Letters to the Editor
Looking For A Friend
Thanks for reminding me about renewing my subscription to DIABETES HEALTH I enjoy the paper and would hate to miss a copy. Being somewhat isolated, I especially look forward to your informative articles on diabetes, and relish reading the stories about your son and experiences with fatherhood. In February, 1991 my doctor told me I had type 2 diabetes. I was more than a little shook up. In March, 1991 I attended a class on diabetes management at the local hospital and was amazed at what I learned. I started my treatment with 1 diabeta 5 mg pill a day. Then progressed to two a day. Now I'm taking 1 1/2 pills twice a day. I'm trying to lose weight but it's difficult. I don't know anyone in Salem who has type 2 diabetes. While I seem to have my diabetes under control and am feeling well, I'd like someone whom I could share my concerns with. Do you know anyone in your area that has type 2 and would be willing to contact me so that we could discuss diabetes? If so, please give them my address.
955 18th street NW
Salem, OR 97301
Eye Doc Endorsement
I hope all is well in California. It's hot as H- here in Florida. Muggy and swampy. Oh well.
I got the latest issues of DIABETES HEALTH, excellent as usual. I get basically all the diabetes media and find Diabetes Health the best and most informative.
In the past I have told you about my extremely excellent retinopathy specialist, and to the best of my knowledge you have not contacted him. He is recognized as one of the best there is, he specializes in retinopathy and vitreous problems. His name is Dr. Jeffrey Weiss and his phone number is (305) 975-0044. Please feel free to use my name. He is of the same caliber as Dr. Alan Marcus. You will be impressed with him. I don't know what precise aspect of eye care problems would make a good article, but I am certain you can find something.
Coral Springs, FL
You're Writing About Me
After reading John Walsh and Ruth Roberts' article on "Uncomplicating Diabetes, Hypoglycemia Unawareness: The Dangerous, Unaware Mind" in the March issue, I was certain they were writing about me! I have had type I diabetes for almost 30 years now and the last 7 to 10 years have been the most difficult to control. I keep my target blood sugar range at 150 mg/dl because of unsuspecting blood sugar levels. I check my sugar at least 8 times a day to see exactly what it is. Once it was 26 mg/dl and I felt fine, no signs or symptoms at all! Another time it was 33 mg/dl with no sweating, hunger, trembling, etc.
Insta-glucose gel has saved my life on more than one occasion. This has 30 grams of carbohydrate and is cherry-flavored. I am also allergic to glucagon.
Thank you, John and Ruth for this in-depth understanding of hypoglycemia unawareness. My husband also appreciates your words of wisdom.
PS: Keep up the excellent articles! I just ordered your "Pumping Insulin" book. I look forward to reading DIABETES HEALTH each month and your book.
Ellen M. Johnson
John Walsh and Ruth Roberts' column in DIABETES HEALTH was very informative. I sent copies to two people who have an above average problem with repeated lows and hypoglycemic unawareness (HU).
Both are penpals of mine. One has had a complete pancreatectomy, the other has had a partial pancreatectomy as part of a Whipple procedure. One of the hurdles they've encountered repeatedly is the lack of knowledge on the part of their physicians. The woman with the Whipple has had the dumping syndrome to contend with, too.
Mr. Walsh, in your 15 years of providing diabetes care, have you had cases of secondary diabetes such as my penpals? If so, do you have any information that I could pass on to them?
Thank you very much for any help you can give me.
Lake Oswego, OR
[In Ruth's and my attempt to provide information that people can use, it's wonderful to know you took the time to direct the information to others who can use it most. We appreciate your help.
Surgery of the pancreas, undergone by your friends, is called secondary diabetes and can is a rare cause of diabetes. Secondary diabetes can be related to surgery of the pancreas or surrounding organs, cancer (usually of the pancreas), other endocrine diseases like Cushing's syndrome, hemochromatosis (excessive deposition of iron), and rarely by trauma or poisons. Hemochromatosis is the most common of these outside causes of diabetes.
People who have secondary diabetes often present with unique control problems: 1) they are quite sensitive to insulin and may have residual insulin production, 2) they have often lost weight as part of their primary disease, 3) the absorption of food in meals may be unreliable if the pancreas no longer releases its fat-digesting enzymes, and 4) glucagon, a hormone produced by the pancreas to raise low blood sugars, may also have been lost. Both of your friends appear to have 3 or 4 of these factors to contend with.
Blood sugar control is often quite erratic with these combined problems. Insulin requirements are often no more than 15 to 25 units a day. If the person takes pancreatic enzymes before a meal, but misjudges the number of tablets needed to digest the fat it contains, rapid transit time results and the meal's carbohydrates are not absorbed. Even an extra half unit of insulin can send them into a severe low blood sugar, and recovery from the low can then be hampered by the lack of glucagon. You can imagine the stress in daily life for they and their families.
In 1987, a Japanese physician named Dr. Ono put a 53 year old woman on an insulin pump after her pancreas had to be removed as a result of intestinal cancer. Her basal rate was only 0.3 units an hour and she used 2 units for each of her meals, a grand total of 14 units a day. Her control improved with this precise insulin delivery, with a dramatic reduction in what had been twice daily insulin reactions.
One recent case of mine, a retired gentleman who developed cancer of the pancreas, parallels this. At first, we attempted to control his blood sugars with low dose insulin injections, but his weight loss and a daily insulin dose under 20 units made him so sensitive to insulin that his control remained quite erratic despite frequent attempts at a variety of insulin regimes. His daily life revolved around feeling bad because he was high and feeling bad because he was low. After starting on an insulin pump, he was able to stabilize his blood sugars largely in the normal range during the last months of his life. Quality of life for he and his wife improved remarkably during this important time.
Every individual with secondary diabetes varies just as those with primary diabetes do. Tailoring the insulin doses to need is critical because they have the same risk for the complications resulting from high blood sugars as everyone else, and they certainly experience the same problems with lows. Reduced meal coverage with Regular and a slight increase in daytime NPH or Lente can help avoid problems in those whose food absorption is unreliable. An insulin pump can be considered in certain cases. People who have these combined medical problems normally need very specialized medical care: a gastroenterologist for the intestinal and absorption problems, someone experienced with insulin pumps, and a talented dietician who can aid food choices as needed for absorption problems and weight gain.
John Walsh, PA, CDE & Ruth Roberts, MA]
I'm Not The Only One
As I become more educated in diabetes care, it's increasingly difficult to get medical care. I go to the doctor and we don't have much to talk about. They can give me suggestions about how to get better sugars, but I'm still shooting from the hip, I'm still taking care of myself. Reading DIABETES HEALTH I have noticed that there are others who are taking an aggressive approach to diabetes care, so I'm not the only one out there. Being an insulin pumper, I'm in a league of my own. The approach to using the insulin pump has forced me to make on-the-spot decisions about my glucose control and has enabled me to learn a good deal about what to do to maintain normal blood sugars. After being on the insulin pump for 3 years, I now feel better qualified to take care of my diabetes than my physician. I often have questions that I feel I can't get answers to.
I'd like to thank DIABETES HEALTH for providing many insights to the great difficulties of taking care of one's self.
C. J. Rember
San Francisco, CA
Keep Up The Good Work
Your newspaper is great-I learn more about diabetes from your articles than I do from my son's doctor!
Keep up the good work. I look forward to each issue!