To a casual observer, Dr. Nat Strand might look like an over-achiever. After all, she and her partner won Season 17 of her favorite television show, "The Amazing Race." Winning the race opened her world up to the diabetes community, which, interestingly enough, inspired her to take better care of herself. Her mission now is to encourage everyone with diabetes to connect with the diabetes community and benefit from knowing others who understand the daily challenges of managing type 1 diabetes. When I caught up with Dr. Strand, we began by talking about what drove her to enter the Amazing Race.
As CEO of a company that manufactures insulin syringes and pen needles for the US and Canadian markets, I have been closely monitoring the regulations and trends pertaining to the safe disposal of the products we produce. Surveys indicate that less than five percent of the over three billion sharps devices sold in the US annually are disposed of in some type of closed container. Most of the remaining 95 percent are deposited, unprotected, in the household trash. Significant changes may be pending with regard to the disposal of used sharps devices, and it's likely that pharmacists will be affected by these changes.
As I listen to the news of the recent Mega Millions jackpot of over $600 million, my dreams aren't about fast cars, vast mansions, or plush vacations. My thoughts revolve around my diabetes. How awesome would it be to have the best care that money can buy?
It's spring break again, when thousands of people head to the beach. A lot of wonderful things come with being out and about on spring break, but if you have diabetes, there are also several things you should consider. There's going to be more traffic, fewer parking places, lots of people, an abundance of uncalculated carbohydrate sources, and longer waits for everything, to name just a few.
The first time I worried about traveling with diabetes was after the 9/11 tragedy. I had been offered a trip to New York to attend a writer's conference. I jumped at the chance, looking forward to the conference, sightseeing, shopping, and seeing the musical The Producers on Broadway.
There's nothing quite like wondering how you're going to pay for prescriptions. I find it odd that we usually don't know what our out-of-pocket cost will be until we're standing in front of the pharmacy staff and praying that we have enough in our wallet to cover it. I often feel like a reality show contestant waiting for the grand total. My pharmacy-based reality show would probably be called "The Biggest Payer," or perhaps "The Amazing Guess," or, aptly, "Survivor." If you've ever walked away from the pharmacy counter embarrassed, panicked, or depressed, you know the feeling I'm referring to. It's a pain no prescription can cure.
In one of Devon Inglee's artworks, a teddy bear, the symbol of childhood innocence, lies flat on its back with three menacing syringes piercing its furry tummy. In the background, the bear's owner, a small girl, stands above the teddy eating an apple. Inglee writes, "In ‘Tit for Tat,' a sweet girl contently eats an apple while hiding a large syringe behind her back, oblivious to her beloved, yet murdered toy. This piece deals with the process of anger, mourning, and denial associated with my personal diagnosis of a chronic disease." For the 33-year-old art student, this work is about mourning and letting go of preconceived notions and ideas of what the future will be.
My son just turned twenty. For the first time, we didn't have a cake, ice cream, friends, balloons, or presents. He spent the day in jail. With vivid memories of his heroin-addicted evening in the ICU several months ago, we had nursed high hopes that his life would be on the mend. But healing takes time, and life doesn't always deliver the happy ending we long for.
When you live with diabetes, there's a lot to do. Checking blood sugars. Counting carbs. Exercising. Not to mention all those fun-filled doctors' appointments. So the last time your physician or diabetes educator suggested ketone testing, it's completely understandable that your head was nodding but your mind was thinking "No way, Jack." But before abandoning the idea completely, there are a few things you should know.
When diagnosed with type 1 diabetes, I was eighteen years old, scared, and confused. Although bone thin, I was older than the usual juvenile diabetic, so the doctor didn't know if I had type 1 or type 2 diabetes. At first, the doctor gave me pills to lower my blood sugar. I avoided carbohydrates and threw myself into exercise, then watched helplessly as the numbers on my blood sugar meter continued to rise.
Utah-based Essential Preparedness Products (EPP) offers an emergency storage case for people with diabetes, called Diabetic med-EcaseTM. The yellow cases, made of high-impact material, are waterproof, airtight, and can float. Buyers of the $69.99 product receive foam inserts for both type 1 and type 2 needs and can outfit the case accordingly.
"Good news," my diabetes nurse educator says to me. "Your new insurance covers continuous glucose monitoring supplies!" I give her a half-smile as my brain screams at me, "CGM? Really? Something else to deal with on top of this damn disease, an insulin pump, exercise, and nutrition?" But I comply, and a CGM is added to the rest of my paraphernalia.
Whenever I tell someone that I have type 1 diabetes, the first words that I typically hear are "I'm terrified of needles! I could NEVER give myself a shot!" But needles are the least of my fears when it comes to my disease. I have bigger fish to fry. Concerns about daily management, combined with fears of heart problems, blindness, and kidney failure, equal one very stressful disease.
Phil Southerland's autobiography is an inspirational coming-of-age memoir about a type 1 baby who wasn't supposed to live. But his doctor's dismal prediction didn't take into consideration his mother's indefatigable determination that her baby would thrive no matter what, and Phil's own fierce drive to conquer every single challenge he encountered, including his diabetes. It's an engrossing book, a sports adventure story with a medical subplot and a roster of dynamic characters, the most dynamic of whom is Phil himself. If we could harness his energy, our dependence on foreign oil would be a thing of the past.
October 27, 2009 - Huntsville AL-Qualitest Pharmaceuticals today issued a voluntary nationwide recall of all Accusure® Insulin Syringes. The distributed syringes are of the following descriptions and NDC numbers: 28G 1/2cc, NDC 0603-6995-21;28G 1cc, NDC 0603-6996-21; 29G 1/2cc NDC 0603-6997-21, 29G 1cc, NDC 0603-6998-21, 30G 1/2cc, NDC 0603-999-21, 30G 1cc, NDC 0603-7000-21, 31G 1/2cc, NDC 0603-7001-21; and 31G 1cc, NDC 0603-7002-21. All Accusure® Insulin Syringes regardless of lot number are subject to this recall. These syringes were distributed between January 2002 and October 2009 to wholesale and retail pharmacies nationwide (including Puerto Rico). The syringes in these lots may have needles which detach from the syringe.
It's not on the market yet, but a patch composed of tiny needles, each the width of a few human hairs, could eventually replace hypodermic needles for most drug injections. Preliminary experiments with people with diabetes have shown that the patch can deliver insulin successfully and with less pain than a hypodermic.
The American Diabetes Association estimates that about 18 million Americans have diabetes. Given that millions of people have lost their jobs during the current recession, the law of averages would suggest that at least a few hundred thousand folks with diabetes are now unemployed. Loss of a job, unfortunately, usually means a concurrent loss of health insurance. For those hundreds of thousands of people with diabetes, no health insurance means big trouble.
Physicians who treat people with type 2 diabetes face difficult choices when selecting the best medical therapy for each patient. The decision process is further complicated by the fact that because type 2 diabetes is a progressive disease, therapeutic agents that were initially successful may fail five or ten years later.
Sandy was giving her son his evening dose of NPH insulin - something she had done many times. But as she finished pushing in the plunger, she said to herself, "That shot took too long." She immediately realized that she had given Joey the wrong dose. In other words, by mistake, she had given him a potentially lethal dose of insulin.
For 2,000 years diabetes has been recognized as a devastating and deadly disease. In the first century A.D. a Greek, Aretaeus, described the destructive nature of the affliction which he named "diabetes" from the Greek word for "siphon." Eugene J. Leopold in his text Aretaeus the Cappodacian describes Aretaeus' diagnosis: "...For fluids do not remain in the body, but use the body only as a channel through which they may flow out. Life lasts only for a time, but not very long. For they urinate with pain and painful is the emaciation. For no essential part of the drink is absorbed by the body while great masses of the flesh are liquefied into urine."
When the sun rose that morning, I was in the kitchen as usual with my daughter, preparing to take my insulin. I usually don't take it in front of her, but we were engaged in one of those frustrating conversations that were so common now that she was a teenager.
Need gift ideas? Holiday gift-giving can be a challenge. Some people like surprise gifts, some make “must have” or “wish” lists. I don’t always know what is on someone’s list, or if they would enjoy a surprise.
The U.S. Food and Drug Administration (FDA) has announced that Tyco Healthcare Group LP (Covidien) is recalling one lot of ReliOn sterile, single-use, disposable, hypodermic syringes with permanently affixed hypodermic needles due to possible mislabeling. The use of these syringes may lead to patients receiving an overdose of as much as 2.5 times the intended dose, which may lead to hypoglycemia, serious health consequences, and even death.
Results from a Harris survey commissioned by the American Association of Diabetes Educators (AADE) show that people with diabetes who must take insulin often struggle with dread and negative impacts on their lives because of it. But more than half of them—52 percent—are reluctant to share their concerns with their healthcare providers.
I was diagnosed with type I insulin-dependent diabetes 54 years ago at the age of 22 months. A dear family friend suggested my parents take me to our family doctor and have me checked for diabetes after I showed some of the more common symptoms. I was unusually cranky and always hungry, but had a stomach that was hard to the touch as though food was not digesting properly. I was also always thirsty, drinking a lot and urinating frequently. Our doctor tested my blood sugar, and the result was high enough to indicate diabetes. He put me on 60 units of insulin per day and told my parents to take me to the hospital 30 miles from the little Western Kansas town where we lived to get a shot of insulin once a day.
It is estimated that nearly 3 million African-Americans have diabetes – 17 percent of all diabetes patients in the United States. That figure is growing as the proportion of African-American patients diagnosed with diabetes consistently increases year to year, according to research from GfK Market Measures’ Roper Global Diabetes Group.
When Dee Brehm was diagnosed in 1949 with type 1 diabetes, her prospects were not bright: a permanent chronic condition, a reduced life span, potentially devastating complications and perhaps no children. She married Bill Brehm in 1952, and they began a partnership knowing that together they would have to manage her disease. Dee subsequently defied the dim outlook for her life: She has two children and six grandchildren, and she has surpassed the half-century mark with this disease having been spared the ordeal of complications.
Eli Lilly and Company has introduced KwikPen, a pre-filled insulin pen
containing its Humalog insulin brand of insulins. The pen is the third that
Lilly has introduced over the past 12 months, following in the wake of the
HumaPen MEMOIR, a digital insulin pen with memory, and the HumaPen® LUXURA
HD, a reusable pen for people who need insulin dosing in smaller increments.
"Delight" is a word rarely found in company mission statements, but it's part of Owen Mumford's rather sweet and very British declaration - the company aims to "delight its customers" with its products, keeping in mind that they just might "change the life of our nearest and dearest."
I have lived with type 2 diabetes for thirteen years, and I know very well how
to take care of myself. In fact, I have it down to a routine. The flaw of a
routine activity, however, is that it is so very routine: you go through the
motions without thinking. And that, as I learned to my deep chagrin, can be
For my contribution this month, I wanted to share an important lesson I learned about twenty years ago from Peggy Wong at the UCSF Diabetes Teaching Center. It concerns how long insulin lasts after you push down that plunger and create a "depot" of insulin under your skin.
Swaying in rhythm like drunk fans singing their team fight song, we
campers bellowed our camp theme, clapping and banging on dining
tables: "Shock, shock for Camp Firefly! We take the insulin - try not to cry!"
I've been doing a lot of flying lately, and it's given me time for
reflection. While aloft a few days ago in JetBlue's comfy seat, as I
took out my syringe and Humalog to dose for my snack, I realized how
many things I no longer do that I was once taught to do.
I've generally been a "good" person. I try to do those ten things on Dalai Lama's list. You know, be kind, not hurt others, let people know you love them, hear a tree when it's falling even if you're not there...
It's about time that we Americans catch up with the rest of the world when it comes to using insulin pens. Maybe we will, now that SoloSTAR, sanofi-aventis's disposable insulin pen, is available in the United States.
This issue, we lay out the many devices with which diabetic people
must poke themselves: syringes, pen needles, and lancing devices.
And we top them off with a sprinkling of sugar: a chart outlining
all the sources of fast-acting glucose.
You know how the pump works: it has an infusion set with a soft
cannula that's inserted only once every few days, and your insulin
infuses into your body by way of the cannula. You certainly don't
get poked with a needle every time the pump sends you some insulin.
Born on the family dairy farm in New York, the second of five
children, Carolyn Gridley was diagnosed with type 1 diabetes after
her grandmother noticed sugar crystals on her diaper that attracted
the bees and flies around the farm.
Each year, one hundred thousand peregrinos, or pilgrims, set out for
Santiago De Compostela in northwestern Spain to visit the bones of
St. James buried beneath the cathedral. Called El Camino de
Santiago, it's one of the world's largest Christian pilgrimages.
I was diagnosed with diabetes in September 1953. During that summer, I was in my second year of graduate school at UCLA when I noticed that I was losing weight and had severe polyuria (frequent urination).
I was diagnosed with type 1 diabetes at the age of three, and I have
lived with it for 62 years. I can still remember my mother learning
to inject insulin into an orange at Hermann Hospital in Houston,
The insulin pump is a wonderful device, a marvel of engineering that
allows diabetics to screw up at the push of a button. With the pump
in use, however, instead of staring at a syringe and racking your
brain to remember what you injected into where and how much, a few
button clicks will remind you of your mistake, allowing you to
correct it with unprecedented accuracy.
Because of recent changes in airline regulations concerning the transportation of medication, diabetics have more to lose than just their lotion or soda. Now more than ever, it is important to know how to notify security and flight personnel of your medical needs, what documentation to bring, and where to find supplies if yours are damaged.
When it comes to administering insulin, many people prefer an insulin pen over the standard syringe and vial because they find pens more convenient and more accurate. And pre-filled disposable pens are easiest of all, because you don’t have to install a new cartridge when the pen is empty–you just toss it out.
Last summer our family changed forever when Lauren, our nine-year-old daughter, was diagnosed with type 1 diabetes. A whirlwind of shock, anger, and worry engulfed me as I watched an incurable chronic illness move into our home.
At 63 years old, I've coped successfully with insulin-dependent diabetes for 46 years. Education and acceptance are the keys, but it took me years (and the support of loving family and friends) to achieve them.
Dismal Predictions - In 1949, at the age of 13, I was diagnosed with diabetes. I was told that I would have to take shots for life and that my life would probably last only 25 years longer. Furthermore, I could eat no candy, and all my children would be diabetic.
To the general public, the mood swings of a teenager are the wildest personal roller coaster around. But there’s another roller coaster out there that puts that kiddie ride to shame: the mood swings of a diabetic person like me. In an average teenager, hormones cause mood swings.
The day after my eleventh Easter, I was diagnosed with Type 1 diabetes. I got a shot that very night, and at least two shots every day for the next fifteen years, until I went on the pump. It seems appropriate that on the day the disease took over my body, a fire took over the chimney of our house.
What are your expectations when it comes to pump training? Are they
realistic? Do you want improved blood glucose control, improved
health and flexibility in choosing when and what to eat? Or, do you
just want to avoid frequent intensive insulin injections? Are you a
“set it and forget it” type?
I am always willing to discuss diabetes with anyone who is
interested. And since I openly perform my blood glucose tests and
administer insulin shots in public, it is fair to say that many
people around me do become interested.
Problems with blood glucose control need to be prevented and solved
when using an insulin pump. When something goes wrong, do you blame
it on the pump or suspect you made an error? Do you assume there is
a pump problem with each alarm?
Several months ago, I met Sophia, a woman in her mid-40s
who had been struggling to manage her type 2 diabetes for
years. Her blood glucose levels were typically well above 300
mg/dl, and she had an equally high A1C of 12.5%. She made
it clear that the last thing she wanted was insulin.
Some things I remember very clearly. Like the moment the doctor told me that I had to take injections for the rest of my life. This news bothered me horribly. But what if he had told me I could inhale the insulin instead? I would have been on cloud nine.
Pramlintide (Symlin) is a synthetic amylin analogue. First described in 1987,
amylin is a neuroendocrine hormone produced by beta cells, which also produce
insulin. This hormone is absent in type 1 diabetes and decreased in type 2
If you have ever dreamed of taking your insulin without needles, your dream
came true on January 27, 2006. That was when the U.S. Food and Drug Administration
(FDA) approved Exubera (insulin of human [rDNA origin]) Inhalation Powder
for treatment of adults with type 1 and type 2 diabetes.
Are you an expectant mother with diabetes? If so, are you wondering about the
disappearance of infusion sites as your baby grows and your abdomen expands?
Do you anticipate that “pinching an inch” will become more of
a challenge? Are you concerned about the angle and depth of insertion, and
how often you should rotate insertion sites? Here are a few suggestions for
Many pump manufacturers have online stores where you can order and pay for
your infusion supplies. In addition to manufacturer Web sites, services are
offered by Advantage Rx, CCS Medical, Fifty 50 Pharmacy, Focus Pharmacy, Logimedix
and National Diabetic Pharmacy. In Canada, supplies can be obtained from AutoControl
It is estimated that that between eight and nine million people use
syringes at home, generating two to three billion used needles each year
in the United States. About two-thirds of the needle users are injecting for
medicinal purposes like diabetes.
I often wonder why insulin pens are
so popular in Europe, yet usage in the
United States continues to hover around
12 percent. I think the main reason is that
many healthcare providers are not familiar
with insulin pens or how to train people to
use them, so they don’t recommend pens to
Five thousand feet above a city besieged by
water, you feel very small. A devastated New
Orleans smoked from chemical explosions and
other rolling disasters. To say it seemed like a war
zone is not quite complete. Our small jet banked
slowly, and I realized that as far as I could see, I
could not see the end of it.
On June 17, 2005, Novo Nordisk received word from the U.S. Food and Drug
Administration (FDA) that their long-acting insulin analog, Levemir (insulin
detemir), had received approval. Levemir will join Lantus (insulin glargine) as
a basal insulin option for people with diabetes who take insulin.
On March 16, 2005, Amylin Pharmaceuticals, Inc., of San Diego, California,
announced it had received FDA approval for Symlin (pramlintide acetate)
injections to be used in conjunction with insulin to treat diabetes.
Back in February, I wrote about what I keep in my diabetes kit. Well, just last month, the contents of that kit, along with my waist pack, disappeared during a trip out of town. I found myself without a meter and no insulin. Anyone whose life depends on these things will be able to identify with me—I felt quite naked.
Recent correspondence and commentary in “My Own Injection” in this publication reinforce what most of us who inject insulin daily know all too well about diabetes: so-called “professional” advice is either contradictory or just plain wrong. The common, well meaning, but just plain wrong admonition: "Don't inject through clothing” is a fine example. Another is “Don’t reuse needles because you may develop an infection.”
Since the early 1980s, people with diabetes have needed
accessory cases to carry their testing and insulin supplies
with them. As the goal of better blood glucose control led to
more frequent glucose testing, multiple daily injections and
insulin pumps, keeping supplies and life support systems handy
has become ever more important.
Though I didn’t get a cake, I just celebrated my biggest birthday. I have now lived for 30 years with diabetes—that’s 30 years of effort and worry, 30 years of information-gathering, testing, dieting, hypos, injections and doctor visits. Somehow, luckily, I have thrived.
Before the mid-1950s, people with diabetes injected insulin using glass syringes with detachable steel needles. Between injections, the glass syringes were boiled and the needles were soaked in alcohol to keep them as germ-free as possible. To reduce the pain of the injection, people would sharpen their needles on a sharpening stone.
Since Lantus first appeared on the market in 2001, it has been praised as the best basal insulin for good blood glucose control, primarily because it has a flat, peakless action. It fills a need for people who desire consistent insulin action around the clock, but like other basal insulins, it has to be set, tested and adjusted to match the user’s need.
Today’s finger-piercing lancets draw much less blood than their predecessors did. But they still hurt, say some. Today’s insulin needles are models of precision engineering. But they’re still not comfortable for everyone—especially if they hit a nerve.
Becton, Dickinson and Company, of Franklin Lakes, New Jersey, best known for its insulin syringes, has entered the blood-glucose meter market with two products: the BD Logic blood-glucose monitor and the BD Latitude Diabetes Management System.
Not so long ago, there were two insulin pump companies—MiniMed and Disetronic. In the past couple of years, however, new companies seem to come along every few months. Now we have Medtronic MiniMed, Disetronic, Animas, Dana, Deltec and soon Nipro.
Select a new insulin syringe from the bottom and dispose of a used one in the top of a new all-in-one syringe dispenser and disposal unit called the UltiGuard, made by Ulti Med, Inc., of St. Paul, Minnesota.
If you're still putting your used lancets, pen needles and syringes in a coffee can or empty detergent bottle and surreptitiously burying it under the empty cans and boxes in the trash because your community doesn't have a sharps disposal program, Becton Dickinson (BD) of Franklin Lakes, New Jersey, has a solution.
Shorter needles for both insulin syringes and pens mean no more pinching and less bleeding and bruising, says Becton Dickinson and Company of Franklin Lakes, New Jersey, in introducing its BD Mini pen needles and insulin syringe needles.
As an insulin pumper, are you prepared for unexpected (or expected) events? For instance, there might be a time when you are not using your insulin pump—either by choice or by necessity. Is this a time for panic?
Over the Fourth of July weekend, my family and I went to the county fair. It was a great day, but the noise really started to bug me, and I began to get cranky. How dare the barkers at the carnival shout so loudly! Why did the rides have to play music incessantly? My children wanted money for this ride and that toy, and I wanted to yell at them and tell them they couldn't have one more nickel!
People who inject insulin can confuse Lantus (insulin glargine) with short-acting Regular insulin or rapid-acting Humalog (insulin lispro) or NovoLog (insulin aspart) because they are all clear in color, warn doctors from the Yale University School of Medicine.
This past December, Jason Johnson, 28, a starting pitcher for the Baltimore Orioles baseball club, was the co-winner of the Tony Conigliaro Award. The award is presented annually to a major league player who has overcome adversity through the attributes of spirit, determination and courage.
Are you planning to start your child on an insulin pump during summer vacation? While this may be a great time to get comfortable with a pump, the next challenge will come when the child returns to school.
After 40 years on insulin, Bob Teskey, 56, could no longer keep his blood-glucose levels under control. As his condition worsened, his hypoglycemic (low blood-glucose) episodes became more and more intrusive on his life. Teskey talked to his doctors, but there was nothing they could do except tweak his insulin regimen, which did not solve the problem. He continued to collapse unexpectedly, as his blood-glucose levels dropped without warning.
Correction: In the Letters to the Editor of the November issue (p. 61), we made an incorrect statement about the use of Lantus. The sentence should read "..those who take three meal-time shots of short-acting insulin plus basal Lantus will take four shots of insulin a day." We apologize for this error.
The Federal Aviation Administration (FAA) has implemented stepped-up security measures at the nation's airports in response to the tragic events of September 11. Some new security measures may affect airline passengers with diabetes. The American Diabetes Association recognizes the added inconvenience this may pose for individuals with diabetes, but understands the necessity to secure airline passenger safety.
John Hughes of Woodburn, Oregon, had never bothered to get a letter from his doctor stating that he has diabetes and is required to carry sharp-pointed insulin-pump infusion sets, lancets and emergency syringes with him into airplane cabins.
Roche Diagnostics of Indianapolis, Indiana, is now offering a new lancet with unique functions for making blood sugar testing as painless as possible. Called the Accu-Chek Softclix, the lancet features 11 different depth settings, which can be set to match your skin type. In addition, the lancet does not use a spring-loaded system, which can cause skin tissue to dilate or tear. Instead, it uses a linear sliding motion to avoid pain caused by side movement, according to company's press release.
Retailers should not switch the brand of diabetes supplies without first informing patients or their healthcare providers, according a recent survey sponsored by Becton Dickinson (BD) of Franklin Lakes, New Jersey. The vast majority (90 percent) of doctors and nurses surveyed said that they don't approve if a retailer changes a syringe from a prescribed brand to a store brand without telling them or the user.
In July 1999, John Buse, MD, PhD, CDE, director of the University of North Carolina's Diabetes Center told Diabetes Health that patients enrolled in clinical trials for insulin glargine (Lantus) absolutely "loved" the 24-hour-a-day long-acting (basal) insulin. Most of the people who participated in the clinical trials were not doing well on just NPH or Ultralente, and Lantus improved their control. However, Buse added, "[The clinical-trial participants are] upset that they cannot continue on it." That was because, at the time, the clinical trials had ended and the participants were told they would have to wait at least one year for FDA approval of Lantus and longer until they could get their hands on it.
Not much strikes fear into the hearts of the parents of a type 1 child than one who is sick and cannot hold his or her food down or who refuses to eat. But researchers at Baylor College of Medicine in Houston, Texas, have found a solution.
I am in my 32nd week of pregnancy with my second child and I wonder if I have developed gestational diabetes. Diabetes does not run in our family, and I am not overweight. Furthermore, I did not develop gestational diabetes with my first child.
Many people with diabetes must have daily insulin injections to live. However, what happens to the billions of insulin syringes generated each year in the United States alone? Often, they are thrown in the trash, exposing family members, sanitation workers and landfill operators to accidental needle-stick injuries.
You made the decision to use an insulin pump. You overcame your anxiety about inserting that infusion set, and you found some basic techniques to wear or hide the pump. But still, some questions may remain. Maybe you're wondering about getting your set to stay in place. Maybe you're concerned about finding an appropriate site to begin with. Either way, the following tips and tricks should help you choose and maintain an infusion site that gives you as little trouble as possible.
In a letter to the June 21 issue of Journal of American Medicine, several physicians at the Medical University of South Carolina detailed their observations of six patients with diabetes who were suffering from needle fragments buried in the skin.
Recently, Dr. James Shapiro and a team of transplant surgeons at the University of Alberta in Edmonton transplanted islets into 10 people with type 1 diabetes. In previous studies, only eight percent of islet-transplant recipients have remained off insulin for one year. The Edmonton Protocol is the first study in which 100 percent of islet-transplant recipients have been insulin-independent for one year.
Let me start off with a big thank you to all of you. As a person with diabetes, I feel I have the best job in the world! An important goal for me is giving consumers of diabetes products and treatments a voice. That is why you will find your voices included in these pages.
Q: Are there any studies of dietary changes to help with problems of gastroparesis? My daughter has had type 1 diabetes for 32 years and is now suffering complications, gastroparesis being one of particular concern.
Although syringe makers and medical professionals alike caution against needle re-use, the practice is widespread, judging from the response to an informal survey we conducted for this article. Forty-three out of the 57 readers we surveyed re-use their needles, from two to as many as 150 times.
1999 did not produce any dramatic breakthroughs where syringes, insulin pens and injection aids were concerned. New products were minor variations or improvements on the same themes. As always, the focus of new injection devices is on less pain and more comfort. The cost-conscious consumer, however, wants durable products that deliver the least pain at the lowest cost. Often, it is hard for manufacturers to meet all these conditions.
Dr. Sharad Pendsey is a physician based in Nagpur, India. Pendsey recalls the story of a girl named Sudha who came to him when she was eight-years old. Sudha had just been diagnosed with type 1 diabetes. When she was discharged from the hospital, Pendsey explained to Sudha's impoverished parents that she would have to take insulin to stay alive. Pendsey recalls Sudha's parents asking, "Doctor, if I understand you correctly, Sudha has to take insulin every day for the rest of her life?" Pendsey nodded yes, and said that Sudha would die if she didn't. The parents understood the predicament, but could not afford the cost of her insulin. One month later, Pendsey learned that Sudha had died.
Manufacturers of disposable syringes recommend that they be used only once because the sterility of a reused syringe cannot be guaranteed. However, some individuals prefer to reuse a syringe until its needle becomes dull. Most insulin preparations have bacteriostatic additives that inhibit growth of bacteria commonly found on the skin. For many patients, it appears both safe and practical for the syringe to be reused if the patient so desires. The syringe should be discarded when the needle becomes dull, has been bent, or has come into contact with any surface other than the skin; if reuse is planned, the needle must be recapped after each use.
One year ago, I was standing in line at a local pharmacy to purchase a prescription drug for my wife. The woman in front of me had given the pharmacist a prescription for a mild agent to help her son sleep. This drug is neither essential nor even clearly effective. As the pharmacist gave the woman the bottle of 30 pills, he asked her for $204.
Not too long ago, I received a hero's medal from Joslin Diabetes Center for having diabetes for more than 50 years. Now approaching 52 years with diabetes, I'm still going strong. I've had a few complications from diabetes, but nothing that has kept me from leading an active life. The complications I've experienced have made me more determined to maintain my present quality of life.
Q: I have been taking vitamin E for over 10 years. I started on 100 mg., then moved up to 200 mg. About six months ago, I switched to 400 mg. Recently, however, I started having swelling in my lower legs and feet. I also started having blisters that oozed on my legs.
Imagine if a free glucose meter showed up at your door. You'd be thrilled, right? Well, it happened to David Fogarty, but he wasn't thrilled. This Berkeley, California, father was fuming mad. Fogarty's HMO, Health Net, sent a free Precision Q.I.D. meter to his 11-year-old son, Lucas, and to all its other members with diabetes. The catch was, Health Net would soon stop covering strips for Lucas's One Touch Profile.
A compound isolated from a fungus controlled blood glucose levels in mice bred to develop diabetes. Researchers are saying that if the fungus, collected from a plant in the Republic of Congo, demonstrates the same effects in humans with diabetes, then millions of people would be freed from taking insulin.
Hundreds of responses came back when DIABETES HEALTH ran its survey on the popular children's Web site, childrenwithdiabetes.com, asking parents for their favorite products and tips on diabetes care. Here are a few of the responses we received.
While insulin pens have made blood glucose management easier and more flexible for many individuals with diabetes, they are also susceptible to technical malfunctions. Such malfunctions could result in extraordinarily high blood glucose (BG) levels, and impair the diabetes patient's health.
Q: I just finished reading the November 1998 issue of DIABETES HEALTH regarding the Juvenile Diabetes Foundation (JDF) islet transplantation $20 million advance. I didn't see anything about the cloning of islets, however, which I had read about in a previous issue of DIABETES HEALTH. I am curious to know how realistic the cloning process is, and when we might see it actually take place.
Bodybuilders try many substances, both legal and illegal, to develop muscle mass. Lately, insulin has emerged as a popular muscle-enhancing agent, and, according to an article in the May 28, 1998 issue of theJournal of the American Medical Association, it could come with dangerous side effects.
If you've ever hit muscle with a needle, you know the pain. If you've ever injected the right dose of insulin and still found your blood sugar sky high, you might have injected too shallowly and hit skin.
My wife's mother, Carol, has been staying with us recently. She's had type 2 diabetes for 14 years, and this past year her vision deteriorated to the point where she is now legally blind. Then, she had a stroke six months ago.
According to a survey conducted by Consumer Health Sciences (CHS), only 70% of people with type 1 and 2 diabetes who are insured have coverage for glucose meters. It was also revealed that 88% have coverage for test strips; 80% have pharmaceutical coverage; 55% have insurance coverage for syringes and only 12% have coverage for insulin pumps.
Living with diabetes increases the likelihood of experiencing on-the-job discrimination. Since 1992 more than 2,000 people filed complaints with the U.S. Equal Employment Opportunity Commission (EEOC) specifically stating they were mistreated at work as a result of their having diabetes. Another 6,500 complaints cite visual ailments and problems with extremities-medical concerns frequently associated with diabetes-as underlying reasons for job discrimination.
Diabetes is a rich and growing industry. Last year alone, the diabetes medication market grew 23 percent. Furthermore, 2,186 more of us are diagnosed with diabetes in this country every day. Do the math and you'll see a growing market.
How does the cost of increased blood glucose testing and more injections affect those with lower incomes? According to the third National Health and Nutrition Survey, "those without health insurance are twice as likely to suffer a lack of food as those who have health insurance."
Before eating lunch at a restaurant, Jim loads his foil packs of insulin into a device about the size of a large flashlight. He then presses a button which releases a cloud of insulin into the clear chamber of the device. He takes a slow, deep draw of powdered insulin into his lungs.
Summer is when pump wearers need to plan ahead and take special precautions. Sun, sand, heat and water are just a few of the hazards that come with the job of summer fun that can impair your pump's performance. If you spend a significant amount of time outdoors, here are a few tips on how to make your pump time worry-free. Have a sensational summer!
Q: I am a mother with type 1 diabetes and read with interest the "My Own Injection" column in March 1998 ("The Diary of a Diabetic Dad") describing Scott King's trials and tribulations as a dad with diabetes.
The following is a greatly abridged list of quotes from respected medical journals on the financial and medical impact of various diabetes practices and products. These can be used in letters to HMOs and purchasers of HMO plans to impress upon them the importance and financial good sense of providing good diabetes care. Again, this list is just a short list of the many facts gathered on the subject. The more you investigate and the more you learn the stronger the case you can present to get the coverage you need and deserve.
In March a U.S. District Court issued a preliminary injunction in favor of Becton Dickinson, a major manufacturer of insulin pens and needles, in its false and misleading advertising suit against its Danish competitor, Novo Nordisk. The court prohibited Novo Nordisk from claiming that its NovoPen 1.5 and Novolin Pre-filled devices can only be used with NovoFine needles.
I was seventeen years old when the doctor told me I had diabetes. In the weeks that followed I heard many strange things about my new disease. Friends, neighbors and relatives had plenty to say about my diabetes and very little of it was positive.
We all know there are all sorts of diabetes care supplies that we might want to carry: batteries, pump tubing, lancets, syringes, even log books and emergency information. And what about other treatment aids, such as glucose tablets, urine test strips, or glucagon?
Cortecs International, an Anglo-Australian biotechnology group, recently announced a breakthrough in the search for an oral version of insulin. Cortecs has produced a capsule containing insulin that is able to get to the liver and reduce blood sugar levels. The capsule overcomes the long-standing problem of capsule destruction by the digestive system.
It can be difficult enough being a child, not to mention a child with diabetes. Luckily, there are educational toys, products and information that can help children with diabetes conquer some of the mountains that diabetes can create. DIABETES HEALTH looked into various products and logged onto a web site for children with diabetes - www.castleweb.com/diabetes/ - to ask parents of children with diabetes firsthand how they deal with the day-to-day challenges of diabetes. Here are a few products and parents' tips that you may want to look into.
Troubleshooting the pump system involves looking at your pump screen to make sure the appropriate basal is set, the appropriate bolus was given at the last meal and the time is correct. If all of this is working appropriately, make sure your syringe has insulin in it, and there is no leakage. Make sure the set is attached appropriately to your body, and the needle or infusion site area looks normal.
So you've decided to go on the pump and everything is going well: BGs are under control and the Dawn Phenomenon is a thing of the past. Then, suddenly you have an unexplainable high blood sugar. What do you do?
I recently learned of a famous diabetologist, Dr. Lawrence in England, who made all the endocrinologists he trained take a shot of insulin to experience an insulin shock. He felt this was necessary for them to become good doctors.
Differing opinions about how to best care for insulin are stirring up a whirlwind of confusion. Over the last few months readers have been sending their questions and concerns to DIABETES HEALTH. The questions are simple enough: What is the best temperature to keep my insulin? Is it okay to use insulin past the expiration date? How should I mix my insulin? But answers to these questions can vary, making it hard to be sure one is doing the right thing. Here the questions and comments of insulin users will be presented with the recommendations of the companies who produce insulin.
Many doctors recommend intensified self-management to lengthen lives and reduce long-term costs of chronic health problems associated with diabetes. But a fiercely competitive health insurance market often produces health plans that contradict appropriate medical treatment.
The following is an informal, unscientific review of some of the leading injection aid products on the market. It is not the result of a comprehensive consumer satisfaction survey. While we are thankful for the responses from our readers included in the article, it should be noted that they are the opinions solely of the individuals and do not reflect the views of Diabetes Health.
DiabetEase Products Inc., the manufacturer of Syringe Guard, has introduced two new portable diabetes packs. The packs, Samsonite World Sport Cool Packer and Samsonite World Sport Cool Packer Jr., are designed to conveniently hold and protect diabetes care products.
If you're looking for encouraging words and education, but the very words "support group" bring forth images of half-naked men pounding bongos in the forest, don't despair. With over 800 groups in the United States for people with diabetes and a whole host of computer-based discussion groups springing up on the internet every day, there's really something for everyone.
Pharmaceutical giant Novo Nordisk filed suit against major competitor Eli Lilly on Aug. 1, alleging that Lilly deliberately created false and misleading packaging information for its new Humulin cartridges.
Now that HMOs have become the most popular choice of health plan for employers, some employees-especially those with diabetes-have found themselves disappointed with the care they receive. Many HMOs do not provide lancets, blood test strips, alcohol swabs or syringes. Many do not cover the cost of specialists such as podiatrists or ophthalmologists.
I was recently invited down to Palm Springs by Jim Cook to participate in "A Day of Hope," a day of researchers speaking at the Eisenhower Medical Center Desert Diabetes Club. For two years, Jim, President Emeritus of the Desert Diabetes Club, has worked on this one day to invite all the people concerned about diabetes in the Palm Springs area to hear scientists talk about the latest research-the things Jim feels offer the most hope to people with diabetes.
A major challenge in diabetes therapy is to match the insulin with food and exercise. Changes in the amount of time that it takes for insulin to be absorbed into the bloodstream can be a critical factor in obtaining diabetes control. Both the amount of insulin and its timing are critical, and both of these can be influenced by a wide range of variables. Here is a list of factors which every person taking insulin should be aware of.
Kids take first priority in Sherry Trunnel's life. As the only diabetes educator at Blank Specialties Clinic of Children's Hospital in Des Moines, Iowa, Sherry skips vacations when the hospital admits a new child with diabetes.
Jolted awake at 4 am with a low blood sugar, my heart racing, is not my first choice to begin a bright day. While it was still dark, I staggered out of bed to find my tube of Dex 4's. I should have tried to get right back in bed, but my hunger was overwhelming. Grabbing a bathrobe, I plodded out of the bedroom to plunder the fridge. I ate three oranges, a pear, and two pieces of toast before my hunger pangs subsided. I was wide awake with my heart still pounding from the hypoglycemia.
Currently there are an estimated 16 million people with diabetes in the United States. Perhaps ten percent are insulin-dependent-the rest have type 2 diabetes, which they control with diet, exercise, oral medications, and insulin.
Because children receive such small doses of insulin compared to adults, accurate measurement is crucial. But doctors at Johns Hopkins Hospital reported in the January 1996 Diabetes Care that caregivers overdraw insulin by an average of 0.22 U.
The Medi-Ject Corporation, makers of a needle-free insulin injector, recently announced a new alliance with Becton Dickinson. The collaboration grants Becton Dickinson (B-D) the rights to market a new needle-free jet injector product for insulin and selected other drugs under its brand name. Medi-Ject will manufacture injectors and B-D will manufacture the disposable drug chamber.
About a month ago I was driving to Santa Cruz and noticed a tingling in my fingers. It got worse when I put my hands up on the steering wheel and better when I rested them on the bottom. During this two-hour drive, it was a struggle to keep my fingers from falling asleep. Soon after, I began to wake up often during the night, having to reposition my hands so they would stop tingling.
Teresa L. Zilka, RN, of Portland, Ore. recently conducted a study funded by Eli Lilly and Company and Legacy Good Samaritan Hospital. Zilka determined that mixing NPH insulin and regular insulin and then reusing the syringe causes "statistically significant" contamination of the regular insulin.
Earlier this summer, MiniMed introduced their new Quick Release Soft Set (see July 1995 issue, page 13). Now a whole new family of sets will be introduced into the United States by Disetronic. This follows after an almost eight-year scarcity of truly innovative infusion sets.
A new video entitled "The Basics of Diabetes" has been released by Pat Gallagher, medical correspondent and producer of the TV show "Living with Diabetes." The video is the first in a series of diabetes education tapes that will be compiled from the previously aired footage.
Today's pump user is afforded a high degree of ease and comfort in maintenance of this type of therapy. Gone are the days where the only options were messy antiseptic solutions and inappropriate bandage tapes. Over the years, a number of special products have been developed to make wearing an insulin pump a relatively problem-free experience.
Phyllis Furst, RN, MA, CDE is a diabetes nurse educator in Long Island, New York. She is the Diabetes Education Director at the Endocrinology and Diabetes Associates of Long Island in Rockville Center, a 3 physician diabetes and endocrinology practice, and has had type I diabetes for 22 years.
Your pharmacist and his staff screen a new prescription for errors, then enter the data into the computer. If a problem is noted the pharmacist will contact your physician. The prescription is dispensed to you and a face-to-face counseling session informs you how to take the medicine correctly, what possible side effects or adverse effects to be aware of, and what to do about a missed dose. Some computer programs also print out an information sheet about your prescription.
The letters we received in response to Joan Hoover's article "The DCCT Offers Nothing to Diabetic Patients" were surprising in a number of ways. Firstly, they were primarily from health professionals: doctors, researchers, nurses. Secondly, almost all of them were opposing Ms. Hoover's viewpoint. We are printing the letters (some have been edited for length) because such a response deserves consideration, but also because the letters touch on many of the reasons behind the DCCT study. Also interesting is that each letter has a different view on the DCCT.
New developments in technology and manufacturing techniques have brought a new level of sophistication among lancets. The consumer now has more questions than ever about choosing the right lancet. In light of this, DIABETES HEALTH has compiled a comprehensive look at the lancets currently on the market, and their differences.
Margaret J. Wilkman, RN, CDE, is a clinical nurse specialist at Duke University Medical Center in Durham, North Carolina. She is part of a consulting team, consisting of an endocrine specialist, a dietitian, and a clinical nurse specialist, that sees patients with diabetes who were admitted to the hospital for reasons other than diabetes.
This is the final installment of Dr. Ginsberg's three-part series called "Intensive Insulin Therapy," which was written in response to the DCCT results. Part one defined intensive therapy and gave an overview of the theories and techniques involved. The second part explained how to start an intensive therapy regimen and calculate your daily insulin doses. The last part deals with adjusting insulin doses when using intensive therapy. The goal of this series is to educate people with diabetes about intensive therapy and enable them to choose the therapy that is right for them.
This past week I was in bed for two days with a severe cold, probably stress induced. Forced to rest, I had time to reflect on this past year. What a year-what a lot of stress! I think it has been the most event-filled year in my life. Below are a few of the major changes that have filled 1993.
This is the second part of a three-part series called "Intensive Insulin Therapy," written by Dr. Ginsberg in response to the DCCT results. Part one defined intensive therapy and gave an overview of the theories and techniques involved. The second part explains how to start an intensive therapy regimen and calculate your daily insulin doses. The third will deal with adjusting insulin doses when using intensive therapy. The goal of this series is to educate people with diabetes about intensive therapy and enable them to choose the therapy that is right for them.
It took years of refining my multiple injection techniques for me to get my blood sugars down to the levels achieved in the DCCT study. It was tough, but with monitoring 8-10 times/day I was able to lower my average blood sugars and my hemoglobin A1C tests. During this period I could not get health insurance and had to save money wherever I could. I would reuse my syringes until the markings rubbed off and I would cut my strips in half. (Don't try this now because today's meters don't work with cut strips.) Then for a brief period in 1989 I was part of a group health insurance plan that paid for durable medical equipment. This enabled me to afford purchasing an insulin pump.
In light of the results of the DCCT, Dr. Barry Ginsberg has written a three-part series on intensive insulin therapy. Look for the continuation of Dr. Ginsberg's "How to Understand and Use Insulin" in future issues.
In an effort to report on all sides of the DCCT (Diabetes Control and Complications Trial), we interviewed eleven of the participants about their experiences; four on conventional therapy, four on multiple injections, and three on the pump. Here are excerpts from our interviews with them. It is interesting to note that whenever someone from the conventional therapy group became pregnant, she was transferred to one of the intensive therapies for the duration of the pregnancy.
For the last ten years the DCCT has been a big part of the participants' lives, affecting everything from what they eat to how they control their diabetes. The study is over now; the doctors have proven the effectiveness of intensive therapy, they have told us that tight control is the new standard in diabetes care. But they have not told us what the new therapies are like and how they affect our day to day life. For that we must talk to the participants themselves. We contacted eleven of the patients for their insights on the study and the therapies they used.
Brett Michaels is the lead singer of the rock group, "Poison," which has sold over 15 million albums. As a rock star, he is on the road 9-10 months of the year, travelling throughout the United States and Europe. In this interview with Pat Gallagher on the live radio show, "Living with Diabetes," he shares his heartfelt ideas and philosophy about living with diabetes. Brett's unusual lifestyle and his willingness to be outspoken about his diabetes provide a sense of encouragement and inspiration to many young people with diabetes.
This is the third and fourth parts of a six part series on "How to Understand and Use Insulin." The goal of this series is to promote a better understanding of insulin for those readers who already take insulin, including the many people with Type II diabetes who have switched from pills to insulin to treat their diabetes. The first and second parts of the series dealt with the technical factors involved in minimizing variations in insulin absorption. These parts focus on adjusting insulin, and parts five and six will focus on insulin research.
Diabetes in cats, dogs, and even birds is not uncommon, and as in humans, it can be controlled once it is diagnosed. The basic rule is that any animal with a pancreas has the potential for contracting the disease, and that includes most household pets. Common symptoms to look for are very similar to those found in humans: increased thirst, urination, and weight loss.
New developments in materials, bio-engineering techniques and other disciplines have recently taken the concept of artificial organs from fantasy to reality. EU 346 PANART-Artificial Pancreas, for example, aims to develop an implanted artificial insulin delivery system, which promises to give diabetes sufferers a more normal and healthy lifestyle.
This is the second part of a six part series on "How to Understand and Use Insulin." The goal of this series is to promote a better understanding of insulin for those readers who already take insulin, including the many people with Type 2 diabetes who have switched from pills to insulin to treat their diabetes. The first and second parts of the series discuss the technical factors involved in minimizing variations in insulin absorption. Parts three and four will focus on adjusting insulin, and parts five and six will focus on insulin research.
This is the first of a six part series on "How to Understand and Use Insulin." The goal of this series is to promote a better understanding of insulin for those readers who already take insulin, including the many people with Type 2 diabetes who have switched from pills to insulin to treat their diabetes. The first and second part of the series will discuss the technical factors involved in minimizing variations in insulin absorption. Parts three and four will focus on adjusting insulin, and parts five and six will focus on insulin research.
To have my own mother come down with diabetes was quite of a shock. It is a big issue for me because my life is already dedicated to helping people with diabetes get a fair shake, and this is such a switch. I was diagnosed with diabetes when I was 17, and it was my mom that cared for me and brought information into our home. Now I have the chance to impact her life in much the same way.
In a study published in The Diabetes Educator, May/June 1992, researchers conducted a survey to evaluate the opinions of patients with insulin-dependent diabetes concerning their use of jet injectors for insulin delivery. It was also the intent of the researchers to find out if the use of a jet injector affected the patient's commitment to their treatment program.
On July 1st,1991, San Francisco introduced a pilot program, initiated by Scott King, Editor in Chief of DIABETES HEALTH, to help reduce the risk of city garbage collectors getting stuck by syringe needles.
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.
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