Letters to the Editor
For Love or Money?
Having used beef-pork ultralente insulin in our intensive diabetes program for ten years, I find it unacceptable that the company would remove it from the market. How can it not be profitable to continue producing the best insulin available for intensive programs? Where has service to the community gone? I realize that there is no room for altruism in business, but surely companies will realize that in the long run they will regret their decision for economic reasons as well.
In Canada, the cut off is July 1, 1995. We have advised our diabetics to do a bit of hoarding in hopes that the company will change its mind.
Howard McEwen, MD
A Mom's Concern
My son was two when he was diagnosed with diabetes. One year later he was diagnosed with celiac sprue, an intolerance to any gluten-containing products such as wheat, oats, rye, or barley. Immediately prior to each condition he had flulike symptoms. Is there a connection here? Now I'm worried that each time gets these flulike symptoms there will be another condition to deal with.
If there is anyone else out there with these two challenges, I would love to hear from you.
Nocturnal Leg Cramps and Low Blood Sugars
This letter is prompted by the correspondence on nocturnal leg cramps that appeared in the June issue.
Occasional nocturnal leg cramps (perhaps once or twice a month) is a universal affliction that affects almost everyone. The scientific literature does not contain references relating this to diabetes. I've had type I diabetes for 49 years. After developing diabetes at the age of 12, I promptly became the only member of my family to experience frequent nocturnal leg cramps. Episodes occurred one or more times per week and involved not only my calves, but ofttimes the anterior part of my legs and my feet. If I attempted to flex my foot upward in order to relieve the knot in my calf, I would precipitate a cramp in the front of my leg. This was most distressing.
It wasn't until after I started monitoring my own blood sugars in 1969 that I found a strong correlation between leg cramp episodes and low blood sugars. Even a slightly low blood sugar of 75 mg/dl could precipitate a cramp. Chewing enough glucose tablets to bring my blood sugar up to my target of 90 mg/dl would rapidly relieve the cramp. This experience has been repeated by many of my patients.
Regardless of blood sugar during an episode, rubbing the overlying skin with a 50% mixture of arnica oil in DMSO provides instant relief. Drinking a glass of diet tonic water, which contains quinine, also relieves the condition. The quinine works more rapidly than other treatments such as chewing a calcium lactate tablet, chewing a nifedipine capsule, or drinking benedryl syrup. Nevertheless, all of these treatments are eventually effective.
My few non-diabetic patients who experience frequent nocturnal leg cramps benefit from taking one or two calcium citrate tablets at bedtime to prevent the episodes.}
Richard K. Bernstein, MD