Letters to the Editor
Marching for a Cure
I just reread your My Own Injection column "What would you do with 300 million?" in the November/December issue.
For a long time now I have had a vision of all the families affected by diabetes in the United States gathering on the mall in Washington, D.C. - a true march to demand the cure. How can we coordinate such an event? We must make our voices heard by the ears of this government. Can we coordinate this though your leadership and readership?
Ellen H. Ullman
Mom of a 9-year-old with type I and a 7-year-old without diabetes
I appreciate your faith that such a task could be coordinated by us at Diabetes Health. I agree that such a show of force would be extremely effective and is necessary to gain the type of exposure we need to affect change. At this point, however, presenting information for the diabetes community and providing an arena for concerns like yours is a full-time job. We are always willing to publish calls for action and provide the ability to disseminate information for those who desire to organize such an event.
Thank you for your support of the paper and rest assured that the efforts of anyone trying to organize such an event will be supported by Diabetes Health.
Where's My Dough?
I am always reading that diabetes educators are receiving money in the form of grants and scholarships from medical companies to promote their products.
Where is the money to educate people with diabetes?
I have three children with diabetes and have not been able to find scholarships except one from LifeScan which limits their scholarship to athletes with diabetes.
It seems a little unfair that educators get a kick-back to push a product when the customers don't receive the same to buy a product.
A Family Affair
Thank you for your recent articles on the NIH.
My aunt has had type I diabetes for 20 years and my son has had it for 10 years.
My family and I have been working for the cure for years, and providing funding since 1970.
Keep up the good work and spread the word about finding a cure. I'm tired of seeing my son inject insulin. How long do we need to continue to maintain and manage?
Robert & Rosalinda Martinez
San Bernardino, Calif.
Waste Not Want Not
I was reading the Injection Aids article in the February issue of Diabetes Health and was interested in the comment from Adelle Carr Smith from Battlefield, Pa. She said she could no longer use her NovoPen at one point because she could not draw up half unit increments. I'm very sensitive to insulin and my sliding scale is in half unit increments. When I use my NovoPen, I dial up to the next increment and then push the button (before injecting) until the indicator line hits in between the two numbers. Yes, you are wasting a half unit of insulin, but for me this is worth the convenience of using the NovoPen.
Diabetes Health contacted Novo Nordisk's Medical Affairs Department, and it responded - "The NovoPen 1.5 insulin pen is not designed for half unit increments. Therefore, there is no guarantee that the injection will be accurate."
What All of Us Must Fight For
So much of what we see in diabetes literature is about treatments. I do not want to diminish the importance of this, but I wish to make it clear that just as much awareness must be directed toward prevention and curing the disease.
Nothing would make a child's life with diabetes easier than reintroducing insulin production to the body on demand.
A cure is what all of us must fight for. As impossible as it may seem today, it is something that gives us all the hope and strength to keep going. I have lived with type I diabetes now for 24 years and fortunately have not had any complications. My HbA1c is 5.8%, and because of my tight control, I have every intention of being alive the day a cure is discovered.
San Jose, Calif.
Good Day Sunshine
I'm writing this in response to a letter written in the March issue. My wife and I cannot understand why anyone would be offended by the photo on page 16 of your January issue.
We thought it was appropriate. The photo illustrated the article on alternative therapies and it brightened up the page. It did not expose anyone and it was not in bad taste.
Setting the Record Straight
We noted the article about the diabetes ribbon campaign in your recent issue and were concerned about David Grove's reference to the Juvenile Diabetes Foundation. I called him for clarification and he indicated that his intention was not to speak negatively of JDF's response to the campaign. To clarify further, we at JDF are in complete support of both the concept and the reality of a ribbon to increase awareness of diabetes. We have already made arrangements for providing ribbons at our annual conference in June and distributing them to our international affiliates.
JDF's preference of a silver ribbon over a gray one reflects our focus on looking for and obtaining the silver lining - a cure. While we have explained this to Mr. Groves, we would appreciate your sharing our response with your readers.
Thanks so much for your help in "setting the record straight."
Director of Foundation Relations
Juvenile Diabetes Foundation
New York, NY
First Hand Account
In February we published a letter to the editor from Anne White, "Discrimination Vexation." In her letter she included her own personal experience of how she, too, has had to face discrimination. Anne White wrote again in response to her published letter:
Thank you for your publication of my personal experiences with discrimination in the February issue. After one denial of justice after another - and becoming a sort of pariah in the public health community because of my political incorrectness - some validation in print really helps.
Diabetes Health feels strongly about the exchange of information and personal experiences. Please continue to send in accounts of your own experiences.
Soured on Nutrasweet
This letter is regarding the Nutrasweet answer in the February issue in the Question & Answer section.
Beth Beller's answer was very disturbing. Nutrasweet contains aspartame as indicated. What was not indicated is that this compound breaks down into:
1) Phenylalanine (50%) which can be neurotoxic;
2) Aspartic acid (40%) which can cause brain damage;
3) Methanol (10%) which turns into formaldehyde.
Aspartame is really bad. A complete story on Nutrasweet can be obtained from Mary Nash Stoddard, founder of the Aspartame Consumer Safety Network, PO Box 780634, Dallas, Texas 75378. Or you can reach a web site on aspartame: "Jeff's Health & Medicine Page" at http://www.endoftheline.com.
It is true that aspartame breaks down into these substances. Whether or not there is a high enough quantity of these substances in Nutrasweet to cause a negative effect is what has raised the controversy.
-Keith Campbell, RPh, CDE
The Once Over Twice
In the February 1997 issue of Diabetes Health you reviewed results on six blood glucose meters evaluated in the December 1996 issue of Diabetes Care. The data in the Diabetes Care study was largely flawed resulting in incorrect conclusions being drawn about the performance of the Glucometer EliteÂ¨, as well as the other five meters.
First off, in the scatter plot used in the Diabetes Care study for the Glucometer Elite, five glucose results are plotted at concentrations of 1.1 to 1.7 mmol/L (20-30 mg/dL). The Glucometer Elite does not report results below 2.2 mmol/L (<40 mg/dL), indicating that the reported results are not correct. These five glucose results are responsible for all of the "unacceptable" statistics calculated for the Glucometer Elite.
The Diabetes Care authors studied the performance of the six meters on healthy patients who had been made hypoglycemic by controlled injection of insulin using a catheter. The authors of the study had organized an interesting examination, but they failed to understand the instruments they were evaluating, resulting in the plotting and reporting of incorrect facts.
For instance, the blood used for testing was taken by catheter inserted in a hand vein, with the hand being held in a hot air box at 60- C (140- F) for extended periods of time. When the sample is placed on the strip, the blood temperature has been elevated, affecting the results.
The reference method used in the study is not a certified reference method. The Beckman Glucose Analyzer II is a good laboratory analyzer, but it has not been manufactured for several years and it is not usually used in many clinical laboratories. The authors of the Diabetes Care study did not run tests to check the bias of the Beckman Glucose Analyzer. As a result they could not pinpoint the "true glucose." Failure to determine the bias invalidates all of the authors' conclusions.
The authors of the Diabetes Care study had some good evaluation concepts of the glucose meters. However, they failed to pay appropriate attention to detail and plotted incorrect data for the Glucometer Elite. If some of the Glucometer Elite data is incorrect, then there is almost certainly additional incorrect data for the other five meters. I believe that it is important your readers understand that the conclusions drawn in this article are questionable at best. There have been two recent publications testing the Glucometer Elite system. In both cases, the scientists found that it effectively evaluated hypoglycemia.
With regards to the second half of the article based on a study found in the December issue of Diabetes Care, the clinical evaluation of the glucose meters and altitude was incorrect as well. For two of the meters, the Boehringer Mannheim TracerÂ¨, and the GlucometerÂ¨ 3, the manufacturer specifically recommends that the meters not be used at altitudes higher than 6,000 feet. In these studies the authors used these meters at altitudes of up to 12,210 feet, an inappropriate experiment which exceeds the intended use of the product.
Donald R. Parker, PhD
Director of Clinical Research
Thumbs Up for Lispro
I've been on the pump since September 1995. In the last couple of months I have started to use Lispro in my MiniMed 506 insulin pump. I think it works great! Now I just give myself a bolus numeral one to 15 minutes before eating. If I wait much longer I'll go low. Occasionally I've found myself with a low BG during or just after eating. I also have to be careful and eat an adequate supply of relatively fast-acting carbohydrates.
Overall my average BGs have gone from around 130 to about 110. If I go over 200, one or two units will bring me back to the 100 range in an hour or less. In addition, I've had no problems with disconnecting for exercise, bathing or for whatever reason for up to an hour.