Letters to the Editor
Let's Oil the Squeaking Wheel
I have just e-mailed the White House to commend the president on his program "Cure AIDS in the Next 10 Years." However, I inquired as to why, as a person with diabetes for 54 years, have I not been given the time or money that AIDS patients have. Why have funds been increased tenfold for AIDS research yet not for diabetes? I would like to suggest that Diabetes Health start a letter-writing or e-mail/fax campaign to the president - let's see if we can oil the squeaking wheel and get those additional funds.
Arlen B. Coffman
Just the Facts
At the time I was interviewed for the Gray Ribbon Campaign article, (March 1997), I had not yet had the opportunity to discuss the ribbon or its color with the wonderful folks at JDF. I'm afraid I committed journalism's unforgivable sin - assuming facts without verifying them. I would greatly appreciate your setting the record straight for me. The JDF had no problems whatsoever with our choice of color (gray vs. silver); I had simply misunderstood what two individuals had suggested might have become an issue. Needless to say, it did not become an issue, and the JDF has gone way out of its way to get the gray ribbon publicized. I apologize to anyone who took my comments to imply that the JDF was anything but wonderful in its support!
Readers Rally Behind Teen
I am furious with the ignorance of the educators at Hollenbeck Middle School ("A Bitter Pill," Diabetes Health, May 1997) and at the superintendents of that school district. If the Missouri Safe School Act prohibits students from sharing medication, there is no problem since glucose tablets are not medication. Is there a clause in this Act that prohibits students from sharing their snacks? These educators should be ashamed. They are misinformed and not interested in learning the facts. What kind of example is that to set? When our children ask us questions we can't answer, do we just make up something? Responsible adults say, "I don't know. Let's look up the answer." These adults are being stubborn and childish by not accepting expert opinions. Unfortunately, these educators from the "show me" state are only showing us their ignorance.
Mission Viejo, Calif.
Kudos for Glucose
My heart goes out to Eric Carr. It is difficult enough to deal with diabetes every day of your life, and then to have to deal with something as ridiculous as the "glucose tablet" event at Hollenbeck Middle School in St. Peters, Missouri. I am a mother of two and have type I diabetes. My children (ages three and five) refer to my glucose tablets as "mommy candies." They are healthier to eat than a candy bar. My kids love them and their pediatrician says there is no harm in eating them. They have no fat, no sodium, four grams of carbohydrates, only four grams of sugar and 10 percent of the RDA of vitamin C.
Hollenbeck Fails the Test
I read with frustration and anger about Eric Carr, and his experience with glucose tablets.
As a recently retired teacher with the New York Board of Education, one of my many responsibilities was to make sure that student health problems were properly taken care of.
The administrators of Hollenbeck Middle School get my failing grade for the way Eric Carr was treated.
They acted in a very hasty and insensitive way. To begin with, glucose tablets are not a drug, in spite of the thinking (or lack thereof) on the part of the principal. Did they not know of Eric's condition?
He shared a glucose tablet with other students - horror of horrors! Is it also against the law for Eric to get an insulin injection during the school day?
Eric and his friends did not deserve suspension. Many teachers regularly give candy to students to reward them. The school administration should take a course on sensitivity, so that accidents like this never happen again.
Howard Beach, N.Y.
A Dangerous Precedent
I have great sympathy for Eric Carr and his family ("A Bitter Pill" May 1997). It is hard enough to live with diabetes without being singled out and convicted for a crime you did not commit.
Passing out drugs is a serious charge and will stay on his record until it is thrown out. Eric's family expressed that they did not wish to spend the money on legal fees. I suggest that they get in contact with the American Civil Liberties Union or their local bar association with respect to the allegations of Eric's violation of the Missouri Safe School Act. I'm sure both organizations have a number of lawyers who love to fight civil rights abuses. If the case qualifies they will not have to pay anything, and if a federal civil rights violation is found, attorney fees can be awarded.
Only Eric can stand up for his rights.
However, this is a dangerous precedent to leave sitting out there.
LifeScan Speaks Up
I would like to second Staci Perkins' suggestion for a space allocated to the needs of younger people with diabetes. My daughter was diagnosed at two-and-a-half years of age, and I have also struggled with the special situations that being a parent of a pre-schooler with diabetes involves.
Presently, we are facing the challenge of the great testing debate in school. At age five, she has the ability to perform the test herself. However, since she is a non-reader, she is unable to follow the prompts indicated on the One Touch Profile meter we use.
I have written and called the LifeScan company (the manufacturers of the One Touch) suggesting that they put a voice chip in the computer (i.e., "insert strip," "apply sample," "your blood sugar is low,""do you need a snack?"). This would enable young children to become more independent in the management of their disease. I think it would also help older diabetics, should they be in a dark room, visually impaired, or in the middle of a low blood sugar reaction. The voice chip would cue them that treatment is needed. I also suggested that they make the meters' memory able to record half-unit increments (an insulin dose common with young children). I have received no response from the people at LifeScan.
If the child was independently able to perform a simple blood test, perhaps the debate over testing in schools and pre-schools would disappear. It seems a shame that good blood sugar control is a debated subject. The brain of a young child can suffer from repeated low blood sugars, yet the institutions we engage to stimulate those brains feel no responsibility to protect them?
LifeScan responds - LifeScan recognizes that different people with diabetes have different testing needs. That's why we offer a choice of meters.
For individuals or their caregivers requiring extra assistance, we offer the SureStep Blood Glucose Meter. It features intuitive icons rather than text to prompt the user through the test. In addition, the absorbent test strip makes it easy to apply blood and a dot on the back of the strip turns blue to indicate when enough blood has been applied. The meter beeps if the strip is inserted incorrectly, and it displays results in large, easy-to-see numbers.
For those individuals who require voice capabilities, three companies offer talking devices for our One Touch II and One Touch Profile Meters:
Digi-Voice for One Touch¨ II
Mini DV for the One Touch¨ Profile1/4
MYNA (Technology for Independence) 800-370-6962
Voice Touch II for One Touch¨ II
Voice Touch for One Touch¨ Profile is not yet ready. It should be out in July or August.
Touch n Talk profile Synthesizer
Dave Detmers, Marketing Communications Manager for LifeScan
Education - Not Kickbacks
I am a diabetes educator responding to the letter from Violet in the May issue (Where's My Dough?, Letters to the Editor, page two). I have been a diabetes educator for almost 10 years and have yet to receive or hear about a grant or scholarship provided by a medical company to promote its products.
The companies supply materials for patient education and grants for research about diabetes. Some also provide scholarships so that diabetes educators can attend meetings and learn more about diabetes education to benefit their patients. None of these materials or moneys are related to recommendation of specific products.
I agree that scholarships for people with diabetes would be helpful. Several groups of diabetes educators provide scholarships for children with diabetes to attend diabetes camps. Check with your local diabetes association.
But please don't assume that we are receiving kickbacks, because we are not!
Barbara J. Bodzin, MSN, RN, CDE
Paying for Punishment?
I'm writing in response to the front page article, "The Gift of Jab," published in the May issue of Diabetes Health. The article discusses the merits of injecting insulin through clothing; the final paragraph quotes Dr. Daniel Einhorn of San Diego as saying, "We certainly are not recommending that insulin be given through clothes, but now it seems less appropriate to vigorously chastise people who do so."
With all due respect to Dr. Einhorn and his like-minded colleagues, may I point out that it is never appropriate to vigorously chastise diabetic patients. Diabetic patients consult their doctor to receive advice and information, not to be punished.
If your patients are paying you to be punished, they are suffering from an affliction, in addition to diabetes, which also deserves your attention.
Joan Williams Hoover
Chevy Chase, M.D.
Dr. Einhorn responds - Bless you for your outspoken sensitivity, and for reminding me that endocrinology may not lend itself to satire. The whole point of my response was exactly yours, namely that there is no place for "chastising" in the collaborative world of diabetes. My choice of those stilted old-fashioned words was meant to satirize health professionals who do blame their diabetic patients for "not complying."
We are preparing an article about taking the "ic" out of diabetic and supporting the need to take out moralistic tones from the management of diabetes. This often involves the individuals with diabetes as much as their healthcare providers. I can't tell you how often I have been dismayed at patients saying things like, "I've been bad since I saw you last" or describing their diabetes physicians as if they were stern school principals rather than trusted advisors. The sooner we shed the baggage of judgmental attitude, the better for everyone involved in diabetes care.
Daniel Einhorn, MD, FACE
UCSD School of Medicine
A Big Production
I'm writing in response to Christine's question ("Stressing over Management," page 31) published in the May 1997 issue. In addition to the excellent question about the effect of stress on blood glucose levels, there is another likely contributor to the difficulties she may be having.
If you have type I diabetes you may find that during the first year or two of diabetes the blood glucose levels may have been more even or easily kept in range than later on. This is due to the production of insulin from your own pancreas in the beginning stages of diabetes.
During the "intensification" stage, your insulin dose may need to increase if it is not adequate and you will find more variable blood glucose readings.
It is helpful to know that this is normal and that you haven't done anything wrong. Many people find they need to re-learn insulin adjustment for food, exercise, illness and stress at this time.
Linda Mackowiak, RN, NP, CDE