conditions develop.

For more information, talk to your doctor, or contact ACFAS; telephone: 1-888-843-3338; Web site: www.acfas.org

NEW SELF-ADJUSTING INSULIN PUMP

Medtronic Minimed, maker of the 508 and Paradigm insulin pumps, announces the Paradigm 512 insulin pump, the first to include a wireless link to a blood glucose monitor.

What is it? The Paradigm 512 is a full-featured Minimed insulin pump incorporating a wireless receiver and computer circuitry. When the pump user tests blood glucose with the (included) Paradigmlink blood glucose monitor (built for Minimed by BD, incorporating BD Logic features and technology), the readings are transmitted to the insulin pump, which automatically calculates most appropriate basal and bolus dosages. All the user has to do is read the screen (wouldn't it be nice if it would "speak" the results of its computations?), "accept or modify those readings," push a button, and the pump does the rest.

Although the "self-adjusting insulin pump" has been a dream for years, this is the first linkage between pump and meter to achieve FDA Marketing Approval. It is historic.

What it Isn't

Minimed has an implantable (subcutaneous) insulin pump, the "Minimed 2007," now available in the EU only. Minimed has the CGMS continuous glucose monitoring system, which attaches with a catheter, much like an insulin pump. Neither is used here.

The 512 pump is very conventional, and the Paradigmlink meter, while based on the state-of-the-art BD Logic, is still a fairly conventional finger-stick meter. The two components are linked, but the system's blood glucose data are generated by conventional finger-stick blood tests. This is not yet a "continuous" or "non-invasive" meter-pump combination. We are closer, but not yet to the "artificial pancreas."

Someday soon, from Minimed or one of its competitors, we hope to see a continuous, self-adjusting meter-pump combination. Such a system would both do away with ponderous computations (as does the 512) and with the need to finger-stick. Such a system could legitimately be called an "artificial pancreas," and we're not there yet.

For more information on the Minimed Paradigm 512 pump and Paradigmlink meter, telephone: 1-888-7837; or visit the following Web site: www.minimed.com/paradigmlink

DIABETIC PERIPHERAL NEUROPATHY

What is Neuropathy?

Prevention and Treatment

As diabetic neuropathy follows extended periods of hyperglycemia, its best prevention is good blood glucose management, "tight control," with test results, blood glucose numbers down in the normal range. A healthy lifestyle, with plenty of exercise and careful attention to diet, helps too. Incidentally, the same "tight control" regime can help those with already established neuropathy. Although it is not clear exactly how it happens (there are several theories), experience shows that getting your diabetes under control, and keeping it there, can, over a several-month period, alleviate at least some of neuropathy's symptoms. Doctors argue whether neuropathy damage is reversible -- but it may be, and you owe it to yourself to try.

Individual symptoms are as varied as individuals, but the most common complaint, in the early stages, is pain, and pain control becomes the single biggest challenge in dealing with established neuropathy. Doctors have prescribed aspirin, acetaminophen, and various other nonsteroidal anti-inflammatory drugs, the anticonvulsants Dilantin and carbamazepine (Tegretol), and tricyclic antidepressants such as paroxetine (Paxil) and amytriptaline (Elavil), or a combination of vitamins B1, B6, and Glutamine, with varying results. Along with the drugs, some are prescribing capsaicin cream (Zostrix and its equivalents), a topical ointment originally formulated for arthritis pain. Some use the epilepsy drug gabapentin (Neurontin), while others relieve symptoms with local anesthetics or muscle relaxants. Still others are investigating acupuncture, although not enough is known about it to say for certain how it works in such cases.

New research utilizing lidocaine (a topical analgesic sold in creams, such as Lanacane, for treatment of itching and skin pain) shows promise. A team from Rochester School of Medicine, Rochester, New York, used "transdermal patches" containing lidocaine 5 percent, applied topically to areas of maximum neuropathy pain. In a three-week, open-label test, patients reported a mean 63.1 percent improvement in pain symptoms -- and this without anesthetics, or recourse to powerful "systemic" drugs that could interact with other patient medications. Further study is underway.

Ever since Mesmer, the inventor of hypnotism, there have been various claims for the medical efficacy of magnets, to treat various conditions. No scientific principle or beneficial effect from static magnetic fields has ever been discovered. Foot magnets to treat neuropathy and other conditions are advertised on the Internet and in consumer magazines. There is some "statistical evidence for pain reduction" (though in data cited by the manufacturer, placebo users also showed unusually high improvement, so one wonders). We don't understand why magnets might work in some cases of neuropathy -- but we don't understand the scientific basis of neuropathy pain, either. The most consistent manufacturer of foot magnets is the Japanese firm, Nikken, whose U.S. offices are in Irvine, California; telephone: (949) 789-2000.

"The best way to treat or prevent neuropathy in any area of the body is to control your blood glucose levels. Good glucose control may not reverse numbness or tingling, but it can slow or stop additional nerve damage. Good control also can bring on dramatic pain relief. Medications can be used to control the symptoms of painful neuropathy and gastroparesis (autonomic neuropathy of the digestive system) as well."

The linkage between dry feet and neuropathy is close. They frequently occur together; both are common symptoms of diabetes. To deal with the dryness, you may need a good "diabetic foot cream" -- and note these are thicker than conventional "hand creams." Talk to your doctor or your podiatrist.

Some folks report that exercise brings relief, however temporary. Others use meditation-based relaxation techniques to help them manage. Another approach, followed by many, is to wear high-quality, proper-fitting athletic (or "walking") shoes with good support, or support sandals such as Birkenstocks, along with the socks mentioned above. Your podiatrist can help you choose an appropriate brand and style -- and appropriate footgear is a good idea for everyone with diabetes, whether you have neuropathy or not - listen to your podiatrist, not the salesman at the neighborhood "discount shoe store."

Many individuals whose feet are affected by diabetic neuropathy are also dealing with circulatory/microvascular problems. Their ability to heal from otherwise minor cuts and scrapes is often seriously impaired, leading to a history of ulceration, or even a partial amputation. Special therapeutic shoes, with custom inserts, or "extra-depth shoes," or several other orthotic shoe modifications, are covered by Medicare as "durable medical equipment." Discuss this with your doctor.

New Research

Conclusion

For Further Reading

Published Sources:

Includes photo of Ed Bryant.

DIABETES ACTION NETWORK
NATIONAL FEDERATION OF THE BLIND
COLUMBIA, MO 65203

TO: Dr. Martin Madaus, President
Roche Diagnostics
Indianapolis, IN 46250

Ed Bryant, President
Diabetes Action Network
National Federation of the Blind

July 28, 2003

RE: AccuChek Voicemate System
Letter of June 25, 2003

Kind regards,

by Sal Perlman

Includes two photos: one of the restored Model A truck, and one of its completely restored engine.

From the Editor: This article appeared in the BRAILLE MONITOR, July 2003 edition, published by the National Federation of the Blind.

Restoring a car is tough. Imagine doing it blind. Imagine having to work on your car blindfolded - not just changing the oil or upgrading the exhaust system, but restoring it completely. No peeking allowed.

Naulty's passion for automobiles is even more fascinating considering he has never actually driven one. Following an accident in 1948 near his hometown of Elizabeth, New Jersey, at the age of 14, he was diagnosed with so-called tunnel-vision syndrome.

By the age of 18 he was already legally blind, although he still retained about 25 percent of his field of vision. As a result he could never obtain a driver's license. For nearly 45 years his wife Arlene has been the family driver.

WHAT IS THE NATIONAL FEDERATION OF THE BLIND?

We seek to show the public that we are just normal people who cannot see -- not helpless and dependent, not blessed with special powers and gifts. We help the newly blinded learn that life can still be good. We show blind children that they can have a meaningful future. With proper training and skills, the blind can take a normal part in society - education, a job, a home, a family, normal recreation (camping, bowling, water skiing), and participation in community affairs.

How Can I Help?

You can inform yourself about blindness and help inform others. You can write

for our literature, and you can get to know blind persons in your community. Blindness can happen to you or to one of your friends or to a member of your family. Don't wait for it to happen before doing something about it. You can begin today.

ISLET CELL TRANSPLANTATION UPDATE

THE DIABETIC STUDENT: COPING HINTS

by Maurice Mines

Secondly, you should carry some food with you, in case your blood sugars run low. You should either bring your lunch, or have a campus restaurant chosen ahead of time. In general, you should stay away from fried foods, and choose the sandwich plates, if you must. You should try to avoid a lot of sauces on your sandwich, and get the portion that is right for you. If you use less mayo and salad dressing, it makes the lunch healthier.

LETTERS TO THE EDITOR

Includes art: fancy writing pen.

Scott A. Schinler
Wauconda, IL

* * * * * * * *
April 29, 2003

I am the Director of the Wound Care Center at Abilene Regional Medical Center, and read the Spring Edition 2003 of your magazine. I think it is a great resource for the Diabetic community. We treat a high percent of diabetic ulcers that could have been prevented. We do an extensive amount of education toward diabetes, foot care, and ulcers.

Please let me know how we can help.

Thank you.

Emmamaria Krabill, BA, LPTA, CWS
Abilene Regional Medical Center
Abilene, TX

May 5, 2003

June 9, 2003

Thank you so much for sending me the Voice of the Diabetic. I read it carefully each time I receive an issue. I find it informational, educational, and often inspirational. Please continue sending it.

July 11, 2003

MEAL-PLANNING RESOURCES

by Peter J. Nebergall, Ph.D.

Includes photo of Peter Nebergall.

What other resources are out there? THE DIABETIC EXCHANGE LISTS FOR MEAL PLANNING booklet has just been updated, and the 2003 edition is now available, in print, English or Spanish, from the American Diabetes Association; telephone: 1-800-232-6733; Web site: http://store.diabetes.org If you are blind, you can get THE DIABETIC EXCHANGE LISTS FOR MEAL PLANNING (1995 Edition) for $2 (on 4-track cassette) or $10 (for Braille) from the National Federation of the Blind, Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314; Web site: www.nfb.org.

For a more complete listing of dietary materials available in alternative formats (large print, braille, and "talking book" audiocassette), contact The National Library Service for the Blind and Physically Handicapped, telephone: 1-800-424-8567.

Many Web sites can help you with diabetic food information. The following is a sample - and you'll no doubt find new ones. Be careful, be sure you are dealing with a reputable organization, before you utilize its information (if its authors are RDs, "Registered Dietitians," or RD, CDEs, "Certified Diabetes Educators," you are probably all right) - just please recognize that all advice is not of equal quality; there's a lot of garbage on the Internet.

The U.S. Government offers an enormous, and downloadable, food database, at the USDA Web site: www.nal.usda.gov/fnic/cgi-bin/nut_search.pl

Kraft Foods offers a lot of useful diabetes-diet information on their Web site, at: www.kraftfoods.com/diabetic

A jazzy-looking site (but whose dietary information still appears to be of good quality) is: www.calorieking.com

BOOK REVIEWS

by Marilyn Helton

In checking recent issues of the Book Reviews, I note we haven't pulled any cookbooks off the shelf since last spring. Since October is "National Cookbook Month," I'm delighted to serve you a feast of new cookbooks for your cool weather consumption, along with a couple of books filled with terrific tips for weight-loss success!

Those of you with a diabetic child or family member will love the newly released COOKING UP FUN FOR KIDS WITH DIABETES, by Patti Geil, MS, RD, FADA, CDE, and Tami Ross, RD, LD, CD. This wonderful cookbook for kids and parents alike impressed me so much, I created a recipe feature around it in the August issue of the CINNAMON HEARTS Web site!

This dynamic and enjoyable book is a good read which you can easily consume in a couple of hours. The Appendices feature a Carbohydrate Countdown Catalog, Sample Menus and offer a number of reliable resource, references and Internet links. Published by the American Diabetes Association, this little book is a good choice, especially if you're challenged with shrinking underwear!

If you want more weight-loss motivation, pick up a copy of 101 WEIGHT LOSS TIPS FOR PREVENTING AND CONTROLLING DIABETES. Co-authored by Anne Daly, MS, RD, BC-ADM, CDE, Linda Delahanty, MS, RD, LD, and Judith Wylie-Rosett, EdD, RD, this American Diabetes Association publication will help you lose the weight and keep it off -- once and for all.

Quick weight-loss diets (and I hate the word d-i-e-t!) are only temporary fixes for the national obesity epidemic. If you're tired of tricky diets, you need a simple plan that will support good health for the rest of your life! In 101 WEIGHT LOSS TIPS you'll learn what reasonable weight loss really is, what to eat and when, what sets off your personal weight loss triggers, how to banish binge eating, how to evaluate a weight-loss program, whether weight loss drugs OR surgery are right for you, how emotions figure in the food triangle, what to do when you're not eating and why exercise may be (IS) the magic key to successful weight loss. Losing weight can save you more than money and make you a healthier person inside and out.

Authors Daly, Delahanty and Wylie-Rosett are three experts in the fields of nutrition and diabetes. Their combined experience will help you avoid the risk of developing diabetes and, if you've already been diagnosed, avoid the risk of serious complications by learning how to successfully lose your extra pounds and keep them off.

Enough said about weight-loss tips. The definitive question most folks with diabetes want answered is: What can I have to eat? The answer, of course, is there's no specific "diet" for diabetes because there are just too many individual variables. Your age, health status, amount of exercise you get, dietary restrictions (i.e., low-salt or low-cholesterol), need for a weight loss program, and so on, are elements which factor into your individual eating plan. Each person with diabetes needs a guide or outline, specifically designed for his or her individual needs, and then he can select from almost any food available within the range of choices for his daily meal plan. Once your plan is developed, by a nutritionist, registered dietitian or health care professional, you're ready to select recipes from any number of cookbooks available for healthy eating and/or diabetic concerns. Once you've established your personal plan you can embark on your search for the perfect cookbook to meet your needs.

The recipe suggestions for each meal in Magic Menus sound delicious. Each recipe has a nutritional analysis which includes calories, total fat, total carbohydrates, cholesterol, sodium, protein, dietary fiber and sugars. Diabetic Exchanges are also included, for those who use the Exchange system. The downside to this tasty little book, however, is in the fact that it is so confusing and cumbersome to find those recipe analyses, which are NOT listed by recipe title or even by menu number or page number! They are found at the back of the book, in order of their appearance in the book (from front to back). This is especially discouraging to those of us who cook on the run and don't have time to look for each analysis in random order.

If this book is rendered again, in a third edition, I would strongly suggest that the editors include the nutritional analysis AND exchange information on the same page with each recipe. I don't want to go on a hunting expedition to see if the fat, carbs and proteins of a recipe that catches my eye will fit into my daily meal plan! Magic Menus for People with Diabetes is published by the American Diabetes Association, Inc.

RECIPE CORNER

Includes art: fruits and vegetables.

This issue, all of the recipes are from The Diabetic's Healthy Exchanges.

Cookbook by JoAnna M. Lund, published by Perigee. Reprinted with permission. Contact Healthy Exchanges at telephone: (319) 659-8234; Web site: www.healthyexchanges.com

Chunky Chicken Gumbo

1/2 cup chopped onion

1/4 cup chopped green bell pepper

1 cup sliced celery

1/2 teaspoon dried minced garlic

1-3/4 cups (one 15-ounce can) Hunt's Chunky Tomato Sauce

2 cups (one 16-ounce can) Healthy Request Chicken Broth

1 full cup (6 ounces) diced cooked chicken breast

1 cup of water

2/3 cup (2 ounces) uncooked instant rice

1 cup frozen whole kernel corn

1 cup frozen cut green beans or okra

1/2 teaspoon Tabasco sauce

1 tablespoon Creole seasoning

1/8 teaspoon black pepper

Instructions:

In a large saucepan sprayed with butter-flavored cooking spray, saute onion, green pepper, and celery until tender, about 10 minutes. Add minced garlic, tomato sauce, chicken broth, chicken, and water. Mix well to combine. Stir in rice, corn, beans, Tabasco sauce, Creole seasoning, and black pepper. Lower heat. Simmer 25 to 30 minutes, stirring occasionally.

Each serving equals:

234 Calories, 2 gm Fat, 20 gm Protein, 34 gm Carbohydrate, 323 mg Sodium, 3 gm Fiber.

Tomato Aspic

1-3/4 cups (one 15-ounce can) Hunt's Tomato Sauce

1 cup water

2 (4-serving) packages JELLO sugar-free lemon gelatin

1-3/4 cups (one 15-ounce can) Hunt's Chunky Tomato Sauce

1/4 cup finely chopped green onion

3/4 cup finely chopped celery

Instructions:

HINT: Garnish with fat-free cottage cheese and chives, if desired. If using, count additional exchanges accordingly.

Each serving equals:

Exchanges: 2 Vegetable.

47 Calories, 0 gm Fat, 3 gm Protein, 9 gm Carbohydrate, 713 mg Sodium, 2 gm Fiber.

Country-Style Green Beans

If you want the flavor of southern cooked beans, but not the excess fats and sugar, I think these tasty beans will fill the bill. Serves four (3/4 cup).

Ingredients:

4 cups frozen or fresh cut green beans

1 cup water

1/2 cup chopped onion

2 teaspoons Sugar Twin or Sprinkle Sweet

1/2 cup (3 ounces) finely chopped Dubuque 97% fat-free ham or any extra-lean ham

1/4 teaspoon black pepper

Instructions:

In a large saucepan, combine green beans and water. Add onion, Sugar Twin, ham, and black pepper. Mix well to combine. Bring mixture to a boil. Lower heat. Cover and simmer 45 minutes, stirring occasionally.

Each serving equals:

Exchanges: 2 Vegetable, 1/2 Meat.

73 Calories, 1 gm Fat, 6 gm Protein, 10 gm Carbohydrate, 188 mg Sodium, 1 gm Fiber.

Cheesy Asparagus-Rice Bake

2 cups chopped fresh asparagus

1 cup water

2 cups cooked rice

1-3/4 cups (one 15-ounce can) Hunt's Chunky Tomato Sauce

2 teaspoons chili seasoning mix

3/4 cup (3 ounces) shredded Kraft reduced-fat Cheddar cheese

Instructions:

HINT: 1-1/3 cups uncooked rice usually cook to about 2 cups.

Exchanges: 2 Vegetable, 1 Starch, 1 Meat.

194 Calories, 6 gm Fat, 11 gm Protein, 24 gm Carbohydrate, 772 mg Sodium, 3 gm Fiber.

Rice-Raisin Pudding

1 (four-serving) package JELLO sugar-free vanilla cook & serve pudding mix

2 cups skim milk

1/2 cup raisins

2/3 cup (2 ounces) uncooked instant rice

Instructions:

Each serving equals:

Exchanges: 1 Fruit, 1 Starch, 1/2 Skim Milk.

168 Calories, 0 gm Fat, 6 gm Protein, 36 gm Carbohydrate, 207 mg Sodium, 1 gm Fiber

DOES MINIMED CARE?

From the Editor: I believe you will find the following letter interesting. I can't understand Minimed's reluctance here; marketing is important for any company, especially where there is such a clear need. Perhaps Mr. Hoese needs to hear from more of us?

Diabetes Action Network
National Federation of the Blind
Columbia, MO 65203
[email protected]

August 14, 2003

Mr. Ray Hoese
Marketing Department
Medtronic Minimed
Sylmar, CA 91342
[email protected]

Dear Mr. Hoese:

For several years I have been trying to interest Medtronic Minimed, and you, in blind diabetics as a potential market for your firm's insulin pumps. CDC estimates 12,000 to 24,000 people are blinded each year by diabetes, so we're not a "small market."

We know the insulin pump provides the most natural control of diabetic blood sugars, and that diabetes is the biggest producer of new blindness -- thus there are thousands of blind diabetics who could use your pump -- with a little help. We've talked about making the controls a bit more "user-friendly" for the blind, and, the more modest goal of assembling an instructional tape to help train blind and visually impaired diabetics to use the pump.

On August 30, 2002, I sent you a list of blind pump users who were ready to help you create such a tape. You acknowledged receiving the list. You said you'd contact them. On August 12, two days ago, I called two of these people, and they said they have yet to hear from you.

Mr. Hoese, some have said that Medtronic Minimed doesn't care about serving the blind: "the market isn't large enough." Really? As I mentioned before, there are thousands of blind diabetics.

I feel it is important for our more than 322,000 Voice readers to be informed about this, so I will publish this letter in the next Voice of the Diabetic, and if you'll please contact me I will be happy to publish your reply. Many diabetics and health professionals will be interested in your response.

Dana Diabecare

(The DIABECARE-II)

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

Deltec

(The DELTEC COZMO)

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

Disetronic

(The H-TRON PLUS and the D-TRON PLUS) Import suspended -- expect resumption sometime in 2004

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

Medtronic Minimed

The MINIMED 508, 512 and PARADIGM

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

For the tiny, very basic DAHEDI 25 insulin pump, contact: Logimedix, 1675 North Commerce Parkway, Weston, FL 33326; telephone: 1-800-821-8241; Web site: www.logimedix.com

WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK

(Resource Column)

Includes Art: Hand removing book from shelf.

New Non-Invasive Meter

The SugarTrac noninvasive blood glucose monitor, by LifeTrac, of Fort Myers, Florida, seems close to FDA approval. In FDA Phase III clinicals, the device appeared acceptably accurate, and the prototypes held up well in a hospital environment. LifeTrac expects FDA approval some time late this year, followed by distribution, perhaps in January 2004. See the story "NEW NON-INVASIVE METER" in this issue.

Access Diabetic Supply promises free delivery, no paperwork, and free in-home training in the use of blood glucose testing devices. Your private insurance is welcome, and they accept Medicare, too. They offer free blood glucose monitors to folks who sign up. Check them out online: www.diabeticsupply.com or call: 1-800-713-7062.

Relief

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

Hear Your Computer

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

Diabetes Supplies and More

MPTotalcare offers the huge, comprehensive www.diabetic.com Web site and magazine. There you can access a lot of U.S. Government diabetes information, find links to pertinent organizations, reviews of the latest products and devices, and in "The Diabetes Superstore," you can purchase your supplies. They'll even complete your Medicare and insurance forms for you. Give them a call, toll-free: 1-800-234-9312, or visit them on the web: www.diabetic.com

Easy Diabetic Cookbook

Tapes from the NFB

Diabetes Action Network Articles, a compendium of "most requested" past articles from Voice of the Diabetic (and these articles are regularly updated) is available in large print, or on NLS-format 4-track audiocassette. No charge for single copies, either format.

New Impotence Medication

For five years, there has been Viagra, if you wanted to "take a pill for it." Now the "little blue pill" has some competition. Levitra, a similar medication manufactured by GlaxoSmithKline and Bayer, was approved on Tuesday, August 19, and is expected to hit the shelves in the next few months. It will also hit the airwaves; a sponsorship deal has been signed with the National Football League, and former NFL coach Mike Ditka has been hired as a product spokesman.

Like Viagra, Levitra is a powerful and effective medication -- under certain conditions. Men with certain health conditions should not use this drug -- and the manufacturers recommend a full physical exam before using it. Talk to your doctor about Levitra.

Full Service Diabetes Supplier

Blindness Web site

For a thoughtful discussion of issues pertaining to living with blindness, go to www.whitsacre.info/vip/index.htm. Moderator Robert Leslie Newman has assembled a collection of short stories, links, papers, and a discussion group ("Thought Provoker") into an extremely usable collection. Check out the site, or contact Mr. Newman at: telephone: (402) 556-3216; email: [email protected].

Disetronic Difficulties

Diabetes Mall reported, on July 31, 2003, that the U.S. Food and Drug Administration has halted importation of any new Disetronic insulin pumps into the United States. There is no "design flaw"; rather the FDA's scheme for testing and certification, designed for monitoring an assembly line, is inappropriate for bench-built, master-craftsman-assembled devices such as Disetronic produces. Roche, who bought Disetronic in April 2003, intends to "start a manufacturing plant in the U.S. to address this need." Roche expects this difficulty to be resolved within the next 12 months, and intends to launch a new generation of insulin pumps at that time.

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

Diabetes Information

Diabetic Exchange List

Some proportions have been revised, and new categories, like "sports drinks" and "sports bars/breakfast bars" have been added. Making the publication more useful, carb counts have been included for all foods. Cost is $2.50 per copy; bulk discounts available. Contact: American Diabetes Association; telephone: 1-800-232-6733, or Web site: www.store.diabetes.org

Diabetes Supplies

Fruit-Flavored Drinks

Diabetic Foot Symposium

Stolen Insulin

What is the Glycemic Index?

2003 Raffle Winners

New Diabetes Action Network Board

First Vice President: Eric Woods, Denver, CO

Second Vice President: Sandie Addy, Prescott Valley, AZ

Secretary: Lois Williams, Huntsville, AL

Treasurer: Bruce Peters, Akron, OH

Board Members: Ed Bryant, Columbia, MO, Joyce Kane, Stratford, CT, and Josie Armantrout, Auburn, WA

We congratulate our new board!

Pills, Pills, Pills

NDC Health reports that in 2002, Americans filled 3,340,000,000 outpatient prescriptions -- about 12 prescriptions for every man, woman, and child in the U.S.A. And that doesn't include over-the-counter ("non-prescription") or "alternative." U.S. drug sales reached $219 billion in 2002, up 12 percent from 2001. As 2001 figures were an 18 percent rise, and 2000 figures a 15 percent rise, we're talking HUGE.

Distance Learning

We have been asked to announce: Hadley School for the Blind, located in Winnetka, Illinois, has been educating blind individuals, people of all ages, since 1920. Today, they offer more than 90 courses, like "Independent Living," "Braille Writing," or "You, Your Eyes, and Your Diabetes," free of charge. The Hadley School has a distance education program. Students can take courses, from their own home, and communicate with instructors via email, fax, or Hadley's toll-free number. Each year they serve more than 8000 blind students. Contact: Hadley School for the Blind, 700 Elm Street, Winnetka, IL 60093-0299; telephone: (847) 446-8111; fax: (847) 446-9916; Web site: www.hadley-school.org

Diabetes Screening Guidelines Not Followed

Many people, for many different reasons, are considered "at increased risk for developing type 2 diabetes." Being overweight, having a family member with the condition, and being a member of certain ethnicities are three such risks. These people are supposed to get tested, so there can be intervention before diabetes complications have time to develop -- but too often they are not receiving the needed screenings. Statistics suggest approximately one-third of all diabetes cases in the U.S. remain undetected -- which means too many people are waiting for overt diabetes to develop -- and by that time, complications can be well established. Follow the guidelines -- if you're "at risk," get checked out.

Another New Insulin

Aventis, makers of Lantus insulin, just announced completion of work on Insulin Glulisine, a new rapid-acting insulin analog and competitor for Lilly's Humalog and Novo Nordisk's Novolog. In June of this year, Aventis filed for marketing/regulatory clearance from both the European Medicines Evaluation Agency (EMEA) and the U.S. Food and Drug Administration (FDA). It will be up to these two regulatory agencies to determine how soon we see this new insulin on the shelves. Stay tuned; the Voicewill report when Insulin Glulisine becomes available.

BAKED STUFFED TURKEY

10 to 12 LB. Turkey

1 cup melted butter

1 cup stuffing

1 cup uncooked popcorn

salt/pepper to taste

Preheat oven to 350 degrees. Brush turkey well with melted butter, salt and pepper. Fill cavity with stuffing and popcorn. Place in baking pan with the neck end toward the back of the oven.

Listen for popping sounds. When the turkey blows the oven door open and flies across the room, it is done.

And, you thought I couldn't cook.

New Class Of Diabetes Drugs

The online diabetes journal Diabetes in Control (www.diabetesincontrol.com) reports Roche is developing a new class of oral medications for the treatment of type 2, non-insulin-dependent diabetes. Called glucokinase enzyme activators, these new meds will (a bit like the sulfonylureas) stimulate the body to produce more insulin. There is some hope they might help ward off the progression into full-blown type 2. And note, it appears a deficiency in the glucokinase enzyme, the same one this drug targets, is responsible for the diabetes variant called MODY, "maturity onset diabetes of the young."

The researchers caution the new drugs will only be effective in the presence of endogenous insulin, and will not be a substitute for insulin injections, where such are necessary.

The first member of this new class, called RO-28-1675, has just successfully completed animal tests, and Roche hopes to start testing on human subjects within the year.

The Neuropathy Association

The Neuropathy Association is a national, patient-based, non-profit organization established to help people suffering from peripheral nerve disorders. They provide patient support and information, advocate for patients' interests, and promote research into causes and cure of peripheral neuropathy. Founded in 1995, they have over 60,000 members and 216 self-help groups, and run a doctors' Web site: www.neuropathymd.org

This year, the Neuropathy Association is sponsoring a research conference. It will be held November 6 through 9, at the Denver Marriott Southeast, in Denver, Colorado. The conference is open to association members, medical professionals, members and leaders of support groups, family members, and people interested in learning more about the condition. For information, contact: The Neuropathy Association, Inc., P.O. Box 26226, New York, NY 10087-6226; telephone: (212) 692-0662; fax: (212) 692-0668; email: [email protected]; Web site: www.neuropathy.org

Research Findings

AcaMax(UPI) reports new research from Mayo Clinic, in Rochester, Minnesota, into the role aging plays in a body's loss of insulin sensitivity (read: "increase in insulin resistance"), and thus one's increased risk of developing type 2 diabetes. It appears that although aerobic exercise raises insulin sensitivity/cuts insulin resistance, younger people maintain that increase in sensitivity longer, up to four days after a good workout. Older individuals, to obtain the same degree of benefit, need to exercise on a near-daily basis. If you are over 40, and dealing with type 2 diabetes, frequent exercise is a really good idea.

Kidney Disease Reversible

A recent study published in the New England Journal of Medicine (June 5, 2003; 348: pages 2285 to 93) highlights how a high level of albuminuria (a common measure of kidney disease) "can be a marker of dynamic, rather than fixed, kidney damage." Researchers found that in about 60 percent of cases, healing took place, and the test results improved with time and intervention - shattering the old stereotype that elevated albuminuria means permanent and irreversible damage.

What does this mean? It means, if you catch it early enough, damaged kidneys can heal. Since, without intervention, kidney damage can readily become permanent, early detection and prompt action are ever more critical. People with diabetes need regular microalbuminuria screenings, and aggressive early intervention.

Articles Needed

If you have diabetes, are a family member or friend of a diabetic, or a health professional with an interest in diabetes, we invite you to submit an article for publication in theVoice of the Diabetic.