Letters to the Editor
In a Gray Area
Are your readers aware of the Ann Landers column printed a few months ago where she suggested that there be stricter regulations for diabetic drivers? This illustrates why we must develop a strong, politically-aware voice that will be heard in Congress and in political forums around the world. This is the basis for the Gray Ribbon Campaign started on the Diabetes Forum last Christmas, which is supported by many persons, as well as the JDF. We are amazed that the ADA has yet to recognize this grass roots symbol of the new diabetic community.
President Clinton was wearing a Gray Ribbon when he announced the $2.4 billion diabetes budget this year. We are very proud of this. Within eight months of its conception, the president of the United States was made aware of - and elected to wear - our ribbon.
It is my belief that a coalition of DIABETES HEALTH, Voice of the Diabetic and the "Diabetes Forum" on CompuServe can and will put diabetes back in the loop in terms of political priorities and create a force that can bring us closer to that "cure in 5 years" that we've been waiting for.
Voice of the Diabetic
Editor's Reply - DIABETES HEALTH contacted Jerry Franz, vice president of communications at the ADA who replied that, though the ADA is not producing or distributing the gray ribbon, "Anything that raises diabetes awareness is a good thing."
Easier Said Than Done
I am a type 2 diabetic and I'm finding that there is very little said to address some of the disorders of this type of diabetes. One way to control type 2 is by "losing a few pounds" (up to 20). This is easier said than done. I am a fairly active 50-year-old woman going through menopause and taking Glucotrol XL (5 mg). I dread the idea of taking insulin, so the entire experience is stressful.
When I was diagnosed two years ago, I initially lost 15 pounds. Two years later, I have gained all the weight back plus a few more pounds. It is not that easy to change my eating habits after 48 years.
Am I the only person in this predicament? Can you address this or provide any news about type 2 diabetics in your newsletter? I feel alone in this.
Editor's Reply - This is an important topic you bring up. Although we cannot give a comprehensive answer, we can offer this tip:
Unfortunately, one of the side effects of the medication you are taking is weight gain. However, a side effect of the new medication, Metformin, is weight loss. Many type 2s around the world take both a Sulfonylurea (like Glucotrol) and Metformin together. You might also be helped by trying the new medications Acarbose and Rezulin. Consult your doctor about these possibilities. To learn more about Rezulin see page 8.
Regarding your September article, "Stress: Let it Go and Keep your BGs Low," I would like to add that as a person with type 1 diabetes for over 25 years, I have experienced numerous high BG levels (175 to 375) when stressed.
No amount of extra insulin will reduce my BG level if I do not change my emotional responses to the situation first. Also, reducing my stress level can drastically lower my BG level and reduce my overall requirement for insulin.
Humalog to the Rescue
I introduced my doctor at Kaiser to Humalog when it first came out, and he was enthusiastic when he read the details on the internet. Humalog is still not a regularly prescribed medicine at Kaiser, so I have to pay full price. It's worth it! As a type 1 for 43 years, I have been plagued with rather severe BG ups and downs. Humalog stops the highs very quickly and it goes away so quickly, that I don't get the rebounds. It's the perfect solution for me.
The Race Toward Research Collaboration
We would like to point out an error in the "Boundaries Being Broken" article published in August 1997.
The article started out by saying (referring to the Santa Barbara Diabetes Project) that "for the first time in history, an international panel of diabetes specialists has come together to work toward a cure." While the Santa Barbara Diabetes Project is clearly pointed in the right direction towards promoting international collaboration, the Diabetes Research Institute (DRI) left the starting block quite some time ago.
The DRI's track record in the field of collaborative research through state-of-the-art technologies goes as far back as February of 1994, when it launched its now very active DRInet - a globally-linked computer system now in its third year of flurried activity. Researchers number more than 20 and they represent the countries of France, Sweden, Germany, England, Italy, the United States, China, Brazil and Australia.
The concept is to unite scientists, each an expert in a given field, for specific research collaborations, while having each investigator remain at his/her own center.
In addition, corporate and academic investigators continue to come to the DRI to test novel approaches to improve treatment and to cure diabetes.
C. Shelton James
Chairman, Diabetes Research Institute
Editors' Reply - Thank you for this correction.
Advisory board member Richard K. Bernstein, MD, FACE, sent in the following response to the July issue article about the cholesterol- lowering drug simvastin, "Good News in the Fight Against Heart Disease". Bernstein believes the article credits its advantages in fighting heart disease, but it fails to delve into the drugs dangerous side effects.
Recently, Bernstein sent in an excerpt from Primary Care Medicine Drug Alerts regarding simvastin.
"This appears to be the first report of peripheral sensorimotor neuropathy developing in patients taking the cholesterol-lowering drug simvastatin (Zocor)."
The report (originally published in the Journal of Neurology, Neurosurgery and Psychiatry in May 1995) discussed four patients taking simvastatin who experienced the following symptoms either soon or up to two years after starting simvastatin therapy: Weakness, fatigue, numbness in the feet, peripheral pain and paresthesias (abnormal sensation such as burning, tingling, prickling, etc.), and muscle weakness. One patient experienced an inability to walk and another needed to use a wheelchair.
The excerpt continues, "These four cases were reported in Australia, where an additional 38 cases of simvastatin-associated paresthesias and neuropathy had been reported by the end of 1993. These cases often involved effects on motor function as well as sensory symptoms.
"Patients usually recovered upon drug discontinuation. It has been suggested that simvastatin may damage peripheral nerves by blocking the synthesis of ubiquitin, an enzyme necessary for mitochondrial function." The mitochondria within cells help convert food to usable energy.
Don't Discontinue Animal Insulin!
After reading your note about Eli Lilly's plans to discontinue beef/pork insulins in 1998, I called the number you gave in the September 1997 issue of DIABETES HEALTH. I was concerned about the possibility of only having human insulin available. I was told that purified pork insulin will continue to be produced for those individuals who seem to be super sensitive to human insulin. I now use beef/pork Iletin, but I'm sure the purified pork will be an acceptable switch when I can no longer get the Iletin mix. I will, of course, check with my doctor before using the purified pork.
I also have used animal insulin for over 40 years and I find that I do not do well with the human insulin. I cannot "feel" my lows - which is not a good thing. I now have to use the human Ultralente because the animal Ultralente was pulled from the market. It's working out OK at this point. That was also a change from Protamine Zinc which I think is no longer offered.
Changes from the old reliables have not been favorable for me! I hope this is it for discontinued products; it's not fair to the persons these insulins have worked for year after year.
Marilyn R. Schnabl Guenther
Editor's Reply - Please see our feature story on animal vs. human insulin for more on this topic.
Kudos to the Congressional Caucus
President Clinton's recent announcement of a new bipartisan $2 billion funding commitment to diabetes prevention, treatment and research initiatives, and the expected increases in this year's annual appropriations for the NIDDK, would not be possible without the efforts of the Congressional Diabetes Caucus.
The Congressional Diabetes Caucus, which includes 94 members of the House, including outspoken diabetes advocate Speaker Newt Gingrich, was created by Congressman George Nethercutt (R-WA) and Congresswoman Elizabeth Furse (D-OR) in the spring of 1996. The mission of the bipartisan caucus is to raise awareness of the serious human and economic costs associated with diabetes, and to support research to find a cure for diabetes.
While we celebrate this new national bipartisan commitment to diabetes, we cannot let up until a cure is found for this disease. As we all know, insulin is not a cure. For this reason, I believe that every person must contact his/her Congressperson in the U.S. House of Representatives and ask him/her to join in this important bipartisan effort. If your Congressperson is already a member of the Caucus, send him/her a note thanking them for their important actions.
An updated list of current Diabetes Caucus members may be obtained from the Juvenile Diabetes Foundation International (JDFI) Internet Home Page at http://www.jdfcure.com or from the JDFI Government Relations Department at 1-800-JDF-1VOTE.
S. Robert Levine, MD
Chairman, JDFI Government Relations Committee