Letters to the Editor
Animal Insulin Becoming Extinct?
I co-chair the Insulin Dependent Diabetes Trust, a charity set up two years ago largely as a result of problems many people have had with human insulin, problems which seem to largely disappear with a change to animal insulin. We are trying to ensure that animal insulins are not withdrawn from the United Kingdom.
I was particularly interested to read in your letters section that the human insulin issue is also a problem for people in the United States. I think that this is a worldwide problem that is not receiving the recognition it deserves from the medical profession. In the United Kingdom we have one pharmaceutical company (Novo Nordisk) with a license to sell pork insulin, so if they decide to withdraw it, as they have with other countries, then patients will have no choice of insulin species. Choice must be maintained.
LifeScan Strips-Plasma or Whole Blood?
I read with interest Alicia Fine's explanation about whole blood vs. plasma blood glucose readings in response to Stephen Schiller's comments. It is interesting that LifeScan is taking a completely different position on this issue on this side of the border. A change has just been made, which makes their Canadian strips calibrated to plasma and not whole blood as they are in the United States. Curious. I don't know what visitors from one country to the other are supposed to do when they are purchasing strips in the country they are visiting. Be confused is probably the answer.
Auto Control Medical
Dave Detmers of LifeScan responds:
Whole blood test results are approximately 12% lower than plasma test results. LifeScan One Touch strips sold in Canada are calibrated to provide plasma-equivalent test results allowing direct comparison with a laboratory's plasma result. This was done to answer the need of healthcare professionals throughout Canada who wanted to compare their patients' meter results with lab results without having to first perform a mathematical conversion. The relatively small number of diabetes patients (compared to the United States) and the nearly universal desire of Canadian healthcare professionals made this change relatively simple.
In the United States, however, there is no clear mandate from healthcare professionals to change the calibration of One Touch test strips. In addition, most of LifeScan's more than two million active One Touch users are accustomed to whole blood results. To convert these individuals to a plasma-calibrated system that would suddenly increase their blood glucose values by 12% might cause unnecessary confusion.
If an individual has occasion to use both whole blood-calibrated and plasma-calibrated One Touch test strips-for instance, someone from the United States buying strips in Canada-they must remember to convert their results into the method measurement they are most accustomed to. To convert a plasma test into its whole blood equivalent requires dividing the plasma result by 1.12.
Second Answer From Diabetes Health Board Member:
Instead of converting your results, it is better to carry extra supplies with you when traveling. Consistency is key. Canadian One Touch strips which read 12% higher are labeled "New Calibration/Lab-Like Results" and should not be used by those who use United States One Touch strips.
Jane Seley RN, MPH, CDE
Beth Israel Medical Center
New York, N.Y.
I am writing you regarding the December 1995 issue. I was very excited to see a diabetes educator from our city of Louisville, Ky. named Educator of the Month. It is true that Kentucky has one of the highest diabetes rates per capita in the country.
Although I did enjoy the article, I found it to be misleading. It is true that Liz Grabowski has the only privately owned diabetes program in Louisville. But it is also true that Louisville has at least three other diabetes education programs recognized by the ADA. I work for Jewish Hospital, in conjunction with Frazier Home Medical, and we also sell diabetes supplies. Our four Health and Information Centers all have free lending libraries of over 3,000 medical books and videos covering many subjects including diabetes.
I would like to thank you for recognizing diabetes educators and all that they do. I would like to personally applaud the other 32 Certified Diabetes Educators in Louisville who educate our community every day.
Tips on Weight Loss
I can't say enough good things about swimming. I highly recommend it. I have back trouble and have invested in a swim spa, where I can swim laps anytime I want, and the air jets help with muscle strain. But if you can't spend that much money, the "Y" is a great idea. Even if you don't know how to swim, there are exercise classes available that don't require swimming but take place in the water to avoid stress on joints. I have been lap swimming for about 15 years and the benefits are tremendous.
Swimming is an excellent aerobic exercise which can assist in weight loss and better glycemic control. However, since it is not a resistance exercise, it does not help prevent osteoporosis.
Jane Seley RN, MPH, CDE
Beth Israel Medical Center
New York, N.Y.
I use a stationary bike with upper arm motion, (Raleigh 2000, similar to Schwinn Aerodyne). I like it because I can start out with just my legs, then after warming up, add the upper arm action and gradually work up to whatever intensity workout I feel like.
Yes, it's working. I'm losing about one pound per week, which is my goal. Of course, I also have to watch what I eat.
But actually, the most helpful aid to exercising properly and comfortably is a heart rate monitor. There's a transmitter belt that goes around your chest across the heart and a receiver that's worn like a watch. You get a very accurate continuous readout of your heart rate.
Before I had this, I tended to exercise too intensely which would burn me out and then I would quit until I got my willpower up again. With the monitor I "make" myself stay within a certain range that I can easily sustain. With a stereo headset and some inspiring music, the time really goes quickly.
I'm a 52-year-old male with type II diabetes, controlled with diet and exercise. I have been using Nordic Track successfully for two years, 20 minutes three to five times a week while I watch something on the Comedy Channel to keep my mind occupied. Because of injuries, I must avoid impact exercises, and my doctor said the Nordic Track was the best whole-body exercise bet for controlled cardiovascular workouts. I monitor my heart rate more than I do calories burned, and I don't push it for 'the burn.' The effects have been a slow, steady physical toning, a disappearance of sedentary flab around the middle, and a stabilized weight at just over my supposed ideal. It's not producing movie star results, but I can now walk uphill without getting winded, and my wife says she likes how I look these days. I'm down more than 30 pounds from my highest pre-diagnosis weight.
I went to a registered dietitian for a personalized meal plan. She was able to tailor a diet to suit me and switched several things around so it was easier for me to follow faithfully. I have three meals that are almost too much to eat and three snacks daily-all for 1,200 calories. My insurance did not pay for this, but I find it well worth the $40 I paid the dietitian.
It can become all too easy to blame diabetes for weight gain when really it's just a matter of exercising too little or eating too much. I started to gain weight and reached my highest weight ever over this past summer. I have started to lose the weight, however, mainly because I no longer have to eat to raise my blood sugar when it goes low. I'm using the pump now, and my life has become much more enjoyable. With the pump I have so much freedom to live the life I led before diabetes became a reality in my life.
LifeScan Replaces Faulty Device
When I got my One Touch II, it had a lancet device with it, the Penlet. The piston that held the lancets was rather flimsy and broken. It was a clear plastic one. (They also make one which has a piston with a white plastic holder, which is apparently stronger.)
I called LifeScan this morning to see if I could purchase a new piston device, and they said they've had a lot of trouble with the Penlets with the clear plastic holder and are sending me a new one, gratis. If anyone else has had this trouble, you might try calling LifeScan to see if they'll send you a replacement.
Needle Disposal is Critical
The ADA here in Cleveland supplies needle disposal bins free of charge. We pick them up there and bring back the full ones. We usually give them a donation, but it is not required. Needle disposal is very important, and we should be careful where we dispose of them. If the garbageman pricks his finger, you could be sued.
Jack Carney, Jr.
Your description of Cleveland's program sounds great. We wish that there was a nationwide system in place, but there is not. Every area has different regulations. Some states actually impose penalties to residents who dispose of syringes improperly. Call your local ADA affiliate and/or department of sanitation for regulations in your area.
Jane Seley RN, MPH, CDE
Beth Israel Medical Center
New York, N.Y.
The answer is to test more, not less! What I experience was that after a short while, I started to get calluses on my testing fingers-I only test the fingers on my right hand. The soreness went away. Sometimes I don't even feel the poke these days!
Natalie A. Sera
More on Animal Insulin
The January 1996 edition was as good as usual, and I would like to make three comments:
It is essential to get a physician who knows about practical diabetes care, but alas, some do not. Often the best way to obtain a physician like this is to find a doctor who has diabetes or a member of his/her family who has the illness. Other doctors who hold the opinion that the patient probably knows more about the practical aspects of diabetes than they do will be almost as good. Doctors often know a lot about theory, and together we can make a good team, providing they listen to the practical points of view made by patients.
Diabetes is more common in milk drinking countries. The recent study in diabetes care confirms what we suggested in the British Medical Journal two years ago, i.e. breast feeding is essential in families that are at risk from diabetes. Several studies have shown a significant reduction in the instances of diabetes if breast feeding is continued exclusively up to nine to 12 months. We also noted in our letter to the BMJ that those countries that drink cow's milk do tend to have a high incidence of diabetes.
There is another point that no one as yet has been able to fully investigate. Bovine serum albumen (BSA) is over 97% destroyed when one treats cow's milk with ultra high temperatures, i.e. sterilized or UHT milk. We have tried to investigate whether the instance of diabetes is less in countries that consume more UHT treated milk.
Regarding human insulin. As a doctor who has lived with diabetes for 26 years and had severe problems on human insulin, my family now refuses to ever let me use human insulin again. I did not notice the problems, but my family did. I suffered from asymptomatic hypoglycemic attacks, some very severe. I had very aggressive behavior, and my diabetes became frankly "brittle."
When my wife insisted I change back to porcine insulin, things seemed to improve dramatically and I really do not understand why. With me there is a significant difference between human and porcine insulin, even if scientific studies do not confirm this.
One must remember of course that I was using insulin in everyday life, not in a highly controlled double blind study, in which patients have their insulin changed every four to eight weeks, are encouraged to do more blood sugar tests, and attend diabetic clinics every one to two weeks. To me, no matter what insulin I was taking, if I was kept under these conditions I am sure my diabetes would be extremely well controlled. To look for a difference between animal and human insulin under such conditions is stupid.
A real life study has never been done, and I am sure never will be. I know four other doctors who have diabetes and take insulin. Two of them also had severe problems when they used human insulin and are much better now on animal insulin. The other two doctors are fine with human insulin and have no reason to wish to change.
It takes all kinds to make a world! Some people are fine on human insulin, some are not.
Please contact us if you would like more information.
M. R. Kiln
Primary Care Physician
Insulin Dependent Diabetes Trust
P.O. Box 294
Northampton, NN3 2BN
A reader responds to Leslie McDermott's concerns about the risks of pregnancy and diabetes:
I am 64-years-old and have had diabetes for 54 years. I have three children, two daughters ages 37 and 38, and a son, 29. Since my children were born, much has been learned. I had wonderful pregnancies. My babies were big and induced early but that was it. Good luck!
P.S. I have two grandchildren.
New Rochelle, New York