A Support and Information Network
The Diabetics Division
of the National Federation of the Blind
Volume 11, No. 2, Spring Edition 1996
The VOICE OF THE DIABETIC, published quarterly, is the national news magazine of the Diabetics Division of the National Federation of the Blind. It is read by those interested in all aspects of blindness and diabetes. We show diabetics that they have options regardless of the ramifications they may have had. We have a positive philosophy and know that positive attitudes are contagious. News items, change of address notices, and other magazine correspondence should be sent to: Ed Bryant, Editor, Voice of the Diabetic, 811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911.
Copyright © 1996 The Diabetics Division, National Federation of the Blind. ISSN 1041-8490
On January 8, 1996, the VOICE OF THE DIABETIC Editorial Office got a new area code! To call us, you will dial (573) 875-8911. Our old (314) area code is being replaced.
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 of this file, and mail it to the editorial office.
Dad
by Annette M. Krupper, MLS
Talking Blood Glucose Monitoring Systems
by Ed Bryant
Glucose Meter "Shell Game"
by Daniel L. Lorber, M.D.
Ask the Doctor
by Wesley W. Wilson, M.D.
Social Security and SSI Facts for 1996
by James Gashel
Insulin Vials With Tactile Markings Discussed
at FDA Headquarters
by Ed Bryant
A Look Back: Diabetes Then and Now
by Peter J. Nebergall, PhD
Noninvasive Glucometer Flunks Its Exam
In Sickness and in Health
by Maile George Lipe
Dialogues About Diabetic Dynamos
by Debra Frank, MS, MS
Volunteers Needed for Research Studies
Convention 1996: We go to Anaheim
by Kenneth Jernigan
Dialysis at National Convention
Dental Care for People With Diabetes
by R. Keith Campbell, RPh, FASHP, FAPP, CDE
About the New Nutritional Guidelines
by Davida F. Kruger, MSN, RN, C, CDE
What You Always Wanted to Know But Didn't
Know Where to Ask
(Resource Column)
by Annette M. Krupper, MLS
My dad had diabetes for as long as I can remember. Diabetes makes people change their lifestyles, but my dad made managing diabetes a way of life. As I look back on our times together, it seems he made watching his diet and exercise so "second nature," so much a part of his normal routine, that sometimes we forgot his diabetes! A non-insulin-dependent diabetic, he was on the oral medication diabinase, a sulfonylurea. His medication stimulated his pancreas to produce sufficient insulin. But there were other things he did. I remember the diet his doctor gave him, with the exchanges, posted on the refrigerator door. Several times I went on the diet with him, and while I was on the diet, I felt better than ever before. But I was not as diligent as he was—after all, I wasn't a diabetic!
My mom was cooperative in what she cooked, and Dad didn't have to refuse many of her foods, but I do remember him skipping mashed potatoes, and choosing Jello instead of cake. Mom would bake special apple or berry pies with sweetener instead of sugar for him. After a while, we all got used to eating less sugar, and these were the only pies she baked! We appreciated what Dad chose to eat, and didn't link it with "him being a diabetic."
Exercise was not a regimented routine of sit-ups, running, or jogging. Dad was not one for formal exercise. Every summer there was the garden to hoe, and then the tomatoes, peppers, cucumbers and zucchinis to plant. During the summer there was the weeding of the garden, the grass to cut, and then the harvesting of vegetables. We used to fight over who would get the first ripe tomato!
In the fall, there were the wild edible mushrooms, such as sheepshead, and the little brown mushrooms to pick in the moist dark woods around our house. When winter came, there was the driveway to shovel, wood to chop for the fireplace, or coal to shovel into the coal bin for the furnace. In the spring, Dad would go out to pick wildflowers, or raspberries and blackberries for my mom's sugar-free homemade pies. If he felt the need for further exercise, he would just go for walks, exploring the woods and countryside around our town's valley. It was like a treasure hunt—we never knew what he was going to find and bring home, from an old Spanish coin found at the roadside, to an old medicine bottle from a long-past medicine show.
My father's example has shown me that diabetes is not something that needs to control your life. Once you accept it, and work what you need to do into the fabric of your life, you can learn to cope with it. With creativity and soul-searching, you can find ways to include exercise in your daily routine. I don't want to portray Dad as "perfect"—he did occasionally stray from his diet, but he usually compensated by eating less carbohydrates at the next meal. He was aware of the foods he ate, and what they could do to his blood sugars, even though testing was done with urine and test-tape, not a glucometer.
I feel privileged to have had such a fine example of how to take care of yourself with diabetes. I am especially glad, because two years ago I too was diagnosed with NIDDM. Following in my father's footsteps, I am currently working on my own enjoyable daily routine and good eating habits; like Dad, making diabetes management a part of my life.
From the Editor: Ms. Krupper dedicates this article to the memory of her father, the late Joseph J. Krupper, Sr., who set a fine example of diabetes self-management. How many of us give thought to the examples WE set for our children and grandchildren?
by Ed Bryant
As editor of VOICE OF THE DIABETIC, I am often asked about the relative strengths and weaknesses of the various glucometers with voice enunciation available today. There is no "best" talking glucometer; there is no one blood glucose monitoring system ideal for everyone. Features, prices, convenience, and clarity of instructions vary, and newequipment periodically appears.
Although many companies make blood glucose monitors, and some glucometers display their results in large print, only three currently available meters allow voice enunciation, in which the device's voice synthesizer "speaks" the glucometer's instructions and test results.
The meter most often adapted to voice enunciation is the now-discontinued LifeScan One Touch II. Although LifeScan, Inc., of Milpitas, CA, the manufacturer, has ceased production, thousands remain on dealer shelves, and it is a proven and reliable piece of equipment. The "voice boxes," small synthesizer modules that plug into the glucometer and give it voice, are not made by LifeScan, but by several competing firms, described below.
LifeScan's new glucometer, the One Touch Profile, is a refinement of the One Touch II, and the two meters have much in common. The Profile is slightly smaller, but its angled display screen is more than twice as large, (though the extra space is used to convey more information, not larger numerals).
Both meters use the same procedures, the same test strips, and feature the same detachable test strip holder. Both meters are equally accurate, but the Profile, with its vastly expanded memory, allows its user to store up to 250 test records with date and time, to record insulin types and dosages with time and date, to insert "event markers" to help track the impact of specific activities on blood glucose levels, to compute test averages for the past 14 or 30 days, and many other features. To achieve these "bells and whistles," it is electronically more complex than its predecessor, so much so that voice synthesizers designed for the One Touch II will not operate with the Profile.
Although LifeScan once regularly supplied aninstructional cassette with the One Touch II (still available upon request, from LifeScan: 1-800-227-8862), it makes no use of tactile landmarks, and is of little utility to the blind. No cassette is offered with the Profile. There is real need for an adaptive instructional audiocassette designed for blind users of the LifeScan Glucometers. Several manufacturers have been producing voice synthesizer units for the One Touch II, and now offer updated versions of their voice boxes, for use with the Profile.
Talking Glucometers and Voice Boxes
1.) The Voice-Touch speech synthesizers, for the LifeScan One Touch II or LifeScan Profile: Technology For Independence, Inc. (TFI), 529 Main Street, The Schrafft Center—Annex, Boston, MA 02129; telephone: 1-800-331-8255, or (617) 242-7007.
TFI makes a pair of light, compact, convenient, and reliable glucometer speech modules. The two models are not interchangeable. The Voice-Touch modules clamp firmly to the glucometer, adding little bulk, and forming a single reliable unit. There are no separate switches to remember; the modules operate off the controls of the LifeScan glucometer. A switch allows the user to choose male or female voice enunciation. A Spanish-speaking Voice-Touch for the One Touch II is now available; other languages are promised.
TFI offers the Voice-Touch speech synthesizers for $189, the LifeScan meters alone for $135, or the combination for $324. An optional AC adapter is offered for $12. TFI says their new instructional cassette, in production at press time, will explain both voice box and Profile meter. Their cassette for the One Touch II's synthesizer clearly explains the speech module, but does not describe operation of the LifeScan glucometer.
The LifeScan One Touch II meter and Voice-Touch speech synthesizer are also offered by the National Federation of the Blind (NFB), Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314. The NFB offers the combination (meter plus voice module) for $309 (the lowest price for a talking glucometer in the U.S.), the voice module alone for $189, or the glucometer alone for $120. An optional AC adapter costs $11.
2.) The Digi-Voice modules: Science Products, Box 888, Southeastern, PA 19399; telephone: 1-800-888-7400. Science Products makes several versions of their robust and reliable Digi-Voice speech module. The Digi-Voice Deluxe functions with the LifeScan One Touch II, as does one version of their smaller Mini Digi-Voice. Another version of the Mini Digi-Voice operates with the Profile. Voice boxes designed for the One Touch II will not operate with the Profile, and vice versa! The Digi-Voice modules connect to the glucometer by a 22-inch patch cord, providing audio output for the meter.
Controls are simple; on the Deluxe a volume control knob and a toggle switch run the voice synthesizer, separate from the glucometer's controls. The Mini's single button both turns on the voice box and adjusts the volume control, again, separate from the glucometer's controls. Readings are announced in a clear, somewhat military, male voice. Clear and thorough cassette instructions explain both voice box and Profile glucometer [Science Products' instructional cassettes do not cover operation of the One Touch II glucometer]. Science Products sells the Digi-Voice Deluxe module alone for $275 ($395 with glucometer), and the Mini Digi-Voice modules alone for $199 (9-volt battery) or $219 (with ac adapter), or for $319 and $339 respectively, with glucometer.
3.) The Touch-N-Talk voice synthesizer units: Lighthouse Consumer Products, 36-02 Northern Boulevard, Long Island City, NY 11101-1614; telephone: 1-800-829-0500. The Touch-N-Talk II voice synthesizer operates with the LifeScan One Touch II meter, and the Touch-N-Talk P voice box works with the Lifescan Profile. Again, the two units are NOT interchangeable; voice boxes designed for the One Touch II will not work with the Profile! Meter and voice synthesizer join by a 12-inch patch cord. A brief instructional cassette is included. The unit uses one 9-volt alkaline battery, not included. An AC adapter is available at an additional cost of $11.95.
Perhaps in the interest of engineering simplicity, the Touch-N-Talk units have simple on-off switches and traditional volume controls. These voice boxes lack any provision for automatic shutoff, and if you forget to turn them off, you can run down your battery. The Lighthouse sells the Touch-N-Talk voice synthesizers for $219.95. They sell the LifeScan meters for $149.95, or the combination for $369.90.
4.) The LHS7 Module, a new voice box for the LifeScan Profile: LS&S Group, P.O. Box 673, Northbrook, IL 60065; telephone: 1-800-468-4789. The small and light LHS7 attaches to the bottom of the Profile glucometer by means of a velcro patch, and operates through the glucometer's controls. Two-position volume control (loud-soft); AC adapter included in purchase price. English-language voice only; no audiocassette instructions are provided. Cost $199.
5.) The Diascan Partner talking glucometer: Home Diagnostics, Inc., 2300 NW 55th Court, Suite 110, Ft. Lauderdale, FL 33309; telephone: 1-800-342-7226. The Diascan Partner is unique in that its voice synthesizer is internal, part of the glucometer. There is no separate speech module to attach or cords to plug in. This slim, "user friendly" unit allows somewhat more leeway in application of blood to test strip—with care, blood may be "painted" onto the strip; all other speech assisted units require a hanging drop of blood. Powered by two AA batteries; weight approximately eight ounces. Some individuals with limited dexterity may find the Partner difficult to operate, as its test strips are designed to receive the blood outside the machine, on a flat surface like a table, so there is no strip guide to aid correct finger placement. Others may appreciate this feature, as it allows movement of strip to sample site, where others require movement of sample site to glucometer. An over-the-shoulder tote bag with adjustable straps is included. An easy-to-understand audiocassette with clear operating instructions is also supplied. Suggested retail price is $399.
Medicare
Medicare recognizes glucometers as "Durable Medical Equipment," and coverage is provided, for insulin-using diabetics, under Medicare Part B. Glucometers without audio output have one specification on the "Fee Schedule" (EO607), and glucometers with voice synthesis, or add-on voice boxes for home blood glucose monitors, have another (EO609). Be sure to follow all guidelines for reimbursement.
Hints and Tips
If an insufficient amount of blood is placed on the test strip, the glucometers will indicate "not enough blood." You may even have to prick your finger again! There are several possible explanations for this frustrating occurrence:
A. The initial drop of blood was too small: Some folks don't bleed enough. They can get more blood by holding hands below waist level for about 15 seconds, shaking them, and/or washing/soaking hands in warm water for a few minutes before the test. Warm water stimulates the flow of blood to the fingers. A slightly longer lancet, with deeper penetration, may help some. "Milking the finger" (squeezing it gently) can also help, as can wrapping a doubled rubber band between the first and second joint of the finger to be lanced. This will help cause the finger to become engorged with blood. Hold the rubber band down with the thumb while lancing. Remove the band as soon as you lance.
B. There may have been enough blood, but it was placed onto the wrong part of the test strip: Some folks bleed fast, and may lose the blood off the finger before they're ready. By the time they get finger to test strip, the blood has fallen, in the wrong place. A fast bleeder needs to work closer to the test strip, and perhaps to employ one of the blood placement aids discussed in this article. Users of the Diascan Partner should try bending up the tail of the test strip as an aid to location and placement.
C. Some enthusiastic people, placing the blood on the strip, press down too hard and push the blood out of its correct position, squishing it onto the wrong part of the strip: It is best to very gently deposit a hanging drop of blood onto the test strip. Marla Bernbaum, MD, writing in "The ADEVIP Monitor," offered the following suggestion: "I have discovered another way to apply blood to the LifeScan test strip, which has been useful for several of our patients. This method allows them to stick the tip rather than the side of the finger. We use the same platform modification [described below], with a dot of Hi-Marks or t-shirt paint on each side of the strip guide near the depression where the blood is to be applied. For this approach the meter should be turned sideways. The patient can then place the pad of the finger on the raised dot perpendicular to the length of the strip and rock the finger forward so that the tip of the finger lines up with the depression on the strip and deposits the blood droplet in the appropriate place. This method increases the portion of the fingertip that can be used, and is preferable for some patients, particularly for those who bleed slowly and therefore must place the blood drop in precisely the right location."
LifeScan Modifications
If you use any of the LifeScan glucometers, some blood placement problems can be solved by modification of the Test Strip Holder (LifeScan Part #043-123, and note this same part fits all LifeScan glucometers). The idea is simply to provide tactile locating aids for finger location and placement of the blood sample on the test strip. A raised dot on either side of the test strip will work for some, but diabetics with limited sensation in the fingertips may find a U-shaped guide more useful. Most diabetics puncture the side of a fingertip, but those with severe neuropathy, who can't feel the lancet, and who prick the center of the fingertip, may be helped by the U-shaped guide. With practice, and the use of such tactile cues, blind diabetics can correctly place blood samples on the test strip.
(Editor's Note: Thanks to Ann S. Williams, MSN, RN, CDE, of the Cleveland Sight Center in Ohio, for providing me with the two modified LifeScan Test Strip Holders pictured in the photograph.)
The Test Strip Holder is detachable, and modifications as described will in no way interfere with the operation, accuracy, or cleaning of the LifeScan meter. LifeScan's Technical Services Dept. (phone: 1-800-227-8862) will provide a spare Test Strip Holder upon request, without charge. It is recommended that the modifications be to this spare. The dots and U-shaped ridge in the photograph were created with t-shirt paint, of the type that stands up sharply from a fabric surface. Upon application, the paint spreads a little, so apply sparingly. Best results come from "tack-painting," applying a small amount, then letting it dry (minimum 12 hours), with subsequent applications to build up the height. Practice first on some other material (posterboard or paper plate), as the paint can come out quickly. Be sure to have the Test Strip Holder OFF THE METER when applying the t-shirt paint. For best results, insert a test strip in the holder as an aid to placement of the dots or U-shaped ridge. T-shirt paint is inexpensive and is available at most craft and fabric stores. Although a full spectrum of colors is available, bright, contrasty colors like orange may aid in low vision situations. Brands and types vary; find one that gives you a nice hard tactile ridge. Some paints feel too rubbery. "Puffy paint" flakes off too easily. You may have to experiment.
Several vendors offer commercial alternatives to modifying the test strip holder. One slips over the LifeScan meter, and the other attaches directly to the test strip holder. Both aid proper finger placement, and serve to guide the drop of blood more surely to the test strip. Science Products (address above, telephone: 1-800-888-7400), makes the Sure Drop, which slips over the body of the meter. The special teflon-like coating on the surface of the device helps direct the blood, but can be damaged by bleach or hard brushing—clean with mild soap and warm water. A Sure Drop made for the One Touch II will not fit the Profile, and vice versa. The unit for the Profile appears well-made and easy to use. Both units are priced at $24.95 each.
Smart Dot, 2655 West Central Avenue, Toledo, OH 43606; telephone: 1-800-984-1137. The Smart Dot clips directly to the test strip holder of ANY LifeScan meter. The same device fits Basic, One Touch II, and Profile. This plastic platform is easy to clean (both devices should be cleaned before the blood dries) and convenient to use, but there have been cases of it detaching from the meter in mid-test. Don Kramolis and Gary Allman, Manual Skills Specialists at Blind Rehab Clinic, VAMC, Waco, Texas 76700; telephone: (817) 752-6581 ext. 7489, have developed the Waco-U-Finger Guide, which, like the Smart Dot, fits any LifeScan Meter.
Much like the t-shirt paint described above, the Waco Guide helps finger orientation. The guide's other features help tactile strip insertion. Its designers do not sell finished guides, but offer plans and advice to interested individuals. I have discussed the strengths and weaknesses of the blood glucose monitoring systems with voice enunciation currently manufactured. This evaluation should help blind diabetics and those losing vision, who are just as capable as the sighted of independently testing their blood glucose levels, and performing all the other tasks of daily diabetes self-management. Both blind and sighted diabetics are encouraged to consult with their health care team, and with individuals experienced in use of glucose monitoring equipment.
Choosing the most appropriate glucometer is an important step in diabetes self-management. As blind diabetics increase their participation in the mainstream, efficient glycemic control is needed, to maintain good quality of life. The Diabetics Division of the National Federation of the Blind, a support and information network, welcomes input on blood glucose testing.
NOTE: Article included photos of glucometers, voice synthesizers, and finger guides. Photos by Peter Nebergall.
by Daniel L. Lorber, M.D.
Dr. Lorber is Editor in Chief of "Practical Diabetology." The activities I describe in this editorial are completely within the law. Ethics are a different matter. John B., 70 years old, has insulin-requiring type II diabetes. He has been using the same blood glucose meter from Company A for several years. He is happy with it and we have cross-checked its accuracy against results from our laboratory. Mr. B. recently replied to a mail order flyer that promised: "Medicare assignment accepted... No out of pocket expenses for your diabetes supplies." Since John tests his blood glucose 20 to 30 times a week, this offer was quite attractive. So he replied.
The next offer was even better: "Free meter... We will send you a brand new, state-of-the-art meter for free. Just sign a Medicare form." This sounded even better. John was happy with his current blood glucose meter, but "free" was an offer he couldn't refuse. So he sent in the order and received his new meter by return mail. The new meter, made by Company B, is also one we recommend to patients. But, for some patients, we prefer Company A's meter and, for others, we prefer Company C's. In John's case, the visual backup provided by Company A's meter was an advantage we recommended. The meter from Company B was a good one, but it did not have a visual backup. Never mind, John was happy with his "free" meter. Imagine his consternation, then, when the Medicare Explanation of Benefits (EOB) arrived from the meter sales company. Medicare had been charged $200 for a meter that retails (before commonly offered discounts and rebates) for $80. As if that weren't bad enough, the finger-sticking device that is included in the $80 meter kit was billed toMedicare for an additional $25. All of this was perfectly legal. Our blood glucose meter prescription form didn't say "Dispense as Written" (it does now!) and the company was able to substitute one meter for another.
When John brought the EOB to our office, I couldn't figure out why the company switched meters on him. Both the Company A and Company B meters could be sold for the same exorbitant price; their wholesale prices were roughly equivalent. The answer was in the next shipment: generic reagent strips! The sales company had substituted generic reagent strips for the manufacturer's original strip. Of course, the bill to Medicare was the same high rate for both generic and brand-name strips. The issue of generic reagent strips is in litigation as I write this. Even if I accept generics as equivalent, I want the right to determine which my patient uses. We are all familiar with the issues concerning the prescription of generic medications, but how many of us write prescriptions for brand-specific reagent strips? Not only was Medicare legally ripped off for the cost of the blood glucose meter, but John was switched to a different meter and to generic reagent strips without his doctor's knowledge. As I read about the new Congress's plans to cut Medicare further and my state's plans to cut Medicaid, I know that they are talking about physician and hospital fees. The glucose meter suppliers have gotten away with our equivalent of the Air Force's $45,000 toilet. Medicare refuses to supply state-of-the-art glucose monitoring for patients with non-insulin-dependent diabetes who are treated with diet, exercise, and oral agents. And it harasses those who do use insulin with endless paperwork. For every insulin-treated person who buys a blood glucose meter through this "shell game," two people with diabetes who are not using insulin could get a meter as well. It's time to review our fiscally foolish policies about "Durable Medical Equipment" supplies. Then maybe we'll be able to afford more intensive diabetes care for all people with diabetes and really save money. (Note: This article appeared in "Practical Diabetology," March 1995. Reprinted with permission.)
by Wesley W. Wilson, M.D.
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: Many members of my family have diabetes and some are experiencing severe complications. Is it inevitable that I will do the same? (I'm 19.)
A: I suspect your family has type II diabetes, since type II diabetes tends to be a very strongly inherited disease. Despite your family history and despite the fact that there is a strong genetic factor in type II diabetes, I cannot answer your question with certainty, but I hope I can encourage you a bit. Type II diabetes does tend to be inherited, probably part of a cluster of abnormalities inherited together, including a tendency to be overweight, and resistance to insulin's action, so that even if insulin is present, its action is blunted or impaired. Frequently included in this "package" is an abnormality of lipid metabolism, bearing elevated cholesterol or triglyceride and increased risk of circulatory problems.
Your question pinpoints a puzzle for diabetes researchers. Can type II diabetes be prevented or significantly delayed? We know that anything that improves insulin action or insulin sensitivity can delay the onset of clinical (diagnosable) diabetes. Maintaining an ideal weight is not easy, especially for a person who has inherited a tendency to gain excessive weight, but maintaining an ideal weight certainly can delay, and may in some cases prevent, the onset of type II diabetes. You can best approach this goal with careful diet and active physical exercise, such as the program developed by the American Diabetes Association. To deal with your question more directly, it is a good idea for you to exercise regularly, maintain your ideal weight, and work to avoid fats in your diet. This last will help control any tendency toward lipid abnormalities you may have inherited. Keep your cholesterol level down, and watch your blood pressure; these will help too. There is a test underway, the Diabetes Prevention Trial Type II, and we must await its results to learn what other measures may be helpful for the prevention of type II diabetes. For now, the ones I have listed make the most sense.
If, despite your efforts to avoid it, you develop diabetes, remember complications can be reduced, sometimes avoided entirely, if you achieve and maintain good glycemic control. The Diabetes Control and Complications Trial (DCCT), a major study of type I diabetics, proved that maintaining a blood sugar as near normal as possible and a glycosylated hemoglobin (A1C) value as near normal as possible avoids or delays the onset of typical diabetes complications involving the eyes, kidneys, and nerve conduction. Although there were no absolutes (some DCCT participants did develop complications) the percentages were far better for those participants who practiced tight control than for those who did not. It seems safe to assume that careful control of blood sugar will reduce, delay, or prevent diabetic complications for type II diabetics in the same manner.
In summary, you may be able to prevent or delay the onset of diabetes by our old tried and true methods: weight control, exercise, and careful attention to diet. We now have new and effective ways to improve diabetes control. It can be a lot of work, but if you are unfortunate enough to develop type II diabetes, you can avoid, prevent, or delay its complications by controlling your blood sugars, cholesterol, blood pressure, weight, and exercise.
by James Gashel
(This article appeared in the January 1996 edition of the Braille Monitor, published by the National Federation of the Blind.)
From the Monitor Editor: Jim Gashel serves as Director of Governmental Affairs for the National Federation of the Blind. Here is his 1996 report on Social Security and Supplemental Security Income: The beginning of each year brings with it annual adjustments in Social Security programs. The changes include new tax rates, higher exempt earnings amounts, and cost-of-living increases. Each year we make an effort to report on these changes in the January issue of the Braille Monitor. This year is no exception. However, the budget controversy at the federal level has made it impossible this year to include information on the annual adjustments in the Medicare program. For that reason the Medicare changes will be reported later. Meanwhile, here are the new facts which we can report for 1996:
FICA and Self-Employment Tax Rates: The FICA tax rate for employees and their employers remains at 7.65 percent. This rate includes payments to the Old Age, Survivors, and Disability Insurance (OASDI) Trust Fund of 6.2 percent and an additional 1.45 percent payment to the Hospital Insurance (HI) Trust Fund, from which payments under Medicare are made. Self-employed persons continue to pay a Social Security tax of 15.3 percent. The self-employment tax rate of 15.3 percent includes 12.4 percent which is paid to the OASDI trust fund and 2.9 percent which is paid to the HI trust fund. Ceiling on Earnings Subject to Tax: During 1995 the ceiling on taxable earnings for contributions to the OASDI trust fund was $61,200. The taxable income ceiling for contributions to the OASDI trust fund during 1996 is $62,700.
As was true in 1995, there is no ceiling on earnings that are subject to the HI trust fund tax contribution of 1.45 percent for employees or 2.9 percent for self-employed persons. Quarters of Coverage: Eligibility for retirement, survivors, and disability insurance benefits is based in large part on the number of quarters of coverage earned by any individual during periods of work. Anyone may earn up to four quarters of coverage during a single year. During 1995 a Social Security quarter of coverage was credited for earnings of $630 in any calendar quarter. Anyone who earned $2,520 for the year (regardless of when the earnings occurred during the year) was given four quarters of coverage. In 1996 a Social Security quarter of coverage will be credited for earnings of $640 during a calendar quarter. Four quarters can be earned with annual earnings of $2,560.
Exempt Earnings: The earnings exemption for blind people receiving Social Security Disability Insurance (SSDI) benefits is the same as the exempt amount for individuals age 65 through 69 who receive Social Security retirement benefits. The monthly exempt amount in 1995 was $940 of gross earned income. During 1996 the exempt amount is $960. Technically, this exemption is referred to as an amount of monthly gross earnings which does not show "substantial gainful activity." Earnings of $960 or more per month before taxes for a blind SSDI beneficiary in 1996 will show substantial gainful activity after subtracting any unearned (or subsidy) income and applying any deductions for impairment-related work expenses.
Social Security Benefit Amounts for 1996: All Social Security benefits (including retirement, survivors, disability, and dependents' benefits) are increased by 2.6 percent beginning with the checks received in January, 1996.The exact dollar increase for any individual will depend upon the amount being paid. Standard SSI Benefit Increase: Beginning January, 1996, the federal payment amounts for SSI individuals and couples are as follows: individuals, $470 per month; couples, $705 per month. These amounts are increased from: individuals, $458 per month; couples, $687 per month.
by Ed Bryant
For almost five years, the Diabetics Division of the National Federation of the Blind has been agitating, lobbying, pressuring, and campaigning, making our voice heard about the need for modification in insulin vial packaging, so blind insulin-users could safely distinguish between insulin types. We are being heard; there are signs of real progress. Last October we met with the insulin manufacturers, regulators from the Food and Drug Administration, and other agencies and associations in the blindness and diabetes fields. At that meeting, held at FDA headquarters in Rockville, Maryland, we achieved a measure of consensus about the need for insulin vial reform. Participants agreed on the necessity for a long-term solution, and on the need for a short-term "temporary" fix while the specifics of such permanent solution are being worked out. Most of the October meeting was spent in informal exchange of ideas about specific proposals. Representatives from the insulin manufacturers agreed to investigate the feasibility of these proposals, and to report their findings at a return meeting, to be held at FDA headquarters in three months' time.
Winter intervened, and the January 1996 meeting never took place. We were rescheduled for April, allowing the manufacturers almost three more months to study proposals, and giving us time to come up with a few more of them. Shortly before the April 10 meeting, I circulated a memo (below) to all scheduled participants: The National Federation of the Blind, the American Association of Diabetes Educators, the Institute for Safe Medication Practice, the American Council of the Blind, the American Diabetes Association, the Juvenile Diabetes Foundation, The West Company, CCL Label, Inc., the Food and Drug Administration, Novo Nordisk Pharmaceuticals Inc., and Eli Lilly and Co.
Diabetics Division
National Federation of the Blind
Columbia, MO 65201
March 22, 1996
TO: FDA Meeting Participants
FROM: Ed Bryant
First Vice-President
SUBJECT: April 10, 1996 meeting
RE: Tactile Markings on Insulin Vials
At our last meeting on October 19, 1995, we achieved agreement on the need for nonvisual identification of insulin vials, so that blind diabetics might safely and reliably distinguish between their different insulin formulations and avoid dangerous dosing errors. A number of different ways to achieve tactile insulin identification have been proposed. Some were covered at the meeting; others have surfaced since. The manufacturers were to study whether specific proposals were technically achievable and financially reasonable. At the October meeting it was agreed to pursue a quick "temporary" solution while researching a viable permanent answer. Major changes (and the required FDA "stability tests" of those changes) might take years, and something was needed in the interim. Such solutions would mark the "R" or "fast-acting" insulins.
* Novo Nordisk has, in European distribution, a system of marking the aluminum stopper ring on its vials of "Actrapid" (fast-acting insulin) with a raised dot. This tactile landmark is not present on its other European insulin formulations, such as "Actraphane," and might furnish a minimal tactile solution to the problem at hand. Manufacturers were to investigate the feasibility of switching the stoppers of American insulin vials to European standards, and, hopefully, the feasibility of making the raised dot bigger and easier to detect without interfering with the use of tactile insulin measuring devices such as Jordan Medical's Count-a-Dose.
* Novo Nordisk also offered samples of insulin pens distinguished by a similar tactile dot. As with the tactile dot on the European "fast-acting" insulin vial, the proposal was a good idea, but too small for reliable identification, if neuropathy is present. Could the dot be enlarged? Lilly, now also making insulin pens, was to also examine possible tactile pen markings.
* The insulin manufacturers and the FDA discussed plans to standardize color-coding of insulin labels, and to make the identification letters: "R," "L," "N," or "U," as large and contrasty as possible. If the "R" were made sufficiently tactile as well, this would be an adequate temporary solution, as discussed above. Manufacturers were to investigate the feasibility of placing raised embossed markings on the label (the letter "R" or various dot patterns), as well as the durability of such markings.
* One proposal was to modify label size and shape, allowing an unglued flap to project free of the vial. Done on vials of "R" insulin only, the result would be an easy and reliable landmark.
* Another alternative brought up at the meeting was the application of a radial pattern of raised dots to the shoulder of the insulin vial. Applied as part of the vial manufacturing process, such might be a practical short-term solution.
* Several proposals for tactile markings have emerged since the October meeting. The simplest of these involves attaching a thin circular band of embossed tape (like Dymotape) around the vial, either above or below the label (with the vial resting on its base). This strip, attached as part of the labeling operation, would be embossed with appropriate tactile marks: dots, a continuous line, dashes, or no markings. Alternatively, the tape might be transparent, wider, and placed directly atop the label, with embossed symbols. Many items are Braille-labeled in exactly such manner.
* Another proposal involves a slight modification in vial-making procedure—although no change in vial shape. To manufacture vials, a long tube of hot glass is trimmed, like sausages, and then shaped appropriately. To receive its flat bottom, the hot vial is pressed against an anvil. This proposal would incise a tactile symbol on the anvil, so that its reverse would be printed on the bottom of each vial.
* On November 13, 1995, I forwarded the narrow tape, wide tape, and vial-anvil proposals to the insulin manufacturers and the FDA, for their consideration.
* On November 17, I sent details and an illustration of another proposal to the FDA and insulin manufacturers. This one involved a 3 x 3mm downward-projecting tab—a flanged extension of the vial's aluminum stopper ring. The resulting projection (on vials of "R" or fast-acting insulin) would be easily detectable, even by individuals with severe neuropathy. Such a tab would not interfere with use of tactile insulin measurement devices, would not modify vial shape or label, and should require only one modification on the assembly line, replacement of rotary roll-crimping by a squeeze-clamping operation. (The West Company, a new participant in these meetings, maker of aluminum stopper rings for Lilly, has already stated that the tab is not compatible with current crimping techniques.)
* A more recent proposal is to use nylon "cable-ties." One would go around the neck of the "R" insulin, like a dog collar. These permanent ties would not alter vial shape, label, or access to adaptive insulin measurement devices—and the cable-ties are inexpensive. There is little danger of the "dog-collar" coming off—it takes a razorblade to remove it. The 4-inch size (smallest available at the corner hardware store) was 100% successful with European-pattern vials, but slightly too large to allow U.S. vials to use the Count-a-Dose device. A smaller size cable tie should remedy this one objection.
As I have stated earlier, a successful proposal must be simple, reliable, durable, and universal. "Simple" means it must contain no more information than is necessary for insulin identification and successful diabetes self-management. "Reliable" means unambiguous—different users should achieve the same results. "Durable" means the tactile cues must survive for the life of the insulin in the vial. And finally "Universal" means that the system must be part of all insulin vials, not merely an extra-price aftermarket option. There are as many as two million blind diabetics in the U.S., and if they and the sighted are to benefit from a system such as we describe, it must be standard for all insulin vials.
We have taken major steps; we are part way to our goal. It is up to us, right here and right now, to go the distance. If we drop the ball now, everybody loses.
In our next issue, Volume 11, No. 3, of VOICE OF THE DIABETIC, we will review what took place at the April meeting. Hopefully, there will be breakthroughs, and we can turn from talking about a solution to implementation of a solution. The Diabetics Division of the National Federation of the Blind will continue to lead the way, and the VOICE will continue to keep you informed.
by Peter J. Nebergall, PhD
Although the Bible states that the years of a man shall be threescore and ten (70), average life expectancy in the ancient world was less than 40. Many died in infancy, or fell in battle. Diseases arising from poor sanitation, especially in the cities, took others. And then there was diabetes. In the superstitious tribal world where disease process was not understood, and was frequently blamed on hostile magic, a man who sickened and died without immediately obvious cause was considered a spiritual battle casualty—victim of the nearest hostile witch doctor. Retaliation, not further study, was the order of the day.
In most of the ancient world, the presence of debilitating disease was considered evidence of spiritual pollution. Disease came from sin, and diseased persons were to be shunned. The Biblical treatment of "leprosy" is one such example. It is interesting to note that modern "Hansen's Disease" (leprosy) is quite different from the ancient scourge. One wonders just what disease process the ancients were observing.
Individual physicians did record their observations. We have Egyptian documents (c 1500 BC) and Indian records (c 1000 BC). Hindu physicians Susruta and Charaka even described type I and type II diabetes, almost 3000 years ago! But these visionaries were battling the ethos of their time. For all the Egyptian physicians' skill with wound care and surgery, it was not until Classical Greece (550-300 BC) that the study of disease broke free of the constraints of religion. Greek physicians interpreted disease as "imbalance" rather than evidence of moral degeneracy. Freed from value judgement, they could study specific afflictions with clear eyes.
The great physicians' school at Kos, home of Hippocrates, taught that a healthy lifestyle, consisting of proper diet and plenty of exercise, was good therapy. It still is! Those diabetics who consulted Hippocrates and his fellows doubtless received some benefit. In 100 BC, Greek physician Aretaeus described the symptoms of diabetes in detail, and named the condition, from the word dia-bainein "to pass out" or "pass through."
Hellenistic and Roman physicians drew on the work of Greek masters, but, through time, the process of inquiry dwindled. Knowledge repeated too long without question becomes dogma, not science but an article of faith. The "dark ages" of medicine arrived even before the fall of Rome. In Medieval times, as in so much of the ancient world, the person with a disease was seen as a moral degenerate—someone needing expiation, remission, absolution, forgiveness—not someone whose body was simply malfunctioning. Since ill health was "evidence of moral imperfection,"families took pains to conceal their chronically ill or disabled members from public view. The word "idiot" comes from Greek otitic, meaning "something private." When the morality of the sufferer was automatically in question, rational inquiry was not likely. Not until the Renaissance would the lot of the diabetic improve.
Tracking diabetes in the Middle Ages is like navigating in a fog. There are tantalizing hints that the Anglo-Saxon Royal House of Wessex, the family of Alfred the Great, Athelstan, Edgar, and Edmund Ironside, was diabetic. All these great leaders sickened in their early thirties, dying shortly after. Chroniclers, who didn't recognize the cause, did make it clear the condition was inherited, and that each scion of the Royal family was watched closely as he approached the vulnerable age. The Renaissance brought renewed interest in medicine, and a return to the search for rational explanation of disease process. Although early studies focused on pestilence (plague, malaria, smallpox), understanding of diabetes improved as well.
In 1650, researcher Thomas Willis described the sweet taste of urine in people with diabetes. In 1750, a scientist named Cullen added mellitus, Greek for "honey-sweet," to the name of the condition, which now aptly described the urine: "passes through honey-sweet." Not until the late 19th century was the source of diabetes identified. Paul Langerhans, who described the islet cells of the pancreas in 1869, misidentified them as lymph glands. But in 1889 Von Mering and Minkowski proved that removal of the pancreas in dogs caused diabetes, and in 1901 Eugene Opie clearly linked diabetes to the islet cells.
In 1910, urinalysis for the measurement of blood glucose was developed. Diabetes could now be easily and reliably diagnosed — but nothing could be done for it. The loss of insulin action meant the same thing in 1915 as in 1015, an early death. Real progress came with the identification of insulin action. In 1921 Banting and Best extracted insulin from the pancreases of dogs, and almost immediately "animal source insulin," what we now call "regular," or "short-acting," was made available for the treatment of diabetes. Early advertisements make it clear that the nature of insulin was not widely understood. In 1926, Metropolitan Life reminded readers of the "National Geographic:" "Occasionally a patient, under insulin treatment, feels so much better that he is tempted to abandon his diet and eat everything he wants. But when he does he is likely to suffer a relapse and die. Then insulin is blamed..."
For years insulin-dependent diabetics tested their urine (not blood), and used big, dull, "reusable" syringes to administer their insulin. Urinalysis was not the still-familiar visual test strip, but a matter of putting urine in a test tube, applying a chemical reagent, watching the fizzing reaction, and making calculations based on both test results and food intake, to come up with the insulin dosage required for the next day. The calculations: Read test percentage, multiply by volume to get grams, calculate food intake (grams of carbohydrate x 1, of protein x 4, of fat x 9), subtract that from total, divide by insulin units taken = next day's dose, are probably beyond today's math competencewithout a computer. However difficult, life with diabetes in the early days of insulin was vastly better than thealternative! In 1936, PZT insulin, a long-acting type, was developed, and in 1938, the familiar NPH. Now insulins could be mixed. The outlook for diabetics had improved so much that a Metropolitan Life advertisement, dated May 1941, could state: "The diabetic whose disease is discovered early; who promptly puts himself under and stays under his physician's guidance; and who masters the details of his treatment, stands a good chance of living as long as he could reasonably expect to live without diabetes." What a long way had we come.
1952 saw the introduction of intermediate-duration Lente insulin, and 1956 saw the first of the sulfonylureas, oral medications to lower glucose in type II diabetics. Up through the 1960s, however, urinalysis and reusable syringes were still the rule. When it took a week just to get the result of a blood test back from the hospital pathology lab, "tight control" was hardly possible.
In 1961 Becton Dickinson introduced the single-use syringe, and in 1969 Ames Diagnostics introduced the first portable, fairly instantaneous, blood glucose meter. Ten years later, glucometers for home use became standard. Innovations have come quick and fast. Glucometers with voice synthesis for the blind and visually impaired, recombinant-DNA insulin, easier testing procedures, new oral medications for better control of type II diabetes...and in 1993 the results of the Diabetes Control and Complications Trial, the huge, Federally-funded study that proved the best approach to diabetes management was to keep closely to the blood sugar levels of the non-diabetic.
We look back, and the past looks "quaint" and "barbaric." But non-invasive blood glucose testing is on the horizon. Our children will look at our ridiculous glucometers and horrid little lancets, and laugh, glad that they live in a better day. As we in our dotage tour the museum of medical curiosities, gazing again on lancets and test strips, let us remind our descendants that though the tools change, each generation must do the best it can with the tools it has at hand.
On February 26, Biocontrol Technologies, Inc. (BICO), showed its Diasensor 1000 noninvasive blood glucose monitor to examiners from the Food and Drug Administration, and they turned thumbs down. The panel decided that company tests had not been sufficiently rigorous, and that test results from the no-finger-stick machine were not statistically reliable. Frank Vinicor, president of the American Diabetes Association, stated "many members of the audience were perplexed that (Biocontrol's application) did get this far" with such inadequate data.
Richard Kahn, the ADA's chief scientific and medical officer, who sat on the panel as a non-voting member, declared he was "disappointed" by the company's lack of adequate data. "What they had was imperfect," he said. The version of the Diasensor examined by the FDA panel requires individual calibration to a specific user, and if that calibration is off, accuracy suffers. Data presented by the company in support of its application suggested that at most perhaps one in four diabetics might use the machine, and test data did not convince the panel that the machine was a reliable substitute for traditional blood glucose monitoring. BICO was invited to improve their machine, perform more rigorous testing, and resubmit for FDA approval. In the meantime, many other companies are researching noninvasive blood glucose testing, with Futrex (The Dream Beam) and Cygnus (the Glucowatch) perhaps ready for FDA examination in the near future. Change will be rapid.
If you or a friend would like to remember the Diabetics Division 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 Division 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 Maile George Lipe
What I remember most about the onset of my diabetes was my tremendous thirst. One afternoon, when I was eleven, my family and I were touring Golden Gate Park, in San Francisco. I walked a long distance to locate a drinking fountain. When I finally slurped voraciously from the thirst-quenching arc of water, I wondered what was going on with my body. My mother noticed my unusual symptoms: thirst, frequent urination, and weight loss. She made an appointment with my pediatrician.
The doctor recognized my symptoms immediately. After confirming his suspicions with a urine glucose test, he proclaimed that I had diabetes mellitus. I was admitted to the hospital on that sunny May afternoon, not realizing that the diagnosis had changed my life forever. I was told that sugary candy, sugar-laden sodas, cookies and gooey cakes and pies were all now off limits. I would be dependent on injected insulin, because my pancreas didn't produce the hormone any longer. Even though I did not have a huge sweet tooth, this was alarming news for an eleven-year-old! One day, while still in the hospital, I felt quite peculiar. My joints felt weak and shaky, my forehead was sweaty, and I hungered for all the things I had just been told I could never eat again. The nurse came with a can of sweet juice, which I drank quickly. She explained that I had just experienced an insulin reaction, that my blood sugar had dropped too low. I felt better within minutes. This was the first of many hypoglycemic episodes I was to encounter in my life.
Toward the end of my hospitalization, the staff instructed me on administering my own injections. I was shown how to draw up the insulin into a syringe (no problem), then how to inject it into an orange (also no problem). When they told me to plunge that needle into my own flesh, it became a problem! I did not master this aspect of my diabetes care until much later, when my parents bribed me with a sleepover. I would not be allowed to go unless I could give my own shot. After sitting for what seemed like hours with the needle poised above my tender thigh, I finally stuck myself. Feeling relieved and accomplished, I joined the others at the slumber party.
The first couple of years with the disease were a game to me. I felt special. Instead of being embarrassed about having to fiddle with my urine, I thought of it as a chemistry experiment. I even invited the neighbor children over, so they too could witness the wizardry of the fizzing reagent tablet and the yellow potion in the test tube. The holidays brought many temptations. I do not recall feeling particularly deprived, even though I couldn't eat the candy canes, Christmas cookies, and foil-wrapped chocolate coins. One Easter, however, at my grandmother's home, all of the other kids were going through their baskets filled with chocolate eggs, marshmallow bunnies, and jelly beans. In my basket, I found the usual decorated hard boiled Easter eggs and a set of "days of the week" underwear. Those panties lasted much longer than the candy my cousins received, but on that Easter morning, I felt cheated.
Like any teenager, I was constantly asking, "How normal am I?" My diabetes caused me to feel alienated, so I decided to hide it as best I could. I did, however, use it to get out of certain undesirable activities, like swimming and oral presentations, usually claiming a hypoglycemic reaction. I was not aware of the dreadful complications of the disease; the things that could occur if the diet, insulin and urine testing were not adhered to. Often I would run the bathroom tap, so my parents would think I was testing. I would deceive my parents by discarding unused syringes, and I would sneak prohibited food. One time I drove to three different ice cream parlors and ordered double scoops at each. I thought I was invincible, and that the horrible side effects some diabetics experienced would never touch me.
I continued in denial of my disease in my college years. I told very few people of my condition. Even those who knew I had diabetes didn't understand it very well. Some thought I needed to drink orange juice all the time. Others knew I had a condition that necessitated injections, but still encouraged me to eat, drink, and party with them. I wanted desperately to fit in, so I joined them.
Later I discovered that by not taking my injections, I could eat all I wanted and not gain weight. Like many of my sorority sisters, I had gained the "freshman ten," so this seemed a perfect remedy. I developed bulimia, a life-threatening eating disorder, and it was now dangerously out of control. I managed to keep the weight off, but because of my antics, my health deteriorated. I was hospitalized several times for hyperglycemia (high blood sugar) and diabetic ketoacidosis. Somehow, even though I was exhausted most of the time, I graduated from college. I was still trying to minimize the importance of managing my diabetes. When I was in my early twenties, the complications that were never supposed to happen to me started happening to me. I almost lost my lower legs from diabetic leg ulcers and poor circulation. I developed nerve damage in my stomach, causing it to not empty properly. My hair lost its pigment, and grew in stripes—dark when I was healthy and light when I was not.
Finally I started losing my sight. Numerous painful laser treatments were administered. These were supposed to cauterize the abnormally-growing capillaries in my retinas. The retinopathy progressed, however, and surgery was finally recommended.It took three surgeries to arrest the problem. Fortunately, one of my eyes still has limited vision. I am eternally grateful to the expert eye surgeon for that! The other eye is completely blind, the retinal damage now beyond repair. Many of the debilitating complications might have occurred even if I had taken care of my disease. I will never know. Because diabetic management technology is constantly improving, today I can test my blood sugars with a talking glucometer, a method far more accurate than the old-fashioned urine tests. Now I take four injections a day, and I administer them myself. Though my figure is far from ideal, I am not fat, and I do not obsess over food as I previously did. I only wish I could have coped with the disease more effectively in my youth. After having felt sick with guiltand shame, I now know that confronting the disease, managing it, and not hiding it are what it takes. Today I feel healthy and grateful to have survived my earlier neglect.
by Debra Frank, MS, MS
Being a Research Volunteer
Over the past two decades many medical organizations and pharmaceutical companies have been doing preventive and corrective research on human volunteers. One such study was the Diabetes Control and Complication Trial (DCCT). Its findings affirmed the value of frequent monitoring and multiple insulin injections, to stay as close as possible to the "normal" blood glucose values of the non-diabetic. As I felt it was my responsibility, I volunteered for this study.
I was randomized into the conventional regimen group, but by my eighth year in the study I had become so knowledgeable about my diabetes that I requested permission to change my insulin format to one of "tight control." I had learned. In the past few years there have been several research studies testing the effects of various pharmaceutical agents on Diabetic Kidney Disease. I volunteered for one, but that experience truly made me feel like a guinea pig rather than a welcome and appreciated research volunteer. One Monday morning in July 1995, I entered the research center, delivered my 24-hour urine sample, and completed a thorough physical exam. Three days later the nurse called me up at home and said: "We are surprised with the elevated levels of protein in your urine, compared to all your other normal tests results. You might have qualified for the study. We will call you back in two months to reevaluate you." CLICK!! No exact numbers, no accurate test results. The woman didn't even leave her name! I was freaked out. When, in a calmer state of mind, I repeatedly tried to call the center, they were too busy to return my calls. A month later they closed the study and left me hanging.
After that ominous call, I immediately called my medical team, and made an appointment ASAP. With another 24-hour urine in hand, and a resting heart rate of 140 (only kidding), I went to my doctor, who scheduled me for a four-hour renal test just to add reassurance to my other test results. His first comment to me was, "Look at your test results for the past nine years from the DCCT and the past year. You have always been in the normal range. Debra, did you exercise the day you collected your 24-hour urine?" My reply was, "Well, yes, I taught three 40-minute water aerobic classes, but they are not overly strenuous..."
Dr. Engle shook his head and laughed at me. "You're an exercise physiologist," he chided. "You know that when any person exercises they break down protein. That's why we always remind you to not do any form of exercise for 24 hours before you collect the urine. This research doctor did not remind you of this." This made me feel really foolish, but also emotionally toyed with. My knowledge of human physiology and the effects of exercise is vast, but little is known of the direct acute and chronic effect of exercise on persons with IDDM. There were too many questions. I fell prey to ignorance from all sides. The research center team, who could have spared me this panic, ignored that aspect completely.
Volunteering for medical research studies that are not overly demanding of my personal or professional time keeps me on the cutting edge of diabetes treatments, and allows me to have a stronger relationship with my medical family. It also brings us that much closer to a cure. Give volunteering a try! The researchers need our participation, and the "bad apple" I encountered does not spoil the barrel. Until a cure is found, I intend to stay as healthy as possible so all my systems will be ready to 'go' when the cure comes our way.
VOLUNTEERS NEEDED FOR RESEARCH STUDIES
Once new therapies and medications successfully pass their animal laboratory tests, they must be tested on human volunteers. To be such a volunteer is to help change the world as we know it—to participate in making our world a better place. Here are some opportunities to participate, courtesy of the Diabetes Research Institute, in Hollywood, Florida, part of the University of Miami School of Medicine. Type I Diabetes Prevention Trial (DPT-1) First and second-degree relatives of individuals with type I diabetes are needed to participate in a study of diabetes prevention in individuals considered at risk of developing this disease. The study requires volunteers age three to 45 who have a first-degree relative (daughter, son, parent, brother, or sister) and volunteers age three to 20 who have a second-degree relative (cousin, nephew, niece, aunt, uncle, or grandchild) with type I diabetes. Participants should not have diabetes, and should have no history of being treated with insulin or oral diabetes medications or other therapy for preventing type I diabetes. They also should have no serious diseases, and women planning a pregnancy in the next six years are discouraged from participating in the trial.
Volunteers for this National Institutes of Health study will receive free screening for islet cell antibodies (ICA) and, if at risk, genetic, immunologic and metabolic testing. Those at high risk will take either insulin injections or will be observed, for the next six years. Those at moderate risk will be given either an oral medication, or a placebo, for the next five years. During the treatment period, the study provides physical exams, study-related medication, a blood glucose meter, and strips, at no charge. Participants will be required to visit the clinical center every six months for five to seven years. For more information, please contact Della Matheson, RN, CDE; telephone: (305) 547-3781.
Genetic Screening For Diabetes
A genetic screening program associated with the Diabetes Prevention Trial—Type I (DPT-1) is seeking family members of individuals with type I diabetes, to participate in a study to determine which genes are responsible for providing protection from or susceptibility to type I diabetes. Volunteers need not be enrolled in the DPT-1 study. However, all first-degree relatives within a family are required to participate in this genetic screening. This study involves a one-time visit for a blood test at no charge. For more information, please call Della Matheson, RN, CDE; telephone: (305) 547-3781.
Type I Diabetes and Kidney Disease
Volunteers, age 22-50 years, with type I diabetes are needed to participate in a four-year clinical study evaluating the study and efficacy of an investigational medication in preserving renal function. Participants must have protein in their urine, onset of insulin dependent diabetes mellitus (type I) prior to age 30, and duration of at least seven years. All medical exams and testing will be provided at no charge. Compensation per visit will be provided. For more information, call Robert Agramonte, RN; telephone: (305) 547-6573.
Diabetic Foot Ulcer
Volunteers age 18 or older, with type I or type II diabetes and an infected foot ulcer, are needed for this trial. In this study, ulcers will be treated, for 14 to 28 days, either with an antibiotic taken by mouth, or an investigational topical cream antibiotic. Participants will receive study-related medications, dressings, and wound care at no charge. For more information, please call Diana Graham, RN; telephone: (305) 547-6145.
70/30 Prefilled Syringe
This study seeks volunteers age 40 to 70 with type II diabetes, who have been on the maximum dose of pills for diabetes, but who continue to have blood glucose values greater than 200 mg/dl. Participants will discontinue pills and start taking either 70/30 insulin from a prefilled syringe or NPH insulin by standard injection. A blood glucose meter, strips, and study-related medications and supplies will be provided at no charge. This is a 22-week study, and it will require six clinic visits. For information, please call Aleida Saenz, RN; telephone: (305) 547-6145.
Depression and Diabetes
Volunteers age 30 to 70 with type II diabetes of one to 12 years duration, who also have depression, are being sought for a study to evaluate the effect of treating depression with an antidepressant over a three-month period. Participants must be treating their diabetes with pills, and may take one insulin injection per day. The study provides diabetes pills, the antidepressant, and visits with a psychiatrist and a dietitian, at no charge. For information, please call Arlynn Owens, RN; telephone: (305) 547-6145.
New Oral Medication
Volunteers age 30 and older, who have type II diabetes and are treated with pills or diet alone, but not insulin, are needed to test a drug recently approved for use in diabetes. Participants receive study medications, laboratory tests, EKGs, and physical exams at no charge. This study requires 11 clinic visits over a four-month period. For information, please call Diana Graham, RN; telephone: (305) 547-6145.
Extended Release Oral Medication
This one-year study is designed to evaluate the effects of three dose levels of an extended release oral medication on blood glucose in persons with type II diabetes. Candidates must be over age 30 and not receiving treatment with insulin. Participants receive a blood glucose meter, strips, study medications, laboratory tests, EKGs, and physical exams at no charge. There are approximately 14 clinic visits over the year. For information, call Arlynn Owens, RN; telephone: (305) 547-6145.
by Kenneth Jernigan
This article appeared in the December 1995 edition of the "Braille Monitor," published by the National Federation of the Blind. Dr. Jernigan is President Emeritus of the Federation. The time has come to plan for the 1996 convention of the National Federation of the Blind. As Federationists know, our recent National Conventions in Detroit and Chicago were outstanding in every sense of the word—excellent programs, good food and facilities, and wonderful hospitality. But Anaheim in '96 promises to be the best we have ever had. The last time we were in California was Los Angeles in 1976, twenty years ago. We now return to Southern California, bigger and stronger than ever before in our history and ready for a wonderful convention. President Jim Willows and the other leaders and members of the NFB of California tell me that plans are going forward for a spectacular meeting.
We are going to the Anaheim Hilton at 777 Convention Way in Anaheim. Those of you who attended the 1995 convention at the Hilton and Towers in Chicago know how good a Hilton can be, and the one in Anaheim is among the best. A short distance away from Disneyland, the Anaheim Hilton has all of the elements required for a tremendous convention. Let's begin with the room rates: one in a room, $45 per night; two in a room, $47; three in a room, $54; and four in a room, $57. As you can see, these rates are slightly better than we had last year in Chicago. In addition to the room rates, there will be a tax. At the time Mrs. Jernigan and I made the arrangements with the hotel, it was just under 15 percent. There will be no charge for children in a room with parents as long as no extra bed is required. If you want to come a few days early or stay a few days late, convention rates will apply.
As to the meeting facilities, there are two side-by-side ballrooms (the Pacific Ballroom and the California Pavilion) located on the ballroom level. We will use one for our general sessions and the other for exhibits. This will give us maximum efficiency and convenience. In recent years we have sometimes taken hotel reservations through the National Office, but for the 1996 convention you should write directly to Anaheim Hilton, 777 Convention Way, Anaheim, California 92802-3497, Attention: Reservations; or call (714) 750-4321. Hilton has a national toll-free number, but do not (we emphasize NOT) use it. Reservations made through this national number will not be valid. They must be made directly with the Anaheim Hilton in Anaheim.
Here are the convention dates and schedule: Saturday, June 29—seminars
for parents of blind children, blind job seekers, and vendors and merchants;
several other workshops and meetings. Sunday, June 30—convention registration,
first meeting of the Resolutions Committee, other committees, and some of the
divisions. Monday, July 1—meeting of the Board of Directors (open to all),
division meetings, committee meetings, continuing registration. Tuesday, July
2—opening general session, evening gala. Wednesday, July 3—general
sessions, tours (you can bet that Disneyland will be on the list). Thursday,
July 4—general sessions, banquet. Friday, July 5—general sessions,
adjournment.
There are two major airports one can use when flying into the
Anaheim area. They are Los Angeles International Airport
and John Wayne Orange County Airport. It may be easier to find a flight into
Los Angeles International, but John Wayne is closer to the Anaheim Hilton. Keep
both of these airports in mind when you make your travel arrangements. Remember
that we need door prizes from state affiliates, local chapters, and individuals.
Prizes should be relatively small in size and large in value. Cash is always
popular. In any case, we ask that no prize have a value of less than $25. Drawings
will be made steadily throughout the convention sessions. As usual the grand
prize at the banquet will be spectacular—worthy of the occasion and the
host affiliate.
The 1995 grand prize in Chicago was a thousand dollars in cash. The 1996 grand prize will be at least as good. Don't miss the fun! You may bring door prizes with you or send them ahead of time to Patsy and Bob Ramlo, 401 Livingston Avenue, Placentia, California 92670-2420. The displays of new technology; the meetings of special
interest groups, committees, and divisions; the exciting tours; the hospitality and renewed friendships; the solid program items; and the exhilaration of being where the actionis and where the decisions are being made—all of these join together to call the blind of the nation to the Anaheim Hilton Hotel in California in July of 1996. Come and be part of it all.
Saturday, June 29 — seminars for parents of blind children, blind job seekers, vendors and merchants; several other workshops and meetings.
Sunday, June 30 — convention registration, first meeting of the Resolutions Committee, other committees, and some of the divisions.
Monday, July 1 — meeting of the Board of Directors (open to all), division meetings, committee meetings, continuing registration.
Tuesday, July 2 — opening general session, evening gala.
Wednesday, July 3 — general sessions, tours (you can bet that Disneyland will be on the list).
Thursday, July 4 — general sessions, banquet.
Friday, July 5 — general sessions, adjournment.
During this year's annual convention of the National Federation of the Blind in Anaheim, California (Sunday, June 30 through Friday, July 5) dialysis will be available. Individuals requiring dialysis must have a transient patient packet and physician's statement filled out prior to treatment. Conventioneers should have their unit contact the desired location in the Anaheim area for instructions. Be advised that the American Kidney Fund's Shearer Program, which formerly paid or reimbursed the Medicare 20% copayment for transient dialysis, has exhausted its funds, and other arrangements will need to be made. Individuals will be responsible for, and must pay out of pocket, prior to each treatment, the approximately $30 not covered by Medicare, plus any additional physician's fees. DIALYSIS CENTERS SHOULD SET UP TRANSIENT DIALYSIS LOCATIONS, AT LEAST THREE MONTHS IN ADVANCE. THIS HELPS ASSURE A LOCATION FOR ANYONE WANTING TO DIALYZE. Anaheim is the home of Disneyland, and in July, travel is very heavy.
Here are some dialysis locations:
* California Kidney Centers of Anaheim, 2051 East Cerritos Ave., Suite 8A, Anaheim, CA 92806; telephone: (714) 778-1530. About 5 to 10 minutes from the convention hotel.
* UCI Dialysis, 101 City Drive, Building 51, Orange, CA 92668; telephone: (714) 456-5555. About 10 minutes from the hotel.
* Garden Grove Artificial Kidney Center, 12555 Garden Grove Blvd, Suite 100, Garden Grove, CA 92643; telephone: (714)741-7255. About 10 minutes from the hotel; openings after 5:30 p.m. weekdays.
* Westminster Artificial Kidney Center, 290 Hospital Circle, Westminster, CA 92683; telephone: (714) 895-3698. About 15 minutes from the hotel. Very new unit; open Monday, Wednesday, and Friday.
PLEASE REMEMBER TO SCHEDULE DIALYSIS TREATMENTS POSTHASTE TO INSURE SPACE. You will be expected to pay, at time of service, the 20% Medicare copayment (about $30 for each treatment), plus any non-covered physician's fees, and charges for EPO or Calcijex. For transportation to and from dialysis centers, contact the Orange County Transit Authority (OCTA), "ACCESS" Division; telephone: 1-800-564-4232 or (714) 636-7433. Their rides for persons with disabilities cost $1.70 each way. This service requires application in writing WELL IN ADVANCE! Approval (not guaranteed) takes a minimum of 21 days. There is also MEDIVAN, a private van service specializing in medical transportation; telephone: (714) 974-8840. It accepts private insurance and MediCal, though only with prior authorization. Be aware that many insurance carriers do not cover transportation services. Charges are $29.42 round-trip, plus $1.08 per mile. Contact them at least one week before you need them.
If scheduling assistance is needed contact: Diabetics Division First Vice-President Ed Bryant at (573) 875-8911.
See you in Anaheim!
by R. Keith Campbell, RPh, FASHP, FAPP, CDE
One often overlooked chronic complication of diabetes is gum and tooth disease. People with diabetes have at least twice the incidence of cavities and gum problems as non-diabetics. There is a simple explanation for this: If your blood sugar is elevated, then saliva sugar is elevated as well. The increased sugar in the mouth is a perfect environment for bacteria to grow and lay down that sticky film known as plaque around the teeth. The bacteria can also attack gums, leading to increased infections, periodontal disease and other significant dental problems. It is especially important for those of us with diabetes, who have a higher risk of developing dental-related disorders, to take daily aggressive action to prevent gum disease and dental cavities, for they can lead to the eventual loss of teeth.
Step One: Manage Your Blood Sugar
The first step in both treating and preventing these problems is to keep blood sugar levels as close to normal as possible, through diet, exercise, and medications. You should also do frequent self-monitoring of blood sugar, keeping track of the results, so you and your doctor will know what adjustments in your therapy may need to be made.
Step Two: See Your Dentist Regularly
You should see your dentist at least two to three times each year. Having a dental hygienist clean your teeth and giving the dentist the opportunity to discover early any dental or gum problems makes it much easier to correct these problems. As gum disease progresses, treatment becomes increasingly more difficult.
Step Three: Floss and Brush Frequently
Everyone, but especially people with diabetes, should floss if possible after each meal. It is especially important to floss before bedtime so that food doesn't remain between your teeth waiting for plaque-creating bacteria. Along with flossing, frequent brushing of your teeth is also extremely important. People who brush frequently and properly (have your hygienist give you a demonstration) have fewer cavities and less gum disease. It is a little-known fact that those bacteria that create problems in your mouth also remain in the bristles of your toothbrush. Therefore, it is very important that you get a new toothbrush every six weeks; throw the old one away. Many people think that not only are flossing and brushing useful, but in addition the use of mouthwashes—especially the anti-plaque kind—are part of the steps to good oral hygiene.
Step Four: Investigate New Dental Care Products
Many new products are being developed to make dental care easier and more effective. Among these are battery-operated toothbrushes with rotating bristles, and devices that provide sonic vibrations to enhance your ability to prevent gum disease and cavities. You should discuss with your dentist the use of some of the following products. Oralgenie: I have personally found this device to be very useful. The rotating brushes not only clean the teeth but also stimulate the gums to the tooth line and provide a thorough cleaning. I've heard from several dentists who say they really notice a significant difference when their diabetic patients use an Oralgenie-type of product. Other devices with rotating bristles that clean teeth and stimulate gums include Inter Plak and Plaq-Trak. Another new product, Sonicare, has recently come onto the market. It is a complete dental hygiene system that sends out sonic vibrations which supposedly improve cleaning ability. In summary: Never forget the importance of good preventive dental care. Keep your blood sugars close to normal, see your dentist regularly, and brush and floss on a frequent and regular basis. That's the way to keep smiling with a full set of teeth!
(Note: Reprinted courtesy of "The Diabetic Reader." For a free copy of the Reader, call 1-800-735-7726.)
The Diabetics Division of the National Federation of the Blind.
President: Tom Ley, 726 E. Belvedere, Baltimore, MD 21212; telephone: (410) 893-3777.
First Vice-President: Ed Bryant, 811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911.
Second Vice-President: Janet Lee, 555-199th Ave. NE, Cedar, MN 55011; telephone: (612) 872-0100.
Treasurer: John Yark, 218 Seaton Road, Apt. 2, Stamford, CT 06902; telephone: (203) 324-7862.
Secretary: Sandie Addy, 2775 Indian Wells Drive, Prescott Valley, AZ 86314; telephone: (602) 775-5912.
January 18, 1996
Please send along 10-20 copies per issue. I have just come across your paper for the first time and really enjoyed reading it! I am quite sure my patients with diabetes would appreciate such a newsletter!
Sincerely,
Lisa J. Trevorron, RD
St. Joseph's Mercy of Macomb
Clinton Township, MI
February 8, 1996
I recently had the pleasure of reading your Winter Edition of the VOICE OF THE DIABETIC. As a health care provider, diabetes educator and diabetic, I found your newspaper most informative. It would make a great addition to our diabetes educational materials distributed to our diabetes patients.
Your box on page 18 of the Winter Edition stated that multiple copies could be obtained free of charge for patient distribution. Would it be possible to send 25 copies each quarter to be disseminated from our nutrition clinic?
Thank you again for your assistance and for providing such a great publication for persons with diabetes.
Sincerely yours,
Peter E. Schwager, RD, LD
Chief, Nutrition Care Division
United States Army Medical Department
Redstone Arsenal, AL
February 14, 1996
First of all, I want to commend you for the excellence of the VOICE OF THE DIABETIC. I really enjoy the down to earth discussions and articles of common concern to all diabetics. I note in your Winter Edition an item about a change in Florida's law that mandates insurance companies to pay for all [diabetic] supplies. Currently, most companies (also Medicaid and Medicare) pay for insulin, syringes and oral medications, but not for the most costly item, glucose blood testing strips. I believe the strips are as vital to blood sugar control as the meds. The testing is the only method we as diabetics have to assess the good or bad being done by our medications, whether oral or injections.
Since I am an "out-of-control" diabetic, I test my blood sugars four to six times per day. At a cost of 69 to 75 cents per strip, monthly cost is $105-$125. My current insurance plan pays for a 90-day supply of meds for $7-$12. I would be pleased if I could even get a one-month supply of strips for the $12. I have written to my insurance company, our state legislature and even the U.S. Congress because normally, if a supply is covered by Medicare, it is also covered by private insurance. This letter is written to encourage other diabetics to write letters too.
Thanks again for an excellent educational tabloid.
Sincerely,
Kathi Granum
Volga, SD
From the Editor: I agree with Ms. Granum. This is a good idea! I suggest to all VOICE readers that you contact your legislators, state and federal.
by Davida F. Kruger, MSN, RN, C, CDE
For years, the belief was that people with diabetes could dangerously increase blood glucose levels by eating simple carbohydrates (sugars, like fruit, honey, or table sugar). These were thought to be absorbed into the bloodstream faster than complex carbohydrates (starches, like potatoes, rice, and grains), possibly causing hyperglycemia. Sophisticated new research conducted at some 15 centers around the country led the American Diabetes Association to review these theories.
Last May, the Association announced revised dietary recommendations for people with diabetes. Davida Kruger provides "The Monitor" with an overview of these nutritional guidelines. Ms. Kruger is Senior Vice President of the American Diabetes Association, as well as a Nurse Practitioner at the Henry Ford Hospital, Division of Endocrinology and Metabolism, in Detroit, Michigan.
Q: Can you recap the ADA's new nutritional guidelines?
A: The research has proven that whether simple or complex, "a carbohydrate is a carbohydrate is a carbohydrate." There's no longer a recommended "diabetes diet" that applies to everyone. Now, the key is in individualizing the diet according to each individual's situation: type of diabetes, overall health, weight and cholesterol levels, lifestyle, exercise habits, family history, likes and dislikes. Based on this information, the dietitian can tailor an appropriate program that the person can adhere to comfortably.
Q: Does this mean greater "freedom of foods?"
A: Yes, we can actually include things like cookies and cakes and ice cream in a limited amount, which certainly makes the diet more acceptable. But as in anyone's diet, it's in a limited quantity. You need to maintain a balanced diet with quality nutrition. This means making substitutions: for every sugary indulgence you must give up an equal amount of other carbohydrates.
Q: Clearly this offers many opportunities for people with diabetes. What about any challenges?
A: The biggest challenge is keeping up a healthy diet and not gaining weight. We've kind of opened the floodgate. For so long we've said, "absolutely no cakes, cookies, or candy." Now we're saying that an occasional use of simple carbohydrates is acceptable, provided it doesn't increase your overall caloric intake. Appropriate adjustments to diet, medications, and exercise must be made.
Q: Do you anticipate an "attitude adjustment" factor to the new guidelines?
A. Yes it will be hard for some people. It's been drummed into our heads for years that this is not food you can eat. Now we're saying those choices are okay, if they're taken in proper amounts and incorporated into the diet. In fact, for many people, real sugar may actually be better than sugar-free foods. Sugar-free foods can still be high in calories, fats, or other types of carbohydrates, which can increase glucose levels. People need to understand that, and make the switch.
Q: Can you foresee a whole new set of guidelines in another 20 years?
A: Who can say what will happen in 20 years? There's always a possibility. The ADA continues to fund quality research with high quality outcomes. The research in the 15 centers across the country clearly supported the need to change our nutritional guidelines.
Q: So these are the principal concepts: Make substitutions, not additions; practice moderation; follow a healthy diet for your individual needs; and enjoy the new flexibility.
A. I like it!
(Note: This article appeared in "The Monitor," Vol.5/No.3, published by LifeScan, Inc.)
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...
Mushroom and Barley Soup
from Dave Griffith of London, Ontario, Canada
8 cups beef stock
1/2 cup barley
1 bay leaf
3 large carrots, chopped
1 celery stalk, chopped
1 large onion, chopped
1 potato, chopped
2 cloves of garlic, minced
1/4 tsp. dried thyme
1 1/2 cups chopped mushrooms
salt and freshly ground black pepper to taste
Combine stock, barley, and bay leaf. Bring to a boil. Reduce heat, cover, and simmer for 1 hour. Add carrots, celery, onion, potato, garlic, and thyme. Simmer, covered, for 20 minutes. Add mushrooms and simmer until tender. Season with salt and black pepper to taste. Yield: 8 servings; Per 1 serving: 110 calories, 0 grams fat, 5 grams protein, 20 grams carbohydrates.
Three Bean Terrine
from Dave Griffith of London, Ontario, Canada
1 1/2 cups romano beans, cooked
1 1/2 cups white beans, cooked
1 1/2 cups red kidney beans, cooked
1/2 cup crumbled feta cheese
1/4 cup shredded cheddar cheese (use reduced fat type)
3 egg whites
1/4 cup light sour cream (use nonfat sour cream)
1/2 packet frozen spinach leaves
2 tsp. lemon juice
1/4 tsp. salt
1/4 tsp. ground nutmeg
1/4 tsp. freshly ground black pepper
2 tbsp. chopped sun dried tomatoes
2 tbsp. millet
1 tbsp. chopped almonds
1 1/2 tsp. yeast extract (Marmite or Vegamite)
1 clove garlic
1/2 tsp. dried basil and chili powder
1/4 tsp. ground thyme
Spray an 8" X 4" loaf pan with a nonstick coating and line bottom with waxed paper. Combine white beans, feta and cheddar cheese, 1 egg white, and 1 tbsp. sour cream. Puree in food processor and transfer to a bowl. Drain liquid from spinach and add romano beans, lemon juice, salt, nutmeg, pepper, 1 egg white, and 1 tbsp. sour cream. Puree in food processor and spread into lined loaf pan. Spread white bean mixture over top. Mix red kidney beans, tomatoes, millet, nuts, yeast extract, garlic, basil, chili powder, thyme, 1 egg white, and remaining sour cream. Puree in food processor and spread on top of white bean mix. Bake at 350 degrees for 75 minutes in pan of water. Cool on a rack for 10 minutes. Turn onto serving platter. Yield: 8 servings; Per 1 serving: 200 calories, 5 grams total fat, 3 grams saturated fat, 19 mg cholesterol, 15 grams protein, 30 grams carbohydrates, 225 mg sodium, 600 mg potassium.
Spring Asparagus and Fiddle Heads
from Dave Griffith of London, Ontario, Canada
1/2 lb. asparagus
1/2 lb. fiddle heads (use asparagus if can't find fiddle heads)
1/4 cup low-fat yogurt
1/2 tsp. honey
2 tbsp. orange juice
2 tbsp. lime juice
1/4 cup minced shallot or green onion
1 tbsp. chopped fresh coriander
salt and fresh ground black pepper to taste
Bring skillet of water to a boil. Add asparagus and fiddle heads. Boil for 3 minutes or until crisp and tender. Drain. Beat honey, orange juice, lime juice, shallot, and coriander into yogurt. Season to taste. Spoon over asparagus and fiddle head mixture. Yum! Yield: 4 servings; Per 1 serving: 45 calories, 4 grams protein, 0 grams fat, 8 grams carbohydrates.
Meringue Dessert
from Mimi Moore, MS, RD of Chicago, IL
1-1/2 cups Vanilla Wafer crumbs
1/4 stick margarine (2 Tbs), melted
Combine and place in 8 inch square pan:
4 egg whites
1 tsp. vanilla
1/2 cup granulated sugar
1 cup Cool Whip Dessert Topping
Beat egg whites until soft peaks form. Add vanilla extract. Add sugar, gradually. Spread over crumb crust. Bake at 350 degrees for 20 minutes or less. Cool. Spread with dessert topping. Refrigerate and serve with sliced fresh fruit. Yield: 12 servings; Per 1 serving: 120 calories, 30 grams carbohydrate, 2 grams protein, 4 grams fat.
Here's a tip for boiling eggs. If you do it this way, they will peel easier, come out intact, and the yolk will be in the center, so you can make good devilled eggs. Start with a pan of cold water. Make sure it is big enough to accommodate all the eggs without too much crowding—that they have room to roll around. Put the eggs on the stove, cover, and bring to a full boil. Then shut off your burner. Start your timer, or keep track of your time for 20 minutes, which is the time it should take for the boiling water to grow cool again. At that time, your eggs should be boiled and tender.
If you want the yolks to be in the center, try this: Uncover the pan five minutes after turning it off. Stir the eggs with a large spoon. Replace the lid, and finish as above. It works! To have eggs that peel more easily, immerse them in cold water upon completion. Enjoy!
Since the VOICE is now offered free, our Diabetics Division will provide extra copies to anyone wanting to help spread the word. We will gladly send from five to five hundred-plus copies each quarter to be used as free literature. Medical facilities can order as needed for patients. Individuals can usually place copies of the VOICE in libraries, pharmacies, hospitals, doctors' offices, or other public locations.
Diabetes education is essential. Anyone who distributes the VOICE will be helping people with diabetes, and their families, to learn about the disease and its ramifications; to learn that they have options; and that their world is far greater than whatever "limits" may be imposed by the disease. If you would like to help spread the word by distributing the publication, please contact: Voice of the Diabetic, 811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911.
Inclusion of materials in this publication is for information only and does not imply endorsement by the Diabetics Division of the NFB. New 1995 Food Exchange List The new 1995 Exchange List 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 and cassette $2. Order from: National Federation of the Blind, Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314.
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.
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 Resource Guide
The NFB Diabetics Division announces the updated "Resource Guide to Aids and Appliances." Once again, we have compiled a list of companies and individuals who offer products and/or information for diabetics, especially those blind or losing vision, to help them self-manage their diabetes. The "Resource Guide" features six subject categories: General and Miscellaneous, Automatic Insulin Injection Systems, Blood Glucose Monitoring Systems, Syringe Magnifiers, Insulin Pumps, and Large Distributors of Diabetes Equipment and/or Supplies. Blind diabetics can and do accurately draw up insulin, monitor blood glucose, and perform the other tasks of independent self-management. By using alternative techniques and products they can continue being independent, and can control their diabetes as efficiently as do their sighted peers. Limitations are usually self-imposed — often all that is needed to overcome negative thinking is simply to know where to go for information. The new "Resource Guide" costs $2 per copy and is available in Braille (30 pages), Large Print (14 pages), and audiocassette. Make checks payable to National Federation of the Blind (Visa, Mastercard or Discover also accepted). Order from: National Federation of the Blind, Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314.
New Books
(The following appeared in "Diabetes Dateline," June 1995) "Quick and Healthy Recipes and Ideas," by Brenda J. Ponichtera, RD, offers 150 easy-to-prepare recipes for foods low in fat, cholesterol, sodium, and calories. The cookbook includes grocery lists, menus, exchange lists, and tips about weight control. The book is available for $16.95, plus $2 shipping, from: Brenda J. Ponichtera, RD, 1519 Hermits Way, the Dalles, OR 97058; telephone: (541) 296-5859.
"Low-Calorie Sweets," by Charlet Snyder, includes more than 100 recipes for dieters, diabetics, or anyone interested in cutting down sugar and salt intake. Recipes are sweetened with fructose instead of sugar. The nutritional information for each recipe includes potassium, fiber, and sodium content. Priced at $10, the cookbook is available from: Charlet Snyder, P.O. Box 1421, Holland, MI 49422-1421.
"Diabetes: Your Complete Exercise Guide," by Neil F. Gordon, MD, PhD, explains the value of exercise for diabetics. The book offers practical, easy-to-understand advice about the different types of diabetes, treatment, and how exercise may improve diabetes control. It includes guidelines for exercise and physical fitness programs, and introduces a health points system to help people gauge their progress and keep motivated. The guide includes information about blood glucose monitoring, hyperglycemia, hypoglycemia, and the warning signs of possible problems during exercise. It is available for $11.95 from: Human Kinetics Publishers, P.O. Box 5076, Champaign, IL 61825-5076; telephone: 1-800-747-4457.
The following books are available in bookstores, or from: Chronimed Publishing, P.O. Box 59032, Minneapolis, MN 55459-9686; telephone: 1-800-848-2793.
"Diabetes Made Easy," by Allison Nemanic, RN, Gretchen Knauth, RD, and Marion Franz, RD, is available in English or Spanish. Written at the second-grade level, this booklet discusses healthy eating, exercise, blood sugar testing, insulin injections, preventing foot problems, and coping with emotions. It is priced at $9.95.
"Beyond Alfalfa Sprouts & Cheese: The Healthy Meatless Cookbook," by Judy Gilliard and Joy Kirkpatrick, RD, features 125 meatless recipes for soups, salads, spreads, dips, main dishes, and desserts. The book offers cooking tips and provides complete nutrition information and exchange values. It is priced at $12.95, with a $3 shipping fee for mail orders.
National Odd Shoe Exchange
The National Odd Shoe Exchange, begun in 1943, is a nonprofit organization dedicated to helping people with different sized feet, or with only one leg, to find shoes. Headquartered in Phoenix, Arizona, the Exchange charges a one-time registration fee, then a yearly "membership" fee—but for that investment, you get your shoes free. Children under 5 or seniors 75 and above pay nothing, children 6 through 17 and seniors 62 through 74 pay a reduced rate of $15 registration and $10 per year. Adult members pay $25 registration and $15 per year. The Exchange can also provide names and phone numbers of an individual's "mismate"—someone who wears the other shoe from your set. "If the shoe fits, share it!" For information, contact: National Odd Shoe Exchange, 7102 N. 35th Ave., Suite 2, Phoenix, AZ 85101; telephone: (602) 841-6691; fax: (602) 841-3349.
New Talking Glucometer
LS&S Group, Inc., announces a new voice synthesizer for the LifeScan One Touch Profile glucometer. This light, compact unit attaches to the LifeScan Profile by a velcro strip, and operates through the glucometer's controls, using a 9-volt battery or AC adapter. The clear male voice has two volume settings, and can work into a headset. The unit is offered with the LifeScan Profile, for $328.95, or separately, if you already have a Profile, for $199. The AC adapter is included without charge. For information, or to receive their free catalog of products for the visually and hearing impaired, contact: LS&S Group, Inc., P.O. Box 673, Northbrook, IL 60065; telephone: 1-800-468-4789.
Sugar Free Marketplace
Not everything for sale at the Sugar Free Marketplace is good for the diabetic diet. They also sell cookbooks, books about diabetes, and diabetic sox. The edible products they list, according to the catalog, are all made without refined sugar, corn syrup, honey or molasses. For more information about the many food products offered by the Sugar Free Marketplace, or their non-food product lines, or for a free copy of their catalog, contact: Sugar Free Marketplace, 6710 N. University Drive, Tamarac, FL 33321; telephone: 1-800-726-6191.
For Sale
Diascan Partner talking glucometer, $75 or best offer; Lo-Dose Count-a-Dose tactile insulin measurement device, $20 or best offer; NEW Lo-Dose Count-a-Dose, $35. Contact: Kerry Smith, 7232 Sarah, Apt. 4-3, Maplewood, MO 63143; telephone: (314) 644-7733.
Rover Seeing Aid
The Rover Seeing Aid is a new device for the blind. A hand-held sensor, it reads light and dark areas, facilitating orientation, translating its findings into tactile feedback. With a few waves of the hand, The Rover provides a substantial picture of the environment. The Rover Seeing Aid, priced at $99, comes with a no-risk, 30-day home trial, and a one-year warranty. For information, contact: The POSSIBILITIES Company, 2103 Burlington Street, Suite 600, Columbia, MO 65202; telephone: 1-800-566-3333.
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 compatible ($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.
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 Diabetics Division of the NFB.
Lyspro Insulin Passes Test
On February 29, Eli Lilly and Company's new Humalog insulin (generic name Lyspro) was unanimously recommended for marketing clearance by an advisory panel of the U.S. Food and Drug Administration. This decision clears the way for final governmental review, scheduled to take place as we go to press.
The FDA advisory panel, cognizant that this insulin is very different from past formulations, recommended that Humalog initially be available only by prescription. The panel also asked Lilly to continue its ongoing studies, and plan studies with other patient groups that might benefit from Humalog. Humalog, a recombinant-DNA insulin characterized by very rapid action, was engineered to more closely mimic the healthy body's naturally occurring insulin. It has already been approved for sale in Switzerland, Russia, South Africa, and Lithuania, and recommended for approval in the 15-member European Union.
New Drug May Reduce Kidney Damage
We have been asked to announce: Researchers at Johns Hopkins Medical Institutions have been performing animal trials and limited tests with humans of aminoguanidine, a new drug that appears to reduce or prevent kidney damage. The drug appears to prevent protein molecules from becoming enlarged with a "sugar-coating" of excess glucose. Suchenlarged molecules, one result of high blood glucose, can clog blood vessels and eventually cause kidney failure, forcing patients into dialysis or a transplantation to survive. Blood vessels in the eyes can become similarly clogged, leading to retinal damage. A successful outcome to the tests of aminoguanidine could mean much to the 16 million Americans with diabetes, of which half a million already have kidney damage.
DVS Videos at Blockbuster
We have been asked to announce: Blockbuster Video, Inc., a large national chain of video rental outlets, has launched a test project to see if they should regularly stock DVS described video titles. DVS videos are regular commercialreleases to which a descriptive narration track has been added, allowing blind and visually-impaired people to follow the action, while in no way impairing the film's original elements.
DVS videos have previously been available only from DVS (for purchase) or on loan (through the National Library Service for the Blind and Physically Handicapped). To have them on the shelf at the local video outlet represents a significant expansion of availability. Ten Blockbuster Video stores, spread across the country, are part of the test. Each now offers 16 DVS titles, current releases like Forrest Gump, The Lion King, Beauty and the Beast, Father of the Bride, and Schindler's List. The DVS cassettes are offered at a reduced rental rate of $2. Blockbuster Video outlets participating in the test are in: Charlotte, NC (704-521-8020), Morganton, NC (704-437-1199), Austin, TX (512-477-3396 and 512-302-3434), St. Louis, MO (314-535-5656), Denver, CO (303-691-9811 and 303-320-1290), Chicago, IL (312-880-5688), New York, NY (212-686-0022), and Woodland Hills, CA (818-813-9990). If demand for DVS described video is judged sufficient at these outlets, Blockbuster expects to expand its availability to other locations. For further information contact your local Blockbuster Video store, or DVS, Descriptive Video Service, WGBH, 125 Western Avenue, Boston, MA 02134; telephone: 1-800-333-1203.
Children's Book on Blindness
Most blind children attend public schools. There is very little material on blindness written for their sighted peers, who need to know how blind people function. When presented appropriately, children find Braille, white canes, talking computers, and other adaptive equipment fascinating. The National Federation of the Blind of Idaho has created a children's activities book about blind children. Titled "Julie and Brandon, Our Blind Friends," it includes samples of Braille, puzzles using Braille, word games, a short story about a blind child, pictures to color, a great deal of information about blind children, and more. It can be used in the classroom, or by other groups. Price of the book is $4 (plus $1.50 shipping—discounted on bulk orders). To order, contact: National Federation of the Blind of Idaho, 1301 S. Capitol Blvd., Suite C, Boise, ID 83706; telephone: (208) 343-1377.
3M Home Health Products
We have been asked to announce: 3M Corporation, maker of many bandages, dressings, and wound-care products routinely used in hospitals, now offers many of the same items for home use. Skin closures, paper, cloth, or plastic bandage tape, wound dressings, even masks and stethoscopes, are included. 3M has established a Health Care Customer Hotline, to give both doctors and patients access to technical/clinical assistance and literature: 1-800-228-3957. For information about 3M's home health products, contact 3M, Health Care, 3M Center Building 275-4E-01, St. Paul, MN 55144-1000; telephone: 1-800-548-6972.
JOB Seminar and Breakfasts
The 1996 Job Opportunities for the Blind (JOB) National Seminar will be held on Saturday, June 29, 1996, from 1 p.m. to 4 p.m., at the Anaheim Hilton in Anaheim, California. This will be an exciting three hours of blind persons talking about their jobs and how they got them. Admission is free; come for practical tips from those who know best because they've been there. This year as before, recruiters from federal agencies and private firms have plans to visit the seminar. The JOB Networking Breakfasts, held every morning of convention for the past five years, will be offered again in 1996, providing further opportunities. All begin at 7 a.m. in "The Oasis," the main restaurant of the Anaheim Hilton, and are BYOB (buy your own breakfast). Some examples include: the JOB First-Timers' Breakfast (a chance to meet convention veterans and start the process) on June 29 and 30; Blind Lawyers on June 30; Braille Proofreaders and Transcriptionists on July 1; Artists and Craftspersons on July 2; Blind Computer Access Teachers on July 4, and more! June 30 through July 4, there will also be a "Generic Breakfast for Job Seekers," to help you get started. All of these will be crowded, so reservations are recommended. Job Opportunities for the Blind (JOB) is a joint program of the National Federation of the Blind and the U.S. Department of Labor. If you have any questions, or want to make breakfast reservations, call JOB at 1-800-638-7518. Further information about the JOB seminars and the NFB National Convention will appear in the "Braille Monitor," published by the National Federation of the Blind, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314.
Brave Souls
To prove their macho, Aztec warriors used to drink hot chocolate without sugar!
Kicking the Soft Drink Habit (from the internet) When one cola-drinker heard that his beverage was "good for cleaning rusty nails," he tried both major brands. They worked. Since then, he reports, he has used soft drinks to clean the terminals on the car battery, to remove bugs from the windshield, to remove tar stains off the car's chrome, and to remove grease from his hands after changing a flat. "Every time I do that," he reports, "I losemy appetite for the drink. If it can do all that, I wonder what it does inside me?"
We Need One!
Lots of people would like to send us a fax—but we don't have a fax machine. If anyone has one they could donate to the VOICE office, it would really be a help. Thanks in advance! It's Confidential! The names, addresses, and phone numbers of subscribers to VOICE OF THE DIABETIC, and members of the Diabetics Division of the National Federation of the Blind are confidential—we don't give your name out. Many organizations make money selling lists of their customers/subscribers to others—which is where all those catalogs you never asked for come from. We have never engaged in this practice, and never will. We can keep a secret.
Hear Ye, Hear Ye, A Raffle
The Diabetics Division of the National Federation of the Blind reaches out and provides support and information to thousands of people. Because it costs to operate this valuable network and to produce the "VOICE OF THE DIABETIC," we must generate funds to help cover these expenses. Our Diabetics Division has elected to hold a raffle, which will be coordinated by our treasurer, John Yark. THE GRAND PRIZE WILL BE $500! The name of the winner will be drawn on July 4, 1996, at the banquet held during the annual convention of the National Federation of the Blind. Raffle tickets cost $1 each, or a book of six may be purchased for $5. Tickets may be purchased from state representatives of our Diabetics Division or by contacting the VOICE Editorial Office, 811 Cherry Street, Suite 309, Columbia, MO 65201; telephone: (573) 875-8911. Anyone interested in selling tickets should also contact the VOICE Editorial Office. Tickets are available now! Names of persons who sell 50 tickets or more will be announced in the VOICE. Please make checks payable to the National Federation of the Blind. Money and sold raffle ticket stubs must be mailed to the VOICE office no later than June 17, 1996, or they can be personally delivered to Raffle Chairman John Yark, at this year's NFB convention in Anaheim, California. This raffle is open to anyone, and the holder of the lucky raffle ticket need not be present to win. Each ticket sold is a donation, helping keep our Diabetics Division moving forward.
Stop Smoking
Cigarette smoking is statistically associated with increased risk of developing neuropathy. That means, if you have diabetes and you smoke, you are making it more likely you will develop this complication. Your best advice is to STOP SMOKING! Nicotine is a "vasoconstrictor"—it shrinks capillaries, reduces circulation efficiency, and raises blood pressure, even in otherwise healthy individuals. Going "smoke-free" not only cuts your risk of vascular complications, it also helps slow the progression of neuropathy already underway. So put it out.
Old Time Radio
We have been asked to announce: Radio Spirits, Inc., will send callers a free catalog listing thousands of Old Time Radio programs available for sale on cassette. For information contact: Radio Spirits, Inc., P.O. Box 2141, Schiller Park, IL 60176; telephone: 1-800-729-4587.
Elections Coming Up
At this year's national convention in Anaheim, California, elections will be held to fill divisional board positions. These are one-year terms, running from July 1, 1996 to June 30, 1997. Positions to be filled are: President, First Vice-President, Second Vice-President, Secretary, and Treasurer. If you are interested in a board position, or know someone who you think would do a good job, then contact our Diabetics Division President, Tom Ley. Yes, hard work and dedication are prerequisites for each board position. Anything worthwhile is usually challenging, and requires hard work. Leadership should be a positive force, and one must lead by good example.
Plan Ahead and Be Prepared
At this year's annual convention of the National Federation of the Blind there will be many insulin-dependent diabetics in attendance. Each of us should have the foresight to bring extra insulin and syringes so as to avoid needing to search for a pharmacy. At every convention, a few diabetics undergo avoidable hypoglycemic attacks. Hotels are jammed, and restaurants are packed, with long waits for a table. We diabetics should always be prepared for an insulin reaction. THINK AHEAD! Always carry something sweet, such as candy or glucose tablets, that can be used for reactions. We should be sure to have, in our rooms, snack foods to help control our food needs. We diabetics can travel anywhere and do almost anything we want, except go without food. Our bloodstreams should have a balance of insulin and glucose. If there is not enough glucose (food) then we have an insulin reaction. "Plan ahead and be prepared."
Steroids and Diabetes
Medications containing steroids can increase insulin resistance. In a person with a tendency toward type II diabetes, steroid use may accelerate its onset. Prednisone, a frequently-used steroidal medication, can be tolerated by a healthy pancreas, but its potential diabetic consequences may be outweighed by the severity of the diseases it is used to treat. Talk to your doctor.
Maine Legitimizes Insulin Adjustment by RN, CDEs
The Maine State Board of Nursing has determined that a registered professional nurse who is a certified diabetes educator may make insulin adjustments when a physician has delegated this authority. The Board's determination followed a discussion about the common but unstated practice of insulin adjustment by diabetes educators. VOICE OF THE DIABETIC applauds this acknowledgement of reality, and hopes other states will take note and follow. Insulin adjustment is an important part of "tight control," the value of which was proved by the Diabetes Control and Complications Trial. No purpose is served by its further administrative restriction.
Display Tables
For this year's annual convention of the NFB, our Diabetics Division has reserved space in the exhibit hall, where we will display literature and equipment of interest to blind diabetics and others interested in diabetes. There will be hundreds of other display tables with products and information that may be of interest to blind persons. CAN YOU HELP? It takes many people to work the display tables, and if you can help for two hours, four hours, or more, please contact our Display Table Committee Chairman: John Yark, 218 Seaton Road, Apt. 2, Stamford, CT 06902; telephone: (203) 324-7862.
Phone Change!
On January 8, a large part of Missouri, including Columbia where our editorial office is located, received a new area code. You used to call (314) 875-8911 to reach us; now you need to dial (573) 875-8911. Please make a note of this change, because, after July 8, if you use the "314" area code to call us, the strange noise you hear in the receiver will not be Editor Ed Bryant's voice!
Neuropathy and Type II Diabetes
A study recently published in the "New England Journal of Medicine" explored the relationship between non-insulin-dependent diabetes mellitus (NIDDM, type II diabetes) and clinical neuropathy. After 10 years, 20% of the type II patients showed painful neuropathy, 30% showed paresthesia (prickling sensation, "pins and needles"), and 44% showed loss of Achilles tendon reflex. Compared to a non-diabetic "control group," nerve amplitude diminished 30-40% and nerve conduction velocity diminished 10% among the NIDDM patients. The study suggests that low insulin levels and higher glycosylated hemoglobin (A1C) levels are associated with worsening of neuropathy. The researchers point out that worsening neuropathy and higher mortality from cardiovascular disease are strongly associated with poor glycemic control. Partanen J, Niskanen L, Lehntinen J, et al: "Natural History of Peripheral Neuropathy in Patients With Non-Insulin-Dependent Diabetes Mellitus." "New England Journal of Medicine" 1995; 333:89-94.
Fructose
If an item is labelled: "Contains no sugar—sweetened with fructose," be careful! Fructose, "fruit sugar," is as much of a carbohydrate as is glucose. It has calories, and it WILL impact your blood glucose, because your body either converts it to glucose or stores it in the liver (in glycogen). So if it says "fructose," its still sugar; you'd better count it as part of your meal plan.
Children's Books in Braille
We have been asked to announce: National Braille Press announces its Children's Braille Book Club. This service offers print-Braille children's books, for the same price as the print editions. Much like "Book of the Month Club," membership is free, and a new title is offered each month. For information, contact: National Braille Press, 88 St. Stephen Street, Boston, MA 02115; telephone: 1-800-548-7323.
1996 NFB Diabetics Division Seminar
The NFB Diabetics Division will hold our yearly business meeting and seminar at this year's National Federation of the Blind annual convention. This year's keynote speaker will address the subject of peripheral neuropathy. This meeting will take place on Monday July 1, beginning at 6:30 p.m. The conference location will be in the agenda, available at the registration table. Plan, prepare, and be rewarded. This year's convention will be great!
Erythropoietin
Erythropoietin (EPO), a drug routinely given to patients on dialysis, is actually a hormone that occurs naturally in healthy human kidneys. It stimulates the production of red blood cells. If the kidneys are damaged (by diabetes or other condition), natural EPO production diminishes, and anemia, low red blood count, can result. To correct this anemia, restoring a healthy blood count, the patient is given recombinant human EPO. Therapeutic use of EPO helps correct anemia and reduces blood transfusion requirements for patients experiencing chronic renal failure or End Stage Renal Disease.
The Price of Diabetes
Diabetes, which affects about 5 percent of the U.S. population, accounted for almost 12 percent of total health care expenditures in 1992, according to a study recently published in the Journal of Clinical Endocrinology and Metabolism. Using data from the 1987 National Medical Expenditure Survey database, a team headed by Dr. Robert J. Rubins at Lewin-VHI, Inc. analyzed the full range of costs associated with diabetes and its ramifications. The team determined that the direct medical costs of physician-confirmed diabetes were $85 billion in 1992. Indirect costs, such as disability, work loss, and premature mortality, amounted to $47 billion in 1992, bringing total estimated costs of diabetes in that year to $132 billion. Dr. Rubin's study estimated that in 1992, per capita annual health expenditures for people with physician-confirmed diabetes were four times greater than for people without—$11,157 versus $2604. Inpatient hospital care accounted for 63% of the former figure, compared to 46% for the latter.
The A1c Test
If you have diabetes, your daily blood-glucose tests are important—but there is another test you should have done every two to three months. 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 two or three months. Where your glucometer 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. The greater the average amount of sugar in your blood, the higher the A1c results. If you test two to four times per day, each test is a "snapshot." Depending on your lifestyle and general health, your glucose levels may fluctuate greatly at different times of day. The A1c 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.
Caffeine and Hypoglycemia
Diabetes, whether treated with insulin or oral medications, carries the risk of hypoglycemic episodes, "low blood sugar reactions." Many veteran diabetics report a lessening of their ability to recognize the onset of a hypoglycemic reaction. Because this "hypoglycemia unawareness" imperils their safety, researchers have been searching for ways to lessen the danger. As reported in the journal "Lancet", Vol. 347, 1996, pp 19-24, caffeine, a common ingredient in coffee, tea, soft drinks, and certain over the counter medications, in dietary amounts (i.e., two to three cups of coffee), "could be beneficial by helping to improve the ability of patients with IDDM to detect the onset of hypoglycemia without adverse effects on cognitive function." So maybe what you need is a nice hot cup of coffee..
The next edition of the VOICE, Volume 11, No. 3, will include information on hypoglycemia and how to deal with it, a report on progress at our latest meeting with the FDA and the insulin manufacturers regarding efforts to include tactile cues on insulin vials. Expect our regular columns and features; as always, articles covering different aspects of diabetes will be presented.
Effective advertising doesn't scream at its audience. It persuades. It sells. The key to cost-effective advertising is making your voice heard where an audience is already listening. VOICE OF THE DIABETIC, circulation 133,000+, offers such an outlet. Make your voice heard. For advertising information contact: Voice of the Diabetic, Ed Bryant, Editor, 811 Cherry Street, Suite 309, Columbia, MO 65201-4892; phone: (573) 875-8911
The VOICE OF THE DIABETIC is a free quarterly news magazine published by the Diabetics Division of the National Federation of the Blind (NFB) for anyone interested in diabetes, especially diabetics who are blind or are losing vision. An outreach publication, it emphasizes good diabetes control, proper diet, independence, and positive outlook. Donations are gladly accepted and appreciated. Contributions are not only tax deductible; they are needed to keep the VOICE and the Diabetics Division moving forward; helping people with all aspects of diabetes. Members of the NFB Diabetics Division enjoy priority services and unique benefits such as a continuous free subscription to the VOICE, automatic access to committees covering all aspects of diabetes, free counseling concerning all facets of blindness and diabetes, as well as access to diabetics who have experienced complications. The VOICE is free to any interested person upon request. Each subscription costs the Diabetics Division approximately $20 per year. To help defray publication expenses, members are invited, and nonmembers are encouraged, to cover the subscription cost.
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Voice of the Diabetic
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End of VOICE OF THE DIABETIC—Volume 11, No. 2, Spring 1996