Letters to the Editor
I recently became insured under PacifiCare PPO Plan with a formulary prescription drug plan. The plan has a list of certain prescriptions that will be covered. If a doctor prescribes a medication not on the formulary list, he or she may request authorization for that drug to be covered. According to PacifiCare representatives, authorization should typically take no more than 48 hours.
After more than a month of trying to get authorization for Lilly's Humalog and Humulin NPH, I was told today that the request for the NPH was denied. I was unable to speak with the "Prescription Solution Department" because they do not speak to members as a matter of policy.
I am interested in knowing if other diabetics are experiencing this problem of getting their prescriptions approved.
ID Bracelets Are As Important as Insulin
I never leave my house without my medical ID bracelet ("Identity Crisis," January 1998). To me, this is just as important as having insulin in my pump or extra syringes when going on a vacation.
Hopefully you'll never need it, but if you do, it just might save your life. It certainly has saved mine a few times. A few police officers and paramedics have commented on how valuable it was for me to wear it. They said that it helps them "piece together" what has happened and to know what action should be taken.
A Hard Case
I enjoyed your "Case Ser? Ser?" article in the February issue. It was well done, but there was nothing there that I wanted to buy. I have looked far and wide for a case that meets the following criteria.
- Size less than seven by four by two.
- Normal capacity to carry meter, test strip container, lancet device, three spare lancets, three alcohol pads, two pre-loaded syringes and maybe a vial of insulin.
- Black or brown easy-to-clean soft foam-lined vinyl exterior with separate exterior compartments for insertion of thin frozen gel pads.
- Zippered closure that is positioned at the half-thickness point, so that when fully opened, the case lays perfectly flat. One could use the test meter without having to remove it from the case and therefore contents wouldn't fall out.
- A sturdy attached carrying loop.
- An interior that has indented foam for placement of the items.
The above would suit my needs for most day-outings. Even when traveling, the case could be refilled daily.
I have seen and physically examined most of the items in your article and have found none that come close to anything I would buy. Most are designed without a great amount of thought and never tested by a serious, active diabetic.
They are either too large and conspicuous, or look like a traveling pharmacy when opened in public. Contents tend to get rearranged while actually carrying the case. Most case makers use elastic loops to hold the various items. I've always found these never fit the particular items I use or are extremely awkward to use. Most elderly, long-term diabetics don't have the fine hand/finger control of younger users, so the placement of items becomes worthy of more than a little consideration.
If I were younger and with adequate financing, I would manufacture my own cases. Some, not all, of the current meter manufacturers provide cases that have been designed with more forethought and come close to being practical. Unfortunately, they all lack the features that I find important.
The Skinny on Fat
I'm questioning Miranda Schwartz's Research Update, "Some Fat is Good" in the February 1998 issue. I took for granted that the information printed in DIABETES HEALTH was accurate and I have shared information from your periodical with others who have diabetes - especially information on Vitamin B and neuropathy.
When she referred to Barry Sears' book The Zone to support her information, I realized that I may need to question everything printed in your newsletter. Some of the information in The Zone has not been proven through studies and are only the thoughts of the author.
In Dr. Dean Ornish's book regarding heart disease, he states that one needs to be on a very low fat diet (10 percent) to receive any cardiac benefit.
The picture accompanying the article seems to promote the idea that all those very fatty meats are in fact good for us. I think that is very misleading.
Editors' Reply: On the contrary, the piece "Some Fat is Good" did not refer to Sears' book to support the information on the effects of dietary fat. The information on fat intake came from, as was stated, one report from the Journal of the American Medical Association and another from the New England Journal of Medicine.
The JAMA report noted that lowering the caloric intake of fat may not have as strong an effect on lowering triglyceride levels and cholesterol levels, and that extreme drops in fat intake might even lower LDL cholesterol, a substance that appears to protect against heart disease. The NEJM article noted that, "Replacement of fat by carbohydrates has not been shown to reduce the risk of coronary disease."
Sears' book was mentioned in conclusion to show that the controversial diet advocated by Sears (which several readers have expressed interest in) recently received some clinical research support.
DIABETES HEALTH strives to present the latest in research and clinical opinion. We present as much of this research data and clinical opinion as possible. It is our hope that this information makes people with diabetes aware of the various schools of thought that exist and makes them better equipped to make educated decisions about their health and diabetes care.
In addition, we would like to remind all our readers that diabetes treatments affect different patients in very different ways just as the disease does. As with all medical information, check with your doctor before modifying any aspects of your treatment.
In retrospect, choosing to run a photo of high fat foods alongside this article was misleading. Pictures convey ideas in a powerful and immediate fashion. The photo we chose may have overstated the message of the piece and the research upon which it was based. We at DIABETES HEALTH apologize for this oversight.
More on Iletin I
I have to respond to the letter by Janice Graham, RN, CDE, "In defense of Lilly's No Iletin Decision," in the February issue. Her faith in Lilly's decision does her credit, but I am surprised that this is greater than her wish to see patients have the availability of the insulin they want.
She implies that Lilly must discontinue Iletin I on the basis that it is somehow harmful. There is no evidence for this, and indeed if it were so, Lilly would have had to discontinue it many years ago.
Her suggestion that we should give human insulin several months before quitting is quite correct, but many people in the United Kingdom gave it several years because their doctors refused to prescribe anything other than human insulins. This resulted in many hypos, loss of warnings and a general deterioration in well-being.
Many of us know the cost we have to pay with human insulins. Many experience more hypos, and therefore, A1cs will be better than with Iletin I or other natural animal insulins. This should not be the proof that any health professional requires, and listening to and trusting their patients would be a good start. Could I remind Ms. Graham that we have no reason to make up these problems, they do exist for some of us!
Insulin Dependent Diabetes Trust
A Vote for Vegetables
In the February Question and Answer section, reader Tom Hennessey asks about a vegan diet alleviating neuropathy. Your responder, Dana Arnold, MS, RD, CDE, was unaware and skeptical of this.
The article, "Regression of Diabetic Neuropathy with Total Vegetarian (Vegan) Diet" was published in the Journal of Nutritional Medicine (4:431, 1994). In the study, Milton Cranse, MD, of the Weimar Institute in Weimar, Calif., took 21 consecutive patients with diabetic neuropathy and put them on a low fat (10 to 15 percent of daily calories), high complex carbohydrate, high fiber, vegan diet devoid of refined foods. Pain disappeared in 17 of the 21 patients in four to 17 days. Blood sugars improved by 35 percent and triglycerides fell by 25 percent.
Researchers from Georgetown University report that diabetics on this kind of regimen, consuming 60 to 70 grams of fiber from foods high in complex carbohydrates, decreased their fasting blood sugars 59 percent more than those put on the ADA diet recommendations. (Nutrition Report, May 2, 1997 27:17:7)
On February 12, 1997 the Journal of the American Medical Association showed that the opposite of this therapeutic diet, i.e. eating high glycemic index foods deficient in cereal fiber, is a powerful risk factor for the development of diabetes. This fact gives added credence to the possibility that the high fiber, unrefined diet might be therapeutic.
The vegan diet involved in alleviating neuropathy is similar to that promoted by John McDougall, MD, in his books and his article in the Journal of the American College of Nutrition. (14:491, October, 1995)
Anu de Monterice, MD