Letters to the Editor
Slaying the Dragon Diabetes
I was thrilled to read the article "Victor or Victim?-The Two Faces of Diabetes" which was published in the October 1996 issue. I have had diabetes for fifteen years and regularly read DIABETES HEALTH. I think Sandra Silvestri hit it right on the nose when she said:
"Anyone who says you can have diabetes and lead a normal life is letting everybody off the hook and robbing Joey of a future. The technology we have now is not good enough. I don't want Joey to live a life with diabetes; I want to find a cure. Diabetes only takes from peoples' lives and I hate it."
I have had diabetes for 15 years and, I hate it too. There is nothing normal about living with diabetes. I am 24 years old and do not have any children. Not a day goes by that I do not wonder whether I can have children of my own. First, I believe that I can bear children as long as I keep very tight control and keep the pregnancy closely monitored by my doctor. Second, I think about all of the risks to both me and my child. Not only do I worry about the complications during pregnancy, but I also have to worry about the possibility of future problems with my child's health. Of course, my husband and I can always adopt a child. But this leaves me with an empty feeling, when I think of missing the experience of carrying and delivering a baby. And then of course there is also the thought of my life expectancy. At what age will I be when I lose my eyesight? How long do I have before I lose a leg? How old will I be when I die? My accounting professor asked the class, "How much money would you need to make per year in order to live comfortably?" While everyone in the class came up with dollar amounts, the only response that I could come up with was, "a cure for diabetes." Here's to you, Sandra Silvestri-let's come up with a cure for this monster.
Lagging Over Lispro
I finally got an endocrinologist where I live and on my first visit I asked about lispro (Humalog), but he doesn't want to give it to me (or anyone else)! He says that the natural arrangement of the elements is pro-lys, rather than lys-pro, and he believes there are cardiac risks with this that haven't yet come to light. Aarrgh! Has anyone else encountered such resistance? Is there any information to deny, or confirm, his suspicions?
Nancy Bohannon, MD, responds:
There is no reason why there should be any increased cardiac risk related to lispro, but one can always make an excuse not to try something because there might be risks that haven't come to light. It seems that your doctor is blowing a smoke screen because he doesn't know how to use lispro. There have been lots of critical studies on thousands of patients around the world. None of them have come up with any suggestion of increased cardiac risk, relative to other insulin. I would suggest that you find yourself an endocrinologist that has experience with lispro.
Hung Up on Hot Fudge
I have a problem with your article "Oh Fudge" written by Judith Jones Ambrosini in the October issue of DIABETES HEALTH. It gives the impression that diabetics can't eat hot fudge sundaes. For example the author says that her doctor, when asked about hot fudge sundaes "gently nodded his head no." "No more sweet hot fudge sundaes with my two favorite ice creams coffee and chocolate," the author writes. Why not? Non-diabetics make their own insulin to metabolize sugar. Diabetics inject insulin to handle sugar. Even those who do eat sugar will manufacture sugar in the body. The author also writes that she "rationalized chocolate as the enemy." Of course apple cobbler is an alternative to hot fudge sundaes, but anyone using insulin does not need to forgo hot fudge sundaes. Heck, a hot fudge sundae could prevent hypoglycemia and keep someone alive.
William A. Burton
Judith Jones Ambrosini replies:
Those of us with diabetes (both type I and type 2) have many choices to make in our diet. We also have the responsibility to look at the big picture of health to determine nutritionally sound and balanced ways of eating which produce long-term effects on our bodies. If chocolate suits your meal plan, know that chocolate contains two powerful stimulants to the nervous system, caffeine and theobromine, and is high in saturated fat (one 4 oz bar of milk chocolate contains 588 calories and 36 grams of fat). The nutritional readout for sugar is 99.5 percent carbohydrate and .5 percent water. As for treating low blood sugars, 15 grams of glucose is the recommended dose. As an alternative to Lifesavers, my research has shown that 1 cup of milk, a small box of raisins, or 1/2 a cup of fruit juice can adjust the low blood sugar and contribute vital nutrients which in the big picture, feed and strengthen the entire body system. The thrust of my article was not to accuse sugar and chocolate but to relay choices.
I am a certified diabetes educator in the St. Paul, Minneapolis area of Minnesota. My colleagues and I were concerned with Dr. Bernstein's response in the July Q & A section. Dr. Bernstein recommends a low-carbohydrate diet, not administering more than seven units of insulin at a time, and avoiding NPH insulin as ways of cutting down on fatty deposits at injection sites.
The ADA recommends approximately 50 percent carbohydrates, not a low-carbohydrate diet. To our knowledge there is no reason for a patient not to use NPH insulin, and over 80 percent of our patients take NPH with excellent results. Also, the current literature recommends the use of the abdomen only for injections, and we have found that a patient is able to inject more than 8 units at one time. To ask a patient to inject himself four times to receive his morning or evening dose is not in the best interest of the patient.
Joyce Weinhandl, CDE
Several other educators have voiced the same concerns and objections as you have. Dr. Bernstein has a very unique approach to diabetes management which is successful for himself (50 years with diabetes) and others, but his therapy approach should not be taken piecemeal-as his answers in our Q & A section suggest. Individual dietary recommendations should be discussed with your health care provider. If you are interested in Dr. Bernstein's dietary guidelines, his tapes and books are available from Prana Publications at 1-800-735-7726.
I Just Want to Thank You
I just wanted to take a moment to stop and say thank you for your publication. I was diagnosed with diabetes at 18, in the middle of mid-terms my first quarter at college. I ended up in the hospital with a cardiologist specialist as my doctor. When I was discharged from the hospital I was given instructions to take two shots per day and call my doctor if my blood sugar level was greater than 180, no further instructions. Luckily for me, my father has had diabetes my entire life and the natural curiosity of a child has driven me to do school reports on the subject for as long as I can remember. Still, this rudimentary knowledge was not sufficient to prepare me with the problems I would come to face with day-to-day diabetes. When summer rolled around I decided to leave my job and return home to San Diego for the summer.
At this time my father was fortunate enough to be working with John Walsh, a certified diabetes educator. With John's help over the previous 18 months my dad had slowly started to turn his diabetes around and take control. I was incredibly fortunate to be part of an intense eight week training class in which John instilled in me the knowledge, tools, and personal power to deal with my diabetes and begin my journey on intensive therapy. It was there in June 1993 that I was first introduced to DIABETES HEALTH. Since then, I have been a faithful subscriber.
I have found DIABETES HEALTH to be a key resource, and I depend on it in order to keep up-to-date with the technology and trends in diabetes management. I look forward to the wealth of relative and useful information that each issue brings. In the restaurant where I work, I recommend DIABETES HEALTH to all the diabetic customers I come in contact with, and there are tons! Your inspirational stories and hilarious cartoons are a nice balance to the hard-core facts. I wish you continued success for many years to come, and once again thank you!
Enough is Enough!
I am 39 years old and have lived with diabetes for 30 years-it has not been easy. I have nearly every complication associated with diabetes.
I agree with the article in your September issue discussing the BIG money being made off of diabetes! I wonder if there is enough incentive to find a cure?
People who don't have diabetes, always feel they have to tell you about a grandmother or a uncle of theirs who went blind or had a leg amputated. I know they are trying to relate, but I really don't want to hear about it. I've been hearing it for 30 years!
North Easton, Mass.