A Support and Information Network
The Diabetes Action Network of the National Federation of the Blind
Volume 11, No. 4, Fall
Edition 1996
Ed Bryant, Editor
Published in inkprint, in Braille, on
cassette and the World Wide Web (http://www.nfb.org) and FTP (nfb.org) on the Internet
The VOICE OF THE DIABETIC, published quarterly, is the national news magazine of the Diabetes Action Network of the National Federation of the Blind. It is read by those interested in all aspects of blindness and diabetes. We show diabetics that they have options regardless of the ramifications they may have had. We have a positive philosophy and know that positive attitudes are contagious.
News items, change of address notices,
and other magazine correspondence should be sent to:
Ed Bryant 1412 I-70 Drive SW, Suite C,
Columbia, MO 65203
Telephone: (573) 875-8911
Fax: (573) 875-8911
Email: ebryant@trib.net
Copyright 1996 Diabetes Action Network, National Federation of the Blind. ISSN 1041-8490
FREE! FREE!
VOICE OF THE DIABETIC is offered absolutely free to any interested person upon request. Readers may receive the publication in standard print, on audio cassette for the blind, or in both formats. To begin receiving the VOICE, please complete the subscription form (or a facsimile), found at the end, and mail it to the editorial office.
Inside This Issue
We're
Changing Our Name
by Ed Bryant
Diabetic Peripheral Neuropathy
Codependency And Diabetes
by Annette M. Krupper, MLS
Great Expectations
by Peter J. Nebergall, PhD
Dialogs About Diabetic
Dynamos
by Debra Frank, MS, MS
Impotence And How To Prevail
by Ed Bryant
New Program For Blind Diabetics
Tactile Insulin Vials:
Movement Toward Solution
by Ed Bryant
Scholarship Available
For IDDM Diabetics
by Debra Frank, MS, MS
Stepping Out With An Attitude
by David Walker
Ask The Doctor
by Wesley W. Wilson, MD
A Long Road A Winding
by Douglas Campbell
Questions To Ask Your Doctor About Blood Sugar Control
What You Always Wanted
To Know But Didn't Know Where To Ask
(Resource Column)
by Ed Bryant
At our Diabetics Division yearly meeting on July 1, 1996, held at the Annual Convention of the National Federation of the Blind, in Anaheim, California, meeting participants voted to change our organizational name to the Diabetes Action Network of the National Federation of the Blind. NOTHING ELSE HAS CHANGED.
Eleven years ago, members of the National Federation of the Blind, moved by the facts that diabetes was the leading cause of new blindness in the United States, and that all diabetics are at risk of complications, founded the Diabetics Division of the National Federation of the Blind. These founders saw the need for a support and information network for all diabetics, to show people facing ramifications that, regardless of personal circumstances, they are not alone, and do have options.
Our work continues. From its initial circulation of 600, the VOICE has grown to a readership of more than 172,000, in all 50 states and more than 40 foreign countries. We work on a personal level, but also nationally, interacting with equipment manufacturers, drug companies, and the U.S. government, improving the options for blind diabetics, those losing vision, and those who may face such ramifications in the future. Our voice is heard.
Our purpose, our role, is the same as always. It is time, however, for more inclusive language about our membership. Along with diabetics, blind and sighted, their friends and family members, caregivers, health and rehabilitation professionals, distributors and manufacturers of diabetes equipment and supplies, we include a great many people with interest and concern about the condition. We are a lot of different folks with a common focus; we are the Diabetes Action Network of the National Federation of the Blind.
Diabetes Action Network Support Committees
For more than eleven years, our support committees have been reaching out with listening ears and helping hands to diabetics in need in the following committee areas:
Blindness/Visual Dysfunction, Amputation—Prevention and Treatment, Heart Disease and Stroke, Insulin Pump, Pancreas Transplantation, Resources (Aids and Appliances), Renal Failure—Dialysis and Transplantation, and Sexual Dysfunction/Male Impotence. Network members with personal experience in these topics offer advice and inspiration to those needing information about diabetes complications. To learn more about our support committees, contact the VOICE editorial Office.
Diabetic
Peripheral Neuropathy
Art: Ancient Greek doctor examining a big foot
Neuropathy is a general term for physical damage to or impairment of the human nervous system. It has many causes, and many symptoms. Because a long period of time with elevated blood glucose can damage nerve fibers, diabetes is one cause of neuropathy.
The human nervous system is enormously complex. The peripheral nerves carry information to and from the brain, connecting it with the rest of the body. These nerves can be motor, sensory, or autonomic. Motor nerves carry messages from the brain for the contraction of different muscles. Sensory nerves relay to the brain sensations of touch, temperature, position and pain, from the body's periphery. Autonomic nerves carry the brain's commands to organs such as the heart, the stomach, lungs, and liver.
The longer the nerves, the more likely they are to be damaged by long-term high blood glucose. The first part of a nerve to show damage is the part furthest away from the central nervous system (brain and spine). Once such damage occurs, problems appear at the nerve terminals of feet, lower legs, and hands.
Symptoms of peripheral neuropathy can include diminished tactile sensation, numbness, loss of reflex reaction, "pins and needles," and various types and degrees of pain. As neuropathy progresses, the symptoms frequently change. Caution: Diabetics experiencing neuropathy sometimes have other ramifications as well, and these have their own symptoms. Sometimes symptoms overlap, and diagnosis can be confusing. Diabetic nephropathy, kidney failure, can exacerbate neuropathy, due to the uremic toxicity of the condition. Other pain can be a symptom of undiagnosed orthopedic problems. If you are experiencing pain or abnormal sensations in hands, feet, or legs, check with your doctor.
As diabetic neuropathy follows extended periods of hyperglycemia, its best prevention is good blood glucose management, "tight control," with 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, 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.
Individual symptoms are as varied as individuals, but the most common complaint is pain, and pain control becomes the single biggest challenge in dealing with established neuropathy. Doctors have prescribed aspirin, acetaminophen, and various other non-steroidal anti-inflammatory drugs, the anticonvulsants Dilantin and carbamazepine (Tegretol), and tricyclic antidepressants such as 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. Others are investigating acupuncture, although not enough is known about it to say for certain if it works in such a case. Researchers are experimenting with aldose reductase inhibitors such as Sorbinil, but in the U.S., these are still in the laboratory stage.
There is a lot of disagreement over effective treatments for neuropathy pain. Folks swear by their particular remedy. You need to find and use what works for you. Beware of extravagant claims for pill or technique; there are no "miracle cures."
None of the pills and creams is as effective in bringing relief as is getting your blood sugars into good control and keeping them there. It is not known just what mechanism causes neuropathy, or even why some healing can occur, but it is established that the best chance for symptom improvement comes with long-term improvement in diabetes control. Although damaged nerves may heal in time, what has been destroyed will not regenerate. Good control is good medicine!
The main reason we, as human beings, have a pain reflex, is because pain lets us know something is wrong in the affected area. If it hurts, we do something about it. With its biggest symptoms being pain (when nothing is there) and diminished sensation/numbness (when something is present), neuropathy can seriously interfere with a diabetic's self-care, especially care of the feet. Circulatory problems stemming from diabetes can lead to dry skin on the feet, with the risk of ulcers and lesions. Lacking normal pain reflexes, the diabetic with neuropathy may not be aware his or her feet are in trouble. Even stepping on a tack may be pain-free. This means otherwise treatable lesions are allowed to progress into severe infection, sometimes into gangrene itself. Amputation is a common result of this progression of events, and complications of diabetes account for the majority of non-traumatic amputations in the U.S. today. All diabetics need to frequently inspect their feet, but individuals with neuropathy need to be especially thorough.
Although there are lots of variations, with the rule being "do what works for you," there are a number of non-medicinal ways folks cope. One individual, who reported "burning feet" at night, slept with her feet uncovered, and a fan blowing cool air on them. Many others cushion aching feet with thick, seamless hikers' socks, especially those made of cotton, or of new materials such as "Thorlo."
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 shoes with good support, or support sandals such as Birkenstocks, along with the socks mentioned above.
Many individuals whose feet are affected by diabetic neuropathy are also dealing with circulatory problems, and perhaps have a history of ulceration, or even a partial amputation. Special therapeutic shoes, with custom inserts, or "extra-depth shoes," or several other shoe modifications, are covered by Medicare as durable medical equipment. Discuss this with your doctor.
Unexplained pain or abnormal sensation is a serious matter. It may indicate neuropathy, which may be from diabetes, or it may stem from some other condition. It is NOT an inevitable ramification of diabetes, but you shouldn't just "grin and bear it," either. A lot of different therapies and interventions bring relief to many diabetics. Keep the best control you can, keep your doctor informed, and don't lose hope.
by Annette M. Krupper, MLS
Codependency is a condition in which the individual is preoccupied with the needs of others, to the exclusion of the self. Codependency is considered an addiction; loss of self in service, as the alcoholic seeks loss of self in alcohol. Codependency is a learned behavior.
The following example will help explain what I mean: a codependent person is preparing a snack in the kitchen. Another person comes into the kitchen and is also hungry and asks what is there to eat. The codependent person will most likely give up their snack for the other person. They will be polite about it and say that it is no trouble, no matter how much they really needed to eat. By giving up their snack, the codependent person is denying their own hunger in order to satisfy the hunger needs of the other person.
Other characteristics of codependency are: A felt need to control one's environment; isolation of oneself in order to more easily achieve that control; low self-esteem and lack of self-affirmation; and inability to recognize one's own physical (or emotional) needs. It goes with the territory that codependent people have a rough time taking care of themselves.
Now what happens when a codependent person is also diabetic? I propose that following a good diabetic regimen assists such a person in a way of acting that can guide them on the road to recovery from codependency. How? It happens because certain necessary actions, part of diabetes self-management, counteract each of the previously mentioned characteristic of codependency.
The first characteristic, the need to control one's environment, is strongly opposed by the nature of diabetes itself. Diabetes is a disease of the metabolic system, which means all systems of the body are involved. There are many variables that defy absolute control. Daily there are changes in the amount of insulin needed to handle the types and amounts of foods we eat. There also is the variable of the amount of exercise that we have recently gotten or are going to get during the day. Another variable comes if we are feeling ill or under stress, because both of these extrinsic and intrinsic influences raise one's blood glucose readings, altering the amount of insulin needed and what foods we can or cannot eat at the moment.
Since there are so many variables to understand and take into consideration when deciding what to eat when, there is no way we can totally control every piece of the food-eating-insulin equation. As many of you have experienced, you can eat the same foods, take the same amount of insulin or orals and still your glucose test results may differ from the day before. The reason behind this is that we are living organisms, human beings who can be influenced by many things social as well as psychological, and certainly by physical changes.
Diabetes is a disease which we must try to control, although it is not totally in our power to do so. Once we accept that diabetes is a disease we have to cope with rather than try to control, then it is easier to accept. We have diabetes and can only do our best one day at a time. Acceptance of our incapability to have absolute control over diabetes allows us to learn, little by little, to cope with the uncontrollable situation of being diabetic. It also helps the codependent person slowly begin to loosen the reins of control on their environment.
Being that we cannot totally and absolutely control our environment, one of the necessary steps in treating diabetes is asking questions. The first, and primary, source of answers is one's own physician. Publications such as the VOICE are good secondary sources. But sometimes you just want to talk to someone who really understands what you are going through. Having the courage to break out of the silence and isolation, actually talking with a fellow diabetic about personal diabetic problems or concerns leads to instant camaraderie. Who better can understand what it feels like to have hyperglycemia or hypoglycemia but another diabetic? Yes, you can describe the condition to others, but who will really understand better than someone who has felt the panic and concern?
Another way of breaking through the code of silence and secrets is to take a more active role in one's own treatment. Don't just be a consumer—talk to the doctor and diabetes management team about how one is coping with the current treatment.
Sharing information about how their own program is going, better or worse, as well as other cares and concerns, allows the codependent to present him/herself as a person of worth. The physician can only guess at how we feel or why our insulin dosage or orals are not working when they worked last month. The more we are aware of our bodies, the more prepared we are to assist the physician in figuring out if changes need to be made in order to give us the best possible treatment. This communication from the patient to the physician about one's own current condition causes the patient to stand up and say "I am important!" To talk about oneself like this takes courage, requires assertiveness, and gives one the ability to see oneself as a person with self-worth.
A codependent person is a person who lacks the ability to recognize their own physical needs. Diabetes insists that the patient be aware of their own physical needs in the following ways:
1. Eat the proper foods at the proper times in the proper amounts 2. Monitor blood glucose readings 3. Adjust the eating and/or exercise patterns according to the glucose readings 4. Make daily exercise and rest a priority 5. Show constant awareness by sight and feel of the condition of our body, to protect against complications. Notify the physician if something is suspected.
As the codependent person learns to meet each of these physical needs of his/her own body, these processes become habits. Such a routine will diminish a codependent's concentration on the physical needs of others, helping to focus on one's own immediate needs.
Good diabetes management is not the total answer to the disease of codependency, but its discipline and routine help assist the codependent person in the process of recovery. Following proper diabetes treatment forces one to be attentive to one's own bodily needs. Joining others in conversations about diabetes, physicians as well as fellow diabetics, and acceptance of the body as a living human organism that cannot be totally controlled, assists the codependent person in overcoming the characteristics: lack of focus on ones needs, isolation, and need for control.
I find that when I take care of my diabetes, eating properly and exercising, being aware of my body and its needs, communicating to my physician and diabetes team my concerns, my disposition is a much more happy one than when I am slack on proper routine. The problem of codependency has not gone away, but at least I know I have a few behaviors that will help me change and assist me on my road to recovery.
Diabetes is a disease where one has to take extraordinary care of oneself in order to appear ordinary. And I think that everyone of us is worth that much and more.
If you have diabetes, your daily blood-glucose tests are important—but there is another test you should have done at regular intervals. This is the "A1c," also known as "Glycosylated Hemoglobin" or "HbA1c Test." Your doctor can use this test to find what your average blood sugar level has been over the past few months.
Where your glucose meter tells you your blood sugar level right now, the figure produced by the A1c is in fact the average of all your highs and lows, for a period of approximately two months preceding the test. The greater the average amount of sugar in your blood, the higher the A1c results.
Although doctors disagree over when to order the A1c test for their patients, there is consensus that "every two months" would be more accurate than longer intervals.
Although different labs (like different glucose meters!) may produce slightly different findings, the theory is the same: Molecules of sugar attach to protein in solution, in proportion to the amount of sugar present. Hemoglobin, a critical part of red blood cells, is a protein. The sugar attaches to the hemoglobin, "glycosylates" it, in direct relationship to the blood glucose level. As red blood cells stay in circulation for about 110 days, the percentage of hemoglobin that has sugar attached to it, "glycosylated hemoglobin," provides a reasonable estimate of the average blood sugar level during the six to eight weeks before the test.
It is important to remember this test measures the average blood sugar level. If a person has a "normal" A1c, this may mean everything's OK, or it may mean they have periods of excessive high blood sugars (as revealed by monitor), "balanced" by periods of abnormally low blood sugar levels. A good example would be folks with high daytime blood glucose, who have undetected nighttime hypoglycemia. This is why you need both tests; neither is a substitute for the other.
When you use your glucose meter to test your blood, each test is a "snapshot." Depending on your diet, lifestyle, and general health, your glucose levels may fluctuate greatly at different times of day. The A1c yields an "average," which, used with your monitor results, lets your doctor know how you're really doing, so you can make the necessary adjustments to get and keep those numbers down, and cut the odds of complications. Don't neglect this important tool.
by Peter J. Nebergall, PhD
I'm always interested in how other cultures approach problems we find familiar. I just finished reading an article, published in a European diabetes journal, that discussed adaptive equipment for blind diabetics and those losing vision. I found its attitude appalling, and I'd like to share why.
In much of the world, the fact of blindness is treated as synonymous with incompetence. Many medical and rehabilitation authorities can't imagine a blind person performing precise activities, such as those necessary for independent self-management of diabetes. And what the authorities don't know to be possible, they don't teach.
This negative attitude colors so much of their approach that they are not even prepared to consider alternatives, even when confronted with the evidence of their viability. The problem transcends both industrial chauvinism and corporate rivalry—sadly, it has more to do with the "meaning" of blindness, with the "mental template" marked "blind." And while the authorities stumble and grope about, blind diabetics, who would be capable of independence if they were provided the appropriate (and available) tools and training, are forced to do without.
The best blindness rehabilitation counselors know that when sight is failing, the client is best served by the incorporation of nonsighted techniques, ideally before all vision is gone. The client so instructed does not have to cling to scraps of failing vision, but is ready to deal with total blindness, if and when it should come. For this client, there are talking glucose monitors, tactile insulin measurement devices, and various other aids. Well prepared, this individual will remain independent and productive.
Now consider a rehab agency, or a whole country, where the above is not the rule. So sure the absence of sight means one can't, the authorities stress maximum utilization of what vision is left, staving off "the moment" with insulin pens, syringe magnifiers, pre-mixed insulins, and large print. It is not a question of technology, nor of ignorance—these are top authorities, and the needed adaptive equipment is freely available here in the U.S. It comes down to belief, to cultural conditioning.
Teachers have known for years that the student who is taught he or she can will outperform those taught they cannot; that expectations shape performance. The attitudes of instructors, counselors, and journalists shape clients' opinions of their own abilities. In too many places, "the authorities," by both omission and commission, continue to pass on the doctrine that blindness equals inability. When the client has nowhere else to turn, no better source for the truth, it does.
What do we expect? It matters. Across the world we encounter differing expectations of the capabilities of the blind. It is those expectations, much more than the availability of adaptive technology or information, that are the true "limiting factors." No accident, then, that where expectations are high, so is performance. Those authorities who cling to outdated and incorrect notions of "inability" are not serving their people. Those who move forward, raising their expectations with each new development in technology or treatment, will be rewarded. We have a choice.
Dialogs About Diabetic Dynamos
by Debra Frank
Exercise Physiology M.S., Recreation Therapy M.S.
Diabetes, Exercise, and Me
In the past few decades both quality and quantity of life have improved for diabetics. The 1970s brought the benefits of sports and physical fitness to the public consciousness, and to the medical and health professionals. The obvious benefits of physical fitness were increased self-esteem, self respect, and the obvious aesthetic improvement. But the real discovery was the increase in overall physiological health. People afflicted with chronic diseases such as hypertension, arthritis, or diabetes, for example, demonstrated scientifically substantiated increases in overall health. What does this mean to me and the millions of others diabetics on this planet? Not only is exercise good for my mind, body, and spirit; it is now considered part of my health care plan.
In 1970 Dr. Kenneth Cooper wrote the book "Aerobics," which told the general public the truth about exercise. Further studies in sports medicine supported what Dr. Cooper and others have been teaching. Researching the pros and cons of exercise for everyone, even diabetics with ramifications, is now common practice.
Specific investigations have been made into the impact of different components of exercise on the diabetic. In 1986 the first edition of the book, "Diabetic's Guide to Health and Fitness," by Kris Berg, EdD, was published. Dr. Berg did not just approach the elements of exercise for the diabetic from a scientific perspective; he included personal research on a very captive study subject, himself. All the organizations serving the diabetic have released their exercise recommendations, but for the most part that's what they are—recommendations. It is our job as diabetics to take this knowledge and apply it to ourselves and our own personal needs.
But how do I start? What is a reasonable workout routine? Can I join a recreational softball team? Who do I ask for advice on how to regulate my blood sugars, before, during and after exercise? Will the school, recreation center, or health club question me about my diabetes, and what should I tell them if they do? Is it dangerous for me to try to start on my own? Maybe, taking all these variables into consideration, I should forget the idea and stick to my regular lifestyle of limited activity... With all this to consider, no wonder so many of us avoid starting a program! Well, you've just got to take it on, one step at a time.
First step: Meet with your medical team and discuss integrating an exercise program or sports activity into your medical protocol. You should be in good metabolic control before you start this new activity. It is suggested anyone, regardless of the presence or degree of complications, find an activity they can do at least three times a week, for at least 40 minutes. According to the ACSM (American College of Sports Medicine), exercise should be comfortable and easy to fit into your weekly routine.
There are many exercise physiologists who specialize in diabetes. Finding one of them to work with you and guide you through the ups and downs of your new program is a great idea. If you are blind, or have other ramifications, these experts can help you design your program.
Many diabetics are on other prescription medications as well. If you are, keep in mind the heightened circulatory response to medication during and after exercise. Exercise can change the way your body responds to specific medications, and you may need to take action. You'll need to pay special attention to your blood sugar levels before, during and after exercise. You and your trainer may decide to add a snack to maintain your normative blood glucose levels, or you might be told to cut back on insulin during some activity. Since the body uses more glucose during exercise, it is important to be in good control prior to and during a program of physical activity. If your blood sugars are elevated at the start, your body will have a negative response to the exercise program. Searching for the fuel to feed the muscles, with insulin levels inadequate, instead of dropping, your sugars will rise still further. Exercise is suggested only when your blood glucose is under 220mg/dl. Although this is a high level, your sugars usually will drop to within normal limits as a result of the activity. If your blood glucose is higher than 220, try to refrain from initiating strenuous physical activity until you can get them down to a healthier level.
Prepare yourself properly, and begin slowly. Keeping snacks and water with you is a must. Diabetics have a tendency to dehydrate, and keeping the fluids plentiful will benefit not only your level of hydration but every other system of the body. Dress for support. Choose your footwear wisely, and keep clean cotton socks available.
Though all the preparation for "Fun and Fitness" seems tedious, it truly pays off in the long run. Whether you're simply starting a daily walking routine, swimming before work, or planning a 100-mile bike ride, be aware of your body and the effect exercise has on your diabetes. Improved insulin sensitivity, weight loss and "body sculpturing" are three primary results of any regular exercise/work out program. There's no secret formula—results are not immediate—but they are worth the wait: Improved body composition, fat to muscle ratio, improved cardiovascular condition, improved overall strength, weight loss or gain if so desired, improved glycemic control if all elements are attended to adequately. So what have you got to lose but...weight and inches? Yes, there are those periods of hypoglycemia, but you will learn to adjust your nutrition and medication, finding your ideal formula for success.
For information on starting an exercise program, contact your medical team, local health club, or school athletic program. Some diabetics are Exercise Specialists, and other Exercise Physiologists specialize in diabetes. There is even an organization called the IDAA, International Diabetic Athlete Association, which does great things supporting safely planned exercise and sports for diabetics. Each year diabetic athletes from around the world run the New York City Marathon. The IDAA arranged for glucose monitoring stations every four miles, with test kits, insulin and the food the runners requested.
The bottom line is this, God made us diabetics extra sweet, but he still wants us to live action-packed quality lives, not merely to exist. What are your goals? A safe rewarding fitness regime? Playing ice hockey, or soccer? The Special Olympics? Competing in a bodybuilding competition someday? Starting to snowboard this winter? Perhaps you merely want to feel more fit playing volleyball at a family picnic? Try incorporating a safely organized, professionally supervised and medically approved training program into your life.
If you or a friend would like to remember the Diabetes Action Network of the National Federation of the Blind in your will, you can do so by employing the following language:
"I give, devise, and bequeath unto the Diabetics Action Network of the National Federation of the Blind, 1800 Johnson Street, Baltimore, Maryland 21230, a District of Columbia nonprofit corporation, the sum of $___________________" (or "___________ percent of my net estate" or "the following stocks and bonds:___________") to be used for its worthy purposes on behalf of blind persons."
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, 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 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. 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 erection, no matter how hard a man tries.
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 fear of 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 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 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 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 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, National Medical Director of the Diagnostic Center for Men, in his "Getting Help: A Patient's Guide for Men With Impotence" (1994, publ. by Integrated Medical Resources, of Lenexa, KS) reports 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 anti-hypertensives (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. 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, 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 non-surgical means, and the National Institutes of Health recommends trying non-surgical treatments before more invasive methods. All options should be considered, but the man's personal preferences—and those of his partnerþare vital in the choice of treatment. For purpose of discussion I've divided treatments into three categories: medications, external mechanical devices, and surgery.
Medications
External Vasodilators 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, the ointment is applied to the penis to increase penile arterial flow and improve erections. The most notable side effect is that it may give the female partner headaches, as it is absorbed into the 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.
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). Most popular medication is Upjohn Corporation's Caverject, the first to be approved for such use by the FDA.
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 is a non-invasive alternative to penile injection. The user dispenses his medication (alprostadil/Caverject) with an eye-dropper-like applicator, directly in the urethra. No needles are required. FDA approval of the device is pending.
"Rejoyn" is an inexpensive, non-prescription 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 cost approximately $400-$450, covered under most insurance plans.
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. Most insurance companies do provide coverage for this type of mechanism.
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. Make sure you don't fall asleep while wearing one of these devices. 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.
"At our institute," says Troy A. Burns, MD, founder and medical director of the Diagnostic Centers For Men, "each doctor regularly prescribes such devices 20 to 30 times a month. Complaints are rare; 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. Through research I have found that the malleable prostheses cost about $1400, and inflatable devices cost about $4000. If the man elected to undergo surgery, and fees were totaled (surgical, operating room, and the markup on the prosthesis), the cost would be about $9000 for the malleable and about $13,500 for the inflatable device. These prices reflect rates in central Missouri and should not be considered national averages. 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 extentþthen 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 MedTech Corporation, 2720 Nevada Avenue, New Hope, MN 55427; telephone: 1-800-524-8014. They offer "Rejoyn," an over-the-counter impotence "support sleeve."
Encore Medical Products Centre, 2300 Plantside Drive, Louisville, KY 40299-1928; telephone: 1-800-221-6603. They offer vacuum constriction devices.
The Impotence Information Center, American Medical Systems, P.O. Box 9, Minneapolis, MN 55440; telephone:
1-800-843-4315. They offer prosthetic devices.
Mentor Corporation, 5425 Hollister Avenue, Santa Barbara, CA 93111; telephone: 1-800-235-5731. They offer both vacuum constriction and prosthetic devices.
Osbon Medical Systems, P.O. Box 1478, Augusta, GA 30903; telephone: 1-800-438-8592. They offer both vacuum constriction and prosthetic devices.
Pos-T-Vac, P.O. Box 1436, Dodge City, KS 67801; telephone: 1-800-627-7434. They offer vacuum constriction devices.
VIVUS, Inc., 545 Middlefield Road, Suite 200, Menlo Park, CA 94025; telephone: (415) 325-5511. They offer their noninvasive MUSE delivery system for the drug alprostadil (Caverject).
RESOURCE LIST OF INFORMATION AND SERVICES
American Association of Sex Educators, Counselors, and Therapists (AASECT), P.O. Box 238, Mount Vernon, IA 52314. For a list of certified AASECT members in your state, send SASE.
The Diabetes Action Network of the National Federation of the Blind, 811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911. They offer free copies of this article and other information pertinent to diabetes and its ramifications.
The Geddings Osbon, Sr., Foundation, Impotence Resource Center, P.O. Box 1593, Augusta, GA 30903; telephone:
1-800-433-4215. They offer two booklets, free on request (single copies, print or audiocassette)þ"Impotence: A Woman's Perspective," and "The Male Treatment Guide." They also offer physician referrals.
Impotence Institute of America, 10400 Little Patuxent Parkway, Suite 485, Columbia, MD 21044-3502; telephone:
1-800-669-1603 or (410) 715-9605. They publish a periodical titled "Impotence Anonymous."
Integrated Medical Resources, Inc. 8326 Melrose Drive, Lenexa, KS 66214; telephone: (913) 894-0591. They publish "Getting Help: A Patient's Guide for Men With Impotence," by Troy A. Burns, MD.
National Kidney and Urological Diseases Information Clearinghouse, Box NKUDIC, 9000 Rockville Pike, Bethesda, MD 20892. They publish a comprehensive bibliography on impotence, free upon request, "Impotence: Patient and Professional Materials."
New Program For Blind Diabetics
The Colorado Center for the Blind, a rehabilitation center established by the National Federation of the Blind, announces a new program for blind diabetics and those losing vision. Recognizing that blind diabetics face a unique set of challenges, the Center's new three-month intensive program (offered four times a year, and not limited to Colorado residents) will focus on further development of skills and attitudes necessary for full participation in the mainstream.
For the first six weeks, participants will attend classes covering: Medical and psychological implications of diabetes, adjustment to blindness, planning for the future, creating a healthy lifestyle, and strategies for setting and achieving personal and vocational goals. Both medical professionals (including the Center's Nurse/Diabetes Educator) and blind diabetics will offer presentations.
In the second segment of the program, individual participants will work, in their own home environment, with members of the Center staff, translating lessons learned into practice, and implementing their goals for community and vocational involvement. Student-staff contact will be as frequent as is needed to ensure individual success in the three areas highlighted by the program: Improved working knowledge of independent diabetes self-management, development and implementation of a healthy lifestyle, and realistic expectations/plans for personal and vocational development.
Tuition for the three-month program is $2000 per month. If housing is needed, it is available at a cost of $350 per month. Students will be expected to provide for their own maintenance.
Regardless of ramifications, blind diabetics can draw their own insulin, test blood glucose, and perform all the other tasks of independent diabetes self-management. They are not alone. The rapid pace of change, both in adaptive technology and medical understanding of diabetes, means that learning is an important part of the prescription. The techniques and technologies are there; programs like this one can help provide the necessary knowledge and positive attitudes.
The Colorado Center for the Blind is one of the three rehabilitation centers established by the National Federation of the Blind across the United States. For information about its new diabetes program, contact: Diane McGeorge, Program Coordinator, The Colorado Center for the Blind, 1830 South Acoma Street, Denver, CO 80223-3606; telephone: 1-800-401-4632 or (303) 765-1330.
Tactile Insulin Vials: Movement Toward Solution
by Ed Bryant
For almost five years, the Diabetes Action Network of the National Federation of the Blind has been lobbying and campaigning to convince the Food and Drug Administration (FDA) and the insulin manufacturers to incorporate tactile markings on insulin vials. Currently, all insulins are still packed in identical vials (or pen cartridges), with the different types distinguished only by writing on the label. Most diabetics, blind or sighted, mix insulins, but how do you tell your R from from NPH, or Lente, or new quick-acting Humalog, if you cannot read the label?
For decades, blind diabetics and those experiencing fluctuating vision (a condition in which vision may go from adequate to unusable, and perhaps back again, in days or hours) have had to mark their insulin types with tape or rubberbands, or ask someone else. Rubberbands break, and tape falls off. Sighted aides are not always available, and blind folks are entitled to their independence.
In letters, calls, and meetings with insulin industry and FDA representatives, we, the Diabetes Action Network, have pushed for permanent, easily detectable tactile markings on insulin vials, sufficiently prominent that individuals with neuropathy could detect them. Both Eli Lilly and Company (on December 14, 1994), and Novo Nordisk Pharmaceuticals Inc. (on January 10, 1995), the two insulin manufacturers who serve the U.S. market, separately sent representatives to meet with me. Lilly showed me prototype tactile vials at their meeting. As part of their testing program, Lilly met with students and staff at B.L.I.N.D., Inc., a rehab center established by the National Federation of the Blind (NFB), and sent a representative to the NFB 1995 annual convention, held in Chicago, Illinois.
After an intensive letter-writing campaign in which you, VOICE readers, played the key role, the FDA called a meeting of "interested participants" on October 19 of last year. Meeting participants discussed various proposals for tactile insulin identification, and moderator John Short gave "my persistence" full credit for making the meeting happen (We know these changes are coming about because they're overdue, because both blind and sighted diabetics will benefit from tactile coding). Minutes of that meeting record that Lilly and Novo Nordisk were to come to the next meeting (scheduled in 3 months' time) "with firm ideas for short-term solutions, and other ideas for long-term solutions."
Although the second meeting was scheduled for January of 1996, bad weather in the Washington DC area forced postponement, and it was not held until April 10. Both Lilly and Novo Nordisk brought prototype vial markings to the meeting. Lilly had used the extended break between meetings to confer with groups of blind people, and to more fully explore the placing of raised horizontal lines on the label.
Novo Nordisk already uses a system of Braille-like dots on the aluminum vial-stopper rim, in Europe, and they sought to have their system adopted in the U.S. At the meeting, all blind participants, and the representative of the American Association of Diabetes Educators, agreed Novo Nordisk's dot-markings were too small to be reliably detected by individuals with neuropathy, and that bars were much more appropriate than dots.
At the close of the second meeting, the FDA and Lilly were ready to agree on a set of one through four horizontal tactile bars to distinguish insulin classes. Novo Nordisk asked for more time "in which to test alternative prototypes," and we agreed to meet again in three months, some time in July.
July came and went without a word from Novo Nordisk.
On August 5, I received the following fax:
Prognosis
Strategic Research for the Business of Medicine
Folsom, CA
August 5, 1996
Ed Bryant
First Vice President
National Federation of the Blind
Diabetics Division
Columbia, MO
Dear Ed:
Our firm is currently working with one of the major insulin manufacturers to design a new tactile coding system for blind patients with diabetes. Our goal is to develop a package coding system that will allow blind patients to readily identify insulin types using a braille-like code. The codes will be used with insulin vials designed for a new pen system that allows blind patients to measure and administer insulin without assistance.
We are now arranging meetings with small groups of blind diabetic patients to discuss how they take insulin currently, and to allow them to handle the insulin vial prototypes. The opinions of the patients and clinicians will be used to determine the final tactile coding submitted to the FDA for approval.
We would like to meet with the patients in your practice that you feel are the most appropriate for this project. I believe that the meetings will be interesting for the patients and that their contribution will benefit all insulin-dependent visually-impaired patients.
Sincerely,
Jon Evans, President
Prognosis
Mr. Evans (we spoke that day) had been hired by Novo Nordisk. A contact in California had suggested he seek help from the NFB, and they had given him my name. I reiterated to him my promise, made to Lilly and Novo Nordisk several years before, to provide the names of rehabilitation centers where he might find blind diabetic students willing to help test prototype tactile vial markings. I helped him arrange a meeting with blind diabetic students at the Colorado Center for the Blind, another rehab center established by the NFB.
Although Prognosis had been instructed to interview insulin-using blind diabetics, Mr. Evans told me Novo Nordisk had given him no instructions to recruit individuals with neuropathy for the test. I was astonished at this omission, as the subject of neuropathy, and its importance, had been thoroughly covered at all previous meetings. Lilly had made certain that blind individuals with neuropathy were part of their test population.
Mr. Evans met with students at the Colorado Center on August 20. Diane McGeorge, Coordinator of the Center's Diabetes Program, reports she offered him the opportunity to meet each student separately (to lessen the impact of persuasive individuals on the opinions of other participants), but he refused, choosing to meet the group together "to get it done in about an hour's time." He brought prototypes marked with dots, circles, or one through six lines.
When I spoke again with Mr. Evans, later that month, he reported almost all of his test population (a total of 25 students from several locations) voted enthusiastically for the horizontal tactile bars, finding them easiest to detect. I note his findings echo Lilly's, so there is absolutely no reason Novo Nordisk should not agree to the adoption of raised horizontal lines to mark the different classes. He "would be passing his finished report to Novo Nordisk in the next few weeks." Perhaps then we might have our long-delayed meeting!
In the January 1997 issue of the VOICE, I will report on the upcoming meeting with the insulin manufacturers and the FDA. Hopefully this will be the last such report, and I will be able to describe the system adopted, and give you a target date for when it will be on pharmacy shelves.
Scholarship Available For IDDM Diabetics
by Debra Frank, MS, MS
The Angelo Centano Golf Scholarship is here again! The Knights of Columbus "St. Therese" and "Father John Farrell" Councils, of Long Island, New York, invite type I diabetics to join in the "spirit of sport" and compete for a $500 prize. Write a 300 to 600 word essay explaining how the award could help you achieve a sport or fitness goal. The winning essay will be published in VOICE OF THE DIABETIC.
The contest is in honor of the late Angelo Centano, a blind, insulin dependent athlete who died in 1992. Write about any aspect of athletics or physical activity which winning the prize would help you achieve. If it is to buy a tandem bicycle so you and a friend or family member can enjoy riding together, or you want to hire a coach to train you for the swimming events at the next Para-Olympics, or you have any other sports- or exercise-based desire, pick up your pen, or sit down at your computer, and GO FOR IT! You just might win!
From the Editor: Debra Frank encourages blind diabetics to submit essays. Entries should reflect any activity good for physical health and positive living. Incidentally, a typed, double-spaced submission would be approx. 1 ½ to three pages long.
All essays should be labeled "Golf Scholarship Essay 1996" and sent directly to the VOICE OF THE DIABETIC. Please send us your submissions by January 1, 1997. The winner will be chosen by committee and announced in the VOICE, Spring 1997 issue. We look forward to hearing from you in the near future. For more information on the scholarship contact: Ed Bryant, Editor, Voice of the Diabetic, 811 Cherry St., Suite 309, Columbia, MO 65201; telephone: (573) 875-8911; fax: (573) 875-8902.
by David Walker
(This article appeared in the July 1996 edition of the BRAILLE MONITOR, published by the National Federation of the Blind.)
From the MONITOR Editor: One of the most difficult and painful dilemmas facing people who are gradually losing their sight is the question of when to begin carrying and, even more important, using the long white cane. One imagines how conspicuous and awkward it would feel to carry a long stick and wave it around, advertising to the world the fact that one is blind. It is easy to understand why week after week, month after month, even year after year people who really aren't safe traveling without a cane put off the decision to begin using it. David Walker of Missouri understands the problem, and he also understands that the key to making a successful transition to using the long cane is attitude. One's technique can improve with practice and the opportunity to observe good cane travelers. But if one never moves beyond the feelings of fear and inadequacy, it doesn't matter how good one's technique is; the person is likely to leave the cane standing unused in the corner. Here is what Dave has to say on the subject:
I recently talked with a young woman who was concerned about a friend with retinitis pigmentosa (RP) who refuses to use a white cane despite difficulty in traveling. I too have been concerned about this when meeting blind people who will not use a cane because they cannot accept their blindness. I hope this article, written by a person with RP, will reach this woman's friend and others struggling with this issue and help them adopt a positive attitude about their blindness and travel.
I grew up with RP. I learned to cope with the progressive loss of vision which caused me to alter methods of doing some things and cease only a few activities as a matter of safety and common sense. One of the activities which required alterations was independent travel. My adjustments were gradual because of the slow progression of RP and because of my own evolving understanding. I imagine this is common among others with RP.
Giving up my ten-speed bike was one of the most difficult things in my life since I had a great love of cycling as an independent mode of travel beyond a reasonable walk. However, my gradual loss of sight in my mid-twenties forced me to reconsider riding a bike after a few close calls and the resulting reductions in my biking to restricted hours and reduced speed. I had to resign myself to the fact that safety was a real issue and eventually sold the ten-speed extension of my powerful legs and independent nature.
My first experiences with a white cane were humiliating. I was a client of Services for the Blind in Michigan in the early sixties, long before I sold my bike. At the time I had very good partial vision. I could read the signs on the buses, identify traffic lights, and see oncoming vehicles at quite a distance. I really didn't need a white cane, but I was talked into getting one from the Lions Club so that I could ride the buses free in Detroit. I was commuting into the city from the suburbs daily for piano-tuning training, and the saved bus fares in the maintenance money I was getting from the agency looked good to me. Keep in mind that I had never heard of the National Federation of the Blind (NFB), so I didn't realize how much damage those so-called free rides do to the self-respect of the individual and the public's attitude toward blind people in general.
When I first held that thirty-eight-inch folding white cane with the bright red tip out in front of me as I walked, I felt as obvious as a neon sign. I was convinced that everyone was staring at me. I felt very odd. I was with the fellow student who had taken me to the place where I got the cane, so I didn't feel completely alone. It wasn't until Charlie and I went our separate ways that I began to feel really conspicuous. When I got on the bus and started to move toward a seat that I could see clearly, two people from opposite sides of the bus grabbed my arms and said, "Sit here." I found that reaction both unnerving and intrusive since I could follow only one instruction at a time. Besides, my freedom to choose my own seat had just been diminished by two strangers. After a few months of such experiences and of people telling me I wanted to go where I didn't want to go, I tossed my cane in the closet.
For years after that I didn't use the cane because of such experiences and because I could still see fairly well to travel on foot and on my bike. I never denied that I was legally blind; I just didn't like the idea of people feeling sorry for me and thinking they had to tell me where I was going. When I went with family members or friends at night, they always warned me of objects so I could walk around them. When my buddies and I went to a bar, they would give me oral cues or an arm to get through the dimly lighted bar. I was comfortable doing this with family members and friends with whom I had grown up.
In 1970, while I was a student at a community college, I had to take a couple of night classes. And although I was familiar with the campus, I was uneasy about the thought of traveling from building to building in the dark, walking into students, or falling down stairs. So I took the old cane out of the closet and put it in my brief case. I remember how uncomfortable I felt using that cane and worrying about what fellow students might say if they saw it in my hand at night, even though they didn't see me using it during the day. Actually, the thought that they would recognize that I was legally blind did not bother me as much as the idea of falling down stairs or walking into people without using the cane. At least the cane would warn me of stairs, other objects, and people despite its shortness. I also learned that most people would not try to drag me where I didn't want to go as had happened before, so I became more comfortable with the cane.
While I attended Michigan State University with its very large and complex campus, I began using the cane more and more frequently. I found that it was very helpful in finding paths in the snow; sidewalks; and those very hard, shin-bruising, concrete benches all over campus. As Charlie had told me back in the sixties, "The cane does a lot of talking to you," and it helped professors understand that I was blind when I was requesting reasonable accommodations for exams. I had developed some pretty good cane travel skills while at MSU, and I taught some other blind students how to get around campus, but I did not use conventional technique.
While I was a student at Michigan State in 1972, my brother introduced me to the National Federation of the Blind. I attended a state board meeting held in Lansing and met local Federationists. I recognized that the Federation and I shared a common philosophy, and through discussions with members and reading the BRAILLE MONITOR, I developed a better attitude about travel. I came up with a saying while helping a blind student learn her way around campus: "If you can get lost, you can get unlost."
After graduation I moved to Rochester, New York, and became more active in the Federation, but I still used my unconventional cane technique. Since I was in a new city and had to do a lot of traveling and nudging people and other objects became more frequent, I signed up for instruction in cane travel with a local agency. My positive attitude and past cane travel experience made learning more conventional techniques easy. Before I started lessons, I bought a longer fiberglass cane from our NFB National Office, which set me on a new path of independence. Many people, however, have trouble taking that first, positive step—conceiving of the cane as a true alternative, leading to independence; but believe me, avoiding those very embarrassing situations by using decent cane technique is far better for one's self-esteem than falling down stairs, walking into people, or having a serious accident with a motor vehicle.
I have met many legally blind people who are obviously in need of cane skills but who try to appear sighted. This is a serious mistake. If people think you are sighted and don't realize you are not, they will not take steps to avoid a collision. The person with diminished vision has the responsibility not to put himself or others in danger. Refusing to use a cane in such circumstances is irresponsible. Those who fall down stairs or walk into poles while trying to look sighted and therefore cool by not using a cane succeed only in looking like fools.
One day while returning to campus from the store, I encountered a blind guy crossing Grand River Avenue, a very busy street in East Lansing, Michigan. He was carrying groceries but had his cane tucked under one arm, pointing behind him. I thought, "What the hell are you doing?" I approached him and introduced myself, without saying what I was thinking. We became good friends. I got him to use the cane a little, but I could never get him to use his cane properly. He had been struck by numerous bicyclists on campus because they did not realize that he was blind when he stepped into their path without a cane. Had he used his cane, those cyclists would have seen it and taken preventative measures. The major problem with this blind person is that he does not accept his blindness, despite all the efforts of rehab services and friends to help him become a self-respecting blind person.
My late brother Jim, who had excellent cane travel skills and even taught cane travel and attitude-adjustment, went through denial as have so many others. Once, before either of us used a cane, he and I were in a bar with sighted friends. Jim went to the men's room, which was past the pick-up point where waitresses got their orders. Less than a minute after he left the table, we heard the crash of glasses and a tray. I remember commenting, "He got her." Jim had not seen the waitress stepping from the bar with a full tray of drinks, and she had no way of knowing that he was blind in the dark. They collided. If Jim had been using a cane and the excellent travel skills he later developed, he could have avoided that embarrassing public event.
During the time when I refused to use a cane, I remember suddenly stepping down a flight of stairs I didn't see in a dark hotel lobby. Luckily, I regained my balance, but not until I had run down several steps to catch up with myself and bounced off a door frame. A few experiences like these and also finding the National Federation of the Blind helped me gain a healthier attitude.
I can't count the number of times I have observed legally blind people dodging themselves in mirrors as they travel down the corridor of a hotel. It is sometimes amusing to watch such antics, but it's not really funny. This kind of public display makes our job of educating the public about the abilities of blind people more difficult. It also gives writers lousy material for television programs. If these blind people used canes, they would realize they were approaching a mirror and not an oncoming person.
I once stopped by the office of a blind woman here in town to do an errand for her. I told her that I had just walked several blocks along the newly repaired section of Madison Street to see what it looked like. (The curbs and sidewalks had just been replaced.) Her response was curious since she has known me for several years. She said, "Boy, you're brave." I told her that bravery had nothing to do with it; they were just sidewalks. It was not bravery but attitude.
I can assure those of you who share my old prejudices about the white cane that a change in attitude is very rewarding. If you think you do not look blind without a cane or do not want to be identified as a blind person by using the cane, consider the alternatives. You look more foolish falling down stairs, bumping into people and objects, dodging yourself in mirrors, than if you were to walk with skill and grace, with dignity and self-respect, using a long white cane. The first step is to develop a positive attitude about blindness and alternative methods of travel. After that, the rest comes much more easily. Before you know it, you are gaining confidence, and that positive attitude goes with you everywhere.
by Wesley W. Wilson, MD
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 Wilson, MD is an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type I diabetes in 1956, during his second year of medical school.
Q: I am an overweight type II diabetic from a big, heavy family. Did my weight (I have always been like this) cause my diabetes?
A: Your question is appropriate, though difficult to answer. It is clear that overweight and type II diabetes go together. It is also clear that if a person who has inherited a tendency toward type II diabetes keeps an ideal weight and follows an adequate exercise program, type II diabetes can be prevented or delayed. (If and when symptoms appear, diet and exercise can help keep them under control.)
In an earlier article, I mentioned that the National Institutes of Health is conducting a study to see what measures might prevent the development of type II diabetes, and the results of this study will help us answer questions such as yours. It appears type II disease is predominantly an inherited condition. Some populations, such as the Pima Indians of Arizona, have a very high frequency, as high as one in three, though, interestingly, type I diabetes is rare in this population. Other populations, especially Hispanic and African American, also show a high frequency of type II disease, as do women with a high birth weight (more than nine pounds) baby. Statistics suggest those most at risk for type II are over 40, overweight, and have a family history of the disease.
Centers for Disease Control statistics suggest that half the individuals with type II are unaware they have it. Particularly at its onset, type II tends to be mild, and may cause no symptoms for some time, finally announcing its presence through the appearance of its complications. Only then are tests administered, and the abnormal blood sugar discovered. It is much like finding termites in your house by discovering the damage they have already done.
Of course the obvious answer is for persons from at-risk groups, such as I have outlined, to get regular blood-sugar tests and examinations. The only way we will ever understand the frequency of the disease, or catch it in its early stages, is to test often. Detected early and answered with tight blood sugar control, diabetes need not necessarily lead to severe complications.
The inherited abnormality that leads to type II diabetes is usually accompanied by a tendency toward overweight. The two disorders must be closely related, since, as in your case, problems with obesity and problems with diabetes run strongly in certain families and population groups. You have apparently inherited those tendencies, but do not lose hope. The key problem with diabetes is the appearance of its complications, and those, in both type I and type II, can be delayed, prevented, or controlled by careful control of blood sugar levels.
Unfortunately, efforts to control diabetes can be troublesome. They require lifestyle change, frequent physician visits, and the need to follow advice about exercise and dietary control. Once the disease has been detected, persons who carefully manage their diabetes, their elevated cholesterol, and their elevated blood pressure, will be least likely to develop their troublesome and potentially lethal complications. HCFA, the Health Care Financing Administration (who regulates Medicare payment policy), isn't helping, because currently the only tests they will pay for in the Medicare-covered population are those that follow a diagnosis. If a person is not already known to have diabetes, HCFA is not anxious to pay for tests to see if they might have it. We hope to see change here...
by Douglas Campbell
I am told that I developed diabetes at approximately three years of age. I have had it now for 60 years, and a lot of things have happened over that time. As far back as I can remember, when I first tried to start school, the principal of the school was hesitant to have me accepted, and school was put off for a year.
My family then moved to the Cape, that's Cape Cod, where I started school in 1938 (I had developed diabetes in '36). A local doctor had the intelligence at the time to advise my mother to take me to the Joslin Diabetes Clinic, which was a Godsend for any diabetic.
As any growing child, I was going to do as much as everyone else did. We would play cowboys and Indians, and of course we would go across a field that had potatoes in it, then we would dig them up and act like we were in the Sahara Desert and cook some potatoes, not paying any attention to my diabetes. During the time period of approximately 12 years of age until I was married at 23 I was trying to eat and break my diet like crazy. I ate candy, ice cream, went to football games and ate hotdogs, and all the other things that everybody else was having.
Some 49 or 50 years ago I went to Camp Joslin for Diabetic Children. During that time we climbed Mt. Monadic. There were 10 diabetic children and a nurse who had a full box of Hershey chocolate bars which were all completely used up by time we climbed the mountain and came back down. At the same time being typical young diabetics we went across the pond to try out sleeping on the ground over night. Low and behold there was a blackberry bush in the area just past where we camped. As you can imagine we all had our fill of blackberries and our blood sugars told us.
Being a typical young diabetic at one time I had a blood sugar of 625 and Dr. Priscilla White entered me into the Deaconess Hospital for additional insulin to bring my blood sugar back down. At that particular time I went up on the roof of the building and taking a high-bouncing rubber ball, threw it as hard as I could for as long as I could until my blood sugar was forced back down again. These involvements I do not advise for any young diabetic, but you try to tell a young diabetic what to do and what not to do and they are going to do the opposite.
Things have changed a great deal since then. In the beginning we even had to file our own needles on a small stone, now they are just disposable. At that time we had to test urine, which took approximately five minutes of boiling it in butadiene solution. Now we have the new talking glucose meters, a Godsend to me because I can now take my own blood sugar which I have not been able to do for some 40 years that I have been blind. Although my sight completely went just prior to the development of the laser beam, I have seen its results with my own brother, who has had laser treatments for some 20 years. Being married twice (my second wife was also a diabetic), the two of us talked to a Boston College graduating nursing class about blindness and diabetes. She had a dog and I used the cane. We also showed Kenneth Jernigan's movie about blind people and what they can do. (Editor's Note: Dr. Jernigan is President Emeritus of the National Federation of the Blind.)
As I learned later in life, what you know about foods can have a great bearing on you. You not only can control your blood sugar by intake of food, but also by the adjustment of regular insulin where necessary. I do not advise the use of additional insulin unless you have had experience in using it—which is one of the things I learned as a young student at the Joslin Clinic Camp.
At age 23, just going blind after 20 years of having diabetes, I entered Perkins School for the Blind, to learn piano tuning. I then became a piano tuner for the Commission of the Blind for Massachusetts. This I did for the next 30 years. I managed to buy a small five-room home, in which I thoroughly enjoy doing as much as I possibly can alone; my wife passed away some 12 years ago (from diabetic heart disease).
To any diabetic I advise you to keep as active as you possibly can, as exercise helps maintain the blood sugar at a much more acceptable plane and keeps you more active all the time.
There is very little that a blind diabetic or even just a blind person can not do with a little bit of exception. Here's one example: Because I did a lot of driving in the four or five years that I drove before I went blind, my friend (who had a Model A Ford, as this was in 1923), one time asked me if I would like to try driving it on the Cape while the tide was out. When I got going at approximately 30 miles an hour, as I was told, I was all of a sudden told, "TURN LEFT!" and when I didn't immediately turn left, I was screamed at to quickly turn left, then realized afterward that it was a big inlet of water, which I would have gone right straight into. Driving at 30 miles an hour did make me feel very much uptight. Another blind friend of mine at one time, who lived in Nantucket drove his car home one night when he had been to a dance with his brother. And his brother didn't want to go home at the time so Charlie got out, took his white cane, walked about 30 yards ahead of the car, then got back in the car, drove the 30 yards, then got out repeated the process until he had driven the two miles all the way home this way.
So there are very few things that you can't do but it's the degree of these things that is acceptable. I wish all of you the best of luck and I will just wait and see how this winding road of mine continues. Thank you very much and God bless you all.
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, non-sighted 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 non-visual operation. A few are the simplest of home-made aids, designed by resourceful blind diabetics, some members of our Diabetes Action Network.
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, 12555 Garden Grove Blvd., Suite 507, Garden Grove, CA 92643; telephone:
1-800-541-1193. Cassette instructions are supplied. Its suggested retail price is $49.95, but the National Federation of the Blind (NFB) sells it for $40, the lowest price on record. Order through: Aids, Appliances, and Materials Center (hours of operation 12:30 PM to 5:30 PM EST), 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 non-sighted insulin measurement.
(NOTE: The NFB Materials Center has a supply of the older, now discontinued, 1cc/100-unit Count-A-Dose. Operation is similar, but this device uses the B-D 100 unit syringe, and each click of the thumb-wheel draws two units. No audio instructions. Price is $40.)
The SYRINGE SUPPORT: This device is manufactured in Canada by the Fondation Centre Louis-Hebert, 525 Boulevard Hamel Est, Aile J, Quebec City (Quebec) Canada GIM 2S8; telephone: (418) 529-6991. Instructions (standard print only) are bilingual. In the U.S., the Syringe Support may be purchased (cost $19.95) through: Lighthouse Consumer Products, 36-02 Northern Blvd., Long Island City, NY 11101-1614; telephone: 1-800-829-0500.
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 twelve 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 for $49.95 from Palco Labs, Inc., 1595 Soquel Drive, Santa Cruz, CA 95065; telephone: 1-800-346-4488.
This device 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. See accompanying article: "Update: Blind diabetics can draw insulin without difficulty.")
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.
If you need help constructing an insulin gauge, Janet Lee, Second Vice-President of our Diabetes Action Network, will construct you a sample, but you must send her an insulin syringe of the type and size you use. Contact her at: Blindness: Learning In New Dimensions (B.L.I.N.D), Inc., 100 E. 22nd Street, Minneapolis, MN 55404; telephone: (612) 872-0100.
Although many people make their own insulin gauges, out of all types of materials, commercial gauges are available. Meditec, Inc., 3322 S. Oneida Way, Denver, CO 80224; telephone: (303) 758-6978, offers INSULGAGES, flat plastic gauges analogous to the homemade types described above, but labeled in Braille with raised numbers. Priced at $9.75 each, these are cut for either B-D or Monoject syringes, and many sizes are available; one insulgage per dose. Use of insulgages in conjunction with the Holdease needle guide and syringe/vial holder, also sold by Meditec (cost: $12.75) enables non-sighted insulin measurement.
The best insulin gauges, homemade or commercial, are those most durable. Insulin gauges constructed from cardboard or staples, however inexpensive, are NOT RECOMMENDED. They distort and break too easily.
A more complex homemade insulin measuring device was designed, years ago, by VOICE editor Ed Bryant. His gauge was a carefully carved block of wood that allowed precise syringe placement, non-sighted insertion of needle into vial, and reliable tactile duplication of preset doses. To change the dose, he had only to replace one wooden or plastic preset with another. It worked well, but he feels that as most folks do not have access to the necessary precision woodworking, blind diabetics would be better served by the Count-A-Dose, which he now uses.
The use of non-standard 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 ½ cc (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. Offered by Diabetic Insulcap, Inc., P.O. Box 34347, Las Vegas, NV 89133-4347; telephone:
(702) 363-0426, the Insulcap is sold in sets of two: one blue, without tactile cues; and one orange, with tactile cues. Suggested retail price is $7.95. 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 INJECT-AID is a syringe/vial holder incorporating a preset that allows consistent non-sighted drawing of a set, pre-determined insulin dose. Note that insulin adjustment requires sighted aid. The Inject-Aid costs $7.95, and is available from George Wright Industries, 3741 Faulkner Drive, Apt. 301, Lincoln NE 68516; telephone: (402) 423-3253.
The UNI-CAL-AID is similar to the Inject-Aid, but incorporates two adjustable preset stoppers, allowing two different doses or insulin mixing. It accepts all syringe types, but any adjustment of dose requires sighted aid. Price $25 U.S. or $30 Canadian, available from: Uni-Cal-Aid, P.O. Box 1000, Hope, B.C., Canada V0X ILO; telephone: (604) 869-5648.
Pen Injection Devices
The NOVOLIN PENS: Novo-Nordisk Pharmaceuticals Inc., 100 Overlook Center, Suite 200, Princeton,NJ 08540; telephone: 1-800-727-6500, produces two pen-type devices (their "Novo Pen" has been discontinued). They offer the "Novolin Pen," which retails at $40 (excluding insulin cartridge), and uses 150-unit "Novolin System" insulin cartridges (R, N, or 70/30 mix) and "Penneedle" replacement needles. This device delivers a measured dose of between two and 38 units, in two-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): $19.10; comparable to the cost of cartridge replacements for the Novolin Pen.
Pending FDA approval, Novo Nordisk intends to introduce a new pen injection device, the "Novo Pen 1.5." Similar to the Novolin pens, it will use the 150-unit Novolin insulin cartridges, and will deliver in one-unit increments.
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 the Novolin system cartridges and disposable needles. In the U.S. it is marketed by Owen Mumford, Inc., 849 Pickens Industrial Drive, Suite 12, Marietta, GA 30062; telephone: 1 -800-421-6936. It 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 is priced at $33.50.
Becton Dickinson Corporation and Eli Lilly and Company plan to offer, as a joint venture, the HUMULIN CARTRIDGE SYSTEM pen insulin injection system. FDA approval has been granted; any remaining problems are logistical. Similar to the Novo Nordisk and Mumford pens, the system will dispense 150 units of R, N, or 70/30 insulin, but in one-unit increments, from one to 59 units. As soon as Lyspro insulin receives final FDA approval, Lilly plans to offer it in cartridge form as well.
Syringe Magnifiers
The INSUL-EZE 6000, manufactured by Palco Labs (listed above) is a suringe-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 EZY-DOSE-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., 11531 Rupp Drive, Burnsville, MN 55337-1295; telephone: 1-800-328-2742, the device does not affect needle insertion, which must be done visually. Price $4.95, available from LS&S Group, Inc., P.O. Box 673, Northbrook, IL 60065; telephone: 1-800-468-4789.
The CEMCO SYRINGE MAGNIFIER, available in three sizes (to fit syringes of 1cc, .5cc, and .33cc), is offered by Cemco, P.O. Box 31, Scandia, MN 55073; telephone: (612) 433-3374. The magnifier clips to the syringe and aids precise filling, but needle insertion into the vial must be done visually. Price: $5 retail, or $42 per dozen (any combination of sizes).
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 non-sighted techniques of diabetes self-management. If you have any questions about diabetes and blindness, feel free to contact us.
On June 14, 1996, the U.S. Food and Drug Administration granted final approval to Eli Lilly and Company to market Humalog insulin (generic name INSULIN LISPRO, sometimes called LYSPRO). At this time it should be available in most pharmacies and hospitals.
Humalog is an insulin analog, genetically modified to more closely match normal (non-diabetic) human insulin. Thus a number of characteristics set it apart from "Regular" insulin.
1. Humalog is faster than Regular, both in time of onset and peak. Where Regular insulin starts working about 30 minutes after injection (different people will react at different rates) and peaks in about 3.5 hours, Humalog starts up in 10 to 15 minutes, and peaks in about 1 hour. It also has the shortest duration of any insulin, being "out of the body" within about 4 hours.
2. Humalog's extremely rapid onset both allows and requires the user follow it with food. Again, this new insulin goes to work fast, and if you don't give it some food to work on, you can find your blood sugars going down in a hurry. Used correctly, it allows greater mealtime flexibility. Lilly reports test users were able to "inject while looking at their food."
3. Because Humalog works so much faster than Regular, some people might mistake the quickness of the resulting blood-glucose drop for the onset of hypoglycemia. The best answer is to test blood glucose whenever in doubt.
4. Because Humalog is the first representative of a new insulin class ("quick-acting"), not a lot of experience has been accumulated in its use. Because it is so different, the FDA advisory committee that approved it recommended it initially be available by prescription only. It is expected that once the diabetes community becomes more familiar with this new product, this limitation will be removed. Humalog insulin is available in U-100 vials and cartridges for the B-D insulin pen. Lilly expects most users will combine it with a longer-acting insulin (NPH or Lente), drawing up a mixed dose. Studies are underway at this time about its use in an insulin pump.
Lispro promises to be a great new tool, a weapon in the diabetes wars. But, like a powerful new car, it needs to be respected. It gets you there faster, but you better watch where you're going, and keep both hands on the wheel.
Questions To Ask Your Doctor About Blood Sugar Control
This information came from the National Diabetes Outreach Program, part of the National Institutes of Health.
The Diabetes Control and Complications Trial (DCCT) showed that people with insulin-dependent diabetes, who keep blood sugar levels as close to normal as possible, can reduce their risk of eye, kidney, and nerve diseases.
Ask your doctor how you can improve blood sugar control. Questions you may want to ask include:
1. What is my glycosylated hemoglobin (a test that measures average blood sugar over the past two to three months)? What is a normal glycosylated hemoglobin?
2. How can I get my glycosylated hemoglobin into the normal range?
3. How often, and under what conditions, should I test my blood sugar? What should I do with the results? What patterns should I try to achieve?
4. What changes should we make in my program as a result of the findings of the DCCT?
5. Do I have microalbuminuria (tiny amounts of albumin in urine, an indicator of early diabetic kidney disease)?
6. What effect has diabetes already had on my eyes and kidneys?
7. When should I get together with a dietitian to review what I eat?
8. What exercises are best for me? What adjustments to my food or insulin should I make if I plan to exercise?
9. What should my family and friends do if my blood sugar goes so low that I need their help?
10. (for women) What should I do about taking care of my diabetes if I plan to get pregnant?
11. How should I take care of my feet? (Editor's Note: When you see your doctor, take off your shoes and socks without being asked. Not enough pysicians check diabetics' feet.)
12. Are there any diabetes groups I could attend in our area?
For an Information Kit, write: National Diabetes Outreach Program, One Diabetes Way, Bethesda, MD 20892-3600; telephone: 1-800-438-5383.
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...
Chayote Squash Salad (Salada de Chuchu)
from Dave Griffith of London, Ontario, Canada
Ingredients:
1 quart water
6 chayote squash, peeled and cored
3 cloves of garlic, crushed
1 large onion, thinly sliced
½ tsp. salt
½ tsp. freshly ground black pepper
6 tbsp. chopped Italian parsley
¼ cup olive oil
5 tbsp. white vinegar (or even better, balsamic vinegar)
Bring water to a boil and add squash. Boil for 10 minutes. Drain and slice squash. Place in a salad bowl with garlic, onion, salt, pepper, parsley, oil, and vinegar. Mix well and refrigerate before serving.
Yield: 4 servings; Per 1 serving: 192 calories, 16.4gm carbohydrates, 2.7gm protein, 13.5gm total fat, 1.8gm saturated fat, 10gm monosaturated fat, 1.1gm polyunsaturated fat.
White Chili
from Dave Griffith of London, Ontario, Canada
Ingredients:
2 tsp. canola oil
1 lb. lean ground turkey
2 stalks celery, chopped
2 cloves garlic, minced
1 onion, chopped
1 tbsp. chopped jalapeno pepper
1 tsp. ground cumin
1 tsp. thyme
½ tsp. chili powder
½ tsp. salt
cayenne pepper to taste
1 bay leaf
2 cups cooked white kidney beans
1 cup chicken stock
1 cup diced raw potato
1 tbsp. lime juice
2 green onions, thinly sliced
Heat oil over medium heat. Cook turkey, celery, garlic and onion. Stir to break up meat and cook until meat is done. Stir in jalapeno pepper, cumin, thyme, chili powder, salt, cayenne, and bay leaf. Cook for 1 minute. Add beans, stock, and potato. Bring to a boil. Reduce heat and simmer for 30 minutes. Before serving, stir in lime juice and remove bay leaf. Garnish with green onions.
Yield: 6 servings; Per 1 serving: 340 calories, 12gm total fat, 3gm saturated fat, 64mg cholesterol, 27gm protein, 32gm carbohydrate, 525mg sodium, 996mg potassium.
Lentil-Carrot-Corn Soup
from Omar Faruque of New York, NY
Ingredients:
1/3 cup dry lentils
¼ cup fresh carrots (peeled and chopped to small cubes)
¼ cup fresh corn
5 cups water
¼ medium onion, chopped
1 clove garlic, finely chopped
1 tsp. fresh ginger, peeled and finely chopped
1 tbsp. vegetable oil
1 tsp. butter
¼ tsp. (or less) turmeric powder (mixed in water)
Wash the lentils, add 5 cups of water and a little salt, bring to boil, reduce heat. Remove the froth at the top of the lentils with a spoon, then add the turmeric water, then the oil. Simmer for 30 minutes, then mix with a hand mixer to dissolve the lentils. Add carrots, corn, onion, garlic, and ginger; simmer for another 20 minutes, stirring occasionally. Add the butter a few minutes before completion. Serve hot; use black pepper or other seasonings to taste.
Yield: 3 servings; per serving: 140 calories, 6gm protein, 7gm fat, 14gm carbohydrate, 0.4gm fiber.
Lentil-Flour Pan Cake (Dal-Puri)
from Omar Faruque of New York, NY
Ingredients:
1/8 cup lentils
1 cup all-purpose flour
¼ small onion, finely chopped
8 tsp. vegetable oil
¼ tsp. (or less) of ground spices including ginger and
garlic, mixed in a little water
1 cup water
Wash the lentils and place in a non-stick pot. Add the cup of water; salt; bring to a boil. Reduce heat, spoon off the froth at the top, then add the spice water and the onion. Simmer uncovered for ½ hour or more; stir occasionally; remove from heat when lentils are soft and pasty. Make a dough of the flour (lightly salted), and make 4 balls; then make a hole in each dough-ball and insert ¼ of the lentil-paste in each. Cover the hole so the lentil-paste cannot come out again. Roll it round with a roller (generally 4 to 5 inches in diameter); fry both sides in a non-stick pan, using 2 tsp. of oil. Use low heat; periodically press down on the sides of the cake, to counteract curling. Serve lukewarm; relish with ketchup.
Yield: 4 servings; Per Serving: 210 calories, 4.5gm protein, 10gm fat, 25gm carbohydrate, 0.8gm fiber.
What
You Always Wanted To Know But Didn't Know Where To Ask
(Resource Column)
Inclusion of materials in this publication is for information only and does not imply endorsement by the Diabetes Action Network of the NFB.
Skin Care Products
From the Editor: MI FINE SKIN is a line of skin care products of interest to diabetics. The line includes a cream, a lotion, and a soap-free cleanser, all appropriate for the dry skin we face as a consequence of our diabetes. I've used the lotion and the cream, and highly approve of them both. The cream is especially appropriate for our dry feet, and has been endorsed by diabetes educators and podiatrists as appropriate for diabetic foot care (a useful "diabetic foot care" pamphlet is furnished with the cream). I tried the cream on my feet; it's not greasy, and it works!
The soap-free cleanser comes in two varieties: "for normal, dry, or sensitive skin" (16 oz. bottle) and "for oily skin" (8 oz. bottle). The face and body lotion comes in an 8 oz. bottle, and the cream is packed in a 4 oz. jar.
FREE SAMPLES OF THE CREAM AND LOTION ARE AVAILABLE.
For information, or to obtain a free sample, contact: MI SKIN, INC., 3645 Warrensville Center Road, Suite 321, Shaker Heights, OH 44122; telephone: 1-800-754-6066.
Diabetes Supplies
If you are looking for a by-mail source for your diabetes equipment and supplies, check out Medi-Mail, Inc. Because it is small, Medimail is able to offer a high level of customer service. They bill Medicare and secondary insurance carriers, accept assignment, and stock difficult-to-find items like Diascan test strips. They also carry diabetes literature and information, and all their employees have received instruction from diabetes educators. For information, contact: Medi-Mail, Inc., 1594 Northgate Drive, Naples, FL 33942; telephone: 1-800-883-9146.
Computer Equipment
Aicom Corporation of San Jose, CA, offers three models of the Accent text-to-speech synthesizer, a device that converts text on your computer screen to speech. It has a vocabulary of over 20,000 words. The models include a full-length PC plug-in card for IBM-PC compatibles ($595), a stand-alone unit with RS-232C link to any computer ($795), or the Messenger-IC PCMCIA Type II ($995), as well as others. The Accent is supported by all major screen-reader programs. For further information contact: Aicom Corporation, 2381 Zanker Road, Suite 160, San Jose, CA 95131; telephone: (408) 577-0370; fax: (408) 577-0373.
Diabetes Educators
The American Association of Diabetes Educators (AADE) maintains a list of Certified Diabetes Educators in different parts of the country. To find a diabetes educator near you, call: 1-800-832-6874.
Diabetes Supplies by Mail
HHCS Pharmacy, a division of HHCS Health Group, provides nationwide delivery of diabetes medications, supplies, and equipment. They offer monthly shipments, refill service, patient/medication profiles, and 24 hour consultation. They offer payment programs and direct billing to third parties, and accept Medicare, Medicaid, and most private insurance. They include a free bottle of multi-vitamins with each monthly order.
For information, contact: HHCS Pharmacy, Inc., 633 East Colonial Drive, Orlando, FL 32806; telephone: 1-800-741-4427.
Diabetes Supplies
Can-Am Corporation carries a full line of diabetes supplies, including: test strips, Dex-4 glucose tablets, skin cream, etc. 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.
For information, contact: Can-Am Care Corporation, Cimetra Industrial Park, Box 98, Chazy, NY 12921-0098; telephone: 1-800-461-7448.
New Cookbook?
The Diabetes Action Network might publish a cookbook. Would you be interested? Tentatively, it would be quite lengthy, would be published in large print, Braille, audio cassette, and IBM computer disk. It might cost as much as $25. All recipes would be "ready to go," with content/meal plan information attached.
Should we proceed? What advice can you offer? Which format(s) would you want? Drop us a note at the VOICE office, 811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911.
New Diabetes Books
The American Diabetes Association has published two new books. "Reflections on Diabetes" is a 121-page motivational collection of 39 real-life stories about coping with the disease and its ramifications, drawn from the pages of "Diabetes Forecast" magazine. "Diabetes A to Z" is a dictionary-style quick reference covering aspects of the disease, terms and areas of interest. Many items are discussed, from alcohol to blood glucose, to exercise, foot care, high blood pressure, vegetarian diets, and your health care team. It covers a lot of territory in 195 pages. The books are priced at $9.95 each, and are available from:
American Diabetes Association, 1660 Duke Street, Alexandria, VA 22314; telephone: 1-800-232-6733.
NFB on the Internet
The National Federation of the Blind has a homepage on the World Wide Web. At this website you can learn more about our organization and its services, or review our national publications. From the homepage, you can also access VOICE OF THE DIABETIC.
To get to the NFB homepage, enter the following address at the "URL" prompt: http://www.nfb.org. To reach the VOICE from the NFB homepage, follow the link for "diabetes," and then the link for "VOICE OF THE DIABETIC."
WINDOWS Screen Reader
GW Micro has developed "WINDOW-EYES," a screen reader for Microsoft WINDOWS. Once equipped with a voice synthesizer such as the Dectalk (your CD-ROM soundcard won't do), any computer that can run WINDOWS can run WINDOW-EYES.
The WINDOW-EYES program costs $495, and is available from: GW Micro, 310 Racquet Street, Fort Wayne, IN 46825; telephone: (219) 483-3625.
New 1995 Food Exchange List
The new 1995 "Exchange Lists for Meal Planning" is now available in Braille (74 pages) and on audio cassette.
This update, the result of a joint effort of the American Diabetes Association and the American Dietetic Association, reflects the new emphasis on total carbohydrate intake, rather than restricting specific sugar types. Users should find its new orientation simpler, and its meal plans vastly more flexible. In its new form, the Exchange List will continue to play a pivotal role in dietary self-management of diabetes.
To purchase, make tax deductible checks payable to: National Federation of the Blind. Cost: Braille $10, cassette $2. Order from: National Federation of the Blind, Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314.
Greeting Cards
The Iffin Group, a North Carolina-based graphic design studio, has just released a series of greeting cards for the blind and their families and friends. Created by blind artist Mickey Cabe, the cards, called "hAndrew," have both visual and embossed elements. The cards, which cover a range of selections, have verses printed in both Braille and ink. More cards will be available in the near future. For information, contact: The Iffin Group, PO Box 8847, Asheville, NC 28814; telephone: (704) 684-6176.
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.
Oral Insulin Study
Researchers at Joslin Diabetes Center are about to commence a trial of oral insulin, not to control blood glucose (orally-administered insulin can't), but to slow or halt the autoimmune attack that produces type I diabetes. Part of the Diabetes Prevention Trial-Type I, this study will attempt to build "oral tolerance" and thus decrease the destruction of pancreatic islet cells by misguided autoimmune attack.
Participants, individuals who have not yet developed type I diabetes but are considered at high risk, will be divided into three groups. One group will receive the oral insulin pills, another will receive insulin injections, and the third group will be given a placebo. This will be a "double-blind study," meaning neither participants nor their physicians will know which group is receiving the placebo.
The test will take three to five years. For information, or to find out about participating in this research, contact: National DPT-1 Operations Coordinating Center, PO Box 016960 (D-110), Miami, FL 33101; telephone: 1-800-415-8361.
"Borderline" Diabetics
In the past, many people with elevated blood glucose were told they were "borderline diabetics." Their numbers were high, but not enough, in their doctors' judgement, to justify insulin or oral diabetes medications.
Diabetes specialists do not use that term anymore. Taking into account the progressive nature of the condition (the tendency of an impaired pancreas to worsen through time), diabetologists recognize those once tagged "borderline" as indeed diabetics, but in early stages of the disease.
It is hoped this change in terminology will inspire those so described, for whom it is never too early to lose weight, watch diet, and start an exercise program.
Talk to Your Computer
While adaptive computers for the blind offer voice output, speaking what would otherwise be presented on screen, there are also computerized dictation-takers, programs that allow your computer to carry out its functions in response to voice input, your spoken command. With these programs, and hardware already standard in many computers configured for Windows-95, you can enter dictation, send e-mail, access databases, or perform computer operations, by telling your computer to do it.
Several firms offer such programs, but one that comes highly recommended is DRAGON DICTATE, from Dragon Systems, Inc. Available in three sizes (small, medium, or large vocabulary), the program makes use of Artificial Intelligence (AI) to "learn" your speech patterns, and then react to your commands as it would react to mouse or keyboard. For information contact: Dragon Systems, Inc., 320 Nevada Street, Newton, MA 02160; telephone: 1-800-825-5897; fax: (617) 965-5200; E-mail: info@dragonsys.com, or on the World Wide Web at: http://www.dragonsys.com.
Can You Believe It?
Is nothing sacred? A recent study in the "Annals of Emergency Medicine" found that doctors, nurses, and emergency workers, so careful about antibiotics, antiseptics and sterile procedures, were often spreading infection—with dirty stethoscopes! Study participants were asked how often they cleaned their stethoscopes (7% of participants had never cleaned them; only 48% cleaned them once a day), then bacteria cultures were taken off the 'scopes. One hundred thirty-three (of 150) 'scopes grew Staphylococcus, making the stethoscope "therefore a potential vector of infection."
Articles Needed
If you have diabetes, are a family member or friend of a diabetic, or a health professional with an interest in diabetes, we invite you to submit an article for publication in the VOICE OF THE DIABETIC.
Our philosophy regarding diabetes is positive. Do you have an inspiring, enlightening story? We, the Diabetes Action Network of the National Federation of the Blind, seek to show people they are not alone, and do have options, regardless of diabetic complications. If you have experienced ramifications, others, who may be facing the same side effects, could benefit from what you have to say.
Perhaps you have not experienced side effects—your unique insight, coping strategies, and lifestyle can still inspire others. Are you a relative, a friend, or a health professional? More than 172,000 VOICE readers could benefit from your story.
For information and article submission guidelines, contact: VOICE OF THE DIABETIC, 811 Cherry St., Suite 309, Columbia, MO 65201; telephone: (573) 875-8911.
Talking Merchandise
We have been asked to announce: "Speak To Me," a merchandiser of useful, esoteric, and humorous items, all of which feature synthesized speech, now offers their Fall/Winter 1996 catalog. Included are talking holiday items, singing and talking greeting cards, children's items, talking gags, and useful items like talking clocks, watches, calculators, caller IDs, and even a talking bread machine. For a catalog, in print, cassette, or IBM computer disk, contact: Speak To Me!, 17913 108th Ave SE, Suite 155, Renton, WA 98005; telephone: 1-800-248-9965.
New Braille Computer
We have been asked to announce: Blazie Engineering announces the availability of the Braille Lite 40, a new, lightweight, fully portable "personal data assistant" for the blind and visually-impaired. Weighing about two pounds, with batteries, the Braille Lite 40 features a Braille keyboard, voice output, and 40-cell refreshable Braille display. Both tactile and audio feedback are simultaneously available. Operation is similar to that of Blazie's Braille'n Speak, but the new machine offers a host of features, and is available in 14 different language configurations. For information contact: Blazie Engineering, 105 E. Jarretsville Road, Forest Hill, MD 21050; telephone: 410-893-9333.
For Sale
Diascan SVM talking glucometer, $250 or best offer. Contact: Mary Hurt, 624 Royer Court, Louisville, KY 40206; telephone: (502) 897-7420.
To Our Readers
To hold down costs, both the VOICE and many of our divisional mailings are sent via "bulk mail." When we have your current address, this works very well, but when we don't, the Post Office throws it away, or returns it to us with a hefty "postage due" attached. They do NOT automatically forward bulk mail!
If you move, please let us know promptly. If the VOICE doesn't follow you to your new address, we may not have your new address. Don't miss a single issue.
Pedorthics Meeting
We have been asked to announce: The Pedorthic Footwear Association, a non-profit group of individuals and companies in the field of pedorthics (the fabricating and fitting of therapeutic footwear) will hold its 38th annual symposium and exposition November 14-17 in San Antonio, Texas.
The theme of this year's meeting is "State-of-the-Art Pedorthics: Materials and Technology." Symposium sessions will explore gait-related changes, pathologies and technologies, closed kinetic ambulation, computer and video gait analysis, foot pressure measurements, physical properties of footwear, and relevant resources on the Internet. In addition, there will be a 3-day exhibition of pedorthic products and equipment, featuring goods available from more than 60 major manufacturers.
To register, or for further information, contact: Pedorthic Footwear Association, 9861 Broken Land Parkway, Suite 255, Columbia, MD 21046-1151; telephone: 1-800-673-8447.
Noninvasive A1c Test
SpectRX, of Norcross, Georgia, working in conjunction with scientists at the U.S. Department of Energy's research facility at Oak Ridge, Tennessee, is developing a noninvasive A1c test. Not yet approved by the FDA, this test will utilize a beam of light reflected from the retina. Changes in the character of the light reflect alterations in the chemical make-up of the eye, many caused by glucose level. The new test should take less than a second. SpectRX hopes to have the new test available to physicians sometime in 1997, pending FDA approval of the device. Stay tuned; the A1c test could get a lot easier!
For Sale
Closed circuit TV/magnifier (1993 model), Telesensory Chroma CCD, Excellent condition, price: $1500 or best offer. Contact: Tammy Cowley, D&H Machinery, Inc., 7247 West Central Avenue, Toledo, OH 43617; telephone: (419) 841-3586.
Participants Needed
The Miami Diabetes Research Institute is conducting a study to test whether bone marrow infusions given with pancreatic islet cells (both from the same donor) can survive without traditional immunosuppressant medications. The biggest barrier to transplantation of healthy islet cells into the pancreas of a diabetic has been rejection, the immune system's destruction of foreign tissues. Successful islet transplantation would be a big step toward a cure.
To be eligible, you must be between 18 and 50, have had insulin-dependent diabetes for more than five years, have very poorly controlled diabetes, demonstrate therapeutic failure despite state-of-the-art management, have been under the care of an endocrinologist for at least six months prior to the test, and meet other physical requirements. For information, call the Miami Diabetes Center; telephone: (305) 243-5557.
Infection and Hyperglycemia
If you use insulin, and you "catch a cold," or sinusitis, or bronchitis, or some other infection, that infection is stressful, and can cause your blood sugar to rise. You'll see this when you monitor. Hyperglycemia, high blood sugar, promotes infection, and, if above 240 mg/dl, can interfere with your body's immune response, making it still harder to get rid of that cold. It won't cure the common cold, but if on "sick days" you monitor extra-carefully, and adjust your insulin accordingly, increasing the dose if needed, it'll help you get well faster. Remember to talk to your doctor about insulin adjustment.
Pamphlet in Spanish
We have been asked to announce: The Lighthouse, Inc., has published "La diabetes, la perdida de la vista y la vejez," a Spanish-language version of its pamphlet "Diabetes, Vision Loss, and Aging." The pamphlet features clear, illustrated descriptions of major visual complications of diabetes, and a somewhat dated discussion of adaptive equipment and where to find it. It is good to see an increase in Spanish-language diabetes information, but the text could have been more up to date.
Single copies, in English or Spanish, are free; multiple copies are $.50 each, and can be obtained from: The Lighthouse, Publications Department, 36-20 Northern Blvd., Long Island City, NY 11101; telephone: 1-800-334-5497.
Catalog for the Blind
We have been asked to announce: Easier Ways, Inc., offers their catalog of items for the blind. The catalog is available free, in print, on 15/16 ips cassette, and computer disk. It is also available in Braille, for a $10 yearly subscription (three catalogs).
Featured are tactile games, recorders and text readers, adaptive household and kitchen products, and products for personal care and security. For more information, or to receive their catalog, contact: Easier Ways, Inc., 1049 Rock Hill Avenue, Baltimore, MD 21229-5134; telephone: (410) 644-4100.
Braille Books
We have been asked to announce: As part of its "Century Series," the American Printing House for the Blind now offers for private sale some of the same Braille titles it produces for the National Library Service (NLS). The books are "over-runs" of NLS titles, and in all respects identical to NLS circulating material. The catalog runs the gamut, from children's books to adult fiction, children's and youth non-fiction, travel/access guides and motivational books. For information, contact: American Printing House for the Blind, PO Box 6085, Louisville, KY 40206-0085; telephone: 1-800-572-0844.
Bible on Cassette
We have been asked to announce: The Aurora Ministries Bible Alliance offers Bible tapes, without charge, to persons who are legally blind or print handicapped. Forty-five different languages are currently offered, from Amharic to Zande, and the service is without charge to anyone who meets the criteria set up by the National Library Service for the Blind and Physically Handicapped. For information, contact: Aurora Ministries Bible Alliance, PO Box 621, Bradenton, FL 34206; telephone: (941) 748-3031.
No Blood Spots
It happens. You're out in public, at a restaurant maybe, and its time to inject. You stick the needle through your shirt, and in goes the insulin, but when you pull the needle out, you get a blood spot. How do you keep from ruining your clothes?
There are a number of ways to deal with this. The simplest two are: Inject through pants/slacks instead, or pull your shirt aside and inject to skin. You could put a band-aid over the injection site in advance, then inject right through the middle of the pad (it'll work), or you can press down on the injection site as soon as you withdraw, helping the blood to clot properly and not stain your shirt.
If you do stain your shirt, don't dispair. Cold water may wash it out, and hydrogen peroxide may shift the stain. A number of advanced commercial stain removers claim the ability to remove bloodstains.
VOICE Distributors Needed
Since the VOICE is now offered free, our Diabetes Action Network will provide extra copies to anyone wanting to help spread the word. We will gladly send from five to five hundred-plus copies each quarter to be used as free literature. Medical facilities can order as needed for patients. Individuals can usually place copies of the VOICE in libraries, pharmacies, hospitals, doctors' offices, or other public locations.
Diabetes education is essential. Anyone who distributes the VOICE will be helping people with diabetes, and their families, to learn about the disease and its ramifications; to learn that they have options; and that their world is far greater than whatever "limits" may be imposed by the disease. If you would like to help spread the word by distributing the publication, please contact:
Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; Phone: (573) 875-8911.
Updated: December 26, 2001