Letters to the Editor
To Listen is Divine
I read with great interest your article on American doctors who don't truly listen to their patients [December 1995].
I was definitely part of the treatment team. Sad to say, he left the area two years ago, and the doctor I have now acts like he is listening but I think he only hears what he wants to hear. I'm trained as a Class I paramedic as well as veterinary technician, yet this doctor treats me like I'm eight years old with no idea what is happening to my body. He's insulted when I tell him he isn't truly listening.
I wish we could get Dr. Robert Anderson more involved in the training of American physicians.
Has there been any adverse news concerning the use of chromium and/or chromium picolinate as a dietary supplement for type I diabetics? At one time, some people felt that it might reduce insulin requirements. However, I thought I recently saw an article about potential genetic damage.
R. Keith Campbell, RPh, CDE, of Diabetes Health's medical advisory board, reports recent bad news about chromium:
While chromium does slightly enhance the action of insulin, its effects are not nearly as dramatic as many people believe. For people on insulin who are chromium deficient, a chromium supplement will usually help reduce insulin requirements by one unit a day. This is not a truly significant benefit, and in addition, true chromium deficiency is actually rare.
On December 6, 1995, the New York Times reported an FDA study which showed that chromium caused chromosome damage in human cells in lab tissue. Critics of the study contend that its results are misleading because the chromium doses administered in the research were much higher than dosages common in chromium supplements. However, Diane Sterns, a researcher involved in the study, says that because chromium accumulates in the body over time, it is possible that people might be exposed to the high levels used in the study.
Chromosome damage has been shown to cause cancer. No one would say at this point that chromium causes cancer, but since it has been shown to cause chromosome damage, the risk is possible.
Campbell says that small amounts of chromium are safe. The Department of Agriculture estimates that men intake 33 mg and women 25 mg of chromium per day in food. No more than 200 mg of chromium should be taken daily in order to stay within safe levels. Campbell says that he himself, an older person with diabetes, would not take more than 100 mg a day.
Unfortunately, health food stores and others have been promoting chromium as a miracle drug which will enhance insulin action, melt fat, grow muscles, and even lengthen life. Some athletes are taking up to 800 mg per day, an amount which Campbell says is much too high.
Nutrition 21, the nation's sole manufacturer of chromium picolinate, has an opposing opinion:
The company maintains that chromium dietary supplement is "exceptionally safe." Despite the fact that chromium has been shown to damage chromosomes in cell cultures in at least nine studies over the past 15 years, Nutrition 21 claims that nutritional chromium has never been found to damage chromosomes in living animals, so therefore the chromosome breaking effect is "strictly a cell-culture phenomenon." The company cites a recent study by Dr. Richard Anderson of the U.S. Department of Agriculture in which rats were fed "extremely high doses" of chromium picolinate for six months and exhibited no signs of toxicity. This study will be presented at the 1996 meeting of the American Society of Toxicology.
Glucotrol Doesn't Cut It
I am a type II and find Glucotrol to be ineffective. I find that my numbers don't change whether I take Glucotrol or not. However, glucophage has significantly changed my numbers and helps me maintain a closer to normal range.
Joanna V. Martell
I was on Glucotrol for five months in 1993-1994 before starting insulin, and my BGs went in one direction-up. I was always highest in morning and evening, and comparatively lower at lunch time and before dinner, but I remember once seeing a 132 before dinner and thinking it was really good for a pre-prandial reading. My fastings were averaging about 145 when I started and 200 when I went to insulin, and my postprandials were about 250 when I started and 350 when I went to insulin. And mind you, the doctor was increasing the Glucotrol regularly during this time.
It seems to me that if Glucotrol is working for you, you should see reasonable and consistent readings both before and after meals, and from day to day. That is, you should theoretically be below 140 fasting at all times, and unless you really pig out, you should stay below 200 two hours after meals. And there should be no rising trend. You should also not be gaining weight, unless you were underweight to begin with.
If it's not working, insulin is not the end of the world. I felt so much better once I went on insulin. I found myself wishing I could have just gone directly to insulin without wasting those five months on Glucotrol, but I do understand that the doctor was following standard medical practice, and don't blame him for it.
Natalie A. Sera
Hope Keeps Us Going
Thank you for continuing to produce Diabetes Health. As a parent of a child with diabetes, I appreciate your emphasis on valid developments in diabetes research, such as the article in the September 1995 issue on islet cells. Updates on current research offer hope, and hope is what keeps us going living day to day with diabetes.
Author of Sarah and Puffle: A Book for Children About Diabetes
Calling All Moms With Diabetes
I would like to hear from women who are insulin dependent and have had diabetes for more than ten years. I am a 27-year-old female and under good control. My doctor has given me the green light as far as getting pregnant, but my husband is very concerned. I have not had the opportunity to speak to a diabetic woman who has had children. Any comments would be very helpful.
Readers can also contact Leslie by writing to Diabetes Health.
I am on 20cc of Lilly 70/30 two times a day. Our health insurance is getting to be such a financial burden because they keep raising the rates to the point where we simply can not afford the premiums. What is a diabetic to do? My diabetes is kept under control with the help of my doctor and diabetes educator, and of course my One Touch, which I use at least twice a day. After I went on insulin in March, our rates skyrocketed.
Do you know of any health insurance that accepts diabetics? We are in a real bind trying to find a company that is willing to insure me. Please help!
If anyone wishes to respond to Jo, please write to us here at Diabetes Health. We will publish your answer.
I have gone through most HMOs in several states since graduating from college. I highly recommend building a file of medical records that you can provide as you change doctors and insurance plans. When I wanted my HMO in Michigan to pay for strips, I faced the catch-22 of having to prove I needed strips before they would pay. To do this I had to collect medical records for the last 15-20 years of being a brittle diabetic [brittle is a key word to have in a letter from an endo to get strips covered since most HMO folks are not medically trained, yet are making medical decisions]. Emphasize the fluctuations that can cause high costs if not minimized and also talk about the short-term benefits of controlled blood sugar. They do not want to hear anything about your long-term concerns since they will not be your insurer in four or five years. Letters from endocrinologists and other doctors are so important. Test results that show fluctuations that must be stabilized also help a ton.
When the Right Doctor Isn't on Your Plan
I would like to relay an experience I'm having. In August I developed a Charcot Foot problem. My podiatrist, whom I like a lot, had very little experience with this condition and did research to determine what to do. He came to the conclusion that surgery was the right option. His lack of experience led me to seek other opinions.
The second opinion was from an orthopedist who had less experience than my podiatrist. He pulled out the wrong x-rays, which I caught, and he had a sour attitude. He was against surgery.
I then paid $250 out of pocket to get an opinion from one of the preeminent orthopedists in Los Angeles. He said a surgery should be done right away. He also said it was a tricky surgery that should be done by someone who had done a lot of them. (He has done over a hundred while my podiatrist has done one.) I checked this guy's credentials out very carefully and he came out looking very good.
I got a fourth opinion from a podiatrist who concurred with the third doctor and agreed that the surgery should be done by an orthopedist. I found out that the orthopedist was a provider under my insurance carrier so I changed to a primary care physician who could refer me to him. I like my previous medical group, but this was a necessary step in my opinion. I had to wait for the change to take effect. When I finally saw my new primary care provider I found out he could not refer me because the medical group had split in two.
I've gone through another week of arguing with my insurance company and they are finally going to allow me to switch again so I can see the doctor I want to see for the surgery.
I hope this story is about over. I hope to get in and see my new orthopedist this week and have surgery before any more damage is done to my foot.
Neil M Scheffler, DPM, FACFAS, of Diabetes Health's medical advisory board, responds:
I take exception to the fourth opinion from the podiatrist who indicated that the surgery should be done by an orthopedist. Both podiatrists and orthopedists perform this surgery. The criteria when choosing a doctor should be based upon which doctor has the most experience with the procedure. Mr. Sunderman had the right idea-find the doctor with the most experience and the best results-whether he or she is an orthopedist or podiatrist shouldn't matter.
I am a twenty-eight year old diabetic and am getting ready to have ALK (automated lamellar keratoplasty surgery) on my eyes with the hope that I will be free of glasses, or at least such thick lenses.
I went to one doctor who told me he didn't work on diabetics, and he also said didn't do ALK, only RK. The ALK opens the cornea and shaves a whole layer and the RK just cuts slits in the cornea. I then went to an eye institute and had all the tests and they agreed to give me the surgery. Is anyone familiar with this procedure or know of any related health risks a diabetic should look for?
Vicki L. Oreskovich
If anyone wishes to respond to Vicki, please write to us here at Diabetes Health. We will publish your answer.
Bicycling and BG
I have a lot of experience with bicycling and insulin use. In the beginning it was very confusing because if I left work at 125, when I got home I might be 175. Eventually I began to realize that my insulin cycle had run its course and so my body was releasing its own sugar but there was no insulin to utilize it. Sometimes I might be 180 or 190 and I will take l unit of insulin and a 20-minute cycle home might easily take 100 points off. So you must be very careful and go slow or if you are using insulin with exercise you might run low. Today I was 138. I took 1-1/2 units of insulin, ate a slice of bread with 15 grams of carbohydrates in it and some cheese, and cycled home hard (4 miles). I came in at 79.
Last spring Diabetes Health published two articles by John Walsh and Ruth Roberts, authors of Pumping Insulin which got me on track. Walsh and Roberts will soon be coming out with a new book, Stop the Roller Coaster, which contains even more extensive diabetes/exercise information. You can call them at Torrey Pines Press in San Diego at (800) 988-4772 to get a copy of it. I would appreciate it if you would mention that we are communicating this information over the Diabetes Health internet chat group. If the book is not ready yet, you should get a copy of their publication called "The Pocket Pancreas." It contains a lot of the information that I am sure will be in the larger publication.
I believe their experience is mostly with people with type I where exact measurements of insulin and carbohydrate used during exercise can be more specifically calibrated. So, those of us who are insulin-requiring with type II or who use other medication will have to find a way to make appropriate adjustments. However, the information is out there and John is a wonderful source.
Before the AIDS epidemic, there were no laws regarding the safe disposal of home use medical products. Now, however, many localities have placed laws there to protect the health and safety of garbage workers and landfill operators, plus anyone who might accidentally step on one of our used insulin syringes. In the Dallas area, we are told to break off the needle, place it in a jug with a screw on lid (windshield washer jugs or antifreeze jugs work best) and then to duct tape the top to prevent accidental unscrewing of the lid. This container can be disposed of in the regular trash.
It's against the law in most states to recycle medical waste, so don't try to recycle the plastic. Always break off the needle, and if you are so inclined, you can also break off the plunger part and then slide it all the way inside the barrel.
Remember, if someone steps on a used insulin syringe, they have no idea if they may have been exposed to AIDS or not-they have to go through six months of fear and worry and testing until they can be sure they are clean.
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